Clinical and Experimental Emergency Medicine最新文献

{"title":"Academic articles with public health perspectives as a potential tool for Korean doctors in addressing health issues.","authors":"Gabyong Jeong","doi":"10.15441/ceem.24.349","DOIUrl":"https://doi.org/10.15441/ceem.24.349","url":null,"abstract":"<p><p>In South Korea, growing frustration among medical doctors over government healthcare policies, such as increasing medical student intake, has led to a surge in doctors considering practicing medicine abroad. Despite efforts to address specialty shortages, 82% of doctors believe these policies fail to tackle underlying issues like low compensation and legal protections for high-risk procedures. Engaging with public health perspectives, physicians can frame healthcare challenges and advocate for policy change. By addressing broader social determinants of health (SDOH), doctors can contribute to more effective, equitable healthcare policies.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common carotid arterial pseudoaneurysm mistaken for peritonsillar abscess.","authors":"Ji Eun Kim, Sayul Kang","doi":"10.15441/ceem.24.332","DOIUrl":"https://doi.org/10.15441/ceem.24.332","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young woman with recurrent paroxysmal stridor after extubation.","authors":"Dong Eun Lee, Jong Kun Kim, Sin-Youl Park","doi":"10.15441/ceem.24.311","DOIUrl":"https://doi.org/10.15441/ceem.24.311","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Concomitant Injuries on Clinical Outcomes in Patients with Isolated versus Non-Isolated Traumatic Brain Injury.","authors":"Kyung Won Park, Sung Wook Song, Woo Jeong Kim, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee, Seo Young Ko, Soo Hoon Lee, Chang Bae Park, Jin Gu Lee, Jong Yeon Kang, Jaeyoon Ha, Jiwon Kim","doi":"10.15441/ceem.24.331","DOIUrl":"https://doi.org/10.15441/ceem.24.331","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) often occurs alongside injuries to other body regions, worsening patient outcomes. This study aimed to evaluate the impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated TBI.</p><p><strong>Method: </strong>A retrospective cross-sectional analysis was conducted using data from the Emergency Department-based Injury In-depth Surveillance System (EDIIS), encompassing 180,058 TBI patients admitted to 23 tertiary hospitals from January 1, 2020, to December 31, 2022. Patients were categorized into isolated TBI (iTBI, n = 127,673) and non-isolated TBI (niTBI, n = 52,385) groups based on injury diagnostic codes. Clinical outcomes-including 24-hour and 30-day mortality, hospital admission, and interhospital transfer-were compared. Multivariate logistic regression analyses adjusted for potential confounders were performed.</p><p><strong>Result: </strong>niTBI patients exhibited significantly higher 24-hour mortality (1.5% vs. 0.4%), 30-day mortality (2.6% vs. 1.0%), hospital admissions (24.5% vs. 8.4%), and interhospital transfers (3.6% vs. 1.1%) compared to iTBI patients (all p < 0.001). Concomitant injuries increased the adjusted odds of 24-hour mortality (aOR = 1.456; 95% CI: 1.286-1.648) and 30-day mortality (aOR = 1.111; 95% CI: 1.022-1.208). Thoracic injuries were the most significant predictor of adverse outcomes in niTBI patients, nearly sixfold increasing the odds of 24-hour mortality (aOR = 5.958; 95% CI: 5.057-7.019).</p><p><strong>Conclusions: </strong>Concomitant injuries significantly worsen clinical outcomes in TBI patients, with thoracic injuries being the most critical predictor of mortality. These findings highlight the importance of comprehensive trauma assessment and targeted prevention strategies to improve survival rates and optimize resource allocation for patients with multiple injuries.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: SABIHA Score.","authors":"Kenan Toprak, Mustafa Kaplangöray, Mesut Karataş, Zuhal Fatma Cellat, Yakup Arğa, Rüstem Yılmaz, Mustafa Begenc Tascanov, Asuman Biçer","doi":"10.15441/ceem.24.314","DOIUrl":"https://doi.org/10.15441/ceem.24.314","url":null,"abstract":"<p><strong>Objective: </strong>In the context of acute cardiogenic pulmonary edema (ACPE), a frequently encountered medical emergency associated with high early mortality rates, there is a need to predict short-term outcomes for risk stratification.Our aim was to derive and validate a model, a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests, that allows accurate prediction of short-term mortality in individuals experiencing ACPE.</p><p><strong>Methods: </strong>This retrospective cohort study included 1088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio, facilitating comprehensive examination and validation of prognostic model. Independent predictors of mortality (p<0.05) from the multivariable model were included in the risk score. The discriminant ability of the score was tested by ROC analysis.</p><p><strong>Results: </strong>In the derivation cohort (n=623), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring 0 and 1. The SABIHA score provided a good calibration with a concordance index of 0.879 (95% CI: 0.821-0.937). While the probability of short-term mortality was 80.0% in the high risk group, this rate was only 3.3% in the low risk group. This score also performed well on the validation set.</p><p><strong>Conclusions: </strong>A simple clinical score consisting of routinely obtained variables can be used in risk stratification to predict short-term outcomes in patients with ACPE.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underuse of Rapid Sequence Intubation Outside the Emergency Department: Insights from Emergency Physicians‒a Preliminary, Retrospective Observational Study.","authors":"Sung-Yeol Park, Sung-Bin Chon","doi":"10.15441/ceem.24.227","DOIUrl":"https://doi.org/10.15441/ceem.24.227","url":null,"abstract":"<p><strong>Objective: </strong>Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI seems to be underutilized outside emergency departments (ED). We compared RSI adoption rates and ETI outcomes outside and within EDs and investigated whether RSI adoption affected ETI outcomes outside EDs.</p><p><strong>Methods: </strong>This retrospective study included adults who underwent emergency ETI outside the operating room at a university hospital between March 2022 and February 2023. The exclusion criteria included CPR, intentional RSI avoidance, and tube exchange via the introducer. The primary outcome was the first-pass success rate. Secondary outcomes included multiple (≥3) attempts, prolonged (>5 min) ETI, and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 490 ETI cases were included: 290 males, 68.3±14.7 y. Cases outside ED (n=286) received less RSI than cases at ED (n=204): 12.6% vs. 86.8%, <i>p</i><0.001. They showed less first-attempt success (62.2% vs. 88.2%) and more multiple attempts (11.5% vs. 2.0%), total time of ETI (8.4±8.3 vs. 2.5±2.5 min, <i>p</i><0.001), and complications (32.2% vs. 19.6%, <i><i>p</i></i>=0.003). However, multivariable logistic regression revealed no significant association between RSI adoption and outcomes outside the ED: odds ratio 1.74 [95% CI: 0.783-3.84], 0.167 [0.022-1.30], 1.04 [0.405-2.69]), and 1.50 [0.664-3.40]), respectively.</p><p><strong>Conclusion: </strong>Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Landscape of Experimental Cardiac Arrest Research Models in Rats: A Bibliometric Analysis of the 100 Most Cited Articles.","authors":"Georgios Mavrovounis, Maria Mermiri, Ioannis Drivas, Konstantinos Drivas, Theodosis Kalamatianos, Sotirios G Zarogiannis, Ioannis Pantazopoulos","doi":"10.15441/ceem.24.290","DOIUrl":"https://doi.org/10.15441/ceem.24.290","url":null,"abstract":"<p><p>This study aimed to conduct a bibliometric analysis of the 100 most cited articles on experimental cardiac arrest models in rats, identifying key contributors, publication trends, research themes, and collaboration networks. A comprehensive literature search was performed on the Web of Science (WoS) database on June 11, 2024, using keywords related to cardiac arrest and rat models. The top 100 most cited articles were analyzed using the Biblioshiny web application from the Bibliometrix R package (version 4.2.3), categorized by primary research focus. Articles, published from 1980 to 2022, involved 416 authors across 44 journals, averaging 106.7 citations each. Primary research themes were neurology (72%), organ transplantation (7%), cardiovascular system (6%), CPR outcomes after local anesthetic toxicity (4%), and other topics (5%). The United States, Japan, and Germany were leading contributors, with limited international collaborations. Major clusters identified included \"Cerebral Ischemia and Outcomes,\" \"Brain Imaging Metrics,\" and \"Blood Brain Barrier\". The most commonly used methodologies for cardiac arrest induction were asphyxia, induction by magnesium or potassium chloride and electrical stimulation. This first bibliometric analysis on the topic reveals a dominance of neuroscience in experimental cardiac arrest models in rats. High-impact journals like the \"Journal of Cerebral Blood Flow and Metabolism\" play critical roles in disseminating significant research. The study highlights substantial gaps in global research engagement, with minimal contributions from lower-income countries and few international collaborations. This analysis provides a roadmap for future research directions and opportunities for more extensive international and interdisciplinary collaboration, always with a focus on scientific rigor.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compare the Efficacy of Bolus Low Dose Ketamine Versus Bolus plus Infusion Low Dose Ketamine on Pain Management in Emergency Department: A randomized clinical trial.","authors":"Reza Azizkhani, Ali Sanaei, Farhad Heydari, Saeed Majidinejad, Keihan Golshani, Fateme Sadeghi, Pardis Rafiei","doi":"10.15441/ceem.24.244","DOIUrl":"https://doi.org/10.15441/ceem.24.244","url":null,"abstract":"<p><strong>Background: </strong>Ketamine is a promising drug for analgesia in emergency medicine, but a high rate of side effects is a barrier to whispered usage. We hypothesized that ketamine bolus followed by ketamine infusion would provide a more even and longer duration of analgesia and lower rates of side effects in comparison to bolus-only administration.</p><p><strong>Methods: </strong>This was a double-blinded, clinical trial. Eligible traumatic patients were randomly allocated with the Numerical Rating Scale (NRS) ≥6 in two study groups. The first group received a dose of 0.3 mg/kg of ketamine over 1 minute, followed by an infusion of saline 0.9% over the next 30 minutes (bolus only group). The second group was given 0.15 mg/kg of ketamine over 1 minute, followed by an infusion of 0.15 mg/kg over the next 30 minutes (bolus and infusion group). The primary outcome was to measure the average reduction in pain scores.</p><p><strong>Results: </strong>80 patients were recruited. Of these, 77 patients were analyzed. Both groups achieved a statistically significant decrease in pain scores (All p-values<0.001). After 30 minutes, patients in the bolus and infusion group reported lower pain scores in all intervals with lower rates of need for rescue analgesia but this difference was not statistically significant. Vital signs remained stable during the study in both groups. No statistically significant difference was observed between study groups in any side effect (p-value< 0.05).</p><p><strong>Conclusion: </strong>Both administration protocols resulted in significant pain control. No statistically significant difference was observed between study groups in terms of analgesic efficacy and side effects.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of good prognosis for pediatric drowning patients.","authors":"Hyunseok Cho, Sang Hoon Lee, Jun Hwi Cho","doi":"10.15441/ceem.24.240","DOIUrl":"https://doi.org/10.15441/ceem.24.240","url":null,"abstract":"<p><strong>Objective: </strong>We evaluated prognostic factors for pediatric drowning patients. The association between functional outcomes and clinical factors was investigated.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data for pediatric drowning patients from the Korean Community-based Severe Trauma Survey from 2016 to 2020. The primary outcome was a good prognosis at discharge, defined as a Glasgow Outcome Scale score of 1. A multivariable logistic regression analysis was performed to evaluate independent factors associated with the primary outcome.</p><p><strong>Results: </strong>From 237,616 patients, we identified 406 drowning patients aged <19 years (mean age, 8.8 years). At discharge, 41.0% of those patients had a good recovery. The absence of prehospital cardiac arrest (adjusted odds ratio [aOR], 98.7; 95% confidence interval [CI], 32.9-295.8), indoor location (aOR, 4.0; 95% CI, 1.7-9.3), and transfer to a high-volume hospital (aOR, 2.5; 95% CI, 1.1-5.8) were significant independent factors associated with a good outcome. Age, sex, the intent of injury, and prehospital time were not associated with the outcome.</p><p><strong>Conclusion: </strong>Our study identified independent prognostic factors for drowning patients, highlighting the importance of prehospital conditions and hospital care settings in determining outcomes. These findings could be useful in developing clinical strategies for managing such patients.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 4-factor fixed dose versus 4-factor weight-based dose prothrombin complex concentrate for emergent warfarin reversal: a systematic review and meta-analysis.","authors":"Mohammed Alrashed, Norah Alabdulkarim, Jana Alaskah, Shrooq Alsoket, Renad Almotairi, Majed Al Yami, Shmeylan Al Harbi, Abdulkareem M Albekairy, Abdulrahman Alshaya, Tariq Alqahtani, Abdulmajeed Alshehri, Abdullah Alshammari, Mohammed A Alnuhait, Ahmed Aljabri","doi":"10.15441/ceem.24.265","DOIUrl":"https://doi.org/10.15441/ceem.24.265","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this systematic review and meta-analysis is to evaluate the efficacy, safety, time to INR reversal, total volume of 4-factor prothrombin complex concentrate (PCC) administered of fixed-dose versus weight-based dosing strategies in patients requiring urgent warfarin reversal, with specific focus on clinical outcomes such as hemostatic efficacy, thromboembolic events, and mortality rates.</p><p><strong>Methods: </strong>A comprehensive systematic review was conducted using the PubMed, Embase, and Cochrane databases from inception through October 2023. We searched for randomized clinical trials or observational studies that compared efficacy or safety outcomes of fixed-dose vs. variable 4-PCC dose in adult patients.</p><p><strong>Results: </strong>A total of fourteen studies were included. The overall use of fixed-dose 4-PCC was associated with a lower likelihood of reaching the INR goal (RR = 0.84, 95% CI 0.80 - 0.89) and a significantly higher proportion of patients (169 out of 651 [26%]) required an additional dose of 4-PCC compared to the variable-dose group. The rate of mortality (RR = 0.85, 95% CI 0.70 - 1.03) and thromboembolic events (RR = 1.27, 95% CI 0.65 - 2.45) were similar between the two treatment groups.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis showed that variable dosing of 4-PCC more successfully achieves the target INR for warfarin reversal compared to fixed dosing. However, both dosing strategies have similar mortality and thromboembolic rates. While fixed dosing offers a simpler approach, it may require additional dosing. Future studies should focus on optimizing dosing strategies to balance efficacy, safety, and practicality in various clinical scenarios.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}