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Adherence to Pediatric Asthma Guidelines in Children with Asthma Exacerbation at the Emergency Department. 急诊科哮喘加重儿童遵循儿科哮喘指南
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-03-19 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S567362
Teeranai Sakulchit, Wichapa Sathapornpunya

Purpose: Pediatric asthma exacerbation guidelines were implemented in the emergency department (ED) of the Songklanagarind Hospital in March 2021. The primary outcome was physician adherence to the guideline. Secondary outcomes included comparisons of selected ED quality indicators.

Patients and methods: This single-center retrospective before-after study included children aged <15 years who presented with asthma exacerbation at the ED. Data were collected before guideline implementation (January 1, 2020, to February 28, 2021) and after implementation (March 1, 2021, to December 31, 2022). Guideline adherence was described as proportions. Between-period comparisons were analyzed using multivariable logistic regression to estimate odds ratios with 95% confidence intervals (CI).

Results: A total of 313 pediatric patients met the inclusion criteria with 135 and 178 patients in the pre-and post-guideline groups, respectively. Overall adherence to the guidelines was approximately 42.1%. After implementation, patients were more likely to have scheduled outpatient follow-up on the next calendar business day (adjusted OR 4.82, 95% CI 2.33-10.38) and less likely to be admitted to the hospital (adjusted OR 0.30, 95% CI 0.11-0.76).

Conclusion: Following the introduction of the guidelines in the ED, physician adherence was partial and was associated with significant improvements in some aspects of care quality. Ongoing review, feedback, education, and monitoring of time-sensitive care processes may help sustain and further improve the care of children with asthma exacerbations.

目的:儿童哮喘加重指南于2021年3月在Songklanagarind医院急诊科(ED)实施。主要结果是医生对指南的依从性。次要结局包括所选ED质量指标的比较。患者和方法:这项单中心回顾性前后对照研究纳入了年龄较大的儿童。结果:共有313例儿童患者符合纳入标准,其中指南前后组分别为135例和178例。总体上遵守指南的比例约为42.1%。实施后,患者更有可能在下一个日历工作日安排门诊随访(调整后的OR为4.82,95% CI为2.33-10.38),住院的可能性更低(调整后的OR为0.30,95% CI为0.11-0.76)。结论:在急诊科引入指南后,医生的依从性是部分的,并且在某些方面与护理质量的显着改善有关。对时间敏感型护理过程的持续审查、反馈、教育和监测可能有助于维持和进一步改善对哮喘加重儿童的护理。
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引用次数: 0
Organizational Challenges and Emergency Response to a Massive Bee Attack on an Isolated Island in French Guiana. 法属圭亚那一个孤岛上大规模蜜蜂袭击的组织挑战和应急反应。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-03-18 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S553868
Julien Marlier, Rémi Mutricy, Hatem Kallel, Camille Deschamps, Alexis Fremery

Introduction: In 2023, close to Cayenne, French Guiana, a significant attack by africanized honey bees struck a group of 35 tourists on an isolated island, with no available means of rescue.

Event description: The incident resulted in 1 death, 2 critical emergencies, 6 moderate emergencies, and a total of 11 emergency room admissions, involving both adults and children.

Discussion: Analysis of challenges encountered that day, particularly in aerial and nautical operations, will help improve our emergency response and healthcare systems in our overseas territories.

简介:2023年,法属圭亚那靠近卡宴的一个孤岛上,一群35名游客遭到了非洲化蜜蜂的严重袭击,没有任何救援手段。事件描述:该事件导致1人死亡,2人出现严重紧急情况,6人出现中度紧急情况,共有11人进入急诊室,涉及成人和儿童。讨论:分析当天遇到的挑战,特别是在空中和海上行动中遇到的挑战,将有助于改善我们在海外领土的应急反应和医疗保健系统。
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引用次数: 0
The Value of First-Day CRP and NLR in Distinguishing Infectious from Non-Infectious Causes of Loss of Consciousness in the Emergency Department. 第一天CRP和NLR在急诊室区分感染性和非感染性意识丧失中的价值。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-03-12 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S560710
Sepehr Hasani, Hadiseh Hosami Rudsari, Majid Akrami, Mehrnaz Fallah-Tafti, Neda Faraji, Fatemeh Dolatkhani, Samaneh Akbarpour

Background: Altered level of consciousness (ALOC) is a common presentation in the emergency department (ED) with a broad spectrum of infectious and non-infectious etiologies and is associated with substantial morbidity and mortality. Early identification of infectious causes is therefore critical for timely management. C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) are readily available inflammatory markers that may assist in this differentiation.

Methods: In this cross-sectional study, 322 patients presenting with ALOC and admitted to the ED of Baharloo Hospital were evaluated. Baseline demographic, clinical, and laboratory data were collected, and patients were classified as having infectious or non-infectious etiologies. First-day CRP and NLR values were compared between groups. Receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of CRP, NLR, and their combination in distinguishing infectious from non-infectious causes. Logistic regression analysis identified predictors of in-hospital mortality.

Results: The mean age was 62 years, and 36.6% of patients had an infectious etiology. Mortality was significantly higher in the infectious group than in the non-infectious group (60.2% vs. 22.1%, p<0.001). Median CRP and NLR values were significantly higher in infectious cases (both p<0.05). CRP at a cut-off of 32.0 mg/L yielded an area under the curve (AUC) of 0.76, with 71% sensitivity and 83% specificity, outperforming NLR (cut-off 5.53; AUC 0.68, sensitivity 71%, specificity 60%). The combined model achieved an AUC of 0.79 with 76.3% sensitivity and 76.5% specificity. Multivariable logistic regression identified older age (odds ratio [OR] 1.07, 95% confidence interval [CI]: 1.04-1.09), longer hospital stay (OR 1.09, 95% CI: 1.05-1.13), lower Glasgow Coma Scale score (OR 0.67, 95% CI: 0.59-0.75), and higher NLR (OR 1.14, 95% CI: 1.02-1.27) as independent predictors of mortality.

Conclusion: First-day CRP and NLR, particularly CRP, show acceptable diagnostic performance for distinguishing infectious from non-infectious causes of ALOC in the ED. Combined use of these markers improves diagnostic accuracy, and elevated NLR is independently associated with in-hospital mortality, supporting its role alongside clinical assessment for early risk stratification.

背景:意识水平改变(ALOC)是急诊科(ED)的常见表现,具有广泛的感染性和非感染性病因,并与大量发病率和死亡率相关。因此,及早发现感染原因对于及时管理至关重要。c反应蛋白(CRP)和中性粒细胞与淋巴细胞比率(NLR)是很容易获得的炎症标志物,可能有助于这种分化。方法:在本横断面研究中,对322例在Baharloo医院急诊科就诊的ALOC患者进行了评估。收集基线人口统计学、临床和实验室数据,并将患者分为感染性或非感染性病因。比较两组患者第一天CRP和NLR值。受试者工作特征(ROC)曲线分析评估CRP、NLR及其组合在区分感染性和非感染性病因方面的诊断性能。Logistic回归分析确定了住院死亡率的预测因素。结果:患者平均年龄62岁,感染病因占36.6%。感染组的死亡率明显高于非感染组(60.2% vs. 22.1%)。结论:第一天CRP和NLR,特别是CRP,在区分ED中感染性和非感染性原因的ALOC方面表现出可接受的诊断性能。联合使用这些标志物可提高诊断准确性,NLR升高与住院死亡率独立相关,支持其在早期风险分层的临床评估中的作用。
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引用次数: 0
Predictive Value of Systemic Immune-Inflammation Index Combined with D-Dimer Levels and Injury Severity Score for the Prognosis of Patients with Multiple Injuries: A Retrospective Analysis. 全身免疫炎症指数联合d -二聚体水平和损伤严重程度评分对多发损伤患者预后的预测价值:回顾性分析
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-03-10 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S549167
Xinlong Du, Yongming He, Xing Liu

Background: The prognosis of patients with multiple injuries (MI) remains challenging to predict accurately due to the complexity and heterogeneity of trauma. Traditional scoring systems or single biomarkers often have limitations in terms of sensitivity or specificity.

Purpose: The objective of the present study was to investigate the predictive value of combining the systemic immune-inflammation index (SII), D-dimer (D-D) and injury severity score (ISS) for evaluating the prognosis of patients with MI.

Patients and methods: A total of 142 patients with MI admitted to the Emergency Department of Shenzhen Longhua District Central Hospital (Shenzhen, China) from January 2019 to December 2023 were retrospectively analyzed. Patients were then divided into survival (n=102) and non-survival (n=40) groups according to their survival status on postoperative day 28. Logistic regression analysis was performed on indicators with significant differences between the two groups to identify prognostic factors in severe MI. Data were retrospectively analyzed using SPSS 26.0 software. In addition, receiver operating characteristic (ROC) curves were plotted to assess the predictive value of the combined SII, D-D and ISS.

Results: The median SII was found to be 340.11 (182.72-578.31) in the survival group and 849.93 (300.83-1034.14) in the non-survival group, yielding a significant difference (P<0.001). Logistic regression indicated that SII, D-D and ISS at admission were independent prognostic factors for mortality. Furthermore, SII, D-D, ISS and their combination showed predictive value [area under the curve (AUC) >0.5] for 28-day mortality, with the combination exhibiting the highest predictive accuracy. Based on the optimal ROC cut-off values (308.8), patients were divided into groups with SII ≤308.8 (n=58) and SII >308.8 (n=84), with significantly lower mortality in the former group (P<0.05). Similarly, patients were categorized into D-D ≤2.35 (n=117) and D-D >2.35 (n=25) groups, with significantly lower mortality in the former group (P<0.05). In conclusion, each indicator demonstrated prognostic significance (AUC >0.5), with the combined model achieving the highest predictive accuracy (AUC =0.969).

Conclusion: The integrated indicators offered improved predictive performance compared with individual measures for MI, providing a clinically valuable reference for patient management.

背景:由于创伤的复杂性和异质性,多发损伤(MI)患者的预后仍然难以准确预测。传统的评分系统或单一生物标志物在敏感性或特异性方面往往存在局限性。目的:本研究旨在探讨综合全身免疫炎症指数(SII)、d -二聚体(D-D)和损伤严重程度评分(ISS)对心肌梗死患者预后的预测价值。患者和方法:回顾性分析2019年1月至2023年12月深圳龙华区中心医院急诊科收治的142例心肌梗死患者。根据患者术后第28天的生存情况分为生存组(n=102)和非生存组(n=40)。对两组间有显著差异的指标进行Logistic回归分析,以确定重度心肌梗死的预后因素。数据采用SPSS 26.0软件进行回顾性分析。此外,绘制受试者工作特征(ROC)曲线,评估SII、D-D和ISS联合的预测价值。结果:生存组的中位SII为340.11(182.72-578.31),非生存组的中位SII为849.93(300.83-1034.14),对28天死亡率的预测差异有统计学意义(P0.5),两者的预测准确率最高。根据最佳ROC cut- cut值(308.8)将患者分为SII≤308.8组(n=58)和SII >308.8组(n=84),前者死亡率显著低于前者(P2.35 (n=25)组,前者死亡率显著低于前者(P0.5),联合模型预测准确率最高(AUC =0.969)。结论:综合指标对心肌梗死的预测效果优于单项指标,为患者管理提供了有临床价值的参考。
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引用次数: 0
From Limited Use to Standard Practice: Retrospective Analysis of Droperidol Administration by Emergency Medical Services (2018-2023). 从有限使用到标准实践:2018-2023年急诊医疗服务部门给予氟哌啶醇的回顾性分析。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-25 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S548610
Rachel L U Schuler, Paul D Schuler Jnr, Christopher Sampson

Objective: This retrospective observational study investigates the usage trends of droperidol (a dopamine receptor antagonist) by Emergency Medical Services (EMS) from 2018 to 2023, focusing on its evolving role in prehospital care.

Methods: Using the ESO Solutions, Inc. (ESO) national dataset, we analyzed 56,232,761 EMS cases over six years, examining the rates of droperidol administration by EMS clinicians. We assessed systolic blood pressure (SBP) and heart rate abnormalities after administration, and usage across primary impressions, procedures, and airway interventions. The total database cases grew from 5,536,297 in 2018 to 13,957,073 in 2023, with participating agencies increasing from 1,234 to 3,068.

Results: Our findings show an increase in droperidol administration, with doses rising from one in 2018 to 22,372 by 2023. The fraction of doses per million cases increased from 0.18 in 2018 to 1,603 in 2023. Droperidol usage grew from <0.01% of cases in 2018 to 0.2% in 2023. Primary impressions most associated with droperidol use were Behavioral/Psychiatric (23.4%), Pain (16.1%), and Neurological (13.8%). Among procedures, 12-lead ECG (21.7%) and patient restraint (21.1%) were most frequent. For cases receiving ECGs, top impressions were Gastrointestinal (34.0%) and Neurological (26.0%), with common age ranges being 60-69 (16.7%) and 50-59 (16.6%). Within airway management, oxygen administration was used in 69.40% of cases, followed by ETCO2 capnography (16.1%). Post-administration, 77.3% of patients maintained normal SBP, while 10.2% experienced hypotension and 12.4% hypertension. Regarding heart rate, 69.7% exhibited normal rates, with bradycardia in 13.4% and tachycardia in 17.0%.

Conclusion: Increasing droperidol utilization by EMS reflects growing adoption in clinical practice. This research highlights the need for ongoing emphasis on evidence-based practices in prehospital care, and advocating for enhanced training and protocol development. Limitations include potential underreporting and variability in protocol adherence, suggesting the need for further investigation into usage barriers and facilitators.

目的:本回顾性观察研究调查2018 - 2023年急诊医疗服务(EMS)使用多巴胺受体拮抗剂哌啶醇的趋势,重点研究其在院前护理中的作用演变。方法:使用ESO Solutions, Inc. (ESO)国家数据集,我们分析了6年来56,232,761例EMS病例,检查EMS临床医生给药氟哌啶醇的比率。我们评估了给药后收缩压(SBP)和心率异常,以及在初级印象、手术和气道干预中的使用。数据库案例总数从2018年的5536297例增加到2023年的13957073例,参与机构从1234个增加到3068个。结果:我们的研究结果显示,氟哌啶醇的使用增加了,剂量从2018年的1次增加到2023年的22,372次。每百万病例的剂量比例从2018年的0.18增加到2023年的1603。结论:EMS中氟哌啶醇使用率的增加反映了临床应用的增加。这项研究强调了在院前护理中持续强调循证实践的必要性,并倡导加强培训和制定协议。限制包括潜在的少报和协议依从性的可变性,这表明需要进一步调查使用障碍和促进因素。
{"title":"From Limited Use to Standard Practice: Retrospective Analysis of Droperidol Administration by Emergency Medical Services (2018-2023).","authors":"Rachel L U Schuler, Paul D Schuler Jnr, Christopher Sampson","doi":"10.2147/OAEM.S548610","DOIUrl":"https://doi.org/10.2147/OAEM.S548610","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective observational study investigates the usage trends of droperidol (a dopamine receptor antagonist) by Emergency Medical Services (EMS) from 2018 to 2023, focusing on its evolving role in prehospital care.</p><p><strong>Methods: </strong>Using the ESO Solutions, Inc. (ESO) national dataset, we analyzed 56,232,761 EMS cases over six years, examining the rates of droperidol administration by EMS clinicians. We assessed systolic blood pressure (SBP) and heart rate abnormalities after administration, and usage across primary impressions, procedures, and airway interventions. The total database cases grew from 5,536,297 in 2018 to 13,957,073 in 2023, with participating agencies increasing from 1,234 to 3,068.</p><p><strong>Results: </strong>Our findings show an increase in droperidol administration, with doses rising from one in 2018 to 22,372 by 2023. The fraction of doses per million cases increased from 0.18 in 2018 to 1,603 in 2023. Droperidol usage grew from <0.01% of cases in 2018 to 0.2% in 2023. Primary impressions most associated with droperidol use were Behavioral/Psychiatric (23.4%), Pain (16.1%), and Neurological (13.8%). Among procedures, 12-lead ECG (21.7%) and patient restraint (21.1%) were most frequent. For cases receiving ECGs, top impressions were Gastrointestinal (34.0%) and Neurological (26.0%), with common age ranges being 60-69 (16.7%) and 50-59 (16.6%). Within airway management, oxygen administration was used in 69.40% of cases, followed by ETCO2 capnography (16.1%). Post-administration, 77.3% of patients maintained normal SBP, while 10.2% experienced hypotension and 12.4% hypertension. Regarding heart rate, 69.7% exhibited normal rates, with bradycardia in 13.4% and tachycardia in 17.0%.</p><p><strong>Conclusion: </strong>Increasing droperidol utilization by EMS reflects growing adoption in clinical practice. This research highlights the need for ongoing emphasis on evidence-based practices in prehospital care, and advocating for enhanced training and protocol development. Limitations include potential underreporting and variability in protocol adherence, suggesting the need for further investigation into usage barriers and facilitators.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"548610"},"PeriodicalIF":1.5,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prehospital Blood pH Testing and Survival in Non-Traumatic Out-of-Hospital Cardiac Arrest: Insights from a Thai EMS Unit. 院前血液pH值测试和非创伤性院外心脏骤停的存活率:来自泰国急救中心的见解。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-24 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S549407
Chavin Triganjananun, Welawat Tienpratarn, Chaiyaporn Yuksen, Lunlita Chukaew, Chetsadakon Jenpanitpong, Suteenun Seesuklom

Background: Point-of-care testing (POCT) for blood gas and electrolyte analysis supports the identification of reversible causes of out-of-hospital cardiac arrest (OHCA). In 2021, the Ramathibodi Emergency Operation (RAMA EMO) unit became the first emergency medical service team in Thailand to apply POCT in its prehospital resuscitation protocol. Prior to this implementation, POCT had not been used in prehospital OHCA care in Thailand, so its clinical impact was unknown. The aim of this study was to evaluate the association between initial prehospital POCT-measured pH and return of spontaneous circulation (ROSC) at emergency department (ED) admission in a Thai EMS-managed OHCA cohort.

Methods: This single-center ambispective cohort study analyzed adult non-traumatic OHCA patients managed by the RAMA EMO unit. Prehospital POCT was used in all eligible OHCA cases after the initiation of advanced resuscitation. Multivariable analysis was employed to assess the association between blood pH and ROSC at ED admission.

Results: A total of 148 patients were included, and ROSC at ED admission occurred in 25% of the cases. Higher prehospital pH was significantly associated with ROSC at ED admission. In ROC analysis, a pH cutoff of ≥ 7.1 demonstrated the optimal discriminative performance. In multivariable logistic regression, pH ≥ 7.1 remained independently associated with ROSC at ED admission (adjusted odds ratio 3.68, 95% CI 1.37-9.89; P = 0.010). Internal bootstrap validation confirmed the robustness of this association.

Conclusion: Prehospital POCT blood gas analysis provides valuable prognostic information regarding OHCA, with a pH ≥ 7.1 serving as an independent predictor of ROSC at ED admission. Bootstrap validation supports the stability and reliability of this cutoff. The integration of POCT into EMS protocols may enhance early clinical decision-making during resuscitation. Further external validation is warranted to confirm these findings.

背景:即时检测(POCT)的血气和电解质分析支持院外心脏骤停(OHCA)可逆原因的识别。2021年,拉玛蒂博迪紧急行动(RAMA EMO)单位成为泰国第一个在院前复苏方案中应用POCT的紧急医疗服务小组。在此之前,POCT尚未在泰国院前OHCA护理中使用,因此其临床影响尚不清楚。本研究的目的是评估在泰国ems管理的OHCA队列中,院前poct测量的初始pH值与急诊科(ED)入院时自然循环恢复(ROSC)之间的关系。方法:这项单中心双视角队列研究分析了由RAMA EMO部门管理的成人非创伤性OHCA患者。院前POCT用于所有符合条件的OHCA病例在开始晚期复苏后。采用多变量分析评估ED入院时血pH值与ROSC之间的关系。结果:共纳入148例患者,急诊入院时发生ROSC的占25%。院前较高的pH值与急诊科入院时ROSC显著相关。在ROC分析中,pH临界值≥7.1显示了最佳的判别性能。在多变量logistic回归中,入院时pH≥7.1仍与ROSC独立相关(校正优势比3.68,95% CI 1.37-9.89; P = 0.010)。内部自举验证证实了这种关联的稳健性。结论:院前POCT血气分析为OHCA提供了有价值的预后信息,pH≥7.1可作为ED入院时ROSC的独立预测因子。引导验证支持这种截止的稳定性和可靠性。将POCT整合到EMS方案中可以提高复苏过程中的早期临床决策。需要进一步的外部验证来证实这些发现。
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引用次数: 0
Impact of a Blended-Learning Rapid Sequence Intubation Training Program on Emergency Physician Confidence: A Single-Center Program Evaluation. 混合学习快速插管训练计划对急诊医师信心的影响:单中心计划评估。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-24 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S574489
Shabbir Ahmad, Zainab Ahmed Alani, Yavuz Yigit, Shahzad Anjum, Khalid Bashir

Background:  Rapid Sequence Intubation (RSI) is a high-risk, time-critical procedure in emergency medicine. Standardizing its practice across a multinational workforce with diverse training backgrounds remains a persistent educational challenge. This mixed-methods program evaluation assessed a blended-learning RSI program's impact on self-reported physician confidence and perceived educational value within a tertiary emergency care setting.

Methods:  A retrospective evaluation was conducted for a blended-learning RSI curriculum delivered between 2020 and 2022. The program combined asynchronous online modules with a 4-hour, small-group simulation-based practical session. A voluntary, anonymous post-program survey was administered in 2025 following IRB approval. Outcomes included retrospective pre-post self-reported confidence (5-point Likert scale), satisfaction with program components, and qualitative feedback. No objective performance measures were assessed.

Results:  Forty-five of 141 eligible physicians completed the survey (adjusted response rate 42%). Self-reported low confidence decreased from 77.8% pre-course to 6.6% post-course, while high confidence increased from 22.2% to 93.4% (Cohen's d = 2.1). Improvements were consistent across professional grades. The simulation-based session received the highest satisfaction rating (mean 4.3/5). Qualitative analysis highlighted the value of realistic simulation, structured debriefing, and standardized checklists. Suggested improvements included more complex scenarios and enhanced online interactivity.

Conclusion:  Participation in a blended-learning RSI program was associated with substantial improvement in self-reported physician confidence and high satisfaction among a multinational emergency medicine workforce. These findings support the feasibility and perceived value of this educational approach for high-risk procedural training in similar settings, though objective competence was not evaluated.

背景:快速序列插管(RSI)在急诊医学中是一种高风险、时间紧迫的手术。在具有不同培训背景的跨国劳动力中标准化其实践仍然是一项持久的教育挑战。这个混合方法的项目评估评估了一个混合学习的RSI项目对三级急救环境中自我报告的医生信心和感知的教育价值的影响。方法:对2020年至2022年期间交付的混合学习RSI课程进行回顾性评估。该课程将异步在线模块与4小时的小组模拟实践课程相结合。在IRB批准后,于2025年进行了一项自愿的、匿名的项目后调查。结果包括回顾性前后自我报告的信心(5点李克特量表),对计划组成部分的满意度和定性反馈。没有评估客观的表现指标。结果:141名符合条件的医生中有45名完成了调查(调整后的应答率为42%)。自我报告的低自信从课程前的77.8%下降到课程后的6.6%,而高自信从22.2%上升到93.4% (Cohen’s d = 2.1)。各专业职系均有一致的改善。基于模拟的会话获得了最高的满意度评分(平均4.3/5)。定性分析强调了现实模拟、结构化汇报和标准化检查清单的价值。建议的改进包括更复杂的场景和增强的在线交互性。结论:参与一项混合学习的重复性劳伤项目与跨国急救医疗人员自我报告的医师信心和高满意度的显著提高有关。这些发现支持了这种高风险程序培训的教育方法在类似环境中的可行性和感知价值,尽管客观能力没有得到评估。
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引用次数: 0
Impact of Prehospital Administration of Aspirin and Unfractionated Heparin on In-Hospital Outcomes in Patients with Suspected Myocardial Infarction: A Retrospective Cohort Study. 院前给予阿司匹林和未分割肝素对疑似心肌梗死患者住院结局的影响:一项回顾性队列研究
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-20 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S571863
Wenke Faller, Ioannis Toskas, Diana Heurich, Manuel Sigle, Meinrad Gawaz, Michal Droppa, Karin Anne Lydia Müller, Andreas Goldschmied

Purpose: In a prehospital setting with limited diagnostic resources, identification of myocardial infarction (MI) can be challenging. However, high diagnostic accuracy of patients with MI is not only necessary to provide early revascularization but also essential to guide prehospital pharmacological therapy. Even though prehospital use of acetylsalicylic acid (ASA) and anticoagulation therapy is widely established, guidelines only recommend these medications in confirmed cases undergoing PCI. This study examines if prehospital treatment with ASA and unfractionated heparin (UFH) influences in-hospital mortality and bleeding rates in patients with suspected MI.

Patients and methods: In this retrospective, single-center cohort study, prehospital treatment with ASA and UFH in 2756 patients with suspected MI was analyzed. Associations between ASA/UFH and death/bleeding until discharge were investigated. To adjust for possible confounders, multiple logistic regression was performed. Furthermore, stepwise logistic regression was carried out in order to investigate factors that influence emergency physicians (EPs) decision to treat with ASA and UFH.

Results: Prehospitally administered ASA and UFH was not associated with a significant change in mortality (odds ratio [OR], 0.813; 95% confidence interval [CI] 0.453 to 1.461; p=0.489 for ASA and OR 1.036; CI 0.566 to 1.898; p=0.908 for UFH) or bleeding (OR, 1.142; 95% CI 0.762 to 2.615; p=0.273 for ASA and OR 1.053; CI 0.558 to 1.986; p=0.874 for UFH). Several factors including the presence of ST elevations, atypical chest pain, and concomitant medication were found to influence the EPs decision to treat with ASA and UFH.

Conclusion: Prehospital administration of ASA and UFH did not affect in-hospital mortality and bleeding outcomes in a cohort of patients with suspected MI. These findings suggest that routine prehospital anticoagulation in suspected MI may not improve short-term outcomes and should be reconsidered pending randomized evidence.

目的:在诊断资源有限的院前环境中,心肌梗死(MI)的识别可能具有挑战性。然而,对心肌梗死患者的高诊断准确性不仅是提供早期血运重建的必要条件,也是指导院前药物治疗的必要条件。尽管院前使用乙酰水杨酸(ASA)和抗凝治疗已被广泛建立,但指南只推荐在确诊的PCI病例中使用这些药物。本研究探讨院前ASA和未分级肝素(UFH)治疗是否影响疑似心肌梗死患者的住院死亡率和出血率。患者和方法:在这项回顾性、单中心队列研究中,分析了2756例疑似心肌梗死患者的院前ASA和未分级肝素治疗。研究了ASA/UFH与死亡/出血至出院之间的关系。为了调整可能的混杂因素,进行了多元逻辑回归。此外,我们进行逐步逻辑回归,以探讨影响急诊医生(EPs)决定使用ASA和UFH治疗的因素。结果:院前给药ASA和UFH与死亡率(优势比[OR] 0.813; 95%可信区间[CI] 0.453至1.461;ASA =0.489, OR 1.036; CI 0.566至1.898;UFH p=0.908)或出血(OR为1.142;95% CI 0.762至2.615;ASA =0.273, OR 1.053; CI 0.558至1.986;UFH p=0.874)的显著变化无关。包括ST段抬高、非典型胸痛和伴随用药在内的几个因素被发现影响EPs是否决定用ASA和UFH治疗。结论:院前给药ASA和UFH对疑似心肌梗死患者的住院死亡率和出血结局没有影响。这些研究结果表明,对疑似心肌梗死患者进行常规院前抗凝可能不会改善短期预后,应在等待随机证据的情况下重新考虑。
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引用次数: 0
Forecasting Road Traffic Injuries in North-Eastern Iran: The Effects of COVID-19 and Time Series Analysis (2009-2023). 伊朗东北部道路交通伤害预测:2019冠状病毒病的影响和时间序列分析(2009-2023)。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-13 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S550300
Toktam Akbari Khalaj, Taiebe Kenarangi, Vahid Fakoor, Vahid Ghavami, Ali Yazdani, Morteza Lotfi, Negar Sangsefidi

Background: Road Traffic Injuries (RTI) represent a major public health issue in the current century. Examining accident data is essential for developing effective strategies and measures aimed at minimizing these incidents and protecting lives.

Methods: This study investigates the impact of the COVID-19 pandemic on RTI in northeast Iran, particularly in Mashhad, a city characterized by a high number of pilgrims and suburban commuters. We employed Seasonal Autoregressive Integrated Moving Average (ARIMA) models to analyze time‑series data collected between 2009 and 2023. The dataset included RTI records from official national sources. The seasonal ARIMA approach was selected to capture seasonal variations, long‑term trends, and the effects of pandemic‑related mobility restrictions on RTI patterns. All analyses were performed by statistical R software version 4.5.1.

Results: The average monthly RTI decreased from 2385 (95% CI: 2055-2794) in 2019 to 2035 (95% CI: 1707-2362) in 2020. This reduction of approximately 14.8% was statistically significant (p < 0.05), highlighting the impact of pandemic-related traffic restrictions on road traffic injuries in Iran. The study employed detailed time series analysis, including seasonal ARIMA modeling, to forecast future RTI trends, which is crucial for informing effective prevention strategies.

Conclusion: The analysis reveals seasonal patterns in RTI data, confirming the presence of non-stationarity. The results indicate a projected upward trend in RTI incidence, driven largely by increased traffic volumes in the post-pandemic period. These findings highlight the urgent need for targeted interventions to address this rising burden. Overall, the study offers valuable insights for policymakers, supporting more effective strategies to improve road safety and help mitigate the ongoing public health challenge posed by RTIs.

背景:道路交通伤害(RTI)是本世纪的一个重大公共卫生问题。审查事故数据对于制定有效的战略和措施至关重要,这些战略和措施旨在尽量减少这些事件并保护生命。方法:本研究调查了2019冠状病毒病大流行对伊朗东北部RTI的影响,特别是在以朝圣者和郊区通勤者为特征的马什哈德市。我们采用季节自回归综合移动平均(ARIMA)模型分析了2009年至2023年收集的时间序列数据。该数据集包括来自国家官方来源的RTI记录。选择季节性ARIMA方法来捕捉季节变化、长期趋势以及与大流行相关的流动限制对RTI模式的影响。所有分析均采用统计R软件4.5.1版进行。结果:月平均RTI从2019年的2385 (95% CI: 2055-2794)下降到2020年的2035 (95% CI: 1707-2362)。减少约14.8%具有统计学意义(p < 0.05),突出了与大流行相关的交通限制对伊朗道路交通伤害的影响。该研究采用详细的时间序列分析,包括季节性ARIMA模型,来预测未来的RTI趋势,这对于告知有效的预防策略至关重要。结论:分析揭示了RTI数据的季节性模式,证实了非平稳性的存在。结果表明,预计RTI发病率呈上升趋势,主要是由于大流行后时期交通量的增加。这些发现突出表明,迫切需要采取有针对性的干预措施来解决这一日益加重的负担。总体而言,该研究为政策制定者提供了宝贵的见解,支持采取更有效的战略来改善道路安全,并帮助减轻交通污染对公共卫生构成的持续挑战。
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引用次数: 0
Accuracy of Medically Experienced Emergency Dispatchers - A Unique Nationwide Model. 医疗经验丰富的紧急调度员的准确性-一个独特的全国模型。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2026-02-13 eCollection Date: 2026-01-01 DOI: 10.2147/OAEM.S562377
Daniel Trotzky, Inon Dimand, Gal Pachys, Eli Jaffe, Daniel Edward Fordham, Tzachi Slutsky, Refael Strugo, Ella Khairish Ben Zeev, Joseph Leonard, Aya Cohen, Roman Sonkin

Background: This research examined the accuracy of the Israeli model of emergency medical dispatch by comparing dispatchers' preliminary diagnosis with the working diagnosis of paramedics in the field.

Methods: Data from emergency medical calls received by Magen David Adom between January 1st 2019 and December 31st 2019 were included. Primary analysis was done by directly comparing preliminary diagnoses made by dispatchers to the diagnoses made by paramedics. Secondary analysis was done by comparing the system identified by the dispatchers' preliminary diagnoses to the system identified by the paramedics' diagnoses. Tertiary analysis was done by subgrouping symptoms and syndromes by an expert panel to create a new preliminary diagnosis which was then compared with paramedic diagnosis.

Results: Primary analysis showed a sensitivity of 48.8%, specificity of 97.3%, PPV of 53.0%, and NPV of 98.0%. Secondary analysis showed a sensitivity of 78.6%, specificity of 88.4%, PPV of 26.5%, and NPV of 99.2%. Tertiary analysis showed a sensitivity of 49.8%, specificity of 97.3%, PPV of 54.4%, and NPV of 97.9%.

Conclusion: Medically experienced emergency dispatchers were able to obtain a high level of sensitivity determining preliminary diagnoses compared to ambulance crews in the field. Further research should focus on widening the variety of diagnoses investigated.

背景:本研究通过比较调度员的初步诊断和现场护理人员的工作诊断来检验以色列紧急医疗调度模式的准确性。方法:纳入2019年1月1日至2019年12月31日Magen David Adom收到的紧急医疗呼叫数据。初步分析是通过直接比较调度员的初步诊断和护理人员的诊断来完成的。将调度员初步诊断识别的系统与护理人员诊断识别的系统进行二次分析。三级分析由专家小组对症状和综合征进行亚分组,以创建新的初步诊断,然后与护理诊断进行比较。结果:初步分析显示敏感性为48.8%,特异性为97.3%,PPV为53.0%,NPV为98.0%。二次分析显示敏感性为78.6%,特异性为88.4%,PPV为26.5%,NPV为99.2%。三级分析显示敏感性为49.8%,特异性为97.3%,PPV为54.4%,NPV为97.9%。结论:与现场救护人员相比,医学上经验丰富的紧急调度员能够获得高水平的灵敏度来确定初步诊断。进一步的研究应集中于扩大所调查的诊断的种类。
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引用次数: 0
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Open Access Emergency Medicine
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