Emergency Medicine International最新文献

{"title":"Early-Phase Computed Tomography Bowel Diameter and Neurological Outcomes Post-Extracorporeal Cardiopulmonary Resuscitation.","authors":"Shunki Hiyama, Mizuki Inoue, Ken Inoue, Taichi Kato, Keita Shibahashi, Kazuhiro Sugiyama","doi":"10.1155/emmi/4291375","DOIUrl":"https://doi.org/10.1155/emmi/4291375","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to conduct an exploratory investigation on the association between bowel diameter on early-phase abdominal computed tomography (CT) and neurological outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA).</p><p><strong>Methods: </strong>This observational study included patients who underwent ECPR for OHCA and abdominal CT before intensive care unit admission between January 2015 and December 2021 at a tertiary emergency medical center. Maximum bowel diameter was measured with a picture archiving and communication system by an investigator blinded to outcomes. The primary endpoint was unfavorable neurological outcomes at 1 month, defined as Cerebral Performance Category 3-5. The discriminatory ability of bowel diameter was assessed using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Data from 181 patients were analyzed (median age, 57 years; 84.5% male). Bowel diameter demonstrated a weak ability to predict unfavorable neurological outcomes, with an AUC of 0.58 (95% confidence interval [CI], 0.47-0.70). However, higher discriminatory performance was observed in subgroups of patients aged ≥ 65 years (AUC, 0.83; 95% CI, 0.69-0.96) and those with initial nonshockable rhythms (AUC, 0.69; 95% CI, 0.47-0.91).</p><p><strong>Conclusion: </strong>The results of this exploratory investigation suggest that bowel diameter may represent a potential adjunctive marker associated with functional outcomes post-ECPR for OHCA.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"4291375"},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Prolonged Emergency Department (ED) Length of Stay (LOS) at a Tertiary Care Hospital in Nepal: A Cross-Sectional Study.","authors":"Pratisha Pradhan, Kabita Hada Batajoo, Alok Kumar, K C Bhushan Bikram, Sneha Pradhananga, Trishna Shrestha","doi":"10.1155/emmi/8919991","DOIUrl":"10.1155/emmi/8919991","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) length of stay (LOS) is an important indicator of healthcare efficiency and patient flow. The duration of ED stay is influenced by a complex interaction of patient-related, clinical and system-level factors. Prolonged LOS (> 4 h) contributes to ED overcrowding and adverse patient outcomes. However, limited data exist regarding factors influencing ED LOS in Nepal.</p><p><strong>Method: </strong>A descriptive cross-sectional study was conducted in the ED of KIST Medical College and Teaching Hospital (MCTH), a tertiary care hospital in Lalitpur, Nepal, from May 15, 2025, to May 30, 2025. All patients presenting to the ED during the study period were eligible for inclusion. Consecutive patient records were reviewed. ED LOS was defined as the time from patient arrival to ED exit. LOS was summarized using median and interquartile range (IQR). Group differences were assessed using the Mann-Whitney U and Kruskal-Wallis tests. Variables with <i>p</i> < 0.20 in univariate analysis were entered into a multivariable logistic regression model to identify factors independently associated with prolonged ED LOS (> 4 h). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.</p><p><strong>Results: </strong>A total of 395 patients were included. The median ED LOS was 3.58 h (IQR 2.42-5.00). A total of 161 (40.8%) experienced prolonged ED LOS, while 234 (59.2%) had a LOS of ≤ 4 h. In univariate analysis, age, triage category, number of specialty consultations, payment method and requirement for advanced investigations were significantly associated with prolonged ED LOS (<i>p</i> < 0.05). On multivariable logistic regression analysis, increasing age, time of presentation and number of specialty consultations were independent predictors of prolonged ED LOS. Patients requiring single specialty consultation had higher odds of prolonged LOS (aOR 3.12; 95% CI 1.34-7.28), while those requiring multiple consultations had markedly higher odds (aOR 13.41; 95% CI 4.47-40.20). Presentation during night shift was associated with lower odds of prolonged LOS compared with morning shift (aOR 0.29; 95% CI 0.16-0.52).</p><p><strong>Conclusions: </strong>ED LOS in this tertiary care hospital was primarily influenced by patient age, time of presentation, consultation processes and administrative factors. Strengthening interdepartmental consultation processes and improving ED workflow efficiency may help reduce prolonged ED stay and overcrowding.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"8919991"},"PeriodicalIF":1.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RETRACTION: The Use of Bacteria in Cancer Treatment: A Review from the Perspective of Cellular Microbiology.","authors":"Emergency Medicine International","doi":"10.1155/emmi/9853270","DOIUrl":"https://doi.org/10.1155/emmi/9853270","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1155/2022/8127137.].</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"9853270"},"PeriodicalIF":1.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red Cell Distribution Width to Red Blood Cell Ratio: A Novel Biomarker for Predicting 30-Day Mortality in Type B Acute Aortic Dissection.","authors":"Jingjing Wang, Jun Zhou","doi":"10.1155/emmi/5722036","DOIUrl":"10.1155/emmi/5722036","url":null,"abstract":"<p><strong>Background: </strong>Type B acute aortic dissection (BAAD) is associated with significant morbidity and mortality. Early identification of high-risk patients remains challenging. This study aimed to investigate whether the ratio of red cell distribution width to red blood cell count (RRR) could serve as a novel prognostic biomarker for 30-day mortality in patients with BAAD.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled 126 BAAD patients between 2017 and 2019. The primary outcome was 30-day mortality. To mitigate overfitting and identify robust predictors from a comprehensive panel of laboratory parameters, we employed the Boruta algorithm for feature selection, followed by variance inflation factor (VIF) analysis to assess multicollinearity. Variables with VIF > 5 were excluded. An optimal RRR cutoff was determined using receiver operating characteristic (ROC) analysis. The Boruta algorithm and multivariate logistic regression were used to identify independent predictors.</p><p><strong>Results: </strong>During the 30-day follow-up period, 16 deaths (12.7%) were recorded. Comparative analysis showed that nonsurvivors had significantly lower RBC counts and hemoglobin, higher RDW, and markedly elevated RRR compared to survivors (all <i>p</i> < 0.05). The AUC for RRR was 0.774 (95% CI: 0.672-0.876) (RBC AUC = 0.741; RDW AUC = 0.684). However, the prognostic performance of RRR was not statistically superior to that of RDW alone (DeLong's test, <i>p</i> = 0.155) or RBC alone (DeLong's test, <i>p</i> = 0.335). After Boruta selection and VIF-based exclusion of collinear variables (AST and RBC, both VIF > 5), the final multivariable logistic regression model included RRR, ALT, PLT, and CREA. In multivariate analysis, only RRR remained independently associated with mortality within this model (OR = 3.059, 95% CI: 1.431-6.540, <i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>The RRR, a simple index derived from routine blood tests, was independently associated with 30-day mortality within our laboratory-based model in patients with BAAD. Given this association, the RRR warrants prospective validation as a prognostic tool.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"5722036"},"PeriodicalIF":1.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Coupled Inflammation-Metabolism Index for Early Prediction of Organ Dysfunction Progression Within 24 h After ICU Admission in Septic Shock.","authors":"Weiying Ding, Qiang Shen, Yingjie Geng","doi":"10.1155/emmi/1308518","DOIUrl":"10.1155/emmi/1308518","url":null,"abstract":"<p><strong>Background: </strong>Early progression of organ dysfunction is common in septic shock and is closely associated with poor outcomes. Reliable tools that integrate key pathophysiological processes for early risk stratification remain limited. This study aimed to develop and internally validate a coupled inflammation-metabolism coupling index (IMCI) for early prediction of organ dysfunction progression within 24 h after intensive care unit (ICU) admission in patients with septic shock.</p><p><strong>Methods: </strong>In this single-center retrospective observational study, 210 adult patients with septic shock admitted to the ICU between January 2020 and June 2025 were included. Organ dysfunction progression was defined as an increase in Sequential Organ Failure Assessment (SOFA) score ≥ 2 within 24 h. Baseline demographic characteristics, laboratory indicators, disease severity scores, and treatment-related variables, including white blood cell count, platelet count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, vasopressor dose, continuous renal replacement therapy, mechanical ventilation, and glucocorticoid administration, were collected and compared between groups. IMCI-A was constructed as ln(IL-6) × ln(lactate), and an extended index (IMCI-B) was evaluated in sensitivity analyses. Logistic regression, receiver operating characteristic analysis, calibration curves, bootstrap validation, and decision curve analysis were performed to assess association, predictive performance, and clinical utility.</p><p><strong>Results: </strong>Organ dysfunction progression occurred in 88 patients (41.9%). Patients with organ dysfunction progression had a higher inflammatory and metabolic burden and more severe baseline illness than those without progression. In the fully adjusted model incorporating demographic variables, baseline SOFA score, laboratory indicators, disease severity, and treatment-related variables, IMCI-A remained independently associated with 24-h organ dysfunction progression (adjusted OR = 1.68, 95% CI: 1.18-2.39; <i>p</i> = 0.004). IMCI-A demonstrated excellent discriminative performance (area under the curve [AUC] = 0.929), which further improved when combined with SOFA (AUC = 0.948). Calibration and decision curve analyses showed good agreement and favorable net clinical benefit.</p><p><strong>Conclusions: </strong>IMCI provides a robust and clinically meaningful tool for early prediction of organ dysfunction progression in septic shock, offering incremental value beyond conventional organ function assessment.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"1308518"},"PeriodicalIF":1.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interrater Agreement Between Paramedic CTAS Scores and an Electronic CTAS Tool: A Retrospective Study Across Eastern Ontario.","authors":"Michael Slatter, Pria Nippak, Nadia Nandlall, Housne Begum, Julie Sinclair, Thula Kandasamy, Ben De Mendonca","doi":"10.1155/emmi/3209833","DOIUrl":"10.1155/emmi/3209833","url":null,"abstract":"<p><strong>Objectives: </strong>To assess interrater agreement between the Canadian triage and acuity scale (CTAS) scores assigned by paramedics and those assigned by a paramedic rater using an electronic smartphone application, aiming to identify training gaps and potential patient safety risks associated with CTAS scoring in Canadian hospital emergency departments (CEDs).</p><p><strong>Methods: </strong>A retrospective analysis was conducted using 192,326 CTAS-level call data collected from electronic patient care records of nine paramedic services. Data were entered into an electronic CTAS smartphone app. The calls were categorized based on contact level and the sample size. Minitab software and VassarStats were used to calculate the quadratic-weighted Cohen's kappa (<i>k</i>) coefficient.</p><p><strong>Results: </strong>A retrospective analysis of 1651 paramedic call reports from across Eastern Ontario compared paramedic-assigned CTAS scores with those generated using an eCTAS smartphone tool. Overall agreement between raters was substantial (<i>k</i> = 0.78), with 55.24% (95% CI: 52.8, 57.66) agreement for CTAS on contact and 52.88% (95% CI: 50.44, 55.31) for CTAS on departure (<i>k</i> = 0.76). Paramedics assigned more low-acuity CTAS 4-5 scores than the eCTAS tool on both contact (39% vs. 31%) and departure (40% vs. 31%). Additionally, 11%-12% of CTAS 2 calls were downgraded by paramedics to CTAS 4 or 5, compared with 7% when eCTAS was used. Cohen's kappa demonstrated near-perfect agreement for CTAS 1 scores, fair agreement for CTAS 2 and 3, slight agreement for CTAS 4, and moderate agreement for CTAS 5 categories. Complaint-specific analyses showed the greatest disagreement in the gastrointestinal and substance overdose/misuse categories.</p><p><strong>Conclusions: </strong>This study found near-perfect agreement between paramedic documentation and the paramedic smartphone application for CTAS-1 in acute patients, with moderate agreement for other levels. Further studies should include multiple raters to better understand the implications of using a smartphone application.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"3209833"},"PeriodicalIF":1.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactate Dehydrogenase, Interleukin-6, and 24 h Intra-Abdominal Pressure Exhibit Early Predictive Value in Hypertriglyceridemic Pancreatitis Complicated by Acute Respiratory Distress Syndrome.","authors":"Kaiqiang Zhu, Bin Lu, Ranran Zhou, Lei Xu","doi":"10.1155/emmi/8368299","DOIUrl":"10.1155/emmi/8368299","url":null,"abstract":"<p><strong>Background: </strong>Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is increasingly recognized as a major cause of acute pancreatitis in China. Acute respiratory distress syndrome (ARDS), a severe and early complication, significantly worsens prognosis and increases intensive care unit (ICU) burden. This study aimed to identify early predictive markers of ARDS in patients with HTG-AP, enabling timely risk stratification and clinical intervention to improve outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 111 patients who were diagnosed with HTG-AP and admitted to the emergency ICU (EICU) between August 2022 and December 2024. Patients were categorized into ARDS (<i>n</i> = 61) and non-ARDS (<i>n</i> = 50) groups according to the complications associated with ARDS throughout the progression of the illness. Clinical variables were compared between groups. The Boruta technique was used to choose predictors, and then multivariate logistic regression was used. To assess prediction ability, receiver operating characteristic (ROC) curve analysis was carried out. We performed internal validation using five-fold cross-validation and bootstrap resampling (1000 iterations) to evaluate the model's capacity for generalization and stability. The clinical utility of the model was assessed using decision curve analysis (DCA).</p><p><strong>Results: </strong>Patients in the ARDS group had lower serum calcium (Ca²⁺) levels (<i>p</i> < 0.05) and longer ICU stays, as well as greater 24 h intra-abdominal pressure (IAP), interleukin-6 (IL-6), lactate dehydrogenase (LDH), and lactate (Lac) levels (<i>p</i> < 0.05) compared to the non-ARDS group. NEU, Lac, Cr, 24 h IAP, IL-6, and LDH are important possible risk factors, according to the Boruta algorithm. Multivariate logistic regression analysis identified 24 h IAP, IL-6, and LDH as independent predictors of concurrent ARDS (<i>p</i> < 0.05). The areas under the ROC curves (AUC) for 24 h IAP, IL-6, and LDH were 0.796 (95% CI: 0.715-0.877), 0.770 (95% CI: 0.683-0.858), and 0.868 (95% CI: 0.880-0.936), respectively (<i>p</i> < 0.05). When combined, the predictive model yielded an AUC of 0.907 (95% CI: 0.849-0.957), with a specificity of 90.00% and a sensitivity of 78.70%, and demonstrated noninferior predictive performance to the existing scoring systems. With an average AUROC score of 0.890 from five-fold cross-validation and a bootstrap-corrected <i>C</i>-index of 0.894, the model shows good discriminatory power. The model's clinical net benefit was verified by the DCA. Additionally, we have created a free online risk calculator for the general public (https://ardsprediction.streamlit.app/).</p><p><strong>Conclusions: </strong>LDH, IL-6, and 24 h IAP are valuable early indicators of ARDS development in patients with HTG-AP. The integrated predictive model demonstrates excellent diagnostic performance and can support early clinical decision-making.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"8368299"},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Single-Centre Evaluation of Alternative D-Dimer Thresholds in the Evaluation of Suspected Acute Pulmonary Embolism.","authors":"Anum Saad, Hannah Raye, David Manners","doi":"10.1155/emmi/3892586","DOIUrl":"10.1155/emmi/3892586","url":null,"abstract":"<p><p>This retrospective evaluation examined the theoretical impact of alternative D-dimer thresholds (age-adjusted and 1000 µg/L) in patients aged ≥ 50 years who underwent computed tomography pulmonary angiography (CTPA) after D-dimer testing. Among 291 patients with positive D-dimer and subsequent CTPA, the age-adjusted threshold maintained 100% observed sensitivity (95% CI 89.7%-100%), while the 1000-µg/L threshold missed three pulmonary emboli (sensitivity 91.2%, 95% CI 76.3%-98.1%). Applying these thresholds would have reduced CTPA use by 21.7% and 46.7%, respectively. These findings suggest that age-adjusted D-dimer thresholds may improve diagnostic efficiency in selected older patients; however, the absence of prospectively recorded pretest probability, verification bias and a lack of follow-up prevents conclusions about clinical safety.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"3892586"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Prognostic Performance of qSOFA and SOFA in Emergency Department Patients With Established Septic Shock.","authors":"Xue Liu, Huajie Zhang, Qirong He","doi":"10.1155/emmi/1902660","DOIUrl":"10.1155/emmi/1902660","url":null,"abstract":"<p><strong>Background: </strong>The quick sequential organ failure assessment (qSOFA) enables rapid bedside screening, whereas sequential organ failure assessment (SOFA) offers a more comprehensive evaluation of organ dysfunction; their comparative prognostic value in established septic shock remains unclear.</p><p><strong>Objective: </strong>To compare the prognostic performance of qSOFA and SOFA for 28-day mortality prediction in patients with established septic shock according to Sepsis-3 criteria presenting to the emergency department and to evaluate the applicability of a simplified bedside scoring tool (qSOFA) within this specific high-risk population.</p><p><strong>Methods: </strong>This retrospective cohort study included 486 patients with complete qSOFA and SOFA data from January 2021 to December 2024. Receiver operating characteristic curves, DeLong tests, multivariable logistic regression, Kaplan-Meier analysis, and calibration testing were performed. Multiple imputation of missing SOFA components was applied in a sensitivity analysis comprising 527 clinically eligible patients, and exploratory subgroup analyses were conducted according to infection source.</p><p><strong>Results: </strong>The 28-day mortality rate was 38.5%. SOFA provided better mortality discrimination than qSOFA (AUC 0.847, 95% CI 0.812-0.882 vs. 0.724, 95% CI 0.679-0.769; <i>p</i> < 0.001) and also outperformed qSOFA in predicting ICU admission (AUC 0.798 vs. 0.686; <i>p</i> < 0.001). The SOFA score, age, and lactate level emerged as independent predictors of mortality. The addition of lactate improved qSOFA performance (AUC 0.789), and the findings remained robust in multiple-imputation and infection-source subgroup analyses.</p><p><strong>Conclusion: </strong>In patients with established septic shock according to Sepsis-3 criteria, SOFA outperformed qSOFA in mortality risk stratification. qSOFA may be useful for rapid bedside screening but should not replace the comprehensive prognostic assessment provided by SOFA.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"1902660"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Pediatric Foreign Body Ingestion: A Decade of Emergency and Specialty Care at King Saud University Medical City (2013-2023).","authors":"Hani A Alghamdi, Maram A Aldeej, Rola K Alzahrani, Reema A Alrashidi, Tarfa N Albaz, Sadeem A Alhazmi, Lama A Al-Eyadhy, Shouq A Alhathal, Ghadah H Alqahtani","doi":"10.1155/emmi/4939829","DOIUrl":"10.1155/emmi/4939829","url":null,"abstract":"<p><strong>Background: </strong>Foreign body ingestion (FBI) is a common pediatric emergency with variable clinical outcomes. Following the introduction of coin currency in Saudi Arabia in 2017, a notable shift in ingestion patterns has been reported. This study aimed to evaluate the epidemiology, clinical characteristics, management strategies, and outcomes of pediatric FBI cases presenting to King Saud University Medical City (KSUMC), Riyadh, over a 10-year period.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including children aged ≤ 14 years who presented with FBI between 2013 and 2023. Cases were identified through electronic medical records. Data collected included demographics, clinical presentation, type and site of foreign body, diagnostic modality, management approach, complications, admission status, and length of stay (LOS). Comparative analyses were performed across time periods, and regression models were used to identify factors associated with hospital admission and LOS. Statistical significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>A total of 89 pediatric patients were included, with a median age of 5 years (IQR 3, 8); 68.5% were male. Coins were the most commonly ingested objects (58.4%), followed by button batteries (11.2%). The esophagus was the most frequent site of impaction (48.3%) and was strongly associated with endoscopic intervention (<i>p</i> < 0.001), whereas gastric and distal bowel foreign bodies were predominantly managed conservatively. Symptomatic presentation significantly increased the likelihood of hospital admission, particularly in patients presenting with vomiting or drooling. Increasing age independently predicted both admission and longer LOS, while observation-only management was associated with reduced admission rates and shorter hospitalization. Complications were uncommon (4.5%), with no major adverse outcomes observed.</p><p><strong>Conclusion: </strong>Coin ingestion remains the predominant form of pediatric FBI following Saudi Arabia's currency transition, with esophageal impaction driving the need for endoscopic intervention. Age, symptomatology, and site of impaction significantly influence admission and LOS. These findings support risk-stratified triage, conservative management for low-risk cases, and targeted preventive strategies, particularly for high-risk objects, such as button batteries. A risk-stratified emergency management framework, summarized in a decision-making flowchart, supports safe triage of pediatric FBIs in tertiary emergency settings.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"4939829"},"PeriodicalIF":1.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}