World journal of emergency medicine最新文献

Background: This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome (AAS) in the emergency department (ED) and to derive a simplified version suitable for rapid clinical application.

Methods: In this multi-center retrospective cohort study, AAS patient data from three hospitals were analyzed. The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People's Hospital of Xinjiang Uygur Autonomous Region, with Peking University Third Hospital data serving as the external test set. Four machine learning algorithms-logistic regression (LR), multilayer perceptron (MLP), Gaussian naive Bayes (GNB), and random forest (RF)-were used to develop predictive models based on 34 early-accessible clinical variables. A simplified model was then derived based on five key variables (Stanford type, pericardial effusion, asymmetric peripheral arterial pulsation, decreased bowel sounds, and dyspnea) via Least Absolute Shrinkage and Selection Operator (LASSO) regression to improve ED applicability.

Results: A total of 929 patients were included in the modeling cohort, and 210 were included in the external test set. Four machine learning models based on 34 clinical variables were developed, achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85, respectively. The simplified model incorporating five key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78, respectively. Both models showed robust calibration and predictive stability across datasets.

Conclusion: Both kinds of models were built based on machine learning tools, and proved to have certain prediction performance and extrapolation.

Background: Serum osmolality is a prognostic indicator in critically ill patients. This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest (CA) admitted to the intensive care unit (ICU).

Methods: Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV. Patients were divided into survivor and non-survivor groups according to the 28-day prognosis. Serum concentrations of sodium, potassium, glucose, and urea nitrogen on the first day of ICU admission were used to determine serum osmolarity. The primary endpoint of this study was 28-day all-cause mortality. Propensity score matching (PSM) analysis was performed to reduce bias between the survivor and non-survivor groups.

Results: Among the 798 included CA patients, the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality (62.0% vs. 35.5%, P<0.001) and reduced cumulative survival (log-rank P<0.05) after PSM. Cox regression identified the high osmolarity on the first day of ICU admission as an independent predictor. High serum osmolarity on the first day of ICU admission effectively predicted 1-, 3-, 7-, and 28-day all-cause mortality, with the strongest predictive performance for 1-day mortality both before and after PSM (all P<0.05).

Conclusion: In this study, elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.

Background: This study is to evaluate clearance effects of hemoperfusion (HP), continuous renal replacement therapy (CRRT), and plasma exchange (PE) for chlorfenapyr and its metabolite tralopyril in patients with acute poisoning.

Methods: This retrospective study included 18 patients with acute oral chlorfenapyr poisoning treated at our department between January 2022 and January 2024. All patients received conventional therapies combined with blood purification, including HP, CRRT, and PE. HP was performed three sessions within the first 24 h, followed by CRRT and PE. Serial blood samples were collected to measure plasma concentrations of chlorfenapyr and tralopyril using gas chromatography/liquid chromatography-mass spectrometry (GC/LC-MS). The toxin-clearance effects were assessed using a linear mixed-effects (LME) model.

Results: The hourly decline rate of the plasma chlorfenapyr concentration (median [IQR]) was 8.83% (1.79%) for HP, 4.12% (1.26%) for CRRT, and 6.85% (1.44%) for PE. LME analysis showed higher decline rate in the plasma concentration with HP (β=5.00; P<0.001) and PE (β=2.15; P=0.003) compared to CRRT. For tralopyril, the hourly decline rates were 3.04% (0.62%) for HP, 1.82% (0.48%) for CRRT, and 3.01% (0.37%) for PE. LME analysis showed that the clearance effects of HP (β=0.027; P<0.001) and PE (β=0.022; P=0.001) were superior to CRRT. Pre-treatment toxin levels and the interval from hospital admission to blood purification showed no significant interaction with clearance outcomes.

Conclusion: In our study, HP was associated with a higher decline rate in plasma chlorfenapyr concentration compared to CRRT and PE, supporting HP as a preferred early intervention. However, all three methods showed limited efficacy in reducing tralopyril levels. Further research into the toxicokinetics and mechanisms of chlorfenapyr is warranted to optimize purification strategies.

Background: Maxillofacial trauma represents a significant challenge in emergency medicine, requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics. The complex anatomy of this region, with its proximity to critical structures, demands a thorough understanding of assessment and management principles. This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma, with particular emphasis on early recognition of critical injuries, airway management strategies, and special population considerations.

Methods: A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases, which focused on maxillofacial trauma management in emergency settings. Articles were selected based on relevance to clinical practice, methodological quality, and current management guidelines. The review synthesized evidence from multiple study types, including original research, systematic reviews, and clinical practice guidelines, to provide practical guidance for emergency physicians.

Results: Initial assessment following Advanced Trauma Life Support (ATLS) principles is crucial, with airway management being a primary concern due to the risk of dynamic obstruction. Critical time-sensitive emergencies include orbital compartment syndrome, trapdoor fractures (in pediatric patients), and facial nerve injuries. Computed tomography (CT) imaging remains the gold standard for diagnosis. Special considerations are required for pediatric patients, who present unique anatomical challenges and injury patterns, and for elderly patients, who often have complex medical comorbidities and increased complication risks. Management strategies range from conservative treatment to urgent surgical intervention, with decisions based on the injury pattern and associated complications.

Conclusion: Emergency physicians must maintain a structured yet flexible approach to maxillofacial trauma, focusing on early recognition of critical injuries, appropriate airway management, and timely specialist consultation. Understanding injury patterns and their potential complications allows for effective risk stratification and treatment planning, ultimately improving patient outcomes.