Open Access Emergency Medicine最新文献

{"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}

{"title":"Prehospital Blood pH Testing and Survival in Non-Traumatic Out-of-Hospital Cardiac Arrest: Insights from a Thai EMS Unit.","authors":"Chavin Triganjananun, Welawat Tienpratarn, Chaiyaporn Yuksen, Lunlita Chukaew, Chetsadakon Jenpanitpong, Suteenun Seesuklom","doi":"10.2147/OAEM.S549407","DOIUrl":"10.2147/OAEM.S549407","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care testing (POCT) for blood gas and electrolyte analysis supports the identification of reversible causes of out-of-hospital cardiac arrest (OHCA). In 2021, the Ramathibodi Emergency Operation (RAMA EMO) unit became the first emergency medical service team in Thailand to apply POCT in its prehospital resuscitation protocol. Prior to this implementation, POCT had not been used in prehospital OHCA care in Thailand, so its clinical impact was unknown. The aim of this study was to evaluate the association between initial prehospital POCT-measured pH and return of spontaneous circulation (ROSC) at emergency department (ED) admission in a Thai EMS-managed OHCA cohort.</p><p><strong>Methods: </strong>This single-center ambispective cohort study analyzed adult non-traumatic OHCA patients managed by the RAMA EMO unit. Prehospital POCT was used in all eligible OHCA cases after the initiation of advanced resuscitation. Multivariable analysis was employed to assess the association between blood pH and ROSC at ED admission.</p><p><strong>Results: </strong>A total of 148 patients were included, and ROSC at ED admission occurred in 25% of the cases. Higher prehospital pH was significantly associated with ROSC at ED admission. In ROC analysis, a pH cutoff of ≥ 7.1 demonstrated the optimal discriminative performance. In multivariable logistic regression, pH ≥ 7.1 remained independently associated with ROSC at ED admission (adjusted odds ratio 3.68, 95% CI 1.37-9.89; P = 0.010). Internal bootstrap validation confirmed the robustness of this association.</p><p><strong>Conclusion: </strong>Prehospital POCT blood gas analysis provides valuable prognostic information regarding OHCA, with a pH ≥ 7.1 serving as an independent predictor of ROSC at ED admission. Bootstrap validation supports the stability and reliability of this cutoff. The integration of POCT into EMS protocols may enhance early clinical decision-making during resuscitation. Further external validation is warranted to confirm these findings.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"549407"},"PeriodicalIF":1.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345039","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":"Impact of a Blended-Learning Rapid Sequence Intubation Training Program on Emergency Physician Confidence: A Single-Center Program Evaluation.","authors":"Shabbir Ahmad, Zainab Ahmed Alani, Yavuz Yigit, Shahzad Anjum, Khalid Bashir","doi":"10.2147/OAEM.S574489","DOIUrl":"10.2147/OAEM.S574489","url":null,"abstract":"<p><strong>Background: </strong> Rapid Sequence Intubation (RSI) is a high-risk, time-critical procedure in emergency medicine. Standardizing its practice across a multinational workforce with diverse training backgrounds remains a persistent educational challenge. This mixed-methods program evaluation assessed a blended-learning RSI program's impact on self-reported physician confidence and perceived educational value within a tertiary emergency care setting.</p><p><strong>Methods: </strong> A retrospective evaluation was conducted for a blended-learning RSI curriculum delivered between 2020 and 2022. The program combined asynchronous online modules with a 4-hour, small-group simulation-based practical session. A voluntary, anonymous post-program survey was administered in 2025 following IRB approval. Outcomes included retrospective pre-post self-reported confidence (5-point Likert scale), satisfaction with program components, and qualitative feedback. No objective performance measures were assessed.</p><p><strong>Results: </strong> Forty-five of 141 eligible physicians completed the survey (adjusted response rate 42%). Self-reported low confidence decreased from 77.8% pre-course to 6.6% post-course, while high confidence increased from 22.2% to 93.4% (Cohen's d = 2.1). Improvements were consistent across professional grades. The simulation-based session received the highest satisfaction rating (mean 4.3/5). Qualitative analysis highlighted the value of realistic simulation, structured debriefing, and standardized checklists. Suggested improvements included more complex scenarios and enhanced online interactivity.</p><p><strong>Conclusion: </strong> Participation in a blended-learning RSI program was associated with substantial improvement in self-reported physician confidence and high satisfaction among a multinational emergency medicine workforce. These findings support the feasibility and perceived value of this educational approach for high-risk procedural training in similar settings, though objective competence was not evaluated.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"574489"},"PeriodicalIF":1.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327700","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":"Impact of Prehospital Administration of Aspirin and Unfractionated Heparin on In-Hospital Outcomes in Patients with Suspected Myocardial Infarction: A Retrospective Cohort Study.","authors":"Wenke Faller, Ioannis Toskas, Diana Heurich, Manuel Sigle, Meinrad Gawaz, Michal Droppa, Karin Anne Lydia Müller, Andreas Goldschmied","doi":"10.2147/OAEM.S571863","DOIUrl":"10.2147/OAEM.S571863","url":null,"abstract":"<p><strong>Purpose: </strong>In a prehospital setting with limited diagnostic resources, identification of myocardial infarction (MI) can be challenging. However, high diagnostic accuracy of patients with MI is not only necessary to provide early revascularization but also essential to guide prehospital pharmacological therapy. Even though prehospital use of acetylsalicylic acid (ASA) and anticoagulation therapy is widely established, guidelines only recommend these medications in confirmed cases undergoing PCI. This study examines if prehospital treatment with ASA and unfractionated heparin (UFH) influences in-hospital mortality and bleeding rates in patients with suspected MI.</p><p><strong>Patients and methods: </strong>In this retrospective, single-center cohort study, prehospital treatment with ASA and UFH in 2756 patients with suspected MI was analyzed. Associations between ASA/UFH and death/bleeding until discharge were investigated. To adjust for possible confounders, multiple logistic regression was performed. Furthermore, stepwise logistic regression was carried out in order to investigate factors that influence emergency physicians (EPs) decision to treat with ASA and UFH.</p><p><strong>Results: </strong>Prehospitally administered ASA and UFH was not associated with a significant change in mortality (odds ratio [OR], 0.813; 95% confidence interval [CI] 0.453 to 1.461; <i>p</i>=0.489 for ASA and OR 1.036; CI 0.566 to 1.898; <i>p</i>=0.908 for UFH) or bleeding (OR, 1.142; 95% CI 0.762 to 2.615; <i>p</i>=0.273 for ASA and OR 1.053; CI 0.558 to 1.986; <i>p</i>=0.874 for UFH). Several factors including the presence of ST elevations, atypical chest pain, and concomitant medication were found to influence the EPs decision to treat with ASA and UFH.</p><p><strong>Conclusion: </strong>Prehospital administration of ASA and UFH did not affect in-hospital mortality and bleeding outcomes in a cohort of patients with suspected MI. These findings suggest that routine prehospital anticoagulation in suspected MI may not improve short-term outcomes and should be reconsidered pending randomized evidence.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"571863"},"PeriodicalIF":1.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311133","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":"Forecasting Road Traffic Injuries in North-Eastern Iran: The Effects of COVID-19 and Time Series Analysis (2009-2023).","authors":"Toktam Akbari Khalaj, Taiebe Kenarangi, Vahid Fakoor, Vahid Ghavami, Ali Yazdani, Morteza Lotfi, Negar Sangsefidi","doi":"10.2147/OAEM.S550300","DOIUrl":"10.2147/OAEM.S550300","url":null,"abstract":"<p><strong>Background: </strong>Road Traffic Injuries (RTI) represent a major public health issue in the current century. Examining accident data is essential for developing effective strategies and measures aimed at minimizing these incidents and protecting lives.</p><p><strong>Methods: </strong>This study investigates the impact of the COVID-19 pandemic on RTI in northeast Iran, particularly in Mashhad, a city characterized by a high number of pilgrims and suburban commuters. We employed Seasonal Autoregressive Integrated Moving Average (ARIMA) models to analyze time‑series data collected between 2009 and 2023. The dataset included RTI records from official national sources. The seasonal ARIMA approach was selected to capture seasonal variations, long‑term trends, and the effects of pandemic‑related mobility restrictions on RTI patterns. All analyses were performed by statistical R software version 4.5.1.</p><p><strong>Results: </strong>The average monthly RTI decreased from 2385 (95% CI: 2055-2794) in 2019 to 2035 (95% CI: 1707-2362) in 2020. This reduction of approximately 14.8% was statistically significant (p < 0.05), highlighting the impact of pandemic-related traffic restrictions on road traffic injuries in Iran. The study employed detailed time series analysis, including seasonal ARIMA modeling, to forecast future RTI trends, which is crucial for informing effective prevention strategies.</p><p><strong>Conclusion: </strong>The analysis reveals seasonal patterns in RTI data, confirming the presence of non-stationarity. The results indicate a projected upward trend in RTI incidence, driven largely by increased traffic volumes in the post-pandemic period. These findings highlight the urgent need for targeted interventions to address this rising burden. Overall, the study offers valuable insights for policymakers, supporting more effective strategies to improve road safety and help mitigate the ongoing public health challenge posed by RTIs.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"550300"},"PeriodicalIF":1.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12911953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221183","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":"Accuracy of Medically Experienced Emergency Dispatchers - A Unique Nationwide Model.","authors":"Daniel Trotzky, Inon Dimand, Gal Pachys, Eli Jaffe, Daniel Edward Fordham, Tzachi Slutsky, Refael Strugo, Ella Khairish Ben Zeev, Joseph Leonard, Aya Cohen, Roman Sonkin","doi":"10.2147/OAEM.S562377","DOIUrl":"10.2147/OAEM.S562377","url":null,"abstract":"<p><strong>Background: </strong>This research examined the accuracy of the Israeli model of emergency medical dispatch by comparing dispatchers' preliminary diagnosis with the working diagnosis of paramedics in the field.</p><p><strong>Methods: </strong>Data from emergency medical calls received by Magen David Adom between January 1st 2019 and December 31st 2019 were included. Primary analysis was done by directly comparing preliminary diagnoses made by dispatchers to the diagnoses made by paramedics. Secondary analysis was done by comparing the system identified by the dispatchers' preliminary diagnoses to the system identified by the paramedics' diagnoses. Tertiary analysis was done by subgrouping symptoms and syndromes by an expert panel to create a new preliminary diagnosis which was then compared with paramedic diagnosis.</p><p><strong>Results: </strong>Primary analysis showed a sensitivity of 48.8%, specificity of 97.3%, PPV of 53.0%, and NPV of 98.0%. Secondary analysis showed a sensitivity of 78.6%, specificity of 88.4%, PPV of 26.5%, and NPV of 99.2%. Tertiary analysis showed a sensitivity of 49.8%, specificity of 97.3%, PPV of 54.4%, and NPV of 97.9%.</p><p><strong>Conclusion: </strong>Medically experienced emergency dispatchers were able to obtain a high level of sensitivity determining preliminary diagnoses compared to ambulance crews in the field. Further research should focus on widening the variety of diagnoses investigated.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"562377"},"PeriodicalIF":1.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12915452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229063","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":"Out-of-Hospital Cardiac Arrest in Portugal - A Call for a Registry Project.","authors":"Pedro Caldeira, Isabel Rabiais, Luís Ladeira, Paulo Alves","doi":"10.2147/OAEM.S557330","DOIUrl":"10.2147/OAEM.S557330","url":null,"abstract":"<p><strong>Introduction: </strong>Sudden Out-of-Hospital Cardiac Arrest (OHCA) is a significant global health issue, with considerable regional variations, and is the third leading cause of death in Europe. With approximately 80% of cases being witnessed, immediate initiation of cardiopulmonary resuscitation (CPR) by lay bystanders can increase OHCA survival by a factor of 2-4. In 2007, the European Resuscitation Council (ERC) established the European Registry of Cardiac Arrest (EuReCa) to systematically collect and analyze OHCA data across Europe, identifying gaps in the chain of survival. EuReCa findings highlight the critical impact of bystander CPR and the importance of measurement for evidence-based improvement. However, previous EuReCa studies in Portugal were limited to Madeira and the Azores, representing less than 5% of the population. This exploratory study is the first to provide comprehensive nationwide OHCA data, aiming to characterize the current national context.</p><p><strong>Objective: </strong>Characterize the current national situation in terms of sudden OHCA survival and bystander CPR.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted from September 1 to November 30, 2022. All EMS-attended OHCA cases were included, and Utstein-style guidelines were applied to ensure standardized data reporting.</p><p><strong>Results: </strong>During the study period, 4769 OHCA cases were recorded, including 2128 witnessed by laypeople. Bystander CPR was performed in 555 cases (26%), and ROSC was achieved in 117 victims, corresponding to a 5% survival rate among witnessed OHCAs.</p><p><strong>Discussion: </strong>The bystander CPR rate in witnessed OHCA was 26%, which is below the average results of EuReCa One (48%) and significantly below the average results of EuReCa Two (58%).</p><p><strong>Conclusion: </strong>Despite limitations related to the retrospective design and lack of a national OHCA registry, bystander CPR in witnessed OHCA showed a significant positive impact on ROSC (p<0.001). Regional differences were observed, underscoring the need to implement ERC recommendations to increase bystander CPR rates nationwide.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"557330"},"PeriodicalIF":1.7,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522253","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":"Antifreeze Poisoning Complicated by Severe Metabolic Acidosis, Toxic Encephalopathy, and Multiple Organ Dysfunction Syndrome: A Case Report.","authors":"Min Liu, Yayuan Tan, Yinchun Xie, Jinglan Liu, Haishuang Mei, Dan Jin, Zhaohui Zhang","doi":"10.2147/OAEM.S578162","DOIUrl":"10.2147/OAEM.S578162","url":null,"abstract":"<p><p>A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"578162"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515582","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":"Utilization of Virtual-Reality in Establishing a Code Trauma Crisis Resource Management Training Module.","authors":"Riyadh Firdaus, Aida Rosita Tantri, Sidharta Kusuma Manggala, Anggara Gilang Dwiputra, Bintang Pramodana, Aino Nindya Auerkari, Noor Hafidz, Andy Omega, Dewi Larasati","doi":"10.2147/OAEM.S557517","DOIUrl":"10.2147/OAEM.S557517","url":null,"abstract":"<p><strong>Purpose: </strong>Crisis Resource Management (CRM) is critical in managing code trauma cases, yet remains underemphasized in many medical training programs in Indonesia. This study aimed to develop and evaluate a virtual reality (VR)-based CRM training module tailored for emergency physicians.</p><p><strong>Patients and methods: </strong>A pilot CRM module was designed through expert focused group discussions (FGDs) and refined using the Delphi method. The module included a lecture, roundtable discussion, and VR simulation. Fifteen emergency physicians participated in the training and were assessed using pre- and post-tests, a checklist based on CRM objectives, the Ottawa General Rating Scale (GRS), and a satisfaction questionnaire.</p><p><strong>Results: </strong>Participants showed a significant improvement in knowledge (mean pretest 70 vs posttest 95.33; p < 0.001). Checklist completion rates had a median of 81% individually and 80% at the team level. Ottawa GRS scores indicated strong performance in leadership, problem-solving, communication, and situational awareness (overall mean score: 6.2/7). Satisfaction ratings reflected positive participant experiences with the module.</p><p><strong>Conclusion: </strong>VR-based simulation is an effective, accessible tool for enhancing CRM skills in emergency settings, particularly in low-resource or remote environments. The module demonstrated high participant satisfaction and notable improvements in both individual and team performance and incorporating VR into trauma team CRM training should be considered.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"18 ","pages":"557517"},"PeriodicalIF":1.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999280","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":"Hidden Risk Factors Overlooked by qSOFA in Emergency Department Sepsis Patients: A Multicenter Retrospective Cohort.","authors":"Saqer Althunayyan","doi":"10.2147/OAEM.S546101","DOIUrl":"10.2147/OAEM.S546101","url":null,"abstract":"<p><strong>Objective: </strong>Despite the numerous studies critiquing the Quick Sequential Organ Failure Assessment (qSOFA) score for sepsis prognosis in the emergency department (ED), there are limited known risk factors that can be missed by qSOFA.</p><p><strong>Methods: </strong>This is a multicenter retrospective cohort study using ED data from Dr Sulaiman AL-Habib Medical Group Hospitals in Riyadh, Saudi Arabia. We assessed all suspected septic patients who came through the EDs from 1st May 2022 to 30th April 2023 with the qSOFA < 2. Among these patients, we identify those who develop critical outcomes (the requirement for vasopressors/inotropes or mortality) within 72 hours of triage. Additionally, we analyzed the potential risk factors of critical outcomes using a multivariable logistic regression model.</p><p><strong>Results: </strong>We identified 1011 patients who presented with suspected sepsis and qSOFA < 2. Among them, 70 patients developed critical outcomes within 72 hours. In the multivariable logistic regression model, the potential risk factors for critical outcomes were age ≥65 years (adjusted OR, 3.87 [1.25, 14.9]), lactate ≥ 2.5 mmol/L with adjusted OR 2.04 [1.16, 3.54], and shock index >1 with adjusted OR 3.27 [1.13, 10.3]. There are no specific comorbidities that were independently associated with the critical outcomes.</p><p><strong>Conclusion: </strong>The study identified potential risk factors for sepsis outcomes that qSOFA overlooks. Integration of risk factors (lactate, shock index, age) with qSOFA could enhance early sepsis recognition and improve patient outcomes. We recommend further studies to validate these risk factors.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"361-369"},"PeriodicalIF":1.5,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670039","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}