Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"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}

{"title":"Association of prehospital invasive blood pressure measurement and treatment times of intubated patients with suspected stroke - a retrospective study.","authors":"Michael Eichlseder, Nikolaus Schreiber, Alexander Pichler, Michael Eichinger, Sebastian Labenbacher, Barbara Hallmann, Simon Orlob, Paul Zajic, Simon Fandler-Höfler","doi":"10.1186/s13049-025-01411-5","DOIUrl":"10.1186/s13049-025-01411-5","url":null,"abstract":"<p><strong>Background: </strong>Invasive blood pressure measurement is commonly used in in-hospital patients with stroke requiring general anesthesia, but is much less established in the prehospital setting. While it allows for more precise blood pressure management, it might also lead to prehospital treatment delays. Therefore, this study aims to evaluate the potential impact of prehospital invasive blood pressure measurement on treatment times.</p><p><strong>Methods: </strong>Adult patients (≥ 18 years) with suspected stroke (both ischemic and hemorrhagic) and prehospital induction of emergency anesthesia by physicians admitted to the University Hospital of Graz between January 1st, 2018 and December 31st, 2023, were included. Optimal one-to-one matching using a propensity score for prehospital invasive blood pressure measurement based on patient age, patient sex, treatment by helicopter emergency medical services and Glasgow coma scale on scene was performed. Primary outcome was the time-interval between on-scene arrival of the prehospital physician and first cranial computed tomography (CCT).</p><p><strong>Results: </strong>One hundred patients with suspected stroke and prehospital emergency anesthesia were identified, of whom 67 (67%) had prehospital invasive blood pressure measurement. After matching, 33 patients of each cohort were used for main analysis. Median (25th to 75th percentile) time between on-scene arrival and first CCT was 79 (70-87) minutes in the prehospital measurement group, compared to 73 (67-81) minutes in the group with in-hospital initiation of invasive measurement (p = 0.21). On-scene time was longer in the prehospital group [45 (37-51) vs. 36 (33-43) minutes, p = 0.009], while transport duration [18 (11-25) vs. 20 (13-31) minutes, p = 0.20] and time spent in the resuscitation room [16 (12-20) vs. 16 (12-21) minutes, p = 0.391] did not differ.</p><p><strong>Conclusion: </strong>In summary, among patients with suspected stroke who underwent prehospital intubation, time from on-scene arrival to the first CCT was not prolonged in those who received prehospital invasive blood pressure measurement compared to those who received it in-hospital.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"90"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086190","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":"A bi-institutional observational study comparing short-term and long-term outcome of operative and non-operative management of clinical and radiological flail chest injuries.","authors":"Eva-Corina Caragounis, Monika Fagevik Olsén, Lena Sandström, Rauni Rossi Norrlund, Lovisa Strömmer, Hans Granhed","doi":"10.1186/s13049-025-01400-8","DOIUrl":"10.1186/s13049-025-01400-8","url":null,"abstract":"<p><strong>Background: </strong>Operative management of chest wall injuries requiring ventilatory support has been shown to decrease the time spent on ventilator. The main purpose of this study was to investigate whether operative management reduces the need for mechanical ventilation and the impact of surgery on long-term outcome concerning pain, lung function and movement.</p><p><strong>Methods: </strong>This is a bi-institutional prospective observational study comparing operative (Op) and non-operative (Non-Op) management of adult trauma patients with flail chest injuries. Data on the need for and LOS in intensive care (ICU), on mechanical ventilator (MV), and in hospital, and incidence of pneumonia and tracheostomy was collected. Clinical follow-up after six weeks, six months and one year concerning lung function, CT-lung volume, physical function, pain, and quality of life (QoL) was performed.</p><p><strong>Results: </strong>There was no difference in the need for (29%) and LOS on MV and in ICU between the Op and Non-Op groups. Chest wall surgery was performed 4 days (range 2-14) post trauma and associated with a longer hospital LOS. Pneumonia was more common in the Non-Op group (37% vs. 18%, p = 0.003). Fifty patients in the Op group and 38 patients in the Non-Op group were enrolled in a follow-up where Non-Op group experienced more pain in the first six months and had a higher daily dose of oral morphine during the first six weeks post trauma. The best residual lung function and CT-lung volume was seen in patients managed with muscle-sparing surgery without thoracotomy. No considerable difference in pain, physical activity, physical function and QoL were seen between the groups after one year.</p><p><strong>Conclusions: </strong>Operative management of flail chest injuries did not decrease the need for mechanical ventilation or the length of stay in ICU. Operating on non-ventilated patients may increase the length of hospital stay depending on day of surgery. Surgery was associated with a decreased incidence of pneumonia, less pain and subjective symptoms the first months' post-trauma despite operated patients being older and with more severe trauma, but after one year there were no significant differences between the groups. Operative technique may influence outcome and should be studied further.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT02132416, 7 May 2014.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"87"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081482","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":"Proximal venous ultrasound with risk stratification safely excludes deep venous thrombosis in emergency department routine care: an observational study.","authors":"Maroan Cherkaoui, Mohammed Al-Attabi, Sara Salimi, Bader Cherkaoui, Jakob L Forberg","doi":"10.1186/s13049-025-01382-7","DOIUrl":"10.1186/s13049-025-01382-7","url":null,"abstract":"<p><strong>Background: </strong>Lower limb deep vein thrombosis (DVT) is common in emergency departments (EDs) and can be fatal if left untreated due to the risk of progression to pulmonary embolism (PE). In Scandinavia, DVT diagnosis typically relies on ultrasound performed outside the ED in the diagnostic departments. However, international guidelines now recommend combining limited/proximal compression ultrasound of the lower extremity PUL with risk stratification as a viable approach for diagnosing and ruling out DVT. The aim of this study was to evaluate the safety of ruling out DVT by integrating PUL with risk stratification in ED routine care.</p><p><strong>Methods: </strong>This observational cohort study was conducted at the Helsingborg Hospital ED, Sweden, from April 2022 to November 2024. Adult patients with suspected DVT underwent PUL combined with risk stratification using the Wells score. Risk stratification, PUL findings, diagnosis and management plan were prospectively recorded. A 30-day follow-up was conducted to identify any subsequent DVT, PE or deaths registered as caused by PE post index visit. Patients prescribed anticoagulation following an ED-diagnosed DVT were followed up at 3 and 6 months to monitor for major bleeding events.</p><p><strong>Results: </strong>A total of 560 patients were evaluated, with an overall DVT prevalence of 18.4%. Of these, 471 patients (82.5%) were managed entirely within the ED, without referral to the diagnostic department. Of the 381 patients discharged from the ED with DVT ruled out (negative PUL and low risk assessment), two were diagnosed with DVT or PE within 30 days. This resulted in a negative predictive value of 99.5% (95% CI: 98-99.9%) and a sensitivity of 97.8% (95% CI: 92.4-99.7%) for PUL combined with low-risk stratification in ruling out DVT. One of the 90 patients diagnosed with DVT in the ED and prescribed anticoagulant therapy experienced a major bleed related to an in-hospital procedure.</p><p><strong>Conclusions: </strong>In this single-center ED study the combination of PUL and risk stratification in routine care was a safe and effective method for the early diagnosis and ruling out DVT. Using this approach, more than 8 out of 10 patients could be diagnosed in the ED without the need for external diagnostic support.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"85"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081508","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":"Acidosis as a promising early indicator of mortality among point-of-care parameters and vital signs in non-traumatic critically ill patients.","authors":"Asen S Georgiev, Tim Filla, Janina Dziegielewski, Katharina Bandmann, Peter Kienbaum, Jörg Distler, Lennert Böhm, Michael Bernhard, Mark Michael","doi":"10.1186/s13049-025-01409-z","DOIUrl":"10.1186/s13049-025-01409-z","url":null,"abstract":"<p><strong>Background: </strong>The management of critically ill patients, arriving at the emergency department (ED), requires structured care in critical care facilities, particularly in the resuscitation room. This study examines the significance of initial vital signs and blood gas analysis (BGA)-derived values as clinically useful early indicators of mortality risk in critically ill patients, both during in the resuscitation room care and within the following 30 days, with a focus on evaluating the individual predictive performance of accessible clinical parameters.</p><p><strong>Methods: </strong>We pooled data from two consecutive retrospective observational studies in a German university ED to analyze an unselected patient population of non-traumatic critically ill patients. Vital signs, such as heart rate, systolic blood pressure, and BGA values (including pH, bicarbonate, carbon dioxide, glucose, lactate, electrolyte levels) on admission to the ED, were used to estimate the impact on both resuscitation room and 30-day mortality.</p><p><strong>Results: </strong>In 1,536 critically ill patients, pH, lactate and bicarbonate were found to be potential predictors of resuscitation room mortality. In contrast, vital signs showed limited reliability in predicting outcomes. Of all tested variables, pH demonstrated the highest area under the curve (AUC) value among the analyzed markers for resuscitation room mortality (AUC 0.81 [95% CI 0.75-0.87]). However, the AUC of pH for 30-day mortality decreased to 0.64 ([0.6 - 0.68], indicating a complex interplay of factors influencing long-term outcome. A subgroup analysis based on pH showed a substantial increase in resuscitation room and 30-day mortality for patients with a pH below 7.2 as well as a second increase below 7.0.</p><p><strong>Conclusion: </strong>Our study highlights important parameters for the assessment of critically ill patients at ED admission that are helpful for formulating immediate medical decisions. Acidosis on the initial BGA appears to be a relevant prognostic marker for mortality in critically ill, non-traumatic patients and may aid in early risk assessment, regardless of the underlying condition. Early detection of acidosis could facilitate rapid decision-making and timely identification of patients requiring intensive care.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"86"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081504","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 \"A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children\".","authors":"Jiajing Wang","doi":"10.1186/s13049-025-01403-5","DOIUrl":"10.1186/s13049-025-01403-5","url":null,"abstract":"<p><p>This comment critiques a trial comparing intranasal dexmedetomidine (DEX) and esketamine (sKET) for pediatric procedural sedation. Despite a large effect size, the small sample (n = 29) likely caused false-negative results (p = 0.09), necessitating larger trials. Safety concerns (e.g., aspiration risk), unaddressed long-term psychological outcomes, and limited pharmacokinetic data (delayed DEX onset, prolonged duration) challenge clinical applicability. Future studies should integrate objective measures and long-term follow-up.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"84"},"PeriodicalIF":3.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040621","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":"Long-term outcomes of out-of-center veno-arterial ECMO cannulation for cardiopulmonary failure: investigation of prognostic parameters for a decision support tool - a 16-year retrospective study.","authors":"Walter Petermichl, Alois Philipp, Maik Foltan, Andrea Stadlbauer, Peter-Paul Ellmauer, Christian Merten, Sebastian Blecha, Thomas Müller, Bernhard Ulm, Bernhard Graf, Dirk Lunz","doi":"10.1186/s13049-025-01401-7","DOIUrl":"10.1186/s13049-025-01401-7","url":null,"abstract":"<p><strong>Background: </strong>Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has served as a crucial intervention for critically ill patients with persistent cardiopulmonary failure. A standardized approach improves VA ECMO outcomes, which is why ECMO is currently limited to specialized centers. However, transferring critically ill patients to these ECMO centers is not without risk. Portable ECMO devices allow implantation in out-of-center settings prior to transportation. Despite efforts to standardize decision-making, significant variability remains, particularly in out-of-center (OoC) settings with limited data. Due to persistently high mortality, accurate indications are needed to optimize outcomes. This study aims to identify key factors associated with favorable outcomes in OoC VA ECMO and to develop practical decision-making tools for clinicians in these settings.</p><p><strong>Methods: </strong>We retrospectively investigated the outcomes of VA ECMO implantation in out-of-center settings between 2006 and 2022 at our institution. Parameters assessed prior to VA ECMO implantation, including organ failure count, mean arterial pressure (MAP), and laboratory data, were analyzed. Follow-up data were collected to evaluate functional (Eastern Cooperative Oncology Group [ECOG] performance status) and neurological (cerebral performance category score [CPC]) (outcomes. Statistical analyses were performed using non-parametric methods and SHAP importance analysis.</p><p><strong>Results: </strong>A total of 56.5% (195 of 345 patients) who underwent VA ECMO implantation in OoC survived, and 43.8% had a favorable neurological outcome (CPC 1). 37.6% of patients had good functional outcomes (ECOG 0-1). Patients with a MAP > 54 mmHg had better long-term functional outcomes, and those with a MAP > 64 mmHg had better mid-term neurological outcomes. Poor outcomes were associated with reduced coagulation activity and increased thrombogenicity. Renal and multi-organ failure prior to VA ECMO implantation were associated with poor neurological and functional outcomes.</p><p><strong>Conclusions: </strong>Through importance analyses, we identified key and secondary factors associated with favorable outcomes in OoC VA ECMO. The extent and severity of organ failure prior to VA ECMO implantation are crucial in determining outcomes. Hemodynamic status, as reflected by MAP, along with organ failure prior to VA-ECMO implantation, significantly influences neurological and functional outcomes. Patients with better hemodynamic stability and coagulation profiles had significantly improved chances of survival with favorable neurological and functional outcomes.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"81"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989562","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":"Association of central capillary refill time with mortality in adult trauma patients: a secondary analysis of the crash-2 randomised controlled trial data.","authors":"Sabrina Jegerlehner, Tim Harris, Martin Mueller, Ben Bloom","doi":"10.1186/s13049-025-01407-1","DOIUrl":"10.1186/s13049-025-01407-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma-related injuries account for up to 4.4 million deaths annually worldwide. Failure to identify haemorrhage in trauma patients increases mortality. This study examines the association of central capillary refill time (CRT) and mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP).</p><p><strong>Methods: </strong>This retrospective observational study analysed data from the CRASH-2 trial, conducted in 274 hospitals across 40 countries and 5 continents between May 2005 and January 2010. A total of 19,054 out of 20,207 adult trauma patients with recorded CRT and complete dataset were included. CRT was taken centrally (sternum) and categorized as ≤ 2, 3-4, and ≥ 5 s. The primary outcome was 28-day mortality, while secondary outcomes included need for transfusion, surgical intervention and thromboembolic events. Univariable and multivariable logistic regression analysis were conducted, incorporating random effects for continent/cluster. Receiver operating characteristic curves were used to assess the discriminatory ability of central CRT measurement.</p><p><strong>Results: </strong>Among the patients, 6,756 (35.5%) had a CRT ≤ 2 s, 9,142 (48%) had a CRT of 3-4 s, and 3,156 (16.6%) had a CRT ≥ 5 s. Compared to the reference category (CRT ≤ 2 s), the odds of death were significantly higher in patients with CRT of 3-4 s (OR 1.7, 95% CI 1.6-1.9) and CRT ≥ 5 s (OR 3.2, 95% CI 2.8-3.5). Higher CRT was also associated with an increased likelihood of blood transfusion, surgical intervention, and thromboembolic events. The AUC values ranged from 0.63 to 0.74 and were consistent with a significant association between the variables.</p><p><strong>Conclusion: </strong>Central CRT is associated with increased mortality and adverse outcomes in trauma patients. In bleeding trauma patients, an increasing central CRT is linked to higher mortality risk, with a central CRT ≥ 5 s being particularly predictive of worse outcomes. This also applies to patients with stable vital signs (normal HR and BP), suggesting that CRT may offer additional value as an indicator of hidden hypoperfusion.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"82"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994254","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":"EMCC dispatch priority for trauma patients in Norway: a retrospective cohort study.","authors":"Inger Marie Waal Nilsbakken, Torben Wisborg, Stephen Sollid, Elisabeth Jeppesen","doi":"10.1186/s13049-025-01387-2","DOIUrl":"10.1186/s13049-025-01387-2","url":null,"abstract":"<p><strong>Background: </strong>Dispatch priority assessments in emergency medical communication centres (EMCC) play a crucial role in determining how quickly emergency medical services reach the scene after an injury. Consequently, accurate prioritization of resources is important in ensuring that patients requiring specialized care receive timely treatment to optimize their outcome. Both dispatch under-triage, where patients with severe injuries receive low priority, and dispatch over-triage, which unnecessarily allocates limited emergency resources, can impact patient outcomes and system efficiency. This study aimed to assess dispatch priority in the EMCC for a cohort of trauma patients in Norway.</p><p><strong>Methods: </strong>This registry-based study included 3633 patients from the Norwegian Trauma Registry and Oslo EMCC during 2019-2020. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative rate (dispatch under-triage rate), false positive rate (dispatch over-triage rate), and accuracy of dispatch priority. The New Injury Severity Score (NISS) > 15 was used as a reference standard. Differences in dispatch priority assessments were analysed using descriptive statistics. Two logistic regression models were used to examine the relationship between dispatch priority and factors associated with the assessment.</p><p><strong>Results: </strong>Our analysis revealed the following dispatch metrics: sensitivity (85%), specificity (11%), PPV (38%), NPV (53%), dispatch under-triage rate (15%), dispatch over-triage rate (89%), and overall accuracy (40%). Under-triaged dispatches frequently involved elderly trauma patients (53%) and patients with low-energy falls (51%). Elderly trauma patients had more than 7 times the odds of receiving inappropriately low dispatch priority compared to children and nearly twice the odds compared to adults, after accounting for factors such as injury mechanism. Similarly, female patients had 81% higher odds of receiving inappropriately low dispatch priority compared to male patients, when controlling for factors like age and injury mechanism. Among over-triaged dispatches, transport-related injuries accounted for half of the cases (50%).</p><p><strong>Conclusion: </strong>This study primarily evaluated the national trauma system's dispatch priority criteria. Our findings indicate that elderly trauma patients, those with low-energy falls and female patients were often assigned inadequate priority by current criteria, indicating a need to reassess the current criteria to better address these patients' needs. Additionally, we found that patients involved in transport-related accidents were overrepresented among over-triaged dispatches, highlighting a potential misallocation of resources.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"83"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036407","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}