International Journal of Emergency Medicine最新文献

Background: Since 1930 it has been accepted that intravenous injection of iodinated contrast agent as part of contrast-enhanced computed tomography (CE-CT) imaging can induce a contrast-associated acute kidney injury (CA-AKI). For the last 10 years, studies have investigated this iatrogenia. However, those works didn't concern patient hospitalised after emergency department (ED) visit. This study assessed the CA-AKI incidence and risk factors in patients hospitalised after a CE-CT in ED.

Materials and methods: This was a monocentric retrospective study, conducted in a University Hospital ED (Beaujon Hospital) between 2019 and 2022. Patients over 16 years old who received a CE-CT and two serum creatinine dosages, one pre-CT and one post-CT (2 to 7 days later), were included. Risk factors and protective factors of CA-AKI as well as population characteristics were analysed.

Results: After studying 5079 enhanced CT-scans, 1463 patients fulfilled the inclusion criteria. The incidence of CA-AKI was 4.1%. The associated risk factors were: hypertension (adjusted odds ratio (aOR) = 3.36, 95% confidence interval (CI) (1.76-6.43)), CKD grade 4-5 (aOR = 5.89, 95% CI (1.39-24.95)), waiting time before CT (aOR = 3.36, 95% CI (1.76-6.43)). Ongoing treatment by metformin was found to be a protective factor (aOR = 0.26, 95% CI (0.06-1.12)).

Conclusion: Our findings suggest that only hypertension and stage 4-5 CKD significantly increase the risk of CA-AKI. Consequently, CT imaging should not be unnecessarily delayed when clinically justified, as prompt diagnosis could help limit morbidity and mortality.

Clinical trial number: The study was registered at ClinicalTrials.gov on 22 July 2025 (NCT07091656).

Background: Hypertension is a major global health problem that affects approximately 1.4 billion people worldwide, and 1-2% of this population experience hypertensive crisis. Hypertensive emergency is a subtype of hypertensive crisis associated with target organ damage and is linked with increased morbidity and mortality. In our setting, the prevalence of hypertensive emergencies and the characteristics of patients with a hypertensive crisis are not certainly known yet. This study aimed to assess the prevalence and associated factors of hypertensive emergency among hypertensive crisis patients admitted to the emergency department at Hawassa University Comprehensive Specialized Hospital, Ethiopia.

Methods: An institution-based cross-sectional study was conducted among 379 randomly selected medical records of hypertensive crisis patients admitted at Hawassa University Comprehensive Specialized Hospital from July 2021 to July 2024. Data were extracted from September 1 to 30, 2024. A structured checklist was used to collect the data from charts through the Kobo toolbox. The descriptive statistics were presented in tables, frequencies, percentages, and graphs. Binary logistic regression analysis was used to identify factors associated with hypertensive Emergency. An adjusted odds ratio along with a 95% confidence interval was reported. The statistical significance level was declared at a p-value ≤ 0.05.

Results: A total of 369 patients with hypertensive crisis were included in the study. The prevalence of hypertensive Emergency was 40.7% (95% CI: 36, 46%). In patients with hypertensive emergencies, cerebrovascular injuries accounted for 25.7% of the hypertension-mediated organ damage, followed by acute renal failure (22%), and cardiovascular emergencies (15.4%). New-onset hypertension [AOR:2.5; 95%CI: 1.52, 4.15] and diabetes mellitus [AOR: 2.92; 95% CI: 1.63, 5.24] were independently associated with a hypertensive emergency.

Conclusion: The study found that in four out of ten hypertensive crises, patients experienced hypertensive emergencies. Cerebrovascular injuries were the most commonly identified target organ damage. New-onset hypertension and diabetes mellitus were independently associated with hypertensive emergency. Routine hypertension screening, monitoring, and counseling of hypertensive individuals could reduce the risk of target organ damage.

Purpose: Thoracic trauma is a frequent cause of emergency department admission in both civilian and military settings however injuries sustained in conflict zones differ in mechanism and severity. The STUMBL Score is a clinical prediction tool originally developed for blunt thoracic trauma in civilian populations. This study aimed to externally validate the STUMBL Score in a wartime context.

Methods: We conducted a retrospective, single-centre validation study of adult patients with thoracic trauma admitted to the ED of a frontline Ukrainian hospital between January 2023 and December 2024. The primary composite outcome was defined as in-hospital mortality, pulmonary complications, or ICU admission. Model performance was assessed by discrimination (area under the receiver operating characteristic curve) and calibration (Hosmer-Lemeshow test and calibration belt).

Results: A total of 374 patients were included (87% male; median age 38 [32-44]). Blast injury was the predominant mechanism. The median STUMBL Score was 30 [24-33], and 92% of patients developed the composite outcome. The area under the receiver operating characteristic curve (AUC) was 0.96 (95% CI 0.94-0.98), and calibration assessed by the Hosmer-Lemeshow test yielded a p-value of 0.812. Using a threshold score of 23, the sensitivity was 0.89 and specificity 0.97.

Conclusion: The STUMBL Score demonstrated excellent predictive performance in a military population with high-acuity, war-related thoracic trauma. These findings support its potential utility in conflict-zone emergency care, although prospective validation in broader military settings is warranted.

Background: The study aimed to evaluate the effectiveness of saline rapid perfusion ultrasonography in assessing the catheter tip position in axillary vein cannulation.

Methods: This prospective observational single-center study was conducted in a tertiary Grade A Hospital in China. Seventy adult patients who underwent successful right axillary vein catheterization were included. Patients were consecutively recruited based on eligibility for central venous catheterization via the axillary vein. Exclusion criteria included unsuccessful catheter placement, poor acoustic window for ultrasound, or known anatomical abnormalities. All enrolled participants completed the study. The primary outcome was the accuracy of saline rapid perfusion ultrasonography in determining catheter tip position, assessed through sensitivity, specificity, and agreement (kappa statistic) compared with chest radiography. The secondary outcome was the time required to complete each diagnostic method.

Results: The sensitivity and specificity of saline rapid perfusion ultrasonography for determining the axillary vein catheter tip position were100% and 77.8%, respectively. The results were highly consistent with X-ray findings (Kappa = 0.859, P < 0.05). The mean operative time for ultrasonography was 5.6 min (95% CI: 5.3‒6.0), significantly shorter than that of X-ray (70.5 min; 95% CI: 66.3‒74.8).

Conclusions: Physiologic saline rapid perfusion ultrasonography is a highly sensitive and efficient method for assessing axillary vein catheter placement. It offers a faster alternative to X-ray examination, avoiding radiation exposure and contrast-related risks, making it suitable for widespread clinical application.