BMC Emergency Medicine最新文献

Background: Sepsis poses a significant threat in emergency settings, necessitating tools for early and interpretable risk assessment. This study aimed to develop a robust explainable boosting machine (EBM) model, one of the explainable artificial intelligence (XAI) technologies, to construct a predictive model that balances high accuracy and clinical interpretability for use in emergency departments (EDs) and to examine candidate biomarkers.

Methods: The study identified a significant class imbalance problem in the sepsis distribution among 560 sepsis and 1012 non-sepsis patients. To address the imbalance issue, SMOTE-NC was applied in the training data. The data was divided into two parts, 80% training and 20% testing. To ensure the reliability of the models and to report unbiased results, this process was repeated 100 times and the average performance was reported. To determine the best model for sepsis prediction, five different models (AdaBoost, Gradient Boosting, CatBoost, LightGBM, and EBM) were trained, and their performances were evaluated. In the last stage, we presented local and global explanations of EBM.

Results: The EBM model achieved the highest success by reaching 79.1% F1-score, 80.9% sensitivity, and 84.8% AUC after resampling. In the global explanations, the variables with the highest weights in the model's decision process were identified as positive blood culture, oxygen saturation, and procalcitonin, respectively.

Conclusion: The EBM model accurately predicts sepsis risk based on clinically relevant biomarkers. The model's high performance and inherent transparency can foster trust among clinicians and facilitate its integration into emergency department workflows for real-time decision support.

Background: Patients presenting to the ED with headache are placed in a quiet, darkened room to minimize external stimuli; however, creating and maintaining such an environment can be challenging in the context of a busy ED setting. This study evaluated whether adding noise-reduction earmuffs and sleep eye masks to standard metoclopramide therapy improves pain relief in adult patients presenting with acute primary headache in the emergency department.

Methods: This single-center, open-label, randomized, controlled, parallel-group trial was conducted in the urban emergency department of a tertiary care hospital. Adult patients diagnosed with primary headache were randomized (1:1:1:1) to receive: Standard treatment alone (10 mg metoclopramide in 150 mL normal saline over 10 min). Standard treatment plus earmuffs (3 M Peltor Optime III, SNR 35 dB). Standard treatment plus a disposable sleep eye mask (> 99.9% light blockage). Standard treatment plus both earmuffs and an eye mask. Pain intensity was recorded on a 100 mm visual analogue scale (VAS) at baseline (VAS0), 30 min (VAS30), and 60 min (VAS60). Primary outcomes were the differences ΔVAS30 and ΔVAS60 versus baseline. Before the study, we calculated that 34 patients in each group would be sufficient to detect a 13 mm difference between the ΔVAS scores between the groups that would be clinically significant.

Results: Of the 194 screened patients, 140 were randomized (n = 35 per group) and analyzed by intention to treat. At 30 min, the combination group exhibited a mean ΔVAS30 reduction 23 mm greater than standard treatment alone (P < .05), exceeding the 13 mm minimal clinically important difference. No significant intergroup differences were observed in ΔVAS60, patient preference, or rescue analgesia rates. No adverse events were reported.

Conclusions: Earmuffs combined with sleep eye masks as an adjunct to metoclopramide significantly enhance early headache relief in the emergency department and represent a safe, low-cost complementary therapy. Participants were not blinded to the intervention due to practical constraints, and for the same reason, placebo control was not used.

Trial registration: The study protocol was established before starting and was registered at clinicaltrials.gov (Clinical Trials Identifier: NCT04178252, Date: 10.08.2019).

Background: Hip fractures (HFs) managed in the emergency department (ED) are associated with severe pain. Locoregional anaesthesia (LRA) using the pericapsular nerve group (PENG) block may be an effective option for pain management in the ED, helping to reduce morphine use and improve postoperative rehabilitation.

Methods: Patients admitted to the ED of a French tertiary hospital with suspected HF were enrolled and randomised into two groups: a standard of care (SOC) group receiving systemic analgesia in line with current recommendations, and an experimental group receiving systemic analgesia plus a PENG block. The primary outcome was morphine consumption per hour from randomisation until 24 hours post-randomisation or until surgery, if performed earlier.

Results: Among the 35 randomised patients, 32 were included in the final analysis (11 men and 21 women; median age of 81 [74-91] years). Median morphine consumption per hour was significantly lower in the PENG group compared to the SOC group (0.2 [0.0-0.5] mg vs 0.4 [0.3-0.8] mg, respectively; p = 0.03). No significant differences were observed between groups in terms of total morphine use, pain scores (numeric rating scale), adverse events, or ED length of stay.

Conclusion: Early PENG block appears to be a feasible and safe LRA technique when performed by trained emergency physicians and may reduce opioids requirements in patients with HF in the ED. Larger, adequately powered studies are warranted to confirm these findings.

Trial registration: The study was registered prospectively at https://www.

Clinicaltrials: gov/ on 5 January 2023 (NCT05673486).

Background: The aim was to compare the hemodynamic and metabolic effectiveness of manual chest compressions and a mechanical chest compression device during in-hospital cardiac arrest by monitoring carotid Doppler flow and end-tidal carbon dioxide (ETCO₂) and arterial lactate levels.

Methods: In this single-center, prospective, observational cohort study, 54 adult patients with nontraumatic cardiac arrest in the emergency department were enrolled between December 2023 and February 2024. Chest compressions were delivered manually for the first three 2-minute cycles and mechanically for the subsequent two cycles. The peak-systolic velocity (PSV) and end-diastolic velocity (EDV) of the common carotid artery and the ETCO₂ and lactate levels were recorded at cycles 1, 3 and 5. The primary and secondary outcomes were the return of spontaneous circulation (ROSC) and 24-h survival, respectively. The predictive performance of physiological markers was assessed with receiver operating characteristic (ROC) analysis.

Results: ROSC was achieved in 41/54 patients (75.9%), and 22/41 patients (53.7%) were alive at 24 h. The ultrasound acquisition time decreased from 39.9 ± 7.2 s in the first (manual) cycle to 25.7 ± 5.5 s in the fifth (mechanical) cycle (p < 0.01). Compared with manual cardiopulmonary resuscitation (CPR), mechanical compression was associated with greater increases in PSV (Δ₃-₅ = 9.0 ± 3.3 cm s⁻¹ vs. Δ₁-₃ = 2.7 ± 2.9 cm s⁻¹; p < 0.01) and EDV, a greater increase in ETCO₂ (3.5 ± 1.7 mm Hg vs. 1.3 ± 1.6 mm Hg; p < 0.01) and a more pronounced decrease in lactate levels (-0.30 ± 0.34 mmol L⁻¹ vs. -0.10 ± 0.19 mmol L⁻¹; p < 0.01). An ETCO₂ value ≥ 35 mm Hg predicted ROSC with 75.6% sensitivity and 53.9% specificity (AUC = 0.70), whereas a lactate level ≤ 5.3 mmol L⁻¹ predicted ROSC with 76.9% sensitivity and 82.9% specificity (AUC = 0.81). Carotid Doppler velocities showed limited discrimination for ROSC (AUC ≈ 0.56-0.58) and should not be used alone for prognostication.

Conclusion: Compared with the preceding manual cycles, the mechanical cycles were associated with higher carotid flow velocities and more favorable ETCO₂-lactate trajectories; however, given the fixed sequence and co-interventions, causality cannot be inferred.

Study objectives: This study aims to investigate the utilization patterns, awareness and factors influencing utilization of emergency medical services among patients reporting to the emergency department of a tertiary care hospital in India.

Methodology: It is a prospective observational study, conducted at the Emergency Department (ED) of a tertiary care hospital in an urban setting in Southern India, conducted over 45 days in November and December 2024, among 434 patients aged ≥ 18 years. Data was collected using a pre-structured proforma covering demographics, triage category, transportation mode, and EMS awareness. Statistical analysis was performed using R version 4.4.3 software and JAMOVI statistics software version 2.4.11. Descriptive and inferential statistics, including chi-square tests and logistic regression analyses, were applied.

Results: Among the 434 patients enrolled, 47% (204) of participants arrived by ambulance, predominantly males. Among trauma and non-trauma patients, non-trauma cases were more common. Patients in higher triage categories, such as P1 and P2 (as per the Emergency Severity Index, ESI), were more likely to be transported by ambulance than those in the lower triage category, P3. However, awareness about EMS was limited to only 43% (188) of the study population; among them, 56.3% (106) only knew the name of emergency medical services without having basic knowledge about them in India. Overall, 45.8% of the study population reported having no awareness about EMS in India or other countries. Logistic regression analysis showed that triage category (OR = 0.31, p < 0.001), EMS awareness (OR = 1.67, p = 0.029), and perceived severity of the patient's condition (OR = 1.20, p < 0.001) were predictors for higher utilisation of ambulance services.

Conclusion: The study reveals significant gaps in EMS awareness, infrastructure, preference for private transport and highlights the key predictors of EMS utilization. There is an urgent need for public education, centralised EMS and policy reforms to enhance EMS utilization.

Background: Given the increasing number of patients presenting to Emergency Departments (EDs), the use of effective and reliable triage tools is essential. Such systems enable rapid assessment of the urgency of medical intervention, which contributes to improved workflow, optimized resource allocation, and potentially better clinical outcomes. This study presents a direct comparison of two of the most widely used triage systems globally: the Manchester Triage System (MTS) and the Emergency Severity Index (ESI), evaluating their classification agreement and predictive value for critical events in the ED population.

Methods: This retrospective study included 1,072 patients who were concurrently assessed using both systems during a transitional six-month period in which both MTS and ESI were applied in parallel at the study hospital. The correlation between triage categories assigned by each system was analyzed, as well as their association with predefined critical events.

Results: A moderate level of classification agreement was observed between the two systems (Cohen's kappa = 0.51; Spearman's rho = 0.49). ESI assigned over 80% of patients to priority level 3, whereas MTS distributed patients more evenly between levels 3 and 4. Both systems demonstrated a statistically significant association between higher acuity levels and an increased risk of critical events-lower category numbers (i.e., higher priority) corresponded with a greater likelihood of severe complications.

Conclusions: The results confirm the effectiveness of both triage systems in assessing patients' clinical condition while highlighting important differences in their classification structures. These findings may inform the choice of triage system in clinical practice and underscore the need for further research on optimization and potential integration with artificial intelligence-based decision support tools.