BMC Emergency Medicine最新文献

Background: The ability of hospitals to provide special care services for critically ill or injured patients during emergencies and disasters poses very significant challenges that necessitate the response in-place plans. the increasing frequency of such events, coupled with limited hospital resources and increasing patient volumes, underscores the urgency of addressing these issues. Specifically, this study aims to identify the challenges faced by hospitals in providing special services during disasters.

Method: This scoping review, conducted in 2024, based upon the framework developed by Arksey and O'Malley. An extensive search of Literature searching was performed using gray literature and databases including Google Scholar, PubMed, Web of Science, and Scopus. Applying the selection criteria, a total of 33 relevant studies were identified that discuss the challenges faced when providing special care services in hospitals during emergencies and disasters. Results are presented in accordance with the PRISMA checklist to ensure quality and transparency. Data was analyzed through a systematic coding process where common themes across the studies were identified.

Results: This review identified 15 distinct challenges associated with providing special care services in hospitals during emergencies and disasters: limited resources, inadequate infrastructure, lack of pre-hospital care, financial constraints, failures in the emergency response system, triage, deficiencies in management structure, planning, and preparation, communication and coordination deficits, training and protocols development, employee welfare challenges, challenges of continuity of care, increased demand, different and complex needs of patients, ethical challenges, imbalance in distribution of service resources.

Conclusions: Response in a hospital to the needs of special care during a disaster has to be responded to with more effective preparedness through comprehensive disaster preparedness plans, better communication and coordination, and training of staff and allocation of resources. In particular, standardized triage protocols and ethical frameworks will provide the foundation for the optimization of resource use in emergency responses. Better communication among departments and also with other outside organizations will improve how resources are used to better achieve good patient outcomes within emergency responses.

Background: Droperidol is a first-generation antipsychotic medication that has been used for various indications in the emergency department (ED); however, its use has been controversial due to reports of QT prolongation and the risk of torsades de pointes (TdP). The aim of the study is to evaluate the safety of droperidol administration in the ED.

Methods: This was a retrospective study, conducted at an academic level I trauma center. System-generated reports were used to identify all droperidol administrations in the ED from the time that droperidol was reintroduced to the institutional formulary on July 1, 2019 through January 31, 2023. The major safety endpoint was a composite of the incidence of QTc interval prolongation, incidence of TdP, ventricular arrhythmia, or hypotension.

Results: A total of 327 administrations of droperidol were identified in 245 patients in the ED. The composite safety endpoint occurred in 30 (9.1%) administrations. None of these events were classified as "probable" or "definite" on the Naranjo adverse drug reaction probability scale. No episodes of TdP or serious ventricular arrhythmia were reported. Higher cumulative droperidol dose and creatinine clearance < 60 mL/min were associated with an increased odds of developing QTc prolongation (OR 1.27 [CI 1.04-1.56]) and (OR 1.01 [CI 1.0-1.02]), respectively.

Conclusions: The study supports the use of low dose droperidol for various indications in the ED. There were no serious adverse events reported that could be directly attributed to droperidol use; however, it is crucial to consider the potential dose dependent impact on QTc prolongation.

Background: Paediatric mortality rates in low- and middle-income countries account for over 80% of the global burden. In South Africa, one in every 33 children will not reach the age of five. Despite the high mortality rate, there is a paucity of data describing the prehospital paediatric under-five emergency care burden in South Africa. Such data are essential to inform the development of local prehospital emergency care guidelines and targeted prevention strategies.

Aim: This study describes the prehospital paediatric under-five emergency care burden managed by the Western Cape Government Health and Wellness (WCGHW) Emergency Medical Services (EMS) in South Africa.

Methods: A retrospective review of the prehospital records was conducted, extracting epidemiological and clinical data from the WCGHW EMS patient record database. The review included all paediatric cases under-five, managed between 1 January 2022 and 31 December 2023, in the Western Cape of South Africa.

Results: In the 87 457 cases, there was a similar distribution between the primary cases (50.7%) and interfacility transfers (49.3%). Most activations emanated from rural areas (47 980, 54.9%), with respiratory emergencies (30 934, 35.4%), non-cardiac pain (11 381, 13.0%) and trauma (10 831,12.4%) being the most common presenting complaints. Most cases were prioritised as priority 2 (46 034, 52.6%), with most of these being older children between one and five years old (29 008, 63.0). Low acuity cases accounted for 67.2% (58 818) of the sample, with the highest mortality occurring between 29 days and 12 months (190, 52.9.%). Most patients spent less than one hour in the prehospital setting (64 431, 73.7%), with advanced airway management (748, 43.1%) being the most common airway intervention.

Conclusion: This first description of the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS reveals a unique burden, particularly regarding the high interfacility transfer rates. As illustrated in graphical abstract, these findings underscore critical considerations for healthcare planners and the prehospital training environment. Future research among this population should focus on characterising the reasons for the high interfacility transfer rates through assessments of healthcare access, EMS care quality and post-EMS follow-up.

Introduction: Learning motivation is essential to obtain and maintain ultrasound competencies in emergency medicine. One's competencies herein and the need for ongoing training are best evaluated by self-assessment. This may be flawed by overconfidence effects - the belief to be better than others or better than tests reveal. This study aims to clarify the underinvestigated interaction of learning motivation and self-assessment in emergency point-of-care-ultrasound (POCUS).

Methods: In this cross-sectional multicenter project, physicians assessed their own and others' competence and learning motivation using the Situational Motivation Scale comprising intrinsic motivation, external and identified regulation, and amotivation. In addition, we presented eight ultrasound loops of different pathologies to emergency physicians of various specialties.

Results: Overall, the motivation to learn was high, while self-assessment showed no significant overconfidence in POCUS. The rate of correct diagnoses based on the loops was relatively low. As a result, we did not detect overconfidence effects in participants who completed questions (n = 86) and tests (n = 56). Overplacing oneself above peers negatively correlated with intrinsic learning motivation and identified regulation and positively correlated to amotivation. Further analyses indicated that learning motivation was associated with the interactions of the physicians' risk perception, speciality, and self-assessment.

Discussion: The absence of overconfidence effects, the complexity of learning motivation and their interaction show that prior findings in other contexts may not be easily transferable to POCUS and could be highly context-sensitive. In conclusion, this study highlights high levels of learning motivation but relatively low diagnostic accuracy in POCUS, which suggests the need for ongoing education and assessment. Ensuring that physicians continue to receive objective feedback and opportunities to refine their skills is critical for maintaining high standards of care. Despite the small sample size and other limitations of the study, the results primarily served to generate hypotheses for future research on emergency ultrasound education.

Background: In the complex landscape of modern warfare, understanding combat-related injuries leading to hospitalization is crucial for optimizing injury treatment. This study aims to compare combat casualty characteristics and outcomes during the major conflicts between Israel and Hamas in 2023 and 2014 as a basis for understanding the effectiveness of trauma care practices for wounded soldiers.

Methods: A cohort study of soldiers hospitalized due to combat injuries during two major wars between Israel and Hamas in 2023 and 2014, using data from the Israeli National Trauma Registry. This study did not include deaths before hospital arrival or casualties who were discharged from the Emergency Department.

Results: Of the 1,198 study subjects, 67.8% belonged to the 2023 cohort and 32.2% to the 2014 cohort. The percentage of casualties with severe and critical injuries (Injury Severity Score [ISS] 16-75) was higher among the 2023 cohort (18.6% vs. 13.7%, p = 0.036), as was the percentage of casualties with multiple severe injuries (≥ 2 regions with Abbreviated Injury Score ≥ 3: 11.5% vs. 7.5%, p = 0.035) and firearm injuries (19.6% vs. 14.5%, p = 0.081). Injuries to the torso and extremities were more frequent among the 2023 cohort. Among the critically injured casualties (ISS 25-75), the mortality rates were 17.3% vs. 28.6%, respectively, for the 2023 and 2014 cohorts (p = 0.351); adjusted HR (95% CI): 0.56 (0.21-1.49). The 2023 cohort had higher rates for treatment in the trauma bay (61.5% vs. 47.9%, p < 0.001), ICU utilization (admission: 16.3% vs 11.7%, p = 0.036), surgical intervention (51.5% vs. 42.7%, p = 0.005), longer duration from arrival to surgery (median [interquartile range]: 4.6 (1.2-18.5) vs. 2.6 (1.1-10.1) hours, p = 0.037), and longer hospital stays (> 14 days: 15.5% vs. 8.8%, p < 0.001).

Conclusions: Our data demonstrated that more casualties who survived to hospital arrival were severely and multiply injured in the 2023 Israel-Hamas war as compared to the 2014 war. Despite the increased severity, in-hospital survival did not worsen though there was an increase in hospital resource utilization.

Background: In emergency settings, difficult intubations often occur unexpectedly despite pre-intubation assessments. Traditional glottic view scoring systems for direct laryngoscope may not apply to video laryngoscopy. With video laryngoscopy, the vertical location of the glottis on the monitor can be clearly defined. If the glottis location is associated with intubation difficulty, it could serve as a simple indicator for anticipating intubation challenges. This study aimed to investigate the relationship between the glottis screen location during video laryngoscopy-guided intubation and the success and timing of the first-attempt intubation.

Methods: We retrospectively analyzed laryngoscopy recordings from adult intubations in the emergency department of a tertiary teaching hospital in Chiayi, Taiwan, using the C-MAC video laryngoscope between March 2020 and April 2023. The vertical screen location of the vocal cords, determined by the arytenoid cartilage position after laryngeal blade engagement, was categorized into upper and lower locations for analysis. The primary outcome was first-attempt intubation success within 90 s, analyzed using Kaplan-Meier survival curves and multivariable Cox proportional hazard analysis.

Results: Among 209 laryngoscopy records, 113 had the arytenoid in the lower field of view and 96 in the upper field. Kaplan-Meier analysis showed a significantly lower cumulative success rate for intubations with a higher arytenoid location (log-rank test, P < 0.001). Multivariable Cox models, adjusted for factors like modified Cormack-Lehane grade, blade tip engagement, and other intubation findings, confirmed the arytenoid's location as an independent predictor of successful intubation within 90 s, with an adjusted hazard ratio of 0.55 (95% confidence interval, 0.38-0.79) for the upper location group compared to the lower (P < 0.001).

Conclusions: A higher screen location of the vocal cords after blade engagement is associated with reduced first-attempt intubation success. Assessing glottis location during video laryngoscopy intubation provides a quick method to anticipate intubation challenges.

Background: Reflection is an essential educational practice often characterized as a self-regulated learning activity. Self-regulated learning has been shown to positively influence learning motivation and metacognition. This study aimed to compare the effect of group and individual reflection methods on self-regulation learning strategies and motivational components among emergency medical technicians.

Methods: This quasi-experimental study was conducted on 54 emergency medical technicians in South Khorasan province in 2023. Thirty pre-hospital emergency centers affiliated to Birjand University of Medical Sciences were randomly assigned to three blocks (A, B, and C). Participants were then selected through convenience sampling based on predetermined inclusion and exclusion criteria. Eighteen participants working in pre-hospital emergency centers were selected from each block. The three blocks (A, B, and C) were randomly assigned into three arms: individual reflection, group reflection, and control. The individual reflection group members were asked to record their feelings and experiences using the Gibbs model in provided notebooks during four weeks (at the end of each week). The group reflection members, after forming groups and selecting leaders, engaged in the group reflection sessions in a designated room, following the Gibbs model for four weeks. The self-regulated learning strategies and learning motivation components of all participants were measured using standardized questionnaires before and after the intervention. Data were analyzed using paired t-test, one-way analysis of variance, Tukey's post hoc test, and Fisher's exact test.

Results: The mean score of self-regulation learning strategies and learning motivation significantly increased in the group reflection arm after the intervention (p < 0.05). While the mean scores of motivational component and its individual components increased significantly in the individual reflection group after the intervention (p < 0.05), no significant difference was observed in the mean scores of self-regulation learning strategies and their components before and after the intervention (p > 0.05).

Conclusion: The results of this research highlight the superiority of group reflection method over individual reflection in promoting self-regulated learning. While both methods were effective in enhancing learning motivation, group reflection proved to be more beneficial. Therefore, it is recommended that Emergency Medical Services managers provide training programs that incorporate group reflection to enable technicians to benefit from its advantages in terms of self-regulated learning strategies and learning motivation.

Background: Accurate triage is required for efficient allocation of resources and to decrease patients' length of stay. Triage decisions are often subjective and vary by provider, leading to patients being over-triaged or under-triaged. This study developed machine learning models that incorporated natural language processing (NLP) to predict patient disposition. The models were assessed by comparing their performance with the judgements of emergency physicians (EPs).

Method: This retrospective study obtained data from patients visiting EDs between January 2018 and December 2019. Internal validation data came from China Medical University Hospital (CMUH), while external validation data were obtained from Asia University Hospital (AUH). Nontrauma patients aged ≥ 20 years were included. The models were trained using structured data and unstructured data (free-text notes) processed by NLP. The primary outcome was death in the ED or admission to the intensive care unit, and the secondary outcome was either admission to a general ward or transferal to another hospital. Six machine learning models (CatBoost, Light Gradient Boosting Machine, Logistic Regression, Random Forest, Extremely Randomized Trees, and Gradient Boosting) and one Logistic Regression derived from triage level were developed and evaluated using EPs' predictions as reference.

Result: A total of 17,2101 and 41,883 patients were enrolled from CMUH and AUH, respectively. EPs achieved F1 core of 0.361 and 0.498 for the primary and secondary outcomes, respectively. All machine learning models achieved higher F1 scores compared to EPs and Logistic Regression derived from triage level. Random Forest was selected for further evaluation and fine-tuning, because of its robust calibration and predictive performance. In internal validation, it achieved Brier scores of 0.072 and 0.089 for the primary and secondary outcomes, respectively, and 0.076 and 0.095 in external validation. Further analysis revealed that incorporating unstructured data significantly enhanced the model's performance. Threshold adjustments were applied to improve clinical applicability, aiming to balance the trade-off between sensitivity and positive predictive value.

Conclusion: This study developed and validated machine learning models that integrate structured and unstructured triage data to predict patient dispositions, distinguishing between general ward and critical conditions like ICU admissions and ED deaths. Integrating both structured and unstructured data significantly improved model performance.

Background: Road traffic injuries are a global public health challenge. This study was conducted to describe the epidemiological patterns of road traffic injuries in a large tertiary care hospital in the West Bank of Palestine. In addition, associations between the different variables of the victims and the patterns of road traffic injuries were also assessed.

Methods: This study was conducted in a retrospective cohort observational design between January 2021 and July 2023 at a large tertiary care hospital in Nablus, Palestine. The data were collected from the electronic medical record system of the large tertiary care hospital using a data collection form.

Results: A total of 1,544 victims of traffic road injuries were included in this study. Lower limb (43.0%), neck (41.2), and upper limb (39.8%) injuries were the most common types of road traffic injuries sustained by the victims admitted to the large tertiary care hospital. The victims who were 30 years or older were more likely to sustain back injuries (aOR = 1.71, 95% CI: 1.20-2.45) pelvic injuries (aOR = 1.84, 95% CI: 1.08-3.12), chest injuries (aOR = 1.59, 95% CI: 1.06-2.38), and neck injuries (aOR = 2.54, 95% CI: 1.68-3.82) compared to the victims who were younger than 30 years. The victims who did not use seatbelts were more likely to sustain abdominal injuries (aOR = 1.88, 95% CI: 1.34-2.63) and head injuries (aOR = 1.49, 95% CI: 1.06-2.10) compared to the victims who used seatbelts. The victims who did not have the airbag deployed were more likely (aOR = 1.85, 95% CI: 1.31-2.63) to sustain neck injuries compared to the victims who had the airbag deployed.

Conclusion: The epidemiological patterns of road traffic injuries in a large tertiary care hospital in Nablus, Palestine were described and the associations between the different variables of the victims and the patterns of road traffic injuries were assessed. The findings indicated a need to design measures to prevent/minimize these injuries. Future studies are still needed to determine the best measures to avoid/minimize the incidence of serious road traffic injuries.

Objective: Studies have shown that Emergency Department physicians have little to no training in recognizing and supporting victims of human trafficking despite being uniquely situated to identify and intervene on behalf of these patients. We assessed if screening for human trafficking was being completed by emergency physicians in three Saskatoon emergency departments.

Methods: We performed a retrospective chart review of patients presenting to three Saskatoon emergency departments deemed to potentially be at risk of human trafficking, based on discharge diagnosis. Of the 223 included charts, data extracted included sex, age, ethnicity, chief complaint, diagnosis, disposition, HT Screening (Y/N), specific quotes relating to HT, time of visit, intimate partner violence (Y/N), and travel history. Both quantitative and qualitative thematic analyses were conducted on this data.

Results: None of the charts (0%) included in this study had any documentation around screening for human trafficking. Furthermore, 21.1% of the high-risk patient charts included in this study -- which included many patients with a discharge diagnosis of sexually transmitted disease or pelvic inflammatory disease -- did not contain a documented sexual history. Thematic analysis revealed that the patients included in this study frequently had challenges with sexual health, substance use, and houselessness.

Conclusion: This study found that Emergency physicians in Saskatoon were not routinely screening for human trafficking. Implementation of further training is needed to help these physicians recognize and subsequently support potential victims of human trafficking.