BMC Emergency Medicine最新文献

Background: When comparing mortality, the severity of illness or injury should be considered; therefore, scoring systems that represent severity have been developed and used. Given that diagnosis codes in the International Classification of Disease (ICD) and vital signs are part of routine data used in medical care, a severity scoring system based on these routine data would allow for the comparison of severity-adjusted treatment outcomes without substantial additional efforts.

Methods: This study was based on the National Emergency Department Information System database of the Republic of Korea. Patients aged 15 years or older were included. Data from between 2016 and 2018 were used to develop the scoring system, and data from 2019 were used for testing. We calculated the products of the number of disease-specific survival probabilities (DSPs) to reflect the severity of the patients with multiple diagnoses. A logistic regression model was developed using DSPs, age, and physiological parameters to develop a more accurate mortality prediction model.

Results: The newly developed model showed predictive ability, as indicated by an area under the receiver-operating characteristic curve of 0.975 (95% CI: 0.974-0.977). When a threshold value of -5.869 was used for determining mortality, the overall accuracy was 0.958 (0.958-0.958).

Conclusion: We developed a scoring system based on ICD codes, age, and vital signs to predict the in-hospital mortality of emergency patients, and it achieved good performance. The scoring system would be useful for standardizing the severity of emergency patients and comparing treatment results.

Introduction: Out-of-hospital pediatric resuscitation is a severe medical condition with a low survival rate. Providing pediatric resuscitation is a significant stressor for medical teams that may impair performance. The vagal nerve is a crucial moderator of stress responses, and its activation (indexed by heart rate variability, HRV) has been shown to predict and improve performance in various settings. However, there is limited data about vagal activation and performance in medical settings.

Methods: In a randomized simulation Study, paramedic students and medics were assigned to 3 min of slow-paced breathing or watching an educational 3-minute video. The participant received a scenario describing an unconscious baby without a pulse and with no breathing. The participants then performed CPR (cardiopulmonary resuscitation) on a manikin. During the scenario, every 2 min, the participant was asked a question that tested the recall of information from the scenario, and CPR performance was continuously monitored. HRV and subjective stress were taken 3 times.

Results: Higher baseline HRV predicted better CPR performance. No difference in CPR performance between the groups was found, and explanations for these results will be discussed.

Conclusion: HRV may be used to predict CPR performance. Short-term slow-paced breathing does not improve CPR performance. Future studies should investigate the effect of long-term stress reduction interventions on CPR performance.

Background: The characteristics of medication administration within the prehospital setting are underexplored. Ambulance professionals operate under varied levels of responsibility, dependent on their training and collaboration with local emergency facilities and other medical personnel. Given the critical condition of many patients using these services and the challenging environments they operate in, the risk of adverse drug events is significant. The aim was to advance the knowledge of the medication administration process in the setting of ambulance services.

Methods: A qualitative mixed-methods design was applied to examine the medication administration process among ambulance professionals in a Norwegian hospital trust. Data collection included individual semi-structured interviews with 11 ambulance professionals at three ambulance stations, complemented by 114 h of observations. Interviews and observations were guided by the System Engineering Initiative for Patient Safety (SEIPS) work system model, and data were analyzed using a combined deductive-inductive content analysis.

Results: The medication administration process in the ambulance work system is condensed into three stages: preparation, administration, and patient transfer, primarily due to constraints related to time and available information. The medication administration work system is influenced by a set of eight interrelated categories. These include technological aspects such as workarounds necessitated by inadequate equipment, organizational dynamics such as the fluid delegation of tasks, physical environmental conditions that impact on decision-making, and personal factors such as collaboration in managing critical patient scenarios.

Conclusion: Medication administration tasks in the ambulance service take place along a continuum involving physical, technological, and organizational factors that interact and continuously influence ambulance professionals in their everyday practices. The study highlights the need for enhanced medication administration processes in ambulance services through improved collaboration, training, technological usability, and organizational adaptability.

Introduction: Workplace bullying among nurses working in emergency departments is a serious issue that can significantly impact their job stress levels. One of the most important sources of stress in every person's life is their job. This study aimed to determine the relationship between workplace bullying and job stress among nurses in emergency departments.

Methods: This cross-sectional study was conducted in the emergency departments of hospitals affiliated with Kurdistan University of Medical Sciences in 2023 in Iran. A total of 211 nurses were selected based on inclusion criteria using a census method. Data collection tools included a demographic information form, the Negative Acts Questionnaire for workplace bullying, and the Nursing Job Stress Questionnaire. Data were analyzed using descriptive and inferential statistics (P < 0.05).

Findings: The findings showed that the mean scores for job stress and workplace bullying in nurses were 127.87 ± 34.30 and 56.47 ± 21.58, respectively, both at moderate levels. Furthermore, the results indicated a significant relationship between nurses' job stress in all dimensions and workplace bullying (P < 0.05).

Conclusion: Considering the average levels of bullying in the work environment and occupational stress of nurses and the existence of a significant statistical relationship between these two variables, the results of this research can help nursing managers to plan effectively to reduce bullying in the workplace and occupational stress of nurses.

Clinical trial number: Not applicable.

Purpose: Mild traumatic brain injury (mTBI) is one of the most common trauma-related diagnoses treated in emergency departments, especially among the geriatric population. Higher age alone is often an indication for a computed tomography (CT) scan, even when, approximately 90% of these scans do not reveal intracranial injuries. Incorporation of new diagnostic parameters into indication schemes for CT scans could improve the efficiency and reduce unnecessary imaging. The primary outcome of this study was to evaluate the association of acute behavioral changes among elderly patients treated for mTBI with the prevalence of intracranial injuries diagnosed by CT scans.

Methods: A retrospective cross-sectional study was conducted at Louis Pasteur University Hospital in Košice. All patients aged 65 and older who presented during the period of 12 months with suspected mTBI and underwent CT imaging were included in the study. Electronic health records were used as a data source.

Results: A total of 586 patients were included in the study. Acute behavioral changes were observed among 60 (10.2%) patients. Intracranial injury was diagnosed in 35 patients (6.0%). There was a statistically significant association between acute behavioral changes and the presence of intracranial injuries (p < 0.05), with those exhibiting behavioral changes having higher odds of injury (OR: 6.51; 3.01-13.7; p < 0.001).

Conclusion: Elderly patients with mTBI who present with acute behavioral changes are more likely to have intracranial injuries detected by CT scans. Incorporating these symptoms into indication schemes for head CT scans may improve strategies aimed at more effective and judicious use of imaging.

Trial registration: Clinical trial number: Not applicable, retrospectively registered.

Background: Comparison of emergency departments (EDs) becomes more important, but differences are difficult to interpret because of the heterogeneity of the ED population regarding reason for ED presentation. The aim of this study was two-fold: First to compare patient characteristics (including diagnoses) across 7 EDs. Secondly, to compare Standardized Mortality Ratios (SMRs) across 7 EDs and in subgroups of ED patients categorized by presenting complaints (PCs).

Methods: Observational multicenter study including all consecutive visits of 7 Dutch (two tertiary care centre and 5 teaching hospitals) EDs. Patient characteristics, including PCs as part of triage systems, and SMRs (observed divided by expected in-hospital mortality) per ED and for the most common PCs (PC-SMRs) were compared across EDs and presented as funnel plots. The expected mortality was calculated with a prediction model, which was developed using multivariable logistic regression in the overall population and for PCs separately. Demographics, disease severity, diagnoses, proxies for comorbidity and complexity, and PCs (overall population only) were incorporated as covariates.

Results: We included 693,289 ED visits from January 1, 2017 to June 31, 2023, with a median age of 56 years, of which 47.9% were women and 1.9% died. Patient characteristics varied markedly among EDs. Expected mortality was similar in prediction models with or without diagnoses as covariate. SMRs differed across EDs, ranging from 0.80 to 1.44. All EDs had SMRs within the 95%-Confidence Intervals of the funnel plot apart from one ED, which had an higher than expected SMR. However, PC-SMRs showed more variation and more EDs had SMRs falling outside the funnel, either higher or lower than expected. The ranking of SMRs across EDs was PC-dependent and differences across EDs are present only for specific PC-SMRs, such as in "dyspnea" and "feeling unwell".

Conclusion: In summary, patient characteristics and mortality varied largely across Dutch EDs, and expected mortality across EDs is well assessed in PC subgroups without adjustment for final diagnoses. Differences in SMRs across EDs are PC-dependent. Future studies should investigate reasons of the differences in PC-SMRs across EDs and whether PC-targeted quality improvement programs can improve outcomes.

Background: The capillary refill test is widely used in pediatric emergency medicine and critical care although its validity and reliability are debated. Naked eye estimation is the recommended method for capillary refill time (CR time) assessment. The goal of this study was to compare naked eye estimations of the CR time in pediatric patients to quantified capillary refill time (qCR time) using polarized reflectance imaging as an objective reference, and to investigate interobserver and intra-observer consistency of naked eye assessments of CR time.

Method: A film sequence comprising videos of capillary refill tests from 15 emergency pediatric patients was shown under standardized conditions to 62 observers (pediatricians, nurses, assistant nurses, and medical secretaries). The observers' estimations of CR time in seconds and in descriptive categorizations were compared to objectively derived qCR time. Three tests were shown twice without the observers' knowledge.

Results: There was poor interobserver agreement in all professions, with limits of agreement ranging from 1.17 s (assistant nurses) to 2.00 s (secretaries). Intra-observer agreement for estimations of both time and descriptive categorizations was limited. The correlation between naked eye assessments and qCR time was weak.

Conclusion: This study shows that naked eye assessment of CR time in children is highly subjective with poor reproducibility in pediatric nurses and pediatricians, as well as in comparison to a quantitative method. Based on the lack of both inter- and intra-observer consistency in the assessments, these findings suggest that CR time assessed by naked eye should be questioned as a routine test in pediatric emergencies.

Background: Given nurses' vital role in emergencies, it is essential to understand their perceptions and strategies for self-control. This study examines nurses' experiences and insights regarding self-control during high-pressure scenarios. The findings could inform the development of effective stress management strategies and enhance nursing training programs, ultimately improving patients' overall quality of care.

Methods: This study utilized a qualitative, descriptive design with a content analysis approach. Data was collected through semi-structured interviews with 24 nurses in various wards of five university-affiliated hospitals, including [specific wards, e.g., emergency, intensive care, internal, etc.]. The nurses were selected using a purposive sampling technique, and the data were analyzed through qualitative content analysis.

Findings: Nurses' lived experiences and understanding of self-control in emergencies revealed three main categories, each comprising several sub-categories: Managing Emotional Intelligence in Crisis Situations (Emotion Regulation in Critical Situations, Using Resources and Experiences for Emotion Management, and Control of Individual Emotions), Adherence to Principles in Crisis Situations (Compliance with Ethical Standards, Ethical Decision-Making, Patient-Centered Focus, and Effective Communication), and Self-Control in Managing Stress and Fatigue (Fatigue Management and Interpersonal Interaction and Collaboration).

Conclusion: This study highlights the importance of self-control for nurses working in high-stress environments. It emphasizes that enhancing emotional intelligence, adhering to professional standards, and effectively managing stress are crucial for overcoming workplace challenges. These factors not only foster resilience but also support self-control, which is essential for maintaining composure and making informed decisions during emergencies. The findings advocate for creating supportive work environments and implementing evidence-based policies to improve nurses' self-control skills, ultimately leading to better patient outcomes. These insights can guide enhancements in nursing education and overall care quality.

Background: The mortality and disability rates among severely injured trauma patients are very high. This study aimed to investigate whether a new in-hospital trauma care model can improve emergency care efficiency and enhance the prognosis of severely injured trauma patients.

Methods: This retrospective observational study included 366 severely injured trauma patients (ISS ≥ 16) who were admitted to the emergency department of a tertiary hospital between 2023 and 2024. Based on the emergency care model used, patients were divided into the traditional model group (n = 213) from January to April 2023 and the new model group (n = 153) from January to April 2024. The general clinical data, prognosis information, as well as seven emergency quality control indicators for both groups were collected and analyzed.

Results: The study included 270 male patients (73.8%) and 96 female patients (26.2%), with a mean age of 56 (44, 69) years. No significant differences were found between the two groups regarding gender, age, time since injury, mechanism of injury, and vital signs upon admission (P > 0.05). The new model group had significantly shorter times for establishing effective circulation access (15.66 ± 3.36 vs. 9.44 ± 3.18 min), establishing an artificial airway (36.90 ± 12.23 vs. 23.91 ± 9.07 min), preparing blood transfusion (48.84 ± 5.73 vs. 31.0 ± 64.67 min), completing whole-body CT scans (57.18 ± 8.26 vs. 42.17 ± 7.28 min), and developing a definitive treatment plan (77.45 ± 6.26 vs. 56.50 ± 6.35 min) compared to the traditional model group. Additionally, the new model group had a significantly higher rate of bedside FAST completion (92.8% vs. 53.1%) and a higher success rate of resuscitation within the first hour (70.9% vs. 85.0%) than the traditional model group. Regarding prognosis, the new model group had a lower overall in-hospital mortality rate (12.1% vs. 5.9%) and a lower incidence of complications such as DIC and ARDS (23.9% vs. 9.2%, all P < 0.05).

Conclusion: The new in-hospital trauma care model significantly enhanced the in-hospital emergency care efficiency, reduced in-hospital mortality, and decreased the incidence of complications for severely injured patients, which may serve as a useful reference for developing countries in similar settings.

Clinical trial number: Not applicable.

Background: Recent trends indicate that the frequency of major incidents (MIs) is increasing. Healthcare systems are vital actors in societies' responses to MIs. Well-prepared healthcare systems may mitigate the effects of MIs. Disaster preparedness is based on region-specific risk and vulnerability analyses (RVAs). Hospital incident command groups (HICGs) are commonly formed per hospital's contingency plan MI to aid in disaster response. Acquiring situational awareness and decision-making in the face of uncertainty are known challenges for HICGs during MIs. However, the remoteness of rural hospitals presents unique challenges.

Aim: The aim of this study was to explore HICG leaders' perceptions of disaster preparedness in rural hospitals.

Methods: A qualitative study with semi-structured, focus group, and individual interviews was used. The data were analyzed through inductive content analysis.

Results: The analysis generated the main category, HICGs' confidence in handling major incidents and four categories. These were Uncertainty and level of recognition (containing two subcategories); Awareness of challenges and risks (containing two subcategories); Factors that facilitate preparedness, response, and leadership (containing three subcategories); and Prerequisites for decision-making (containing three subcategories and four subcategories).

Conclusions: HICG leaders generally perceived their hospital's disaster preparedness as adequate. However, preparedness was found to be influenced by several factors. The findings revealed a complex interplay of factors influencing preparedness and response, particularly highlighting challenges related to geographical isolation and resource constraints. Effective preparedness requires a comprehensive understanding of local contexts, hospital capabilities, and risks, which directly impacts training, decision-making, and resource allocation. Addressing the identified vulnerabilities necessitates targeted interventions focused on situational awareness, decision-making, collaboration, and training.

Clinical trial number: Not applicable.