Acute Medicine & Surgery最新文献

{"title":"Jesaconitine monitoring in a case of severe aconitum poisoning with torsade de pointes treated via extracorporeal membrane oxygenation","authors":"Yoshitaka Tomita,&nbsp;Keisuke Suzuki,&nbsp;Asuka Kaizaki-Mitsumoto,&nbsp;Natsumi Hattori-Usami,&nbsp;Satoshi Numazawa,&nbsp;Kazuki Kikuchi,&nbsp;Gen Inoue,&nbsp;Kazuyuki Miyamoto,&nbsp;Masaharu Yagi,&nbsp;Kenji Dohi","doi":"10.1002/ams2.70047","DOIUrl":"https://doi.org/10.1002/ams2.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p><i>Aconitum</i> poisoning can cause severe arrhythmias. We report, for the first time, the detailed blood and urine concentrations of four aconitine alkaloids in a male patient in his 20s who ingested aconite roots with suicidal intent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>The patient developed refractory torsade de pointes (TdP) and required veno-arterial extracorporeal membrane oxygenation. His TdP resolved 7 h after arrival, with sinus rhythm returning within 12 h. The patient was discharged 6 days later. Subsequent measurements of the four alkaloids over time showed that jesaconitine had the highest serum concentration, with the patient's sinus rhythm returning when the jesaconitine concentration was less than 1 ng/mL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This report provides valuable insights into the disposition of aconitine alkaloids during severe intoxication. The changes in jesaconitine concentrations over time correlate with clinical symptoms, suggesting that these levels could guide treatment decisions in patients with severe <i>Aconitum</i> poisoning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis in Global Health: Current global strategies to fight against sepsis","authors":"Hiroki Saito","doi":"10.1002/ams2.70045","DOIUrl":"https://doi.org/10.1002/ams2.70045","url":null,"abstract":"<p>Sepsis is prevalent globally, causing a significant disease burden in global health. Sepsis is a complex disease condition, and therefore, the effective strategies to overcome sepsis need to be set up in layers across different sectors and populations. Over the years, the global society has been making progress in addressing sepsis as a public health threat. This review aims to examine and describe the current sepsis strategies globally and to sustain the fight against sepsis in the context of global health.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic internal carotid artery aneurysm distant from facial bone fractures treated with a flow diverter stent: A case report","authors":"Tatsuya Watanabe,&nbsp;Junzo Nakao,&nbsp;Keishun Boku,&nbsp;Koji Hirata,&nbsp;Yasukazu Totoki,&nbsp;Kuniharu Tasaki,&nbsp;Takeshi Miura,&nbsp;Tetsuya Hoshino,&nbsp;Yukei Matsumoto,&nbsp;Yuki Enomoto,&nbsp;Aiki Marushima,&nbsp;Yuji Matsumaru,&nbsp;Yoshiaki Inoue","doi":"10.1002/ams2.70034","DOIUrl":"10.1002/ams2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traumatic intracranial aneurysms (TICAs) can be fatal if ruptured. We report a case of a TICA, distant from facial bone fractures, successfully treated with flow diverter (FD) before rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 20-year-old woman was admitted following a car accident. Initial contrast-enhanced computed tomography revealed traumatic subarachnoid hemorrhage, a 5-mm internal carotid artery aneurysm, LeFort type I + II, and mandibular fracture. On Day 8, she developed oculomotor palsy, and digital subtraction angiography revealed the aneurysm had increased to 12 mm. She started dual antiplatelet therapy (DAPT) following facial fracture repair. On Day 17, FD was placed, resulting in contrast agent stagnation within the aneurysm. Three months postinjury, her neurological symptoms improved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Screening for cerebrovascular injury is crucial several days following severe head trauma, even without skull base fractures. Unruptured TICA can be safely treated with FD following DAPT administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing the delivery of automated external defibrillators by lay rescuers to the scene of out-of-hospital cardiac arrests in schools","authors":"Kosuke Kiyohara,&nbsp;Mamoru Ayusawa,&nbsp;Masahiko Nitta,&nbsp;Takeichiro Sudo,&nbsp;Taku Iwami,&nbsp;Ken Nakata,&nbsp;Yuri Kitamura,&nbsp;Tetsuhisa Kitamura,&nbsp;For the SPIRITS Investigators","doi":"10.1002/ams2.70040","DOIUrl":"10.1002/ams2.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Timely use of automated external defibrillators by lay rescuers significantly improves the chances of survival in out-of-hospital cardiac arrest cases. We aimed to identify the factors influencing whether lay rescuers bring automated external defibrillators to the scene of nontraumatic out-of-hospital cardiac arrests in schoolchildren in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on out-of-hospital cardiac arrests among schoolchildren from April 2008 to December 2021 were obtained from the database of the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools study. A multivariate Modified Poisson regression analysis was performed to evaluate the factors influencing whether a lay rescuer brought an automated external defibrillator to the scene of out-of-hospital cardiac arrest and the year-by-year changes in automated external defibrillator delivery for each factor were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 333 nontraumatic out-of-hospital cardiac arrests across the entire study period, lay rescuers brought automated external defibrillators in 85.3% of cases. Female patients and incidents occurring during non-sports activities had lower proportions of automated external defibrillator delivery. Significant year-by-year improvements in automated external defibrillator delivery were observed, with the overall proportion increasing from 73.7% in 2008–2010 to 93.3% in 2020–2021. However, the trend was less pronounced for female students, non-sports activities, and incidents occurring in classrooms/other locations than their counterparts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AED delivery to the scene of OHCA in schools has improved overall, with the proportion increasing from 73.7% in 2008–2010 to 93.3% in 2020–2021. However, there is still room for improvement, particularly in female patients, and incidents during non-sports activities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on resuscitation after hospital arrival for patients with out-of-hospital cardiac arrest: An interrupted time series analysis","authors":"Takuya Sato,&nbsp;Hiroyuki Ohbe,&nbsp;Yusuke Sasabuchi,&nbsp;Ryota Inokuchi,&nbsp;Hideo Yasunaga,&nbsp;Kent Doi","doi":"10.1002/ams2.70039","DOIUrl":"10.1002/ams2.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In this study, we aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Using the Japanese Diagnosis Procedure Combination inpatient database, we included patients with OHCA who were transported to hospitals between April 2018 and March 2021. Patients were categorized into groups, before and during the COVID-19 pandemic, according to the day of admission (before or after April 1, 2020, respectively). The primary outcome was in-hospital CPR duration after hospital arrival, and secondary outcomes included in-hospital death, intubation, and other resuscitation-related treatments. We examined the impact of the pandemic using interrupted time series (ITS) analyses. Among 144,867 patients with OHCA, 82,425 died in the outpatient department (53,286 before the pandemic and 29,139 during the pandemic) during the study period. The ITS analyses for patients who died in the outpatient department showed no significant level change in CPR duration after hospital arrival (0.41 min increase; 95% confidence interval [CI]: −0.54 to 1.4; <i>p</i> = 0.39), but the intubation rate was significantly lower (−5.9%; 95% CI: −8.4 to 3.4; <i>p</i> &lt; 0.001). In-hospital death among all patients with OHCA showed a significant increase in trend (0.41% per month; 95% CI: 0.081–0.74; <i>p</i> = 0.016).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The COVID-19 pandemic had little impact on CPR duration after hospital arrival; however, there was a marked decrease in intubation for patients with OHCA after hospital arrival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inadvertent insertion of dialysis catheter into subclavian artery treated with a covered stent: A case report","authors":"Yohei Takenobu,&nbsp;Akihiro Furuta,&nbsp;Sumire Haga,&nbsp;Hiroshi Yukawa,&nbsp;Noriko Nomura,&nbsp;Mizuha Toyama,&nbsp;Akihiro Okada,&nbsp;Takeshi Kawauchi,&nbsp;Yukinori Terada,&nbsp;Manabu Inoue,&nbsp;Kenji Hashimoto","doi":"10.1002/ams2.70038","DOIUrl":"10.1002/ams2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When inserting central venous catheters, inadvertent injury of major vessels is a rare yet critical complication. Direct surgery is sometimes overly invasive. This report describes a subclavian artery injury caused by inadvertent cannulation of a dialysis catheter, successfully treated with a covered stent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 82-year-old woman with acute renal failure due to sepsis required emergency dialysis. During the insertion of a 12-Fr dialysis catheter into the right jugular vein, pulsatile reflux was noted. Computed tomography revealed catheter misplacement in the subclavian artery. Considering the patient's fragility, endovascular repair was performed. After embolization of side branches, a GORE VIABAHN stentgraft was delivered using a pull-through technique and deployed to seal the injury site. The patient was discharged without neurological or vascular complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Covered stents offer an effective solution for major vessel injuries requiring immediate hemostasis, particularly when direct surgery is complicated by underlying medical or anatomical conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crayon ingestion","authors":"Kisho Noda,&nbsp;Tomoki Wada,&nbsp;Ryohei Horie,&nbsp;Toshifumi Asada,&nbsp;Ryota Inokuchi,&nbsp;Kent Doi","doi":"10.1002/ams2.70030","DOIUrl":"10.1002/ams2.70030","url":null,"abstract":"<p>A 24-year-old male with autism presented to the emergency department with recurrent vomiting. His mother found crayon fragments in the vomitus. Computed tomography revealed multiple high-density cylindrical objects in the lower esophagus, stomach, and isolated in the ileum (Figure 1A,B). Urgent upper gastrointestinal endoscopy was performed under general anesthesia and 24 crayon fragments were successfully retrieved from the stomach (Figure 1C,D). The crayons in the ileum were defecated without complications.</p><p>Although methemoglobinemia induced by colored crayons has been reported previously,<span>^{1, 2}</span> current crayon formulations consist largely of nontoxic wax with an extremely low risk of acute toxicity. Because crayons are not readily digestible enzymatically or thermally in the gastrointestinal tract owing to a melting point of approximately 60°C, they can readily cause complications such as gastrointestinal obstruction or choking on aspirated vomit. Guidelines for the management of foreign bodies in the stomach recommend urgent removal of sharp or long (≧6 cm in length) objects by urgent endoscopy.<span>³</span> In this case, the crayon fragments were blunt and &lt;6 cm each, but urgent endoscopy under general anesthesia was performed because the patient with autism was concerned about being unable to express discomfort or pain when complications occurred.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Written informed consent was obtained from the patient's family for the publication of this case report and accompanying images.</p><p>Registry and registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11712129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Warfarin overdose successfully treated using prophylactic vitamin K infusion without severe coagulopathy: A case report","authors":"Ryosuke Omoto,&nbsp;Yutaka Umemura,&nbsp;Yuki Kokubu,&nbsp;Takeyuki Kiguchi,&nbsp;Satoshi Fujimi","doi":"10.1002/ams2.70036","DOIUrl":"10.1002/ams2.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Warfarin, a vitamin K antagonist, is widely used for preventing and treating thromboembolic diseases. While guidelines exist for managing elevated prothrombin time-international normalized ratio (INR) in patients on warfarin, the treatment for warfarin overdose in these patients is yet to be standardized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 41-year-old woman ingested 230 mg of warfarin with suicidal intent, along with other medications. Initially unconscious, her INR was 1.0, and laboratory results were normal. Prophylactic continuous menaquinone-4, vitamin K2, injections were administered before the INR increased. After stopping vitamin K2 72 h later, her INR rose to 1.8, but she recovered without severe coagulopathy or bleeding, despite a high initial warfarin concentration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first case of warfarin overdose managed with prophylactic vitamin K2 injections before INR elevation, successfully preventing severe complications. Prophylactic vitamin K infusion may be a practical approach for warfarin overdose treatment in non-dependent patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11712172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypothermia-associated acute pancreatitis: A multicenter prospective observational study","authors":"Masaki Takahashi,&nbsp;Shuhei Takauji,&nbsp;Mineji Hayakawa","doi":"10.1002/ams2.70033","DOIUrl":"10.1002/ams2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Hypothermia-associated pancreatitis lacks comprehensive understanding owing to limited studies exploring its mechanism, epidemiology, risk factors, and outcomes. We aimed to investigate the frequency, characteristics, and predictive factors associated with the development of acute pancreatitis in patients with accidental hypothermia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study comprised a post hoc analysis of data from a multicenter prospective observational study (ICE-CRASH study) conducted in 36 tertiary emergency hospitals in Japan. Patients aged ≥18 years with core body temperatures ≤32°C admitted to emergency departments between 2019 and 2022 were enrolled. We identified patients who developed acute pancreatitis within 1 week of admission and described their characteristics. Age, vital signs, and blood gas analysis data were analyzed as potential predictors of acute pancreatitis using receiver operating characteristic (ROC) curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 421 eligible patients with accidental hypothermia, 16 (3.8%) developed acute pancreatitis within 1 week. The age distribution of patients with acute pancreatitis showed bimodal peaks around 50–80 years. Patients with acute pancreatitis had a higher proportion of alcohol consumption than those without acute pancreatitis. ROC curve analysis showed age and pH as significant factors; however, their predictive power was not high.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of acute pancreatitis was 3.8% in patients with accidental hypothermia with core body temperatures ≤32°C. An association was found between the development of acute pancreatitis and alcohol consumption. No strong predictors of acute pancreatitis were identified.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of subarachnoid hemorrhage from vertebral artery dissection: A comparative study with other non-traumatic etiologies","authors":"Shu Oshita,&nbsp;Tetsuya Yumoto,&nbsp;Shunta Jinno,&nbsp;Ippei Matsuo,&nbsp;Takashi Hongo,&nbsp;Hiromichi Naito,&nbsp;Masafumi Hiramatsu,&nbsp;Jun Haruma,&nbsp;Kenji Sugiu,&nbsp;Shota Tanaka,&nbsp;Atsunori Nakao","doi":"10.1002/ams2.70031","DOIUrl":"10.1002/ams2.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into “VAD rupture” and “other etiologies” groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3–6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, <i>p</i> = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, <i>p</i> = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, <i>p</i> &lt; 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, <i>p</i> = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}