Archives of Academic Emergency Medicine最新文献

Introduction: Calcium channel blocker (CCB) poisoning is a critical toxicological emergency that can result in severe complications, particularly cardiovascular effects. This study aimed to evaluate the accuracy of Machine learning (ML) models in predicting the outcomes of CCB poisoning.

Methods: This retrospective cross-sectional study analyzed the medical records of patients diagnosed with CCB poisoning at Loghman Hakim Hospital between 2019 and 2024. The accuracy of machine learning (ML) models in predicting the outcomes of CCB poisoning and identifying its predictive factors was evaluated. Various ML models, including XGBoost, CatBoost, Random Forest, and AdaBoost, were trained on clinical and laboratory data. Then, feature selection was performed to identify the most relevant variables. The hold-out set was randomly selected to avoid selection bias. Model performance was assessed using accuracy, precision, recall, F1-score, and macro-averaged area under the receiver operating characteristic (ROC) curve (AUC).

Results: 274 CCB poisoning cases with the mean age of 31.99± 17.47 (range: 1.5 to 89) years were evaluated (70.4% female). Feature selection identified 18 key prognostic factors, including body temperature, whole bowel irrigation, need for cardiology consultation, arterial oxygen saturation, Glasgow coma scale (GCS)-eye response, electrocardiography (ECG) findings, serum level of alkaline phosphatase (ALP), pH-venous blood gas (VBG), HCO₃-VBG, serum level of lactate dehydrogenase (LDH), blood sugar, pulse rate, fraction of inspired oxygen (FiO2), time elapsed from ingestion to admission, troponin, serum level of alanine aminotransferase (ALT), serum level of creatinine, and serum level of potassium. Among the ML models, XGBoost and CatBoost demonstrated the highest predictive performance, with macro-averaged AUC values of 0.9899 (95%confidence interval (CI): 0.98-0.99) and 0.9983 (95%CI: 0.997-0.999), respectively. These models outperformed traditional statistical approaches, providing enhanced risk stratification for patients with CCB poisoning.

Conclusion: This study highlights the potential of ML-based models for predicting outcomes in CCB poisoning, offering a data-driven framework for early risk stratification. The superior performance of XGBoost and CatBoost suggests their clinical applicability. Future research should focus on external validation in multi-center settings and real-time integration into clinical decision-making systems.

Introduction: Many international search and rescue teams were deployed to the devastating earthquake of Southeastern Turkey and Northern Syria on February 6^th, 2023, including the Jordan International Search and Rescue Team (JSAR). This study aims to explore the challenges faced by the JSAR team members during their deployment.

Methods: We employed a qualitative face-to-face semi-structured interview approach. Eighteen respondents were interviewed using an interview guide. Interviews took between 25 and 60 minutes (mean 45 minutes). Data were transcribed verbatim and an inductive thematic approach was used to analyze data and develop codes, categories, and themes.

Results: The challenges were categorized into three main themes; logistical, coordination, and environmental. Logistical challenges included delays in deployment due to government and flight arrangements, difficulties in transporting excess equipment, and a lack of fuel upon arrival that led to delays in setting up camp and heating. Coordination challenges involved disruption in operation schedule and difficulties working with local volunteer responders. Environmental challenges encompassed extreme cold temperatures, which affected personnel comfort and performance, and recurrent aftershocks, which complicated rescue operations and posed safety risks.

Conclusion: The JSAR experience highlights that technical readiness alone is insufficient for effective disaster response. Findings from this study underscore significant gaps in logistics, coordination, and environmental adaptation. These gaps can be addressed through improved pre-deployment coordination, context-specific resource planning, and better collaboration mechanisms between host countries and international teams, which would be crucial for enhancing the effectiveness of international search and rescue operations. Host governments, International Search and Rescue Advisory Group (INSARAG) stakeholders, and emergency management bodies can build on these lessons to better integrate specialized teams, reduce procedural delays, and enhance global disaster response systems.

Introduction: Understanding the epidemiological patterns of poisoning cases in specific regions is essential for health authorities to implement preventive measures and strategic planning. This study aimed to describe the epidemiologic characteristics of acute poisoning cases registered in Tehran province's emergency medical services (EMS).

Methods: This retrospective cross-sectional study was conducted on all registered acute poisoning cases from 2022 to 2024 in the Asayar database of Tehran Province's EMS. The cases were included through census sampling and descriptive analysis was used for evaluating the epidemiologic characteristics of registered cases.

Results: 76,113 acute poisoning cases were registered by Tehran Province EMS during the study period. The mean age of cases was 34.3 ± 15.0 years (59.1% male). The most frequent method of poisoning was oral, with 71,521 (94.0%) cases, and inhalational, with 3,236 (4.2%) cases. The highest number of cases was reported in the eastern region of Tehran with 15,058 cases. Seasonal distribution of poisonings was as follows: 20,201 (26.6%) cases in summer, 21,322(28.0%) cases in winter, 21,105 (27.7%) cases in autumn, and 13,485 (17.7%) cases in spring. Most poisonings occurred in residential settings, accounting for 72,194 (94.9%) cases. The most frequent used antidote was naloxone, in 12,662 (16.6%) cases, and atropine, in 961 (1.3%) cases.

Conclusion: Based on the findings of this study, the most vulnerable population groups to the poisoning were young individuals, males, and those with a history of psychiatric illness and substance abuse, predominantly affected by oral route. The geographical and temporal distribution of poisonings highlights the need for targeted preventive interventions, public education, and enhancement of prehospital emergency service infrastructure in high-risk areas.

ST segment elevation patterns on Electrocardiogram (ECG) are a crucial finding in the diagnosis and treatment of acute coronary syndrome. An ST segment elevation pattern can be a sign of acute myocardial ischemia requiring immediate intervention. However, ST elevation patterns have been reported to occur due to obstructive intraabdominal pathology, a diagnosis often confirmed by cardiac catheterization. Here we report a 75-year-old female who presented to the emergency department with worsening chest and epigastric abdominal pain. ECG demonstrated ST-segment elevations in inferior leads (II, III, and aVF) with reciprocal changes in the lateral leads (I and aVL). Physical exam was suggestive of a bowel obstruction at the site of a large incarcerated ventral hernia, which was later confirmed by imaging. Due to the lack of typical chest pain symptoms and a strong suspicion of obstructive intraabdominal pathology, activation of the catheterization laboratory was deferred. Decompression of the bowel obstruction was achieved with a nasogastric tube, which resulted in immediate resolution of ST-segment elevations. During her admission, her ventral hernia was repaired, and left heart catheterization was deferred per cardiology recommendations. While an ST-segment elevation due to occlusive myocardial infarction is a diagnosis that cannot be missed and requires an emergent workup, it is important to be aware that it is possible for a small bowel obstruction (SBO) to present with ECG changes consistent with an ST-segment elevation myocardial infarction (STEMI). We also found that ST-segment elevations due to obstructive intraabdominal pathology are more reportedly seen in the literature in the inferior leads than any other contiguous leads, which is a novel pattern not discussed in past literature.

Introduction: Effective information transfer between healthcare providers is essential for patient safety. This study aimed to evaluate the impact of ISBAR (Identify, Situation, Background, Assessment, Recommendation) framework on the quality of clinical handovers in emergency department (ED).

Methods: This prospective, pre- and post-intervention study was conducted at Hazrat Ali Asghar Pediatric Hospital in Tehran, Iran, from May to September 2023. A total of 428 clinical handovers were recorded (214 pre-intervention and 214 post-intervention) following a 90-minute training session and the introduction of a standardized ISBAR checklist. Handover quality was measured using the completeness of a 16-item ISBAR checklist. Data analysis employed descriptive statistics, the Mann-Whitney U test, and Chi-square tests.

Results: Implementation of the ISBAR protocol significantly improved the overall quality of information conveyed during handovers. Total handover scores increased from a mean rank of 127.55 pre-intervention to 301.45 post-intervention (P < 0.001). All five ISBAR domains showed significant enhancements; Identify (from 145.41 to 283.59, P=0.001), Situation (from 129.64 to 299.36, P=0.001), Background (from 136.40 to 292.60, P=0.001), Assessment (from 156.00 to 273.00, P< 0.001), and Recommendations (from 198.14 to 230.86, P=0.03). In addition, the completeness of individual items such as patient diagnosis, admission date, and vital signs improved markedly.

Conclusions: Adopting a standardized ISBAR handover protocol in a high-stakes pediatric environment ED significantly enhances the accuracy and completeness of patient handovers, thereby reducing the potential for errors and strengthening patient safety.

Introduction: The stroke scale for the mid-level personnel (SML) was designed for emergency medical services personnel to predict acute ischemic stroke due to large vessel occlusion (LVO) in both prehospital and in-hospital settings. This study aimed to validate and determine the appropriate cut point of the SML score in this regard.

Methods: This single-centered, prospective validation study to assess a novel LVO triage tool was performed in a tertiary care hospital in Bangkok. Patients presenting within 24 hours of onset of acute stroke were included in the study. The scale is designed for mid-level providers and emergency medical services (EMS) personnel including paramedics, emergency medical technicians (EMTs) and emergency department (ED) nurses. LVO was confirmed by brain and neck computed tomography angiography (CTA). Area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LRs), and correctly classified instances (CCI) were calculated. Youden's index was used to determine an appropriate cut point of the SML score for LVO prediction.

Results: 200 cases with the median age of 64.0 (56.5-73.0) years were included (53.5% female). 83 (41.5%) cases were affiliated to the LVO and 117 (58.5%) to the non-LVO group. The median SML scores for non-LVO and LVO stroke patients were 3 (2 - 3) and 6 (5 - 7), respectively (p < 0.001). The most common presentations in both groups were facial palsy, arm weakness and speech impairment or dysarthria. There was significantly higher prevalence of neglect (8 (6.8%) vs. 5 (4.3%); p < 0.001) and eye deviation (39 (47%) vs. 29 (35%); p < 0.001) in the LVO stroke group than in the non-LVO group. LVO patients scored higher in all categories when compared to non-LVO cases. SML scores of 4 and 5 had the highest Youden's index of 0.82 and 0.67, respectively. SML score of 4 yielded the highest correctly classified instances (CCI) of 90% with sensitivity and specificity of 96.4% (95% confidence interval (CI): 89.9-99.3%) and 85.3% (95% CI: 77.6-91.2), respectively. SML score of 4 also achieved the lowest negative LR of 0.04 and an odds ratio of 157 (95% CI: 46.7-521). The AUC of SML in cutoff point of 4 was 0.901 (95%CI: 0.853 - 0.949).

Conclusions: SML score may be helpful for mid-level medical providers and also EMS personnel in detecting LVOs since prehospital phase. According to the results, we recommend a cut point SML score ≥ 4 for enhanced sensitivity and NPV.

Introduction: Chest Compression Synchronized Ventilation (CCSV) is a novel approach aimed at optimizing gas exchange and hemodynamics during cardiopulmonary resuscitation (CPR). However, its clinical value, safety profile and implementation barriers remain unclear. This study aimed to systematically synthesize existing evidence on the use of CCSV during cardiac arrest in animals and humans.

Methods: We conducted a scoping review and systematically searched five databases (Medline, Embase, CENTRAL, Scopus, Web of Science) up to May 2025. Studies investigating CCSV or mechanistically related ventilation strategies during cardiac arrest were included regardless of study design, language or publication date. Data were charted for study characteristics, outcomes and adverse events.

Results: Thirty-two studies published between 1980 and 2025 were included. Most were animal studies (n=19), primarily conducted in pigs, with limited human data (n=10). CCSV showed positive effects on arterial oxygenation, carbon dioxide clearance, and hemodynamic parameters as well as cerebral oxygenation compared to conventional ventilation modes. Adverse events such as pneumothorax and lung injury were inconsistently reported.

Conclusions: Available data on CCSV suggests potential physiological benefits during CPR, particularly in experimental settings. Human data remain scarce, and larger, prospective human trials are essential to evaluate clinical effectiveness, guide implementation, and assess risks compared to conventional ventilation strategies.

A study by Le Xuan et al. suggested that the lactate/albumin ratio (LAR) may aid in predicting sepsis-associated acute kidney injury. However, overlapping receiver operating characteristic (ROC) curve confidence intervals, creatinine-only acute kidney injury (AKI) definitions, and single-point biomarker assessments limit interpretation. Given its single-centre retrospective design, broader validation with dynamic biomarkers and kidney-specific comparators is needed before the LAR can be integrated into sepsis risk stratification.

Introduction: Diabetic ketoacidosis (DKA) is one of the complications of diabetes mellitus that requires rapid and accurate diagnosis. End-tidal carbon dioxide (EtCO₂) has been used for diagnosing DKA, however, there is uncertainty about the predicting value of this tool. In the current systematic review and meta-analysis, we purposed to assess the predictive value of EtCO₂ in diagnosing DKA.

Methods: We conducted a comprehensive search in PubMed, Scopus, and Web of Science for relevant studies and after screening based on the inclusion criteria, we extracted data. DKA diagnosis in the included studies was based on a composite clinical reference standard, including arterial blood gas (ABG) analysis and ketone testing. We used the Joanna Briggs Institute (JBI) checklist for diagnostic test accuracy studies for quality appraisal. Meta-analysis was performed based on the methods of the Cochrane DTA Handbook using the MetaDTA: Diagnostic Test Accuracy Meta-Analysis v2.1.3.

Results: A total of 13 studies were included in the systematic review, eight of which were proceeding to meta-analysis. The pooled sensitivity and specificity of EtCO₂ for diagnosing DKA were 0.96 (95% confidence interval (CI): 0.85-0.93) and 0.88 (95% CI: 0.79-0.93), respectively. The pooled diagnostic odds ratio (DOR) was 211.07 (95% CI: 38.3- 1162.1). The positive and negative likelihood ratios were 8.27 (95% CI: 4.6-14.7) and 0.03 (95% CI: 0.009-0.18), respectively. The results of the quality appraisal of include studies indicated moderate to low risk of bias.

Conclusions: The findings of this systematic review and meta-analysis show the high sensitivity and specificity of EtCO₂ in diagnosing DKA, which indicates its potential as a reliable diagnostic tool in emergency settings. However, the overall quality of the included studies, which were assessed to have medium to high risk of bias, should be considered when using EtCO₂ in clinical practice. Further high-quality research is needed to confirm the diagnostic value of EtCO₂ in emergency settings.