Open Access Emergency Medicine最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.