Emergency Medicine International最新文献

{"title":"Geographic Validation of the SADFUL Scores for Identifying Bacteremia in the Unscheduled Emergency Department Revisit Cohorts.","authors":"Cheng-Yi Fan, Chun-Ju Lien, Po-Lin Wang, Chi-Hsin Chen, Jiun-Wei Chen, Edward Pei-Chuan Huang, Chih-Wei Sung","doi":"10.1155/emmi/1195292","DOIUrl":"10.1155/emmi/1195292","url":null,"abstract":"<p><strong>Background: </strong>The SADFUL score is developed to identify bacteremia in emergency department revisits (EDR), but its generalizability in various healthcare facilities and superiority over other scores remain unclear. This study aims to validate the SADFUL score in two hospitals with different levels of care.</p><p><strong>Method: </strong>This retrospective cohort study included adult EDR patients from an academic medical center (Hospital A) and a rural regional hospital (Hospital B) between March 1, 2019, and December 31, 2022. The SADFUL, quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) criteria, and shock index (SI) scores were compared using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The prevalence of bacteremia in the EDR cohort was 2.2% (120/5455). The SADFUL score's performance was inconsistent across the two hospitals. In Hospital A, its AUROC of 0.64 was significantly higher than those of the SIRS criteria, qSOFA, and the SI. In contrast, in Hospital B, its numerically higher AUROC of 0.72 was not statistically superior to the other scores. The optimal cutoff also differed between the two settings (≥ 2 in Hospital A and ≥ 4 in Hospital B).</p><p><strong>Conclusion: </strong>The SADFUL score demonstrated only modest accuracy and was not consistently superior to other commonly used clinical scoring systems. Overall, all evaluated tools exhibited limited utility in identifying bacteremia among EDR patients, highlighting the need for further research in this area.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"1195292"},"PeriodicalIF":1.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270721","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":"Accuracy and Reliability of AI Models in Emergency Myocardial Infarction Education.","authors":"İbrahim Korkmaz","doi":"10.1155/emmi/5530861","DOIUrl":"10.1155/emmi/5530861","url":null,"abstract":"<p><strong>Background: </strong>Acute myocardial infarction (AMI) is a major global cause of morbidity and mortality. Large language models (LLMs) are emerging tools for patient education. This study evaluated the performance of three LLMs in delivering accurate, reliable, and readable educational content regarding AMI.</p><p><strong>Methods: </strong>In this cross-sectional study (February-March 2025), a clinical case of a patient with an inferior STEMI ECG was presented to three LLMs: ChatGPT-4o, Claude 3.7 Sonnet, and Gemini Advanced 2.0 Flash. Each model answered 30 patient-focused questions across three domains: general disease knowledge, diagnostic processes, and treatment approaches. Responses were assessed by four emergency medicine associate professors (10-20 years of experience) using a 5-point Likert scale for accuracy, DISCERN and EQIP tools for reliability and quality, and standard readability indices.</p><p><strong>Results: </strong>ChatGPT-4o achieved the highest accuracy score (4.38 ± 0.38), followed by Claude 3.7 (4.09 ± 0.55) and Gemini 2.0 (3.92 ± 0.41) (<i>p</i> < 0.001). ChatGPT-4o performed significantly better in general information (<i>p</i> = 0.002) and diagnostics (<i>p</i> = 0.009), while Claude 3.7 excelled in treatment-related content (<i>p</i> = 0.015). Claude 3.7 produced significantly more readable responses than both ChatGPT-4o and Gemini 2.0 across all indices (Flesch-Kincaid, <i>p</i> = 0.002, Gunning Fog, <i>p</i> ≤ 0.001, Coleman-Liau, <i>p</i> = 0.003). ChatGPT-4o scored \"excellent\" on the DISCERN scale; all models were rated as \"good quality with minor shortcomings\" on EQIP. Reliability scores did not differ significantly (DISCERN, <i>p</i> = 0.188; EQIP, <i>p</i> = 0.935).</p><p><strong>Conclusions: </strong>LLMs show promise in supporting patient education on AMI. While ChatGPT-4o offers superior accuracy and reliability, Claude 3.7 enhances accessibility through clearer language. This is the first study comparing three LLMs for AMI education in an emergency context, underscoring that physician oversight remains essential for educational applications in emergency medicine.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"5530861"},"PeriodicalIF":1.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249181","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":"Nontechnical Skills (NTS) and the Quality of Conducting Prehospital Advanced Cardiopulmonary Resuscitation Among Paramedics.","authors":"Tomasz Ilczak, Michał Ćwiertnia, Kacper Sumera, Piotr Babik, Piotr Białoń, Mieczysław Dutka, Iwona Malinowska-Lipień, Magdalena Augustyn, Mateusz Majewski, Anna Lis, Piotr Leszczyński, Arkadiusz Stasicki, Piotr Abramczyk, Paweł Kukla, Wioletta Pollok-Waksmańska, Joanna Trojak-Piętka, Marek Kawecki","doi":"10.1155/emmi/2207053","DOIUrl":"10.1155/emmi/2207053","url":null,"abstract":"<p><strong>Introduction: </strong>It is common knowledge that the correct application of cardiopulmonary resuscitation (CPR) requires technical skills such as defibrillation, high-quality chest compressions, and efficient airway management. However, scientific research is increasingly underlining the role of appropriate training in nontechnical skills (NTS).</p><p><strong>Research aim: </strong>This exploratory study aimed to assess the relationship between NTS and the quality of advanced CPR among paramedics.</p><p><strong>Materials and methods: </strong>The research involved 51 paramedics randomly assigned to 17 three-person teams. Each team participated in a 15-min cardiac arrest scenario. After the first session, the teams were divided into two groups: the intervention group (Group 1), which underwent specialized NTS training, and the control group (Group 2), which did not receive the initial training. Directly after the training phase, all teams from both groups carried out a second attempt during a simulated sudden cardiac arrest (SCA) scenario identical to the first one.</p><p><strong>Results: </strong>The lowest CPR result in the intervention group (Group 1) was Min = -3.00, and the highest Max = 13.00, while in the control group (Group 2), the lowest result was Min = -42.00, and the highest Max = 8.00 (<i>p</i> < 0.05). In Group 1, a statistically significant correlation (<i>p</i> < 0.05) was noted between the change in the NTS score and the change in the CPR result. A higher NTS score was accompanied by a higher CPR score.</p><p><strong>Conclusions: </strong>A short NTS training session was associated with improved NTS application by paramedic resuscitation teams. Furthermore, higher chest compression quality positively correlated with NTS proficiency.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"2207053"},"PeriodicalIF":1.6,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210483","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":"Temperature Trajectories Are Associated With the Prognosis of Septic Patients.","authors":"Keying Ding, Chang Xu, Xueqi Zhu, Hua Wang, Zhaojun Xu, Zhongqiu Lu","doi":"10.1155/emmi/9111659","DOIUrl":"10.1155/emmi/9111659","url":null,"abstract":"<p><strong>Purpose: </strong>Sepsis is a heterogeneous clinical syndrome, and identification of its subphenotypes is essential. We aimed to investigate the correlation between the different trajectories of temperature and outcomes in septic patients.</p><p><strong>Patients and methods: </strong>This was a retrospective cohort study that included sepsis patients admitted to the intensive care unit (ICU) of a tertiary care hospital. Patients' temperature data were collected during the first 48 h after ICU admission, and patients' temperature trajectories were identified using growth-based trajectory modeling (GBTM). A multivariable logistic regression model was performed to assess the independent association of clinical outcomes. External validation was conducted using the MIMIC-IV database.</p><p><strong>Results: </strong>A total of 312 patients with sepsis were included. Four temperature trajectories were identified: hypothermia group (<i>n</i> = 33), fever and rapid temperature drop group (<i>n</i> = 45), persistently elevated temperature group (<i>n</i> = 63), and normothermia group (<i>n</i> = 171). Hypothermia patients exhibited the highest mortality and incidence of hospital-acquired bloodstream infections (HA-BSIs). Multivariable logistic regression showed that compared with the normothermia group, patients in the hypothermia group (OR 2.73; 95% CI 1.10-6.73; <i>p</i> = 0.030) and the persistently elevated temperature group (OR 3.40; 95% CI 1.74-6.67; <i>p</i> < 0.001) had significantly higher in-hospital mortality. Similar subphenotypes were observed in the MIMIC-IV cohort. Further analysis reached similar results in the MIMIC-IV dataset.</p><p><strong>Conclusion: </strong>This study used longitudinal body temperature data to identify the subphenotypes of sepsis, with significant variability in in-hospital mortality and HA-BSI. A better understanding of the temperature trajectory may be helpful in identifying deteriorating septic patients in advance.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"9111659"},"PeriodicalIF":1.6,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197706","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":"ICD-Related Emergencies in Prehospital Care: A Descriptive Survey of Self-Reported Experience and Equipment Availability Among Polish Paramedics.","authors":"Wojciech Telec, Tomasz Kłosiewicz, Magdalena Dimmich, Marta Szczygieł, Maria Krzemińska, Rafał Wójcik, Artur Baszko","doi":"10.1155/emmi/2737258","DOIUrl":"10.1155/emmi/2737258","url":null,"abstract":"<p><strong>Background: </strong>The number of patients with implantable cardioverter-defibrillators (ICDs) is steadily increasing, making encounters with ICD-related emergencies more frequent in prehospital care. Paramedics are often the first healthcare professionals to manage these situations; however, data on their exposure to ICD-related emergencies and access to appropriate equipment remain limited. This study aimed to describe Polish paramedics' self-reported experience with ICD-related emergencies and the availability of ICD deactivation magnets in prehospital settings.</p><p><strong>Methods: </strong>A descriptive cross-sectional survey was conducted among Polish paramedics between April and November 2024 using an anonymous online questionnaire. The survey assessed demographic and professional characteristics, self-reported exposure to ICD-related emergencies, perceived familiarity with selected ICD-related concepts, and access to ICD deactivation magnets. Data were analyzed descriptively, with exploratory subgroup analyses performed for selected variables.</p><p><strong>Results: </strong>A total of 340 paramedics participated in the survey. Most respondents reported having assisted patients experiencing ICD discharges, including during cardiopulmonary resuscitation. Self-reported familiarity with ICD-related terminology and ECG features varied across items. Only 7.93% of respondents reported access to an ICD deactivation magnet in their ambulance, most often self-provided rather than officially supplied. Greater professional experience was associated with more frequently reported exposure to ICD-related emergencies.</p><p><strong>Conclusions: </strong>Our study suggests that ICD-related emergencies are commonly encountered in prehospital practice, while access to ICD deactivation magnets remains limited. The findings reflect self-reported experience and perceived familiarity rather than objectively assessed competence and highlight potential system-level considerations for prehospital emergency care.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"2737258"},"PeriodicalIF":1.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148137052","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":"Assessment of the Technical Interpretability of Prehospital ECGs Performed by Medical and Nonmedical Teams in a French Emergency Medical System: A Descriptive Pilot Study.","authors":"Damien Duval, Delphine Douillet, Dominique Savary","doi":"10.1155/emmi/7380174","DOIUrl":"10.1155/emmi/7380174","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In prehospital emergency care systems, early electrocardiogram (ECG) acquisition is essential for patient triage and management. In France, nonmedical personnel, such as private ambulance technicians and firefighters, were authorized to perform ECGs. While ECGs are crucial for diagnosis, the technical quality and interpretability of these ECGs when transmitted to emergency medical dispatch centers remain uncertain, especially with newly trained nonmedical personnel for emergency medical services (EMS) (private ambulance drivers and public firefighters). This study aimed to assess the technical interpretability of prehospital ECGs transmitted to the emergency dispatch center, according to the type of prehospital team performing ECG acquisition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective observational study was conducted at Angers Emergency Medical Dispatch Centers, France. Adult patients who underwent prehospital ECG acquisition by either mobile intensive care units (MICUs) or nonmedical EMS teams were included. The primary endpoint was the technical interpretability of ECGs based on predefined core technical criteria derived from guideline-based ECG acquisition standards, including patient identification, recording speed and calibration, baseline stability, and absence of interference by the MICUs or nonmedical team. Precordial R-wave transition was analyzed separately as an exploratory marker of potential electrode placement issues. To assess this outcome, all ECGs were analyzed by two independent emergency physicians blinded to clinical data and team type, with consensus adjudication in case of disagreement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 149 prehospital ECGs were analyzed, including 125 performed by MICU teams and 24 by nonmedical EMS. In a sensitivity analysis excluding ECGs with ST-elevation myocardial infarction or conduction abnormalities and removing the R-wave transition criterion from the endpoint, overall interpretability increased to 73.7% (95% CI: 65.1%-80.8%, &lt;i&gt;n&lt;/i&gt; = 87/118). No statistically significant difference was observed between MICU teams (73.7%; 95% CI: 64.3%-81.4%, &lt;i&gt;n&lt;/i&gt; = 73/99) and nonmedical EMS (73.7%; 95% CI: 51.2%-88.2%, &lt;i&gt;n&lt;/i&gt; = 14/19) (RR 1.00; 95% CI: 0.75-1.34; &lt;i&gt;p&lt;/i&gt; = 1). Normal R-wave progression was frequently observed (53%) and was analyzed as an exploratory finding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this prehospital setting, less than half of ECGs met predefined composite technical interpretability criteria. However, these criteria reflect a strict technical assessment and should not be directly equated with clinical usefulness. No significant difference was observed between medical and nonmedical teams, although the study was underpowered and estimates were imprecise. These findings highlight the technical challenges of ECG acquisition in prehospital emergency care and support the need for prospective studies to optimize training, standardizati","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"7380174"},"PeriodicalIF":1.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986983","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 Poor One-Month Glasgow Outcome Scale Scores After Traumatic Brain Injury With Intracranial Hemorrhage in Adult Patients Presenting to the Emergency Department.","authors":"Welawat Tienpratarn, Phichayut Phinyo, Chaiyaporn Yuksen, Sirote Wongwaisayawan, Jiraporn Khorana, Jayanton Patumanond, Suteenun Seesuklom","doi":"10.1155/emmi/1023217","DOIUrl":"10.1155/emmi/1023217","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a major public health concern in Thailand, contributing to substantial morbidity and mortality. This study aimed to identify prognostic factors associated with poor Glasgow Outcome Scale (GOS) scores 1 month after TBI with intracranial hemorrhage (ICH). This is particularly relevant in the emergency department (ED), where early decisions regarding triage, monitoring, and disposition must be made rapidly.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at Ramathibodi Hospital, Bangkok, Thailand, including trauma patients aged ≥ 15 years with TBI and ICH who presented to the ED between 2020 and 2022. Outcomes were categorized into three groups based on the 1-month GOS: unfavorable (GOS 1-2), intermediate (GOS 3-4), and favorable (GOS 5). Clinical factors and CT findings were analyzed using multivariable ordinal logistic regression to identify factors associated with poor GOS scores across these groups.</p><p><strong>Results: </strong>A total of 227 patients were included in the study. Among them, 31 patients (13.6%) were in the unfavorable group, 81 patients (35.7%) in the intermediate group, and 115 patients (50.7%) in the favorable group. Factors associated with poorer outcomes included elderly patients (age ≥ 65 years) (multivariable odds ratio [mOR] 5.25, 95% confidence interval [CI] 2.33-11.85), low initial systolic blood pressure (SBP < 100 mmHg) (mOR 4.38, 95% CI 1.02-18.86), and initial glasgow coma scale (GCS) scores: severe vs. mild (mOR 49.88, 95% CI 14.26-174.44) and moderate vs. mild (mOR 12.26, 95% CI 3.86-38.98). Other factors included slight pupillary reaction (mOR 8.36, 95% CI 1.76-39.67), although this finding should be interpreted cautiously due to the small number of abnormal observations and wide CIs, as well as subdural hematoma (SDH) (mOR 3.10, 95% CI 1.53-6.25) and midline shift or brain herniation (mOR 4.41, 95% CI 1.84-10.57).</p><p><strong>Conclusions: </strong>These factors were associated with poorer 1-month GOS scores and may support early risk stratification in adult TBI patients with traumatic ICH.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"1023217"},"PeriodicalIF":1.6,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962598","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":"Application of Continuous Improvement of Pre-Examination Process Based on Evidence-Based Nursing Concept in Acute Chest Pain of Adults.","authors":"Qiongyao Gan, Rongrong Yao","doi":"10.1155/emmi/8401158","DOIUrl":"10.1155/emmi/8401158","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and effectiveness of implementing a continuous improvement of the pre-examination process based on evidence-based nursing concept in the management of acute chest pain in adults.</p><p><strong>Methods: </strong>Based on the inclusion and exclusion criteria, the 92 cases of acute chest pain patients who aged ranging from 18 to 75 years old were admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from December 2022 to December 2024 and were allocated by admission date into the control group (<i>n</i> = 46) and the observation group (<i>n</i> = 46). The control group received routine pre-examination and triage, while the observation group underwent continuous improvement of the pre-examination process based on evidence-based nursing concept. The waiting time, consultation time, triage duration, triage accuracy rate, misdiagnosis rate, missed diagnosis rate, revisit rate, complaint rate, rescue success rate, and patient satisfaction were compared between the two groups.</p><p><strong>Results: </strong>The waiting time, consultation time, and triage duration in the observation group ([4.45 ± 1.21] min, [2.08 ± 0.44] min, [1.56 ± 0.37] min) were shorter than the control group ([5.61 ± 1.08] min, [2.97 ± 0.25] min, [2.52 ± 0.42] min) (<i>t</i> = 4.851, 11.928, 11.632, <i>p</i> < 0.05). The triage accuracy rate in the observation group was higher than the control group (95.65% <i>vs</i> 80.43%, <i>χ</i> ² = 5.059, <i>p</i> < 0.05). The misdiagnosis rate, missed diagnosis rate, and complaint rate in the observation group were (4.35%, 2.17%, 2.17%) lower than the control group (17.39%, 17.39%, 17.39%) (<i>χ</i> ² = 4.039, 6.035, 6.035, <i>p</i> < 0.05). The rescue success rate and patient satisfaction in the observation group (97.83%, 95.56%) were higher than the control group (84.78%, 79.49%) (<i>χ</i> ² = 4.929, 5.144, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The implementation of an evidence-based continuous improvement program for the pre-examination process was associated with enhanced triage accuracy, reduced diagnostic errors and complaints, and improved rescue outcomes and patient satisfaction in adult patients with acute chest pain. These findings support the feasibility and potential clinical value of integrating structured, evidence-guided processes into emergency triage workflows.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"8401158"},"PeriodicalIF":1.6,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927810","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":"Predictors of Massive Transfusion in Patients With Hollow Organ Injury After Blunt Multiple Trauma: A Cohort of Blunt Bowel Mesenteric Injury.","authors":"Ting-Min Hsieh, Po-Chun Chuang, Chun-Ting Liu, Bei-Yu Wu, Ching-Hua Hsieh, Fu-Jen Cheng","doi":"10.1155/emmi/5286788","DOIUrl":"10.1155/emmi/5286788","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Massive transfusion (MT) is life-saving for patients with exsanguination, especially after blunt abdominopelvic trauma, due to subtle manifestations. Blunt bowel mesenteric injuries (BBMIs), besides their potential risk of peritonitis, are still one of the few indications for emergency laparotomy for hemorrhagic shock in the era of nonoperative management. Early prediction of the need for MT defined as using ≥ 10 units of packed red blood cells (PRBCs) in 24 h and activation of the MT protocol (MTP) is a critical aspect in resuscitation. Current scoring systems predicting MT are usually laboratory data or hemodynamic status-dependent, which are limited by the time-consuming and dynamic characteristics of trauma; thus, they seem to lack objectivity in patients with BBMI due to dramatic clinical deterioration. The present study aimed to determine the predictors of associated injuries contributing to the requirement for MT in patients who underwent surgical BBMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2022. The patients were divided based on the presence or absence of MT before emergency laparotomy. Associated injury parameters and bowel mesenteric injury characteristics were used in multivariate regression analysis to identify independent predictors of MT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 163 adult patients with surgically proven BBMI were enrolled in the study. The overall patients with MT were 30.6% (50/163). Compared to the MT (-) group, BBMI patients receiving MT had worse clinical injury severity, vital signs, and prognosis; patients receiving MT had significant a lower initial hemoglobin level and higher percentages of receiving PRBC (11.15 mg/dL vs. 13.10 mg/dL, &lt;i&gt;p&lt;/i&gt; &lt; 0.001 and 47% vs. 42%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and required more volume of PRBC at emergency department (ED) (5.5 units vs. 0 units, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) as compared to the MT (-) group. Besides, patients with MT administered more amounts of PRBC within 24 h and at operation room in comparison with patients without MT (16 units vs. 2 units, &lt;i&gt;p&lt;/i&gt; &lt; 0.001 and 8 units vs. 0 units, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Patients with MT involved with more isolated mesenteric injury or combined injury and had both higher complications and overall mortality rates (94% vs. 55.8%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001 and 32% vs. 4.4%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In multivariate analysis, the presence of traumatic brain injury (TBI) (odds ratio [OR] = 6.7, 95% confidence intervals [CIs]: 1.66-27.02) and pelvic fracture (OR = 6.01, 95% CIs = 1.45-24.89) was identified as an independent predictor of MT after adjusting for confounding factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;For patients with BBMI, one-third require MT prior to laparotomy, necessitating early activation of the MTP. When BBMI patients present with hemodynamic instability or higher injury severity, particularly in the presence of concomita","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"5286788"},"PeriodicalIF":1.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688871","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":"Association Between the Lactate-to-Albumin Ratio and ICU/In-Hospital Mortality in Critically Ill Patients With Comorbid Type 2 Diabetes Mellitus : A Cohort Study Utilizing the MIMIC-IV Database.","authors":"Zhuo-Ting Cheng, Jia-Liang Wang, Yan-Bo Zhao, Zheng-Ming Zhao, Zhi-Jun Li, Yang Liu","doi":"10.1155/emmi/2751114","DOIUrl":"10.1155/emmi/2751114","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) accounts for over 90% of diabetes cases worldwide, and its rising prevalence poses a substantial public health challenge. The lactate-to-albumin ratio (LAR) is a novel biomarker that reflects both metabolic stress and nutritional-inflammatory status, and it has demonstrated independent prognostic value in various critical illnesses. However, its association with mortality in critically ill patients with T2DM remains unclear. This study aims to evaluate the predictive value of LAR for prognosis in this specific patient population through a retrospective analysis.</p><p><strong>Methods: </strong>This retrospective observational cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) v3.0 database, which includes complete medical records of patients admitted to the intensive care unit (ICU) of a U.S. medical center between 2008 and 2022. Subjects were categorized into three groups based on LAR tertiles. The study assessed ICU mortality and in-hospital mortality as primary outcomes; 30-day, 90-day, and 365-day mortality after ICU admission served as secondary outcomes. Machine learning identified key variables related to LAR and outcomes. The association between LAR and primary outcomes was analyzed using multivariate logistic regression and restricted cubic spline (RCS) regression. Cumulative mortality was analyzed using Kaplan-Meier curves. Threshold effects were evaluated using generalized additive models to enhance clinical applicability. Sensitivity and subgroup analyses were used to validate the robustness of the results and the interactions within subgroups.</p><p><strong>Result: </strong>The study included 5463 critically ill T2DM patients. Using Boruta and SHapley Additive exPlanations (SHAP) algorithms, 14 key variables were identified. RCS analysis revealed a nonlinear relationship between LAR and in-hospital mortality (<i>p</i> for nonlinearity = 0.001). Threshold effect analysis identified a critical LAR threshold of 2.10. Kaplan-Meier survival curves showed that higher LAR values were correlated with increased mortality (<i>p</i> < 0.001). Subgroup analyses revealed significant interactions in gender subgroups for ICU mortality (<i>p</i> for interaction = 0.043) and in hyperlipidemia (HLD) subgroups for in-hospital mortality (<i>p</i> for interaction = 0.049). Sensitivity analyses confirmed robust associations between LAR and ICU mortality (OR 1.32, 95% CI: 1.20-1.45, <i>p</i> < 0.001) and in-hospital mortality (OR 1.37, 95% CI: 1.26-1.50, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This study identified a significant correlation between elevated LAR and adverse ICU outcomes in critically ill patients with T2DM.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2026 ","pages":"2751114"},"PeriodicalIF":1.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688894","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}