Acute Medicine & Surgery最新文献

{"title":"Divergent mortality risks associated with lower body temperature and interleukin-6 levels in elderly and non-elderly patients with sepsis","authors":"Takashi Shimazui, Takehiko Oami, Tadanaga Shimada, Keisuke Tomita, Taka-aki Nakada","doi":"10.1002/ams2.70070","DOIUrl":"https://doi.org/10.1002/ams2.70070","url":null,"abstract":"<p>Identifying prognostic indicators in sepsis is crucial for improving clinical practice. Aging is associated with attenuated physiological and immune responses, potentially altering these indicators' dynamics and prognostic values. Our previous study demonstrated that lower body temperature (BT) as well as higher blood interleukin-6 (IL-6) levels were significantly associated with higher mortality in non-elderly patients with sepsis, but not in the elderly.<span><sup>1, 2</sup></span></p><p>IL-6 plays a central role in inflammation and fever regulation.<span><sup>3</sup></span> In severe inflammatory states, host response failure can manifest as hypothermia, which is associated with poor prognosis.<span><sup>4</sup></span> Given the close relationship between IL-6 and BT, combining these indicators may enhance prognostic accuracy in sepsis.</p><p>To examine age-related differences in the associations between IL-6 and BT abnormalities at intensive care unit admission with mortality, we analyzed a published sepsis cohort in which patients were classified as non-elderly (<70 years) or elderly (≥70 years) with similar severity scores and mortality.<span><sup>2</sup></span> Blood IL-6 levels were categorized as low or high using a Youden index-derived cutoff of 1974 pg/mL.<span><sup>2</sup></span> BT was stratified into tertiles: low (<36.8°C), middle (36.8–37.9°C), and high (>37.9°C). An IL-6 cutoff of 1000 pg/mL<span><sup>5</sup></span> and age cutoffs of 65 and 75 years were tested in sensitivity analyses. Interactions between age and IL-6 levels as well as age and BT for mortality were assessed. Continuous variables are presented as medians (interquartile ranges) and were analyzed using the Wilcoxon test. BT trends and mortality were analyzed using the Cochran–Armitage test for trend. A two-tailed P-value <0.05 was considered significant.</p><p>Elderly patients had significantly higher IL-6 levels than non-elderly patients (1021 [244–11,404] vs. 1767 [318–14,312] pg/mL, <i>p</i> = 0.029), whereas BT levels were similar (37.4 [36.5–38.3] vs. 37.3 [36.5–38.3]°C, <i>p</i> = 0.51). Consistent with prior findings,<span><sup>1</sup></span> lower BT was associated with higher mortality in non-elderly patients but not in elderly with high IL-6 (Figure 1). A novel finding was that lower BT was significantly associated with increased mortality in elderly patients with low IL-6 (<i>p</i> = 0.030, Figure 1). Analysis using a 1000 pg/mL IL-6 cutoff yielded similar results (Figure S1). Analyses with 65- and 75-year age cutoffs showed similar trends in the elderly low IL-6 groups (Figures S2 and S3). Interaction between age and IL-6 was significant (<i>p</i> = 0.0010), with a trend toward for age and BT (<i>p</i> = 0.16).</p><p>Elderly patients often have multiple comorbidities, resulting in complex prognostic factors beyond inflammation. Their host response is not as straightforward as that of non-elderly. Lower BT in sepsis may suggest host respo","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514906","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":"Comparison of bathing-related adverse events, including drowning, between hot spring bathing and general bathing: A single-center retrospective study","authors":"Ryuto Yokoyama,&nbsp;Kenya Yarimizu,&nbsp;Kento Sakaguchi,&nbsp;Yu Onodera,&nbsp;Tadahiro Kobayashi,&nbsp;Masaki Nakane","doi":"10.1002/ams2.70064","DOIUrl":"https://doi.org/10.1002/ams2.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>While Japan's bathing culture contributes to better health, it has also become a social problem due to the high number of medical care emergencies arising from bathing-related adverse events. In particular, bathing in hot springs may pose unique risks. This study aimed to examine the relationship between bathing-related adverse events, including drowning, and the location of bathing, specifically hot springs and other bathing sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective cohort study included 125 participants who had bathing-related adverse events from March 1, 2012 to February 29, 2024. Participants were classified into two groups according to the bathing location: hot spring (Group H; <i>n</i> = 24) and other bathing (Group B; <i>n</i> = 101) groups. Logistic regression analysis was conducted using drowning as the objective variable and bathing in hot springs and age as explanatory variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only the incidence of drowning showed a significant difference between the two groups (Group H: 9/24 [37%] vs. Group B: 18/95 [18%]). Logistic regression analysis showed that bathing in hot springs was an independent factor associated with drowning, with no significant difference by age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of this study suggest that drowning is more frequent among individuals who bathe in hot springs. Larger scale studies are needed to explore the causes of drowning during hot spring bathing and the relationship between hot spring bathing and bathing-related adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367591","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":"Effect of closed negative pressure wound therapy after laparotomy for gastrointestinal perforation: A single-center observational study","authors":"Takahiro Oishi,&nbsp;Fumiko Nakamura,&nbsp;Nao Okuno,&nbsp;Keisuke Tamagaki,&nbsp;Yoshihiro Nakamura,&nbsp;Kazuhito Sakuramoto,&nbsp;Yasuyuki Kuwagata","doi":"10.1002/ams2.70069","DOIUrl":"https://doi.org/10.1002/ams2.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Laparotomy for gastrointestinal perforation is associated with a high risk of surgical site infection (SSI). The present study aimed to evaluate the effect of closed negative pressure wound therapy (NPWT) against SSI in patients undergoing laparotomy for gastrointestinal perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective, observational study was carried out in a tertiary emergency medical center. We performed closed NPWT following emergency laparotomy for gastrointestinal perforation between May 2019 and May 2024, and compared it to standard dressings used between January 2016 and April 2019. Cases of open abdominal management were excluded. The primary outcome was the incidence of superficial and deep SSI between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The closed NPWT group comprised 65 patients, and the standard dressing group comprised 62 patients. There were no significant differences in patient characteristics, comorbidities, operative indications, and wound classification between the two groups. The rate of superficial and deep SSI was significantly lower with closed NPWT (26.2% with closed NPWT vs. 45.2% with standard dressing, <i>p</i> = 0.028).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The application of closed NPWT in patients undergoing laparotomy for gastrointestinal perforation was associated with a lower incidence of SSI compared with that of a standard surgical dressing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206383","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":"Gut dysbiosis and its treatment in patients with critical illness","authors":"Kentaro Shimizu,&nbsp;Hiroshi Ogura,&nbsp;Jun Oda","doi":"10.1002/ams2.70068","DOIUrl":"https://doi.org/10.1002/ams2.70068","url":null,"abstract":"<p>The gut is a target organ that functions as the “motor” of critical illness. In patients with critical illness, the disrupted gut microbiota following infection and injury could cause diarrhea, pneumonia, and systemic inflammation. For maintaining the gut microbiota, therapeutic approaches are required to modulate host responses and prevent systemic inflammation. Probiotics and synbiotics could maintain the gut microbiota and decrease not only the incidence of diarrhea but also that of ventilator-associated pneumonia. The effects of probiotics/synbiotics differ with the type of bacteria and disease severity. Adverse effects of probiotics have been reported; therefore, the selection of safe and effective probiotics/synbiotics is warranted. Refractory diarrhea with prolonged dysbiosis may require a novel intestinal therapy, such as fecal microbiota transplantation, to alleviate gut dysbiosis.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206384","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":"Current state and challenges of multidisciplinary collaboration by fire defense headquarters in Japan: A nationwide cross-sectional survey","authors":"Keiko Ueno,&nbsp;Daisuke Nishioka,&nbsp;Chie Teramoto","doi":"10.1002/ams2.70067","DOIUrl":"https://doi.org/10.1002/ams2.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The role of emergency medical service personnel has recently shifted, necessitating fire defense headquarters to engage in multidisciplinary collaboration with community organizations. However, evidence of this collaboration is limited. This study aimed to investigate the current state and challenges of multidisciplinary collaboration between fire defense headquarters and long-term care, welfare, and health organizations in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A web-based cross-sectional survey was conducted in 2023 among fire defense headquarters in Japan to examine their collaboration with long-term care, welfare, and health organizations, as well as the challenges encountered during collaboration. Descriptive statistics were used for numerical data, and a qualitative descriptive method was applied to text data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 529 participants, constituting a response rate of 72.9%, were enrolled in this study. A total of 445 (84.1%) fire defense headquarters collaborated with long-term care, welfare, and health organizations. The most common collaborating organizations were public health centers (62.5%), community comprehensive support centers (54.6%), and municipal departments of long-term care (40.0%). Challenges of collaboration included “cannot contact organizations during nights and holidays” and “cannot obtain patient information from organizations due to privacy reasons.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fire defense headquarters and community organizations should continue fostering collaboration, addressing challenges, and adopting best practices, which will help define the role of fire defense headquarters within local collaborative frameworks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148381","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":"Performance of Universal TOR rule for out-of-hospital cardiac arrest in the Pan-Asian Resuscitation Outcomes Study","authors":"Atsunori Onoe,&nbsp;Kentaro Kajino,&nbsp;Ng Wei Ming,&nbsp;Hideharu Tanaka,&nbsp;Takashi Tagami,&nbsp;Hyun Ho Ryu,&nbsp;Chih-Hao Lin,&nbsp;Marcus Eng Hock Ong,&nbsp;Yasuyuki Kuwagata","doi":"10.1002/ams2.70063","DOIUrl":"https://doi.org/10.1002/ams2.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Out-of-hospital cardiac arrest (OHCA) is a public health problem. The Universal Termination of Resuscitation (TOR) rule attempts to reduce the rate of futile transports. The aim of this study was to examine and compare the performance of the TOR rule for OHCA cases in Japan, Korea, Singapore, and Taiwan, where the TOR rule has not been implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study examined data from January 1, 2009, to June 30, 2018, reported to the Pan-Asian Resuscitation Outcomes Study. We included patients with nontraumatic OHCA in the four countries and compared the performance of the Universal TOR rule in these countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of eligible cases was 173,629. The performance of the Universal TOR rule for cases of neurologically poor survival showed a positive predictive value of more than 0.99 in all four countries. However, specificity differed among them: Japan 0.938, 95% confidence interval (CI): 0.931–0.945; Korea 0.922, 95% CI: 0.901–0.939; Singapore 0.985, 95% CI: 0.964–0.993; and Taiwan 0.773, 95% CI: 0.736–0.807.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The positive predictive value of neurologically poor survival in cases meeting the Universal TOR rule among the four countries was greater than 99%. However, the specificity of these cases that met the Universal TOR rule differed among the four countries. Therefore, further refinement of the Universal TOR rule may be needed for local implementation. The quality of resuscitation in an out-of-hospital setting may also impact survival and neurological outcomes and needs to be considered in any implementation of TOR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108952","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":"Rapidly progressive dementia due to superior sagittal sinus dural arteriovenous fistula: A case report","authors":"Hiroki Karita,&nbsp;Koji Hirata,&nbsp;Kyoji Tsuda,&nbsp;Keishi Fujita,&nbsp;Alexander Zaboronok,&nbsp;Yuji Matsumaru,&nbsp;Eiichi Ishikawa","doi":"10.1002/ams2.70059","DOIUrl":"https://doi.org/10.1002/ams2.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dural arteriovenous fistula (dAVF) presenting primarily with memory disturbance is relatively rare and may be diagnosed late. However, symptoms often improve with appropriate treatment, as in our case.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 74-year-old man presented with cognitive decline and, within 2 months, developed gait disturbance, dysarthria, and ataxia, leading to hospitalization for suspected dAVF on magnetic resonance imaging. Angiography revealed a superior sagittal sinus dAVF. The patient underwent surgical disconnection of the dAVF from the superior sagittal sinus, and his cognitive function, paresis, and dysarthria improved, allowing for discharge with a modified Rankin Scale score of 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In cases with memory disturbance, dAVF should be considered a differential diagnosis, verified, and treated accordingly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100467","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":"A case report: Efficacy of thoracic MRA for ischemic stroke due to acute aortic dissection","authors":"Jun Nagayama,&nbsp;Kenji Fujizuka,&nbsp;Shioya Hayato,&nbsp;Ryosuke Tsuchiya,&nbsp;Mitsunobu Nakamura","doi":"10.1002/ams2.70066","DOIUrl":"https://doi.org/10.1002/ams2.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ischemic stroke requires prompt diagnosis and treatment but rarely results from acute aortic dissection. The administration of tissue-type plasminogen activator (t-PA) to such patients can lead to serious complications and potentially fatal outcomes. Here, we report a case in which thoracic magnetic resonance angiography (MRA) was useful for identifying cerebral infarction complicated by acute aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 60-year-old man presented with a sudden onset of left-sided hemiplegia, right-sided hemiparesis, and dysarthria. Noncontrast CT ruled out intracranial hemorrhage; however, aortic dissection was not detected. MRI showed reduced blood flow in the right middle cerebral artery, and t-PA administration was suspected to have caused ischemic stroke. However, thoracic MRA revealed dissection from the ascending aorta to the arch, which was diagnosed using contrast-enhanced CT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Thoracic MRA is useful for diagnosing acute aortic dissection in patients with a stroke.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085249","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":"Letter to ‘Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion’","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1002/ams2.70065","DOIUrl":"https://doi.org/10.1002/ams2.70065","url":null,"abstract":"<p>We would like to comment on “Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion.<span>¹</span>” This study created an automatic detection system for acute cholecystitis (AC) that can recognize gallbladders from CT scans of patients and controls. It detected gallbladders using the VGG-16 architecture and processed them using techniques such as the Flood fill algorithm and centroid calculation, as well as U-Net for picture segmentation and feature extraction. The combination of results from many models aided in the development of an automatic and accurate AC detection system.</p><p>However, using the accuracy value to evaluate the system's performance may not be sufficient to reflect the ability to distinguish between cases with different conditions, especially when there is an imbalance of data, such as the difference between AC patients and non-patient controls, or when the data is not evenly distributed, which may cause the accuracy value to not reflect the model's effectiveness in handling more difficult cases. Other indices, such as sensitivity, specificity, and AUC (Area Under Curve) values, can help increase the accuracy of model performance evaluation. The example of this kind of study is the previous publication by Ma et al.<span>²</span></p><p>Furthermore, it should be considered to develop techniques that improve processing in cases with low-quality or noisy images, which may cause the model to misclassify or skip over complex cases. This includes the use of diverse data from various sources, such as adding images from patients with complications or changes in gallbladder characteristics.</p><p>Approaches that can learn from various data and adapt to the diversity of CT scans, as well as deep learning approaches, should be applied in future development. Further investigation into the model's capacity to process under multiple scenarios, such as changing operational conditions or patient diversity, will improve the system's robustness and accuracy in practice. This study describes the development of an AI-based AC detection system that can work quickly and accurately; however, further developments in low-quality image processing and the use of more diverse statistical techniques are required to enable this technology to detect the disease more accurately and efficiently in clinical practice.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: Not applicable, there is no involvement of humans or animals.</p><p>Informed consent: Not applicable, there is no human subject.</p><p>Registry and the registration no. of the study/trial: NA.</p><p>Animal studies: NA.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944949","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":"Incidence and risk stratification of caller noncompliance with dispatcher instructions for cardiopulmonary resuscitation","authors":"Keita Shibahashi,&nbsp;Norikazu Nonoguchi,&nbsp;Ken Inoue,&nbsp;Taichi Kato,&nbsp;Kazuhiro Sugiyama","doi":"10.1002/ams2.70057","DOIUrl":"https://doi.org/10.1002/ams2.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to describe the incidence of, identify risk factors for, and develop a simple risk-scoring model for cases where callers fail to follow dispatcher instructions regarding cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Tokyo Fire Department's database, cases of out-of-hospital cardiac arrest in adults where callers received dispatcher instructions regarding CPR between 1 January 2018 and 31 December 2022 were identified. Factors associated with noncompliance with CPR instructions were determined using multivariable logistic regression analysis. A simple scoring model was developed to stratify the caller noncompliance probability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 19,525 cases were included. Bystander CPR was not provided in 11,443 (58.6%) of these cases; the 1-month favorable neurological outcome rate was significantly lower in this group (1.1% vs. 2.2%, <i>p</i> &lt; 0.001). Regression analysis revealed that patient age, male patient sex, emergency call at night, cardiac arrest in the bathroom, and a familial relationship between the caller and the patient were significantly associated with noncompliance. The scoring model assigned 1 point for each of the following criteria: patient aged ≥65 years, familial relationship between the caller and the patient, and cardiac arrest in the bathroom. It also stratified caller noncompliance probability, with scores of 0, 1, 2, and 3 corresponding to probabilities of 48.0%, 50.8%, 61.3%, and 70.5%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that callers frequently did not follow dispatcher CPR instructions and identified risk factors for caller noncompliance. Furthermore, the simple scoring model developed effectively stratified the probability of caller noncompliance associated with dispatcher instructions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944948","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}