African Journal of Emergency Medicine最新文献

{"title":"A silent epidemic: Exploring the clinico-epidemiological impact of explosion and gunshot injuries in the emergency department of a tertiary hospital in Somalia","authors":"Hussein Hassan Mohamed ,&nbsp;Hassan Adan Ali Adan ,&nbsp;Selim Turfan ,&nbsp;Murat Aysin ,&nbsp;Mohamed Farah Yusuf Mohamud","doi":"10.1016/j.afjem.2025.100898","DOIUrl":"10.1016/j.afjem.2025.100898","url":null,"abstract":"<div><h3>Background</h3><div>Mass casualty incidents, such as explosions and gunshot wounds (GSWs), pose significant public health challenges. This study analyzes the clinico-epidemiological profile and outcomes of patients with explosive injuries and GSWs in Somalia.</div></div><div><h3>Method</h3><div>A retrospective analysis was conducted on 225 patients admitted to the Emergency Department of a tertiary hospital in Somalia between January and December 2021. Data collected included injury type, anatomical distribution, demographics, hospital admissions, and outcomes.</div></div><div><h3>Results</h3><div>Of the 225 explosion and GSW injuries, explosive injuries accounted for 58 %, while GSWs made up 42 %. The majority of patients were male (85.3 %), with 89.5 % in the GSW group and 82.3 % in the explosion group. More than half(58.7 %) of the patients were aged 18 to 30 years, with 59.2 % in the explosion group and 57.9 % in the GSW group. Anatomical analysis revealed that head injuries were most common(21 %), particularly in explosion cases, as well as higher rates of head (26.2 %), maxillofacial(7.7 %), and lower-limb injuries (12.3 %) compared to GSW patients. Some 21.7 % of patients were discharged from ED, 19 % admitted to ICU and an inpatient death rate of 12.9 %, including three patients (1.3 %) who died in the Emergency Department, all from the explosion injury group.</div></div><div><h3>Conclusion</h3><div>The rising incidence of traumatic injuries necessitates a multifaceted approach, including enhanced emergency response systems and public health initiatives. This data serves as a call to action for healthcare providers and policymakers to prioritize the management and prevention of explosion and gunshot-related injuries in Somalia.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100898"},"PeriodicalIF":1.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exhaled carbon monoxide concentration in correlation to clinical parameters to detect carbon monoxide poisoning among fire victims in an Egyptian Emergency Department","authors":"Ahmed KhalafAllah Mohamed ,&nbsp;Amany Atef ElKareem Abouzeid ,&nbsp;Mohamed Galal Morsi ,&nbsp;Amira Ismail Alamelden ,&nbsp;Aisha Safwat Saif Eldeen ,&nbsp;Marwa Mohammed Fouad","doi":"10.1016/j.afjem.2025.100899","DOIUrl":"10.1016/j.afjem.2025.100899","url":null,"abstract":"<div><h3>Background</h3><div>Fire victims are at risk of inhaling potentially toxic gases contained within smoke. Carbon monoxide gas (CO) is the most significant and may contribute to morbidity and mortality of patients. Early detection of CO poisoning by measuring exhaled CO in correlation to the clinical parameters suggestive of CO poisoning in mild to moderate burn injuries among fire victims was our aim.</div></div><div><h3>Methods</h3><div>Case-control study involving 40 fire victims presenting with flame burn injuries within 24 h who were assessed for CO poisoning. Control group involved 40 healthy nonsmoker individuals. Exhaled CO level was measured using a CO Check Pro Device, which was correlated to clinical parameters suggestive of CO poisoning in addition to elevated lactate level.</div></div><div><h3>Results</h3><div>The median exhaled CO level was significantly higher in cases compared to controls (4.5 ppm vs. 1.5 ppm, <em>p</em> &lt; 0.001). Among fire victims, 37.5 % had mild CO poisoning. Significant positive correlations were found between exhaled CO levels and lactate levels (<em>r</em> = 0.54, <em>p</em> &lt; 0.001), duration of flame exposure (<em>r</em> = 0.59, <em>p</em> &lt; 0.001), and crowding index (<em>r</em> = 0.49, <em>p</em> = 0.009).</div></div><div><h3>Discussion</h3><div>Exhaled carbon monoxide levels is a valuable diagnostic tool for the early detection of CO poisoning among fire victims with mild to moderate burn injuries. The correlation between elevated exhaled CO levels and clinical symptoms, alongside serum lactate level, supports their use as reliable indicator of CO exposure in fire victims, thereby optimizing emergency response strategies.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100899"},"PeriodicalIF":1.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a pilot simulation training on interdisciplinary closed-loop communication and time to critical actions at an emergency centre in Burundi","authors":"Eric Arnold ,&nbsp;Patricial Bulakali ,&nbsp;Elizabeth Burner ,&nbsp;Taylor Burkholder ,&nbsp;Carlan Wendler","doi":"10.1016/j.afjem.2025.100893","DOIUrl":"10.1016/j.afjem.2025.100893","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency medicine simulation is an effective training modality in both high and low resource settings. We describe the authors’ experiences conducting a four-week interdisciplinary, <em>in situ</em>, simulation training series at an emergency centre in Burundi.</div></div><div><h3>Methods</h3><div>Training emphasized effective closed loop communication, early airway, breathing, and circulation assessment, as well as time to vital signs, IV placement, and oxygen administration when appropriate. Six doctor-nursing teams participated in four training sessions as well as pre- and post-test simulation cases which were graded by an independent evaluator.</div></div><div><h3>Results</h3><div>The training resulted in a statistically significant improvement in closed loop communication as well as notable narrowing in standard deviation of times to critical actions after the training intervention. Although the small sample size and large variation of data limited their statistical significance, these results may indicate a short-term benefit towards early assessment, management and team communication when simulating management of critical patients. Additionally, we found that interdisciplinary, <em>in situ</em> simulation was a safe and likely beneficial option for training and team building in a resource-limited emergency centre.</div></div><div><h3>Conclusion</h3><div>While this pilot study establishes feasibility of low-cost, interdisciplinary emergency simulation training in resource-limited settings, further research is needed to establish educational effectiveness on quality-of-care measures and its generalizability to other contexts prior to implementing similar trainings.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100893"},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors contributing to extended length of stay in the emergency department and potential strategies for improving patient flow in a central hospital in the Gauteng Province, South Africa","authors":"L. Motimele ,&nbsp;V. Lalloo ,&nbsp;T. Sefala ,&nbsp;A. Engelbrecht ,&nbsp;L. Majake-Mogoba ,&nbsp;D. Basu","doi":"10.1016/j.afjem.2025.100896","DOIUrl":"10.1016/j.afjem.2025.100896","url":null,"abstract":"<div><h3>Background</h3><div>Length of stay (LOS) is an integral part of inpatient care in hospitals, particularly in Emergency Departments (EDs). It is an essential performance indicator for the National Indicator Data Set in South Africa. Multiple studies have indicated a correlation between an increased LOS and worse patient outcomes in a variety of acute medical conditions. The study aims to establish the key factors of LOS in the ED at a central hospital in the Gauteng Province of South Africa.</div></div><div><h3>Methodology</h3><div>A cross-sectional study was conducted over seventeen months (Aug 2023 to Dec 2024) based on 2927 entries of patients admitted at the ED for more than 48 hours. No intervention was done as part of this study.</div></div><div><h3>Results</h3><div>The median LOS was 2.81 days (IQR: 2-3) with a minimum of 2 days and a maximum of 12 days. A regression analysis demonstrated that the most significant determinants for prolonged LOS were gender and disease group of boarded patients awaiting ward transfer.Significant differences (p &lt; 0.001) in the LOS between clinical disciplines were noted, with medical (45%) and surgical departments (46%) accounting for most boarding patients compared to all other clinical disciplines.</div></div><div><h3>Conclusions</h3><div>Data demonstrated that 80% of patients in the ED wait an average of 3 days before transfer into the wards. This extended ALOS in the ED has consequences for patient outcomes and the quality of healthcare provided. Based on the findings of this study, strategies to improve patient flow are essential in facilitating timeous discharge from wards and to prioritise the forward flow of patients waiting in ED.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 4","pages":"Article 100896"},"PeriodicalIF":1.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to providing facility-based emergency care in Addis Ababa, Ethiopia: A mixed methods study","authors":"Demelash Ataro Ambushe ,&nbsp;Lee A Wallis ,&nbsp;Willem Stassen","doi":"10.1016/j.afjem.2025.100894","DOIUrl":"10.1016/j.afjem.2025.100894","url":null,"abstract":"<div><h3>Background</h3><div>Illness and injury that may be impacted by emergency care account for over half of all deaths in low- and middle-income countries. However, studies show that Emergency Units in these countries face numerous barriers to facility-based emergency care. Yet, data on the barriers to facility-based emergency care in Ethiopia and some reasons for these barriers have not been established, and this study aimed to bridge this gap.</div></div><div><h3>Methods</h3><div>The study followed an explanatory, sequential mixed-methods design. In phase one, a cross-sectional evaluation of five hospitals was done using WHO's Hospital Emergency Unit Assessment Tool (HEAT). A purposive sampling technique was used to select the hospitals, and a convenience sampling technique was used to determine the participants. Quantitative data were analysed descriptively. In phase two, in-depth key informant interviews were done. Qualitative data were analysed using content analysis. Finally, the integration of the results from the two phases was done.</div></div><div><h3>Results</h3><div>We surveyed 38 participants in phase one and interviewed 15 in phase two. The most apparent findings to emerge from the quantitative phase of the study were the participants from across the hospitals reported the absence of equipment (<em>n</em> = 119) and stock out of supplies (<em>n</em> = 47) as the two most common barriers. Similarly, the most common reasons reported for not performing diagnostic services across all facilities were absent equipment (<em>n</em> = 128) and stock out of supplies (<em>n</em> = 99). The most important barriers identified from the qualitative phase of the study included a shortage or lack of resources, and inadequate management of resources. The facilitators identified for the procedures they could perform were the availability of essential resources, including trained human resources, good management practices, and coordination among the staff.</div></div><div><h3>Conclusion</h3><div>Overall, the tertiary hospitals in Addis Ababa reported they could perform the majority of the diagnostic and therapeutic procedures in the emergency units despite the interruption of some of the services. Some of the services' complete absence or interruptions were due to several barriers. Both existing literature and the findings of this study indicate the EUs of Ethiopian hospitals need further investment to improve resource availability and proper management of available resources.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100894"},"PeriodicalIF":1.2,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived support needs of novice nurses working in emergency departments of selected public hospitals in Tshwane, South Africa","authors":"Kapari Mashao,&nbsp;Celia Filmalter,&nbsp;Tanya Heyns","doi":"10.1016/j.afjem.2025.100889","DOIUrl":"10.1016/j.afjem.2025.100889","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients present with diverse healthcare needs in emergency departments, necessitating nurses to have diverse clinical competencies to function effectively. Novice nurses in emergency departments may be ill-equipped to handle responsibilities and workload, necessitating adequate support for a smooth transition. However, providing practical support requires a comprehensive understanding of support needs.</div></div><div><h3>Methods</h3><div>This descriptive qualitative study investigated the perceived support needs of novice nurses working in emergency departments. Fifteen participants were purposively selected from three selected public hospitals in Tshwane, South Africa. Semi structured, face-to-face interviews were conducted between September and November 2023. The interviews were audio-recorded, and the transcripts were thematically analysed via ATLASti Version 24.</div></div><div><h3>Results</h3><div>Three key themes emerged to support the transition of novice nurses in emergency departments: a dedicated orientation programme, a dedicated preceptor, and a supportive culture to facilitate the transition to emergency departments. A dedicated orientation programme encompasses essential components, including emergency equipment, triage, basic life support skills, admission and treatment protocols, and specific competencies. The participants emphasised the value of dedicated preceptors, trained and experienced professionals who offer guidance, feedback and remedial support. Additionally, the importance of a supportive culture, particularly one that fosters a positive learning environment and provides emotional support to ease the transition process, was highlighted.</div></div><div><h3>Conclusion</h3><div>The successful transition of novice nurses in emergency departments is a cost-effective way of improving job satisfaction and retention. However, novice nurses working in emergency departments have diverse support needs. Thus, ensuring a successful transition requires understanding these nurses’ support needs. This study revealed that establishing a structured orientation programme, assigning trained preceptors and fostering a supportive culture are critical in facilitating the successful transition of novice nurses to emergency departments. These strategies can address novice nurses’ support needs by improving competence and patient care outcomes and promoting confidence, emotional well-being, job satisfaction and retention. Realising the support needs of novice nurses may inform the development of evidence-based transition interventions that offer support in specific ED contexts.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100889"},"PeriodicalIF":1.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the WHO/ICRC Basic Emergency Care (BEC) course on nurses’ knowledge, confidence, and competence in Primary Health Care facilities in Gauteng, South Africa","authors":"Meghan Botes ,&nbsp;Lauren Lai King ,&nbsp;Robert Holliman ,&nbsp;Santel de Lange ,&nbsp;Simon Isabwe Tumusiime ,&nbsp;Mahlomola Kutoane ,&nbsp;Dylan Quiroga ,&nbsp;Petra Brysiewicz","doi":"10.1016/j.afjem.2025.100890","DOIUrl":"10.1016/j.afjem.2025.100890","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary health care (PHC) nurses handle preventative care and emergencies, despite the latter not being their focus. Upskilling in basic emergency care is essential as PHC facilities serve as the first point of care. The World Health Organization and International Committee of the Red Cross developed a Basic Emergency Care (BEC) course, but its suitability for Gauteng PHC nursing staff remains unknown. This study assessed the BEC course's impact on nurses' knowledge, confidence, and competence in emergency care at selected Gauteng PHC facilities.</div></div><div><h3>Methods</h3><div>A pre-post intervention design was used with purposive sampling of eighty-six nurses who completed the BEC course from three emergency departments. Data collection occurred April-June 2024. Knowledge, confidence and competence were assessed using pre- and post-course surveys and knowledge tests, plus a final evaluation with 6 open-ended questions. Data analysis included descriptive statistics, correlational analyses, and inferential methods to determine statistical significance of observed variations.</div></div><div><h3>Results</h3><div>The study included <em>N</em> = 86 nurses across various categories. Knowledge scores significantly increased from 55.1% pre-test to 78.8% post-test. Self-perceived competence and confidence improved from 2.72 to 3.54 post-course. ANOVA revealed significant relationships between nurse categories and scores in pre-tests (<em>p</em> = 0.004) and post-tests (<em>p</em> &lt; 0.001). Post-test confidence also varied significantly between categories (<em>p</em> = 0.046). Content analysis of open-ended responses identified four themes: \"Correcting wrongs\", \"Extremely congested course\", \"Contextual relevance\" and \"Skills update.\"</div></div><div><h3>Discussion</h3><div>The results highlight significant knowledge gains for all nurses who received BEC training. However, differences in performance between nurse categories suggest a need for further exploration and consideration of how to accommodate different categories of nurses. While nurses found the course highly useful and relevant, content loading and course duration should be considered.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100890"},"PeriodicalIF":1.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data completeness and quality of emergency triage in Ethiopian public tertiary hospitals: A multicenter study","authors":"Woldesenbet Waganew ,&nbsp;Ayalew Zewde ,&nbsp;Sisay Yifru Abera ,&nbsp;Menbau Sultan ,&nbsp;Temesgen Beyene ,&nbsp;Tesfaye Getachew ,&nbsp;Bethelehem Tebebe ,&nbsp;Zelalem Getahun ,&nbsp;Daniel Alemu ,&nbsp;Esubalew Gobegnew ,&nbsp;Etsegent Aklog ,&nbsp;Tigist Bacha ,&nbsp;Sisay Teklu ,&nbsp;Aklilu Azazh ,&nbsp;Asefu W∕Tsadik","doi":"10.1016/j.afjem.2025.100888","DOIUrl":"10.1016/j.afjem.2025.100888","url":null,"abstract":"<div><h3>Introduction</h3><div>Triage is a system of ranking sick or injured persons according to their severity. Its data is critical for evidence-based action. The aim of this study was to assess the quality and completeness of emergency department triage tool in three tertiary Ethiopian public hospitals.</div></div><div><h3>Method</h3><div>This study utilized a multicenter cross-sectional design with sample size estimation calculated using a single population proportion formula. Data were collected from multiple sites and analyzed using the Statistical Package for the Social Sciences (SPSS), version 25. All statistical analyses were conducted to evaluate the completeness of triage documentation.</div></div><div><h3>Result</h3><div>In a review of 450 client charts from three tertiary hospitals providing acute care, the completeness of triage data varied. Patient name, age, and gender were documented with a completeness of 79.1 %, 77.5 %, and 70.8 %, respectively. The cumulative analysis of the triage early warning score showed, highest recorded completeness was for heart rate (98.4 %), followed closely by respiratory rate (96.0 %). However, significant discrepancies were noted in other areas, such as systolic blood pressure, which had an overall completeness of 87.7 %. Temperature assessment was notably poor, with a cumulative completeness of only 59.3 %. Other parameters, including mobility and AVPU/CNS assessments, showed completeness of 86.4 % each.</div></div><div><h3>Conclusion</h3><div>This study identifies significant inconsistencies in triage documentation completeness across three Ethiopian hospitals, highlighting an urgent need for interventions. Standardized triage scales and continuous professional development focusing on documentation are crucial to enhance patient safety and optimize care delivery.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100888"},"PeriodicalIF":1.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health research abstracts: May '25","authors":"Jonathan Kajjimu","doi":"10.1016/j.afjem.2025.100885","DOIUrl":"10.1016/j.afjem.2025.100885","url":null,"abstract":"<div><div>The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100885"},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock","authors":"Trudy D Leong ,&nbsp;Rephaim Mpofu ,&nbsp;Sumaya Dadan ,&nbsp;Karen Cohen ,&nbsp;Halima Dawood ,&nbsp;Tamara Kredo ,&nbsp;Andy Parrish ,&nbsp;Marc Blockman ,&nbsp;P. Dean Gopalan","doi":"10.1016/j.afjem.2025.05.005","DOIUrl":"10.1016/j.afjem.2025.05.005","url":null,"abstract":"<div><div>Background: Septic shock is associated with significant mortality. The International Surviving Sepsis Campaign guidelines recommend noradrenaline as first-line vasopressor, whilst South African guidelines recommend adrenaline. Clinical trials show similar efficacy but suggest safety advantages for noradrenaline. We reviewed the evidence comparing noradrenaline and adrenaline in the initial management of adult patients with septic shock.</div><div>Methods: We searched PubMed, Epistemonikos, Cochrane Library, and clinical trial registries for clinical practice guidelines, health technology assessments, and systematic reviews of randomised controlled trials (RCTs) through July 2024. We appraised these using AGREE II and AMSTAR 2 tools and assessed eligible RCTs extracted from systematic reviews with Cochrane's Risk of Bias 2.0 Tool. We estimated random-effects rate ratios (RR) and mean differences (MD) with 95 % confidence intervals and rated certainty of evidence using GRADE. Key outcomes included mortality, time to shock reversal, and adverse effects. (PROSPERO: CRD42022368373).</div><div>Results: We identified three guidelines, one systematic review, from which five RCTs were extracted. Comparing adrenaline to noradrenaline, we found little to no difference in mortality (RR 0.99, 0.83 to 1.18), time to improvement of mean arterial pressure (MD 7.17 min, -16.74 to 31.08), vasopressor-free days (MD -0.05 days, -4.07 to 3.96), or dysrhythmias (RR 0.92, 0.59 to 1.45). Change in lactate concentrations 24 h after resuscitation was lower for noradrenaline than adrenaline. The certainty of evidence was assessed as low to very low.</div><div>Conclusion: Adrenaline and noradrenaline are associated with similar outcomes in managing septic shock. The choice of vasopressor should be based on availability, patient population, and cost.</div></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"15 3","pages":"Article 100881"},"PeriodicalIF":1.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144516976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}