International Journal of Emergency Medicine最新文献

{"title":"Treatment of agitation in dementia - a systematic review.","authors":"Misha Choudry, Murdoc Gould, Latha Ganti","doi":"10.1186/s12245-025-00902-7","DOIUrl":"10.1186/s12245-025-00902-7","url":null,"abstract":"<p><p>Dementia, including Alzheimer's disease (AD), affects millions worldwide, leading to cognitive decline, memory loss, and behavioral disturbances. Agitation, a common symptom, poses significant challenges for patients and caregivers. This systematic review evaluates pharmacological and non-pharmacological interventions for managing agitation in dementia. Nine clinical studies were analyzed, encompassing medications like brexpiprazole and non-pharmacological approaches such as music therapy and digital care programs. Pharmacological treatments showed mixed efficacy and safety profiles, with brexpiprazole demonstrating dose-dependent benefits and mirtazapine associating with higher mortality rates. Non-pharmacological interventions exhibited promising results in reducing agitation without adverse effects. The review underscores the importance of personalized care strategies tailored to individual patient needs and preferences to enhance treatment efficacy and quality of life, highlighting the shift toward holistic, individualized care.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"101"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142504","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":"Hypocalcemia associated with adverse outcomes following severe traumatic injury in the Western Cape of South Africa: a secondary analysis of multicenter data from the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study.","authors":"Christiaan A Rees, Jessica L Wild, Mengli Xiao, Lani L Finck, Jessica B Oudakker, Hendrick J Lategan, George Oosthuizen, Shaheem de Vries, Janette Verster, Mohammed Mayet, Lesley Hodsdon, Karlien Doubell, Leigh Wagner, L'Oreal Snyders, Denise Lourens, Elmin Steyn, Julia M Dixon, Steven G Schauer, Nee-Kofi Mould-Millman","doi":"10.1186/s12245-025-00893-5","DOIUrl":"10.1186/s12245-025-00893-5","url":null,"abstract":"<p><strong>Background: </strong>Hypocalcemia precipitated by severe traumatic injury is well-described in the literature and has been associated with numerous adverse outcomes including mortality, transfusion requirement, and coagulopathy severity. The majority of studies to-date have been conducted in well-resourced clinical practice settings. Here, we describe adverse outcomes associated with severe hypocalcemia among a cohort of individuals presenting to emergency care following acute traumatic injury in a resource-limited setting.</p><p><strong>Methods: </strong>The present study is a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study, a prospective observational multicenter study of adult trauma patients in the Western Cape of South Africa. Individuals for whom a serum calcium level was measured at the time of hospital arrival were included, and the incidence of various adverse outcomes, including 30-day mortality, length of hospital stay, need for ICU admission, severity of organ dysfunction (defined by Sequential Organ Failure Assessment (SOFA) score), and blood transfusion requirement were compared across calcium strata. In total, 1989 individuals met criteria for inclusion.</p><p><strong>Results: </strong>The incidence of any hypocalcemia (ionized calcium < 1.15 mmol/L) was 52%, while the incidence of severe hypocalcemia (< 1.00 mmol/L) was 5%. Adverse outcomes including 30-day mortality (4.0% vs. 2.9%), need for ICU admission (17% vs. 5.9%), maximum total SOFA score within 7 days (4 vs. 2), and need for blood product transfusion (35% vs. 18%), were all significantly more common in the severe hypocalcemia group as compared with others (p < 0.001 for all). Although hypercalcemia was uncommon (n = 21), there was a disproportionally high incidence of 30-day mortality in this population as compared with normocalcemic controls (19% vs. 2.6%, p < 0.001).</p><p><strong>Conclusion: </strong>Severe hypocalcemia following trauma is associated with an increased risk of adverse outcomes including mortality, severe organ dysfunction, and need for ICU admission. It remains unclear whether hypocalcemia is a mediator of adverse events or simply a marker of illness severity. Furthermore, given the significantly increased risk of mortality observed in the hypercalcemia group, the role for calcium supplementation in the prevention of adverse outcomes in this population remains similarly unknown.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"100"},"PeriodicalIF":2.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119395","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":"Diagnostic challenges in pulmonary lymphomatous spread mimicking ARDS in an AIDS patient: a case report.","authors":"Elisa Baratella, Giorgio Berlot, Maurizio Pinamonti, Rossana Bussani","doi":"10.1186/s12245-025-00889-1","DOIUrl":"10.1186/s12245-025-00889-1","url":null,"abstract":"<p><strong>Background: </strong>Immunocompromised individuals, particularly those with AIDS, are at increased risk of developing lymphoproliferative tumours and opportunistic infections. Radiologic findings alone may not always distinguish between these entities.</p><p><strong>Case presentation: </strong>We describe the case of a patient with acquired immunodeficiency syndrome (AIDS) with rapidly worsening dyspnoea and clinical signs suggestive of acute respiratory distress syndrome (ARDS). Despite initial concerns for ARDS, autopsy revealed an advanced-stage, aggressive lymphoma as the underlying cause. This case highlights the challenge of differentiating ARDS from lymphoma in AIDS patients, especially when atypical radiologic findings, such as nodular opacities, are present.</p><p><strong>Conclusions: </strong>The diagnosis of ARDS relies on imaging, oxygenation abnormalities, and clinical timing. However, various infectious and non-infectious conditions can mimic ARDS, making an accurate differential diagnosis essential. This case adds to the literature by underscoring the importance of considering lymphoproliferative disorders in AIDS patients presenting with respiratory distress, especially in the absence of typical lymphoma-related symptoms.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"99"},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086205","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 retrospective study to predict failure of high-flow oxygen therapy for acute hypoxic respiratory failure.","authors":"Mingming Xue, Fengqing Liao, Feixiang Xu, Yumei Chen, Sheng Wang, Yannan Zhou, Hailin Ding, Su Lu, Chenling Yao, Zhenju Song, Mian Shao","doi":"10.1186/s12245-025-00891-7","DOIUrl":"10.1186/s12245-025-00891-7","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze the characteristics of patients who fail high-flow nasal cannula(HFNC) therapy for acute hypoxemic respiratory failure(AHRF) and to identify predictors of treatment failure.</p><p><strong>Methods: </strong>This single-center, retrospective, observational study analyzed clinical data from 388 patients with AHRF. Patients were divided into two groups: the HFNC success group (HFNC-S, n = 256) and the HFNC failure group (HFNC-F, n = 132). The primary endpoint was the need for escalation of respiratory support to tracheal intubation in the enrolled patients. The demographic data, laboratory tests, blood gas analysis data, CT severity scores, and disease severity scores were analysed to determine the difference between patients who were successful and those who failed HFNC treatment. Univariate and multivariate logistic regression models were used to assess potential predictors of failure of HFNC for patients with acute hypoxaemic respiratory failure.</p><p><strong>Results: </strong>The mean age of patients enrolled was 67.97 ± 14.40 years. The HFNC-F group had significantly higher PSI(Pneumonia Severity Index) score, CURB(Confusion, Urea, Respiratory Rate, Blood Pressure, and Age)-65 score, CPIS(Clinical Pulmonary Infection Score) score, CT score and SOFA(Sequential Organ Failure Assessment) scores compared to the HFNC-S group. Within 12 h of the initiation of treatment, the HFNC-F group exhibited significantly lower oxygen saturation index (PaO2/FiO2) and significantly higher respiratory rate. Additionally, the HFNC-F group exhibited significantly higher levels of C-reactive protein (CRP), platelet count (PLT), D-dimer, interleukin-10 (IL-10), total bilirubin (TB) and creatinine (CB), but lower albumin levels. Multivariate analysis identified CT score, SOFA score, interleukin-1β (IL-1β), and albumin as independent predictors of HFNC failure.</p><p><strong>Conclusion: </strong>HFNC is effective for treating AHRF. CT score, SOFA score, IL-1β, and albumin are independent predictors of HFNC failure.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"98"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077967","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":"Stroke prophylaxis after US emergency department diagnosis and discharge of patients with atrial fibrillation and flutter from 21 hospitals.","authors":"Bory Kea, E Margaret Warton, Candice E Kutz, Erin Kinney, Dustin W Ballard, Mary E Reed, Gregory Y H Lip, Merritt Raitt, Benjamin C Sun, David R Vinson","doi":"10.1186/s12245-025-00887-3","DOIUrl":"10.1186/s12245-025-00887-3","url":null,"abstract":"<p><strong>Background: </strong>Oral anticoagulation (OAC) reduces stroke and mortality risk in patients with non-valvular atrial fibrillation/flutter (AF). Patterns of OAC initiation upon discharge from US emergency departments (ED) are poorly understood. We sought to examine stroke prophylaxis actions upon, and shortly following, ED discharge of stroke-prone AF patients.</p><p><strong>Methods: </strong>We included all adults with a primary diagnosis of non-valvular AF, high stroke risk (CHA₂DS₂-VASc ≥ 2), low/intermediate bleeding risk (HAS-BLED < 4), and no recent (< 90 days) OAC at discharge from 21 community EDs (2010-2017). Annual rates of appropriate stroke prevention action (OAC Action) were calculated for eligible discharges and as defined as an OAC prescription or anticoagulation management service consultation within 14 days of ED discharge. We modeled OAC Action using a parsimonious Poisson regression with identity link adjusting for sex, age, race/ethnicity, stroke risk score (CHA₂DS₂-VASc), year of visit, provider race/ethnicity, number of ED beds, and presence of an outpatient observation unit, with the patient as a random effect.</p><p><strong>Results: </strong>We studied 9,603 eligible ED discharges (mean age 73.1 ± 11.4 years, 62.3% female), and mean CHA₂DS₂-VASc score 3.5 ± 1.5. From 2010 to 2017, OAC Action increased from 21.0% to 33.5%. Factors associated with lower OAC initiation included the following: female sex (-3.6%, 95% CI -5.4 to -1.9), age ≥ 85 vs < 64 years (-3.8%, 95% CI -6.7 to -1.0%), ED beds, n = 20 to 29 (-5.3%, 95% CI -8.36 to -2.4%), 30-49 (-3.8, 95% CI -6.5 to -1.2%), and 50 + (-7.1%, 95% CI -10.6 to -3.7%); with referent being the male sex, < 40 years, and fewer than 20 beds (18.1%, 95% CI 12.8 to 23.4). OAC initiation in 2017 was greater than in 2010 (16.0%, 95% CI 12.3 to 19.7%).</p><p><strong>Conclusion: </strong>Within a community-based ED population of AF patients at high stroke risk, rates of appropriate stroke prevention action increased over the 7-year study period. Rates of AF thromboprophylaxis may be improved by addressing sex and age disparities, as females and those age ≥ 75 were less likely to receive indicated stroke prevention.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"97"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978645","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":"Stem cell therapy use in patients with dementia: a systematic review.","authors":"Olivier Uwishema, Malak Ghezzawi, Magda Wojtara, Ignatius N Esene, Kehinde Obamiro","doi":"10.1186/s12245-025-00876-6","DOIUrl":"https://doi.org/10.1186/s12245-025-00876-6","url":null,"abstract":"<p><strong>Background: </strong>Stem cell therapy (SCT) is increasingly recognized for its potential in managing cognitive impairment, particularly that of dementia. The application of SCT aims to restore cognitive functioning in people living with dementia. Beyond pre-clinical studies, several clinical trials have evaluated specific stem cell (SC) types for their efficacy in treating dementia.</p><p><strong>Aims & objectives: </strong>To assess the status and efficacy of pre-clinical and clinical studies utilizing SCs as a therapeutic approach for dementia.</p><p><strong>Methods: </strong>A systematic review was conducted using two electronic databases: MEDLINE and Embase. We reviewed studies on the application of SCs in dementia, focusing on the following aspects: Animal models used in pre-clinical studies, tissue sources of SCs and donor species, and administrative routes and outcome assessments. Included papers comprised randomized control trials (RCTs) and original studies, while those involving adjuvant therapies for dementia were excluded. Quality assessment criteria included relevance to the research question, type of SCs, stage of SC transplantation, duration and route of administration, methods for outcome assessment, and the total number of animals implicated.</p><p><strong>Results: </strong>A total of 32 papers were included, encompassing 21 clinical trials and 11 preclinical studies. The preclinical studies employed various transgenic animal models to evaluate SCT outcomes. Animal models of dementia, particularly transgenic mice, have proven instrumental in replicating human disease mechanisms. These models facilitate understanding of pathophysiology and preclinical testing of therapeutic interventions. Studies utilizing SCT demonstrated notable improvements in spatial memory, reduced neuroinflammation, and protection against amyloid-beta (Aβ) toxicity. Key mechanisms included modulation of inflammation, microglial immune responses, neurogenesis support, and anti-amyloidogenic effects. Preclinical studies predominantly employed human placenta-derived mesenchymal stem cells (PD-MSCs), umbilical cord-derived MSCs (U-MSCs), and induced pluripotent stem cell-derived neuronal precursors. Administration routes varied, with stereotactic and intravenous injections targeting affected brain regions. Reductions in inflammatory markers such as IL-1β, TNF-α, and increases in anti-inflammatory cytokines like IL-4 and IL-10 were observed. These outcomes emphasize the immunomodulatory and neuroprotective capacities of SCT.</p><p><strong>Conclusion: </strong>SCT shows promise in addressing dementia-related pathologies by leveraging diverse therapeutic mechanisms. Continued refinement of preclinical models and translational research is essential to bridge gaps between preclinical findings and clinical applications, potentially paving the way for novel treatments for dementia.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"95"},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992501","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":"Aluminum phosphide poisoning with Brugada ECG: a case report highlighting diagnostic challenges arising from patient nondisclosure.","authors":"Mohammed Ahmed Sadeq, Magdy Soliman Dawood, Reem Mohamed Farouk Ghorab, Marwa Salah Roshdy Aggour","doi":"10.1186/s12245-025-00899-z","DOIUrl":"https://doi.org/10.1186/s12245-025-00899-z","url":null,"abstract":"<p><strong>Background: </strong>Aluminum phosphide (AlP) poisoning is a major cause of mortality, often presenting with non-specific symptoms that complicate diagnosis.</p><p><strong>Case: </strong>A 19-year-old male presented with vomiting, abdominal pain, hypotension, and ECG abnormalities. He initially denied ingestion, delaying treatment. Despite supportive care, he progressed to cardiac arrest and death.</p><p><strong>Conclusion: </strong>This case illustrates the diagnostic challenges of AlP poisoning and underscores the need for early suspicion and intervention to improve patient outcomes.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"96"},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994549","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 pilot study of coughing into the shirt to disrupt respiratory pathogen transmission.","authors":"Matthew D Steimle, Jacob Steenblik, Brandon D King, Amy A Gooch, Jeremy Baird, Jane Yee, Valerio Pascucci, Margaret Carlson, Patrick Ockerse","doi":"10.1186/s12245-025-00892-6","DOIUrl":"https://doi.org/10.1186/s12245-025-00892-6","url":null,"abstract":"<p><strong>Background: </strong>Scientific evidence is lacking for the respiratory etiquette maneuver of coughing into the elbow. This pilot study introduces and evaluates a novel maneuver \" coughing into the shirt\" comparing effectiveness of containing respiratory plumes to existing respiratory etiquette strategies.</p><p><strong>Methods: </strong>In this open-bench, observational respiratory etiquette pilot study, five healthcare workers performed four respiratory etiquette maneuvers including: unobstructed, into the elbow, into a mask, and into the shirt. Observational data for the cough maximal plume area, an area calculation, were collected using slow-motion video recording. The various respiratory plume areas of the participants were compared to the unobstructed maneuver, assessing the percent reduction of the maximal plume area.</p><p><strong>Results: </strong>All respiratory etiquette maneuvers significantly reduced the maximal plume area as compared to the unobstructed condition (F(3,12) = 18.56, P < 0.005). Comparing the maximal plume area of the unobstructed maneuver to the \"into the shirt\" maneuver, we found a 95.4% decrease for the \"into the shirt\" respiratory etiquette maneuver (P < 0.005). There was no statistically significant difference when comparing the obstructive maneuvers to each other. Additionally, the maximal plume area from the \"into the shirt\" maneuver was 35.75% less than the \"into the elbow\" maneuver (P = 0.15). Comparing the maximal plume area of the \"into the shirt\" maneuver to the \"into the mask\" maneuver, results were inconclusive, with an average difference of 2.24% (P = 0.66).</p><p><strong>Conclusions: </strong>Coughing into the shirt may offer superior containment of the respiratory plume than coughing into the elbow. Larger studies are warranted to validate these findings and guide future public health recommendations.</p><p><strong>Study design: </strong>Open bench, observational, cough etiquette pilot study comparing the into the shirt respiratory etiquette maneuver to other respiratory etiquette maneuvers.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"94"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999555","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":"Instantaneous rigor - the challenge of securing an airway in cardiac arrest: a case report.","authors":"Michal Soták, Tomáš Henlín, Tomáš Tyll","doi":"10.1186/s12245-025-00900-9","DOIUrl":"https://doi.org/10.1186/s12245-025-00900-9","url":null,"abstract":"<p><p>Cadaveric spasm, also known as instantaneous rigor, is a rare and poorly understood phenomenon characterized by immediate muscle rigidity at the moment of death or cardiac arrest. This can result in severe trismus, making conventional airway management impossible. We present a case of a morbidly obese patient who suffered a sudden cardiac arrest with instantaneous rigor, necessitating an urgent surgical cricothyrotomy. This report underscores the need for early recognition of this condition, rapid decision-making regarding airway management, and the importance of specialized training for emergency physicians, particularly in anatomically challenging scenarios.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"92"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011470","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":"Utility of core to peripheral temperature gradient using infrared thermography in the assessment of patients with sepsis and septic shock in the emergency medicine department.","authors":"Vrinda Lath, Prithvishree Ravindra, Freston Marc Sirur, Rachana Bhat, Avinash Bhat, Karthik Naik, Ramya R, Jayaraj Mymbilly Balakrishnan","doi":"10.1186/s12245-025-00890-8","DOIUrl":"https://doi.org/10.1186/s12245-025-00890-8","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis is a disease affecting microcirculation, reflected in temperature changes between the core and the skin. This study explores correlation of this gradient using infrared thermography (IRT) with mortality and markers of hypoperfusion in patients admitted with sepsis and septic shock and its changes with resuscitation.</p><p><strong>Design: </strong>We conducted a prospective, single center observational study on patients admitted in the Department of Emergency Medicine of a tertiary care center in Karnataka, India. These patients were enrolled based on the inclusion criteria and infrared thermography was performed and cases were followed up after 28 days. Adults presenting to the emergency medicine department with clinically suspected sepsis or septic shock were enrolled and infrared thermography was performed. A final sample size of 187 cases was analyzed after retrospectively excluding patients with any exclusion criteria.</p><p><strong>Interventions: </strong>Patients underwent thermal imaging of all four limbs on arrival and after 3  hours of resuscitation. Core temperature was measured using a tympanic thermometer. Infrared thermography was performed, and limb temperature was extracted from the images. Other parameters including mean arterial pressure and lactate were recorded and SOFA score was calculated.</p><p><strong>Outcome measure(s): </strong>The temperature gradients were correlated with 7 and 28-day mortality along with markers of hypoperfusion including mean arterial pressure and serum lactate levels.</p><p><strong>Results: </strong>A total of 187 patients were included, with a mean SOFA score of 5. Forty four patients (23.5%) died within 7-days. 28-day mortality was 31%. Temperature gradients of core to knee > 8.85°F (p = 0.003) and core to great toe > 12.25°F (p = 0.020) on arrival were found to be correlated with 7-day mortality. Core to knee temperature gradient was found to correlate with 48-hour mortality(p < 0.013). Core to index finger gradient on arrival correlated with vasopressor requirement within 48h (p = 0.020). Core to index finger temperature gradient had a negative correlation with mean arterial pressure (spearman coefficient - 0.286, p = < 0.001), and a positive correlation with lactate (0.281, p = < 0.001), SOFA score (0.242, p = 0.001), qSOFA score (0.167, p = 0.023).</p><p><strong>Conclusions: </strong>Core-to-knee and core-to-toe temperature gradients using IRT significantly correlate with 7-day mortality. IRT can be a useful adjunct to predict clinical courses in patients with sepsis and septic shock.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"18 1","pages":"93"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000845","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}