Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by episodic tachycardia, tachypnea, hypertension, fever, sweating, pupillary dilatation, and dystonic postures. Traumatic brain injury is the leading cause of PSH; however, its occurrence following basilar artery (BA) dissection has not been reported.
Case Presentation
A previously healthy 23-year-old man was found unresponsive and was transported with a Glasgow Coma Scale score of 11. Imaging studies revealed an acute ischemic stroke attributable to BA dissection. Magnetic resonance imaging showed progressive lesions involving the bilateral thalami, occipital lobes, cerebellar hemispheres, vermis, midbrain, pons, and periaqueductal gray. On the 8th day after admission, he developed PSH symptoms, which subsided after medical treatment.
Conclusion
A case of PSH following BA dissociation is reported. The ischemic lesions presented here indicate the essential anatomical location causing PSH. Early treatment is warranted, recognizing that PSH could be an adverse event following BA dissection.
{"title":"A case of paroxysmal sympathetic hyperactivity following cerebral infarction due to basilar artery dissection","authors":"Erina Yoritsune, Akira Sugie, Hitoshi Kobata","doi":"10.1002/ams2.70086","DOIUrl":"https://doi.org/10.1002/ams2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by episodic tachycardia, tachypnea, hypertension, fever, sweating, pupillary dilatation, and dystonic postures. Traumatic brain injury is the leading cause of PSH; however, its occurrence following basilar artery (BA) dissection has not been reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A previously healthy 23-year-old man was found unresponsive and was transported with a Glasgow Coma Scale score of 11. Imaging studies revealed an acute ischemic stroke attributable to BA dissection. Magnetic resonance imaging showed progressive lesions involving the bilateral thalami, occipital lobes, cerebellar hemispheres, vermis, midbrain, pons, and periaqueductal gray. On the 8th day after admission, he developed PSH symptoms, which subsided after medical treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A case of PSH following BA dissociation is reported. The ischemic lesions presented here indicate the essential anatomical location causing PSH. Early treatment is warranted, recognizing that PSH could be an adverse event following BA dissection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858595","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}
Predicting outcomes for out-of-hospital cardiac arrest (OHCA) patients remains challenging. We aimed to evaluate the association between the lactate/albumin ratio (LAR) upon hospital arrival and neurological outcomes in OHCA patients.
Methods
This multicenter, retrospective, nationwide observational study was based on data from the JAAM-OHCA registry, including 28,098 adults with non-traumatic OHCA from 140 emergency medical centers across Japan (June 2014 to December 2021). Receiver-operating characteristic curves assessed the predictive ability of LAR, lactate, and albumin levels. A reference model based on age, sex, witnessed arrest, initial cardiac rhythm, and time from call to hospital arrival was compared with models including LAR, lactate, or albumin levels. The primary outcome was a favorable neurological outcome at 30 days, with a secondary outcome at 90 days. Subgroup analyses were conducted among admitted patients and those who received active post-resuscitation treatments.
Results
Among the 28,098 patients, 1421 (5.1%) achieved favorable neurological outcomes at 30 days. We demonstrated that LAR had a significantly higher area under the curve than either lactate or albumin for predicting both 30- and 90-day outcomes (all p < 0.001), and better predictive value than either marker when added to the reference model. However, in the subgroup analysis of admitted patients, the statistical difference between LAR and albumin was no longer apparent.
Conclusion
The lower LAR upon hospital arrival was independently associated with a favorable neurological outcome in OHCA patients. However, its utility may vary depending on patient background, and further studies are needed to establish its clinical relevance.
{"title":"Predictive effects of the lactate/albumin ratio on neurological outcomes in patients after out-of-hospital cardiac arrest","authors":"Koki Nakada, Yuki Miyamoto, Toshinari Kawama, Toshihiro Hatakeyama, Tetsuhisa Kitamura, Bon Ohta, Tasuku Matsuyama","doi":"10.1002/ams2.70082","DOIUrl":"https://doi.org/10.1002/ams2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Predicting outcomes for out-of-hospital cardiac arrest (OHCA) patients remains challenging. We aimed to evaluate the association between the lactate/albumin ratio (LAR) upon hospital arrival and neurological outcomes in OHCA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective, nationwide observational study was based on data from the JAAM-OHCA registry, including 28,098 adults with non-traumatic OHCA from 140 emergency medical centers across Japan (June 2014 to December 2021). Receiver-operating characteristic curves assessed the predictive ability of LAR, lactate, and albumin levels. A reference model based on age, sex, witnessed arrest, initial cardiac rhythm, and time from call to hospital arrival was compared with models including LAR, lactate, or albumin levels. The primary outcome was a favorable neurological outcome at 30 days, with a secondary outcome at 90 days. Subgroup analyses were conducted among admitted patients and those who received active post-resuscitation treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 28,098 patients, 1421 (5.1%) achieved favorable neurological outcomes at 30 days. We demonstrated that LAR had a significantly higher area under the curve than either lactate or albumin for predicting both 30- and 90-day outcomes (all <i>p</i> < 0.001), and better predictive value than either marker when added to the reference model. However, in the subgroup analysis of admitted patients, the statistical difference between LAR and albumin was no longer apparent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The lower LAR upon hospital arrival was independently associated with a favorable neurological outcome in OHCA patients. However, its utility may vary depending on patient background, and further studies are needed to establish its clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833221","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}
Maintaining rapid response team (RRT) response quality is difficult. A system that supports RRT assessment could potentially contribute to medical safety. Although rapid response system (RRS) triggers have been well-studied, studies on the prediction models of short-term prognosis after RRS activation are scarce. We aimed to develop a model to predict short-term outcomes after RRS activation using machine learning.
Methods
This retrospective cohort study used the In-Hospital Emergency Registry in Japan, a multicentre RRS online registry. We collected data on patient demographics, treatment before RRS, RRT calls, and physiological parameters. The outcome was death within 24 h after RRS calls or unplanned transfers to an intensive care unit. To develop the eXtreme Gradient Boosted Tree Classifier (XGB) and Random Forest (RF) algorithms, a logistic regression (LR) algorithm was used. For model comparison, receiver-operating area under the curve (AUC) was evaluated and compared with those of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS).
Results
5414 cases were included in the study. The outcome occurred in 28.4% of the cases. The XGB model showed the highest AUC (0.798) compared to the RF model (0.796), LR model (0.785), NEWS (0.696), and MEWS (0.660). The most weighted feature in the XGB model was doctor activation, followed by hypotension as the activation criteria and usage of oxygen.
Conclusions
We developed the first machine learning model for short-term prognosis after RRS. This model has the potential to support decision-making by RRT.
{"title":"A machine learning model for predicting short-term outcomes after rapid response system activation","authors":"Takaki Naito, Micheal Li, Shigeki Fujitani","doi":"10.1002/ams2.70083","DOIUrl":"https://doi.org/10.1002/ams2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Maintaining rapid response team (RRT) response quality is difficult. A system that supports RRT assessment could potentially contribute to medical safety. Although rapid response system (RRS) triggers have been well-studied, studies on the prediction models of short-term prognosis after RRS activation are scarce. We aimed to develop a model to predict short-term outcomes after RRS activation using machine learning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used the In-Hospital Emergency Registry in Japan, a multicentre RRS online registry. We collected data on patient demographics, treatment before RRS, RRT calls, and physiological parameters. The outcome was death within 24 h after RRS calls or unplanned transfers to an intensive care unit. To develop the eXtreme Gradient Boosted Tree Classifier (XGB) and Random Forest (RF) algorithms, a logistic regression (LR) algorithm was used. For model comparison, receiver-operating area under the curve (AUC) was evaluated and compared with those of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>5414 cases were included in the study. The outcome occurred in 28.4% of the cases. The XGB model showed the highest AUC (0.798) compared to the RF model (0.796), LR model (0.785), NEWS (0.696), and MEWS (0.660). The most weighted feature in the XGB model was doctor activation, followed by hypotension as the activation criteria and usage of oxygen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed the first machine learning model for short-term prognosis after RRS. This model has the potential to support decision-making by RRT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815035","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}
Nathkapach Kaewpitoon Rattanapitoon, Patpicha Arunsan, Nav La, Schawanya Kaewpitoon Rattanapitoon
<p>The recently published case report by Kitai et al. brings forward a timely and clinically impactful discussion on the role of point-of-care ultrasound (POCUS) in the early diagnosis of gastric anisakiasis<span><sup>1</sup></span>—a parasitic disease whose clinical patterns and geographical distribution are being reshaped by global dietary trends and food distribution networks.<span><sup>2, 3</sup></span></p><p>The authors are to be commended for the clarity of their diagnostic approach. The combination of symptom chronology, dietary history, and real-time POCUS allowed for immediate endoscopic referral. The ultrasonographic finding of gastric wall thickening, though non-specific, provided critical support in narrowing down the differential diagnosis in a patient with acute epigastric pain.<span><sup>4, 5</sup></span> This case not only illustrates the diagnostic agility of POCUS but also challenges conventional reliance on CT in early anisakiasis management.</p><p>While POCUS is more commonly applied to hepatobiliary or intestinal emergencies,<span><sup>4</sup></span> its role in gastric parasitic infections remains underexplored. Previous reviews on intestinal anisakiasis have emphasized submucosal edema, ascites, and segmental ileal wall thickening as typical sonographic features.<span><sup>3</sup></span> However, sonographic patterns specific to gastric anisakiasis remain largely anecdotal. The current report thus adds a valuable datapoint to the limited body of literature.</p><p>We propose two directions for expanding the utility of POCUS in this context. First, a multicentric image repository could aid in recognizing consistent gastric findings in anisakiasis—be it focal mucosal swelling, peristaltic arrest, or even visualization of the larval body, as sporadically reported in intestinal cases.<span><sup>3</sup></span> Second, pretest probability stratification using clinical scoring systems (e.g., raw seafood consumption, timing of pain onset, absence of fever) could guide clinicians on when POCUS might be most effective or when CT should be prioritized.</p><p>Notably, the diagnostic success in this case was likely supported by the operator's advanced ultrasound experience (14 years). This emphasizes the need to include GI parasitology scenarios in emergency ultrasound training—a currently underrepresented domain. Embedding such cases in simulation-based curricula could build operator confidence in less common applications of POCUS.</p><p>In summary, this case invites emergency physicians and acute care teams to rethink the scope of POCUS—not merely as a triage tool, but as a frontline diagnostic modality for select gastrointestinal infections. Future efforts should aim at building evidence-based protocols for its judicious use in anisakiasis-endemic areas.</p><p>The authors declared that this study received no financial support.</p><p>The authors declare no competing interests.</p><p>Approval of the research protocol: NA.</p><p>Informed
{"title":"Repositioning POCUS in the diagnostic landscape of gastric anisakiasis: A call toward pragmatic integration","authors":"Nathkapach Kaewpitoon Rattanapitoon, Patpicha Arunsan, Nav La, Schawanya Kaewpitoon Rattanapitoon","doi":"10.1002/ams2.70084","DOIUrl":"https://doi.org/10.1002/ams2.70084","url":null,"abstract":"<p>The recently published case report by Kitai et al. brings forward a timely and clinically impactful discussion on the role of point-of-care ultrasound (POCUS) in the early diagnosis of gastric anisakiasis<span><sup>1</sup></span>—a parasitic disease whose clinical patterns and geographical distribution are being reshaped by global dietary trends and food distribution networks.<span><sup>2, 3</sup></span></p><p>The authors are to be commended for the clarity of their diagnostic approach. The combination of symptom chronology, dietary history, and real-time POCUS allowed for immediate endoscopic referral. The ultrasonographic finding of gastric wall thickening, though non-specific, provided critical support in narrowing down the differential diagnosis in a patient with acute epigastric pain.<span><sup>4, 5</sup></span> This case not only illustrates the diagnostic agility of POCUS but also challenges conventional reliance on CT in early anisakiasis management.</p><p>While POCUS is more commonly applied to hepatobiliary or intestinal emergencies,<span><sup>4</sup></span> its role in gastric parasitic infections remains underexplored. Previous reviews on intestinal anisakiasis have emphasized submucosal edema, ascites, and segmental ileal wall thickening as typical sonographic features.<span><sup>3</sup></span> However, sonographic patterns specific to gastric anisakiasis remain largely anecdotal. The current report thus adds a valuable datapoint to the limited body of literature.</p><p>We propose two directions for expanding the utility of POCUS in this context. First, a multicentric image repository could aid in recognizing consistent gastric findings in anisakiasis—be it focal mucosal swelling, peristaltic arrest, or even visualization of the larval body, as sporadically reported in intestinal cases.<span><sup>3</sup></span> Second, pretest probability stratification using clinical scoring systems (e.g., raw seafood consumption, timing of pain onset, absence of fever) could guide clinicians on when POCUS might be most effective or when CT should be prioritized.</p><p>Notably, the diagnostic success in this case was likely supported by the operator's advanced ultrasound experience (14 years). This emphasizes the need to include GI parasitology scenarios in emergency ultrasound training—a currently underrepresented domain. Embedding such cases in simulation-based curricula could build operator confidence in less common applications of POCUS.</p><p>In summary, this case invites emergency physicians and acute care teams to rethink the scope of POCUS—not merely as a triage tool, but as a frontline diagnostic modality for select gastrointestinal infections. Future efforts should aim at building evidence-based protocols for its judicious use in anisakiasis-endemic areas.</p><p>The authors declared that this study received no financial support.</p><p>The authors declare no competing interests.</p><p>Approval of the research protocol: NA.</p><p>Informed","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810986","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}
The ingestion of glyphosate herbicides can cause severe acute kidney injury. We present a case of glyphosate poisoning in which creatinine levels were falsely elevated when measured using a dry chemistry analyzer.
Case Presentation
An 83-year-old man ingested glyphosate herbicide during a suicide attempt and presented with gastrointestinal symptoms. A dry chemistry analyzer showed high creatinine levels (10.62 mg/dL); thus, the patient was transported to our hospital for renal replacement therapy. However, enzymatic testing showed a lower creatinine level (1.36 mg/dL). Further investigation comparing creatinine measurements revealed a high creatinine level only through the dry chemistry method, despite the relatively low glyphosate concentration (55 mg/L).
Conclusion
The dry chemistry method falsely shows an elevated creatinine value, which may affect clinical decisions regarding the management of patients with glyphosate poisoning. Careful interpretation of creatinine measurements using the dry chemistry method is important in glyphosate poisoning cases.
{"title":"A case of glyphosate poisoning with falsely elevated creatinine levels measured by dry chemistry methods","authors":"Kento Hojo, Tomohiro Abe, Saki Tanaka, Kengo Hatanaka, Hidenobu Ochiai","doi":"10.1002/ams2.70079","DOIUrl":"https://doi.org/10.1002/ams2.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The ingestion of glyphosate herbicides can cause severe acute kidney injury. We present a case of glyphosate poisoning in which creatinine levels were falsely elevated when measured using a dry chemistry analyzer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 83-year-old man ingested glyphosate herbicide during a suicide attempt and presented with gastrointestinal symptoms. A dry chemistry analyzer showed high creatinine levels (10.62 mg/dL); thus, the patient was transported to our hospital for renal replacement therapy. However, enzymatic testing showed a lower creatinine level (1.36 mg/dL). Further investigation comparing creatinine measurements revealed a high creatinine level only through the dry chemistry method, despite the relatively low glyphosate concentration (55 mg/L).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The dry chemistry method falsely shows an elevated creatinine value, which may affect clinical decisions regarding the management of patients with glyphosate poisoning. Careful interpretation of creatinine measurements using the dry chemistry method is important in glyphosate poisoning cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758664","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}
Thrombotic thrombocytopenic purpura is a life-threatening thrombotic microangiopathy characterized by systemic microvascular thrombosis. Cardiovascular complications, including myocardial ischemia and necrosis, are a leading cause of acute mortality.
Case Presentation
A 54-year-old man was diagnosed with immune-mediated thrombotic thrombocytopenic purpura. On Day 2, he developed sudden cardiac arrest, requiring venoarterial extracorporeal membrane oxygenation for circulatory support. Echocardiography revealed diffuse severe hypokinesis, ventricular hypertrophy, and pericardial effusion. Myocardial biopsy performed on Day 3 showed no findings of microthrombi or necrosis. These findings suggested fulminant myocarditis rather than myocardial ischemia. The patient was successfully treated with multidisciplinary treatment including plasma exchange, achieving full recovery by Day 44.
Conclusion
This case highlights fulminant myocarditis as a complication of immune-mediated thrombotic thrombocytopenic purpura. As myocarditis is potentially reversible, providing appropriate supportive therapy may contribute to an improved prognosis.
{"title":"Fulminant myocarditis in immune-mediated thrombotic thrombocytopenic purpura: A case report","authors":"Haruka Ishikita, Akira Endo, Keisuke Suzuki, Tomohiro Akutsu, Yuichi Araki, Koji Morishita","doi":"10.1002/ams2.70075","DOIUrl":"https://doi.org/10.1002/ams2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Thrombotic thrombocytopenic purpura is a life-threatening thrombotic microangiopathy characterized by systemic microvascular thrombosis. Cardiovascular complications, including myocardial ischemia and necrosis, are a leading cause of acute mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 54-year-old man was diagnosed with immune-mediated thrombotic thrombocytopenic purpura. On Day 2, he developed sudden cardiac arrest, requiring venoarterial extracorporeal membrane oxygenation for circulatory support. Echocardiography revealed diffuse severe hypokinesis, ventricular hypertrophy, and pericardial effusion. Myocardial biopsy performed on Day 3 showed no findings of microthrombi or necrosis. These findings suggested fulminant myocarditis rather than myocardial ischemia. The patient was successfully treated with multidisciplinary treatment including plasma exchange, achieving full recovery by Day 44.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights fulminant myocarditis as a complication of immune-mediated thrombotic thrombocytopenic purpura. As myocarditis is potentially reversible, providing appropriate supportive therapy may contribute to an improved prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647080","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}
Self-harm and suicide attempts (SA) are a significant cause of emergency department visits in Japan, where over 20,000 suicides occur annually. Each suicide death is estimated to correspond to over 20 attempts, highlighting the urgent need for intervention strategies. Therefore, in 2022, the JAPAN Registry of Self-harm and Suicide Attempts (JA-RSA) was established as the first nationwide prospective registry.
Aim
This study describes the design, objectives, and initial findings of JA-RSA and evaluates its potential to inform national suicide prevention policies.
Methods
JA-RSA collects comprehensive data on patients presented to critical care centers in Japan for self-harm or SA. Between December 2022 and December 2023, data from 1987 registered cases from 44 institutions were analyzed. Patient demographics, self-harm methods, and treatment outcomes were examined and compared with national suicide statistics for 2023.
Results
The mean age of patients was 39.3 years (36.9% male). Self-harm was inflicted through intentional drug overdose (58.2%), jumping from a height (12.1%), self-cutting (11.2%), and hanging (10.8%). Of the 1987 cases, 68.4% required intensive care treatment, 11.9% received outpatient care, and 8.3% died. Compared with national suicide statistics, JA-RSA revealed that more females and individuals aged below 20 engage in self-harm.
Conclusions
JA-RSA provides critical insights into the characteristics and treatment outcomes of patients who engage in self-harm. The registry's findings underscore the need for greater participation of institutions and further improvement in prevention strategies. By offering unique data, JA-RSA could help improve suicide prevention and intervention strategies.
{"title":"JAPAN Registry of Self-harm and Suicide Attempts: Study protocol and profile in 2022–2023","authors":"Mayumi Hangai, Yudai Iwama, Satoshi Kobayashi, Yoshiharu Fukuda, Chiaki Toida, Tomoyuki Yamashita, Satoshi Hashimoto, Yasufumi Miyake","doi":"10.1002/ams2.70081","DOIUrl":"https://doi.org/10.1002/ams2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Self-harm and suicide attempts (SA) are a significant cause of emergency department visits in Japan, where over 20,000 suicides occur annually. Each suicide death is estimated to correspond to over 20 attempts, highlighting the urgent need for intervention strategies. Therefore, in 2022, the JAPAN Registry of Self-harm and Suicide Attempts (JA-RSA) was established as the first nationwide prospective registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study describes the design, objectives, and initial findings of JA-RSA and evaluates its potential to inform national suicide prevention policies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>JA-RSA collects comprehensive data on patients presented to critical care centers in Japan for self-harm or SA. Between December 2022 and December 2023, data from 1987 registered cases from 44 institutions were analyzed. Patient demographics, self-harm methods, and treatment outcomes were examined and compared with national suicide statistics for 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of patients was 39.3 years (36.9% male). Self-harm was inflicted through intentional drug overdose (58.2%), jumping from a height (12.1%), self-cutting (11.2%), and hanging (10.8%). Of the 1987 cases, 68.4% required intensive care treatment, 11.9% received outpatient care, and 8.3% died. Compared with national suicide statistics, JA-RSA revealed that more females and individuals aged below 20 engage in self-harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>JA-RSA provides critical insights into the characteristics and treatment outcomes of patients who engage in self-harm. The registry's findings underscore the need for greater participation of institutions and further improvement in prevention strategies. By offering unique data, JA-RSA could help improve suicide prevention and intervention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615081","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}
The diagnosis of gastric anisakiasis is typically confirmed by detecting larvae during upper gastrointestinal endoscopy. Therefore, it is important to raise clinical suspicion to prompt this procedure. While abdominal computed tomography is often performed for this purpose, the utility of ultrasound as a workup for gastric anisakiasis is not well established.
Case Presentation
A 40-year-old male with a past medical history significant for IgA vasculitis visited the emergency department with acute onset epigastric pain. The patient had sushi containing horse mackerel, mackerel, and sardines the night before admission. Point-of-care ultrasound revealed the thickened gastric wall, which enabled us to suspect gastric anisakiasis, prompting an emergent upper gastrointestinal endoscopy. An emergency upper gastrointestinal endoscopy revealed the presence of three Anisakis larvae penetrating the gastric mucosa. Following treatment, his symptoms completely resolved.
Conclusion
This case suggests that point-of-care ultrasound can be a powerful diagnostic tool when clinicians suspect gastric anisakiasis.
{"title":"Gastric anisakiasis suspected by point-of-care ultrasound finding in the emergency department","authors":"Yuya Kitai, Ryota Sato, Tetsuya Inoue","doi":"10.1002/ams2.70080","DOIUrl":"https://doi.org/10.1002/ams2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The diagnosis of gastric anisakiasis is typically confirmed by detecting larvae during upper gastrointestinal endoscopy. Therefore, it is important to raise clinical suspicion to prompt this procedure. While abdominal computed tomography is often performed for this purpose, the utility of ultrasound as a workup for gastric anisakiasis is not well established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 40-year-old male with a past medical history significant for IgA vasculitis visited the emergency department with acute onset epigastric pain. The patient had sushi containing horse mackerel, mackerel, and sardines the night before admission. Point-of-care ultrasound revealed the thickened gastric wall, which enabled us to suspect gastric anisakiasis, prompting an emergent upper gastrointestinal endoscopy. An emergency upper gastrointestinal endoscopy revealed the presence of three <i>Anisakis</i> larvae penetrating the gastric mucosa. Following treatment, his symptoms completely resolved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case suggests that point-of-care ultrasound can be a powerful diagnostic tool when clinicians suspect gastric anisakiasis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606552","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}
Patrick McNeal, Elizabeth B. Winton, Marc T. Bartman
Background
Patellar dislocations are common, but superior-lateral dislocation with vertical axis rotation is rare and challenging to reduce.
Case Presentation
A woman in her 20s presented with left knee pain and deformity after minor trauma. Traditional reduction attempts failed due to a vertical rotational component. Reduction was achieved using a technique involving hip flexion, a modified varus–valgus force, and knee extension.
Conclusion
Emergency clinicians must recognize complex patellar dislocations and consider early orthopedic consultation to minimize complications.
{"title":"Superior-lateral patella dislocation with rotation along its vertical axis","authors":"Patrick McNeal, Elizabeth B. Winton, Marc T. Bartman","doi":"10.1002/ams2.70078","DOIUrl":"https://doi.org/10.1002/ams2.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patellar dislocations are common, but superior-lateral dislocation with vertical axis rotation is rare and challenging to reduce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A woman in her 20s presented with left knee pain and deformity after minor trauma. Traditional reduction attempts failed due to a vertical rotational component. Reduction was achieved using a technique involving hip flexion, a modified varus–valgus force, and knee extension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Emergency clinicians must recognize complex patellar dislocations and consider early orthopedic consultation to minimize complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606553","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}
To develop and evaluate a predictive model for delayed pseudoaneurysm formation after non-operative management (NOM) in children with blunt splenic injuries.
Methods
A post hoc analysis of a multicenter cohort study in Japan included patients aged ≤16 years who underwent NOM for isolated blunt splenic injuries. The outcome was the formation of a pseudoaneurysm, which was not identified on admission and confirmed at least 24 h after admission. Predictors were determined from data available within 24 h of hospital arrival. Five predictive models were developed using logistic regression analysis and evaluated using discrimination (receiver operating characteristic [ROC] and precision-recall curve [PRC]), calibration (calibration plot and Brier score) and decision curve analysis (DCA) with bootstrap resampling data.
Results
Pseudoaneurysms developed in 41 (9.4%) of 434 cases of isolated splenic injury in our cohort. Model 1 (19 predictors) had the highest ROC (0.828) and PRC (0.358), followed by model 5 (8 predictors; ROC 0.805, PRC 0.295). Calibration was similar across models, indicating good calibration. Models 1 and 5 outperformed the other DCAs. Overall, model 5, incorporating factors such as age, sex, Injury Severity Score, American Association for the Surgery of Trauma-Organ Injury Scale, contrast extravasation on computed tomography, concomitant injuries, cryoprecipitate dose and NOM details, was simpler and showed better predictive ability than the other models.
Conclusion
A predictive model for delayed pseudoaneurysm formation was developed with moderate discrimination and calibration. Further improvement using different modelling methods, such as machine learning, may be necessary.
{"title":"A predictive model of delayed pseudoaneurysm formation in paediatric patients with isolated blunt splenic injury using logistic regression analysis","authors":"Haruka Taira, Hideto Yasuda, Morihiro Katsura, Takatoshi Oishi, Yutaro Shinzato, Yuki Kishihara, Shunsuke Amagasa, Masahiro Kashiura, Yutaka Kondo, Shigeki Kushimoto, Takashi Moriya","doi":"10.1002/ams2.70073","DOIUrl":"https://doi.org/10.1002/ams2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To develop and evaluate a predictive model for delayed pseudoaneurysm formation after non-operative management (NOM) in children with blunt splenic injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A post hoc analysis of a multicenter cohort study in Japan included patients aged ≤16 years who underwent NOM for isolated blunt splenic injuries. The outcome was the formation of a pseudoaneurysm, which was not identified on admission and confirmed at least 24 h after admission. Predictors were determined from data available within 24 h of hospital arrival. Five predictive models were developed using logistic regression analysis and evaluated using discrimination (receiver operating characteristic [ROC] and precision-recall curve [PRC]), calibration (calibration plot and Brier score) and decision curve analysis (DCA) with bootstrap resampling data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pseudoaneurysms developed in 41 (9.4%) of 434 cases of isolated splenic injury in our cohort. Model 1 (19 predictors) had the highest ROC (0.828) and PRC (0.358), followed by model 5 (8 predictors; ROC 0.805, PRC 0.295). Calibration was similar across models, indicating good calibration. Models 1 and 5 outperformed the other DCAs. Overall, model 5, incorporating factors such as age, sex, Injury Severity Score, American Association for the Surgery of Trauma-Organ Injury Scale, contrast extravasation on computed tomography, concomitant injuries, cryoprecipitate dose and NOM details, was simpler and showed better predictive ability than the other models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A predictive model for delayed pseudoaneurysm formation was developed with moderate discrimination and calibration. Further improvement using different modelling methods, such as machine learning, may be necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606554","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}
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