International Journal of Emergency Medicine最新文献

Objective: This study aimed to identify independent predictors of under-triage among patients with non-traumatic acute abdominal pain (NAAP) and quantify their impact on emergency department length of stay (EDLOS).

Methods: A multicenter retrospective study was conducted at three tertiary hospitals in China from December 2023 to May 2024, enrolling 769 patients with NAAP. Data collected included patient demographics, environmental factors, nurse characteristics, and clinical presentations. Binary logistic regression was employed to identify risk factors for under-triage, and multivariate linear regression was used to assess its association with EDLOS.

Results: The incidence of under-triage was 16.38% (126/769). Multivariate analysis revealed that a history of hyperlipidemia (OR = 7.944), scleral icterus (OR = 5.731), persistent pain (OR = 4.116), and advanced age (OR = 2.447) were significant independent risk factors for under-triage (all P < 0.05). Conversely, higher nursing seniority (Senior Nurse: OR = 0.295; Charge Nurse: OR = 0.311) served as a protective factor. Furthermore, under-triage independently predicted operational inefficiency, prolonging EDLOS by approximately 310 min (B = 309.765, P < 0.001) after adjustment for confounders.

Conclusion: This multicenter study demonstrates that under-triage in NAAP is associated with patient age, history of hyperlipidemia, higher nurse professional titles, and abdominal pain characteristics. Under-triage significantly prolongs EDLOS. These findings provide a foundation for understanding and mitigating under-triage through competency-based training and risk-stratified assessment protocols in emergency departments.

Background: Takotsubo cardiomyopathy (TTC) is a stress-induced cardiac disorder characterized by transient left ventricular dysfunction. Myasthenia gravis (MG), an autoimmune neuromuscular disease, can precipitate TTC during exacerbations such as myasthenic crises. However, the clinical features and outcomes of TTC associated with MG remain unclear.

Methods: We conducted a systematic review by the PRISMA guidelines. A comprehensive search of PubMed, Web of Science, and Google Scholar was performed up to May 31, 2025, using terms related to TTC and MG. Case reports and series were included if they described patients with confirmed diagnoses of both MG and TTC, with MG exacerbation occurring at the time of TTC onset. Data were extracted and compared between apical and non-apical TTC subtypes. Statistical analyses included the Mann-Whitney U test and chi-squared or Fisher's exact test, as appropriate.

Results: A total of 38 articles comprising 40 cases were included. The median age was 69 years; 67.5% of the participants were female. Apical TTC was the most common subtype (71.8%). Myasthenic crisis was the most frequent TTC trigger (37.5%), while chest pain was reported in only 17.5% of cases. Mechanical ventilation and ICU admission were required in 95% and 97.4% of cases, respectively. Overall mortality was 17.5%. No significant differences were found between TTC subtypes; apical cases showed numerically higher troponin levels, which should be interpreted cautiously.

Conclusions: TTC associated with MG exacerbation is a rare but serious condition with high rates of respiratory failure, ICU admission, and mortality. Emergency and critical care physicians should suspect TTC in MG patients presenting with hemodynamic instability or ECG abnormalities, even in the absence of chest pain.

Background: Acquired hemophilia A is an uncommon but potentially life-threatening bleeding disorder caused by autoantibodies against factor VIII. It can be associated with autoimmune disease, malignancy, or pregnancy.

Case report: We describe a 31-year-old woman, five weeks postpartum, who presented to the emergency department with left arm pain and swelling complicated by concern for compartment syndrome. Laboratory evaluation revealed an isolated markedly prolonged partial thromboplastin time (PTT) of 86.9 s with a normal international normalized ratio, and severely reduced factor VIII activity of 1.5%. A mixing study showed no correction, and factor VIII inhibitor titer was 16 Bethesda units, confirming acquired hemophilia A. She was admitted to the intensive care unit and treated with bypassing hemostatic therapy (recombinant factor VIIa and factor VIII concentrate), tranexamic acid, corticosteroids, rituximab, and a single dose of emicizumab, with subsequent clinical and laboratory improvement. The patient was discharged home without any complications.

Conclusions: Postpartum acquired hemophilia A is rare but can present with limb-threatening bleeding. This case emphasizes the importance of recognizing spontaneous postpartum hematomas as potential indicators of acquired hemophilia in the emergency setting.