BMC Emergency Medicine最新文献

Background: Most early warning scores were derived in heterogeneous acutely ill populations and are not specifically tailored to patients with suspected sepsis in the emergency department (ED). In sepsis, respiratory rate (RR) is frequently elevated as part of the pathophysiologic response, suggesting that sepsis-focused tools may require recalibrated RR thresholds. We therefore aimed to develop and evaluate the Respiratory National Early Warning Score (R-NEWS), a sepsis-oriented modification emphasizing respiratory parameters, to improve prediction of 28- and 7-day mortality among ED patients with suspected sepsis.

Methods: We conducted a prospective cohort study in the ED of Thammasat University Hospital, enrolling adults with suspected sepsis and excluding those with cardiac arrest or do-not-resuscitate orders. Multivariable backward stepwise logistic regression identified significant predictors of 28-day mortality, which were then used to construct the R-NEWS scoring system. Predictive performance was evaluated and compared with NEWS, qSOFA, and SIRS using the area under the receiver operating characteristic curve (AuROC).

Results: A total of 1,348 patients were analyzed; 28-day mortality was 13.4%. Five independent predictors were identified: respiratory rate, need for supplemental oxygen, systolic blood pressure, heart rate, and Glasgow Coma Scale. R-NEWS demonstrated good calibration (Hosmer-Lemeshow p = 0.474) and higher discrimination than NEWS, qSOFA, and SIRS. The AuROC of R-NEWS was 0.72 (95% CI, 0.68, 0.76) for 28-day mortality and 0.76 (95% CI, 0.71, 0.81) for 7-day mortality. Internal validation using bootstrapping yielded consistent results. High-risk R-NEWS (≥ 7) was associated with a 28-day mortality of 28.9%, compared with 3.9% in the low-risk group (≤ 3).

Conclusion: R-NEWS, a simplified five-parameter score emphasizing respiratory function, demonstrated favorable performance for predicting short- and intermediate-term mortality in ED patients with suspected sepsis. Used alongside clinical judgment, R-NEWS may aid early risk stratification and sepsis management. External, multicenter validation and prospective evaluation are warranted before widespread implementation.

Background: Emergency department (ED) overcrowding has become a global public health concern, underscoring the importance of rapid and reliable risk stratification tools. Early warning scores are widely used to identify patients at risk of deterioration and mortality. The recently developed International Early Warning Score (IEWS), which incorporates age and sex adjustments into the National Early Warning Score (NEWS) model, has shown promising results and has undergone initial external validation in a Danish cohort; however, no prospective external validation has yet been conducted, and broader international validation remains limited. This study aimed to evaluate the performance of IEWS compared with NEWS in predicting in-hospital mortality, 30-day mortality, and ICU admission among adult ED patients.

Methods: This prospective observational cohort study was conducted between July and August 2024 in a tertiary university hospital ED with an annual census of ~ 70,000 visits. Adult patients presenting to the ED were included, while trauma cases, patients without vital signs on arrival, interhospital transfers, and cases with incomplete data were excluded. IEWS and NEWS were calculated at presentation. The primary outcome was all-cause in-hospital mortality; secondary outcomes included 30-day mortality and ICU admission.

Results: A total of 8,666 patients were analyzed. The median age was 40 years (IQR: 26-58), and 51.5% were female. In-hospital mortality was 1.5% (n = 134), and 30-day mortality was 1.9% (n = 163). IEWS demonstrated excellent discriminative ability for in-hospital and 30-day mortality (AUC: 0.944 and 0.930, respectively), and good performance for ICU admission (AUC: 0.876). In contrast, NEWS showed good performance for in-hospital and 30-day mortality (AUC: 0.884 and 0.848, respectively) and moderate performance for ICU admission (AUC: 0.781). IEWS consistently outperformed NEWS across all outcomes (p < 0.05, DeLong's test).

Conclusion: IEWS outperformed NEWS in predicting in-hospital mortality, 30-day mortality, and ICU admission among non-traumatic ED patients. Given its high sensitivity, specificity, and overall discriminative performance, IEWS may serve as a reliable bedside tool for patient risk stratification in the ED. Large-scale multicenter studies are needed to confirm its generalizability across diverse populations.

Clinical trial number: Not applicable.

Background: Oncologic emergency is a serious clinical experience that presents significant challenges to patients and caregivers. A comprehensive understanding of the overall magnitude of oncologic emergencies is critical. However, existing literatures are fragmented and varying in the report of results. Therefore, this study aims to determine the overall magnitude of oncologic emergency in Ethiopia METHODS: Comprehensive literature search was conducted from various sources. A random-effects meta-analysis was conducted using DerSimonian-Laird to estimate the pooled effect size. Heterogeneity was checked using I² statistic. Sub group and sensitivity analysis was conducted to mitigate heterogeneity. Funnel plot and egger's regression test was used to check publication bias and small study effect.

Results: This study included 23 studies involving a total of 6755 cancer patients. The pooled prevalence of oncologic emergency across in Ethiopia was 30.87% (95%CI 23.72-38.02). Substantial heterogeneity (I² = 98.5%) across the studies were identified. The 95% prediction interval ranged from 5.62% to 67.40%, reflecting the expected prevalence in a new study. Comorbidity, advanced age, being on cancer treatment, and metastasis were significant predictors of oncologic emergency.

Conclusion: Advancing innovations in early detection and prompt intervention is critical to reduce the burden of oncologic emergency on patients and the health care system. A notable challenge encountered was the variability in definitions and measurement of oncologic emergencies across included studies.

Background: Despite breathlessness (dyspnoea) being a common and serious symptom that often necessitates ambulance care, there is still a limited understanding of how ambulance clinicians (ACs) experience and manage these situations in the pre-hospital setting. Given the potential severity and complexity of breathlessness, as well as its impact on patient outcomes, a deeper insight into ACs' perspectives is essential. This study aimed to explore ACs experiences of caring for patients with breathlessness within ambulance services.

Methods: An inductive qualitative design was employed. Data were collected through dyadic interviews with 16 ACs from two ambulance organizations in southwestern Sweden during two days in May and June 2021. The data were analyzed using qualitative content analysis.

Results: The ACs experienced several challenges in caring for patients with breathlessness, which is captured in three generic categories: navigating patients' experiences during breathlessness, navigating relatives and their involvement, and navigating one's own capability in care. ACs highlighted challenges of identifying and addressing patients' individual needs, emphasizing the crucial role of trust-building. While ACs relied on their clinical expertise, assessing a patient's condition remained challenging in certain situations. Furthermore, their ability to manage stress and emotional demands were essential for providing quality care.

Conclusions: This study underscores the challenges of caring for patients with breathlessness, with ACs employing strategies to manage stress and establish a safe environment. Clinical experience and ongoing training and education are strategies to strengthen clinical reasoning and decision-making. Pairing less experienced ACs with seasoned colleagues could also improve care quality and support the development of professional competence.