Archives of Academic Emergency Medicine最新文献

Introduction: Emergency medicine is a relatively new and rapidly growing specialty, and its research monitoring is important for future policies. This study aimed to analyze the published literature related to emergency medicine, to create a documented research perspective for this field.

Methods: This research is a bibliometric study that analyzes the research outputs of the subject area of emergency medicine indexed in the Web of Science database from the beginning to 2023. VOSviewer software was used to visualize and predict the trends in research on the topic.

Results: The findings showed that the University of California, The Journal of Neurotrauma and Brain Injury, Elsevier, and the USA were the most prolific units in the cycle of scientific productions in the field of emergency medicine. Results showed that most scientific productions in this field fall into 6 clusters: psychological impressions, injuries caused by traumatic events and the effects of traumas on children, pathophysiology and nervous system issues and related diseases, complications of traumatic events and injuries, biomechanics and complications caused by sports injuries, and consciousness.

Conclusion: In addition to interventions and clinical complications, research in the field of emergency medicine has also focused on psychological structures. So, based on various measurement indicators, the subjects of this field have been the focus of researchers' attention.

Introduction: Dizziness is a common scenario in the Emergency Departments (EDs). Among dizziness underlying causes, the posterior circulation stroke is especially relevant due to its mobimortality and concerning misdiagnosis rates. Therefore, we conducted this study to assess dizziness evaluation and baseline characteristics of patients with PS in the ED.

Methods: We conducted a 3-year retrospective observational study on PS cases confirmed by magnetic resonance imaging (MRI). Concretely, we analysed the demographic profile of these patients, the initial PS clinical presentation, and diagnostic workup (with emphasis on dizziness evaluation) performed at the ED.

Results: During the study period, 85 cases were registered. Risk factors for cardiovascular disease were present in 85.5% and previous visits to the ED due to dizziness were recorded in 16.5%. The main clinical presentation was dizziness, concretely as an acute vestibular syndrome (38.8%) with additional neurological signs or symptoms (80%). Evaluation by the otolaryngologist on call was requested in less than 10% of the cases and included the HINTS protocol use with a sensitivity of 100% for central nervous system underlying causality. A brain CT study was always performed with a sensitivity of 27%. However, 96.47% of patients were primarily admitted to the Neurology hospitalization ward and MRI was always performed in a mean time of 3.21 days confirming the diagnosis.

Conclusions: Dizziness is the most frequent symptom of PS. Patients usually present an AVS (associated with additional N-SS or not) and HINTS bedside examination is the most adequate protocol to differentiate a PS from other AVS causes until the diagnostic confirmation via MRI. Interestingly, mainly otolaryngologists seem to use HINTS. However, the use of CT is widespread despite its poor value.

Introduction: Provision of pre-hospital care by emergency medical services (EMS) requires paying attention to self-care and patient care against possible infections. The present study was conducted with the aim of determining the level of self-care and patient care against COVID-19.

Methods: The present correlational, descriptive, analytical study was carried out on 301 EMS personnel in Iran. Data were collected using a demographic information form and questionnaires made by the researcher on the level of self-care and patient care against COVID-19.

Results: The results showed that more than half of the participants (55%) were aged 27 to 34 years. The majority of the participants had an experience of participating in self-care (88.7%) and patient care (83.7%) training courses against COVID-19. The overall score of self-care was 55.96 ± 6.97 out of 72 and that of patient care was 26.86± 3.39 out of 32, both of which revealed a favorable level. However, in some questions, the mean score was lower than the optimal level. The lowest mean score among items related to self-care against COVID-19 was allocated to wearing protective clothing (1.77±1.19). Among items related to patient care against COVID-19, the lowest mean score was related to training the patient about hand hygine after touching contaminated equipment (2.83±1.08 out of 4). There was a positive (r=0.491) and significant correlation between self-care and patient care against COVID-19 (p=0.001) based on our findings.

Conclusion: Although the general level of self-care and patient care against COVID-19 was favorable, due to the undesired level of some domains, it seems necessary to implement corrective planning through periodical training and monitoring the performance of the personnel.

Introduction: During the COVID-19 outbreak, dental professionals have demonstrated their importance in combating mass casualty incidents. This study aimed to understand dental students' perceptions of their potential roles in a bioterrorism attack.

Methods: This cross-sectional study used a self-administered anonymous questionnaire, which was sent to all dental students and interns at King Abdulaziz University, Saudi Arabia. Bivariate and multiple linear regression analyses were conducted to assess dental students' willingness to provide care during a bioterrorism attack, knowledge regarding bioterrorism and total number of roles a dentist should play during an attack.

Results: This study included 472 dental students and interns. The mean knowledge score regarding bioterrorism was 3.3 ± 1.9 out of 5. A large majority of the respondents (83.8%) were willing to provide care during a bioterrorism attack. Students with a cumulative grade point average (GPA) of 4.5-5 were more likely to indicate that a dental professional should take on more roles during a bioterrorism attack than those with a GPA of 2.5-2.99. Fourth- and fifth-year dental students had lower knowledge scores regarding bioterrorism than dental interns (B: -0.71; SE: 0.30; 95% CI: -1.3--0.1 and B: -0.68; SE: 0.30; 95% CI: -1.3- -0.1, respectively).

Conclusion: Despite the fact that dental curricula do not cover topics related to bioterrorism, most students would be willing to provide care under bioterrorism conditions. There is wide agreement among the students regarding the need to add bioterrorism-related educations to dental curricula.

Introduction: It could be beneficial to accelerate the hospitalization of patients with the identified clinical risk factors of intensive care unit (ICU) admission, in order to control and reduce COVID-19-related mortality. This study aimed to determine the clinical risk factors associated with ICU hospitalization of COVID-19 patients.

Methods: The current research was a cross-sectional study. The study recruited 7182 patients who had positive PCR tests between February 23, 2020, and September 7, 2021 and were admitted to Afzalipour Hospital in Kerman, Iran, for at least 24 hours. Their demographic characteristics, underlying diseases, and clinical parameters were collected. In order to analyze the relationship between the studied variables and ICU admission, multiple logistic regression model, classification tree, and support vector machine were used.

Results: It was found that 14.7 percent (1056 patients) of the study participants were admitted to ICU. The patients' average age was 51.25±21 years, and 52.8% of them were male. In the study, some factors such as decreasing oxygen saturation level (OR=0.954, 95%CI: 0.944-0.964), age (OR=1.007, 95%CI: 1.004-1.011), respiratory distress (OR=1.658, 95%CI: 1.410-1.951), reduced level of consciousness (OR=2.487, 95%CI: 1.721-3.596), hypertension (OR=1.249, 95%CI: 1.042-1.496), chronic pulmonary disease (OR=1.250, 95%CI: 1.006-1.554), heart diseases (OR=1.250, 95%CI: 1.009-1.548), chronic kidney disease (OR=1.515, 95%CI: 1.111-2.066), cancer (OR=1.682, 95%CI: 1.130-2.505), seizures (OR=3.428, 95%CI: 1.615-7.274), and gender (OR=1.179, 95%CI: 1.028-1.352) were found to significantly affect ICU admissions.

Conclusions: As evidenced by the obtained results, blood oxygen saturation level, the patient's age, and their level of consciousness are crucial for ICU admission.

Introduction: Acute COVID-19 infection is associated with increased adverse clinical outcomes in patients with acute coronary syndromes (ACS). Given that some studies suggested improved pulmonary function with Ticagrelor, this clinical trial aimed to compare the effects of Ticagrelor versus Clopidogrel on the short-term outcomes of these patients.

Methods: In this multicenter clinical trial, 180 COVID-19 patients with ACS who underwent urgent percutaneous coronary intervention (PCI) were randomized to receive Ticagrelor (180mg loading dose followed by 90mg twice daily, n=90) or Clopidogrel (600mg loading dose with 75mg daily, n=90), and then followed for one month after their procedure. The primary composite endpoint was a combination of all-cause mortality, myocardial infarction, and early stent thrombosis within the first month after stent implantation.

Results: After thirty days of follow-up, the primary composite endpoint was non-significantly lower in the Ticagrelor compared to the Clopidogrel group (18.5% vs 23.5% respectively, p = 0.254). Based on the time-to-event analysis, the mean survival rate was 26.8 ±7.7 and 24.7 ±9.9 days, respectively, for the Ticagrelor and the Clopidogrel arms (Log-rank p = 0.275). Secondary endpoints were similar in the two trial arms, except for the mean oxygen saturation, which was higher in the Ticagrelor group (95.28 ±2.68 % vs. 94.15 ± 3.55 %, respectively; p = 0.021).

Conclusion: Among COVID-19 patients with concomitant ACS, who were treated with urgent PCI, the composite outcome of death, myocardial infarction, and early stent thrombosis was not different between Ticagrelor and Clopidogrel groups. However, administration of Ticagrelor was associated with a slight but statistically significant increase in oxygen saturation compared to Clopidogrel, but this difference wasn't clinically important.

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma exacerbation are two common emergency situations. This study aimed to investigate the impact of pre-hospital dexamethasone initiation on treatment outcomes of these patients.

Methods: In this retrospective cross-sectional and comparative study, data from the emergency medical service (EMS) care report of patients with a final diagnosis of asthma or COPD, coded with Thailand's emergency medical triage protocol, collected between January 1, 2021, and October 31, 2022, were used. Data on baseline characteristics, emergency department length of stay (ED-LOS), and hospital admission rates were collected from electronic medical records and compared between cases with and without pre-hospital dexamethasone administration by EMS.

Results: 200 patients with COPD (n = 93) and asthma (n = 107) exacerbation were enrolled. The dexamethasone-treated group had a lower but statistically non-significant hospital admission rate (71.0% versus 81.0%, absolute difference: -10%, 95% confidence interval (CI): -21.76, 1.76; p = 0.100). In patients with asthma, the dexamethasone-treated had lower median ED-LOS time (235 (IQR: 165.5-349.5) versus 322 (IQR: 238-404) minutes; p = 0.003). Dexamethasone-treated asthma patients had lower but statistically non-significant hospital admission rates (60.4% versus 78.0%, absolute difference: -17.55%, 95% CI: -34.96, -0.14; p = 0.510). In COPD patients the dexamethasone-treated and untreated groups had non-significantly lower hospital admission rates (80.8% versus 85.40%, absolute difference: -4.60%, 95% CI: -19.82, 10.63; p = 0.561) and non-significantly lower ED-LOS (232 (IQR: 150 - 346) versus 296 (IQR: 212 - 330) minutes, absolute difference: -59 (-130.81, 12.81); p = 0.106).

Conclusion: The dexamethasone administration by EMS in pre-hospital setting for management of asthma and COPD patients is beneficial in reducing the ED-LOS and need for hospital admission but its effects are not statistically significant, except regarding the ED-LOS of asthma exacerbation cases.

Introduction: Several clinical manifestations have been discovered for COVID-19 since the emergence of SARS-CoV-2, which can be classified into early, medium, and long-term complications. However, late complications can be present after recovery from acute COVID-19 illness. The present study aims to comprehensively review the available evidence of late complications related to COVID-19.

Method: A search was conducted, using keywords, through electronic databases, which included Scopus, Web of Science, PubMed, and Embase up to August 29, 2022. Study selection was performed according to a strict inclusion and exclusion criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was followed, and studies were appraised using the National Institute of Health (NIH) quality assessment and risk of bias tool.

Results: In total, 50 studies were included, and nine distinct COVID-19 late complication categories were identified. A review of these studies revealed that neurologic and psychiatric (n=41), respiratory (n=27), musculoskeletal and rheumatologic (n=22), cardiovascular (n=9), and hepatic and gastrointestinal (n=6) complications were the most prevalent complications of long COVID-19.

Conclusion: Almost all human body systems are affected by late complications of COVID-19 with different severity and prevalence. Fatigue and some other neuropsychiatric symptoms are the most common late complications among long COVID-19 patients. Respiratory symptoms including dyspnea (during exercise), cough, and chest tightness were the next most prevalent long-term complications of COVID-19. Since these complications are persistent and late, being aware of the signs and symptoms is essential for the healthcare providers and patients.

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections affecting one-third of patients with mechanical ventilation. This study aimed to synthesize available evidence regarding the effect of treatment with povidone-iodine (PI) among adult patients admitted to intensive care units (ICUs) for the prevention of VAP.

Methods: An extensive search was conducted in online databases, including PubMed, Web of Science and Scopus, from the earliest records until January 1, 2023. STATA software v14 was used for statistical analysis. Publication bias was assessed via funnel plot, Begg's and Egger's tests. A P-value less than 0.1 was considered statistically significant for publication bias value.

Results: Four studies were included in the meta-analysis. Three studies showed rhat PI decreased VAP compared to the placebo group, but it was not statistically significant (RR: 0.61, 95%CI: 0.25 to 1.47, Z=1.10, P=0.27, I2:71.5%). One study compared the effect of PI with chlorhexidine on the rate of VAP, the difference between which was not statistically significant (RR: 1.50, 95%CI: 0.46 to 4.87, Z=0.67, P=0.50, I2:0). Two studies demonstrated that the use of PI intervention compared to placebo decreased the average length of stay in ICU; however, it was not statistically significant (WMD: -0.35, 95%CI:-3.90 to 3.20, Z=0.19, P=0.85, I2:0). Also, three studies showed that using PI had almost no effect on mortality rate compared to placebo (RR: 1.05, 95%CI: 0.66 to 1.53, Z=0.8, P=0.27, I2:29.0%).

Conclusion: More rigorously designed randomized clinical trials and further evidence are required to make a better decision/comparison about using PI as a suitable choice for preventing VAP among adult patients admitted to the ICU.

Introduction: The Corticosteroid Randomization After Significant Head injury (CRASH) and the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) are two prognostic models frequently used in predicting the outcome of patients with traumatic brain injury. There are ongoing debates about which of the two models has a better prognostic value. This study aims to compare the CRASH and IMPACT in predicting mortality and unfavorable outcome of patients with traumatic brain injury.

Method: We performed a literature search using Medline (via PubMed), Embase, Scopus, and Web of Science databases until August 17, 2022. After two independent researchers screened the articles, we included all the original articles comparing the prognostic value of IMPACT and CRASH models in patients with traumatic brain injury. The outcomes evaluated were mortality and unfavorable outcome. The data of the included articles were analyzed using STATA 17.0 statistical program, and we reported an odds ratio (OR) with a 95% confidence interval (95% CI) for comparison.

Results: We included the data from 16 studies. The analysis showed that the areas under the curve of the IMPACT core model and CRASH basic model do not differ in predicting the mortality of patients (OR=0.99; p=0.905) and their six-month unfavorable outcome (OR=1.01; p=0.719). Additionally, the CRASH CT model showed no difference from the IMPACT extended (OR=0.98; p=0.507) and IMPACT Lab (OR=1.00; p=0.298) models in predicting the mortality of patients with traumatic brain injury. We also observed similar findings in the six-month unfavorable outcome, showing that the CRASH CT model does not differ from the IMPACT extended (OR=1.00; p=0.990) and IMPACT Lab (OR=1.00; p=0.570) in predicting the unfavorable outcome in head trauma patients.

Conclusion: Low to very low level of evidence shows that IMPACT and CRASH models have similar values in predicting mortality and unfavorable outcome in patients with traumatic brain injury. Since the discriminative power of the IMPACT Core and CRASH basic models is not different from the IMPACT extended, IMPACT Lab, and CRASH CT models, it may be possible to only use the core and basic models in examining the prognosis of patients with traumatic injuries to the brain.