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Effect of Out-Of-Hour Admission on Fluid Treatment of Emergency Department Patients with Suspected Infection; a Multicenter Post-Hoc Analysis. 非分时入院对急诊疑似感染患者输液治疗的影响多中心事后分析。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.1839
Marie Kristine Jessen, Anna Drescher Petersen, Hans Kirkegaard

Introduction: Sepsis is a life-threatening and common cause of Emergency department (ED) referrals. Out-of-hour staffing is limited in ED, which may potentially affect fluid administration. This study aimed to investigate fluid volume variation in out-of-hour vs. routine-hour admissions.

Methods: The present study is a post-hoc analysis of a multicentre, prospective, observational study investigating fluid administration in ED patients with suspected infection, from Jan 20th - March 2nd, 2020. Patient groups were "routine-hours" (RH): weekdays 07:00-18:59 or "out-of-hours" (OOH): weekdays 19:00-06:59 or Friday 19:00-Monday 06:59. Primary outcome was 24-hour total fluid volumes (oral + intravenous (IV)). Secondary outcomes were total fluids 0-6 hours, oral fluids 0-6 and 0-24 hours, and IV fluids 0-6 and 0-24 hours. Linear regression adjusted for site and illness severity was used.

Results: 734 patients had suspected infection; 449 were admitted during RH and 287 during OOH. Mean (95% CI) total 24-hour fluid volumes were equal in simple infection and sepsis regardless of admission time: Simple infection RH: 3640 (3410 - 3871) ml and OOH: 3681 (3451 - 3913) ml. Sepsis RH: 3671 (3443;3898) ml and OOH: 3896 (3542;4250) ml. Oral fluids 0-6h were reduced in simple infection and sepsis among OOH vs. RH. Sepsis patients received more 0-6-hour IV fluid when admitted OOH vs. RH. There were no associations between admission time and 0-24-hour oral or IV volumes in simple infection or sepsis.

Conclusion: Admission time did not have an association with 24-hour total fluid volumes. Sepsis patients admitted during OOH received more 0-6-hour IV fluids than RH patients, and simple infection and sepsis patients received less oral fluid in 0-6 hours if admitted during OOH vs. RH.

简介:败血症是危及生命的常见原因急诊科(ED)转诊。急诊室的非工作时间人员有限,这可能会影响液体管理。本研究旨在调查非工作时间与正常工作时间入院患者的体液量变化。方法:本研究是对一项多中心、前瞻性、观察性研究的事后分析,该研究调查了2020年1月20日至3月2日期间ED疑似感染患者的液体给药。患者分组为“常规时间”(RH):工作日07:00-18:59或“非工作时间”(OOH):工作日19:00-06:59或周五19:00-周一06:59。主要终点是24小时总液体量(口服+静脉注射)。次要结果为总液体0-6小时,口服液体0-6和0-24小时,静脉液体0-6和0-24小时。采用校正部位和疾病严重程度的线性回归。结果:734例疑似感染;RH期间入院449人,OOH期间入院287人。无论入院时间如何,单纯感染和脓毒症患者24小时总液体体积的平均值(95% CI)相同:单纯感染RH: 3640 (3410 - 3871) ml, OOH: 3681 (3451 - 3913) ml。脓毒症患者RH: 3671 (3443;3898) ml, OOH: 3896 (3542;4250) ml。单纯感染和脓毒症患者0-6h的口服液减少。脓毒症患者接受0-6小时静脉输液时,OOH比RH更多。单纯感染或败血症患者入院时间与0-24小时口服或静脉注射量无相关性。结论:入院时间与24小时总液体容量无关。在户外活动期间入院的败血症患者比RH患者在0-6小时内接受更多的静脉输液,单纯感染和败血症患者在0-6小时内接受的口服液少于RH患者。
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引用次数: 0
The Effect of L-Citrulline Supplementation on Outcomes of Critically Ill Patients under Mechanical Ventilation; a Double-Blind Randomized Controlled Trial. 补充l -瓜氨酸对危重患者机械通气预后的影响一项双盲随机对照试验。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.1774
Mohammad Reza Asgary, Sayid Mahdi Mirghazanfari, Ebrahim Hazrati, Vahid Hadi, Mojgan Mehri Ardestani, Faeze Bani Yaghoobi, Saeid Hadi
<p><strong>Introduction: </strong>Effective parenteral and enteral amino acid replacement is crucial for critically ill patients with altered amino acid metabolism. This study aimed to assess the effects of l-citrulline supplementation on the clinical and laboratory outcomes in critically patients.</p><p><strong>Methods: </strong>This was a double-blind placebo-controlled randomized clinical trial. 82 critically ill patients who were expected to receive mechanical ventilation for more than 72 hours were selected. The patients were assigned to either a placebo or an intervention group. The patients in the placebo group received 10 gr of microcrystalline cellulose and the ones in the intervention group were given l-citrulline daily for 7 days. Serum levels of fasting blood sugar (FBS), lipid profile, hepatic enzymes, serum electrolytes, urea nitrogen, creatinine, and C-reactive protein (CRP) were evaluated before and after the intervention. Duration of invasive ventilation, intensive care unit (ICU) length of stay, ventilator-free days, and 28-day mortality rate were recorded and compared between groups.</p><p><strong>Results: </strong>Eighty-two patients completed the trial. No statistically significant differences were observed between the two groups in terms of age (p = 0.46), sex (p = 0.49), body mass index (BMI) (p = 0.41), Sequential Organ Failure Assessment (SOFA) Score (p = 0.08), Clinical Pulmonary Infection Score (CPIS) score (p = 0.76), Acute Physiology and Chronic Health Evaluation (APACHE II) score (p = 0.58), risk factors (p = 0.13), ICU stay before randomization (p = 0.32), and reason of admission (p = 0.50) before the intervention. Citrulline group had a notable reduction in FBS (p = 0.04), total cholesterol (TC) (p = 0.02), low density lipoprotein (LDL-C) (p <0.001) and high-sensitivity CRP (hs-CRP) (p <0.001). Also, a significant increase in lactate dehydrogenase (LDH) concentration (p <0.001) was observed in the intervention group at the end of the trial. Total duration of invasive ventilation and the mean SOFA score on 7th day were significantly lower in the citrulline group compared to the control group. Moreover, a significant increase in days alive and ventilator-free days within 28 days after admission was found in the citrulline group at the end of the trial. Also, there were no significant differences between the groups in terms of mortality rate during intervention, serious adverse events, endotracheal intubation, the use of tracheotomy or non-invasive ventilation after extubation, length of ICU stay, ICU-free days at 28 days, and CPIS and APACHE II scores. For mortality, in the citrulline group, there was two deaths compared to eight deaths in the control group. This resulted in an absolute risk reduction (ARR) of 14.05% (95% CI: 0.39-27.71%) and a number needed to treat (NNT) of 7.1 (95% CI: 3.6-29.5), regarding mortality.</p><p><strong>Conclusions: </strong>The results of the present study demonstrated the probable pos
有效的肠外和肠内氨基酸替代对于氨基酸代谢改变的危重患者至关重要。本研究旨在评估补充l-瓜氨酸对危重患者临床和实验室结果的影响。方法:采用双盲、安慰剂对照的随机临床试验。选择机械通气时间超过72小时的危重患者82例。这些患者被分为安慰剂组和干预组。安慰剂组患者给予10克微晶纤维素,干预组患者给予l-瓜氨酸,每天7天。评估干预前后空腹血糖(FBS)、血脂、肝酶、血清电解质、尿素氮、肌酐和c反应蛋白(CRP)的血清水平。记录两组患者有创通气时间、重症监护病房(ICU)住院时间、无呼吸机天数和28天死亡率并进行比较。结果:82例患者完成了试验。两组患者干预前年龄(p = 0.46)、性别(p = 0.49)、体重指数(BMI) (p = 0.41)、序期器官衰竭评估(SOFA)评分(p = 0.08)、临床肺部感染评分(CPIS)评分(p = 0.76)、急性生理与慢性健康评估(APACHE II)评分(p = 0.58)、危险因素(p = 0.13)、随机分组前ICU住院时间(p = 0.32)、入院原因(p = 0.50)差异均无统计学意义。瓜氨酸组FBS (p = 0.04)、总胆固醇(TC) (p = 0.02)、低密度脂蛋白(LDL-C) (p)显著降低。结论:本研究结果表明,补充瓜氨酸对血脂、hs-CRP水平、有创通气持续时间和SOFA评分可能有积极影响。此外,l-瓜氨酸的消耗可能会增加没有机械通气的生存概率。
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引用次数: 0
Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis. 成人及儿童皮肤软组织脓肿的即时超声诊断系统评价和荟萃分析。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.2021
Erfan Rahmani, Ehsan Fayyazishishavan, Arian Afzalian, Sanaz Varshochi, Reza Amani-Beni, Seyed-Amirabbas Ahadiat, Zeynab Moshtaghi, Seyyed-Ghavam Shafagh, Roya Khorram, Elnaz Asadollahzade, Raihaneh Atbaei, Mohammad Saeed Kahrizi, Atoosa Rahbari, Negar Baharlouie, Farzaneh Mostanbet, Bahamin Amirabadiquchani, Moein Kiani, Mozhdeh Memarizadeh, Shahin Keshtkar Rajabi, Reza Barati, Hengame Hajinouri, Shahrzad Najafi, Zeynab Abdollahi, Nahid Dadashzadehasl, Atousa Moghadam Fard, Mozhgan Afshar, Atefeh Abedi, Sara Saeidi, Adeleh Mansourirad, Pedram Emami Shahrezaei, Sepideh Shah Hosseini, Zahra Rostami Ghotbabadi, Reza Vafadar, Roozbeh Roohinezhad, Nogol Ghalamkarpour, Mehrdad Farrokhi

Introduction: Differentiating the soft tissue abscess from other types of skin and soft tissue infections (SSTIs) poses a particular challenge because they have similar physical evaluation findings, but each disease has a different course, outcome, and treatment. This meta-analysis aimed to investigate the diagnostic accuracy of point-of-care ultrasonography for diagnosis of soft tissue abscess in the emergency departments.

Methods: A comprehensive literature search of MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, from inception to January 2023, was conducted to identify relevant studies investigating the diagnostic performance of point-of-care ultrasonography for identification of abscess. Methodological quality of the included studies was assessed using a revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2).

Results: The pooled estimates of diagnostic parameters of ultrasonography for diagnosis of abscess were as follows: sensitivity, 0.93 (95% CI: 0.92-0.94); specificity, 0.87 (95% CI: 0.85-0.89), and the area under the summary receiver-operating characteristic (SROC), 0.95. The pooled sensitivity, specificity, and area under the SROC of studies in adult patients were 0.98 (95% CI: 0.92-1), 0.92 (95% CI: 0.86-0.95), and 0.99, respectively. The pooled sensitivity, specificity, and area under the SROC of studies in pediatric patients were 0.9 (95% CI: 0.87-0.92), 0.78 (95% CI: 0.73-0.82), and 0.91, respectively.

Conclusion: Our meta-analysis demonstrated that the point-of-care ultrasonography has excellent diagnostic value for the abscess in the emergency department. Furthermore, we found that the diagnostic performance of point-of-care ultrasonography for diagnosis of abscess was higher for adult cases than for pediatric patients.

将软组织脓肿与其他类型的皮肤和软组织感染(SSTIs)区分开来是一个特别的挑战,因为它们具有相似的物理评估结果,但每种疾病都有不同的过程、结果和治疗方法。本荟萃分析旨在探讨急诊现场超声诊断软组织脓肿的准确性。方法:综合检索MEDLINE、Scopus、Web of Science、Embase、Google Scholar等数据库自成立至2023年1月的相关文献,寻找即时超声诊断脓肿的相关研究。使用修订后的诊断准确性研究质量评估工具(QUADAS-2)评估纳入研究的方法学质量。结果:超声诊断脓肿的诊断参数汇总估计如下:敏感性为0.93 (95% CI: 0.92 ~ 0.94);特异性为0.87 (95% CI: 0.85-0.89),综合受者操作特征(SROC)下面积为0.95。在成人患者中,合并的敏感性、特异性和SROC下的面积分别为0.98 (95% CI: 0.92-1)、0.92 (95% CI: 0.86-0.95)和0.99。在儿科患者的研究中,合并的敏感性、特异性和SROC下的面积分别为0.9 (95% CI: 0.87-0.92)、0.78 (95% CI: 0.73-0.82)和0.91。结论:我们的荟萃分析表明,即时超声检查对急诊科的脓肿有很好的诊断价值。此外,我们发现,点护理超声诊断脓肿的诊断性能,成人病例高于儿童患者。
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引用次数: 0
HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis. HEART与GRACE评分预测急性冠脉综合征患者预后的比较系统评价和荟萃分析。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.2001
Ali Kabiri, Pantea Gharin, Seyed Ali Forouzannia, Koohyar Ahmadzadeh, Reza Miri, Mahmoud Yousefifard

Introduction: Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.

Method: The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.

Results: 25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.

Conclusion: The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.

已经提出了几种评分系统来预测缺血性心脏病患者的预后。全球急性冠状动脉事件登记(GRACE)和病史、心电图、年龄、危险因素和肌钙蛋白(HEART)评分是急性冠状动脉综合征(ACS)患者中两种更广泛使用的风险预测工具。本系统综述和荟萃分析旨在比较GRACE和HEART评分在ACS患者预后预测中的价值。方法:检索Medline、Embase、Web of Science和Scopus等在线数据库,检索到2022年9月前直接比较GRACE和HEART评分对ACS患者预后预测价值的文章。GRACE评分截止点分为小于等于100分和大于100分两组,HEART评分截止点分为小于4分、等于4分和大于4分三组。研究结果为主要不良心血管事件(MACE)、急性心肌梗死(AMI)和全因死亡率。结果:共纳入25篇文章。GRACE评分预测MACE的敏感度和特异度在临界值≤100时分别为0.96和0.26,在临界值>100时分别为0.58和0.69。cut off小于4时,HEART评分预测MACE的敏感性和特异性分别为0.99和0.16;cut off等于4时,敏感性和特异性分别为0.93和0.47;cut off大于4时,敏感性和特异性分别为0.77和0.78。GRACE评分预测AMI的敏感性和特异性分别为0.95和0.29。HEART评分预测AMI的敏感性和特异性分别为0.94和0.48。风险评分不适合作为全因死亡率的预测指标。结论:结果显示GRACE和HEART评分在预测MACE、AMI和全因死亡率方面的特异性较低,与使用的截止值无关。考虑到两种评分在预测MACE和AMI方面的可接受敏感性,这两种评分更适合作为一种排除工具,用于识别发生不良结局风险较低的ACS患者。
{"title":"HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis.","authors":"Ali Kabiri,&nbsp;Pantea Gharin,&nbsp;Seyed Ali Forouzannia,&nbsp;Koohyar Ahmadzadeh,&nbsp;Reza Miri,&nbsp;Mahmoud Yousefifard","doi":"10.22037/aaem.v11i1.2001","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2001","url":null,"abstract":"<p><strong>Introduction: </strong>Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.</p><p><strong>Method: </strong>The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.</p><p><strong>Results: </strong>25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.</p><p><strong>Conclusion: </strong>The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e50"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/7b/aaem-11-e50.PMC10440758.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10061426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparing the Emergency Medicine Residency Programs in Iran and around the World; a Descriptive Study. 伊朗与世界各国急诊医学住院医师制度比较描述性研究。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.1867
Mahdi Talebi, Morteza Talebi Doluee, Mohamadali Jafari, Hamid Zamani Moghaddam, Mahdi Foroughian, Mojtaba Moazzami, Hassan Gholami, Hamidreza Reihani

Introduction: To identify the strengths and weaknesses of emergency medicine residency curriculum in Iran, and to benefit from the experiences of successful universities, comparative studies are crucial. This study compared the components of the national curriculum of emergency medicine in the United States, Canada, the European Union, Australia, and Saudi Arabia with Iran.

Method: Data for this research was collected by searching the websites of different universities and also contacting them for requesting curriculums. The leading countries in emergency medicine and one of the countries in the Middle East region (Saudi Arabia) along with the World Federation of Emergency Medicine were selected as the sample. The model used in this field is a range model that identifies four stages of description, interpretation, proximity, and comparison in comparative studies.

Results: In the curriculum of the United States, Canada, the European Union, Australia, and Saudi Arabia, there were lots of similarities in expressing the general characteristics of the curriculum, mission elements, vision, values, and ​beliefs of the discipline, educational strategy, techniques, expected competencies, rotation programs, and evaluation method, which were also similar to the Iranian curriculum. However, the duration of residency for emergency medicine in Iran is three years, which is shorter than other countries. As expected, the number and duration of rotations are less than other countries. Also, the process of entering into this field is different in Iran and is based on an exam for entrance, while most other countries use self-requested residency program.

Conclusion: Considering the results of comparing the Iranian curriculum with the curriculums of the United States, Canada, the European Union, Australia, and Saudi Arabia, it seems that Iran's program is comprehensive and complete; but, a reappraisal of the course duration and entering options are necessary to eliminate or improve the inadequacies.

导言:为了确定伊朗急诊医学住院医师课程的优势和劣势,并从成功大学的经验中获益,比较研究至关重要。本研究比较了美国、加拿大、欧盟、澳大利亚和沙特阿拉伯与伊朗急诊医学国家课程的组成部分。方法:本研究的资料收集方式为搜寻各大学的网站,并联络各大学索取课程资料。选取急诊医学的领先国家和中东地区的一个国家(沙特阿拉伯)以及世界急诊医学联合会作为样本。在这个领域中使用的模型是一个范围模型,它确定了比较研究中的描述、解释、接近和比较四个阶段。结果:美国、加拿大、欧盟、澳大利亚和沙特阿拉伯的课程在表达课程的总体特征、使命要素、学科愿景、价值观和信念、教育策略、技术、期望能力、轮岗计划和评价方法等方面与伊朗课程有很多相似之处。然而,伊朗急诊医师的居留期限为三年,比其他国家短。正如预期的那样,轮调的次数和时间比其他国家少。此外,进入这个领域的过程在伊朗是不同的,是基于入学考试,而大多数其他国家使用自我要求的居留计划。结论:从伊朗课程与美国、加拿大、欧盟、澳大利亚和沙特阿拉伯的课程比较结果来看,伊朗的课程似乎是全面和完整的;但是,重新评估课程的持续时间和进入选项是必要的,以消除或改善不足。
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引用次数: 1
Periosteal Nerve Block Vs. Intravenous Morphine in Pain Relief of Distal Radius and Ulna Fracture; a Double-Blind Randomized Clinical Trial. 骨膜神经阻滞与静脉吗啡对桡骨、尺骨远端骨折疼痛的缓解作用一项双盲随机临床试验
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.2056
Shadi Ashtari, Alireza Hasanzadeh, Alireza Bahmani, Ali Abdolrazaghnejad

Introduction: Distal forearm fractures' realignment and fixation is a painful procedure. This study aimed to compare the efficacy of periosteal nerve block and intravenous morphine in distal radius and ulna fractures' pain management.

Methods: In the present randomized, parallel, double-blind, controlled clinical trial, patients with distal radius or ulna fractures were divided into two groups. In the first group, for periosteal nerve block, 1% lidocaine was injected at a distance of 6 to 8 cm near the wrist from the lateral radius and medial ulna. In the second group, morphine sulfate at a dose of 0.1 mg/kg was slowly injected through the peripheral vein within 5 minutes. The visual analog scale (VAS) score was evaluated before the intervention and every 15 minutes until 90 minutes after the intervention and was compared between the two groups.

Results: 75 subjects were studied (39 in the periosteal nerve block and 36 in the intravenous morphine group). There were no significant differences between the groups in terms of mean age (p = 0.384), gender distribution (p = 0.464), past medical history (p = 0.106), trauma type (p = 0.836), fracture type (p = 0.613), and baseline pain severity on VAS (p = 0.987). Both methods reduced the VAS scores during the 90 minutes of the study. The mean pain scores of the patients in the periosteal nerve block group with 2.56±1.44, 2.15±1.11, 2.66±1.26, and 3±1.27 at 15, 30, 45, and 60 minutes after the analgesic injection, respectively, were significantly lower than those of the intravenous morphine group with 4.75±1.27, 4.22±1.22, 3.97±1.27, and 4.13±1.35, respectively (p < 0.001 for all comparisons). In the present study, no local or systemic complications were observed in the periosteal nerve block group, while the complications of dyspnea, vomiting, and pruritus were reported by 5.5%, 2.8%, and 2.8%, respectively, in the intravenous morphine group. Moreover, the percentage of need for additional analgesia in the intravenous morphine group was higher than that of the periosteal nerve block group.

Conclusion: In the first hour after the intervention, pain reduction in periosteal block was significantly higher than intravenous morphine administration. Also, the incidence of complications and the need for additional analgesia were lower in the periosteal block group compared to intravenous morphine administration.

简介:前臂远端骨折的复位和固定是一个痛苦的过程。本研究旨在比较骨膜神经阻滞和静脉注射吗啡治疗桡骨远端骨折和尺骨远端骨折疼痛的疗效。方法:采用随机、平行、双盲、对照临床试验,将桡骨或尺骨远端骨折患者分为两组。第一组骨膜神经阻滞,1%利多卡因在距桡骨外侧、尺骨内侧近腕6 ~ 8 cm处注射。第二组在5分钟内通过外周静脉缓慢注射剂量为0.1 mg/kg的硫酸吗啡。在干预前及干预后每15分钟至90分钟评估一次视觉模拟量表(VAS)评分,比较两组间的差异。结果:共75例受试者(骨膜神经阻滞组39例,静脉注射吗啡组36例)。在平均年龄(p = 0.384)、性别分布(p = 0.464)、既往病史(p = 0.106)、创伤类型(p = 0.836)、骨折类型(p = 0.613)和VAS基线疼痛严重程度(p = 0.987)方面,组间差异无统计学意义。在90分钟的研究中,两种方法都降低了VAS评分。骨膜神经阻滞组患者在镇痛药注射后15、30、45、60分钟的平均疼痛评分分别为2.56±1.44、2.15±1.11、2.66±1.26、3±1.27,显著低于静脉注射吗啡组的4.75±1.27、4.22±1.22、3.97±1.27、4.13±1.35,差异均有统计学意义(p < 0.001)。本研究中,骨膜神经阻滞组未出现局部或全身并发症,而静脉注射吗啡组出现呼吸困难、呕吐和瘙痒的发生率分别为5.5%、2.8%和2.8%。此外,静脉注射吗啡组需要额外镇痛的百分比高于骨膜神经阻滞组。结论:干预后1小时,骨膜阻滞镇痛效果明显高于静脉注射吗啡。此外,与静脉注射吗啡相比,骨膜阻滞组的并发症发生率和额外镇痛的需要更低。
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引用次数: 0
Enhancing Emergency Response through Artificial Intelligence in Emergency Medical Services Dispatching; a Letter to Editor. 利用人工智能提高医疗急救调度中的应急响应能力给编辑的信。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.2097
Payam Emami, Karim Javanmardi
The emergency medical dispatcher (EMD) serves as a crucial link between individuals in need of emergency medical assistance and the emergency medical services (EMS) resource delivery system. Through their expertise and training, EMDs are able to accurately assess emergency situations, provide appropriate guidance over the phone, and dispatch the necessary EMS personnel to the scene. With adequate training, program management, supervision, and medical guidance, the EMD can accurately assess the caller’s needs, choose an appropriate response approach, furnish relevant information to responders, and offer suitable assistance and guidance to patients through the caller. By diligently adhering to a written and medically approved EMD protocol, informed decisions regarding EMS responses can be made in a reliable, replicable, and fair manner (1, 2). Artificial intelligence (AI) is the concept of a computer program that utilizes existing information to make decisions and enhances its performance based on accumulated experience. Machine learning (ML), a crucial aspect of AI,
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引用次数: 1
Short-term Side Effects of mRNA-based COVID-19 Vaccine Among Jordanian Population; a Cross-sectional Study. 基于mrna的新型冠状病毒疫苗在约旦人群中的短期副作用横断面研究
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.1850
Razan I Nassar

Introduction: One type of the developed COVID-19 vaccines that received emergency permission and was approved by the food and drug administration (FDA) is the mRNA-based vaccine. The aim of this study is to gather information on the Jordanian population's experience with the vaccine's side effects.

Methods: The study objectives were addressed through a cross-sectional study, which collected information regarding the short-term side effects experienced by the vaccinated individuals within one month following the injection of an mRNA-based COVID-19 vaccine. Data collection was carried out in August 2021. Participants were invited to take part in a self-administered web-based survey created using Google Forms.

Results: Among the study's participants (n= 533), about 56% experienced side effects after the first dose of the mRNA-based COVID-19 vaccine. The most commonly reported side effects after the first dose were sore arm at the injection site (91.6%), and fatigue (83.06%). The female gender was significantly associated with experiencing fatigue, discomfort, chills, and hair loss. Being over 30 years old was significantly associated with experiencing cough. Being a smoker was significantly associated with experiencing shortness of breath and gastrointestinal symptoms.

Conclusion: The mRNA-based COVID-19 vaccine side effects were common, yet, mild, local, and self-limited. The local pain at the injection site was the most commonly reported side effect. Hopefully, the study's findings will aid in lowering resistance to vaccination.

导论:获得紧急许可并获得美国食品药品监督管理局(FDA)批准的新型冠状病毒疫苗之一是基于mrna的疫苗。这项研究的目的是收集有关约旦人口对疫苗副作用的经验的信息。方法:通过一项横断面研究来解决研究目标,该研究收集了注射基于mrna的COVID-19疫苗后一个月内接种疫苗的个体所经历的短期副作用的信息。数据收集工作于2021年8月进行。参与者被邀请参加一项使用谷歌表格创建的自我管理的网络调查。结果:在该研究的参与者(n= 533)中,约56%的人在首次注射基于mrna的COVID-19疫苗后出现了副作用。第一次给药后最常见的副作用是注射部位手臂疼痛(91.6%)和疲劳(83.06%)。女性与疲劳、不适、发冷和脱发的经历显著相关。30岁以上的人与咳嗽有显著关系。吸烟者与呼吸短促和胃肠道症状显著相关。结论:基于mrna的新型冠状病毒疫苗毒副反应普遍,但具有轻度、局部和自限性。注射部位的局部疼痛是最常见的副作用。希望这项研究的发现将有助于降低对疫苗的抵抗力。
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引用次数: 0
An Adult Female with Periumbilical Pain and Intractable Vomiting; a Photo quiz. 成年女性脐周疼痛伴难治性呕吐1例照片测验
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.1849
Hamzah Adel Ramawad, Amirmohammad Toloui, Adelaide Viguri
A 25-year-old female with no significant past medical history presented to the emergency room with complaints of worsening, sharp, periumbilical pain for two days, with an intensity of 8 out of 10 based on the visual analogue scale. She complained of fever, nausea, anorexia, and multiple episodes of non-bloody, non-bilious emesis. The patient appeared unwell and diaphoretic. Her vital signs were as follows, blood pressure of 108/66 mmHg, heart rate of 106 beats/minute and body temperature of 39.3°C. Physical examination showed a distended abdomen with localized tenderness and guarding in the periumbilical region.
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引用次数: 0
Acute Hepatitis Associated with Intake of Pistacia Vera L. Bud Tea; a Case Report. 饮用黄连木花蕾茶与急性肝炎的关系一份病例报告。
IF 5.4 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-01 DOI: 10.22037/aaem.v11i1.2006
Kazım Ersin Altınsoy, Mehmet Murat Oktay

In this study, a patient who developed acute hepatitis due to drinking Pistacia vera L. bud tea is presented. A twenty-eight-year-old woman who had just come out of the postpartum period applied to our clinic with complaints of nausea, vomiting, loss of appetite and weakness. Blood serum alanine aminotransferase and aspartate aminotransferase levels were increased. All serological tests were negative for viral hepatitis and autoimmune diseases. She had been drinking an herbal tea containing Pistacia vera L. bud every day for four weeks to increase milk production. Three weeks after discontinuation of herbal tea, liver enzymes returned to normal. Based on our knowledge, this is probably the first hepatitis report due to the use of an herbal tea containing Pistacia vera L. bud.

本研究报告一位因饮用黄连木花蕾茶而患上急性肝炎的病人。一位28岁刚产后的妇女来我诊所就诊,主诉恶心、呕吐、食欲不振、身体虚弱。血清谷丙转氨酶和天冬氨酸转氨酶水平升高。病毒性肝炎和自身免疫性疾病的血清学检测均为阴性。为了增加产奶量,她已经连续四周每天喝一种含有黄连木芽的凉茶。停用凉茶三周后,肝酶恢复正常。据我们所知,这可能是第一个由于使用含有黄连木芽的凉茶而导致肝炎的报告。
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引用次数: 0
期刊
Archives of Academic Emergency Medicine
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