Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Trauma center vs. nearest non-trauma center: direct transport or bypass approach for out-of-hospital traumatic cardiac arrest.","authors":"Ming-Fang Wang, Chen-Bin Chen, Chip-Jin Ng, Wei-Chen Chen, Shang-Li Tsai, Chien-Hsiung Huang, Chi-Yuan Chang, Li-Heng Tsai, Chi-Chun Lin, Cheng-Yu Chien","doi":"10.1186/s13049-025-01335-0","DOIUrl":"10.1186/s13049-025-01335-0","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital traumatic cardiac arrest (TCA), a sudden loss of heart function caused by severe trauma such as blunt, penetrating, or other injuries, presents significant public health challenges due to its high severity and extremely low survival rates. Approximately 2.7% of trauma patients experience cardiac arrest at the scene, with an overall survival rate of less than 5%. The correlations of prognosis with various transport approach, such as hospital level with different distance, are yet to be clarified. Thus, we conducted this study to assess the association of transporting TCA patients to hospitals of different levels and distances on critical outcomes, including the return of spontaneous circulation (ROSC), survival to admission, and 30-day survival.</p><p><strong>Methods: </strong>This retrospective study included adults with TCA who were admitted to various emergency departments in Taoyuan City between January 2016 and December 2022. The patients were stratified by destination hospital into three groups: those transported to a trauma center (TC; TC group), those transported to the nearest non-TC (non-TC group), and those cross-regionally transported to a TC (cross-region TC group). Geographic information system (GIS) data were utilized to determine hospital locations and distances. The associations between various factors and key outcomes-any return of spontaneous circulation (ROSC), survival to admission, 24-h survival and 30-day survival-were analyzed. Multivariable logistic regression was used to determine the association of these outcomes based on transportation to hospitals of different levels.</p><p><strong>Results: </strong>This study included 557 patients with TCA (TC: 190 [direct transport: 72; cross-region transport: 118]; non-TC: 367). The TC and cross-region TC groups demonstrated significantly higher rates of ROSC at 30.6% and 30.5%, respectively, as well as lower mortality rates (95.8% for both), compared to the non-TC group, which had a ROSC rate of 12.0% and a mortality rate of 99.5%. Multivariable analysis revealed significant associations between favorable outcomes and transportation to a trauma center, either directly (aOR 2.91, 95% CI 1.54-5.49) or via cross-region transfer (aOR 2.05, 95% CI 1.01-4.15). Furthermore, blunt trauma was significantly associated with a poorer survival prognosis (aOR 0.31, 95% CI 0.08-0.78).</p><p><strong>Discussion: </strong>This study highlights the positive associations of direct or cross-region transportation to a TC on the outcomes of TCA. Our findings challenge the current EMT transport approach in Taiwan, which prioritizes transporting TCA patients to the nearest hospital regardless of its level, potentially leading to worse outcomes. Transport time and TC distance may not significantly influence prognosis.</p><p><strong>Conclusion: </strong>Bypassing and directly transporting to a TC within the observed (10 km) distances are associated with better ","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"29"},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400486","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":"Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study.","authors":"Nicolò Capsoni, Giovanni Carpani, Francesca Tarantino, Silvia Gheda, Jean Marc Cugnod, Sabrina Lanfranchi, Jhe Lee, Simone Lizza, Sara Marchesani, Enrica Meloni, Annalisa Rigamonti, Irene Serrai, Silvia Vergani, Elisa Ginevra Zuddio, Bruno Gherardo Zumbo, Daniele Privitera, Francesco Salinaro, Davide Bernasconi, Gianmarco Secco, Filippo Galbiati, Stefano Perlini, Michele Bombelli","doi":"10.1186/s13049-025-01337-y","DOIUrl":"10.1186/s13049-025-01337-y","url":null,"abstract":"<p><strong>Background: </strong>Anticoagulated patients with mild traumatic brain injury (mTBI) and a negative cerebral CT on admission, commonly undergo a repeated CT scan after observation in the emergency department (ED) to detect delayed intracranial hemorrhage (ICH). However, the utility of this practice is controversial, with recent evidence suggesting that the risk of delayed ICH in these patients is low. This study aims to evaluate incidence, outcomes, and risk factors of delayed ICH in patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) presenting to the ED with mTBI.</p><p><strong>Methods: </strong>A multicenter, observational, retrospective cohort study was conducted in the EDs of three hospitals in Northern Italy, from January 2017 to December 2021. All consecutive adult patients on DOACs or VKAs therapy, admitted for a mTBI, who underwent a second CT scan after 12-24 h from a negative first one, were enrolled.</p><p><strong>Results: </strong>A total of 1596 anticoagulated patients were enrolled, 869 (54%) on DOACs and 727 (46%) on VKAs therapy. The median age was 84 [79-88] and 56% of patients were females. The incidence of delayed ICH was 1.8% (95% CI: 1.1-3.0%; 14/869 patients) for DOACs, and 2.6% (95% CI: 1.6-4.1%; 19/727 patients) for VKAs patients, with no cases requiring neurosurgical intervention. Vomiting after head injury and the onset of new symptoms during observation were associated with a higher risk of delayed bleeding (OR 4.8; 95% CI: 1.4-16.5, and OR 4.7; 95% CI 1.2-23.7, respectively). At a 30-day follow-up, 2% of patients had a new ED admission related to their previous mTBI, with no significant difference between the groups.</p><p><strong>Conclusions: </strong>Delayed ICH is uncommon among anticoagulated patients with mTBI and has minimal impact on their outcome. Routine performance of a second CT scan may be unnecessary and may be considered only in presence of high-risk clinical risk factors or signs of deterioration.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"26"},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392192","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":"Prognostic accuracy of point-of-care ultrasound in patients with pulseless electrical activity: a systematic review and meta-analysis.","authors":"Shang-Jun Zhang Jian, Tzu-Heng Cheng, Chieh-Ching Yen","doi":"10.1186/s13049-025-01327-0","DOIUrl":"10.1186/s13049-025-01327-0","url":null,"abstract":"<p><strong>Background: </strong>The prognosis for pulseless electrical activity (PEA) is typically poor; however, patients with cardiac activity observed on point-of-care ultrasound (POCUS) tend to have better outcomes compared to those without. This systematic review and meta-analysis were conducted to assess the prognostic accuracy of cardiac activity detected by POCUS in predicting resuscitation outcomes in patients experiencing PEA.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify relevant studies. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio, and the area under the summary receiver operating characteristic curve (SROC) were calculated using the bivariate model.</p><p><strong>Results: </strong>Eighteen studies comprising 1202 patients were included in the meta-analysis. Cardiac activity observed on POCUS demonstrated a pooled sensitivity of 0.86 (95% CI 0.67-0.95) and specificity of 0.64 (95% CI 0.51-0.75) for predicting return of spontaneous circulation, a pooled sensitivity of 0.89 (95% CI 0.80-0.94) and specificity of 0.73 (95% CI 0.63-0.81) for survival to admission (SHA), and a pooled sensitivity of 0.79 (95% CI 0.58-0.91) and specificity of 0.58 (95% CI 0.47-0.68) for survival to discharge. The highest area under the SROC, 0.89 (95% CI 0.86-0.92), was observed for SHA.</p><p><strong>Conclusions: </strong>Our study suggests that POCUS may serve as a vital component of a multimodal approach for early termination of resuscitation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"27"},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392228","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":"Impact of a POCUS-first versus CT-first approach on emergency department length of stay and time to surgical consultation in patients with acute cholecystitis: a retrospective study.","authors":"Chien-Tai Huang, Liang-Wei Wang, Shao-Yung Lin, Tai-Yuan Chen, Yi-Ju Ho, Pei-Hsiu Wang, Kao-Lang Liu, Yao-Ming Wu, Hsiu-Po Wang, Wan-Ching Lien","doi":"10.1186/s13049-025-01341-2","DOIUrl":"10.1186/s13049-025-01341-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the impact of point-of-care ultrasound (PoCUS) and computed tomography (CT) on emergency department (ED) length of stay (LOS) and time to surgical consultation in patients with mild acute cholecystitis (AC).</p><p><strong>Methods: </strong>Adult patients with CT-confirmed grade I AC were retrospectively enrolled and divided into the PoCUS-first group and the CT-first group. The primary outcome was the relationship between the door-to-ultrasound (US)/CT time and ED-LOS. The secondary outcome was the relationship between the door-to-US/CT time and time to surgical consultation.</p><p><strong>Results: </strong>A total of 1627 patients were included with 264 in the PoCUS first group. In the PoCUS group, door-to-US time was positively associated with ED-LOS (β = 0.27, p < 0.001) and time to surgical consultation (β = 0.36, p < 0.001). Similarly, door-to-CT time was also positively associated with ED-LOS (β = 0.21, p < 0.001) and time to surgical consultation (β = 0.75, p < 0.001) in the CT group. Conducting PoCUS within 60 min was associated with a reduced ED-LOS and time to surgical consultation, resulting in a saving of 22.4 h and 266 min, respectively. In the CT group, performing CT within 120 min was associated with a reduced ED-LOS and time to surgical consultation, resulting in a decrease of 12 h and 188 min, respectively. The ED-LOS and time to surgical consultation were similar between patients receiving PoCUS within 60 min in PoCUS group and those receiving CT within 120 min in the CT group.</p><p><strong>Conclusions: </strong>Performing PoCUS within 60 min or CT within 120 min was associated with shorter ED-LOS and earlier surgical consultation, enhancing the ED efficiency in patients with mild AC.</p><p><strong>Trial registration: </strong>NCT04149041 at ClinicalTrial.gov.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"28"},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391990","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":"Balloon occlusion of the aorta during cardiac arrest -a death blow to the intestines?","authors":"Bjørn Hoftun Farbu, Jostein Brede","doi":"10.1186/s13049-025-01321-6","DOIUrl":"10.1186/s13049-025-01321-6","url":null,"abstract":"<p><strong>Background: </strong>The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in non-traumatic cardiac arrest may result in worsened intestinal ischaemia. What are the consequences?</p><p><strong>Main text: </strong>Human data on REBOA in non-traumatic cardiac arrest is limited. In general, cardiac output is reduced during resuscitation, and mesenteric blood flow may be further reduced by intravenous adrenaline (epinephrine). Balloon occlusion of the thoracic aorta will potentially lead to a complete cessation of intestinal blood flow. Experimental studies demonstrate that intestinal damage increases with REBOA inflation time, and that 45-60 min of ischaemia may result in irreversible damage. However, it is unclear when intestinal ischaemia starts to affect patient-oriented outcomes. A barrier for assessing the consequences of intestinal ischemia is that it is a challenge to diagnose. A biomarker for intestinal injury, Intestinal Fatty Acid Binding Protein (IFABP), was elevated in all cardiac arrest patients and had a striking association with mortality in one study. In another study, all patients with intestinal ischemia diagnosed on CT died. However, intestinal ischemia could be a marker of whole-body ischemia and not an independent contributor to poor outcome. The clinical importance of worsened intestinal ischemia by REBOA during cardiac arrest is not established.</p><p><strong>Conclusion: </strong>The impact of intestinal ischaemia following cardiac arrest is uncertain, but ischaemia is likely to be exacerbated by REBOA. However, inflation of the balloon will occur when the patient is still in cardiac arrest and is a means to achieve ROSC. Hence, we argue that the added intestinal ischaemia caused by REBOA may be of limited clinical importance, but this is still to be answered.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"24"},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366390","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":"ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury.","authors":"Olivia Kiwanuka, Philipp Lassarén, Alexander Fletcher-Sandersjöö, Charles Tatter, Jonathan Tjerkaski, David W Nelson, Eric P Thelin","doi":"10.1186/s13049-025-01338-x","DOIUrl":"10.1186/s13049-025-01338-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate whether incorporating pre-injury health status, measured by the American Society of Anesthesiologists (ASA) score, improves outcome prediction models for moderate-to-severe traumatic brain injury (msTBI) patients.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study of msTBI patients (2005-2021). The primary outcome was 1-year Glasgow Outcome Scale (GOS, dichotomized as GOS1-3 (unfavorable) vs. 4-5 (favorable)), and secondary outcome was 90-day mortality. Logistic regression evaluated the contribution of ASA score to the International Mission for Prognosis and Clinical Trials in Traumatic Brain Injury (IMPACT) core + CT outcome prediction model incorporating age, admission GCS, pupillary reactivity, Marshall CT classification, hypoxia, hypotension, epidural hematoma, and subarachnoid hemorrhage.</p><p><strong>Results: </strong>Among the 720 adult patients that were included 51% had an unfavorable GOS at 1 year. The 90-day mortality was 19%. ASA score and TRISS were independently associated with both outcomes (p < 0.001). Incorporating the ASA score to our IMPACT model significantly enhanced its explanatory value of dichotomized GOS (35% vs. 32% variance explained, p < 0.001) and improved the model's prognostic accuracy.</p><p><strong>Conclusion: </strong>In this retrospective single-center cohort study, we found that ASA score improves existing prognostic models for msTBI. Incorporating this simple comorbidity measure could enhance outcome prediction and support more personalized acute management. Future prospective studies are needed to validate these results.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"25"},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366380","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":"Pain assessment and management of adult patients in the Swedish EMS: a nationwide registry study.","authors":"Glenn Larsson, Pär Wennberg, Kristoffer Wibring","doi":"10.1186/s13049-025-01333-2","DOIUrl":"10.1186/s13049-025-01333-2","url":null,"abstract":"<p><strong>Background: </strong>Pain is a frequent reason for contacting the Emergency Medical Services (EMS), and effective pain management constitutes one of its cornerstones. The aims of this study have been: (a) to describe the prevalence of pain intensity ratings in EMS care of patients with pain-related conditions; (b) to describe pain treatment in the EMS setting in terms of drugs administered and the proportion of patients receiving analgesics and (c) to investigate the relationship between patients' self-reported pain intensity and vital signs.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study using data from 394,700 EMS missions conducted 2021 and 2022, as recorded in the Swedish Ambulance Registry. The study focused on patients who contacted the EMS due to pain, trauma, or injury. Pain intensity was recorded using the Numeric Rating Scale (NRS). NRS scores of 5-10 were considered as high-level pain and NRS ≤ 4 as low-level. Descriptive statistics were used to present categorical and continuous variables. Chi-square tests were applied for dichotomous variables, while Kruskal-Wallis tests were used for ordinal data. Logistic regression analysis was carried out to identify factors associated with pain intensity and analgesic treatment. p value < 0.001 was considered statistically significant.</p><p><strong>Results: </strong>Pain intensity was recorded in 23.6% of cases. Most patients rated their pain as high-level (NRS 5-10, 57.4% of those assessed). Analgesics were administered in 27.5% of cases, with higher administration rates observed when pain intensity was documented. Female sex, higher breathing rates, and higher systolic blood pressure were associated with higher pain intensity, while increasing age was associated with lower odds of reporting high-level pain intensity. No significant association was found between heart rate and pain intensity.</p><p><strong>Conclusion: </strong>This 2-year cohort study highlights significant deficiencies in recorded pain assessment and management in the Swedish EMS. Only 22.5% of the patients had their pain assessed with a validated scale, while 27.5% received analgesics, although pain-related conditions were a common reason for contacting the EMS. The findings indicate a lack of systematic pain assessment which puts many patients at risk of insufficient pain relief.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"22"},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255988","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":"The use of strong analgesics for prehospital pain management in children in the region of Southern Denmark: a register-based study.","authors":"Josefine Tvede Colding-Jørgensen, Gina Maj Graven Brandstrup, Vibe Maria Laden Nielsen, Josefine Gradman, Line Anker Bang Thybo, Peter Martin Hansen, Daniel Wittrock, Stig Nikolaj Fasmer Blomberg, Helle Collatz Christensen, Søren Mikkelsen","doi":"10.1186/s13049-025-01339-w","DOIUrl":"10.1186/s13049-025-01339-w","url":null,"abstract":"<p><strong>Background: </strong>Acute pain in the prehospital setting is frequent and prehospital pain management presents multiple challenges, especially in children. There is a lack of high-level evidence regarding prehospital pain management in the paediatric population worldwide. In Denmark, this lack of evidence particularly concerns the frequency of the prehospital use of strong analgesics. Guidelines are sparse but there is evidence that prehospital fentanyl may be administered up to 5 µg/kg.</p><p><strong>Method: </strong>This register-based study investigated the prehospital analgesic treatment in the population under 15 years from January 2017 to December 2022 in the Region of Southern Denmark. Data were extracted from electronic prehospital medical records. The analgesic treatment was characterised by the type of medication, dosage, administration method, and cause of ambulance dispatch. Lastly, response- and transport times were registered.</p><p><strong>Results: </strong>A total of 28,933 prehospital paediatric medical records were examined. In one in seventeen of all prehospital contacts with children, fentanyl, alfentanil, morphine and/or s-ketamine was administered. Three-quarters of the doses of strong analgesics were administered to patients older than 10 years. Fentanyl was the most frequently administered medication (96.4%). The median fentanyl-equipotent doses of opioids were 1.7 µg/kg adjusted according to standardised patient weight. In 63.4% of cases, the analgesic treatment was administered intravenously.</p><p><strong>Conclusion: </strong>The doses of opioids as administered by the EMS personnel seem safe as 97% of the doses were within the recommended range and even at the lower end of the recommended range. Although apparently safe, the utilisation of strong analgesics points to a risk of under-treating pain in children.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"23"},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256169","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":"Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service.","authors":"Salman Naeem, Shadman Aziz, Thomas Hirst, Johannes Strobel, Jamin M Mulvey, Ailidh Lang, Jankee Patel, Alexander Smith, Ka Jun Cheng, Michael Palmer, Jonas Schlautmann, Michael D Christian, Daniel Nevin","doi":"10.1186/s13049-025-01340-3","DOIUrl":"10.1186/s13049-025-01340-3","url":null,"abstract":"<p><strong>Background: </strong>There has been increased use of prehospital point-of-care ultrasound (PoCUS) by helicopter emergency medical services (HEMS) in recent years. Lack of governance structure and evidence of benefit have been described as major barriers to its implementation. This paper describes a novel approach to implementation of prehospital PoCUS and clinical governance framework in a UK HEMS.</p><p><strong>Methods: </strong>A retrospective database review was undertaken at London's Air Ambulance (LAA) from 1st September 2021 to 31st March 2023. All patients who had PoCUS examination were included. Scans were archived in a cloud-based server and reviewed weekly by expert clinicians. They were graded in adequacy, agreement between reviewer and clinician was recorded and fed back to the clinicians allowing continuous feedback learning. In-hospital diagnosis was sought for patients having the full Pump, Pleura and Pouring blood (PPPB) protocol. Cohen's Kappa (ƙ) was calculated for inter-rater reliability. Sensitivity and specificity analysis was performed using 2 × 2 tables.</p><p><strong>Results: </strong>LAA attended 3,068 missions. Our reviewers identified 701 PoCUS scanning encounters and 628 were included in the final analysis. Clinicians performed 420 scans for pneumothorax, 308 for free fluid and 305 pericardial effusions respectively. Majority of the population were male (85%) who sustained traumatic (93.5%) thoracic injuries (65%). Paramedics performed 29% of the scans. Reviewers deemed 83% of the scans of adequate quality. Inter-rater reliability between clinicians and reviewers was 0.6 for pericardial effusion, 0.67 for pneumothorax and 0.71 for free fluid respectively. A full PPPB protocol was performed in 52 patients out of which 46 were included. The sensitivity and specificity of PPPB protocol for diagnosis life-threatening injuries was 0.5 and 0.9 respectively.</p><p><strong>Conclusion: </strong>Introduction of prehospital PoCUS in a HEM service utilizing high quality training, user-friendly workflow and image archiving system, robust governance framework and continuous feedback may be feasible allowing high quality ultrasound examinations. The bespoke PPPB protocol in prehospital may improve diagnosis of life-threatening injuries.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"21"},"PeriodicalIF":3.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191115","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":"Prothrombin complex concentrate for reversal of oral anticoagulants in patients with oral anticoagulation-related critical bleeding: a systematic review of randomised clinical trials.","authors":"Christian Ovesen, Jan Purrucker, Josefine Grundtvig, Theis Bech Mikkelsen, Christian Gluud, Janus Christian Jakobsen, Hanne Christensen, Thorsten Steiner","doi":"10.1186/s13049-025-01334-1","DOIUrl":"10.1186/s13049-025-01334-1","url":null,"abstract":"<p><strong>Background: </strong>Swift reversal of oral anticoagulation is deemed essential for the outcome of patients with anticoagulation-related critical bleeding. The aim of this systematic review was to evaluate the benefits and harms of prothrombin complex concentrate (PCC) in patients with oral anticoagulants-related critical bleeding.</p><p><strong>Methods: </strong>For this systematic review CENTRAL, MEDLINE, Embase, LILACS, BIOSIS, Web of Science, and clinical trial registries were systematically searched. Clinical study reports were also requested from competent authorities. Eligible for inclusion were randomised clinical trials comparing PCC versus no intervention, placebo, or other reversal interventions in participants with critical bleeding related to ongoing treatment with vitamin K antagonist (VKA) or direct oral anticoagulants (DOAC). Pre-specified primary outcomes were all-cause mortality, health-related quality of life, and serious adverse events for which meta-analyses, Trial Sequential Analysis, and GRADE assessments were conducted.</p><p><strong>Results: </strong>Three trials, randomising a total of 291 participants, evaluated PCC against two different active comparators in participants with VKA-related critical bleeding, and two trials, randomising a total of 534 participants, evaluated PCC against two different active comparators in participants with factor Xa-related critical bleeding. Among participants with VKA-related critical bleeding, meta-analyses showed no evidence of a difference between PCC versus fresh frozen plasma (FFP) when assessing all-cause mortality (risk ratio [RR] 1.05; 95% confidence interval (CI) 0.27 to 4.05; low certainty), health-related quality of life (mean difference 1.04; 95% CI - 0.94 to 3.02; very low certainty), and serious adverse events (RR 1.33; 95% CI 0.94 to 1.88; very low certainty), but information is currently sparse. Among participants with factor Xa-related critical bleeding, PCC could not be shown superior or inferior to other reversal strategies (FFP or andexanet alfa) on any patient-relevant outcome, but information is currently sparse.</p><p><strong>Conclusion: </strong>Among participants with VKA or DOAC-related critical bleeding, evidence from randomised clinical trials is currently insufficient to establish if PCC is superior or inferior versus other interventions in decreasing the risk of undesirable patient-relevant outcomes or improving health-related quality of life.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"19"},"PeriodicalIF":3.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191117","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}