BMC Emergency Medicine最新文献

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.

Background: Sepsis is a critical emergency condition characterized by life-threatening organ dysfunction due to a dysregulated response to infection. In the fast-paced emergency department (ED) setting, rapid identification and prompt initiation of treatment within the initial hours following sepsis onset are critical for reducing mortality and improving patient outcomes. However, a timely and accurate diagnosis remains a significant challenge in emergency medicine. Biomarkers such as procalcitonin (PCT) and presepsin (P-SEP) have been proposed as tools to distinguish sepsis from other non-infectious inflammatory conditions frequently encountered in the ED, though their diagnostic effectiveness remains controversial. This study aimed to evaluate the diagnostic performance of PCT and P-SEP for diagnosis patients with sepsis.

Methods: A comprehensive systematic search was conducted across the Cochrane Central Register of Controlled Trials, PubMed, and Scopus databases up to April 1st, 2024 and updated on June 30th, 2025. Studies reporting sensitivity and specificity of PCT and P-SEP for sepsis detection among patients in acute and emergency settings were included. Hierarchical modeling techniques were utilized to pool data for sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) along with their 95% confidence intervals (CIs).

Results: Thirty-eight observational studies met inclusion criteria. The pooled sensitivities and specificities for detecting sepsis using PCT were 0.78 (95% CI: 0.74-0.81) and 0.77 (95% CI: 0.71-0.82), respectively. Similarly, for P-SEP, pooled sensitivity and specificity were 0.82 (95% CI: 0.77-0.86) and 0.78 (95% CI: 0.73-0.83), respectively. No statistically significant differences were identified between PCT and P-SEP regarding sensitivity (p = 0.169) or specificity (p = 0.792). The summary receiver operating characteristic analysis yielded an AUROC of 0.84 (95% CI: 0.81-0.87) for PCT and 0.87 (95% CI: 0.84-0.90) for P-SEP.

Conclusions: Both PCT and P-SEP represent reliable biomarkers for early and accurate sepsis detection in acute and ED settings, demonstrating comparable diagnostic performance. Their integration into routine ED assessment protocols may support timely clinical decision-making and prompt initiation of appropriate treatment strategies.

Background: Carbon monoxide (CO) poisoning is a leading cause of toxicological emergencies worldwide. Although carboxyhemoglobin (COHb) levels are traditionally used to confirm exposure, they often fail to reflect clinical severity. This study aimed to evaluate the diagnostic performance of serum lactate and hematological parameters in predicting the need for hyperbaric oxygen therapy (HBOT) among patients with acute CO poisoning.

Materials and methods: This retrospective cross-sectional study included 292 adult patients with confirmed CO poisoning admitted to a tertiary emergency department between 2020 and 2024. Patients were categorized according to HBOT administration. Laboratory values including lactate, COHb, and hematologic parameters and indices were analyzed. Multivariable logistic regression and ROC curve analysis were used to assess predictive performance.

Results: Of the 292 patients, 94 (32.2%) received HBOT. Serum lactate and COHb were significantly higher in the HBOT group (p < 0.001 for both) and were identified as independent predictors of HBOT requirement (lactate OR = 2.04; COHb OR = 1.32). AUC for lactate alone was 0.754; combining lactate with hematologic markers modestly improved AUC to 0.769. The most robust model, incorporating lactate and COHb, achieved an AUC of 0.936. Hematologic markers alone showed limited predictive value.

Conclusion: Serum lactate, particularly when combined with COHb, provides strong diagnostic value in predicting HBOT need in CO poisoning. The integration of these readily available biomarkers may improve triage decisions in emergency care.