Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Trauma outcomes differences in females: a prospective analysis of 76 000 trauma patients in the Asia-Pacific region and the contributing factors.","authors":"Mohamad Iqhbal Bin Kunji Mohamad, Sabariah Faizah Jamaluddin, Norhaiza Ahmad, Arifah Bahar, Zarina Mohd Khalid, Nuraina Aqilah Binti Mohd Zaki, Nurul Azlean Norzan, Sang Do Shin, Goh E Shaun, Wen-Chu Chiang, Kentaro Kajino, Kyoung Jun Song, Do Ngoc Son","doi":"10.1186/s13049-025-01342-1","DOIUrl":"10.1186/s13049-025-01342-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of mortality, particularly in low and middle-income countries. While extensively studied in North America and Europe, data from the Asia-Pacific are limited. An important area of research is the difference in trauma outcomes, which are theoretically noted to be better among females. However, the clinical findings are inconclusive among Asians. This study examines sex-based differences in trauma outcomes in Asia Pacific, focusing on in-hospital mortality and functional recovery at discharge.</p><p><strong>Methods: </strong>This observational study, from the Pan-Asia Trauma Outcomes Study (PATOS), included 76,645 trauma patients from 12 Asian Pacific countries. We analysed in-hospital mortality and functionality at discharge using the Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS). Logistic regression models were built to test the association of sex on the outcomes.</p><p><strong>Results: </strong>Males exhibited higher in-hospital mortality (1.6%) compared to females (1.06%) ( p < 0.001). Adjusted logistic regression models showed that the female sex is not independently associated with in-hospital mortality. Females have a better functional outcome at discharge for patients younger than 50 years with ISS < 16. However, no significant differences existed between those > 50 years and ISS > 15.</p><p><strong>Conclusion: </strong>This study indicates no difference in the general trauma outcomes in the Asia Pacific between females and males. Although younger females with less severe injuries had better functional outcomes, this advantage disappeared in severe injuries and those over 50 years. These results align with some previous studies, and understanding the nuances may lead to more tailored trauma care, potentially improving patient outcomes.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"34"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494499","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":"Determining the methodological rigor and overall quality of out-of-hospital clinical practice guidelines: a scoping review.","authors":"Brendan V Schultz, Timothy H Barker, Emma Bosley, Zachary Munn","doi":"10.1186/s13049-025-01344-z","DOIUrl":"10.1186/s13049-025-01344-z","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital clinical practice guidelines (CPGs) guide paramedics, emergency medical technicians and first responders, but their quality remains uncertain. This scoping review aims to identify, aggregate and describe all literature that has used a structured appraisal instrument to assess the methodological rigor and overall quality of out-of-hospital CPGs.</p><p><strong>Methods: </strong>This study was conducted in accordance with the JBI methodology for scoping reviews and involved systematically searching the following databases and/or information sources with no publication or language limit applied: MEDLINE (Ovid), Embase (Elsevier), CINAHL with full text (EBSCO), Scopus (Elsevier), ProQuest Central (ProQuest).</p><p><strong>Results: </strong>This review identified 15 articles that appraised 311 unique out-of-hospital CPGs. These CPGs ranged in date of publication from 1998 to 2022. The majority of CPGs (267/311) were assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) instrument, with 146 guidelines appraised against two tools. Following aggregation, CPGs scored highest in Domain 4 (clarity of presentation) at 77.7% (SD = 15.1%), and lowest in Domain 5 (applicability) at 42.6% (SD = 23.7%). The average Domain 3 score (rigor of development) was 55.6% (SD = 25.7%). Of CPGs appraised against the AGREE-II instrument, 34.4% met our a priori definition of being high-quality (Domain 3 score of equal to or greater than 75%), while 31.3% were deemed medium-quality (Domain 3 score between 74% and 50%), and 34.3% were considered low-quality (Domain 3 score less than 50%). There were no significant changes observed in the average Domain 3 score over time (p = 0.092). 146 CPGs were assessed against the National Academy of Medicine criteria with 34.9% meeting all elements indicative of being a high-quality guideline, while 39 CPGs were assessed the 2016 National Health and Medical Research Council Standards for Guidelines with 0% meeting all criteria.</p><p><strong>Conclusions: </strong>Out-of-hospital CPGs currently have poor methodological rigor and are of medium to low overall quality. These results should be used to inform future research and initiatives that aim to standardize the methods used to develop guidelines used in this healthcare setting.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"32"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473101","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":"Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically ill and injured patients: a systematic review and meta-analysis.","authors":"Adam J Boulton, Terry Brown, Joyce Yeung","doi":"10.1186/s13049-025-01347-w","DOIUrl":"10.1186/s13049-025-01347-w","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"33"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473095","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":"Critical interventions, diagnosis, and mortality in children treated by a physician-manned mobile emergency care unit.","authors":"Alexandra Claire McKenzie, Mads Belger Risom, Jens-Jakob Kjer Møller, Johan Mikkelsen, Sarah Friis Skole-Sørensen, Vibe Maria Laden Nielsen, Nicola Groes Clausen, Søren Mikkelsen","doi":"10.1186/s13049-025-01346-x","DOIUrl":"10.1186/s13049-025-01346-x","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to clarify the potentially life-saving critical interventions performed on children below the age of seven by the physician-manned mobile emergency care unit (MECU) in Odense, Denmark. We investigated critical interventions in relation to morbidity and mortality.</p><p><strong>Methods: </strong>A retrospective cohort study of all MECU missions involving children below the age of seven. The study period was from October 1 2007 to December 31 2020. Data sources were the MECU Odense database, the Danish National Patient Registry, and the Danish Civil Registration System. Variables were critical interventions, the severity of injury/illness, MECU on-scene time, in-hospital diagnosis and 7-day, 30-day, and 90-day mortality.</p><p><strong>Results: </strong>The MECU carried out 4,032 missions to children below 7 years. 88 patients (2.2%) received at least one critical prehospital intervention. Upper airway suction was performed in 39 cases (1.0%), endotracheal intubation (all causes) in 36 cases (0.9%), and intraosseous access in 21 cases (0.5%). General anaesthesia was induced in 29 cases (0.7%). Seventeen patients (0.4%) received cardiopulmonary resuscitation and two patients received manual defibrillation (< 0.1%). 3,278 patients were admitted to the hospital and assigned a diagnosis when discharged. The most common diagnoses were assigned within the International Statistical Classification of Diseases and Related Health Problems 10th Revision Chapter XVIII (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified), which includes febrile convulsions. 1,437 patients (43.8%) were assigned diagnoses within this diagnosis group. The overall 7-day mortality in the cohort was 0.74%, 30-day mortality was 0.82%, and 90-day mortality was 1.02%.</p><p><strong>Conclusion: </strong>Prehospital critical interventions are rarely performed in children under the age of 7 years. The low frequency of these interventions may have implications for maintaining the clinical routine of the prehospital care providers.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"30"},"PeriodicalIF":3.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469699","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 revised Canadian Bleeding (CAN-BLEED) score for risk stratification of bleeding trauma patients: a mixed retrospective-prospective cohort study.","authors":"Alexandre Tran, Tyler Lamb, Shannon M Fernando, Manya Charette, Marie-Joe Nemnom, Maher Matar, Jacinthe Lampron, Christian Vaillancourt","doi":"10.1186/s13049-025-01336-z","DOIUrl":"10.1186/s13049-025-01336-z","url":null,"abstract":"<p><strong>Background: </strong>Traumatic hemorrhage is a significant cause of morbidity and mortality. There is considerable interest in risk stratification tools to aid with early activation of intervention pathways for bleeding patients. In this study, we refine the Canadian Bleeding (CAN-BLEED) score for the prediction of major interventions in bleeding trauma patients.</p><p><strong>Methods: </strong>We conducted a mixed retrospective-prospective cohort study. We included a retrospective cohort from the CAN-BLEED derivation study, from September 2014 to September 2017. We also conducted a prospective cohort from May 2019 to August 2021 and included both datasets for refinement of the CAN-BLEED score. The primary outcome was major intervention, defined by a composite of massive transfusion, embolization, or surgery for hemostasis. Predictors were pre-specified based on previous validation work. We used a stepdown procedure and regression coefficients to create a clinical risk stratification score. We used bootstrap internal validation to assess optimism-corrected performance.</p><p><strong>Results: </strong>We included 1368 patients in the overall cohort. Incidence of penetrating injury was 23% and median injury severity score was 17. The overall incidence of the need for major intervention was 17%. The revised score included 8 variables: systolic blood pressure, heart rate, lactate, penetrating mechanism, pelvic instability, Focused Abdominal Sonography for Trauma positive for free fluid, computed tomography positive for free fluid, or contrast extravasation. The C-statistic for the simplified score is 0.89. A score cut-off of less than 2 points yielded a 97% (94-98%) sensitivity in ruling out the need for major intervention.</p><p><strong>Conclusion: </strong>The revised CAN-BLEED score offers a clinically intuitive and internally validated tool with excellent performance in identifying patients requiring major intervention for traumatic bleeding. Further efforts are required to evaluate its performance with an external validation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"31"},"PeriodicalIF":3.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469713","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":"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":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;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}