Emergency Medicine International最新文献

{"title":"Etiology of Out-of-Hospital Cardiac Arrest Among Patients Presenting to the Emergency Department of a Tertiary Care Hospital in Bhutan: A Prospective Cohort Study.","authors":"Ugyen Rinzin, Yeshey Dorjey, Chimi Rinzin, Tsheten Wangchuk","doi":"10.1155/emmi/8562238","DOIUrl":"10.1155/emmi/8562238","url":null,"abstract":"<p><strong>Background: </strong>High mortality rates following out-of-hospital cardiac arrest (OHCA) make identification of its etiology vital for prevention. In low-resource settings, limited access to diagnostics and clinical autopsy often prevents definitive conclusions. This study aimed to describe the presumed etiology of OHCA cases presenting to a tertiary emergency department (ED) in Bhutan.</p><p><strong>Methods: </strong>A prospective cohort study was conducted from August 1, 2023, to July 31, 2024, in the ED of the National Referral Hospital, Bhutan. All patients presenting with OHCA were included and followed until hospital discharge, death, or the end of the study period. Data were extracted from patient records and analyzed using STATA Version 18.</p><p><strong>Results: </strong>Of the 110 OHCA patients, 59.1% (<i>n</i> = 65) were male, and 90.9% (<i>n</i> = 100) were adults, with a median age of 53 years (IQR: 32-69). Prehospital emergency medical services (EMS) attended 27.3% (<i>n</i> = 30) of cases, and resuscitation was attempted in the ED in 93.6% (<i>n</i> = 103). Using the 2024 Utstein OHCA framework, medical causes accounted for 91.8% (<i>n</i> = 101) of presumed etiologies and trauma for 6.4% (<i>n</i> = 7). Within medical causes, presumed cardiac/unknown was most common (68.3%, <i>n</i> = 69), followed by other medical (26.7%, <i>n</i> = 27) and respiratory causes (5.0%, <i>n</i> = 5). One case each was attributed to drowning/electrocution and asphyxiation (0.9%). Among the 69 presumed cardiac/unknown causes, 94.2% (<i>n</i> = 65) had no specific etiology identified after available evaluation, while 5.8% (<i>n</i> = 4) had clinical features suggestive of a cardiac etiology. No clinical autopsies were performed. In multivariable logistic regression, increasing age was independently associated with presumed cardiac/unknown with no specific etiology identified after available evaluation (aOR: 1:02; 95% CI: 1.00-1.03; <i>p</i> = 0.022), and no other variables were significantly associated with this outcome.</p><p><strong>Conclusion: </strong>Most OHCA cases were medical in origin, with the majority classified as presumed cardiac/unknown due to the absence of a specific etiology after available evaluation. These findings highlight challenges in etiological classification in resource-limited settings. Strengthening postresuscitation diagnostic evaluation, standardized post-ROSC protocols, access to clinical autopsy where feasible, and development of a nationwide OHCA registry may improve etiological classification and guide future preventive strategies.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"8562238"},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560991","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":"Efficacy and Safety of Albumin in Critically Ill Adults: A Systematic Review.","authors":"Talía Gabriela Porras Suárez, Marta Gutiérrez Valencia, Luis Carlos Saiz, Juan Pedro Tirapu León, Aitor Ansotegui Hernández, Amaia Egüés Lugea, Leire Leache Alegría, Juan Erviti","doi":"10.1155/emmi/7434218","DOIUrl":"10.1155/emmi/7434218","url":null,"abstract":"<p><strong>Introduction: </strong>Albumin, the most abundant blood protein, is widely used as a plasma expander in critically ill patients.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of albumin compared to other alternatives in the prevention and treatment of complications in critically ill adults, considering different comparators and clinical situations.</p><p><strong>Methods: </strong>A systematic review was conducted, including randomized controlled trials (RCTs) comparing albumin with crystalloids, other colloids, or standard care without albumin. Primary outcomes were total mortality, blood transfusion requirement, and serious adverse events. The search was performed in MEDLINE, Embase, and Cochrane Central. Meta-analysis was conducted using the Mantel-Haenszel method with a random-effects model, and heterogeneity was assessed with the I² statistic. The risk of bias was evaluated using Cochrane RevMan 5.4, and the quality of evidence was assessed with the GRADE approach.</p><p><strong>Results: </strong>Thirty-five RCTs involving 13,975 critically ill adults were included. Mortality was 23.8% (1327/5586) with albumin and 24.2% (1361/5618). Compared with colloids, mortality was 21.9% (83/379) versus 24.4% (113/463). When compared with standard care without albumin, mortality was higher with albumin: 15.8% (60/380) versus 9.2% (39/424). SAEs occurred in 37.6% (298/793) of albumin-treated patients versus 33.5% (266/793) with crystalloids. Albumin required less transfused blood volume than colloids.</p><p><strong>Conclusions: </strong>Albumin showed no benefit over crystalloids, colloids, or standard care without albumin in reducing mortality. It resulted in less blood transfusions compared to colloids, but serious adverse events were higher than with crystalloids.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"7434218"},"PeriodicalIF":1.6,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600471","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":"Interpreting Near-Threshold Age-Adjusted D-Dimer for Suspected Pulmonary Embolism in the Emergency Department: A Retrospective Diagnostic Accuracy Study.","authors":"Cem Yıldırım, Ahmet Fırat Bektaş, Ertuğ Günsoy, Ahmet Aykut, Vedat Kırpat, Mehmet Veysel Öncül","doi":"10.1155/emmi/8353356","DOIUrl":"10.1155/emmi/8353356","url":null,"abstract":"<p><strong>Background: </strong>Age-adjusted D-dimer (AAD) thresholds are used to reduce false positives in older patients evaluated for pulmonary embolism (PE). However, evidence is limited regarding test behavior near the individualized cutoff (\"near-threshold\" zone) and the safety of excluding PE in AAD-negative cases.</p><p><strong>Methods: </strong>We conducted a retrospective diagnostic accuracy study of adults ≥ 50 years presenting to a tertiary emergency department (2015-2019) with suspected PE who underwent D-dimer testing and definitive imaging (CT pulmonary angiography or V/Q scintigraphy). Diagnostic performance of the standard threshold (0.5 µg/mL, FEU) and AAD (age ×  0.01 µg/mL) was assessed using ROC analysis. Accuracy metrics are reported with 95% confidence intervals (CIs) via bootstrap; AUC CIs and between-curve comparisons used the DeLong method. The near-threshold zone was defined as ±0.1 µg/mL around the AAD cutoff. Clinical charts of AAD-negative PE cases were reviewed.</p><p><strong>Results: </strong>Among 979 patients, 162 (16.5%) had imaging-confirmed PE. Standard D-dimer showed sensitivity 99.4% (95% CI 98.0-100.0) and specificity 4.0% (2.7-5.4); AAD showed sensitivity 97.5% (94.8-99.4) and specificity 11.8% (9.6-13.9). AUCs were 0.734 and 0.727, with no significant difference (DeLong <i>p</i> = 0.41). Within the near-threshold window, PE prevalence was 7.7%, increasing with age (28.6% in ≥ 80 years). Three patients had PE despite AAD-negative results; all had segmental or subsegmental emboli, and no in-hospital complications were documented in the available records.</p><p><strong>Conclusion: </strong>In this imaging-selected retrospective cohort, AAD improved specificity with minimal sensitivity loss. However, AAD should not be used as a stand-alone rule-out strategy and should be applied only within clinical probability-guided diagnostic pathways. Near-threshold results are not risk-free, particularly in older adults, and should prompt careful clinical reassessment when overall probability remains concerning.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"8353356"},"PeriodicalIF":1.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577448","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":"Validation of the UB-ROSC Score for Predicting OHCA Survival in Chiayi City, Taiwan.","authors":"Wei Ta Chang, Chung Chyi Chou, Chia-Chou Tsai","doi":"10.1155/emmi/5871234","DOIUrl":"10.1155/emmi/5871234","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) is a critical public health issue, with survival rates varying widely due to multiple well-established factors, including emergency medical service (EMS) system structure, bystander response, initial cardiac rhythm, and patient-level characteristics. This study evaluates the Utstein-Based Return of Spontaneous Circulation (UB-ROSC) score's performance in predicting sustained Return of Spontaneous Circulation (ROSC > 2 h) in a midsized Asian city where EMS delivery is standardized and geographic variation in access is minimal. A total of 209 OHCA cases from Chiayi City in 2024 were analyzed, using Utstein-aligned data to compute UB-ROSC scores. Predictive performance was assessed via receiver operating characteristic (ROC) curves, calibration intercept and slope, the Hosmer-Lemeshow goodness-of-fit test, and bootstrap internal validation, focusing on sustained return of spontaneous circulation (ROSC) (> 2 h). After excluding pediatric and traumatic cases, 209 cases were analyzed. The cohort was 60.3% male, with 47.8% witnessed arrests and 67.0% receiving bystander CPR. The UB-ROSC score demonstrated fair discrimination, with an area under the ROC curve (AUC) of 0.78 (95% confidence interval [CI]: 0.70-0.85), stable on bootstrap and cross-validation. The calibration slope was 0.90 (95% CI: 0.62-1.18) but the calibration intercept was +0.71 (95% CI: 0.36-1.05), and the Hosmer-Lemeshow test was significant (<i>χ</i> ² = 28.6, <i>p</i> < 0.001), indicating systematic underprediction of observed survival. Risk stratification yielded a low-risk group (<i>n</i> = 109) with a 15.6% ROSC rate, a medium-risk group (<i>n</i> = 94) with a 48.9% rate, and a high-risk group (<i>n</i> = 6) with an 83.3% rate. The Chiayi cohort showed a slightly higher observed ROSC rate in the low-risk group, whereas the medium- and high-risk groups fell within the predicted ranges although estimates in the high-risk group were imprecise because of the small sample size. Local recalibration may be needed before applying absolute probability estimates in clinical settings.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"5871234"},"PeriodicalIF":1.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435601","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 eFAST Exams to Detect COVID-19 in Trauma Patients.","authors":"Nicholas Gossett, Michelle Thao Nguyen, Roy Almog, Andy Hsueh, Soheil Saadat, Megan Guy, Edmund Hsu, Madison Nashu, Ronald Goubert, Amanda Dos Santos, Andy Nguyen, Matthew Whited, Jessa Baker, John Christian Fox","doi":"10.1155/emmi/6173255","DOIUrl":"10.1155/emmi/6173255","url":null,"abstract":"<p><strong>Background: </strong>This original research study evaluates the utility of pulmonary point-of-care ultrasound (POCUS) within the extended focused assessment with sonography in trauma (eFAST) exam to detect asymptomatic COVID-19 in emergency department trauma patients. Specifically, it examines whether lung findings, such as B-lines, pleural thickening, and subpleural consolidations, can indicate a COVID-19 infection.</p><p><strong>Methods: </strong>This retrospective review includes trauma patients aged 18 years or older who underwent eFAST and COVID-19 swab testing at the University of California, Irvine Medical Center, from December 2020 to October 2022. Two blinded reviewers analyzed eFAST scans for more than two B-lines, irregular pleural interface, or subpleural consolidations, with discrepancies resolved by ultrasound fellows. Sensitivity, specificity, and predictive values were calculated with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 152 patients were included. Of 41 eFAST scans positive for COVID-19 findings, six were confirmed by PCR testing, yielding a positive predictive value of 15.6% (CI: 7.9%-25.6%). Among the 111 eFAST scans negative for COVID-19, 10 were PCR-positive, giving a negative predictive value of 91.0% (CI: 84.1%-95.6%). Sensitivity was 37.5% (CI: 15.2%-64.6%), and specificity was 74.3% (CI: 66.1%-81.4%).</p><p><strong>Conclusion: </strong>Lung POCUS within the eFAST exam is not a reliable tool for detecting asymptomatic COVID-19 infection in trauma patients due to limited sensitivity and low positive predictive value. Standard diagnostic methods, such as PCR testing, and the use of personal protective equipment should remain the primary approach to protect healthcare providers.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"6173255"},"PeriodicalIF":1.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677422","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":"Predicting Adverse Outcomes in Upper Gastrointestinal Bleeding: A Focus on Blood Urea Nitrogen-Based Ratios and Age-Adjusted Shock Index.","authors":"Omer Faruk Cakiroglu, Julide Gurbuz, Bilal Arac, Yilmaz Ersoz, Bahadir Taslidere, Basar Cander","doi":"10.1155/emmi/3772312","DOIUrl":"10.1155/emmi/3772312","url":null,"abstract":"<p><strong>Background/aim: </strong>Rapid risk stratification is crucial in managing upper gastrointestinal bleeding (UGIB). This study evaluated the prognostic value of the age-adjusted shock index (ASI), blood urea nitrogen (BUN)/haemoglobin ratio and BUN/platelet ratio for predicting adverse clinical outcomes.</p><p><strong>Materials and methods: </strong>This single-centre retrospective observational cohort study included 204 adult patients (age ≥ 18 years) presenting to the emergency department with UGIB between 1 January 2022 and 31 December 2022. Patients with oesophageal variceal bleeding, lower gastrointestinal sources, trauma, pregnancy, malignancy, prior diagnosis at another institution or incomplete data were excluded. Receiver operating characteristic (ROC) curve analysis was the primary statistical method used to determine prognostic performance.</p><p><strong>Results: </strong>Among the 204 included patients, the intensive care unit (ICU) admission rate was 14%, and the in-hospital mortality rate was 5.4%. ROC curve analyses for in-hospital mortality revealed statistically significant predictive capabilities across all evaluated parameters. The BUN/haemoglobin ratio demonstrated an area under the curve (AUC) of 0.779 at an optimal cut-off of > 8.45, yielding a high negative predictive value (NPV) of 97.26%. The BUN/platelet ratio produced an AUC of 0.747 at a cut-off of > 0.17, with an NPV of 98.32%. Additionally, the ASI achieved an AUC of 0.780 at an optimal cut-off of > 61.72 and an NPV of 98.03%.</p><p><strong>Conclusion: </strong>The ASI, BUN/haemoglobin and BUN/platelet ratios are rapid, inexpensive and easily calculable parameters upon admission. Their notably high NPVs make them effective complementary tools to established scoring systems, aiding clinicians in safely identifying low-risk patients who can be managed in the general ward rather than the ICU.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"3772312"},"PeriodicalIF":1.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13342697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410899","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":"Does Early Opioid Use for Relief of Acute Abdominal Pain Increase Use of Abdominal CT or Prolong Emergency Department Length of Stay?","authors":"Ben Bloom, Christie Fritz, Shivani Gupta, Jason Pott, Imogen Skene, Raine Astin-Chamberlain, Carlo L Rosen, Stephen H Thomas","doi":"10.1155/emmi/3925923","DOIUrl":"10.1155/emmi/3925923","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid use is common for emergency department (ED) patients presenting with undifferentiated abdominal pain (AbdPain). Whether the potential analgesic benefits of opioids are offset by prolonged ED length of stay (LOS)-possibly due to extended evaluations or increased diagnostic testing-remains unclear. The primary objective was to determine whether administration of an opioid, compared to a nonopioid drug, as initial analgesia in AbdPain patients is associated with longer ED LOS after adjusting for demographics and pain severity. Secondary objectives evaluated whether initial opioid use was associated with higher adjusted likelihood of ordering abdominal CT (CTabd) or white blood cell count (WBC) testing.</p><p><strong>Methods: </strong>This retrospective observational study analyzed 4 months of electronic health record data from a single UK health system, including consecutive adult ED patients presenting with AbdPain who received analgesia and had a documented pain score. Variables included demographic factors, initial pain level, and analgesic administered. ED workup variables included diagnostic testing (CTabd, WBC), LOS, and disposition. Categorical data were summarized as proportions with binomial exact 95% confidence intervals (CIs); continuous data were summarized with medians and interquartile ranges (IQRs). Univariable analyses used Wilcoxon rank-sum or Pearson's <i>χ</i> ² tests. Multivariable analyses employed quantile median regression for LOS and logistic regression for secondary outcomes.</p><p><strong>Results: </strong>During the study period, there were 884 patients meeting eligibility criteria. The median ED LOS was 7.7 h (IQR 5.0 to 11.9). CTabd and WBC were ordered in 362 (41.0%) and 797 (90.2%) of cases. Univariable analysis showed no association between initial opioid use and ED LOS (<i>p</i> = 0.255), CTabd ordering (<i>p</i> = 0.404), or WBC testing (<i>p</i> = 0.820). Multivariable modeling adjusting for operational factors, demographics, and pain score confirmed no significant association between initial opioid use and ED LOS (coefficient 0.18, 95% CI: -0.71-1.08, <i>p</i> = 0.684), CTabd (OR 1.12, 95% CI: 0.84-1.50, <i>p</i> = 0.430), or WBC testing (OR 0.91, 95% CI: 0.58-1.43, <i>p</i> = 0.698).</p><p><strong>Conclusions: </strong>Among ED patients with abdominal pain, initial opioid administration was not associated with longer LOS or increased use of diagnostic testing.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"3925923"},"PeriodicalIF":1.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410909","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":"Predictive Value of SpO2/RR Ratio for Short-Term Intubation and Mortality Risks in Pre-ED Patients With Acute Dyspnea Without Oxygen Therapy: A Retrospective Cohort Study.","authors":"Yuwei Tan, Sicheng Yuan, Panpan Wu, Xiaoqian Du, Hang Wang, Ge Guo, Lu Li, Li Dou, Tao Guo","doi":"10.1155/emmi/1372222","DOIUrl":"10.1155/emmi/1372222","url":null,"abstract":"<p><strong>Background: </strong>Dyspnea is a common and complex symptom in patients presenting to the emergency department, with multiple possible underlying diseases and a high risk of tracheal intubation or even death as the condition progresses. Therefore, an easily accessible, quick, and convenient index is needed to predict patient prognosis at emergency. A single measurement of peripheral capillary oxygen saturation (SpO₂) or respiratory rate (RR) is not sufficiently accurate, while other related indices are relatively complex. This study investigated the predictive value of the SpO₂/RR ratio (SR) in patients with acute dyspnea without oxygen therapy presenting to the emergency department.</p><p><strong>Methods: </strong>This single-center retrospective analysis was conducted in the emergency department of Jiangsu Provincial Hospital of Traditional Chinese Medicine. Patients diagnosed with acute dyspnea without oxygen therapy who were presented to the emergency triage by the 120 ambulance were included. SR was calculated from the first vital signs obtained at the 120 ambulance real-time transmission system for vehicles. Patients were divided into three groups based on terciles. Kaplan-Meier analysis, Cox regression models, and restricted cubic splines (RCS) were used to examine the associations between SR and clinical outcomes.</p><p><strong>Results: </strong>In total, 1339 patients were included. The rates of 7-day intubation and 28-day mortality differed significantly across SR groups (22.77%, 15.28%, 15.25%; <i>p</i> = 0.003) and (24.55%, 15.06%, 11.88%; <i>p</i> < 0.001), respectively. Cox regression and Kaplan-Meier analyses showed that lower SR was significantly associated with greater intubation and mortality risk (log-rank <i>p</i> = 0.003, <i>p</i> < 0.001). Subgroup and sensitivity analyses supported these findings, with the effect more pronounced in patients with an RR of ≥ 30 breaths/min. RCS nonlinear analysis revealed L-shaped associations between SR and 7-day intubation and 28-day mortality, with inflection points identified at 4.85 and 3.53.</p><p><strong>Conclusion: </strong>A lower SR was associated with increased 7-day intubation and 28-day mortality in emergency department patients with acute dyspnea without oxygen therapy. Inflection points of 4.85 and 3.53 suggest that SR may serve as a useful prognostic indicator for identifying high-risk patients with acute dyspnea.Yuwei Tan and Sicheng Yuan contributed equally to this work and both as co-first authors.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"1372222"},"PeriodicalIF":1.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367278","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":"Prognostic Role of Copeptin, H-FABP, and TTE in Pulmonary Embolism in the Emergency Department.","authors":"Huseyin Furkan Kucukbezirci, Seda Ozkan, Eser Durmaz, Fatih Cakmak, Ibrahim Ikizceli, Dildar Konukoglu, Gokcan Aman, Afsin İpekci","doi":"10.1155/emmi/9544238","DOIUrl":"10.1155/emmi/9544238","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) remains a major diagnostic and prognostic challenge in emergency departments due to its heterogeneous clinical presentation and potentially high mortality. Although echocardiography and conventional cardiac biomarkers are commonly used in clinical practice, the additional prognostic value of novel biomarkers such as copeptin and heart-type fatty acid-binding protein (H-FABP) requires further investigation.</p><p><strong>Methods: </strong>This exploratory prospective study (March 2021-September 2022) included adult patients (≥ 18 years) diagnosed with acute PE confirmed by radiological imaging in the emergency department. Patients with chronic/unconfirmed PE, incomplete data, or those referred from external centers were excluded. The primary analysis compared survivors and nonsurvivors at 30 days to evaluate the prognostic value of copeptin, H-FABP, and echocardiographic parameters. Transthoracic echocardiography (TTE) was performed after diagnosis to assess right heart function and pulmonary artery pressure (PAP), right ventricular/left ventricular ratio (RV/LV), right and left ventricular end-diastolic diameters (RV-EDD and LV-EDD), and tricuspid annular plane systolic excursion (TAPSE). Biomarkers (troponin, pro-BNP, D-dimer, copeptin, and H-FABP) were analyzed using standard laboratory assays and enzyme-linked immunosorbent assay (ELISA). The primary outcome was 30-day mortality.</p><p><strong>Results: </strong>A total of 88 patients were analyzed. Although H-FABP and copeptin levels were higher in nonsurvivors, these differences were not statistically significant for predicting 30-day mortality. Echocardiographic parameters-particularly PAP, RV-EDD, and RV/LV-were significantly associated with the severity of right ventricular dysfunction and clinical outcomes (<i>p</i> < 0.05). In multivariable logistic regression analysis copeptin, H-FABP, PESI score, ICU admission, RV-EDD, and LV-EDD remained independently associated with 30-day mortality. Cut-off values were determined by ROC analysis using the Youden index.</p><p><strong>Conclusions: </strong>Although biomarkers were not significant as continuous variables, exploratory categorized analysis based on cut-off values suggested a potential association with mortality. Rapid bedside echocardiography combined with appropriate biomarker testing may improve risk stratification in patients with PE in emergency settings, while larger studies are needed to clarify the role of these biomarkers.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"9544238"},"PeriodicalIF":1.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351071","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":"Emergency Department Disposition Among Pediatric Road Traffic Injury Patients Admitted to AaBET Hospital Emergency Department, Addis Ababa, Ethiopia.","authors":"Ayalew Zewdie, Biruktawit Zemede, Nebiyat Semeredin, Zelalem Negash","doi":"10.1155/emmi/8575907","DOIUrl":"10.1155/emmi/8575907","url":null,"abstract":"<p><strong>Background: </strong>Children are particularly vulnerable to road traffic injuries (RTIs) leading to morbidity and mortality. Despite the high incidence of pediatric RTIs in Ethiopia, data on the patterns and consequences of pediatric RTIs are limited.</p><p><strong>Objective: </strong>To assess the characteristics and ED disposition among pediatric patients (age ≤ 18 years old) with RTI admitted to emergency department of Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital, Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted, focusing on pediatric patients with RTIs who presented it to the emergency department of AaBET Hospital from December 12, 2021, to December 30, 2023, retrospectively. Data were collected using a standardized structured data collection checklist from hospital data records and medical charts. A sample size of 279 pediatric RTI patients was included from registered hospital records. After data cleaning, data were analyzed using SPSS Version 21. Descriptive statistics were used to describe the dependent variables.</p><p><strong>Result: </strong>Out of 279 patients, the median age was thirteen (IQR: 9-17). A total of 54.1% of the patients were male. One hundred and fourteen (40.9%) of those were from age 15-18. Two hundred and eight (74.6%) patients were pedestrians. Forty-eight percent of the patients sustained injury while in transit to work or school. Seventy six (27.2%) came to the hospital with private cars or trucks, while 63 (22.6%) came with an ambulance. One-hundred thirty five (48.4%) of the patients sustained extremity and pelvis injuries, while 41.9% sustained head injuries. Two-hundred fifty-five (91.4%) patients were discharged home from the emergency department. The emergency department mortality was 0.7%.</p><p><strong>Conclusion: </strong>In this study, children from the ages of 15-18 were more affected by RTIs. Pedestrians and while in transit to school or work were more injured. Head and extremity injuries were the predominant injuries that happened to children. Children and schools should be prioritized in targeted road safety initiatives, supported by stricter enforcement of traffic laws near school zones.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"8575907"},"PeriodicalIF":1.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270789","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}