Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Optimising the care of the trapped patient following a motor vehicle collision: A UK-Based Delphi consensus study.","authors":"Tim Nutbeam, Rob Fenwick, Ian Marritt, Brian Lee, Luke Staveley-Wadham, Nigel Lang, Louise Johnson, Nicolas Mattock, Jane Ogilvie, Emily Foote, Francis Screech, Lara Lebeau-Humarau, Caroline Leech","doi":"10.1186/s13049-025-01449-5","DOIUrl":"10.1186/s13049-025-01449-5","url":null,"abstract":"<p><strong>Background: </strong>Motor vehicle collisions (MVCs) are a leading cause of injury and death worldwide. Up to 40% of casualties may become trapped and entrapment is associated with delayed care and worse outcomes. There is little national or international consensus guiding the care of physically trapped patients who cannot self-extricate. This study aimed to develop multidisciplinary consensus-based principles to optimise clinical and operational care for trapped patients following MVC.</p><p><strong>Methods: </strong>A three-round Delphi study was conducted from January to March 2025, following the CREDES framework. A multi-professional steering group developed preliminary statements informed by literature review and expert consultation. Subject matter experts (SMEs) with operational experience in extrication, prehospital, and trauma care were recruited through stakeholder organisations. Statements were refined iteratively through SME feedback. Consensus was defined as ≥ 70% agreement or disagreement. Statements reaching consensus were removed from subsequent rounds; others were revised based on free-text feedback.</p><p><strong>Results: </strong>Sixty-six SMEs participated, with high engagement across all three rounds. Consensus was achieved for 104 statements covering standardised extrication terminology, prioritisation of time-sensitive extrication for critically injured patients, minimisation of unnecessary on-scene interventions, emphasis on early psychological support for trapped casualties, and the importance of interdisciplinary communication and coordination. The consensus supports a paradigm shift towards rapid, patient-centred extrication, balancing clinical needs, operational realities, and psychological welfare.</p><p><strong>Conclusions: </strong>This Delphi study establishes expert-endorsed principles for the care of physically trapped patients following MVCs. Adoption of these principles could reduce delays, strengthen multi-agency response and improve patient outcomes. Further work is required to validate the impact of these recommendations on clinical outcomes and to support their integration into practice through policy development, training, and evaluation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"137"},"PeriodicalIF":3.1,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823034","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":"Immediate post-ECPR management strategies in the prehospital and critical care transport medicine environments.","authors":"Ella Purington, Christopher R Shaw, Erica Berglund, Bronwyn Finney, Jeffrey Dellavolpe, Mark Dennis, Dinis Reis Miranda, Alice Hutin, Andrea M Elliott, Jason A Bartos, Cindy H Hsu, Brittney Bernardoni, Michael J Lauria, Adam L Gottula","doi":"10.1186/s13049-025-01448-6","DOIUrl":"10.1186/s13049-025-01448-6","url":null,"abstract":"<p><p>Despite advancements in care, out-of-hospital cardiac arrest has a low survival rate. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown improved outcomes in select cases, notably in the ARREST trial. However, ECPR is resource-intensive and limited to specialized centers, restricting access in many regions. Estimates suggest only 2-10% of out-of-hospital cardiac arrest patients are ECPR candidates. Advanced systems initiating ECPR in prehospital environments or non-ECMO-capable centers have shown promise. As ECPR utilization increases, so does the need for transport to ECMO-capable centers. Unlike conventional out-of-hospital cardiac arrest care, high-quality evidence for post-resuscitation management of ECPR patients is lacking. This review provides suggestions for the immediate post-resuscitation management (4-6 h) of ECPR patients in prehospital settings, the critical care transport medicine environment, and at non-ECMO-capable centers. Goals include treating the precipitating cause of cardiac arrest, maintaining end-organ perfusion, optimizing oxygen delivery, promoting myocardial recovery, and preventing complications associated with V-A ECMO. Continued research is needed to establish evidence-based protocols that ensure the safe and effective management of ECPR patients.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"135"},"PeriodicalIF":3.1,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800738","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":"Blood transfusion training for prehospital providers: a scoping review.","authors":"Pierre-Marc Dion, Kanwal Singh, Jillian Coleby, Andrew Beckett, Jacinthe Lampron, Melissa McGowan, Risa Shorr, Brodie Nolan","doi":"10.1186/s13049-025-01440-0","DOIUrl":"10.1186/s13049-025-01440-0","url":null,"abstract":"<p><strong>Background: </strong>Blood transfusion is increasingly utilised to manage haemorrhagic shock in prehospital environments. This practice is particularly relevant in settings where delays to definitive treatment are common due to extended evacuation timelines, limited resupply, and challenging environmental conditions. Safe and effective transfusion in these contexts depends on competent, well-prepared providers. Non-physician personnel may be required to perform transfusions independently in high-stakes situations without direct physician supervision. This scoping review synthesizes current literature on blood transfusion training for prehospital providers, with a focus on instructional design, simulation modalities, knowledge retention, and outcome evaluation.</p><p><strong>Methods: </strong>We conducted a scoping review following Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR framework. Seven databases were systematically searched through 20 February 2025. Eligible studies described transfusion training for non-physician healthcare providers in prehospital or austere environments. Data were extracted on instructional strategies, simulation modalities, and outcome measures. Outcomes were categorised using the Kirkpatrick Model, and instructional design features mapped to simulation-based education frameworks.</p><p><strong>Results: </strong>Six studies involving 475 participants were included. Participants included combat medics, paramedics, registered nurses, physician assistants, and medical students. Training was delivered across environments including simulation centres, field-based exercises, and in-theatre deployments. All studies featured face-to-face instruction and hands-on skills training. Simulation modalities included part-task trainers in four studies, high-fidelity mannequins in two, live human models in two, and real-world transfusions in one. Instructional design features such as team-based learning, repeated practice, and structured feedback were reported in most studies. Outcomes were reported across all four Kirkpatrick levels. Four studies assessed learner satisfaction and confidence (Level 1), five evaluated knowledge and procedural skill acquisition (Level 2), three assessed behavioural change in practice (Level 3), and one reported patient-level outcomes during operational missions (Level 4). None assessed long-term retention. Variability in instructional methods and limited evaluation at higher outcome levels constrained generalizability.</p><p><strong>Conclusions: </strong>Blood transfusion training for prehospital providers appears feasible and associated with short-term improvements in knowledge, skills, and confidence. However, inconsistent instructional design and limited evaluation of long-term or clinical outcomes indicate important gaps. Structured, simulation-informed programs aligned with operational needs may improve training consistency and effectiveness.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"134"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762094","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":"Pre-hospital blood product transfusion and calcium management in the United Kingdom: a multicentre service evaluation.","authors":"Anna Forbes, Chris Simpson, Jo Griggs, Jack Barrett, Richard Lyon, Caroline Leech","doi":"10.1186/s13049-025-01446-8","DOIUrl":"10.1186/s13049-025-01446-8","url":null,"abstract":"<p><strong>Background: </strong>Hypocalcaemia and hypercalcaemia are associated with increased morbidity and mortality in trauma patients. Although in-hospital calcium replacement protocols target normocalcaemia, UK pre-hospital services lack standardised calcium monitoring capabilities and demonstrate significant variation in calcium supplementation. No evidence-based guidelines exist for pre- and early in-hospital calcium administration in patients receiving blood product transfusion. This study characterises current UK pre-hospital calcium management in patients requiring blood transfusion prior to ionised calcium (iCa) measurement.</p><p><strong>Methods: </strong>A multicentre pre-hospital service evaluation across five UK Helicopter Emergency Medicine Services (HEMS) from February to April 2024, including all adult trauma patients receiving pre-hospital blood transfusions. Data collected included baseline demographics, pre- and in-hospital blood products transfused, calcium dose and calcium measurement in the Emergency Department. The primary outcome was iCa on initial blood gas measurement.</p><p><strong>Results: </strong>Fifty-eight patients were included, stratified by calcium levels on hospital arrival: 25 (43.1%) hypocalcaemic, 20 (34.5%) normocalcaemic, and 13 (22.4%) were hypercalcaemic. Most patients were male (84%) sustained blunt trauma (76%) and the overall median iCa was 1.14 mmol/L on first blood gas analysis. Pre-hospital calcium was given to 57%, with hypercalcaemic patients more likely to receive replacement. Normocalcaemic patients received fewer blood products overall. Increasing blood product administration was associated with lower calcium levels, especially in those not receiving pre-hospital calcium.</p><p><strong>Conclusion: </strong>Hypocalcaemia and hypercalcaemia were common. Calcium replacement protocols may under- or overtreat due to diverse injury patterns and baseline patient factors. Pre-hospital point-of-care testing (POCT) for iCa could help tailor treatment, especially in cases with longer times between injury and arrival at hospital. We demonstrate the feasibility of collecting comprehensive pre- and in-hospital data across multiple HEMS services to better inform future guidelines in patients with traumatic haemorrhage.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"133"},"PeriodicalIF":3.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734926","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":"Use of the HOPE score to assess survival outcome of hypothermic cardiac arrest selected by ECLS rewarming.","authors":"Nicolas Hall, Jessika Métrailler-Mermoud, Valentin Rousson, Chloé Conforti, Amélie Dupasquier, Pierre-Nicolas Carron, Silke Grabherr, Bettina Schrag, Matthias Kirsch, Cheyenne Falat, Dominique Delay, Vincent Frochaux, Mathieu Pasquier","doi":"10.1186/s13049-025-01445-9","DOIUrl":"10.1186/s13049-025-01445-9","url":null,"abstract":"<p><strong>Background: </strong>We studied adult hypothermic cardiac arrest (CA) patients admitted to a University Hospital (UH) and a Regional Hospital (RH) for whom Extracorporeal Life Support (ECLS) was implemented. We used the HOPE score to estimate individual survival probabilities and to compare overall results between hospitals.</p><p><strong>Methods: </strong>We included hypothermic CA patients who underwent ECLS between 2000 and 2022. We assessed the predicted survival probabilities by calculating the HOPE scores, both at individual and hospital levels. We assessed the performance of a HOPE score cutoff of 10% in predicting survival to hospital discharge, as ECLS rewarming is currently recommended when the HOPE is ≥ 10%. We also assessed the utility of the HOPE score in evaluating and comparing patient management within and between two hospitals.</p><p><strong>Results: </strong>In the 46 patients with successful ECLS implementation, a HOPE score < 10% would have contraindicated and therefore prevented futile ECLS rewarming procedures for 17 patients (37%) who did not survive, while finding that ECLS was indicated for 100% of survivors. The observed survival rate was 24% (UH: 35%, RH: 11%) whereas the HOPE score predicted a survival rate of 35% (UH: 41%, RH: 26%), suggesting underperformance of ECLS rewarming among both hospitals. The difference of survival between the two hospitals was not statistically significant.</p><p><strong>Conclusions: </strong>This study confirmed the utility of the HOPE score in estimating individual survival probabilities. The HOPE score may also be used to estimate the overall survival rate in a patient cohort, enabling internal quality-control and outcome results comparisons between different settings.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"132"},"PeriodicalIF":3.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734927","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":"Interleukin-6 and its association with outcome in traumatic brain injury: a prospective cohort.","authors":"Eder Cáceres, Afshin A Divani, Juan Olivella-Gomez, Mario Di Napoli, Luis F Reyes","doi":"10.1186/s13049-025-01430-2","DOIUrl":"10.1186/s13049-025-01430-2","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) continues to be a major cause of death and disability worldwide. Biomarkers for treatment and prognostication are needed for counseling and clinical management.</p><p><strong>Objective: </strong>In this study, we evaluated the ability of serum IL-6 to predict mortality and disability in a population whith moderate and severe TBI (msTBI).</p><p><strong>Methods: </strong>Adult patients with msTBI were included consecutively from December 2019 to August 2023. Clinical data were collected during hospital stays and functional outcome was established at 6 months using GOSE. Serum IL-6 levels were measured on day 0, day 3 and day 7 after injury.</p><p><strong>Results: </strong>Eighty-eight patients were recruited and completed 6-month follow-up. Clinical variables associated with the 6-month adverse outcome were admission GCS (OR 0.77 95% CI 0.67-0.87, p < 0.001), age (OR 1.10 95% CI 1.03-1.1, p = 0.001), Rotterdam score (OR 2.8 95% CI 1.7-5.0, p < 0.001), hospital infections (OR 4.7 95% CI 1.9-12.1, p < 0.001) and day-0 IL-6 (OR 1.1 95% CI 1.08-1.13, p < 0.001). When adjusted for age, severity of injury,and the presence of a hospital infection, day-0 IL-6 was significantly associated with the adverse outcome at 6 months (OR 1.15 95% CI 1.1-1.2, p = 0.031). Area under the curve (AUC) of 89% (95% CI 82%-96%). Calculated sensitivity and specificity were 75% and 89%, respectively, at a cut-off point of 59 pg/ml.</p><p><strong>Conclusion: </strong>In a population of msTBI, levels of serum interleukin-6 within the first 24 h after injury is an independent predictor of 6-month mortality and disability with a net benefit in clinical decision-making across relevant threshold probabilities.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"131"},"PeriodicalIF":3.1,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718961","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":"Bleeding resuscitation in the ambulance service, an observational study of standard care in Sweden.","authors":"G Skallsjö, G Sandström, J G Sato Folatre, A M Harstad, A Åström Victorén, E Sömoen, E Höglund, J Haglund, J Sköld, T Bergström, C Magnusson, K Wibring, B Romlin, A Wikman","doi":"10.1186/s13049-025-01439-7","DOIUrl":"10.1186/s13049-025-01439-7","url":null,"abstract":"<p><strong>Background: </strong>The ambulance service in Sweden has most often only crystalloids as resuscitation, even though restrictive use of clear fluids in bleeding patients is recommended. The aim of this study was to describe the treatment and outcome of bleeding patients treated by the ambulance service.</p><p><strong>Methods: </strong>This was a prospective observational multi-center study. Ambulance organizations in six different regions were invited to participate, each of them for a period of six months. Adult bleeding patients where fluid resuscitation with crystalloids was initiated by the ambulance service was consecutively included. Prehospital data on type of bleeding, mechanism and severity of injury, vital signs, estimated bleeding volume, treatment and transport time was collected from the ambulance service. Results from laboratory tests and data of transfusion requirements and mortality were obtained from the medical records, after hospital admission.</p><p><strong>Results: </strong>181 patients were resuscitated with crystalloid fluids by the ambulance service and were included in the study. Gastrointestinal bleeding was the cause of fluid resuscitation in 48% of the patients and bleeding due to trauma in 23%. A high proportion of the patients (41%) had a coagulopathy upon admission at the hospital, defined as prothrombin time > 1,2, platelet count < 150 × 10⁹/L and/or activated prothrombin time > 32 s. Shock Index (SI) was 1.2 (mean) (SD 0.4). The mean volume of crystalloid fluids administered was 626 mL (SD 366), with one third of the patients receiving 1000 mL or more. Tranexamic acid was administered to 28% of the patients. Blood transfusions were given to 50% of the patients upon hospital admission. SI more than 1.3 predicted need of blood transfusions and bleeding > 500 mL predicted increased 24 h mortality. The overall 24-hour mortality was 7.2% and in patients with blood loss greater than 500 mL, the mortality rate was 12.1%.</p><p><strong>Conclusion: </strong>In this study gastrointestinal bleeding and trauma were the leading causes of severe prehospital bleeding. Blood loss over 500 mL and Shock Index above 1.3 were key predictors of poor outcome, highlighting the potential benefit of earlier blood product administration.</p><p><strong>Trial registration: </strong>Clinical trial number: Not applicable.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"130"},"PeriodicalIF":3.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12291521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718960","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 role of serial point-of-care ultrasound during cardiac arrest to predict termination of resuscitation.","authors":"Farhad Heydari, Mehdi Nasr Isfahani, Babak Masoumi, Sayed Hamed Khajebashi, Forough Hajian, Fatemeh Soleimani","doi":"10.1186/s13049-025-01447-7","DOIUrl":"10.1186/s13049-025-01447-7","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"129"},"PeriodicalIF":3.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709696","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":"Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study.","authors":"Jessica B Oudakker, Christiaan A Rees, George Oosthuizen, Elmin Steyn, Shaheem de Vries, Janette Verster, Craig Wylie, Mohammed Mayet, Lesley Hodsdon, Karlien Doubell, Leigh Wagner, L'Oreal Snyders, Denise Lourens, Julia M Dixon, Jessica L Wild, Mengli Xiao, Lani Finck, Steven G Schauer, Hendrick J Lategan, Nee-Kofi Mould-Millman","doi":"10.1186/s13049-025-01441-z","DOIUrl":"10.1186/s13049-025-01441-z","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"128"},"PeriodicalIF":3.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692137","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":"Outcome metrics in recommended performance measurement tools for emergency department performance evaluation: a systematic review.","authors":"Tytti Kristiina Toukola, Reija Katri Kyllikki Mertanen, Johanna Marjut Kaartinen, Eeva Anneli Tuunainen, Maaret Kaarina Castrén, Paulus Mikael Torkki","doi":"10.1186/s13049-025-01442-y","DOIUrl":"10.1186/s13049-025-01442-y","url":null,"abstract":"<p><strong>Background: </strong>There is no established protocol for measuring the overall performance of an emergency department (ED). This study sought to evaluate in terms of outcome measures the existing measurement tools created for ED use.</p><p><strong>Design: </strong>A comprehensive systematic literature review was conducted following the PRISMA guidelines. A systematic literature search was performed in databases of Medline and Scopus using the following eligibility criteria: (1) article context is the hospital ED; (2) the purpose is to develop or use a measurement tool concerning either quality or value; (3) the measurement tool evaluates the overall ED performance; (4) the measurement tool consists of more than two single performance indicators; and (5) the article is published in English.</p><p><strong>Main results: </strong>Fifteen unique articles met the eligibility criteria and were included in the systematic review. The Delphi method was the most popular method for identifying the recommended performance indicators for ED use. Ten articles defined outcome metrics as a separate category of indicators. The indicators perceived as outcome metrics differed widely among the studies. The outcome metrics recommended can be divided into the following five dimensions: reattendances, mortality, diagnostic and procedural errors and complications, diagnosis-specific survival rates, and patient experience. Forty-six single outcome metrics were identified. Reattendances were the most frequently recommended outcome metrics, with 20 single indicators falling into this category.</p><p><strong>Conclusions: </strong>The lack of consensus on applicable outcome metrics makes it difficult to evaluate ED performance reliably. This study highlights the need to define and classify more specifically suitable outcome metrics for ED use to justify improvement actions and investigate the effect of healthcare reforms on ED operations.</p><p><strong>Registration: </strong>PROSPERO CRD42023470855.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"127"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651015","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}