International Journal of Emergency Medicine最新文献

{"title":"Alcohol-positive polytrauma patients: injury patterns, ICU resource use and mortality at a German Level I trauma center.","authors":"Claudius Thiedemann, Sergei Gorovoi, Lorenz Huber, Daniel Popp, Michael Galler, Paul Schmitz, Volker Alt, Antonio Ernstberger","doi":"10.1186/s12245-026-01411-x","DOIUrl":"10.1186/s12245-026-01411-x","url":null,"abstract":"<p><strong>Background: </strong>In most countries, alcohol consumption is so culturally ingrained that even small amounts are permitted while driving. Even at a blood alcohol concentration of 0.5 g/L, ethanol impairs mental and cognitive performance. Studies from the US and Europe estimate that elevated blood alcohol levels may be detected in 10%-40% of all emergency department patients. Against this background, we investigated the impact of alcohol consumption on injury severity, injury patterns, as well as primary and secondary outcomes in polytrauma patients.</p><p><strong>Materials and methods: </strong>This retrospective, single-center cohort study included patients admitted to a Level I trauma center via the trauma room and documented in the TraumaRegister DGU^® between 2015 and 2023. Serum ethanol was determined routinely in all adolescent and adult trauma room patients. Patients without serum ethanol measurement or younger than 13 years were excluded. Patients with detectable serum ethanol (> 1 mg/dL, detection limit of the laboratory; ALC) were compared with patients without (noALC) using the χ² and Mann-Whitney U tests. Multivariable logistic and linear regression analyses were adjusted for age, sex, Injury Severity Score (ISS), severe traumatic brain injury (TBI) and pre-injury ASA classification. A dose-response analysis was performed using serum ethanol categories.</p><p><strong>Results: </strong>A total of 1,524 patients were analyzed: 431 (28.3%) were alcohol-positive (ALC) and 1,093 (71.7%) were not (noALC). ALC patients were younger, more often male and had a lower prehospital Glasgow Coma Scale (GCS) score (p < 0.001), whereas the ISS did not differ (p = 0.396). They were more frequently victims of violent crime and were overrepresented among pedestrians and falls from < 3 m, whereas motorcyclists were more often sober. Alcohol-positive patients were more often treated in the ICU (90.0% vs. 86.3%; p = 0.048), but this association was attenuated after multivariable adjustment (adjusted odds ratio [aOR] 1.40; 95% CI 0.96-2.03). Length of ICU stay and duration of mechanical ventilation did not differ, and alcohol was not independently associated with mortality (aOR 0.91; 95% CI 0.56-1.47). Severe TBI was more frequent in alcohol-positive patients (38.5% vs. 29.5%), increased with serum ethanol concentration, and was the strongest predictor of ICU treatment and mortality.</p><p><strong>Conclusion: </strong>Nearly one in three severely injured patients had detectable serum ethanol. After adjustment for confounders, alcohol was not independently associated with mortality or intensive care resource use, and no dose-response relationship was found for these outcomes. The more frequent ICU treatment of alcohol-positive patients appears to be explained by their distinct injury pattern, particularly the concentration-dependent increase in severe TBI.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of CBRN health sector preparedness in Lebanon.","authors":"Eveline Hitti, Tharwat El Zahran, Antoine Kallab, Layla Farah","doi":"10.1186/s12245-026-01379-8","DOIUrl":"10.1186/s12245-026-01379-8","url":null,"abstract":"<p><strong>Background: </strong>As chemical, biological, radiological, and nuclear (CBRN) events become increasingly recognised within international and national emergency preparedness efforts, this study aims to provide the first system-level overview of Lebanon's preparedness capacities for CBRN-related health emergencies.</p><p><strong>Methods: </strong>A narrative review of peer-reviewed and grey literature was conducted using a structured search strategy, with findings thematically synthesised to assess governance and operational CBRN preparedness capacities across eight health system domains in Lebanon.</p><p><strong>Results: </strong>The review identified important advances in Lebanon's preparedness for CBRN health emergencies, including engagement with international preparedness frameworks, development of governance structures, and implementation of coordination, training, and simulation initiatives. However, preparedness remains uneven and constrained by fragmented coordination, legislative gaps, limited surveillance and operational integration, shortages in material and human resources, and dependence on external support. Economic instability and workforce migration further challenge sustainability, while preparedness capacities and readiness levels vary across emergency response and healthcare institutions. Overall, strategic planning and governance capacities appeared stronger than operational response and surveillance functions.</p><p><strong>Conclusion: </strong>While major efforts towards CBRN preparedness in Lebanon have been initiated, key aspects remain under-developed. Given Lebanon's continued exposure to recurrent crises and regional instability, strengthening CBRN preparedness should be considered a critical component of broader health system resilience and national disaster risk reduction efforts.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three doors, three locks: a domain-specific framework for the residual door-to-balloon gap in STEMI care : Matters Arising, commentary on Krishnan et al., Int J Emerg Med 2026;19:113.","authors":"Sajid Kadir, Travis Murphy","doi":"10.1186/s12245-026-01405-9","DOIUrl":"https://doi.org/10.1186/s12245-026-01405-9","url":null,"abstract":"<p><p>Krishnan and colleagues report that 91% of STEMI patients at a large Indian tertiary centre received primary PCI within the 90-minute door-to-balloon (D2B) target, a meaningful achievement in contemporary STEMI care. Their analysis of the 9% who missed the target is equally valuable: delays distributed almost evenly across three categories, delayed informed consent, hemodynamic instability, and diagnostic ambiguity. We argue these categories are not interchangeable quality-improvement targets. They are mechanistically distinct problems requiring different solutions. We propose a conceptual, hypothesis-generating framework rather than a validated taxonomy. Future STEMI quality improvement efforts should categorize residual delays by domain rather than reporting them in aggregate, and should match interventions to the specific mechanism of delay.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric evaluation of the Persian version of the shared decision‑making questionnaire in patients undergoing emergency surgery.","authors":"Nasrin Hanifi, Hamid Sharif-Nia, Seyede Fatemeh Gheiasi, Maryam Maleki, Abbas Mardani","doi":"10.1186/s12245-026-01401-z","DOIUrl":"10.1186/s12245-026-01401-z","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate assessment of shared decision-making (SDM) is essential in emergency surgery, yet no culturally adapted and validated instrument is available in Iran. This study aimed to translate, culturally adapt, and assess the psychometric properties of the Persian SDM-Q-9 among patients undergoing emergency surgery.</p><p><strong>Methods: </strong>This methodological cross-sectional study followed a forward-backward translation procedure to adapt the SDM-Q-9 into Persian. Face and content validity were established prior to construct validation. Data were collected from 575 patients undergoing emergency surgery and randomly split into two independent subsamples for exploratory factor analysis (EFA; n = 287) and confirmatory factor analysis (CFA; n = 288). Internal consistency was assessed using Cronbach's alpha, McDonald's omega, and composite reliability (CR). Convergent validity was examined using average variance extracted (AVE).</p><p><strong>Results: </strong>The data were suitable for factor analysis (Kaiser-Meyer-Olkin [KMO] = 0.923; Bartlett's test of sphericity: χ² = 3433.445, df = 36, p < 0.001). EFA using Maximum Likelihood (ML) extraction with Promax rotation supported a single-factor structure explaining 58.60% of the total variance, with all factor loadings exceeding 0.70. CFA of the independent validation subsample initially showed inadequate fit for the one-factor model. After reviewing modification indices and item content, three theoretically justified residual correlations were retained. The resulting model showed good fit (χ²/df = 2.78, Comparative Fit Index [CFI] = 0.962, Tucker-Lewis Index [TLI] = 0.944, Root Mean Square Error of Approximation [RMSEA] = 0.059, and Standardized Root Mean Square Residual [SRMR] = 0.052). Factor loadings ranged from 0.67 to 0.84, supporting a predominantly unidimensional structure. The scale demonstrated strong internal consistency (Cronbach's alpha = 0.921, McDonald's omega = 0.926, and CR = 0.924). Convergent validity was supported by an AVE of 0.576.</p><p><strong>Conclusion: </strong>The Persian SDM-Q-9 demonstrated satisfactory validity and strong reliability for assessing patient-perceived shared decision-making in emergency surgical settings in Iran. Its predominantly unidimensional structure supports its use, although the localized residual associations identified in CFA warrant replication in independent, multicenter samples.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Acute Physiology, Age and Chronic Health Evaluation II score and Peradeniya Organophosphorus Poisoning Scale in predicting clinical outcomes and mortality in organophosphorus poisoning.","authors":"Geo George Thomas, Santosh Kumar Chandaka, S Raghavendra Goud, Shehana Punnilath Salim, Premchand Bangaru, Vignan Kappagantu","doi":"10.1186/s12245-026-01397-6","DOIUrl":"10.1186/s12245-026-01397-6","url":null,"abstract":"<p><strong>Background: </strong>Organophosphorus poisoning is a major health hazard in developing countries. We conducted a study to compare the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system and Peradeniya Organophosphorus Poisoning Scale in predicting the complications, ventilator requirement and mortality in patients of Acute Organophosphorus Poisoning.</p><p><strong>Methodology: </strong>A prospective observational study was done on 100 patients above 18 years of age, presenting with alleged history of consumption of organophosphorus compounds. The patients were evaluated for the required details to calculate the APACHE II score and Peradeniya Organophosphorus Poisoning Scale and were followed up till discharge or mortality to identify the complications, ventilator requirement and mortality. This data was tabulated using Excel and analyzed using SPSS software to look for correlation between the scores and the outcome.</p><p><strong>Results: </strong>The mean age of our patients was 33.64 ± 12.99 years. The APACHE II cutoff score for complications, ventilator requirement and mortality was ≥ 7 (sensitivity 94.3%, specificity 96.9%, Area under Receiver Operator Characteristic (ROC) 0.99, p < 0.01), ≥9 (sensitivity 86.7%, specificity 82.4%, Area under ROC 0.91, p < 0.01) and ≥16 (sensitivity 85.7, specificity 96.8%, Area under ROC 0.98, p < 0.01) respectively. Similarly, the Peradeniya Organophosphorus Poisoning Scale cutoff was for complications, ventilator requirement and mortality was ≥ 3 (sensitivity 80%, specificity 92.3%, Area under ROC 0.90, p < 0.01), ≥3 (sensitivity 80%, specificity 75.3%, Area under ROC 0.85, p < 0.01) and ≥7 (sensitivity 85.7%, specificity 97.8%, Area under ROC 0.99, p < 0.01) respectively.</p><p><strong>Conclusion: </strong>Both APACHE II and POPS demonstrated good predictive performance for adverse outcomes in acute organophosphorus poisoning. Both scores showed excellent discrimination for mortality, with no statistically significant difference between their AUCs.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charting the rise of artificial intelligence in medical education: a global bibliometric and network analysis, 2000-2026.","authors":"Rishi Selvaraj, Ethan Nichols, Latha Ganti, Shayne Gue","doi":"10.1186/s12245-026-01388-7","DOIUrl":"10.1186/s12245-026-01388-7","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence has moved from a peripheral curiosity to a core feature of modern medical education through adaptive learning, simulation-based training, automated assessment, and large language models such as ChatGPT. Publication activity has accelerated rapidly, but the structure of this expanding literature has not been comprehensively mapped.</p><p><strong>Methods: </strong>Bibliographic data were obtained from the Web of Science Core Collection using a search strategy that combined medical education terms in the title field with artificial intelligence terms in the topic field. Articles, review articles, and data papers published from 2000 to 2026 were included. A total of 2,298 records were retrieved. Microsoft Excel was used for descriptive analyses, and VOSviewer (version 1.6.20) was used to construct keyword co-occurrence, country collaboration, and institutional collaboration networks. Data for 2026 represent a partial calendar year.</p><p><strong>Results: </strong>Publication output remained limited until the late 2010s and rose sharply after 2021. Of the 2,298 records, 2,066 (89.9%) were published from 2021 to 2026, with the highest complete-year output in 2025 (821 publications). The United States led in publication volume (918 records) and raw citation count (14,582 citations), followed by the People's Republic of China (367 records; 4,404 citations). The Journal of Surgical Education published the most articles. Harvard Medical School led institutional output, whereas Stanford University and the University of California San Francisco had higher raw citation totals despite fewer publications. Artificial intelligence, medical education, ChatGPT, medical students, and machine learning were the most prominent keywords.</p><p><strong>Conclusions: </strong>Artificial intelligence in medical education is a rapidly expanding but geographically and institutionally concentrated field. Raw citation patterns differed from publication volume, although these unadjusted measures should not be interpreted as direct comparisons of research quality. Thematic patterns emphasize learner-facing applications, assessment, and generative AI, while responsible curricular integration and empirical evaluation remain important priorities. These findings are especially relevant to emergency medicine education, where simulation, time-sensitive decision-making, and competency assessment are central.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and psychosocial factors of PTSD among disaster-affected populations in India: a systematic review and meta-analysis.","authors":"U Harikrishnan, Anila Elizabeth John, Deva Reghuchandran Nair, Arif Ali, M M Rajeev, Joe Thomas","doi":"10.1186/s12245-026-01394-9","DOIUrl":"10.1186/s12245-026-01394-9","url":null,"abstract":"<p><strong>Background: </strong>Post-Traumatic Stress Disorder (PTSD) is a widespread condition affecting individuals globally in the aftermath of disasters. For this review, the disaster-affected population refers to individuals or populations who have experienced a potentially traumatic event with psychosocial consequences. The current review aims to assess the prevalence and psychosocial factors of PTSD among disaster-affected populations in India.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in the present study. Relevant keywords were identified and used to search databases, including Scopus, PubMed, ScienceDirect, and Cochrane, as well as websites and reference lists, to identify eligible studies. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow chart was used for the final included studies to reveal the results. The current review conducted a critical appraisal of the included studies by using the Joanna Briggs Institute (JBI) quality evaluation. Meta-analysis using Jeffreys's Amazing Statistics Program (JASP) software and manual analysis was done to assess the psychosocial factors and conceptual framework.</p><p><strong>Results: </strong>A total of 1370 documents were identified from the databases, and 151 documents were duplicates. Following title/abstract screening, 1178 studies were excluded, 21 full text not retrieved, and 20 studies were included for the final results. The critical appraisal results found that more than half of the studies demonstrated good methodological quality. The results revealed that the pooled prevalence of PTSD was 38%, with young populations disproportionately affected, although no significant associations were found with age group, disaster type, or region. Nineteen psychosocial risk factors were identified, prominently including loss of family members or pets and property damage. The conceptual framework highlights the interplay between traumatic events and psychosocial factors in PTSD outcomes.</p><p><strong>Conclusion: </strong>The findings underscore the need for multidisciplinary collaboration among mental health professionals, long-term intervention strategies, and evidence-based practices to address India's mental health challenges.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe symptomatic hypocalcemia with neuromuscular hyperexcitability associated with long-term pantoprazole use: a case report.","authors":"Arshia Khaneghahi, Saber Zamani, Mohammad Akbari, Ali Akbari, Arian Zarrintaj","doi":"10.1186/s12245-026-01398-5","DOIUrl":"10.1186/s12245-026-01398-5","url":null,"abstract":"<p><strong>Background: </strong>Hypocalcemia is a common electrolyte abnormality; however, severe symptomatic hypocalcemia presenting with neuromuscular hyperexcitability and cardiac manifestations is an uncommon clinical condition requiring prompt recognition and management. Long-term proton pump inhibitor (PPI) therapy has been associated with disturbances in mineral metabolism, particularly hypomagnesemia, which may contribute to impaired calcium homeostasis.</p><p><strong>Case presentation: </strong>A 54-year-old woman from a remote rural area was referred to our hospital after developing progressive weakness, paresthesia, and painful involuntary muscle contractions. Neurological examination revealed bilateral carpopedal spasms with positive Trousseau's and Chvostek's signs. Electrocardiography demonstrated QTc prolongation. Laboratory evaluation showed severe hypocalcemia with a total calcium level of 5.2 mg/dL and ionized calcium of 0.74 mmol/L, accompanied by mild hypomagnesemia, vitamin D insufficiency, and an inappropriately low parathyroid hormone (PTH) response. The patient had been self-administering pantoprazole 40 mg daily for approximately four years without regular reassessment. Pantoprazole was discontinued because of its potential contribution to impaired calcium and magnesium homeostasis. She was treated with intravenous calcium gluconate under cardiac monitoring, followed by magnesium and vitamin D supplementation and transition to oral calcium therapy. Her clinical symptoms resolved during hospitalization. At the one-month follow-up, she remained asymptomatic, with sustained normalization of serum calcium and magnesium levels and no recurrence of electrolyte imbalance.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering severe symptomatic hypocalcemia in patients receiving long-term pantoprazole therapy, particularly when neuromuscular and cardiac manifestations are present. Although a direct causal relationship cannot be definitively established, the coexistence of prolonged PPI exposure, mild hypomagnesemia, vitamin D insufficiency, and impaired PTH response suggests a multifactorial mechanism. Early recognition, comprehensive evaluation of calcium homeostasis, and appropriate correction of electrolyte abnormalities are essential to prevent serious complications.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of early recognition and intervention in Ludwig's angina by emergency medicine physicians to prevent life-threatening complications.","authors":"Harrison Phillips, Majid Ali Qureshi, Abdul Jalil, Mehtab Khan, Christy Collins, Omar Hafeez-Bore","doi":"10.1186/s12245-026-01396-7","DOIUrl":"https://doi.org/10.1186/s12245-026-01396-7","url":null,"abstract":"<p><strong>Background: </strong>Ludwig's angina is a life-threatening cellulitis that can easily progress to airway compromise. Significant infection, often from periodontal abscesses of the molar teeth, may cause superior and posterior displacement of the tongue compromising patient's airways if not identified and treated promptly. Early recognition and clinical diagnosis, with or without imaging and blood cultures, and antibiotic treatment can help prevent rapid airway compromise, systemic infection and Le Mierre's disease (a rare life-threatening complication). Given that emergency departments are often the first point of contact, maintaining a high index of suspicion and acting decisively can significantly improve patient outcomes.</p><p><strong>Case presentation: </strong>We report a case of a 79-year-old male presenting with a swollen neck progressing over the course of 24 h. This gentleman presented to our emergency department with a superior and inferior swelling to the mandible, a change in voice, and displacement of his tongue. Clinical examination showed a trismus of 1.5 cm, a superiorly and posteriorly displaced tongue, and a tender dental abscess of the lower molars. From examination a clinical diagnosis of Ludwig's angina was made, later confirmed on CT head and neck. A suspicious incidental finding of an internal jugular embolus on the background of dental infection was also suspicious for an early presentation of Le Mierre's disease. Intravenous antibiotics were promptly started. Intensive care team was contacted to support the patient's airway and facilitate transfer to our intensive care unit (ICU). Maxillofacial team was also notified and following antibiotics and tooth/abscess removal the patient made a full recovery and has no repeat presentation since.</p><p><strong>Conclusion: </strong>This case highlighted and emphasised the importance of early recognition of neck swelling by emergency physicians to prevent progression of airway compromise and Le Mierre`s disease. Assessing emergency doctors must be able to identify, diagnose, treat and escalate Ludwig's angina secondary to periodontal abscesses prior airway compromise or systemic infection.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global research trends in violence against emergency department healthcare workers.","authors":"Harish Krishnan, Pranay Gadikota, Shayne Gue, Michelle Wallen","doi":"10.1186/s12245-026-01359-y","DOIUrl":"https://doi.org/10.1186/s12245-026-01359-y","url":null,"abstract":"<p><strong>Background: </strong>Violence in emergency departments (EDs) threatens healthcare worker safety, workforce well-being, and the quality of patient care. This study characterized the growth, geographic distribution, influential contributors, and thematic evolution of research addressing violence in ED settings, with particular emphasis on healthcare workers.</p><p><strong>Methods: </strong>A bibliometric analysis was conducted using the Web of Science Core Collection. The search was performed on June 16, 2026, and included publications from 1984 to 2026. Records were analyzed descriptively and mapped with VOSviewer to examine publication output, subject categories, journals, authors, countries, co-authorship patterns, keyword co-occurrence, and highly cited publications. Reporting was guided by the BIBLIO recommendations.</p><p><strong>Results: </strong>The search identified 1,074 publications. Annual output increased substantially after 2020 and peaked at 113 publications in 2025. Nursing and emergency medicine were the leading subject categories, and the Journal of Emergency Nursing was the most productive journal. The United States contributed 498 publications, followed by Australia and China. Gloria Gillespie was the most productive author. Network analyses demonstrated a dense workplace-violence and healthcare-worker-safety core alongside partially distinct clusters related to behavioral health, substance use, intimate partner violence, agitation management, and COVID-19. Collaboration between major thematic communities appeared limited.</p><p><strong>Conclusions: </strong>Research on violence in ED settings has expanded rapidly, particularly since the COVID-19 pandemic. The literature remains concentrated in high-income countries and is dominated by descriptive and prevalence-focused work. Future research should prioritize multicenter intervention studies, implementation science, cross-disciplinary collaboration, and greater representation of low- and middle-income settings.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}