Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

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

{"title":"Implementing ultrasound in emergency medical services: assessing physician proficiency and training requirements.","authors":"C Engelen, J Haack, D Lämmermann, W Hitzl, J C Kubitz, G Breuer, A Kamphausen, T Hübner","doi":"10.1186/s13049-025-01391-6","DOIUrl":"10.1186/s13049-025-01391-6","url":null,"abstract":"<p><strong>Background: </strong>Bedside ultrasound plays an important role in diagnostics and monitoring, especially in emergency medicine. Modern technology makes ultrasound available in a mobile and portable form, so it can be used even in prehospital emergency care with several interventional and diagnostic applications. This also raises the question of what kind of education and training is necessary for EMS (emergency medical services) physicians to be able to use Point-of-Care Ultrasound (POCUS) in the prehospital setting.</p><p><strong>Aims: </strong>This observational study investigates the use of prehospital POCUS in a rural EMS area. It focuses the question of what level of competence is needed for EMS physicians to use POCUS adequately in the prehospital emergency setting for correct application and interpretation of the findings.</p><p><strong>Method: </strong>This was a quality assurance measure designed as a prospective cohort study. We investigated POCUS examinations performed by EMS physicians in the EMS Service Area of Nuremberg City, Germany between June 2021 and July 2022. Patients transported to three specific hospitals in Nuremberg city after care were followed up and the prehospital findings were compared with the in-hospital radiological results. The number of correct findings was correlated with the level of competence in POCUS examinations of the performing EMS physicians. Various classifications of competence were used to assess the influence of training and education on the safe application of prehospital POCUS.</p><p><strong>Results: </strong>Two hundred fifty-eight prehospital POCUS examinations were documented, with 108 followed up, including 268 sonographic findings. There was a wide range of indications for POCUS use. In 79.5% of cases the prehospital findings correspond with those in-hospital. By correlating the correct findings with the participants level of competence, there was no significant difference between POCUS-experienced and -inexperienced EMS physicians, even when divided into different categories.</p><p><strong>Conclusion: </strong>POCUS can be used in prehospital emergency care for a wide range of indications safely, with a high number of correct diagnoses and findings. Our results suggest that emergency POCUS is easy to learn and EMS physicians do not need intensive training to perform POCUS adequately in the prehospital setting.</p><p><strong>Take home messages: </strong>Mobile ultrasound appears to be useful in the prehospital setting It can be used by EMS physicians even without extensive prior experience and expertise POCUS is able to find important findings for prehospital patient's care with a high level of certainty.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"92"},"PeriodicalIF":3.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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

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

{"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}