Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Association of mortality and physician experience in prehospital anaesthesia: a registry study on new physicians in Finnish helicopter emergency medical services.","authors":"Anssi Saviluoto, Piritta Setälä, Miretta Tommila, Jussi Pirneskoski, Lasse Raatiniemi, Jouni Nurmi","doi":"10.1186/s13049-025-01412-4","DOIUrl":"10.1186/s13049-025-01412-4","url":null,"abstract":"<p><strong>Background: </strong>Prehospital anaesthesia is a challenging procedure, and the outcome depends on the quality of the process. Hospital-acquired anaesthesia experience does not necessarily translate to high performance in the prehospital setting. We aimed to assess the quality and practice patterns in prehospital anaesthesia related to cumulative experience amongst new prehospital critical care physicians. In this study, we aimed to evaluate whether quality indicators for prehospital anaesthesia and related mortality improve as new prehospital critical care physicians become more experienced with this intervention.</p><p><strong>Methods: </strong>We conducted a registry-based observational study including all patients who underwent anaesthesia and airway management by physicians who started working in the national HEMS between January 2013 and August 2019. Patients were grouped and compared based on the provider's cumulative case volume at the time of the mission: 1-10, 11-20, 21-40, 41-80 and > 80 cases. The association between cumulative experience and 30-day mortality was assessed using multivariate logistic regression analysis. Secondary outcomes included first-pass intubation success, post-intubation hypoxia and hypotension, the combined use of a neuromuscular blocking agent and anaesthetic, on-scene time, mechanical ventilation usage, and rates of normocapnia, hypoxia, and hypotension at handover.</p><p><strong>Results: </strong>1,638 patients (median age 59, 64% male) were treated by 32 physicians. Median on-scene time decreased with increasing experience from 33 (interquartile range [IQR] 23-44) to 28 (IQR 19-38) minutes, P = 0.03. Higher experience was associated with increased use of mechanical ventilation (P < 0.001) and a combination of neuromuscular blocking agents and anaesthetics (P = 0.03). Other secondary outcomes did not show a statistically significant difference between the groups. Crude mortality decreased from 38 to 26% in the lowest to highest experience groups. In the multivariate logistic regression analysis, the same trend was still seen with the odds ratio of the highest experience group for 30-day mortality 0.59 (95% CI 0.38-0.94, lowest experience group as a reference).</p><p><strong>Conclusions: </strong>In a prehospital critical care service, outcomes improve after a high number of prehospital cases, even when physicians with a solid foundation in in-hospital anaesthesia are employed. Limiting physician turnover may improve the quality of care.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"98"},"PeriodicalIF":3.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-altitude HEMS missions-a retrospective analysis of 3,564 air rescue missions conducted between 2011 and 2021.","authors":"Eva Klocker, Lea Wienandts, Dario Josi, Simon Rauch, Roland Albrecht, Jürgen Knapp, Urs Pietsch","doi":"10.1186/s13049-025-01419-x","DOIUrl":"10.1186/s13049-025-01419-x","url":null,"abstract":"<p><strong>Background: </strong>Mountain sport activities are being practiced by an increasing number of people: The number of tourists visiting altitudes greater than 2,500 m above sea level in the Alps has been estimated at around 40 million people per year. For this reason, however, the number of emergencies in remote areas, which can be reached most rapidly by helicopter, has also increased.</p><p><strong>Methods: </strong>We retrospectively reviewed all rescue missions conducted by the Swiss Air Ambulance (Rega) in the period 2011-2021 that were carried out at an altitude of more than 2,500 m above sea level. Demographic and epidemiological data, medical measures implemented on scene, and the on-scene time were then analyzed for both trauma and non-trauma patients. Patients were categorized based on the National Advisory Committee for Aeronautics (NACA) score into non-injured (NACA 0), minor injured (NACA 0-3), seriously injured (NACA 4-6), deceased during mission (NACA 7), and already deceased on arrival of the HEMS team.</p><p><strong>Results: </strong>A total of 3,564 rescue missions were analyzed. Of the patients, 66.8% were male and the vast majority (88.4%) were adults. In terms of injury level, 88.1% of the patients were minor injured, with an NACA score of 0-3, while 9.4% were seriously injured, with a score of 4-6. Patients who died in scene (NACA 7) accounted for 2.5% of cases. We observed a significant increase in the number of minor injured patients with traumatic injuries over the period of observation. Factors that significantly influenced the on-scene time included the NACA score, hoist missions, and traumatic injuries in summer.</p><p><strong>Conclusion: </strong>Over the last ten years, the number of HEMS missions conducted at more than 2,500 m above sea level with non-injured and slightly injured patients has increased. The large number of HEMS missions with uninjured patients are of a preventive nature. Only around 9% of all rescue missions involved the medical treatment and rescue of seriously injured patients who required advanced medical interventions.</p><p><strong>Trial registration: </strong>Ethics approval and consent to participate BASEC Nr. Req202200189.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"97"},"PeriodicalIF":3.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on van wegen et al.: the association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems.","authors":"Amir Mirhaghi","doi":"10.1186/s13049-025-01414-2","DOIUrl":"10.1186/s13049-025-01414-2","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"96"},"PeriodicalIF":3.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nordic physician-staffed prehospital services - organisation and preparedness for major emergency surgical procedures.","authors":"Peter Galos, Karl Chevalley, Robert Larsen, Göran Sandström, Jyrki Tenhunen","doi":"10.1186/s13049-025-01416-0","DOIUrl":"10.1186/s13049-025-01416-0","url":null,"abstract":"<p><strong>Background: </strong>Prehospital physician-staffed services in the Nordic countries vary in crew structure, medical specialisation of crew and preparedness for major emergency surgical procedures. Performing emergency surgical procedures in prehospital settings requires equipment, training and clinical ability. This study aimed to explore the organisation of Nordic prehospital physician-staffed services and their preparedness for resuscitative thoracotomy, perimortem caesarean section and prehospital amputation.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among Nordic prehospital physician-staffed services. A web-based questionnaire was distributed to medical directors. The questions included local organisation, equipment, training, and the ability of the service to perform major emergency surgical procedures. The responses were analysed using descriptive statistics.</p><p><strong>Results: </strong>Out of 61 prehospital physician-staffed services, 54 responded (89% response rate). The various organisations showed variability in geographical coverage, staffing, and transportation options. Resuscitative thoracotomy had been carried out by 41% of the services, 85% had equipment for the procedure, and 48% had established local guidelines. Perimortem caesarean section had been performed by 7% of the services, 80% had equipment for the procedure, and 31% had established local guidelines. Prehospital amputations had been carried out by 35% of the services, 81% had equipment for the procedure, and 22% had established guidelines. Preparation for the procedures varied. 61% of the services carried out special training for resuscitative thoracotomy, 22% for perimortem caesarean section, and 39% for prehospital amputation.</p><p><strong>Conclusions: </strong>Prehospital physician-staffed units need to be prepared and have a strategy and guidelines for the treatment of unusual but life-threatening conditions. To perform major surgical procedures outside a hospital, guidelines, training, equipment, and experience are required. The study has demonstrated significant differences between Nordic countries and regions in how major surgical procedures outside the hospital are addressed. Many services lack standardised procedures and training. Addressing these gaps by implementing protocols and training programs may improve patient care. However, the potential benefits for a small number of patients should be weighed against the investment to have the ability to perform major surgical procedures outside the hospital.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"95"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance measures of the medical priority dispatch system in an urban basic life support system.","authors":"Vittorio Nicoletta, Maxime Robitaille-Fortin, Valérie Bélanger, Éric Mercier, Jessica Harrisson","doi":"10.1186/s13049-025-01410-6","DOIUrl":"10.1186/s13049-025-01410-6","url":null,"abstract":"<p><strong>Background: </strong>Accurate dispatch prioritization for emergency medical services (EMS) is essential for optimizing resource allocation and ensuring timely emergency response. In the Province of Quebec, Canada, a locally adapted dispatch system was implemented using the standardized codes of the Medical Priority Dispatch System (MPDS) but with regional priority definitions. Despite periodic reviews, the system's performance has not been formally assessed. This study evaluates the effectiveness of this prioritization system by comparing priority levels assigned at call-taking with on-scene paramedic assessments and by examining how the system's performance has evolved over three years and across chief complaints.</p><p><strong>Methods: </strong>In this retrospective observational study, we analyzed EMS dispatches in the Capitale-Nationale administrative region of the Province of Quebec, Canada, between July 15 and December 15 over three consecutive years (2021, 2022, and 2023). We assessed system performance using sensitivity, specificity, overtriage, undertriage, predictive values, and accuracy. Statistical analyses included chi-square tests for priority consistency and pairwise t-tests for performance changes over time. Additionally, we examined variations across chief complaints to identify high overtriage and undertriage medical conditions.</p><p><strong>Results: </strong>This study analyzed 96,099 EMS dispatches over a three-year period. While 61.8% of these dispatches were classified as urgent at call-taking, paramedics later determined that 79.7% of all cases were stable and required non-urgent transport, indicating a high level of overtriage. Conditions such as abdominal pain, falls, and psychiatric issues were the chief complaints that showed high overtriage rates (> 90%), whereas allergic reactions, diabetic problems, and heart conditions had the highest undertriage rates (> 10%). Over the three-year period, priority modifications led to a 2.5% decrease in undertriage but a 3.7% increase in overtriage (p < 0.05), highlighting the ongoing challenge of balancing accuracy with an adequate response in dispatch prioritization.</p><p><strong>Conclusion: </strong>The studied prioritization system effectively identifies non-urgent dispatches but exhibits a high overtriage rate, which strains EMS resources. The recent priority modifications further increased overtriage, underscoring the challenge of balancing resource allocation with timely intervention. Refining dispatch criteria and integrating secondary triage or AI-based decision support could potentially improve accuracy and system efficiency.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"94"},"PeriodicalIF":3.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing ultrasound in emergency medical services: assessing physician proficiency and training requirements.","authors":"C Engelen, J Haack, D Lämmermann, W Hitzl, J C Kubitz, G Breuer, A Kamphausen, T Hübner","doi":"10.1186/s13049-025-01391-6","DOIUrl":"10.1186/s13049-025-01391-6","url":null,"abstract":"<p><strong>Background: </strong>Bedside ultrasound plays an important role in diagnostics and monitoring, especially in emergency medicine. Modern technology makes ultrasound available in a mobile and portable form, so it can be used even in prehospital emergency care with several interventional and diagnostic applications. This also raises the question of what kind of education and training is necessary for EMS (emergency medical services) physicians to be able to use Point-of-Care Ultrasound (POCUS) in the prehospital setting.</p><p><strong>Aims: </strong>This observational study investigates the use of prehospital POCUS in a rural EMS area. It focuses the question of what level of competence is needed for EMS physicians to use POCUS adequately in the prehospital emergency setting for correct application and interpretation of the findings.</p><p><strong>Method: </strong>This was a quality assurance measure designed as a prospective cohort study. We investigated POCUS examinations performed by EMS physicians in the EMS Service Area of Nuremberg City, Germany between June 2021 and July 2022. Patients transported to three specific hospitals in Nuremberg city after care were followed up and the prehospital findings were compared with the in-hospital radiological results. The number of correct findings was correlated with the level of competence in POCUS examinations of the performing EMS physicians. Various classifications of competence were used to assess the influence of training and education on the safe application of prehospital POCUS.</p><p><strong>Results: </strong>Two hundred fifty-eight prehospital POCUS examinations were documented, with 108 followed up, including 268 sonographic findings. There was a wide range of indications for POCUS use. In 79.5% of cases the prehospital findings correspond with those in-hospital. By correlating the correct findings with the participants level of competence, there was no significant difference between POCUS-experienced and -inexperienced EMS physicians, even when divided into different categories.</p><p><strong>Conclusion: </strong>POCUS can be used in prehospital emergency care for a wide range of indications safely, with a high number of correct diagnoses and findings. Our results suggest that emergency POCUS is easy to learn and EMS physicians do not need intensive training to perform POCUS adequately in the prehospital setting.</p><p><strong>Take home messages: </strong>Mobile ultrasound appears to be useful in the prehospital setting It can be used by EMS physicians even without extensive prior experience and expertise POCUS is able to find important findings for prehospital patient's care with a high level of certainty.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"92"},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remimazolam for procedural sedation in the emergency department: a prospective study of effectiveness and patient satisfaction.","authors":"Sofus Andreassen, Vibe Maria Laden Nielsen, Anne Lund Krarup, Annika Kamp, Dennis Møller Andersen, Steven Krogh-Larsen, Dorte Melgaard","doi":"10.1186/s13049-025-01402-6","DOIUrl":"10.1186/s13049-025-01402-6","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam (RM) is a novel ultra-short acting benzodiazepine. This study evaluates the safety of using RM for procedural sedation in the emergency department (ED) comparing its administration by registered nurse anaesthetists versus house officers in 1st year residency in emergency medicine and emergency medicine physicians without previous anaesthesiologic specialisation. Secondary aims were patient satisfaction and proportion of successful procedures.</p><p><strong>Methods: </strong>This prospective study was performed at the ED at Aalborg University Hospital from 10 May through 20 August 2024. Five emergency medicine physicians (group 1) started administering RM to patients after completion of training and direct supervision. Results were compared to patients sedated by two registered nurse anaesthetists (group 2) who had been administering RM more than 50 times before study start. Time was recorded during sedation and a questionnaire filled out immediately after the patient had awakened. T-tests or Mann-Whitney U tests were used to compare groups. Proportions were calculated with chi-square (χ²) tests of proportion.</p><p><strong>Results: </strong>In group 1, 53 patients were sedated by emergency medicine physicians, and in group 2, 50 patients were sedated by registered nurse anaesthetists. No or mild respiratory adverse effects were observed in 97% of patients in group 1 versus 100% in group 2. Procedural amnesia was 93% in group 1 versus 90% in group 2. Patients were safe to be left unsupervised after a median of 15 min in both groups. Procedural success was 92% in group 1 versus 100% in group 2.</p><p><strong>Conclusions: </strong>Severe respiratory adverse effects after sedation were rare in both groups. Most patients had amnesia and adequate pain relief for the procedure. The use of RM by physicians without anaesthesiologic specialisation is considered a safe and effective alternative for procedural sedation in the ED.</p><p><strong>Trial registration: </strong>The study was registered and approved as a quality study (ID 2017-011259) by the hospital administration.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"93"},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resilience enhancement interventions for disaster rescue workers: a systematic review.","authors":"Xiaorong Mao, Ying Suo, Xiaoqing Wei, Yinxia Luo","doi":"10.1186/s13049-025-01397-0","DOIUrl":"10.1186/s13049-025-01397-0","url":null,"abstract":"<p><p>Resilience is defined as the ability of individuals to adapt to stress and adversity. In recent years, the concept of resilience in the context of disaster, particularly that of disaster rescue workers, has received considerable attention from academic researchers, disaster response organizations, and policymakers involved in disaster management. This systematic review aimed to identify interventions designed to enhance the resilience of disaster rescue workers. A systematic search was conducted from inception to January 31, 2024, in ten electronic databases: ISI Web of Science, Scopus, PubMed, MEDLINE (Ovid), Embase, Cochrane Library, CINAHL, PILOTS, PsycInfo, and the CNKI. A manual search of the reference lists of the included articles and an author search were conducted to identify additional relevant literature. A total of 22 studies that aimed to enhance resilience among disaster rescue workers were included in this review. These interventions focused on resilience-related knowledge and skills, stress and energy management, coping strategies, mindfulness, and psychological first aid. The duration of these interventions ranged from 1 to 24 h within 8 weeks, with sessions conducted in-person or online in group formats. Individual resilience, coping, social support, mindfulness, and burnout improvements were reported. The most common types of interventions were psychoeducation, followed by mindfulness-based training. However, the methodological quality of these interventions was generally sub-optimal. A well-designed intervention study is needed to enhance the resilience of disaster rescue workers.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"91"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TeLePhone Respiratory (TeLePoR) score to assess the risk of immediate respiratory support through phone call for acute dyspnoea: a prospective cohort study.","authors":"Frederic Balen, François Saget, Axel Benhamed, Oussama-Ibrahim Boudjemline, Lisa Girard, Elisa Lescanne, Pauline Mimouni, Paul-Georges Reuter, Sandrine Charpentier, Nicolas Marjanovic","doi":"10.1186/s13049-025-01405-3","DOIUrl":"10.1186/s13049-025-01405-3","url":null,"abstract":"<p><strong>Background: </strong>Acute dyspnea is a frequent cause to call the Emergency Medical Call Center (EMCC). The main challenge for EMCC dispatchers is to quickly identify patients that will require respiratory support in order to provide them with the most accurate prehospital response. Our main objective was to derivate a score assessable during the first call to detect the most severe patients needing medical assistance.</p><p><strong>Methods: </strong>This prospective observational cohort study was conducted in four different French EMCC from January 22nd to March 7th 2024. Patients over the age of 18 years old that called once the EMCC for acute dyspnea were included in our study. The primary endpoint was an immediate respiratory support requirement (i.e. high-flow oxygen, non-invasive ventilation or mechanical ventilation after intubation) before or at the Emergency Department Registration. Variables of interest to predict respiratory support were prospectively collected in each EMCC. A multivariate analysis by stepwise logistic regression was used to select variables associated with the primary endpoint and to create in the TeLePhon Respiratory Score (TeLePoR score). The TeLePoR score was compared to medical dispatcher intuition for predicting respiratory support.</p><p><strong>Results: </strong>Six hundred and forty-nine patients were analyzed, including 49 (8%) that required immediate respiratory support. The risk factors included in the TeLePoR score were: altered ability to speak complete sentences (OR = 8.62; CI95% = [3.49-21.3]), abdominal respiration (OR = 2.42; CI95% = [1.23-4.76]), altered consciousness (OR = 2.05; CI95% = [0.90-4.65]) and self-report breathing discomfort > 7/10 (OR = 1.83; CI95% = [0.96-3.47]) respectively. Considering these factors, TeLePoR score presented a 0.810 AUC. Medical dispatcher intuition was not statistically superior to TelePoR score to predict immediate respiratory support (AUC = 0.836 vs. 0.810; p = 0.431).</p><p><strong>Conclusion: </strong>TeLePoR score is a simple scoring system including 4 variables to predict immediate respiratory support in patients calling the EMCC for acute dyspnea.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"88"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of pre-hospital invasive arterial blood pressure monitoring for haemodynamic management in traumatic brain injury and spontaneous intracranial haemorrhage.","authors":"J E Griggs, S Clarke, R Greenhalgh, A N Watts, J Barrett, S Houghton Budd, M Dias, K Hunter, R M Lyon, E Ter Avest","doi":"10.1186/s13049-025-01393-4","DOIUrl":"10.1186/s13049-025-01393-4","url":null,"abstract":"<p><strong>Background: </strong>Neuroprotective measures to prevent secondary brain injury are a critical aspect of pre-hospital management in patients with acute traumatic brain injury (TBI) and spontaneous intracranial haemorrhage (sICH). Haemodynamic optimisation guided by non-invasive blood pressure (NIBP) measurements is an important neuroprotective measure, as cerebral autoregulation is often absent or impaired. The accuracy and clinical relevance of invasive arterial blood pressure (IBP) monitoring to optimise haemodynamic management has not been established in patients with a brain insult.</p><p><strong>Methods: </strong>A retrospective clinical diagnostic accuracy study to establish the accuracy and clinical relevance of IBP-guided haemodynamic optimisation in patients with TBI or sICH. The occurrence- and clinical relevance of IBP-NIBP discrepancies in patients attended by a UK Helicopter Emergency Medical Service (HEMS) between 6 January 2022 and 6 January 2024 was evaluated. Bland-Altman plots with adjustment for repeated measures were constructed to analyse disagreement in relation to absolute blood pressure values. Multivariate analysis was performed using generalised linear mixed effects regression (GLMER) models with random effects to identify predictors of disagreement. Error Grid Analysis (EGA) classified the clinical relevance of discrepancies. The primary outcome was pairwise agreement between IBP and NIBP, defined as less than 10% difference in mean arterial pressure (MAP).</p><p><strong>Results: </strong>For 209 patients (159 TBI and 50 sICH) 1020 concurrent IBP and NIBP measurements were available. The average [95% CI] difference in MAP was -1.4 mmHg (-3.09 to 0.27) and 2.6mmHg in TBI. Only 459 (54.7%) MAP data met criteria for pairwise agreement. Multivariate regression analysis revealed a strong association between MAP disagreement and ground emergency medical service conveyance (aOR 2.01, 95% CI 0.98-4.10). Bland-Altman analysis demonstrated proportional bias, with NIBP underestimation of MAP at higher blood pressures and overestimation at lower blood pressures. EGA revealed that in 6.1% (95% CI: 4.5-7.7) of TBI and 12.5% (95% CI: 7.8-17.2) of patients with sICH pairwise disagreement was associated with a moderate to dangerous risk of over- or undertreatment.</p><p><strong>Conclusion: </strong>NIBP guided pre-hospital haemodynamic management of patients with TBI or sICH is hampered by clinically relevant measurement inaccuracies in a significant proportion of patients. Pre-hospital IBP has the potential to improve early haemodynamic optimisation, especially when hypo- or hypertension is present, enabling tailored neuroprotection in the hyperacute phase.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"89"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}