BMC Emergency Medicine最新文献

Background: The management of pain in patients with traumatic injuries is a common task for emergency medicine providers, particularly in the prehospital setting. However, for sufficient and safe analgesia, correct pain recording and documentation is also necessary. The aim of this study was to assess trends in analgesia over the study period and to identify factors that may enable more sufficient pain management in trauma care.

Methods: The TraumaRegister DGU^® recorded data of patients who were primarily treated at one of the participating hospitals between 2011 and 2020 and received analgesia as part of their prehospital care. This retrospective analysis included a total of 105.908 severely injured patients from Germany, Switzerland, and Austria. Patients with and without analgesia were compared, and factors associated with analgesia were investigated with logistic regression analysis.

Results: The mean age of the patients enrolled was 50 ± 22 years. 71% were male and 29% were female. Out of all the patients, 66% (n = 70,257) received prehospital analgesia. The average age of patients in the analgesia group was 48 ± 21 years, the non-analgesia group had an average age of 54 ± 23 years. 67% of the male patients received analgesia compared to 64% of the female patients. The mean Injury Severity Score (ISS) in the analgesia group was 21.2 points, compared to 16.5 points in the non-analgesia group. 4% of the patients were under the age of sixteen, and of these, 65% received analgesia. 29% of patients were older than 65 years and received analgesia in 57%. Presence of an emergency physician at scene, was a remarkable independent variable for the receipt of analgesia (Odds Ratio 5.55; p < 0.001). Transportation by helicopter was also a significant predictor for analgesia (OR 1.62; p < 0.001).

Conclusions: Analgesia is a crucial aspect of emergency medicine, as evidenced by relevant guidelines. Nevertheless, it is plausible that a considerable proportion of seriously injured patients do not receive optimal analgesic treatment, or at the very least, this is not documented. In this regard, both aspects require optimization.

Background: Evidence suggests a benefit of a rhythm control approach in patients with a recent diagnosis of atrial fibrillation (AF). This study sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF) undergoing a non-invasive rhythm control strategy in an emergency department (ED).

Methods: This analysis uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB). HERA-FIB is a retrospective single-centre observational study which consecutively included patients presenting to the ED of the University Hospital of Heidelberg between June 2009 and March 2020 with a sequential follow-up for all-cause mortality, stroke, major bleeding events and myocardial infarction (MI). Outcomes of patients with FDAF were related to treatment strategy (non-invasive rhythm vs. rate control).

Results: Among the 2,758 (27%) patients who presented with FDAF, a non-implementation of a non-invasive rhythm control strategy at admission was observed in 75.4% and associated with an excess of all-cause mortality hazard ratio (HR): 1.61 (95%CI 1.30-1.99), p < 0.0001 and incident MI HR: 1.88 (95% CI 1.22-2.90), p = 0.0043 during follow-up. The non-implementation of a non-invasive rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables with an adjusted HR of 1.52 (95%CI: 1.14-2.04, p = 0.0043) and 1.89 (95%CI: 1.03-3.45, p = 0.0392), respectively.

Conclusion: Real-world data from FDAF patients presenting to an ED showed a benefit regarding all-cause mortality and MI favouring a non-invasive rhythm control strategy. Further prospective research is needed to validate this hypothesis.

Trial registration: The trial was registered at ClinicalTrials.gov Identifier: NCT05995561.

Background and aim: One of the most common presentations of sickle cell disease (SCD) in the emergency department (ED) is acute severe pain episodes due to a vaso-occlusive crisis (VOC). Management of these episodes is primarily through intravenous pain control, but patients often return to the ED with the same complaint a few days after discharge. While some global studies have explored the risk factors for ED revisits due to VOC, the literature is lacking in the adult population, specifically in Saudi Arabia where SCD prevalence is high. The goal of this study is to measure the incidence of ED 72-hour early revisit (ERV) among SCD patients due to a VOC episode and to identify factors that might be associated with an ERV in this population. We conducted a retrospective cohort study using the electronic medical records, retrieving all patients who presented to the ED with a VOC from the period of 2017 to 2022.

Results: This study included 120 VOC visits. The percentage of 72-hour ERV to the ED among VOC patients was 39.2%, in which 91.5% received opioids, and 31.9% were admitted during the return visit. Return visitors' median age was 29, most of them were male. There was no statistically significant correlation found between the patients' 72-hour ERV to the ED and their age, gender, comorbidities, history of exchange transfusion, pain score, or dose of opiates received. Of the variables measured at the index visit only the direct bilirubin level, and time to first opioid dose was associated with 72-hour ERV with an OR of 1.08 (95%CI: 1.0 to 1.16, P = 0.022) and 0.99 (95%CI: 0.99 to 0.99, P = 0.012) respectively.

Conclusion: We found that 39.2% of VOC episodes discharged from the ED had an ERV. This rate is higher than what is reported internationally. Additionally, the lack of clear predictors for revisits raises doubts regarding the efficacy of the ED ''treat and release'' approach in this population.

Clinical trial number: Not applicable.

Background: Given the importance of diagnosing intra-abdominal injury (IAI) in children with blunt abdominal trauma (BAT) and preventing radiation exposure to children by avoiding CT scans, this study aimed to evaluate a scoring criterion based on ultrasound (US) findings and laboratory data in assessing the clinical risk of IAI in children with BAT.

Materials and methods: In this retrospective study, baseline and clinical information of 180 children (under 18 years of age) with BAT including physical examination, hemodynamic parameters, and laboratory data, were extracted from medical records. US findings were considered abnormal if any report of mild free fluid or solid organ injury was noted. The presence or absence of IAI was assessed through medical records or telephone interviews to inquire about the patients' outcome within the two-week period post-discharge. The primary outcome was the identification of IAI, assessed through a combination of US findings, physical examination (abdominal tenderness), and laboratory parameters (WBC count and hematuria). The measurement methods included Chi-squared tests, Fisher's exact test, independent samples t-test, logistic regression, and ROC analysis.

Results: The current study showed that 153 (85%) and 27 (15%) patients were without and with IAI, respectively. The positive US finding with sensitivity and specificity of 92.59% and 44.44%, respectively, abdominal tenderness with sensitivity and specificity of 81.48% and 87.58%, respectively, hematuria with sensitivity and specificity of 62.96% and 50.33%, respectively, and high WBC level with sensitivity and specificity of 85.19% and 76.47%, had a significant diagnostic value in detecting the presence of IAI (P value < 0.001). A cutoff point ≥ 2 from the sum of the scores of these four criteria can predict the presence of IAI with a sensitivity of 81.48% and a specificity of 94.12% (AUC = 0.94; P value < 0.001).

Conclusion: This study shows that a scoring system based on positive US findings, abdominal tenderness, hematuria, and high WBC levels effectively diagnoses IAI in BAT children. A score of 2 or more strongly indicates the presence of IAI, improving decision-making for further imaging and treatment. Implementing this system can reduce unnecessary CT scans and radiation exposure, enhancing pediatric trauma care.

Background: Non-invasive ventilation (NIV) is a cornerstone in the management of acute chronic obstructive pulmonary disease (COPD) exacerbations with respiratory failure. While extensively studied in hospital settings, limited data exist on its use in the pre-hospital setting and clinical factors influencing its application. This study aimed to identify predictors of NIV use in the pre-hospital setting and to assess its association with patient-centered outcomes.

Methods: This single-center retrospective cohort study analyzed data from a pre-hospital emergency medical service registry in Geneva, Switzerland. Adult patients with a presumptive diagnosis of acute COPD exacerbation were included, spanning a control period (2007-2010, before NIV implementation) and an intervention period (2013-2017, after NIV implementation). For the primary analysis, multivariable logistic regression was used to identify predictors of NIV use during the intervention period. For the secondary analysis, coarsened exact matching balanced patients treated with NIV during the intervention period with those from the control period, followed by conditional regression analyses to assess patient-centered outcomes.

Results: Among 270 included patients, 84 (46%) received NIV during the intervention period. Age ≥ 70 years (aOR 2.49, 95% CI 1.11, 5.76), female sex (aOR 2.48, 95% CI 1.13, 5.60), and systolic blood pressure (SBP) ≥ 140 mmHg (aOR 2.75, 95% CI 1.19, 6.62) were independent predictors associated with receiving NIV in the pre-hospital setting. In the matched cohort, pre-hospital NIV use was significantly associated with increased ICU admission rates, but was not associated with transport time, emergency department length of stay, hospital length of stay, or 28-day mortality. Sensitivity analyses demonstrated consistent results across different modeling approaches.

Conclusions: Age ≥ 70 years, female sex, and SBP ≥ 140 mmHg were independent predictors associated with receiving NIV in the pre-hospital management of acute COPD exacerbation. The association between NIV use and increased ICU admissions may reflect its application in more severely ill patients. Pre-hospital NIV was not associated with short- or long-term outcomes beyond ICU admission. These findings underscore the need for prospective studies to clarify the role of pre-hospital NIV in patient outcomes.

Background: Providing timely first-aid by trained responders can reduce deaths and disabilities from road traffic accidents, a leading global cause of death. Ethiopia ranks 19th worldwide and 4th in Africa. Therefore, this study assesses the knowledge and, attitudes toward emergency first aid, and its factors among public transport drivers in Injibara, Ethiopia.

Objective: To assess the Knowledge, and Attitude towards first-aid utilization and its associated factors among Public Transport Service Drivers in Injibara, Northwest Ethiopia, 2023.

Methods: A cross-sectional study was conducted involving 419 public transport drivers, selected systematically based on vehicle side numbers, starting with a random choice for the first respondent. Subsequent participants were chosen at every second interval (k = 2). A structured questionnaire was used to collect relevant data. Binary logistic regression was performed using SPSS V.26 to assess the associations between independent and dependent variables. The strength of these associations was measured using odds ratios and 95% confidence intervals, with a P-value < 0.05 deemed statistically significant.

Result: The study revealed that the prevalence of good knowledge and favorable attitudes toward first-aid utilization was 33.2% and 38.2%, respectively. Participation in first-aid training (AOR = 0.566, p = 0.027), access to a first-aid kit (AOR = 1.65, p = 0.027), and prior experience using first-aid at accident scenes (AOR = 0.476, p = 0.014) were factors associated with better first-aid utilization. Drivers who had used a first-aid kit (AOR = 0.476, p = 0.014) and those exposed to training (AOR = 0.486, p = 0.034) demonstrated more positive attitudes toward first aid.

Conclusion: The knowledge and attitude toward first-aid utilization remain low. Participation in first-aid training, access to first-aid kits, and experience using them during accidents were factors associated with improved knowledge. Additionally, drivers who have used first-aid kits and received training tend to have a favorable attitude toward their use. Therefore, relevant authorities must enhance the availability of first-aid kits, increase the exposure of drivers, and provide training to drivers to increase their knowledge and favorable attitude towards first-aid utilization.

Clinical trial number: Not applicable.

Introduction: Implementing innovative educational methods is crucial for enhancing emergency technicians' knowledge and skills in providing fundamental care for trauma patients. This study aims to assess the impact of a scenario-based pre-hospital trauma management (PHTM) course on the knowledge and skill level of emergency medical system (EMS) students in Iran.

Methods: This semi-experimental, single-group pre-test-post-test study involved 25 emergency medical students participated in the PHTM training course. The students underwent two days of training (6 h per day) in a simulated, scenario-based environment across 5 stations, using realistic patients. The PHTM course knowledge assessment tool and a standard clinical skills checklist were used to collect data before and after the intervention.

Results: The results revealed that EMS students had an average level of trauma knowledge and clinical skills before the PHTM course, which significant improved to a desirable level after the intervention(P = 0.0001). The average skill level increased from 57.44 before the intervention to 122.24 afterward. The results also demonstrated that the interventions significantly improved students' skill levels in various PHTM domains, including trauma patient assessment, spinal motion restriction for sitting and lying positions, immobilization of injured long bones and joints, application of a traction splint, bleeding control and shock treatment, airway management, and ventilation/endotracheal intubation skills(P = 0.0001).

Conclusion: The findings of this study indicate that scenario-based and simulated training methods, as applied in the PHTM workshop, are effective in improving emergency medical students' knowledge and clinical skills for managing trauma patients.

Background: Anemia affects up to 25% of emergency department (ED) patients. Restrictive red blood cell (RBC) transfusion strategies are recommended for stable patients, but ED transfusion practices often remain liberal. Benefits of ED transfusion remains unclear.

Objective: To evaluate the impact of ED transfusion on death-adjusted in-hospital length of stay (LOS) in stable anemic patients requiring hospitalization.

Methods: This single-center retrospective propensity-matched study included patients ≥ 18 years admitted to the ED of Nîmes University Hospital in 2022 with hemoglobin levels between 70 and 90 g.L^- 1. Patients with hemorrhagic shock or requiring emergent hemostatic procedures were excluded. Propensity score matching was conducted on variables including age, comorbidities, hemoglobin levels, and diastolic blood pressure. Primary outcome was adjusted in-hospital LOS. Secondary outcomes included ED LOS and RBC transfusion volumes.

Results: Among 564 patients, 118 (21%) were propensity-matched: 59 (50%) ED-transfused, 59 (50%) non-ED-transfused. Adjusted in-hospital LOS 13 [8-32] for ED-transfused patients and 12 [6-24] days for non-ED-transfused patients (median difference = 0; 95%CI: -10-7; p = 0.52). Median difference in ED LOS was 7:13 (95%CI: 1:00-11:25; p < 0.001) between ED transfused and non-ED-transfused patients. Median difference in number of RBC transfused during in hospital stay was 2 (95%CI: 1-3); p < 0.01) between ED transfused and non-ED-transfused patients.

Conclusion: In stable anemic patients with 70 to 90 g.L^- 1 hemoglobin level, ED transfusion did not reduce adjusted in-hospital LOS but prolonged ED LOS. Identifying patients who may safely defer transfusion could improve ED efficiency and safety.

Background: Emergency endotracheal intubation is a critical skill for managing airway emergencies in the emergency department (ED). Accurate prediction of difficult laryngoscopy is essential for improving first-attempt success, minimizing complications, optimizing resource utilization, and enhancing patient outcomes. Traditional methods, such as the LEMON criteria, have limited predictive accuracy. Machine learning (ML) offers advanced predictive capabilities by analyzing large datasets and identifying complex variable interactions. This study aimed to develop and validate the performance of ML models for predicting difficult laryngoscopy in the ED, comparing it with a conventional regression model.

Methods: A retrospective cohort study was conducted on 4,370 adult patients who underwent intubation in the ED at Thammasat University Hospital. Difficult laryngoscopy was defined as a Cormack-Lehane grade III or IV. Patients were divided into development (training, 70%) and validation (testing, 30%) cohorts. Predictors of difficult laryngoscopy were identified using multivariable stepwise backward elimination logistic regression and were used to develop ML models, including Logistic Regression, Decision Tree, Random Forest, and XGBoost. Model performance was evaluated using the area under the receiver operating characteristic curve (AuROC), accuracy, precision, recall, and F1-score. Validation was performed on the validation cohort to confirm model accuracy.

Results: Nine significant predictors were identified: male sex, trauma, absence of neuromuscular blocking agents, large incisors, large tongue, limited mouth opening, short thyrohyoid distance, obstructed airway, and poor neck mobility. The Random Forest model demonstrated the highest predictive performance, with an AuROC of 0.82 (95% CI: 0.78-0.85), accuracy of 0.89, recall of 0.89, and F1-score of 0.87, outperforming conventional regression (AuROC 0.76, 95% CI: 0.73-0.78) and other ML models. DeLong's test confirmed a statistically significant difference in AuROC between the two models (p = 0.002). The Decision Tree showed limited performance due to overfitting, while XGBoost demonstrated strong precision. No significant differences were found when comparing the two models with conventional regression (p = 0.498 and 0.496, respectively).

Conclusion: The Random Forest model provides the most robust prediction of difficult laryngoscopy, outperforming both conventional and other ML methods. While ML models improve predictive accuracy, logistic regression remains a practical option in resource-limited settings. Integrating ML into clinical workflows could enhance decision-making, resource allocation, and patient safety in emergency airway management. Future research should prioritize external validation and real-world implementation.

Background/aim: Disasters are becoming more frequent globally. In the past years, Saudi Arabia has been exposed to various disasters. Public awareness of disasters and disaster preparedness/response are deemed important to reduce risks, injury, or even death from disasters. This study was conducted to determine the level of knowledge, beliefs, and performance of female high school students in relation to disaster preparedness.

Method: From November to December 2016, a cross-sectional study was conducted among 579 female high school students enrolled in five public schools in Riyadh, Saudi Arabia. Participants were distributed a self-administered questionnaire on disaster experiences, knowledge of disaster, attitudes and beliefs, and health belief model components.

Results: The students' level of knowledge was high (48.7%), while their level of performance in disaster preventive behaviours was average (28.5%). The students' total preparedness for disasters was also average (30%). Their beliefs regarding the risk of catastrophe were low (45.1%).

Conclusion: The findings of this study reveal a significant gap between knowledge and action. The students' disbelief in the occurrence of disasters and the importance of preparation has led to a lack of readiness. This underscores the critical need for increased education and emphasis on disaster response and preparedness among female high school students.