Archives of Academic Emergency Medicine最新文献

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.

Introduction: A comprehensive analysis of the epidemiological features of aortic dissections in Azerbaijan Province, Iran, and their influence on patient survival remains unexplored. This study aimed to determine the incidence of aortic dissection and identify the associated factors of mortality in these patients.

Methods: A retrospective longitudinal study was conducted using hospital records of patients diagnosed with aortic dissection in Tabriz, Iran, between 2017 and 2021. The 3-month mortality was followed up via telephone calls using the contact numbers provided in the patients' records. Then, independently associated factors of mortality were identified using a multivariate stepwise logistic regression analysis.

Results: Among the 150 cases of aortic dissection identified, 74% (n = 111) were classified as type A, and 26% (n = 39) were classified as type B. The overall incidence proportion of aortic dissections was 2.35 per 100000 population. In type A dissections, 64% (71 out of 111) of patients received surgical treatment, while 21.6% (24 out of 111) received medical treatment. Among type B dissections, only 23.1% (9 out of 39) underwent surgery. The all-cause mortality rate at 3 months was 52.5% (73 out of 139 patients with complete follow-up), 47 male (54%) and 26 female (50%). Multivariate analysis showed that higher age was independently associated with increased mortality (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.00-1.06, p = 0.027). In contrast, patients with DeBakey Type III classification (OR = 0.29; 95% CI: 0.01-0.87, p = 0.027), hypothyroidism (OR = 0.12; 95% CI: 0.01-0.99, p = 0.049), and those who received either surgical treatment (OR = 0.19; 95% CI: 0.05-0.76, p = 0.019) or medical treatment (OR = 0.18; 95% CI: 0.04-0.80, p = 0.024) had a lower chance of mortality. Gender was not found to be associated with the outcome.

Conclusion: The study revealed an annual incidence rate of aortic dissection as 2.35 per 100000 population. Aortic dissection, regardless of type, remains a highly fatal condition, with over half of patients dying within 3 months of the initial event. To reduce the high mortality rates associated with aortic dissections, it is crucial to implement specific measures for the early identification of patients and ensure prompt and appropriate care.

Introduction: Low back pain (LBP) represents the leading cause of disability worldwide and is a major economic and welfare problem. This study aimed to report incidence, prevalence, and disability-adjusted life years (DALY) rates of LBP in Iran by gender and different sociodemographic index (SDI) countries from 1990 to 2019.

Methods: The age-standardized LBP and incidence, prevalence, and DALY were extracted based on the Global Burden of Disease (GBD) 2019 in Iran for males and females, and low- and high-SDI countries during 1990- 2019.

Results: GBD 2019 data for LBP in Iran indicate a significant downward trend of incidence and prevalence from 1993 to 2019 in males, females, and both, except during the 1999-2002 period for females. A sharp reduction is seen in LBP incidence and prevalence from 1996 to 1999. Gender is not a determining factor in the LBP prevalence in Iran. Regarding the SDI categories, Iran had the highest incidence rate compared to countries with low- and high SDIs. High-SDI countries had the highest prevalence and DALY compared with Iran and low-SDI countries.

Conclusion: The age-standardized incidence and prevalence of LBP in Iran showed a downward trend, from 1993 to 2019, especially from 1996 to 1999. Comparing Iran with low- and high-SDI countries, a heavier incidence of LBP was observed in Iran and heavier prevalence and DALY were seen in high-SDI countries. Therefore, more therapeutic healthcare interventions are required to reduce the LBP burden more effectively.

Introduction: Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO.

Methods: We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31^st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke.

Results: Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%-99%) and the specificity of 17% (95% CI: 4%-54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%-88%) and specificity of 62% (95% CI: 48%-74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%-69%) and the highest specificity of 81% (95% CI: 71%-88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO.

Conclusion: A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.

Aeromonas hydrophila has been identified as a causative agent of necrotizing fasciitis and myonecrosis, with most reported cases having a connection to aquatic-related trauma. Cases without such trauma history are rare in existing literature. Here, we present the case of a 56-year-old cirrhotic patient who lacked any prior aquatic-related trauma and arrived at the emergency department in a state of septic shock. The suspected route of entry was through necrotizing fasciitis and myonecrosis in his left forearm. Unfortunately, the patient succumbed to multi-organ failure and passed away within 12 hours of admission to the emergency department.

Introduction: Proper cervical spine immobilization is essential to prevent further injury following trauma. This study aimed to compare the cervical range of motion (ROM) and the immobilization time between traditional spinal immobilization (TSI) and spinal motion restriction (SMR).

Methods: This study was a randomized 2x2 crossover design in healthy volunteers. Participants were randomly assigned by Sequential numbered, opaque, sealed envelopes (SNOSE) with permuted block-of-four randomization to TSI or SMR. We used an inertial measurement unit (IMU) sensor to measure the cervical ROM in three dimensions focusing on flexion-extension, rotation, and lateral bending. The immobilization time was recorded by the investigator.

Results: A total of 35 healthy volunteers were enrolled in the study. The SMR method had cervical spine movement lower than the TSI method about 3.18 degrees on ROM in flexion-extension (p < 0.001). The SMR method had cervical spine movement lower than the TSI method about 2.01 degrees on ROM in lateral bending (p = 0.022). The immobilization time for the SMR method was 11.88 seconds longer than for the TSI method (p < 0.001) but not clinically significant.

Conclusion: SMR that used scoop stretcher resulted in significantly less cervical spine movement than immobilization with a TSI that used long spinal board. We recommend implementing the SMR protocol for transporting trauma patients, as minimizing cervical motion may enhance patient outcomes.