International Journal of Emergency Medicine最新文献

Background: Frailty assessment is crucial for predicting outcomes in acute care settings; however, its application remains challenging. Therefore, this study aims to evaluate and compare two electronic medical record-based tools-the Canadian Institute for Health Information Hospital Frailty Risk Measure (CIHI-HFRM) and the United Kingdom Hospital Frailty Risk Score (UK-HFRS)-in older patients requiring urgent admission.

Methods: In this retrospective cohort study, we analyzed 35,564 patients aged 65 or older from the MIMIC-IV 2.0 database. Frailty was assessed using CIHI-HFRM and UK-HFRS. Primary outcomes included in-hospital mortality, one-year post-discharge mortality, post-discharge care needs, timely hospital discharge, and one-year readmission rates. Logistic regression, Cox regression, and competing risk models were used for analysis.

Results: The CIHI-HFRM and UK-HFRS were significantly associated with in-hospital mortality [odds ratio (OR) per point: CIHI-HFRM 1.10 (95% confidence interval (CI) 1.07-1.13); UK-HFRS 1.06 (95% CI 1.05-1.07)] and one-year post-discharge mortality [hazard ratio (HR) per point: CIHI-HFRM 1.08 (95% CI 1.06-1.09); UK-HFRS 1.05 (95% CI 1.04-1.05)]. Both measures were associated with prolonged hospital stays and post-discharge care needs, while only CIHI-HFRM was linked to one-year readmission risk.

Conclusion: The CIHI-HFRM and UK-HFRS effectively stratify adverse outcomes risk in older patients requiring urgent admission. They may be considered alongside traditional measures as part of a pragmatic multimodal pathway, which represents a potential direction for clinical application.

Background: Kawasaki disease (KD), previously termed mucocutaneous lymph node syndrome, is a childhood vasculitis affecting medium-sized arteries and is the leading cause of acquired heart disease in children. It primarily affects children under five years of age. If left untreated, KD can lead to serious cardiovascular complications, particularly coronary artery aneurysms (CAA) and thrombosis. Incomplete KD presents with fewer clinical criteria, making it more difficult to diagnose. Importantly, long-term sequelae such as CAA may remain clinically silent for years. This case highlights the critical need for awareness that even minimal or transient symptoms can be the only warning sign of life-threatening complications in adolescents with a remote history of incomplete or unrecognized KD.

Case presentation: We describe a fatal case of a 12-year-old boy with a history of presumed myocarditis at age five, which retrospectively fulfilled criteria for incomplete KD but remained undiagnosed. From age five to twelve, he was asymptomatic except for occasional, brief chest tightness. At twelve, he presented with mild chest pain followed by rapid clinical deterioration, cardiac arrest, and death. Post-mortem imaging and autopsy revealed a thrombosed giant aneurysm of the left anterior descending coronary artery, consistent with chronic coronary disease.

Conclusion: This case illustrates the potentially fatal long-term cardiovascular sequelae of unrecognized and untreated incomplete KD. Early recognition and treatment with IVIG are critical to reduce coronary complications. Healthcare providers must maintain clinical vigilance for patients with a history of KD. Even subtle or transient symptoms in patients with a history of KD should prompt immediate evaluation to prevent fatal outcomes.

Background: Ambulance offload delay (AOD) indicates the persistent and increasingly visible problem of Emergency Department (ED) crowding. AOD is defined as the extended time from ambulance arrival at the ED until patient care is transferred to ED staff. Despite its negative consequences and international attention, AOD is currently not monitored within the Dutch Emergency Care. It is also unknown whether or not AOD is associated with the ambulance diversion (AD) status. In the Dutch ED the AD status is monitored by means of the traffic light system. This study aims to monitor AOD at the EDs of Franciscus Gasthuis & Vlietland (FGV).

Methods: A 10-week observational study was conducted at both the EDs of FGV. Ambulance personnel was queried regarding AOD duration and traffic light statuses by means of paper questionnaires. Descriptive statistics are reported as frequencies, medians and interquartile ranges (IQR). Associations between the traffic light status and categorical AOD data were analyzed using Chi-square tests.

Results: During the study period, 2967 ambulances arrived at the EDs. In 229 cases (7.7%), the definition of AOD was met. The median AOD was 16 min (IQR: 10-25 min). In 95.6% (n = 2830) of the cases the handover time was less than 15 min. No statistically significant association was found between the traffic light status (green, orange, red) and offload delay categories (p = 0.109). A non-significant difference remained (p = 0.075) when comparing median AOD in the absence of an AD with the median AOD during an (impending) AD.

Conclusion: This is the first observational study conducted in the Netherlands collecting data regarding the AOD. The limited observation period, the reliance of self-reported data and the single-center design restricts the generalizability of the data. Consequently, the authors conclude hypothesis-generating findings which warrant validation through planned multicenter research. Nevertheless, besides the existing traffic light system, this unique study provides policy makers with a candidate complementary quality indicator for ED-crowding in the Dutch context.