Archives of Academic Emergency Medicine最新文献

Introduction: Various treatment protocols have been recommended since the beginning of the COVID-19 pandemic and have gradually evolved. This study aimed to assess the effectiveness and safety of incentive spirometer exercise (ISE) in outcomes of hospitalized patients with moderate-to-severe COVID-19 pneumonia.

Methods: A 3-month single-blind, two parallel-armed randomized controlled trial was conducted at Imam Hossein Hospital, Tehran, Iran. Participants aged >18 years with documented COVID-19 pneumonia were randomly allocated to 2 groups of IS (ISE in addition to the usual treatment) and control (usual care alone). The IS group was also asked to perform ISE after discharge for three months. The primary outcomes were peripheral O2 saturation (SpO2), VBG parameters (pCO2, PH, HCO3), dyspnea level measured by Modified Borg Scale (MBS), length of hospital stay (LOS), and respiratory rate (RR). Secondary outcomes included mortality rate, intubation rate (IR), and ICU admission rate.

Results: A total of 160 eligible patients were randomly assigned to either the IS (n = 80) or control (n=80) groups. Although there were no significant differences in primary and secondary outcomes between the groups post-intervention, adjusted analysis showed that participants allocated to the IS group had significantly higher SpO2 levels and lower RR, MBS levels, and LOS. Also, the adjusted model analysis showed a marginal statistically significant difference between groups in secondary outcomes, such as IR, the 1-month mortality rate, and the 3-month mortality rate.

Conclusion: It seems that adding the ISE to usual care in the early treatment setting of COVID-19 patients resulted in a relatively significant increase in SpO2 levels, improved respiratory status, and marginally decreased LOS. Additionally, ISE minimally reduced ICU admissions and intubation rates, with no significant impact on in-hospital or long-term mortality in patients with COVID-19 pneumonia.

Introduction: Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures.

Methods: This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed.

Results: A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions.

Conclusion: Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.

Introduction: Chinese populations have an increasingly high prevalence of cardiac arrest. This study aimed to investigate the prehospital associated factors of survival to hospital admission and discharge among out-of-hospital cardiac arrest (OHCA) adult cases in Macao Special Administrative Region (SAR), China.

Methods: Baseline characteristics as well as prehospital factors of OHCA patients were collected from publicly accessible medical records and Macao Fire Services Bureau, China. Demographic and other prehospital OHCA characteristics of patients who survived to hospital admission and discharge were analyzed using multivariate logistic regression analysis.

Results: A total of 904 cases with a mean age of 74.2±17.3 (range: 18-106) years were included (78%>65 years, 62% male). Initial shockable cardiac rhythm was the strongest predictor for survival to both hospital admission (OR=3.57, 95% CI: 2.26-5.63; p<0.001) and discharge (OR=12.40, 95% CI: 5.70-26.96; p<0.001). Being male (OR=1.63, 95% CI:1.08-2.46; p =0.021) and the lower emergency medical service (EMS) response time (OR=1.62, 95% CI: 1.12-2.34; p =0.010) were also associated with a 2-fold association with survival to hospital admission. In addition, access to prehospital defibrillation (OR=4.25, 95% CI: 1.78-10.12; p <0.001) had a 4-fold association with survival to hospital discharge. None of these associations substantively increased with age.

Conclusion: The major OHCA predictors of survival were initial shockable cardiac rhythm, being male, lower EMS response time, and access to prehospital defibrillation. These findings indicate a need for increased public awareness and more education.

Introduction: The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard.

Methods: In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria.

Results: Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear.

Conclusion: Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians' decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.

Carotid complications resulting from extra-luminal migration of ingested foreign bodies (FB) are rare but potentially life-threatening. Previous data on the topic predominantly comprises isolated case reports, leaving a gap in comprehensive evidence necessary to guide clinical decision-making. In this article, we offer a narrative review alongside a novel case report, aimed at providing a broad, evidence-based perspective on the topic to guide clinical practice. The search strategy employed keywords related to carotid artery complications from ingested FB across the following electronic databases: PubMed, Scopus, Google Scholar, and Cochrane Central. Screening involved standardized data extraction by two independent reviewers, with a focus on abstracts meeting inclusion criteria and excluding non-English literature and non-relevant studies from further analysis. Moreover, we present a novel case report on the topic that was successfully managed using a unique surgical approach. Overall, a total of sixteen case reports were finally included, data on clinical presentations, diagnostic strategies and findings, surgical management and outcome were extracted, tabulated, and discussed. In carotid complications from extra-luminal migration of ingested FB, high clinical suspicion is crucial due to potentially mild symptoms and negative first-level examinations. Computed tomography (CT) scan plays a pivotal role for accurate diagnosis and surgical planning, along with neck ultrasound to detect complications. Tailored surgical strategies based on the severity of carotid involvement, including venous patch grafts in severe vessels involvement, are crucial for optimal patient outcomes. As a novelty, in our case report, carotid shunt was successfully employed instead of prolonged carotid clamping to reduce the risk of associated neurological sequelae. It could be concluded that, diagnosis and managing carotid complications from extra-luminal migration of ingested FB remains challenging and a multidisciplinary approach is warranted.

Introduction: Distinguishing between ruptured and non-ruptured acute appendicitis presents a significant challenge. This study aimed to validate the accuracy of RAMA-WeRA Risk Score in predicting ruptured appendicitis (RA) in emergency department.

Methods: This study was a multicenter diagnostic accuracy study conducted across six hospitals in Thailand from February 1, 2022, to January 20, 2023. The eligibility criteria included individuals aged >15 years suspected of acute appendicitis, presenting to the ED, and having an available pathology report following appendectomy or intraoperative diagnosis by the surgeon. We assessed the screening performance characteristics of RAMA-WeRA Risk Score, in detecting the ruptured appendicitis (RA) cases.

Results: 860 patients met the study criteria. 168 (19.38%) had RA and 692 (80.62%) patients had non-RA. The area under the receiver operating characteristic curve (AuROC) of RAMA-WeRA Risk Score was 75.11% (95% CI: 71.10, 79.11). The RAMA-WeRA Risk Score > 6 points (high-risk group) demonstrated a positive likelihood ratio (LR) of 3.22 in detecting the ruptured cases. The sensitivity and specificity of score in > 6 cutoff point was 43.8% (95%CI: 36.2, 51.6) and 86.4% (95%CI: 83.6, 88.9), respectively.

Conclusions: The RAMA-WeRA Risk Score can predict rupture in patients presenting with suspected acute appendicitis in the emergency department with total accuracy of 75% for high-risk cases.

Introduction: Infectious diarrhea, a significant global health challenge, is exacerbated by flooding, a consequence of climate change and environmental disruption. This comprehensive study aims to quantify the association between flooding events and the incidence of infectious diarrhea, considering diverse demographic, environmental, and pathogen-specific factors.

Methods: In this systematic review and meta-analysis, adhering to PROSPERO protocol (CRD42024498899), we evaluated observational studies from January 2000 to December 2023. The analysis incorporated global data from PubMed, Scopus, Embase, Web of Science, and ProQuest, focusing on the relative risk (RR) of diarrhea post-flooding. The study encompassed diverse variables like age, sex, pathogen type, environmental context, and statistical modeling approaches.

Results: The meta-analysis, involving 42 high-quality studies, revealed a substantial increase (RR = 1.40, 95% CI [1.29-1.52]) in the incidence of diarrhea following floods. Notably, bacterial and parasitic diarrheas demonstrated higher RRs (1.82 and 1.35, respectively) compared to viral etiologies (RR = 1.15). A significant sex disparity was observed, with women exhibiting a higher susceptibility (RR = 1.55) than men (RR = 1.35). Adults (over 15 years) faced a greater risk than younger individuals, highlighting age-dependent vulnerability.

Conclusion: This extensive analysis confirms a significant correlation between flood events and increased infectious diarrhea risk, varying across pathogens and demographic groups. The findings highlight an urgent need for tailored public health interventions in flood-prone areas, focusing on enhanced sanitation, disease surveillance, and targeted education to mitigate this elevated risk. Our study underscores the critical importance of integrating flood-related health risks into global public health planning and climate change adaptation strategies.

Introduction: Immature Platelet Fraction (IPF) is a measure of the proportion of reticulated platelets (RPs) to all platelets in circulation. IPF may have both prognostic and diagnostic values in patients with Acute Coronary Syndrome (ACS). This study aims to comprehensively summarize the diagnostic utility of IPF levels in patients with ACS, specifically focusing on its ability to differentiate between different subtypes of ACS.

Methods: We conducted a systematic search in online databases including MEDLINE, Scopus, and Google Scholar up to March 4^th 2024, to identify relevant studies. The random-effect model, employing inverse variance for mean differences (MD) and Mantel-Haenszel methods for odds ratios (OR) were utilized to combine the data. Joanna Briggs Institute (JBI) appraisal tool was employed to assess the quality of included studies.

Results: Our systematic review contains 15 articles with a total sample size of 2,030 ACS patients. Pooled analysis revealed significant differences in IPF levels of ACS patients compared to healthy controls (MD (95%CI): 2.85 (0.86, 4.85), P-value = 0.004) and stable angina patients (MD (95%CI): 0.58 (0.23, 0.92), P-value < 0.001). Subgroup comparisons within ACS patients demonstrated higher IPF levels in myocardial infarction (MI) vs. unstable angina (UA) (MD (95%CI): 1.81 (0.41, 3.22), P-value = 0.01), ST elevation MI (STEMI) vs. non-ST elevation (NSTEMI) ACS (MD (95%CI): 0.74 (0.31, 1.17), P-value < 0.001), and NSTEMI vs. UA (MD (95% CI): 1.07 (0.24, 1.90), P-value = 0.01).

Conclusion: IPF levels could increase in patients with ACS, particularly during the acute phase of STEMI. This suggests that IPF may be a useful biomarker for early diagnosis of ACS. Additionally, IPF levels may help differentiate between ACS subtypes.

Introduction: Sport Concussion Assessment Tool (SCAT) aids the physicians in early management of concussion among suspected athletes and its 6^th version was published in 2023 in English. This study aimed to describe the translation and validation process of SCAT6 from English to Persian.

Methods: The Persian translation of SCAT6 and its evaluation has been done in seven stages: initial translation, appraisal of the initial translation, back translation, appraisal of the back-translation, validation (face and content validities), final reconciliation and testing by simulation.

Results: Initial translation, was done by two bilingual translators followed by an initial appraisal, which was made by both translators and one general physician. Back translation was done by two naïve translators who were unfamiliar with SCAT6, followed by its appraisal by initial translators. Face and content validity of the translation were surveyed by medical professionals and athletes and the results of the validation process were provided to the reconciliation committee and this committee made the modifications needed. Finally, the use of Persian SCAT6 was simulated and the mean time needed to complete the Persian SCAT6 was roughly a little more than 10 minutes.

Conclusions: The present study provides the readers with the translation and cross-cultural adaptation process of SCAT6 from English to Persian. This translated version will be distributed among the Iranian sports community for assessing concussions among athletes.