Open Access Emergency Medicine最新文献

{"title":"Correlation Between Hemodynamic Parameters Measured by Ultrasonic Cardiac Output Monitor and Serum Troponin I Levels in Pediatric Septic Shock Patients: A Prospective Observational Study.","authors":"Indra Sandinirwan, Dzulfikar Djalil Lukmanul Hakim, Sri Endah Rahayuningsih, Saptadi Yuliarto, Stanza Uga Peryoga","doi":"10.2147/OAEM.S606300","DOIUrl":"10.2147/OAEM.S606300","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric septic shock is frequently associated with myocardial dysfunction and high mortality. Cardiac troponin I (cTnI) is a biomarker of myocardial injury, while the Ultrasonic Cardiac Output Monitor (USCOM) enables non-invasive hemodynamic assessment. This study aimed to explore the correlation between USCOM-derived hemodynamic parameters and serum cTnI levels in pediatric septic shock, and to examine the association of inotropic therapy with troponin levels.</p><p><strong>Patients and methods: </strong>A prospective observational study was conducted in 32 pediatric patients with septic shock admitted to Hasan Sadikin Hospital, Bandung, between May and September 2025. Serial USCOM measurements were performed at 1, 3, 6, 12, and 24 hours to assess cardiac index (CI), stroke volume index (SVI), Smith-Madigan Inotropy Index (SMII), and systemic vascular resistance index (SVRI). Serum cTnI levels were measured at 6 and 24 hours using a high-sensitivity assay. Correlations were analyzed using Spearman's test, and multivariable regression was applied to explore independent associations.</p><p><strong>Results: </strong>Median cTnI levels increased significantly from 71 pg/mL at 6 hours to 201 pg/mL at 24 hours (p < 0.01). Early changes in SVI (1-6 hours) were negatively correlated with cTnI at 6 hours (r = -0.409; p = 0.020). SMII at 1 hour was positively correlated with cTnI at 24 hours (r = 0.409; p = 0.025), while SVI at 24 hours showed a positive correlation with cTnI at 24 hours (r = 0.387; p = 0.035). The number of inotropic agents was independently associated with higher cTnI levels at both 6 and 24 hours.</p><p><strong>Conclusion: </strong>Serum cTnI levels increased during the first 24 hours of pediatric septic shock and were associated with dynamic hemodynamic changes. These findings suggest a potential role for integrating serial troponin measurement with non-invasive hemodynamic monitoring. Further studies with larger cohorts are needed to validate these observations.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"606300"},"PeriodicalIF":1.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819872","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":"Cyberwarfare Beyond the Hospital: Emergency Medical Services as a Critical Infrastructure Vulnerability.","authors":"Kelsey R Gordon, Edward E Denton, Carlos Talledo, Grace Mathew, Jessie Nicholson, Christian Angelo I Ventura","doi":"10.2147/OAEM.S613972","DOIUrl":"10.2147/OAEM.S613972","url":null,"abstract":"<p><p>This commentary examines cyberwarfare targeting healthcare supply chains as an underrecognized threat to emergency medical services (EMS) in the United States, using the March 2026 Stryker cyberincident as a case study. We argue that in the context of prehospital settings, cybersecurity is inseparable from patient safety, operational continuity, and equipment readiness.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"613972"},"PeriodicalIF":1.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708068","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":"Factors Associated with Survival in Non-Trauma Subjects Treated in the \"Shock Room\" in a Tertiary Medical Center.","authors":"Yousef Shukha, Salam Ghanayim, Hisam Hossen Zaidani, Ihab Dabbah, Jubran Boulos, Ahmad Hassan, Shadi Hamoud","doi":"10.2147/OAEM.S604796","DOIUrl":"10.2147/OAEM.S604796","url":null,"abstract":"<p><strong>Background: </strong>Emergency department shock rooms provide immediate care for critically ill patients requiring life-saving interventions. Rapid diagnosis and treatment are crucial determinants of survival, yet factors predicting outcomes in this population remain poorly understood. This study evaluated factors associated with survival among patients hospitalized after shock room treatment in a tertiary medical center.</p><p><strong>Methods: </strong>In this retrospective cohort study, medical records of patients treated in the emergency department shock room of a tertiary referral center were reviewed. Patients were categorized according to hospital survival. Variables analyzed included age, sex, comorbidities, etiology of the acute event, vital signs at admission and discharge from the SR (including blood pressure, heart rate, respiratory rate, body temperature, and oxygen saturation), out-of-hospital mechanical ventilation, and laboratory values including creatinine, hemoglobin, lactate, electrolytes, and coagulation parameters.</p><p><strong>Results: </strong>A total of 101 patients treated over 24 consecutive months were included. The cohort comprised 50 men and 51 women with a mean age of 68±20 years (range 18-100). The mean shock room stay was 4.69±4.3 hours. Sixteen patients (16%) arrived following out-of-hospital resuscitation and were invasively ventilated. Overall, 60 patients (60%) died during hospitalization. Approximately half of all admissions were related to respiratory system morbidity. Mortality was significantly higher among patients aged >65 years than among those aged ≤65 years (75% vs 34%, p=0.046). Oncological disease as a comorbidity was significantly more prevalent in deceased patients (38% vs 10%, p=0.001). Admission creatinine was higher in deceased patients (1.5 vs 0.9 mg/dL, p=0.004) and hemoglobin was lower (11.9 vs 12.9 g/dL, p=0.044). Respiratory rate was significantly higher (18 vs 12 breaths/min, p=0.002) and diastolic blood pressure lower (67.5 vs 79.0 mmHg, p=0.011) in patients who died. Diastolic blood pressure remained significantly lower at shock room discharge in deceased patients (p=0.010). Shock room stay duration (≤4 vs >4 hours) was not significantly associated with mortality (OR 0.66, p=0.320).</p><p><strong>Conclusion: </strong>Age over 65, elevated creatinine, low hemoglobin, high respiratory rate, and low diastolic blood pressure at admission were associated with in-hospital mortality. Persistent diastolic hypotension at shock room discharge was a novel finding. Shock room stay duration was not independently associated with mortality. These findings are exploratory and prospective validation in larger cohorts is needed.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"604796"},"PeriodicalIF":1.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702576","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 Twelve-Year Retrospective Analysis of a Journey Towards Rural Level I Trauma Center Verification.","authors":"Lanny C Orr, Alexa L Peterson, Tessa C Savell, Craig E Palm, Manoj Pathak, Michael S Englehart, Simon J Thompson","doi":"10.2147/OAEM.S618725","DOIUrl":"10.2147/OAEM.S618725","url":null,"abstract":"<p><strong>Purpose: </strong>This study describes the transformation of a rural trauma center in the Upper Mountain West, which expanded from 280 to 305 beds between 2011 and 2022, and from an American College of Surgeons (ACS) verified Level II to Level I facility, serving a four-state region.</p><p><strong>Patients and methods: </strong>A retrospective analysis of all 8947 trauma activations from 2011-2022 was conducted using the institution's trauma registry. A structured gap analysis assessed alignment with ACS Level I principles.</p><p><strong>Results: </strong>The gap analysis identified four priority areas for growth and development of our trauma program to become an ACS Level I Trauma Center: patient volumes, absence of a Surgical Intensive Care Unit (SICU), lack of a surgical residency program, and limited trauma research infrastructure. Targeted interventions led to the establishment of a dedicated SICU, initiation of PGY-4 surgical rotations, and the development of trauma-focused research capacity. By 2023, the number of severely injured patients (Injury Severity Score (ISS) ≥16) exceeded ACS thresholds despite total admissions remaining below 1200. Between 2011 and 2022, 8947 trauma patients were treated. Mean patient age increased from 42.6 to 51.8 years (<i>p</i> <0.0001), with geriatric cases rising from 19.8% to 37.1% and female patients from 33.3% to 41.2%. Overall injury severity decreased (mean ISS 10.4 to 9.7; <i>p</i> <0.0001), but ICU patient acuity rose (ISS 15.9 to 17.9; <i>p</i> <0.0001). Mortality remained stable (3.3-4.0%). ICU admissions declined from 33.1% to 22.6%, while length of stay and patient acuity increased (49.6% and 4.7%, respectively). Interfacility transfer rates decreased from 2.8% to 1.1% (<i>p</i>=0.0372), reflecting improved system capacity.</p><p><strong>Conclusion: </strong>Strategic investments in infrastructure, workforce development, education, and research enabled this rural trauma center to achieve Level I criteria while adapting to changing patient demographics and clinical demands. These implementation strategies may inform similar resource-constrained rural trauma systems pursuing ACS Level I verification.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"618725"},"PeriodicalIF":1.7,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550749","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":"Emergency Department Clinician Perspectives on an EMR-Adjacent Microsoft Teams Consultation Workflow.","authors":"Carly Rosen, Norman Ng, Arsalan Shawl, Kurien Mathews, Alexia Armanious, Boris Khodorkovsky, Amin Mohamadi, Barry Hahn","doi":"10.2147/OAEM.S624827","DOIUrl":"10.2147/OAEM.S624827","url":null,"abstract":"<p><strong>Background: </strong>Communication failures in the emergency department (ED) can delay consultations and worsen crowding. Hospitals now use phone-based systems, EMR-integrated secure chat, and EMR-adjacent messaging platforms for consultant communication, but few studies describe ED clinician experience with these workflows.</p><p><strong>Objective: </strong>To describe ED clinicians' perceived acceptability of, and experience with, an EMR-adjacent Microsoft Teams-based consultation workflow used alongside a telephone-based consultation pathway.</p><p><strong>Methods: </strong>We conducted a single-center post-implementation survey of clinicians who used a Microsoft Teams consultation workflow in an academic ED. The primary analysis focused on ED clinician responses; consulting clinician responses were reported descriptively because of the low estimated non-ED response rate.</p><p><strong>Results: </strong>Of 121 respondents, 82 were ED clinicians, and 39 were consulting clinicians. Among ED clinicians, 78.0% reported high acceptability of the Teams consultation workflow, 85.4% perceived improvements in the workflow, and 89.0% perceived a positive impact on patient care. Delays remained common, with 24.4% of ED clinicians reporting that responses were often delayed. Consulting clinician responses are reported descriptively only because of the low estimated non-ED response rate.</p><p><strong>Conclusion: </strong>ED clinicians reported high perceived acceptability of an EMR-adjacent Microsoft Teams consultation workflow used alongside a telephone-based consultation pathway. These results reflect post-implementation clinician perceptions and do not establish improved consultation timeliness, patient flow, or clinical outcomes.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"624827"},"PeriodicalIF":1.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521192","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 Performance of the BE-FAST-V Scale for Detecting Strokes in the Emergency Department: A Prospective Cohort Study.","authors":"Liping Zhou, Yiqing Xu, Beibei Hu, Jiexiang Lou, Xinying Zhou, Huilin Chu, Zhihong Ye","doi":"10.2147/OAEM.S616905","DOIUrl":"10.2147/OAEM.S616905","url":null,"abstract":"<p><strong>Background: </strong>Acute stroke, particularly posterior circulation stroke, is often missed in emergency departments due to non-specific symptoms. We aimed to evaluate the diagnostic performance of the BE-FAST-V scale, which adds Vertigo assessment to the original BE-FAST, for acute stroke screening.</p><p><strong>Methods: </strong>The study included 1,094 patients presenting to a tertiary hospital's emergency department with suspected stroke. On arrival, the BE-FAST-V scale, which assesses Balance, Eyes, Face, Arm, Speech, Time, and Vertigo, was administered. Stroke diagnoses were confirmed through imaging. Diagnostic accuracy metrics, including sensitivity, specificity, and predictive values, were calculated.</p><p><strong>Results: </strong>The BE-FAST-V scale demonstrated high diagnostic accuracy, strong sensitivity, and moderate specificity. Adding vertigo improved the detection of posterior circulation strokes, which are often missed due to nonspecific symptoms.</p><p><strong>Conclusion: </strong>The BE-FAST-V tool presented a highly sensitive and practical value for stroke screening in the emergency department. Its ability to identify posterior circulation strokes, including those presenting with vertigo, addresses a critical gap in stroke diagnosis and supports early treatment initiation. Broader implementation and further validation across multiple centers could enhance its role in improving stroke outcomes globally.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"616905"},"PeriodicalIF":1.7,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498167","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":"Shock Index versus Systolic Blood Pressure for Mortality Prediction in Traumatic Hemorrhage: A Comparative Prognostic Evaluation in a Middle-Income Country.","authors":"Adane F Wogu, Mengli Xiao, Dale A Barnhart, Sophia Centi, Hendrick Lategan, George Oosthuizen, Craig Wylie, Shaheem de Vries, Janette Verster, Willem Stassen, Mary D Sammel, Steven G Schauer, Julia M Dixon, Nee-Kofi Mould-Millman","doi":"10.2147/OAEM.S618018","DOIUrl":"10.2147/OAEM.S618018","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate and compare the prognostic performance of shock index (SI) and systolic blood pressure (SBP) for predicting mortality among trauma patients at risk of hemorrhage in South Africa, a high-trauma burden setting with resource constraints.</p><p><strong>Patients and methods: </strong>This is a secondary analysis of data from the EpiC study, a prospective, multicenter observational investigation of trauma patients in the Western Cape, South Africa. Adult patients with blunt or penetrating injuries and no significant head injury were included. The predictor variables-SI and SBP at facility arrival-and the outcome (30-day mortality) were analyzed through a sequential analytical framework. Segmented logistic regressions identified inflection points; ROC analyses with Youden's J statistic determined optimal thresholds. Model comparisons employed DeLong's test, calibration plots, Brier scores, and decision curve analysis. Subgroup analyses were conducted by injury mechanism and severity.</p><p><strong>Results: </strong>Among 3609 patients, 6.1% died within 30 days. SI demonstrated an inflection point at 0.69 and SBP at 82 mmHg. ROC analysis yielded similar AUCs of 0.62 (SI) and 0.60 (SBP) (p=0.418). However, SI showed superior calibration (Brier score: 0.054 vs 0.058), a higher positive likelihood ratio (2.70 vs 2.01; p<0.001), and greater net benefit across a broader range of predicted-risk thresholds on decision curve analysis. The optimal SI cutoff of ≥1.21 yielded 85.1% specificity and 40.3% sensitivity.</p><p><strong>Conclusion: </strong>Both SI and SBP demonstrated only modest discrimination for 30-day mortality, reflecting the inherent limitations of single vital-sign predictors in complex trauma populations. Within these constraints, SI showed marginally better calibration and rule-in performance than SBP; however, neither predictor alone is sufficient for definitive mortality risk prediction. An SI threshold of ≥1.21 may serve as a practical screening tool to flag high-risk patients warranting closer monitoring or escalated care, particularly in resource-limited settings where laboratory and imaging resources are constrained.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"618018"},"PeriodicalIF":1.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449890","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":"Clinical Characteristics, Complications, and Outcomes of Heat Stroke Among Pilgrims During the Hajj Mass Gathering: A Prospective Cohort Study.","authors":"Namareq Aldardeer, Abdulrahman Harisi, Saleh S Alzahrani, Nada Alkhani, Ahmed O Alenazi, Abdulmajeed M Alshehri, Ayman Alahdal, Hanan Mohammed Almalki, Reham Alharbi, Rahaf Alqahtani, Lina Al-Dawood, Ohoud Aljuhani, Shady Kamel, Badr Alghamdi, Mohammed Alshennawi, Sahar Fahad Almushikah, Khalid Al Sulaiman","doi":"10.2147/OAEM.S616665","DOIUrl":"10.2147/OAEM.S616665","url":null,"abstract":"<p><strong>Background: </strong>Heat stroke is a leading cause of mortality during the Hajj season, yet data on its clinical progression remain limited.</p><p><strong>Objective: </strong>This study evaluates the clinical characteristics, complications, and outcomes of heat stroke among pilgrims.</p><p><strong>Methods: </strong>This prospective exploratory cohort study included adult pilgrims (≥18 years) who were admitted with a confirmed diagnosis of heat stroke, defined as a core temperature ≥40°C and central nervous system dysfunction, across nine hospitals. The primary endpoint measure is the frequency of at least one heat stroke-related complication. Patients were stratified into those discharged from the treating ICU and those transferred to an advanced referral center, with transfer used as a pragmatic surrogate for greater clinical severity within the Hajj healthcare system.</p><p><strong>Results: </strong>Twenty-three patients were included (mean age 65.1 ± 10.5 years; 56.5% male). Fifteen (65.2%) were discharged from the treating ICU, whereas eight (34.8%) were transferred to an advanced referral center. Compared with discharged patients, the transferred group showed higher ccreatinine upon admission (165.50 (146.00-185.50) vs. 130.50 (114.25-152.25); P=0.02), Peak creatinine values (275.90 (223.32-328.80) vs. 143.00 (126.00-160.50); p = 0.001), peak Urea values (17.40 (13.70-23.95) vs. 11.00 (8.70-13.00); p = 0.01); and the highest AST during admission was also higher in the transferred group (P=0.015). The lowest platelet counts during the patient's admission were significantly reduced in the transferred group (p = 0.007). Mechanical ventilation was required more often in the transferred group (75.0% vs. 26.7%; p = 0.026), and its duration was longer (p = 0.019). Given the small sample size, these findings should be considered exploratory.</p><p><strong>Conclusion: </strong>In this small, exploratory cohort, patients requiring transfer to an advanced referral center generally had a greater burden of organ dysfunction and required more critical care interventions. These observations should not be interpreted as establishing predictors of severe heat stroke because transfer status may also reflect healthcare system factors. Larger prospective multicentre studies are required to determine whether these observed differences are reproducible and clinically meaningful.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"616665"},"PeriodicalIF":1.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449848","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":"Characteristics and Palliative Care Involvement in Patients Dying in Five UK Emergency Departments: A Retrospective Service Evaluation.","authors":"Sarah Wilson, Sarah C Vince, Heather Jarman, Graham Johnson, Nicolas E Marquinez Vecchione, Cathy Leyland, Joseph Salf, Parampreet Singh Heer, Jack Dainty, Liza Keating","doi":"10.2147/OAEM.S566284","DOIUrl":"10.2147/OAEM.S566284","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 600,000 people die every year in the United Kingdom including 24,000 who die in the Emergency Department (ED). The National Audit of Care at the End of Life looks at the care of dying people during their last hospital admission. However, patients who die in the ED are excluded from this audit and therefore little is currently known about this population.</p><p><strong>Purpose: </strong>This service evaluation aimed to describe the population who died in a 12-month period in five NHS EDs, including whether palliative care teams were involved.</p><p><strong>Patients and methods: </strong>Records from all eligible patients in the 12 months from 1^st June 2022 were reviewed. Anonymised data from each site was collated and compared.</p><p><strong>Results: </strong>There were 704,303 ED patient presentations across the 5 sites, and 852 deaths. The mean age of death was 74.04 with a slight male preponderance of 56.8%. Between sites there was a wide range (0.4%-25%) of involvement from palliative care with these patients whilst in ED. The overwhelming majority had a medical (rather than surgical or traumatic) cause of death.</p><p><strong>Conclusion: </strong>Research is needed in order to ascertain how care can be improved for this group of patients. More UK-centric work is required to understand the characteristics of patients who die in EDs including their cause of death and ethnicity, as well as an exploration of whether greater palliative care collaboration in ED improves patient, family and staff experience.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"566284"},"PeriodicalIF":1.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437739","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":"Small Bowel Adenocarcinoma Presenting as a Chronic Pelvic Mass Mimicking Gynecologic Malignancy: A Case Report and Focused Narrative Review.","authors":"Lana Sbitan, Haitham Qandeel, Mustafa Imhaisen, Hamzah A Hasan, Yazan Abohijleh, Ayman Issa Nabhan, Kamal Bani-Hani","doi":"10.2147/OAEM.S603817","DOIUrl":"10.2147/OAEM.S603817","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Small bowel adenocarcinoma (SBA) is considered an unusual malignancy with vague presentations thus risk of delayed diagnosis. Despite being rarely reported in the literature, SBA can present with gynecological manifestations, especially adnexal mass, misleading surgeons in dealing with it as a primary gynecological malignancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We report a case of a 60 year old female patient who had SBA with pelvic mass as initial presentation. Identification of intestinal origin was done intraoperatively. Surgical resection of tumor and adnexal involvement with referral for oncological chemotherapy was done. Through this case we highlight the challenges experienced by surgeons in diagnosing SBA with gynecological disease, as well the clinical implications of atypical SBA presentations. Reported following CARE guidelines. In addition to the case reported, a focused narrative review of literature was performed. Searching Pubmed database from inception to December 2025 using related keywords, identification of case reports reporting SBA presentation with gynecological disease was done. Data related to patient demographics, clinical manifestations, diagnostic, treatment strategies, and oncological outcomes, were extracted and pattern identification was conducted. A diagnostic algorithm was developed and presented to improve diagnostic delay in approaching adnexal masses with \"Red Flags\" suspicious of SBA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fourteen cases describing small bowel adenocarcinoma (SBA) presenting with gynecologic manifestations were identified - published between the years (1995-2024). Approximately the age range of patients was between 12 and 65 years with most patients presenting in the fifth and sixth decades. The jejunum was the most common primary tumor site (10/14 cases, 71%), followed by the ileum (4/14 cases, 29%). The most common initial presentation reported across the studies was ovarian/adnexal mass. Diagnostic delay was common, ranging from several weeks to over 12 months, with SBA rarely suspected preoperatively. Recurrent red flags included iron-deficiency anemia, chronic gastrointestinal symptoms, unintentional weight loss, obstructive symptoms, disproportionate ovarian tumor size, and discordance between clinical presentation and gynecologic findings. Ovarian metastases were present in all reported cases (14/14 cases, 100%), while peritoneal, mesenteric, nodal, hepatic, and uterine involvement occurred less frequently. The definitive diagnosis was established following surgical exploration through histopathological and immunohistochemistry evaluation. Surgical management was dependent on timely diagnosis, with both bowel and gynecological resections required, followed by postoperative chemotherapy. Outcomes were also dependent on disease stage at the time of diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Atypical adnexal masses in association with gastrointestinal or systemic re","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"603817"},"PeriodicalIF":1.7,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346779","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}