Open Access Emergency Medicine最新文献

{"title":"Communities of Practice in Emergency Mental Health Care for Involuntary Patients in Common Law Countries: A Scoping Review of Evidence Gaps.","authors":"Alan R Clough, Veronica Graham, Janet Catterall, Richard Stone","doi":"10.2147/OAEM.S603253","DOIUrl":"10.2147/OAEM.S603253","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) play a critical role in managing individuals experiencing mental health crises who are involuntarily transported under mental health legislation. Although collaborative models such as co-responder teams and diversion services have shown operational benefits, their implementation is inconsistent and rarely embedded within systems that support sustained practice development. Communities of Practice (CoPs), which emphasise ongoing social learning and shared practice, may offer a framework to address this gap.</p><p><strong>Objective: </strong>To map the scope of published research on involuntary mental health presentations to EDs and to assess whether the evidence supports the existence, implementation, or potential value of CoP approaches in this context.</p><p><strong>Eligibility criteria and information sources: </strong>Peer-reviewed studies published in English from 2008 onwards were included if they examined responses to involuntary mental health presentations in EDs within common law countries (Australia, Canada, Aotearoa New Zealand, the United Kingdom, and the United States). Searches were conducted in Medline, PubMed, Embase, PsycINFO, and Google Scholar, supplemented by targeted grey literature searches and an AI-assisted search tool.</p><p><strong>Methods: </strong>Following Joanna Briggs Institute scoping review methodology, studies were screened and selected by two independent reviewers. Data extraction and synthesis were conducted using a structured framework, with studies analysed for evidence of CoP-consistent elements such as collaborative learning, interagency communication, and shared practice development.</p><p><strong>Results: </strong>Sixty-five studies met inclusion criteria (40 quantitative retrospective, 11 quantitative prospective, 10 qualitative, and 4 mixed methods), predominantly from the United States (n=30) and Australia (n=23). Only one study explicitly evaluated a CoP, and no sustained CoP structures were identified. While many studies described collaborative practices consistent with CoP principles-such as interagency coordination, shared training, and improved communication-these were typically operational and episodic rather than embedded in ongoing systems of shared learning and practice development.</p><p><strong>Conclusion: </strong>Despite the growth of research and the demonstrated benefits of collaborative service models, there is little evidence of formalised CoP approaches in emergency mental health care for involuntary patients. This absence suggests a gap in sustained collaborative learning mechanisms that may limit system level improvement. CoPs may offer a theoretically coherent framework to address this gap. Future research should examine the feasibility, implementation, and impact of CoPs, particularly through qualitative and mixed-methods approaches.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"603253"},"PeriodicalIF":1.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253929","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 Value of D-Dimer in Patients Visiting the Emergency Department with Symptoms of Acute Coronary Syndrome: A Retrospective Observational Study.","authors":"Mohammad K Alsuleiman, Ahmad A Oqlat, Abdel Salam Ewais, Mosab Said, Fadi Jalal Alkhawaja, Liqaa A Raffee, Anwar Mustafa","doi":"10.2147/OAEM.S600069","DOIUrl":"10.2147/OAEM.S600069","url":null,"abstract":"<p><strong>Background: </strong>D-dimer is a fibrin degradation product formed during fibrinolysis and reflects the activation of coagulation and fibrinolytic pathways. The role of D-dimer in acute coronary syndrome (ACS) remains uncertain. This study was designed to analyse differences in D-dimer levels in patients with different forms of ACS and the diagnostic efficiency and possible complementary role of the D-dimer biomarker.</p><p><strong>Methods: </strong>This study applied a retrospective observational design and included adult patients presenting to the emergency department with chest pain. Differences in D-dimer levels across diagnostic categories were analysed. To evaluate the diagnostic performance of D-dimer, receiver operating characteristic (ROC) analysis was conducted, which involved calculations of area under the curve (AUC), sensitivity, specificity, and likelihood ratios. Also, the incremental value of D-dimer over clinical data and cardiac troponin was determined through a multivariate logistic regression model.</p><p><strong>Results: </strong>The study found that the level of D-dimer was significantly higher in patients with ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI) compared to patients with unstable angina (UA) and non-specific chest pain (p < 0.001). As per ROC analysis, the level of D-dimer demonstrated modest discrimination between STEMI/NSTEMI and unstable angina (AUC 0.618; 95% CI 0.538-0.697), and a fair discrimination between STEMI/NSTEMI and non-specific chest pain (AUC 0.668; 95% CI 0.601-0.736). At a cutoff of 0.50 mg/L, sensitivity and specificity were limited. In multivariable models, D-dimer did not provide incremental diagnostic value beyond clinical variables and cardiac troponin (ΔAUC not significant).</p><p><strong>Conclusion: </strong>Despite higher D-dimer concentrations in myocardial infarction, the marker exhibited modest diagnostic performance and did not provide additional diagnostic value over cardiac troponin. Therefore, D-dimer is suggested to be used as an adjunct rather than primary diagnostic instrument in patients presenting with suspected acute coronary syndrome.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"600069"},"PeriodicalIF":1.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869872","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":"Level of Emergency Preparedness and Associated Barriers at the Accident and Emergency Ward of a LMIC Hospital: A Cross-Sectional Assessment Using the WHO HEAT Tool.","authors":"Joel Nabeshya, Elizabeth Atiang, Charity Kwarikunda, Rachel Luwaga, Vallence Niyonzima","doi":"10.2147/OAEM.S603948","DOIUrl":"10.2147/OAEM.S603948","url":null,"abstract":"<p><strong>Background: </strong>Emergency preparedness is a challenge for hospital emergency departments (EDs). In the USA, over 68% of 983 EDs were not emergency prepared, while in Ghana, one hospital's emergency preparedness level was only 57.4%. At the health facility level, several barriers to emergency preparedness have been reported, including poor access to medical supplies, medications, and equipment; deficits in medical training; and the absence of formal clinical management protocols.</p><p><strong>Methodology: </strong>A cross-sectional study was conducted at the Accident and Emergency (A&E) Ward of Mbarara Regional Referral Hospital (MRRH). Data was collected using the modified WHO HEAT checklist, completed by three (3) key hospital informants, who were preferred for their key insights over a large sample of general staff. Data fell into 11 variables with items in each variable scored between 0 and 2, then the total scores generated percentages. By univariate analysis, the level of emergency preparedness and the associated barriers at the A&E Ward of MRRH were determined.</p><p><strong>Results: </strong>The overall emergency preparedness score at the A&E ward of MRRH was 62.6%, with the human resources category under ED capacity scoring the lowest (37.5%), while the consulting services category under ED resources scored the highest (71.4%). The two most common associated barriers to emergency preparedness in the A&E were medicine stockouts (35.0%) and missing emergency equipment (29.2%), while the least reported barriers were user fees (2.2%), and opening hours (0.7%).</p><p><strong>Conclusion: </strong>According to this study, the level of emergency preparedness in the A&E ward of MRRH was weak, with low level of human resource, and weak quality improvement checks the most contributing factors. The highest reported barriers to strong emergency preparedness in the A&E ward of MRRH were medication stockouts and the absence of emergency equipment.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"603948"},"PeriodicalIF":1.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844340","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":"Limits of Transfusion Burden as a Predictor of Mortality in Severely Injured Trauma Patients.","authors":"Mohammad Barouqa, Katrina J Jiang, Juyeon Kim, Marianne E Yassa, Nestor Dela Cruz, Huseyin Kilic","doi":"10.2147/OAEM.S599789","DOIUrl":"10.2147/OAEM.S599789","url":null,"abstract":"<p><strong>Background: </strong>Severe hemorrhage remains a leading cause of early and preventable mortality in trauma patients. While massive transfusion protocols (MTPs) have improved resuscitation strategies, the prognostic value of transfusion burden alone remains unclear. This study evaluated the reliability of total blood product and blood cooler issuance as predictors of mortality in trauma MTP and assessed the added prognostic value of early laboratory parameters, neurological status on arrival and injury severity scores.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult trauma patients requiring MTP activation upon arrival to a Level I trauma center between January 2023 and May 2025. Demographic, clinical, transfusion, and first laboratory data obtained within 15 to 30 minutes of presentation were analyzed. Blood cooler utilization was categorized as ≤5, 6-10, or >10 coolers. Outcomes were defined as survival or death at the conclusion of MTP.</p><p><strong>Results: </strong>A total of 135 patients were included; 36 (26.7%) expired during MTP activation. Non-survivors received significantly greater numbers of red blood cells, plasma, and total blood products requiring higher numbers of blood coolers. They also demonstrated more severe coagulopathy, higher lactate levels, greater metabolic derangement, lower platelet counts, hypothermia, lower Glasgow Coma Scale scores, and higher injury severity. Kaplan Meier and Cox regression analyses showed no statistically significant association between cooler category and survival. A transfusion threshold of ≥36 total blood units yielded modest predictive performance (accuracy 69.6%) using Youden's index. Integration of laboratory markers significantly improved mortality prediction models (AUC from 0.62 to 0.78).</p><p><strong>Conclusion: </strong>In trauma patients requiring MTP activation, mortality was driven primarily by injury severity, neurologic status, and early physiologic derangements. Blood product utilization demonstrated limited prognostic value in isolation but contributed meaningfully when combined with laboratory and clinical parameters. Blood cooler notifications may serve as useful adjuncts to prompt timely clinical reassessment.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"599789"},"PeriodicalIF":1.7,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785076","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":"Pre-Hospital Calcium Administration Reduces Incidence of Hypocalcemia and Mortality in Trauma Patients.","authors":"Oluwafolaranmi E Sodade, Katherine A Kummer, Cindy L Austin, Brian B Draper","doi":"10.2147/OAEM.S556834","DOIUrl":"10.2147/OAEM.S556834","url":null,"abstract":"<p><strong>Background: </strong>Extensive literature has established how critical calcium is to countless physiological pathways; however, the consequences of trauma-induced hypocalcemia, if not pro-actively managed, are often overlooked. Data suggests that timely calcium administration may be advantageous in correcting hypocalcemia and preventing unfavorable clinical outcomes. There is limited data examining the impact of pre-hospital calcium administration in trauma patients transported from the injury scene by air ambulance. Our Lifeline air transport service initiated a pre-hospital calcium administration protocol in October 2021.</p><p><strong>Objective: </strong>To determine the efficacy of the pre-hospital calcium protocol on ED ionized calcium (iCa) values and clinical outcomes.</p><p><strong>Methods: </strong>A single-center, retrospective cohort analysis of 87 trauma patients transported from the scene via Lifeline air services was conducted. Cohort 0 had 54 patients who received pre-hospital blood products without calcium, and Cohort 1 had 33 patients who received blood products and calcium. Eleven patients were excluded from final analysis due to missing iCa values.</p><p><strong>Results: </strong>Cohort 1 had significantly higher iCa values (4.92 ± 0.74 vs 4.24 ± 0.76 mg/dL, <i>p</i>-value = 0.007) and lower incidences of hypocalcemia (multivariate OR: 0.03 [95% CI: 0.002, 0.27]) when compared with Cohort 0. Hospital mortality rates appeared lower in Cohort 1 compared to Cohort 0, though this difference did not reach statistical significance (<i>p</i>-value = 0.38). Clinical data points including ICU and hospital length of stay were similar. Twelve patients were hypercalcemic on ED arrival: nine in Cohort 1, and three in Cohort 0. This could be attributed to variable injury severities, comorbidities, type and volume of blood products, and calcium overtreatment.</p><p><strong>Conclusion: </strong>The administration of pre-hospital calcium significantly reduced episodes of hypocalcemia and severe hypocalcemia.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"556834"},"PeriodicalIF":1.7,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700105","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":"Adherence to Pediatric Asthma Guidelines in Children with Asthma Exacerbation at the Emergency Department.","authors":"Teeranai Sakulchit, Wichapa Sathapornpunya","doi":"10.2147/OAEM.S567362","DOIUrl":"10.2147/OAEM.S567362","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric asthma exacerbation guidelines were implemented in the emergency department (ED) of the Songklanagarind Hospital in March 2021. The primary outcome was physician adherence to the guideline. Secondary outcomes included comparisons of selected ED quality indicators.</p><p><strong>Patients and methods: </strong>This single-center retrospective before-after study included children aged <15 years who presented with asthma exacerbation at the ED. Data were collected before guideline implementation (January 1, 2020, to February 28, 2021) and after implementation (March 1, 2021, to December 31, 2022). Guideline adherence was described as proportions. Between-period comparisons were analyzed using multivariable logistic regression to estimate odds ratios with 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of 313 pediatric patients met the inclusion criteria with 135 and 178 patients in the pre-and post-guideline groups, respectively. Overall adherence to the guidelines was approximately 42.1%. After implementation, patients were more likely to have scheduled outpatient follow-up on the next calendar business day (adjusted OR 4.82, 95% CI 2.33-10.38) and less likely to be admitted to the hospital (adjusted OR 0.30, 95% CI 0.11-0.76).</p><p><strong>Conclusion: </strong>Following the introduction of the guidelines in the ED, physician adherence was partial and was associated with significant improvements in some aspects of care quality. Ongoing review, feedback, education, and monitoring of time-sensitive care processes may help sustain and further improve the care of children with asthma exacerbations.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"567362"},"PeriodicalIF":1.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515574","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":"Organizational Challenges and Emergency Response to a Massive Bee Attack on an Isolated Island in French Guiana.","authors":"Julien Marlier, Rémi Mutricy, Hatem Kallel, Camille Deschamps, Alexis Fremery","doi":"10.2147/OAEM.S553868","DOIUrl":"10.2147/OAEM.S553868","url":null,"abstract":"<p><strong>Introduction: </strong>In 2023, close to Cayenne, French Guiana, a significant attack by africanized honey bees struck a group of 35 tourists on an isolated island, with no available means of rescue.</p><p><strong>Event description: </strong>The incident resulted in 1 death, 2 critical emergencies, 6 moderate emergencies, and a total of 11 emergency room admissions, involving both adults and children.</p><p><strong>Discussion: </strong>Analysis of challenges encountered that day, particularly in aerial and nautical operations, will help improve our emergency response and healthcare systems in our overseas territories.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"553868"},"PeriodicalIF":1.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505227","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 Value of First-Day CRP and NLR in Distinguishing Infectious from Non-Infectious Causes of Loss of Consciousness in the Emergency Department.","authors":"Sepehr Hasani, Hadiseh Hosami Rudsari, Majid Akrami, Mehrnaz Fallah-Tafti, Neda Faraji, Fatemeh Dolatkhani, Samaneh Akbarpour","doi":"10.2147/OAEM.S560710","DOIUrl":"10.2147/OAEM.S560710","url":null,"abstract":"<p><strong>Background: </strong>Altered level of consciousness (ALOC) is a common presentation in the emergency department (ED) with a broad spectrum of infectious and non-infectious etiologies and is associated with substantial morbidity and mortality. Early identification of infectious causes is therefore critical for timely management. C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) are readily available inflammatory markers that may assist in this differentiation.</p><p><strong>Methods: </strong>In this cross-sectional study, 322 patients presenting with ALOC and admitted to the ED of Baharloo Hospital were evaluated. Baseline demographic, clinical, and laboratory data were collected, and patients were classified as having infectious or non-infectious etiologies. First-day CRP and NLR values were compared between groups. Receiver operating characteristic (ROC) curve analysis assessed the diagnostic performance of CRP, NLR, and their combination in distinguishing infectious from non-infectious causes. Logistic regression analysis identified predictors of in-hospital mortality.</p><p><strong>Results: </strong>The mean age was 62 years, and 36.6% of patients had an infectious etiology. Mortality was significantly higher in the infectious group than in the non-infectious group (60.2% vs. 22.1%, p<0.001). Median CRP and NLR values were significantly higher in infectious cases (both p<0.05). CRP at a cut-off of 32.0 mg/L yielded an area under the curve (AUC) of 0.76, with 71% sensitivity and 83% specificity, outperforming NLR (cut-off 5.53; AUC 0.68, sensitivity 71%, specificity 60%). The combined model achieved an AUC of 0.79 with 76.3% sensitivity and 76.5% specificity. Multivariable logistic regression identified older age (odds ratio [OR] 1.07, 95% confidence interval [CI]: 1.04-1.09), longer hospital stay (OR 1.09, 95% CI: 1.05-1.13), lower Glasgow Coma Scale score (OR 0.67, 95% CI: 0.59-0.75), and higher NLR (OR 1.14, 95% CI: 1.02-1.27) as independent predictors of mortality.</p><p><strong>Conclusion: </strong>First-day CRP and NLR, particularly CRP, show acceptable diagnostic performance for distinguishing infectious from non-infectious causes of ALOC in the ED. Combined use of these markers improves diagnostic accuracy, and elevated NLR is independently associated with in-hospital mortality, supporting its role alongside clinical assessment for early risk stratification.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"560710"},"PeriodicalIF":1.7,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475786","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":"Predictive Value of Systemic Immune-Inflammation Index Combined with D-Dimer Levels and Injury Severity Score for the Prognosis of Patients with Multiple Injuries: A Retrospective Analysis.","authors":"Xinlong Du, Yongming He, Xing Liu","doi":"10.2147/OAEM.S549167","DOIUrl":"10.2147/OAEM.S549167","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of patients with multiple injuries (MI) remains challenging to predict accurately due to the complexity and heterogeneity of trauma. Traditional scoring systems or single biomarkers often have limitations in terms of sensitivity or specificity.</p><p><strong>Purpose: </strong>The objective of the present study was to investigate the predictive value of combining the systemic immune-inflammation index (SII), D-dimer (D-D) and injury severity score (ISS) for evaluating the prognosis of patients with MI.</p><p><strong>Patients and methods: </strong>A total of 142 patients with MI admitted to the Emergency Department of Shenzhen Longhua District Central Hospital (Shenzhen, China) from January 2019 to December 2023 were retrospectively analyzed. Patients were then divided into survival (n=102) and non-survival (n=40) groups according to their survival status on postoperative day 28. Logistic regression analysis was performed on indicators with significant differences between the two groups to identify prognostic factors in severe MI. Data were retrospectively analyzed using SPSS 26.0 software. In addition, receiver operating characteristic (ROC) curves were plotted to assess the predictive value of the combined SII, D-D and ISS.</p><p><strong>Results: </strong>The median SII was found to be 340.11 (182.72-578.31) in the survival group and 849.93 (300.83-1034.14) in the non-survival group, yielding a significant difference (P<0.001). Logistic regression indicated that SII, D-D and ISS at admission were independent prognostic factors for mortality. Furthermore, SII, D-D, ISS and their combination showed predictive value [area under the curve (AUC) >0.5] for 28-day mortality, with the combination exhibiting the highest predictive accuracy. Based on the optimal ROC cut-off values (308.8), patients were divided into groups with SII ≤308.8 (n=58) and SII >308.8 (n=84), with significantly lower mortality in the former group (P<0.05). Similarly, patients were categorized into D-D ≤2.35 (n=117) and D-D >2.35 (n=25) groups, with significantly lower mortality in the former group (P<0.05). In conclusion, each indicator demonstrated prognostic significance (AUC >0.5), with the combined model achieving the highest predictive accuracy (AUC =0.969).</p><p><strong>Conclusion: </strong>The integrated indicators offered improved predictive performance compared with individual measures for MI, providing a clinically valuable reference for patient management.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"549167"},"PeriodicalIF":1.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463837","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":"From Limited Use to Standard Practice: Retrospective Analysis of Droperidol Administration by Emergency Medical Services (2018-2023).","authors":"Rachel L U Schuler, Paul D Schuler Jnr, Christopher Sampson","doi":"10.2147/OAEM.S548610","DOIUrl":"10.2147/OAEM.S548610","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective observational study investigates the usage trends of droperidol (a dopamine receptor antagonist) by Emergency Medical Services (EMS) from 2018 to 2023, focusing on its evolving role in prehospital care.</p><p><strong>Methods: </strong>Using the ESO Solutions, Inc. (ESO) national dataset, we analyzed 56,232,761 EMS cases over six years, examining the rates of droperidol administration by EMS clinicians. We assessed systolic blood pressure (SBP) and heart rate abnormalities after administration, and usage across primary impressions, procedures, and airway interventions. The total database cases grew from 5,536,297 in 2018 to 13,957,073 in 2023, with participating agencies increasing from 1,234 to 3,068.</p><p><strong>Results: </strong>Our findings show an increase in droperidol administration, with doses rising from one in 2018 to 22,372 by 2023. The fraction of doses per million cases increased from 0.18 in 2018 to 1,603 in 2023. Droperidol usage grew from <0.01% of cases in 2018 to 0.2% in 2023. Primary impressions most associated with droperidol use were Behavioral/Psychiatric (23.4%), Pain (16.1%), and Neurological (13.8%). Among procedures, 12-lead ECG (21.7%) and patient restraint (21.1%) were most frequent. For cases receiving ECGs, top impressions were Gastrointestinal (34.0%) and Neurological (26.0%), with common age ranges being 60-69 (16.7%) and 50-59 (16.6%). Within airway management, oxygen administration was used in 69.40% of cases, followed by ETCO2 capnography (16.1%). Post-administration, 77.3% of patients maintained normal SBP, while 10.2% experienced hypotension and 12.4% hypertension. Regarding heart rate, 69.7% exhibited normal rates, with bradycardia in 13.4% and tachycardia in 17.0%.</p><p><strong>Conclusion: </strong>Increasing droperidol utilization by EMS reflects growing adoption in clinical practice. This research highlights the need for ongoing emphasis on evidence-based practices in prehospital care, and advocating for enhanced training and protocol development. Limitations include potential underreporting and variability in protocol adherence, suggesting the need for further investigation into usage barriers and facilitators.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"548610"},"PeriodicalIF":1.7,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349028","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}