Emergency Medicine Journal最新文献

Interstitial lung diseases (ILDs) represent a heterogenous group of disorders affecting the lung parenchyma. Patients with ILD are frequently admitted to hospital secondary to respiratory decompensation which can result in acute respiratory failure (ARF). High flow nasal oxygen (HFNO) has increasingly been used in other causes of ARF following the recommendations of the European Respiratory Society. A review was undertaken to evaluate the question: in adults with ILD and ARF without hypercapnia, is HFNO better than conventional oxygen therapy (COT) at reducing symptoms and all-cause mortality outcomes? Medline via PubMed, EMBASE via OVID and the Cochrane Library were searched between 1975 and 20 June 2025. 2362 papers were identified with 17 undergoing full-text review. Two systematic reviews met inclusion criteria and directly answered the three-part question. Study information, participant demographics, key results and study weaknesses were established for each paper. Neither systematic review found HFNO improved mortality outcomes, when compared with COT, to a statistically significant threshold for patients with ILD with ARF. Reported median survival with HFNO use was 21.0 days (95% CI 13.0 to 61.0) and COT use 133 days (95% CI 26.0 to 374.0, p=0.1323). Inpatient mortality with HFNO use ranged between 26.5% and 59.1%. Symptomatically, one review reported a numerical improvement in the Quality of Death and Dying Score for the HFNO group versus the COT group (4.58 ± 0.67 vs 4.09 ± 0.96). There is limited evidence to suggest that HFNO improves mortality outcomes for patients with ILD in ARF. However, it may be beneficial for symptom management. Mortality remains high despite HFNO use, thus careful discussions with patients and their relatives are required should a trial be used in the setting of ARF.

Background: Cauda equina syndrome (CES) is a neurosurgical emergency, and suspected cases require urgent magnetic resonance imaging (MRI) scanning of the lumbosacral spine. This pilot study explores whether serum levels of neuron-specific enolase (NSE) can predict the degree of nerve compression seen on MRI scanning.

Methods: This was a prospective, diagnostic cohort pilot study of adult patients presenting to the emergency department (ED) in York between February 2024 and July 2024 with symptoms suggestive of CES in the opinion of the treating clinician (eg, back pain, sciatica, perianal paraesthesia, bladder or bowel dysfunction, sexual dysfunction). Patients either self-presented to the ED or had been referred by local primary care doctors or physiotherapists. All patients underwent MRI scanning (or fine-slice computed tomography scan if MRI contraindicated) of the lumbosacral spine and measurement of serum NSE. Imaging was classified as positive if the radiological report described cauda equina compression, nerve root compression or impingement and negative if none of these were described. We compared the serum levels of NSE in patients with positive imaging with those in patients with negative scans.

Results: 98 patients were included. 97 patients had urgent MRI of the lumbosacral spine and 1 patient had fine-slice CT. 52 patients had imaging classified as positive, and 46 patients had scans classified as negative. Patients with positive scans had a mean serum NSE level of 7.16 µg/L (SD 2.54) and those with negative imaging had a mean serum NSE level of 6.82 µg/L (SD 2.91). NSE did not demonstrate any ability to discriminate between patients with positive and negative imaging with an area under the receiver operating characteristic curve of 0.542.

Conclusion: The study shows that serum NSE is not a useful biomarker in the management of patients presenting to an ED with symptoms of CES.

Background: Civilians in South Africa experience a high incidence of crush injury, or traumatic rhabdomyolysis. Community assault (CA) is a common mechanism of crush injury in South Africa, where victims are assaulted by multiple persons using a variety of objects. A crush injury places patients at risk of renal dysfunction. The study objective is to evaluate the association between CA and adverse renal outcomes (AROs) among patients with crush injury.

Methods: In this secondary analysis of abstracted medical records, we examined clinical data from adult crush patients who presented to one of six trauma centres in the Western Cape Province of South Africa from September 2021 to December 2023. ARO was defined as potassium >6 mEq/L, creatinine >4 mg/dL, initiation of dialysis or death due to renal failure. We used multivariable logistic regression to evaluate the association between CA and ARO.

Results: Of 976 crush patients (mean age 32 years, 89% male), half were victims of CA (n=464, 48%). 4% of the overall cohort had ARO, but less than 1% (n=7) received dialysis. More patients with CA developed ARO (n=27, 6%) compared with patients without CA (n=15, 3%) (unadjusted p=0.03). In-hospital all-cause mortality was not significantly different between CA and non-CA (8% vs 7%, p=0.58). After adjusting for age, sex, systolic blood pressure and injury severity, patients with CA had 2.42 times the odds of ARO than patients without CA (95% CI 1.20 to 4.85, p=0.01).

Conclusion: This study suggests that CA is an independent risk factor for AROs among patients with crush injury in South Africa. Victims of CA with renal dysfunction require aggressive resuscitation and may warrant early transfer to tertiary care centres.

Introduction: The emergency medical disease burden in low-income countries such as Ethiopia is four times that of high-income countries. It is estimated that more than half of all deaths occurring in low-and-middle-income countries each year could be prevented by organised Emergency Care System but the emergency care in these countries is fragmented and unstructured. The WHO's Emergency Care Systems (WHO-ECS) toolkit aims to systematise and structure emergency care in such countries. Objectives To identify and analyse key facilitators and barriers encountered during the implementation of the (WHO-ECS) toolkit in primary hospitals in Ethiopia, within the context of a national emergency care strengthening initiative.

Methods: This was a qualitative research arm of a larger implementation study conducted within 10 primary hospitals in the Oromia region, Ethiopia for 14 months. Qualitative data were collected using focus group discussions with healthcare workers in target hospitals (Amaya, Arsi Kersa, Tulu Bolo and Robe Dida Hospitals) selected via lottery method and key-informant questionnaires among project coordinators from May 2021 to February 2022. Facilitators and barriers to the implementation process were identified using thematic data analysis.

Results: There were 40 participants in four focus group discussions and four respondents to the key informant questionnaires. Facilitators of the toolkit included a supportive model of implementation, enthusiastic staff and the toolkit itself. Lack of medications and equipment, some components in the toolkit itself and lack of permanent staff in emergency departments were found to be barriers. Support from hospital administrators was a facilitator while lack thereof was a hurdle.

Conclusion: This study has outlined the significant factors related to implementing the WHO-ECS toolkit in a low-income setting. Support from project implementers and hospital administrators as well as key stakeholder involvement facilitates success. Conversely, lack of support and resources as well as toolkits misaligned with context can hamper it. Comparable healthcare setups can use these lessons before and during implementation.