Journal of Emergencies, Trauma, and Shock最新文献

{"title":"Comparative Analysis of Machine Learning Models for Prediction of Acute Liver Injury in Sepsis Patients.","authors":"Xiaochi Lu, Yi Chen, Gongping Zhang, Xu Zeng, Linjie Lai, Chaojun Qu","doi":"10.4103/jets.jets_73_23","DOIUrl":"10.4103/jets.jets_73_23","url":null,"abstract":"<p><strong>Introduction: </strong>Acute liver injury (ALI) is a common complication of sepsis and is associated with adverse clinical outcomes. We aimed to develop a model to predict the risk of ALI in patients with sepsis after hospitalization.</p><p><strong>Methods: </strong>Medical records of 3196 septic patients treated at the Lishui Central Hospital in Zhejiang Province from January 2015 to May 2023 were selected. Cohort 1 was divided into ALI and non-ALI groups for model training and internal validation. The initial laboratory test results of the study subjects were used as features for machine learning (ML), and models built using nine different ML algorithms were compared to select the best algorithm and model. The predictive performance of model stacking methods was then explored. The best model was externally validated in Cohort 2.</p><p><strong>Results: </strong>In Cohort 1, LightGBM demonstrated good stability and predictive performance with an area under the curve (AUC) of 0.841. The top five most important variables in the model were diabetes, congestive heart failure, prothrombin time, heart rate, and platelet count. The LightGBM model showed stable and good ALI risk prediction ability in the external validation of Cohort 2 with an AUC of 0.815. Furthermore, an online prediction website was developed to assist healthcare professionals in applying this model more effectively.</p><p><strong>Conclusions: </strong>The Light GBM model can predict the risk of ALI in patients with sepsis after hospitalization.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"91-101"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788168","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":"What's New in Emergencies, Trauma, and Shock: Early Recognition of Scurvy in Emergency Departments Can Improve Patient Outcomes.","authors":"Vivek Chauhan","doi":"10.4103/jets.jets_71_24","DOIUrl":"10.4103/jets.jets_71_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"51-52"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788175","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":"Air Everywhere without Bowel Injury.","authors":"Shikha Bhatia, Binit Sureka, Niladri Banerjee","doi":"10.4103/jets.jets_13_24","DOIUrl":"10.4103/jets.jets_13_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"119-120"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788166","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 Case of Spastic Quadriplegia Remaining after Multiple Traumatic Injuries Complicated by Sepsis and Reversible Posterior Leukoencephalopathy Syndrome, as well as Delayed Multifocal Microbleeds.","authors":"Hiromichi Ohsaka, Hiroki Nagasawa, Rino Isogai, Hiroaki Taniguchi, Soichiro Ota, Michika Hamada, Tatsuro Sakai, Youichi Yanagawa","doi":"10.4103/jets.jets_154_23","DOIUrl":"10.4103/jets.jets_154_23","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"121-122"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788164","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":"Using Children's Artwork to Improve Adherence with Timely Antibiotic Administration in Open Fractures.","authors":"Kathy Chu, Shahriar Zehtabchi, Valery Roudnitsky, Fred Harry, Bonny J Baron","doi":"10.4103/jets.jets_133_23","DOIUrl":"10.4103/jets.jets_133_23","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotics for open fractures (OFs) administered within 60 min of emergency department (ED) arrival reduce patients' infection risk. We tested a novel method of displaying children's drawings to prompt clinicians to improve adherence with early antibiotics for OFs.</p><p><strong>Methods: </strong>Registry-based pre- (January 1, 2016-June 30, 2019) and post- (July 1, 2019-March 31, 2022) intervention at a level 1 trauma center. In July 2019, children's artwork depicting OF was displayed in the ED alongside OF guidelines and E-mailed to faculty and residents. Primary outcome: proportion of OF patients who received antibiotics within 60 min of arrival. Time to antibiotics was calculated from ED arrival to time-stamped administration in the electronic health record. We compared time to antibiotics as continuous variables between the two groups. Proportions are presented with percentages and 95% confidence interval (CI); continuous variables as median and quartiles. Chi-square or Mann-Whitney <i>U</i>-tests were used for group comparisons.</p><p><strong>Results: </strong>Five hundred fifty-four total OF patients were identified (excluded: transferred = 1, ED death = 4, unclear time to antibiotics = 11); 281 pre-implementation and 257 post-implementation. The median age was 34 years (quartiles 24 and 46). Trauma mechanisms of injury included 300 blunt (56%) and 238 penetrating (44%). Gustilo OF classification by type were as follows: 71% I, 13% II, 15% III, 1% unclassified. There was a significant difference (<i>P</i> = 0.001) in both percentage of patients who received antibiotics within 60 min (58%, 95% CI, 52%-63% vs. 79%, 95% CI, 74%-84%) and time to antibiotics (median: 46 min vs. 25 min) between pre- and postphases, respectively.</p><p><strong>Conclusions: </strong>Children's artwork in our ED improved adherence with OF guidelines and decreased time to antibiotics.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"80-83"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788174","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":"Outcomes of Video-assisted Thoracic Surgery-guided Early Evacuation of Traumatic Hemothorax: A Randomized Pilot Study at Level I Trauma Center.","authors":"Abhinav Kumar, Dinesh Gora, Dinesh Bagaria, Pratyusha Priyadarshini, Narendra Choudhary, Amit Priyadarshi, Sahil Gupta, Junaid Alam, Amit Gupta, Biplab Mishra, Subodh Kumar, Sushma Sagar","doi":"10.4103/jets.jets_132_23","DOIUrl":"10.4103/jets.jets_132_23","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous.</p><p><strong>Methods: </strong>Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate.</p><p><strong>Results: </strong>The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, <i>P</i> = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, <i>P</i> = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, <i>P</i> = 0.003) and lesser need of additional interventions (0% vs. 30%, <i>P</i> = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, <i>P</i> = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, <i>P</i> = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality.</p><p><strong>Conclusion: </strong>VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"73-79"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788171","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":"What's New in Emergencies Trauma and Shock: Cerebral Vein Thrombosis in Pregnancy and Postpartum Period: An Enigma in Emergency.","authors":"Tarun Sharma, Dhanashree Kelkar, Steve Kamm","doi":"10.4103/jets.jets_38_24","DOIUrl":"10.4103/jets.jets_38_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 1","pages":"1-2"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853155","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":"Cerebral Venous Thrombosis in Pregnant and Postpartum Women Presenting to the Emergency Department with Headaches.","authors":"Aaron Jacob Grossberg, Sagar C Galwankar","doi":"10.4103/jets.jets_92_23","DOIUrl":"https://doi.org/10.4103/jets.jets_92_23","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral venous thrombosis (CVT) is a thromboembolic disease of the intracranial venous systems. The disease can be difficult to diagnose as it often requires a high index of suspicion. Risk factors for the disease include pregnancy, oral contraceptive pills, congenital thrombophilia, infection, cancer, polycythemia, head trauma, and recent surgery. However, there have been no studies in the United States that have examined whether pregnancy and the postpartum stage are truly a risk factor for CVT. The aim of this study is to determine whether pregnant and postpartum women presenting to the emergency department with headaches have a higher incidence of CVT to better risk stratify which patients need to have advanced imaging pursued.</p><p><strong>Methods: </strong>A retrospective, observational case-control study was performing by querying the electronic medical record at a large county hospital for patients presenting with a headache to the emergency department. Patients were stratified into groups based on whether they were diagnosed with CVT, pregnancy status, and comorbid conditions to determine the risk associated between pregnancy, the puerperium stage, and CVT.</p><p><strong>Results: </strong>A total of 20,955 males and females presented to the emergency department between January 1, 2016 and April 13, 2023, with a chief complaint of headache. There were 19,474 female patients and 9581 male patients. In the case group, there were 793 pregnant women and 53 postpartum women. In the control group, there were 18,628 women who were not pregnant. Of the 22 patients diagnosed with CVT, 1 was in the puerperium stage and no patients were pregnant. Pregnant and postpartum patients were 1.05 (0.14-7.80) times more likely to develop CVT. Pregnant and postpartum patients were 1.73 (0.23-13.52) times more likely to develop CVT when controlled for comorbidities. Patients in the puerperium stage were 26.48 (3.33-210.87) times more likely to develop CVT when controlled for comorbidities.</p><p><strong>Conclusion: </strong>Pregnant patients presenting to the emergency department with headaches do not have a significantly higher risk of CVT; however, puerperium patients have a significantly higher risk of CVT compared to the general population.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 1","pages":"3-7"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850898","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":"Head-and-neck Cancer in the Emergency Department: A Contemporary Review of Common Presentations and Management.","authors":"Ee Lyn Chan, Aleix Rovira","doi":"10.4103/jets.jets_40_23","DOIUrl":"https://doi.org/10.4103/jets.jets_40_23","url":null,"abstract":"<p><p>Head-and-neck cancer (HNC) can present with life.threatening symptoms in the emergency department. Patients can sometimes be misdiagnosed with pulmonary disease due to similar signs and symptoms, ultimately leading to delayed diagnosis and potentially devastating consequences. Reasons for this include lack of awareness of patient risk factors and knowledge of the myriad of presenting complaints in the disease process among physicians working in primary care and in the emergency department. This article explores the contemporary risk factors and common presenting symptoms and discusses initial management for a patient with potential head-and-neck malignancy. Emergency presentations of HNC are wide ranging and can overlap with common respiratory pathologies. Clinician awareness of this can assist the team in deciding what appropriate examination and investigations are required to reduce the risk of delaying diagnosis and further treatment.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 1","pages":"33-39"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11045002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863221","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":"The Efficiency of Focused Assessment with Sonography for Trauma in Pediatric Patients with Blunt Torso Trauma","authors":"Ozlem Inci, Y. Altuncı, Ozge Can, F. K. Akarca, Murat Ersel","doi":"10.4103/jets.jets_137_22","DOIUrl":"https://doi.org/10.4103/jets.jets_137_22","url":null,"abstract":"\u0000 \u0000 \u0000 Focused Assessment with Sonography for Trauma (FAST) has attracted attention for its use in the detection of intra-abdominal pathology for pediatric patients. However, computed tomography (CT) remains the gold standard for the assessment of blunt torso trauma. The study examines the effectiveness of FAST both in the detection of intra-abdominal pathology in pediatric patients (<19 years) with blunt torso trauma and in the determination of the need for CT for further examination.\u0000 \u0000 \u0000 \u0000 The study was designed as a retrospective observational investigation of diagnostic value. The pediatric patients who were admitted to the Emergency Department with blunt torso trauma between January 2013 and October 2016 were included in the study. The sample of the study comprised 255 patients who met the inclusion criteria. The primary outcome was the effectiveness of FAST in the detection of intra-abdominal pathology and the determination of the need for CT. The secondary outcome was to identify the agreement between CT and FAST for intra-abdominal injuries. The Chi-square test and Fisher’s exact test were used for comparisons. A logistic regression model was developed to determine the variables that independently affect the agreement between FAST and CT.\u0000 \u0000 \u0000 \u0000 FAST was determined to have low sensitivity (20.3%) despite its high specificity (87%). However; FAST had a good negative likelihood ratio. There was a poor agreement between CT and FAST in terms of the presence of both intra-abdominal and intrathoracic injuries in pediatric patients with blunt trunk trauma. The error rate of FAST increased by five-fold, especially in the presence of concomitant thorax trauma. However, FAST had a good negative likelihood ratio.\u0000 \u0000 \u0000 \u0000 FAST should not be regarded as an equivalent tool to CT for pediatric patients with blunt torso trauma. It is, instead, a noteworthy complementary tool that is a negative predictor.\u0000","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"31 13","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138602482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}