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Fundamental care in the emergency room: insights from patients with life-threatening conditions in the emergency room. 急诊室的基础护理:急诊室中危及生命的病人的见解。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-17 DOI: 10.1186/s12873-024-01133-4
Veronica Pavedahl, Åsa Muntlin, Ulrica Von Thiele Schwarz, Martina Summer Meranius, Inger K Holmström

Background: Persons who become life-threateningly ill or injured (due to for example trauma or cardiac arrest) are cared for in hospitals' designated emergency rooms at the emergency department (ED). In these rooms, the life-threatening condition and biomedical focus may reinforce a culture that value the medical-technical care. Meeting patients fundamental care needs (integrating physical, psychosocial and relational care needs) in a person-centred way might hence be challenging in emergency rooms. Little is known about how person-centred fundamental care is experienced and valued by vulnerable and exposed patients in emergency rooms. This study aims to describe fundamental care needs experienced by patients with a life-threating condition in the emergency room.

Methods: A descriptive deductive qualitative study with individual interviews were carried out with 15 patients who had been life-threateningly ill or injured and admitted in an emergency room, in Sweden. Data collection was conducted during 2022. Transcribed interviews were analyzed with deductive content analysis, based on the Fundamentals of Care framework.

Results: Despite being life-threateningly ill or injured, patients were still able to describe their unique needs-which were not only related to biomedical care. A relationship was established between healthcare professionals and the patient in the initial stage, but not maintained during their stay at the emergency room. Patients felt their physical needs were met to a greater extent than psychosocial and relational needs, despite their prioritizing the latter. Patients preferred personalized care but described care as task oriented. The physical environment limited patients from having their fundamental care needs met, and they adopted to a "patient role" to avoid adding to staff stress. The emergency room situation evoked existential thoughts.

Conclusions: This paper provides unique insights into patients' experiences of being cared for in an emergency room. From the patient perspective, physical care was not enough. Relationship, timely and personalized information, and existential needs were identified as essential fundamental care needs, which were not, or only partly met. The finding highlights the need to embed and prioritize fundamental care in practice also for patients who are life-threateningly ill or injured, which in turn calls for focus on organizational prerequisites to enable person-centred fundamental care.

背景:生命垂危的病人或受伤者(如因外伤或心脏骤停)在医院指定的急诊科(ED)急诊室接受治疗。在这些急诊室里,危及生命的状况和生物医学重点可能会强化重视医疗技术护理的文化。因此,在急诊室里,以人为本的方式满足病人的基本护理需求(包括身体、心理和关系护理需求)可能具有挑战性。人们对急诊室中易受伤害和暴露在外的病人如何体验和重视以人为本的基本护理知之甚少。本研究旨在描述急诊室中生命垂危的患者所体验到的基本护理需求:方法:本研究对瑞典急诊室收治的 15 名危及生命的患者进行了描述性演绎定性研究和个别访谈。数据收集工作于 2022 年进行。根据 "护理基本原则 "框架,采用演绎式内容分析法对访谈记录进行了分析:结果:尽管患者的病情或伤势危及生命,但他们仍能描述自己的独特需求--这些需求不仅与生物医学护理有关。在最初阶段,医护人员与患者之间建立了关系,但在急诊室住院期间,这种关系并没有得到维持。患者认为,他们的生理需求在很大程度上得到了满足,而不是社会心理和人际关系方面的需求,尽管他们把后者放在了首位。患者更喜欢个性化护理,但他们认为护理是以任务为导向的。物理环境限制了病人的基本护理需求得到满足,他们采用了 "病人角色",以避免增加工作人员的压力。急诊室的情况唤起了患者的生存思考:本文对患者在急诊室接受护理的经历提供了独特的见解。从病人的角度来看,仅有身体护理是不够的。关系、及时和个性化的信息以及生存需求被认为是必不可少的基本护理需求,但这些需求没有得到满足或仅得到部分满足。这一发现突出表明,在实践中需要将基本护理纳入并优先考虑那些生命垂危的病人或伤员,这反过来又要求关注组织的先决条件,以实现以人为本的基本护理。
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引用次数: 0
Predictive value of qSOFA and hypothermia combined with PT for prognosis in patients with severe trauma: a single-center retrospective cohort study. qSOFA 和低体温联合 PT 对严重创伤患者预后的预测价值:一项单中心回顾性队列研究。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-17 DOI: 10.1186/s12873-024-01132-5
Limei Ma, Chen Yang, Cen Chen, Yan Wu, Rong Tang, Xiaolong Cheng, Haifei Wu, Jianjun Zhu, Bing Ji

Background: Trauma represents a significant global health challenge.The development of an effective scoring tool capable of predicting mortality risk in trauma cases is essential. This study aimed to investigate the combined effects of quick sequential organ failure assessment (qSOFA) and hypothermia (H) along with prothrombin time (PT) in predicting the prognosis of patients with severe trauma.

Methods: A retrospective cohort study was conducted to analyze data from severe trauma patients in the Trauma Database of the Trauma Center at the Second Affiliated Hospital of Soochow University between January 2017 and December 2021. Patients were categorized into survival and non-survival groups based on clinical outcomes. Baseline and clinical data were compared between the groups, and prognostic factors were explored using logistic regression analysis. Receiver operating characteristic (ROC) curves generated by 10-fold cross-validation using the caret in R programming language were used to assess the predictive efficacy of Injury Severity Score (ISS) and qSOFA + H + PT score for trauma patient mortality.

Results: A total of 509 severe trauma patients (377 males and 132 females) were included, with a median age of 53 years (range: 42-65 years). The mortality rate was found to be 23.4%. Logistic regression analysis revealed that age, ISS, and qSOFA + H + PT were significant predictors of death in severe trauma patients, with odds ratios of 1.035 (95%CI:1.014-1.057), 1.052 (95%CI:1.017-1.090), and 6.124 (95%CI:3.107-12.072), respectively (P < 0.05). The predictive efficacy of ISS and qSOFA + H + PT for mortality prediction was 0.742 and 0.816, respectively.The predictive efficacy of qSOFA + H + PT for emergency blood transfusion and operation was 0.743 and 0.702.

Conclusion: qSOFA + H + PT are identified as significant predictors to the death of severe trauma patients. They could be utilized as early intervention indicators in emergency departments, facilitating clinical management strategies such as emergency blood transfusion, emergency operation, and prognosis prediction.

背景:开发一种能够预测创伤病例死亡风险的有效评分工具至关重要。本研究旨在调查快速器官功能衰竭序列评估(qSOFA)和低体温(H)以及凝血酶原时间(PT)在预测严重创伤患者预后方面的综合效果:一项回顾性队列研究分析了苏州大学附属第二医院创伤中心创伤数据库中2017年1月至2021年12月期间严重创伤患者的数据。根据临床结果将患者分为存活组和非存活组。比较两组患者的基线和临床数据,并使用逻辑回归分析探讨预后因素。使用 R 编程语言 caret 通过 10 倍交叉验证生成受体操作特征曲线(ROC),用于评估损伤严重程度评分(ISS)和 qSOFA + H + PT 评分对创伤患者死亡率的预测效果:共纳入 509 名严重创伤患者(377 名男性和 132 名女性),中位年龄为 53 岁(范围:42-65 岁)。死亡率为 23.4%。逻辑回归分析显示,年龄、ISS 和 qSOFA + H + PT 是严重创伤患者死亡的重要预测因素,其几率比分别为 1.035(95%CI:1.014-1.057)、1.052(95%CI:1.017-1.090)和 6.124(95%CI:3.107-12.072)(P 结论:qSOFA + H + PT 是严重创伤患者死亡的重要预测因素。它们可作为急诊科的早期干预指标,促进临床管理策略,如紧急输血、紧急手术和预后预测。
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引用次数: 0
What do community paramedics in Germany do regarding the care of older people? A retrospective, descriptive analysis of low-acuity cases. 德国社区护理人员如何护理老年人?对低危病例的回顾性描述分析。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-16 DOI: 10.1186/s12873-024-01134-3
Anna Lena Obst, Insa Seeger, Falk Hoffmann

Background: Non-life-threatening cases treated by emergency services have been increasing in recent years, especially in older people. In a region in Germany with approximately 600,000 inhabitants, the role of a specially trained community paramedic (Gemeindenotfallsanitäter, G-NFS) was introduced in 2019. The G-NFS is dispatched to low-acuity requests, attends the assignment alone and is allowed to treat patients at home.

Aim: The aim of this study was to analyse the assignments attended by the G-NFS relating to the suspected diagnoses, with a focus on older people (≥ 65 years) according to their care setting.

Methods: In this descriptive, retrospective study, we analysed the anonymous assignment report forms 07/2023-12/2023 of cases where patients were aged ≥ 65 years. The suspected diagnoses (free text field) were categorised according to the International Classification of Primary Care 2nd Edition (ICPC-2) scheme. Furthermore, baseline characteristics, urgency of the assignment, provided measures, transport and further treatment were analysed, stratified by care setting.

Results: Of the 1,643 included anonymous assignment report forms, 52.9% (n = 869) related to patients aged ≥ 65 years. In this population, the mean age was 80.7 years (SD 8.2), 49.6% were female and most were in long-term care, whether as home care recipients (34.8%) or as nursing home residents (26.9%). The most frequent diagnoses were categorised as urological (24.9%), general and unspecified (13.7%), circulatory (13.6%), digestive (12.8%), musculoskeletal (11.5%) and respiratory (10.3%). In 52.7% of the cases no transport was necessary, while 73.7% of urological cases did not need to be transported.

Conclusion: The G-NFS was dispatched mainly to older people. Most of them were in long-term care and were not transported. The most common suspected diagnoses were categorised as urological, followed by general and unspecified, and circulatory, and differed by care setting. There is a strong need to strengthen outpatient healthcare structures for low-acuity health issues in older and immobile patients.

背景:近年来,接受急救服务治疗的非危及生命的病例不断增加,尤其是老年人。德国一个拥有约 60 万居民的地区于 2019 年引入了经过专门培训的社区辅助医务人员(Gemeindenotfallsanitäter,G-NFS)。目的:本研究旨在分析 G-NFS 参与的疑似诊断任务,根据护理环境重点关注老年人(≥ 65 岁):在这项描述性、回顾性研究中,我们分析了患者年龄≥ 65 岁的匿名分配报告表 07/2023-12/2023。疑似诊断(自由文本字段)根据国际初级保健分类第二版(ICPC-2)计划进行分类。此外,还对基线特征、任务紧迫性、提供的措施、交通和进一步治疗进行了分析,并按医疗机构进行了分层:在收录的 1643 份匿名分配报告表中,52.9%(n = 869)涉及年龄≥ 65 岁的患者。在这些人群中,平均年龄为 80.7 岁(标准差为 8.2),49.6% 为女性,大多数为长期护理人员,无论是家庭护理人员(34.8%)还是疗养院居民(26.9%)。最常见的诊断分为泌尿系统(24.9%)、普通和不明原因(13.7%)、循环系统(13.6%)、消化系统(12.8%)、肌肉骨骼系统(11.5%)和呼吸系统(10.3%)。52.7%的病例无需转运,73.7%的泌尿科病例无需转运:结论:G-NFS 的主要服务对象是老年人。结论:G-NFS 的出诊对象主要是老年人,其中大多数人都在接受长期护理,不需要转运。最常见的疑似诊断为泌尿系统疾病,其次是普通和不明原因疾病以及循环系统疾病,并且因护理环境而异。亟需加强门诊医疗保健机构,以解决老年和行动不便患者的低急性健康问题。
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引用次数: 0
Factors affecting emergency medical dispatchers decision making in stroke calls - a qualitative study. 影响紧急医疗调度员在中风呼叫中决策的因素--一项定性研究。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-15 DOI: 10.1186/s12873-024-01129-0
Bjørn Jamtli, Edel Jannecke Svendsen, Trine Møgster Jørgensen, Jo Kramer-Johansen, Maren Ranhoff Hov, Camilla Hardeland

Objectives: Emergency Medical Communication Centers (EMCC) have a key role in the prehospital chain-of-stroke-survival by recognizing stroke patients and reducing prehospital delay. However, studies on EMCC stroke recognition report both substantial undertriage and overtriage. Since mis-triage at the EMCC challenges the whole chain-of-stroke-survival, by occupying limited resources for non-stroke patients or failing to recognize the true stroke patients, there is a need to achieve a more comprehensive understanding of the dispatchers' routines and experiences. The aim of this study was to explore factors affecting EMCC dispatcher's decision-making in stroke calls.

Materials and methods: A qualitative exploratory study, based on individual semi-structured interviews of 15 medical dispatchers from EMCC Oslo, Norway. Interviews were conducted during August and October 2022 and analyzed using the principles of thematic analysis.

Results: We identified four themes: [1] Pronounced stroke symptoms are easy to identify [2]. Non-specific neurological symptoms raise suspicion of acute stroke but are difficult to differentiate from other medical conditions [3]. Consistent use of the Criteria Based Dispatch (CBD) protocol may increase EMCC overtriage [4]. Contextual conditions at EMCC can affect dispatchers' decision-making process and the ability for experiential learning.

Conclusions: Medical dispatchers at the EMCC perceive vague and non-specific stroke symptoms, such as dizziness, confusion or altered behaviour, challenging to differentiate from symptoms of other less time-critical medical conditions. They also perceive the current CBD protocol in use as less supportive in assessing such symptoms. High workload and strict EMCC response time interval requirements hinder the gathering of essential patient information and the ability to seek guidance in cases of doubt, potentially exacerbating both EMCC undertriage and overtriage. The absence of feedback loops and other strategies for experiential learning in the EMCC hampers the medical dispatcher's ability to evaluate their own assessments and improve dispatch accuracy.

目的:紧急医疗通信中心(EMCC)通过识别卒中患者和减少院前延误,在院前卒中救治链中发挥着关键作用。然而,有关急救医疗通信中心卒中识别的研究报告显示,存在大量误诊和过度误诊的情况。由于急救中心的误诊会占用有限的资源用于非卒中患者或无法识别真正的卒中患者,从而对整个卒中救治链造成挑战,因此有必要更全面地了解调度员的日常工作和经验。本研究旨在探讨影响急救中心调度员在中风呼叫中决策的因素:这是一项定性探索性研究,基于对挪威奥斯陆急救中心 15 名医疗调度员进行的个人半结构式访谈。访谈于 2022 年 8 月至 10 月间进行,采用主题分析法进行分析:我们确定了四个主题:[1] 明显的卒中症状易于识别[2]。非特异性神经症状会引起对急性卒中的怀疑,但很难与其他疾病区分开来[3]。持续使用基于标准的调度(CBD)协议可能会增加急救中心的过度诊断[4]。急救中心的环境条件会影响调度员的决策过程和经验学习能力:结论:急救中心的医疗调度员认为,头晕、意识模糊或行为改变等模糊且非特异性的卒中症状很难与其他时间紧迫性较低的疾病症状区分开来。他们还认为目前使用的 CBD 协议对评估此类症状的支持作用较小。高负荷的工作量和对急救中心响应时间间隔的严格要求,阻碍了对病人基本信息的收集和在有疑问时寻求指导的能力,有可能加剧急救中心的漏诊和误诊。急救中心缺乏反馈回路和其他经验学习策略,阻碍了医疗调度员评估自身评估和提高调度准确性的能力。
{"title":"Factors affecting emergency medical dispatchers decision making in stroke calls - a qualitative study.","authors":"Bjørn Jamtli, Edel Jannecke Svendsen, Trine Møgster Jørgensen, Jo Kramer-Johansen, Maren Ranhoff Hov, Camilla Hardeland","doi":"10.1186/s12873-024-01129-0","DOIUrl":"10.1186/s12873-024-01129-0","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency Medical Communication Centers (EMCC) have a key role in the prehospital chain-of-stroke-survival by recognizing stroke patients and reducing prehospital delay. However, studies on EMCC stroke recognition report both substantial undertriage and overtriage. Since mis-triage at the EMCC challenges the whole chain-of-stroke-survival, by occupying limited resources for non-stroke patients or failing to recognize the true stroke patients, there is a need to achieve a more comprehensive understanding of the dispatchers' routines and experiences. The aim of this study was to explore factors affecting EMCC dispatcher's decision-making in stroke calls.</p><p><strong>Materials and methods: </strong>A qualitative exploratory study, based on individual semi-structured interviews of 15 medical dispatchers from EMCC Oslo, Norway. Interviews were conducted during August and October 2022 and analyzed using the principles of thematic analysis.</p><p><strong>Results: </strong>We identified four themes: [1] Pronounced stroke symptoms are easy to identify [2]. Non-specific neurological symptoms raise suspicion of acute stroke but are difficult to differentiate from other medical conditions [3]. Consistent use of the Criteria Based Dispatch (CBD) protocol may increase EMCC overtriage [4]. Contextual conditions at EMCC can affect dispatchers' decision-making process and the ability for experiential learning.</p><p><strong>Conclusions: </strong>Medical dispatchers at the EMCC perceive vague and non-specific stroke symptoms, such as dizziness, confusion or altered behaviour, challenging to differentiate from symptoms of other less time-critical medical conditions. They also perceive the current CBD protocol in use as less supportive in assessing such symptoms. High workload and strict EMCC response time interval requirements hinder the gathering of essential patient information and the ability to seek guidance in cases of doubt, potentially exacerbating both EMCC undertriage and overtriage. The absence of feedback loops and other strategies for experiential learning in the EMCC hampers the medical dispatcher's ability to evaluate their own assessments and improve dispatch accuracy.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"214"},"PeriodicalIF":2.3,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prolonged length of stay and associated factors among emergency department patients in Ethiopia: systematic review and meta-analysis. 埃塞俄比亚急诊科患者住院时间延长及相关因素:系统回顾和荟萃分析。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-13 DOI: 10.1186/s12873-024-01131-6
Temesgen Ayenew, Mihretie Gedfew, Mamaru Getie Fetene, Animut Takele Telayneh, Fentahun Adane, Baye Tsegaye Amlak, Belayneh Shetie Workneh, Mengistu Abebe Messelu

Background: The duration between a patient's arrival at the Emergency Department (ED) and their actual departure, known as the Emergency Department Length of Stay (EDLOS), can have significant implications for a patient's health. In Ethiopia, various studies have investigated EDLOS, but a comprehensive nationwide pooled prevalence of prolonged EDLOS, which varies across different locations, is currently lacking. Therefore, the objective of this systematic review and meta-analysis is to provide nationally representative pooled prevalence of prolonged EDLOS and identify associated factors.

Methods: In this study, we conducted a comprehensive systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. We conducted a thorough search of numerous international databases, including PubMed/Medline, SCOPUS, Web of Science, and Google Scholar. The primary outcome was the prevalence of prolonged EDLOS. The secondary outcome was factors affecting the EDLOS. Random-effects model was used to since there was high heterogeneity. We also conducted subgroup analysis and meta-regression to investigate heterogeneity within the included studies. To assess publication bias, we used Egger's regression test and funnel plots. All statistical analyses were performed using STATA version 17.0 software to ensure accurate and reliable findings.

Result: We have identified eight articles that met our inclusion criteria with a total sample size of 8,612 participants. The findings of this systematic review and meta-analysis indicate that the pooled estimate for the prevalence of prolonged EDLOS is 63.67% (95% CI = 45.18, 82.16, I2 = 99.56%, P = 0.0001). The study identified several significant factors associated with prolonged EDLOS, including patients admitted to overcrowded emergency departments (OR = 5.25, 95% CI = 1.77, 15.58), delays in receiving laboratory findings (OR = 3.12, 95% CI = 2.16, 4.49), and delays in receiving radiological results (OR = 3.00, 95% CI = 2.16, 4.16).

Conclusion: In this review, the EDLOS was found to be very high. Overcrowding, delays in laboratory test findings, and delays in radiology test results make up the factors that have a statistically significant association with prolonged EDLOS. Given the high prevalence of prolonged EDLOS in this review, stakeholders should work to increase the timeliness of ED services in Ethiopia by proper disposition of non-emergency palliative patients to the appropriate destination, and implementing point-of-care testing and imaging.

背景:患者从到达急诊科(ED)到实际离开的时间称为急诊科住院时间(EDLOS),它对患者的健康有重大影响。在埃塞俄比亚,已有多项研究对 EDLOS 进行了调查,但目前还缺乏全国范围内关于延长 EDLOS 的综合流行率,不同地区的情况也不尽相同。因此,本系统综述和荟萃分析的目的是提供具有全国代表性的长时间 EDLOS 的总体流行率,并确定相关因素:在本研究中,我们采用《2020 年系统综述和荟萃分析首选报告项目》(PRISMA)清单进行了全面的系统综述和荟萃分析。我们对众多国际数据库进行了全面检索,包括 PubMed/Medline、SCOPUS、Web of Science 和 Google Scholar。主要结果是延长 EDLOS 的发生率。次要结果是影响 EDLOS 的因素。由于存在高度异质性,我们采用了随机效应模型。我们还进行了亚组分析和元回归,以调查纳入研究中的异质性。为了评估发表偏倚,我们使用了 Egger 回归检验和漏斗图。所有统计分析均使用 STATA 17.0 版软件进行,以确保结果准确可靠:我们发现有 8 篇文章符合我们的纳入标准,总样本量为 8,612 人。本系统综述和荟萃分析的结果表明,对延长 EDLOS 患病率的汇总估计值为 63.67% (95% CI = 45.18, 82.16, I2 = 99.56%, P = 0.0001)。研究发现了几个与延长 EDLOS 相关的重要因素,包括急诊科人满为患(OR = 5.25,95% CI = 1.77,15.58)、实验室检查结果延迟(OR = 3.12,95% CI = 2.16,4.49)和放射检查结果延迟(OR = 3.00,95% CI = 2.16,4.16):结论:在本次审查中,发现 EDLOS 非常高。过度拥挤、实验室检查结果延迟和放射科检查结果延迟是与 EDLOS 延长有显著统计学关联的因素。鉴于本次研究中 EDLOS 延长的发生率很高,相关人员应努力提高埃塞俄比亚急诊室服务的及时性,将非急诊姑息治疗患者妥善安置到适当的目的地,并实施护理点检测和成像。
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引用次数: 0
Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children. 调整触发工具,以识别儿童院前急救中的有害事件、无害事件和险情。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-13 DOI: 10.1186/s12873-024-01125-4
Niclas Packendorff, Carl Magnusson, Christer Axelsson, Magnus Andersson Hagiwara

Background: The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers.

Methods: The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Results: The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement.

Conclusion: This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

背景:紧急医疗服务(EMS)在各种情况下处理各年龄段的所有主诉。急救医疗服务中的儿童因其独特的解剖和身体特征而面临着特殊的挑战,他们需要接受专门的培训,而急救医疗服务的临床医生往往缺乏这方面的培训。这种组合使儿童面临威胁患者安全的事故。突出事故的最常见方法是事故报告系统。研究表明,此类事件的报告率较低,因此需要采用多种方法来衡量和加强儿童急救服务中的患者安全。因此,本研究的目的是修改并改编当前的公路急救医疗救护车工具(ATT),使其成为儿科版本(pATT),并提供包含触发器定义的指南:将救护车触发工具改编为适合儿童使用的版本时,采取了循序渐进的方式,其中包括:(1)回顾以往的文献,找出急救服务中儿童患者安全的风险领域。(2)通过视频会议举行三次专家小组讨论,从临床相关性、可理解性、语言和急救医疗中儿童患者安全的风险领域等方面对 ATT 的每个触发点进行评估。(3) 结合回顾性记录审查(RRR)对 pATT 进行临床使用。(4) 计算每个触发点的项目级有效性指数和阳性预测值(PPV)。(5) 计算两名独立记录审查员之间的互评可靠性:通过文献检索,在 Cinahl 和 Medline 中分别找到了 422 篇和 561 篇文章,并阅读了标题和摘要,以确定在儿童急救中对患者安全构成风险的领域。在结构化讨论过程中,在 ATT 现有的 19 个触发点的基础上增加了一个触发点,并修改了触发点的定义以适应儿童。在随机抽取的 900 份记录中,最常见的三个触发因素分别是偏离治疗指南(63.9%)、记录不完整(48.3%)和急救评估后未转运病人(41.1%)。阳性触发因素分为险情(54.6%)、无害事件(5.8%)和有害事件(0.4%)。评分者之间的可靠性测试表明两者之间的一致性极佳:本研究表明,现有的触发工具(ATT)经过调整后适合儿童使用。研究还表明,触发工具和回顾性记录审查是评估急救医疗服务中患者安全的可行方法,从而对现有方法起到了补充作用。
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引用次数: 0
Prevalence and severity of pediatric cases in Stockholm's physician-staffed prehospital units: a retrospective cohort study. 斯德哥尔摩由医生值班的院前单位中儿科病例的发生率和严重程度:一项回顾性队列研究。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-12 DOI: 10.1186/s12873-024-01126-3
Denise Bäckström, Henrik Jörnvall, Erik Strandqvist, Robert Ahlerup, Rebecka Rubenson Wahlin

Background: Ambulance missions involving pediatric patients are common in emergency medical services (EMS) globally, with variations in prevalence based on geographic location. This retrospective cohort study analyzes the prehospital physician staffed units (p-EMS) in Stockholm, assignment dispatches and the prehospital characteristics and interventions involved, from January 1, 2021, to December 31, 2022.

Methods: Utilizing data from LogEze, a quality assurance system, we reviewed all Rapid Response Vehicle (RRV) operations in the Stockholm Region, which totaled 4,682 pediatric assignments. The analysis included dispatch types and interventions assessing the frequency and nature of pediatric prehospital missions.

Results: Pediatric cases constituted 20.0 % of RRV dispatches, with the majority involving respiratory distress, seizures, and blunt trauma. Despite high dispatch rates, advanced medical interventions were seldom required, indicating most pediatric cases were not severe. Stand-downs occurred in 30.1 % of cases, reflecting the cautious approach in pediatric dispatches. Furthermore, the study observed a significant reliance on p-EMS for complex pediatric cases, underscoring the value of specialized training and resources in managing such emergencies.

Conclusion: The study highlights the crucial role of p-EMS in enhancing pediatric emergency care in Stockholm. Despite frequent pediatric dispatches, the low incidence of severe cases underscores the need for precise triage and resource allocation. This analysis supports the need for continuous training and resource optimization in p-EMS to ensure high-quality care for pediatric patients across varied emergency scenarios.

背景:在全球范围内,涉及儿科患者的救护车任务在急救医疗服务(EMS)中很常见,但根据地理位置的不同,发生率也有所不同。这项回顾性队列研究分析了 2021 年 1 月 1 日至 2022 年 12 月 31 日期间斯德哥尔摩的院前医生配备单位(p-EMS)、任务派遣以及院前特征和干预措施:利用质量保证系统 LogEze 中的数据,我们对斯德哥尔摩地区的所有快速反应车 (RRV) 行动进行了审查,共计 4,682 次儿科任务。分析包括派遣类型和干预措施,评估儿科院前任务的频率和性质:结果:儿科病例占 RRV 派遣任务的 20.0%,其中大部分涉及呼吸窘迫、癫痫发作和钝性外伤。尽管派遣率很高,但很少需要高级医疗干预,这表明大多数儿科病例并不严重。30.1%的病例需要停机,这反映了儿科派遣中的谨慎态度。此外,研究还观察到复杂的儿科病例在很大程度上依赖于 p-EMS,这强调了专业培训和资源在处理此类紧急情况中的价值:这项研究强调了急诊急救系统在加强斯德哥尔摩儿科急救护理方面的重要作用。尽管儿科派遣频繁,但重症病例的发生率较低,这凸显了精确分流和资源分配的必要性。这项分析表明,有必要对 p-EMS 进行持续培训和资源优化,以确保在各种紧急情况下为儿科病人提供高质量的护理。
{"title":"Prevalence and severity of pediatric cases in Stockholm's physician-staffed prehospital units: a retrospective cohort study.","authors":"Denise Bäckström, Henrik Jörnvall, Erik Strandqvist, Robert Ahlerup, Rebecka Rubenson Wahlin","doi":"10.1186/s12873-024-01126-3","DOIUrl":"10.1186/s12873-024-01126-3","url":null,"abstract":"<p><strong>Background: </strong>Ambulance missions involving pediatric patients are common in emergency medical services (EMS) globally, with variations in prevalence based on geographic location. This retrospective cohort study analyzes the prehospital physician staffed units (p-EMS) in Stockholm, assignment dispatches and the prehospital characteristics and interventions involved, from January 1, 2021, to December 31, 2022.</p><p><strong>Methods: </strong>Utilizing data from LogEze, a quality assurance system, we reviewed all Rapid Response Vehicle (RRV) operations in the Stockholm Region, which totaled 4,682 pediatric assignments. The analysis included dispatch types and interventions assessing the frequency and nature of pediatric prehospital missions.</p><p><strong>Results: </strong>Pediatric cases constituted 20.0 % of RRV dispatches, with the majority involving respiratory distress, seizures, and blunt trauma. Despite high dispatch rates, advanced medical interventions were seldom required, indicating most pediatric cases were not severe. Stand-downs occurred in 30.1 % of cases, reflecting the cautious approach in pediatric dispatches. Furthermore, the study observed a significant reliance on p-EMS for complex pediatric cases, underscoring the value of specialized training and resources in managing such emergencies.</p><p><strong>Conclusion: </strong>The study highlights the crucial role of p-EMS in enhancing pediatric emergency care in Stockholm. Despite frequent pediatric dispatches, the low incidence of severe cases underscores the need for precise triage and resource allocation. This analysis supports the need for continuous training and resource optimization in p-EMS to ensure high-quality care for pediatric patients across varied emergency scenarios.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"211"},"PeriodicalIF":2.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive score for diagnosing acute colonic diverticulitis in the emergency department: a retrospective study. 急诊科诊断急性结肠憩室炎的预测评分:一项回顾性研究。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-09 DOI: 10.1186/s12873-024-01127-2
Siriwimon Tantarattanapong, Choasita Glawsongkram, Wasuntaraporn Pethyabarn

Background: Acute diverticulitis is commonly misdiagnosed among patients with acute abdominal pain in the emergency department (ED). There are predictive scores that assist in the diagnosis of acute left-sided diverticulitis, but no scoring system is available for diagnosing acute diverticulitis without regard to the affected side. Therefore, developing a predictive score for diagnosing acute diverticulitis that is not limited to the left side will guide physicians in making a diagnosis and increase the appropriateness of computed tomography. This study aimed to establish a predictive score for diagnosing acute diverticulitis.

Method: This single-centre retrospective study included adult patients (≥ 18 years) who presented to the ED with acute abdominal pain. Multivariate logistic regression analysis was used to identify essential factors for diagnosing acute diverticulitis, and the Akaike information criterion was calculated to identify significant predictive factors for diagnosing acute diverticulitis using a clinical scoring system.

Results: Of 424 patients who fulfilled the inclusion criteria, 72 (17%) were diagnosed with acute diverticulitis. The significant factors associated with acute diverticulitis were age ≥ 60 years (adjusted odds ratio (adj.OR) 2.23, 95% confidence interval (CI): 1.20 - 4.14, p = 0.01), duration of abdominal pain ≥ 48 h (adj.OR 2.64, 95% CI: 1.28 - 5.45, p = 0.017), history of a diverticulum (adj.OR 7.77, 95% CI: 3.27 - 18.45, p < 0.001), absence of nausea and vomiting (adj.OR 3.42, 95% CI: 1.65 - 7.10, p < 0.001), absence of anorexia (adj.OR 3.33, 95% CI: 1.34 - 8.33, p = 0.026), absence of tachycardia (adj.OR 3.51, 95% CI: 1.39 - 8.87, p = 0.003), and abdominal guarding (adj.OR 2.99, 95% CI: 1.52 - 5.91, p = 0.002). These predictive factors were converted into predictive scores for diagnosing acute diverticulitis. For the score of ≥ 4, the sensitivity and specificity were 73.24% (95% CI: 0.61-0.83) and 80.40% (95% CI: 0.76-0.84), respectively, and the negative predictive value was 93.71% (95% CI: 0.90-0.96). No significant signs, symptoms, or laboratory findings were associated with complicated diverticulitis.

Conclusion: Predictive factors for diagnosing acute diverticulitis included age ≥ 60 years, duration of abdominal pain ≥ 48 h, history of a diverticulum, abdominal guarding, and absence of nausea and vomiting, anorexia, and tachycardia. A predictive score ≥ 4 suggested the presence of acute diverticulitis.

背景:急性憩室炎在急诊科(ED)急性腹痛患者中常被误诊。有一些预测性评分可以帮助诊断急性左侧憩室炎,但目前还没有不考虑患侧的急性憩室炎诊断评分系统。因此,制定一个不局限于左侧的急性憩室炎诊断预测评分将指导医生做出诊断,并提高计算机断层扫描的适当性。本研究旨在建立诊断急性憩室炎的预测性评分:这项单中心回顾性研究纳入了因急性腹痛就诊于急诊室的成年患者(≥ 18 岁)。采用多变量逻辑回归分析确定诊断急性憩室炎的基本因素,并利用临床评分系统计算阿凯克信息标准,确定诊断急性憩室炎的重要预测因素:在符合纳入标准的 424 名患者中,72 人(17%)被诊断为急性憩室炎。与急性憩室炎相关的重要因素有:年龄≥60 岁(调整后比值比 (adj.OR) 2.23,95% 置信区间 (CI):1.20 - 4.14,P = 0.01)、腹痛持续时间≥48 小时(调整后比值比 (adj.OR) 2.64,95% 置信区间 (CI):1.28 - 5.45,P = 0.017)、憩室病史(调整后比值比 (adj.OR) 7.77,95% 置信区间 (CI):3.27 - 18.45,P 结论:急性憩室炎的诊断具有重要的预测意义:诊断急性憩室炎的预测因素包括:年龄≥ 60 岁、腹痛持续时间≥ 48 小时、有憩室病史、腹部警戒、无恶心呕吐、厌食和心动过速。预测评分≥4分表明存在急性憩室炎。
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引用次数: 0
Root causes behind patient safety incidents in the emergency department and suggestions for improving patient safety - an analysis in a Finnish teaching hospital. 急诊科患者安全事故背后的根本原因及改善患者安全的建议--芬兰一家教学医院的分析。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-07 DOI: 10.1186/s12873-024-01120-9
Minna Halinen, Hanna Tiirinki, Auvo Rauhala, Sanna Kiili, Tuija Ikonen

Background: Adverse events occur frequently at emergency departments (ED) because of several risk factors related to varying conditions. It is still unclear, which factors lead to patient safety incident reports. The aim of this study was to explore the root causes behind ED-associated patient safety incidents reported by personnel, and based on the findings, to suggest learning objectives for improving patient safety.

Methods: The study material included incident reports (n = 340) which concerned the ED of a teaching hospital over one year. We used a mixed method combining quantitative descriptive statistics and qualitative research by inductive content analysis and deductive Ishikawa root cause analysis.

Results: Most (76.5%) incidents were reported after patient transfer from the ED. Nurses reported 70% of incidents and physicians 7.4%. Of the reports, 40% were related to information flow or management. Incidents were evaluated as no harm (29.4%), mild (46%), moderate (19.7%), and severe (1.2%) harm to the patient. The main consequences for the organization were reputation loss (44.1%) and extra work (38.9%). In the qualitative analysis, nine specific problem groups were found: insufficient introduction, adherence to guidelines and protocols, insufficient human resources, deficient professional skills, medication management deficiencies, incomplete information transfer from the ED, language proficiency, unprofessional behaviour, identification error, and patient-dependent problems. Six organizational themes were identified: medical staff orientation, onboarding and competence requirements; human resources; electronic medical records and information transfer; medication documentation system; interprofessional collaboration; resources for specific patient groups such as geriatric, mental health, and patients with substance abuse disorder. Entirely human factor-related themes could not be defined because their associations with system factors were complex and multifaceted. Individual and organizational learning objectives were addressed, such as adherence to the proper use of instructions and adequate onboarding.

Conclusions: System factors caused most of the patient safety incidents reported concerning ED. The introduction and training of ED -processes is elementary, as is multiprofessional collaboration. More research is needed about teamwork skills, patients with special needs and non-critical patients, and the reporting of severe incidents.

背景:急诊科(ED)经常出现不良事件,这是因为与不同情况相关的几个风险因素。目前还不清楚是哪些因素导致了患者安全事件的报告。本研究旨在探讨急诊科人员报告的患者安全事件背后的根本原因,并根据研究结果提出改善患者安全的学习目标:研究材料包括一家教学医院一年来的急诊室事故报告(n = 340)。我们采用了一种混合方法,通过归纳式内容分析和演绎式石川根本原因分析,将定量描述性统计与定性研究相结合:大多数(76.5%)事件是在病人从急诊室转出后报告的。护士报告的事故占 70%,医生报告的事故占 7.4%。在这些报告中,40%与信息流或管理有关。事故对患者造成的伤害分为无伤害(29.4%)、轻微伤害(46%)、中度伤害(19.7%)和严重伤害(1.2%)。对机构造成的主要后果是名誉损失(44.1%)和额外工作(38.9%)。在定性分析中,发现了九类具体问题:介绍不足、不遵守指南和规程、人力资源不足、专业技能不足、药物管理缺陷、来自急诊室的信息传递不完整、语言能力不足、非专业行为、识别错误以及患者依赖性问题。确定了六个组织主题:医务人员的入职培训、上岗培训和能力要求;人力资源;电子病历和信息传输;用药记录系统;跨专业合作;为特定患者群体(如老年病患者、精神疾病患者和药物滥用症患者)提供资源。与人的因素相关的主题无法完全界定,因为它们与系统因素的关联是复杂和多方面的。个人和组织的学习目标得到了解决,如遵守正确的使用说明和充分的入职培训:结论:系统因素导致了大多数与急诊科有关的患者安全事故。急诊室流程的介绍和培训是基础,多专业合作也是如此。需要对团队合作技能、有特殊需求的患者和非危重患者以及严重事故的报告进行更多研究。
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引用次数: 0
Relatives' experiences of unsuccessful out-of-hospital cardiopulmonary resuscitation attempts: a qualitative analysis. 亲属在院外心肺复苏失败后的经历:定性分析。
IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-11-05 DOI: 10.1186/s12873-024-01117-4
Caroline Huxley, Eleanor Reeves, Justin Kearney, Galina Gardiner, Karin Eli, Rachael Fothergill, Gavin D Perkins, Michael Smyth, Anne-Marie Slowther, Frances Griffiths

Aim: Relatives of patients who have experienced an out of hospital cardiac arrest (OHCA) experience confusion and distress during resuscitation. Clear information from ambulance clinicians and the opportunity to witness the resuscitation helps them navigate the chaotic scene. However, UK-based evidence concerning relatives' experiences of unsuccessful resuscitation attempts and interactions with ambulance clinicians is lacking. This qualitative study explores those experiences to inform ambulance clinician practice.

Methods: Two ambulance services in the UK identified OHCA events attended by their clinicians within the previous two weeks. After a minimum of three months relatives of non-survivors of these events were invited to participate in either a remote or face-to-face interview. Interviews focussed on their experiences of the resuscitation attempt and interactions with ambulance clinicians, their feelings at the time, and their reflections on the event afterwards. Data were analysed using reflexive thematic analysis.

Results: Semi-structured interviews were conducted with 14 relatives of OHCA non-survivors. Thematic analysis identified four themes. Cardiac arrest is a traumatic event for relatives, with chaotic noisy scenes increasing their distress. Many described feelings symptomatic of Post-Traumatic Stress Disorder since the event. During resuscitation, participants needed information from clinicians about what was happening, and provided information about their relatives' wishes. Participants needed reassurance from clinicians that everything possible was done to save their relative and were reassured when they could witness some of the resuscitation. Participants were surprised how long resuscitation seemed to last; some were distressed that it lasted so long.

Conclusion: Relatives' experiences highlight two key challenges for ambulance clinicians: (1) being aware of the tension relatives feel between needing reassurance that the crew is doing everything to save the patient and wanting to avoid prolonged and ultimately futile resuscitation attempts; and (2) having ongoing conversations with those present to inform clinical decision-making whilst managing the resuscitation attempt.

目的:院外心脏骤停(OHCA)患者的亲属在复苏过程中会感到困惑和痛苦。救护车临床医生提供的清晰信息和亲眼目睹复苏过程的机会有助于他们在混乱的现场中游刃有余。然而,英国缺乏有关亲属在复苏失败后的经历以及与救护车临床医生互动的证据。本定性研究探讨了这些经历,以便为救护车临床医生的实践提供参考:方法:英国的两家救护车服务机构确定了其临床医生在过去两周内参加的 OHCA 事件。至少三个月后,这些事件的非幸存者的亲属被邀请参加远程或面对面访谈。访谈的重点是他们尝试复苏的经历、与救护车临床医生的互动、当时的感受以及事后的反思。采用反思性主题分析法对数据进行分析:对 14 名非幸存者的亲属进行了半结构式访谈。主题分析确定了四个主题。心脏骤停对亲属来说是一个创伤性事件,混乱嘈杂的场景增加了他们的痛苦。许多人描述了事件发生后创伤后应激障碍的症状。在复苏过程中,参与者需要从临床医生那里了解发生了什么,并提供有关其亲属意愿的信息。参与者需要得到临床医生的保证,即他们已经尽了一切可能来抢救他们的亲属,当他们能够目睹部分抢救过程时,他们就会感到安心。参与者对抢救持续时间之长感到惊讶;一些人对抢救持续如此之久感到痛心:亲属的经历凸显了救护车临床医生所面临的两大挑战:(1)要意识到亲属在需要得到医护人员尽全力抢救病人的保证与希望避免长时间抢救最终徒劳无功之间所感受到的矛盾;(2)与在场人员进行持续对话,以便在管理抢救尝试的同时为临床决策提供信息。
{"title":"Relatives' experiences of unsuccessful out-of-hospital cardiopulmonary resuscitation attempts: a qualitative analysis.","authors":"Caroline Huxley, Eleanor Reeves, Justin Kearney, Galina Gardiner, Karin Eli, Rachael Fothergill, Gavin D Perkins, Michael Smyth, Anne-Marie Slowther, Frances Griffiths","doi":"10.1186/s12873-024-01117-4","DOIUrl":"10.1186/s12873-024-01117-4","url":null,"abstract":"<p><strong>Aim: </strong>Relatives of patients who have experienced an out of hospital cardiac arrest (OHCA) experience confusion and distress during resuscitation. Clear information from ambulance clinicians and the opportunity to witness the resuscitation helps them navigate the chaotic scene. However, UK-based evidence concerning relatives' experiences of unsuccessful resuscitation attempts and interactions with ambulance clinicians is lacking. This qualitative study explores those experiences to inform ambulance clinician practice.</p><p><strong>Methods: </strong>Two ambulance services in the UK identified OHCA events attended by their clinicians within the previous two weeks. After a minimum of three months relatives of non-survivors of these events were invited to participate in either a remote or face-to-face interview. Interviews focussed on their experiences of the resuscitation attempt and interactions with ambulance clinicians, their feelings at the time, and their reflections on the event afterwards. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Semi-structured interviews were conducted with 14 relatives of OHCA non-survivors. Thematic analysis identified four themes. Cardiac arrest is a traumatic event for relatives, with chaotic noisy scenes increasing their distress. Many described feelings symptomatic of Post-Traumatic Stress Disorder since the event. During resuscitation, participants needed information from clinicians about what was happening, and provided information about their relatives' wishes. Participants needed reassurance from clinicians that everything possible was done to save their relative and were reassured when they could witness some of the resuscitation. Participants were surprised how long resuscitation seemed to last; some were distressed that it lasted so long.</p><p><strong>Conclusion: </strong>Relatives' experiences highlight two key challenges for ambulance clinicians: (1) being aware of the tension relatives feel between needing reassurance that the crew is doing everything to save the patient and wanting to avoid prolonged and ultimately futile resuscitation attempts; and (2) having ongoing conversations with those present to inform clinical decision-making whilst managing the resuscitation attempt.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"208"},"PeriodicalIF":2.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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BMC Emergency Medicine
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