Acute Medicine & Surgery最新文献

{"title":"Clinical Impact of Initial Fluid Resuscitation in Patients With Cardiogenic Shock","authors":"Takashi Yokota,&nbsp;Kana Sugiyama,&nbsp;Seiko Hasegawa,&nbsp;Masato Naraoka,&nbsp;Katsuhiro Ito,&nbsp;Eizo Tachibana,&nbsp;Yoshio Tahara,&nbsp;Naohiro Yonemoto,&nbsp;Tetsuya Matoba,&nbsp;Tsukasa Yagi,&nbsp;Hiroyuki Hanada","doi":"10.1002/ams2.70157","DOIUrl":"https://doi.org/10.1002/ams2.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the current status of initial fluid administration in patients with cardiogenic shock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with cardiogenic shock registered in the Japanese Circulation Society Cardiovascular Shock Registry were analyzed to investigate real-world fluid resuscitation status upon hospital arrival. From this registry, patients with and without pulmonary congestion were investigated to identify differences in fluid administration. Additionally, the 30-day mortality rate between the groups was examined on the basis of the initial fluid volume administered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 586 patients with cardiogenic shock were included. Initial fluid resuscitation within 30 min after hospital arrival was administered to 568 (96.9%) patients. In multivariate logistic regression for 30-day mortality, older age, lower systolic blood pressure, and a fluid volume of 1001–2000 mL within 30 min after hospital arrival were significant predictors. The 30-day mortality rate in patients with pulmonary congestion (442 patients) was higher than that in patients without pulmonary congestion (144 patients). However, there was no difference in the 30-day mortality rate between the groups based on the initial fluid volume administered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Initial fluid administration in patients with cardiogenic shock is common practice. Although patients with pulmonary congestion had higher overall 30-day mortality, the volume of initial fluid administered after hospital arrival was not associated with worse 30-day mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753632","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 of Lamotrigine-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Coagulopathy and Altered Consciousness","authors":"Toya Hirose,&nbsp;Saeko Kohara,&nbsp;Hiroaki Takada,&nbsp;Eiju Hasegawa","doi":"10.1002/ams2.70156","DOIUrl":"10.1002/ams2.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We report a case of severe drug reaction with eosinophilia and systemic symptoms (DRESS) associated with early coagulation abnormalities following lamotrigine administration, in which aggressive treatment, including steroid pulse therapy and plasma exchange, resulted in a favorable outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 20-year-old woman with a history of epilepsy presented with fever, rash, anorexia, and cervical lymphadenopathy after initiating lamotrigine and valproate sodium treatment for seizures. Laboratory results showed thrombocytopenia, an elevated prothrombin time/international normalized ratio, and low fibrinogen, high fibrinogen degradation product, and elevated liver enzyme levels, raising suspicion of DRESS. Lamotrigine was discontinued, and fresh-frozen plasma was administered without improvement. Steroid pulse therapy and plasma exchange were initiated. The patient was diagnosed with DRESS based on a RegiSCAR (Registry of Severe Cutaneous Adverse Reaction) score of 6, indicating a definite case. Valproate sodium was reintroduced without recurrence of the DRESS. The patient's condition improved, and she was discharged after 32 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lamotrigine-induced DRESS may present with severe coagulation abnormalities early in the course of the disease. In severe cases of coagulopathy, steroid pulse therapy and plasma exchange may be considered viable treatment options.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676458","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":"Localized Endoscopic Lesions in Phlegmonous Gastritis Successfully Treated With Antibiotics Alone","authors":"Hiroshi Shimizu,&nbsp;Atsuhiro Ogawa,&nbsp;Masayuki Kanai","doi":"10.1002/ams2.70155","DOIUrl":"10.1002/ams2.70155","url":null,"abstract":"<p>A 73-year-old man with autoimmune hemolytic anemia and idiopathic neutropenia, treated with prednisolone and vonoprazan and with a history of <i>Pseudomonas aeruginosa</i> pneumonia, presented with progressive epigastric pain and shock (blood pressure 90/63 mmHg). Laboratory tests showed a C-reactive protein level of 15.7 mg/dL and a white blood cell count of 3300/μL. Contrast-enhanced computed tomography (CT) demonstrated diffuse gastric wall thickening suggestive of phlegmonous gastritis (Figure 1A). Piperacillin/tazobactam and vasopressors were initiated. Upper gastrointestinal endoscopy the following day revealed diffuse erythematous mucosa, whereas map-like ulcerations with purulent exudate were localized to the upper gastric body and fornix (Figure 1C). <i>Pseudomonas aeruginosa</i> was isolated from gastric aspirates and biopsy specimens. Follow-up CT and endoscopy showed improvement (Figure 1B,D), and he improved with antibiotics alone.</p><p>Phlegmonous gastritis is a rare, potentially life-threatening bacterial infection of the gastric submucosa. Predisposing factors include immunosuppression, hematologic disorders, mucosal injury, and hypochlorhydria related to acid-suppressive therapy [<span>1, 2</span>]. Although CT suggested diffuse involvement, endoscopy demonstrated diffuse erythema with localized suppurative ulcerative lesions. A similar endoscopic pattern has been reported in a patient successfully treated with antibiotics alone [<span>3</span>]. These observations suggest that localized suppurative mucosal lesions, together with early clinical improvement, may support conservative treatment with broad-spectrum antibiotics [<span>3, 4</span>].</p><p>Informed consent for publication, including the use of clinical images, was obtained from the patient.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676421","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 Preceding Chest CT on Functional Malpositioning of Chest Tubes in Traumatic Pneumothorax and Hemopneumothorax","authors":"Yuki Mitani,&nbsp;Mitsuaki Nishikimi,&nbsp;Junki Ishii,&nbsp;Michihito Kyo,&nbsp;Satoshi Yamaga,&nbsp;Shinichiro Ohshimo,&nbsp;Nobuaki Shime","doi":"10.1002/ams2.70154","DOIUrl":"10.1002/ams2.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It remains controversial whether the lateral or the anterior approach is optimal for chest tube insertion in patients with traumatic pneumothorax (PTH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to evaluate the incidence of functional malpositioning of chest tubes inserted via the lateral versus anterior approach in patients with traumatic pneumothorax (PTH) and/or hemopneumothorax (HPTH), with or without a preceding CT examination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a two-center, retrospective, observational study of consecutive patients treated with a chest tube for traumatic PTH/HPTH between August 2012 and September 2021. Patients were divided into two groups according to the presence or absence of CT examination before chest tube insertion: CT(+) or CT(−) group. In each group, the risk of functional malpositioning was compared between the lateral and anterior approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 388 patients, 271 patients were analyzed. The CT(+) group comprised 200 (74%) patients, while the CT(−) group comprised 71 (26%) patients. The adjusted odds ratio of functional malpositioning with the lateral approach was 1.38 (95% confidence interval 0.64–2.98, <i>p</i> = 0.41) in the CT(+) group and 9.24 (95% confidence interval 1.49–57.50, <i>p</i> &lt; 0.01) in the CT(−) group. There was a trend suggesting that the risk of functional malposition of chest tubes associated with the lateral approach, compared with the anterior approach, was modified by the presence or absence of a preceding CT examination (<i>p</i>_interaction = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The occurrence of functional malpositioning of the chest tube in patients with traumatic PTH/HPTH was higher with the lateral approach in patients without a preceding CT examination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668034","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":"Development of a Consensus-Based Checklist for Physician-Performed Prehospital Endotracheal Intubation in Japan: A Two-Round Delphi Study","authors":"Hiroaki Taniguchi,&nbsp;Kazuhiko Omori,&nbsp;Hiroki Nagasawa,&nbsp;Hiromichi Ohsaka,&nbsp;Youichi Yanagawa,&nbsp;Yutaka Kondo","doi":"10.1002/ams2.70153","DOIUrl":"10.1002/ams2.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prehospital endotracheal intubation (ETI) is a high-risk, multicomponent procedure that requires standardized preparation, team coordination, and rescue planning. In Japan, however, no national protocol exists for physician-performed ETI, and practice remains inconsistent despite recognition of appropriate care. Within the development phase of complex intervention research, this study aimed to develop a consensus-based checklist for physician-performed prehospital ETI in Japan using a Delphi process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A two-round Delphi survey was conducted among experienced physicians involved in physician-staffed prehospital care in Japan. Candidate items were developed from the literature and organized according to the workflow of prehospital ETI. Participants rated each item using a 4-point Likert scale, and consensus was defined as ≥ 70% agreement. Consensus items were subsequently summarized into a practical checklist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty experts participated in Round 1 (response rate, 69%). All completed Round 2. Consensus increased from 72 of 90 items (80%) in Round 1 to 76 of 80 items (95%) in Round 2 after item refinement. Agreement was high for preparation, monitoring, and confirmation. In contrast, context-dependent items, such as patient relocation and medication choices, showed lower agreement. The final items were integrated into an eight-domain checklist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This Delphi study developed a proposed consensus-based checklist for physician-performed prehospital ETI in Japan. As a consensus-building step within the development phase of a complex intervention, the checklist identifies core procedural elements while allowing for local operational variation. Future studies should assess feasibility, adherence, and clinical impact in real-world prehospital settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597592","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":"Clinical Course of Pediatric Versus Adult Mamushi (Gloydius blomhoffii) Envenomation: A Secondary Analysis of the OROCHI Study","authors":"Hiroyuki Nawata,&nbsp;Kotaro Kaneda,&nbsp;Ryo Ayata,&nbsp;Tomoaki Inoue,&nbsp;Yasutaka Koga,&nbsp;Takeshi Yagi,&nbsp;Masaki Todani,&nbsp;Motoki Fujita,&nbsp;Ryosuke Tsuruta","doi":"10.1002/ams2.70151","DOIUrl":"10.1002/ams2.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Mamushi (<i>Gloydius blomhoffii</i>) bite is the most common type of snakebite in Japan. However, clinical information on pediatric patients remains limited. This study aimed to clarify the clinical characteristics of pediatric cases of mamushi envenomation by making comparisons with adult cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This secondary analysis used data from the OROCHI study, a multicenter prospective observational study conducted at 24 hospitals in Japan, of patients hospitalized for confirmed or suspected mamushi envenomation. The primary outcome was hospital stay. Secondary outcomes included adverse events, pain scores, and the grade of swelling. Patients were classified into pediatric (&lt; 18 years) and adult (≥ 18 years) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 106 patients enrolled in the OROCHI study, 99 met the inclusion criteria for this analysis (7 pediatric cases; 92 adult cases). There was no significant difference in median (interquartile range) hospital stay between the pediatric and adult groups (4 days; <i>p</i> = 0.375). Among patients who received antivenom, no adverse reactions were observed in the pediatric group, whereas four adults experienced adverse reactions, including one case of anaphylaxis. The pain scores at antivenom administration were higher in pediatric patients (median 10 vs. 5), but no significant differences were observed after 6 h. The grade of swelling did not differ significantly between the groups at any time point.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The clinical course and outcomes of pediatric patients with mamushi envenomation appear similar to those of adult patients. Further accumulation of pediatric cases is warranted to strengthen these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583260","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":"Outcomes and Risk Factors for In-Hospital Mortality in Mild-to-Moderate Trauma Patients: A Nationwide Observational Study","authors":"Shogo Takashima,&nbsp;Kazuma Yamakawa,&nbsp;Ryo Yamamoto,&nbsp;Akira Endo,&nbsp;Noritaka Ushio,&nbsp;Ryo Hisamune,&nbsp;Tomonobu Nishii,&nbsp;Akira Takasu","doi":"10.1002/ams2.70145","DOIUrl":"10.1002/ams2.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although minor (mild-to-moderate) trauma generally leads to favorable outcomes, some patients experience in-hospital mortality. Traditional trauma severity scores alone may not sufficiently reflect the prognostic variability in aging populations with comorbidities. This study examined the associations between patient characteristics and in-hospital mortality among patients with minor trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used data from adult patients with minor trauma, defined by an Injury Severity Score (ISS) &lt; 16 from the Japan Trauma Data Bank. A logistic regression analysis was performed to evaluate associations between mortality and patient characteristics, including age, sex, ISS, and the Charlson Comorbidity Index (CCI) score. Subgroup analyses were conducted among patients with moderate trauma (ISS 9–15) to examine the associations between the Abbreviated Injury Scale (AIS) scores of injuries at three specific anatomical regions and in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After applying the exclusion criteria, of the 56,821 patients with ISS &lt; 16 identified in the Japan Trauma Data Bank, 50,087 were included in the final analysis. The logistic regression analysis identified older age, male sex, ISS ≥ 9, and higher CCI scores as independent predictors of in-hospital mortality. In patients with moderate trauma, the AIS scores of injuries involving the three regions (head/neck, abdomen, and external/other trauma injury regions) were significantly associated with increased mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among patients with minor trauma, advanced age, male sex, comorbidities, and specific injury regions were associated with increased in-hospital mortality. These findings highlight the importance of early risk recognition and tailored clinical management in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576662","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 Artificial Intelligence Assistance on Diagnosing Traumatic Pneumothorax: A Comparison of Specialist and Non-Specialist Emergency Physicians","authors":"Keisuke Suzuki,&nbsp;Kaede Hiruma,&nbsp;Kazuyuki Miyamoto,&nbsp;Miho Saeki,&nbsp;Takahiro Kanai,&nbsp;Yoshitaka Tomita,&nbsp;Kazuki Kikuchi,&nbsp;Gen Inoue,&nbsp;Yuki Kaki,&nbsp;Masaharu Yagi,&nbsp;Jun Sasaki,&nbsp;Kenji Dohi","doi":"10.1002/ams2.70149","DOIUrl":"https://doi.org/10.1002/ams2.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Supine chest radiography is routinely used in trauma care; however, its sensitivity is limited in pneumothorax detection. Although artificial intelligence (AI) has recently been introduced as a diagnostic support tool for chest radiograph interpretation, its use in trauma radiographs and its interaction with physician experience remain unclear. We aimed to evaluate the diagnostic performance of AI-assisted image interpretation in traumatic pneumothorax detection among emergency medicine specialists and non-specialists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective single-center study, 34 supine chest radiographs (17 pneumothorax and 17 non-pneumothorax cases confirmed with computed tomography) were interpreted by 20 emergency medicine physicians (10 specialists and 10 non-specialists). Each participant reviewed all radiographs twice: first without AI assistance and then with AI assistance after a 2-week washout period. Sensitivity, specificity, accuracy, and precision were calculated. To account for clustering of observations within readers and cases, mixed-effects logistic regression analysis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AI assistance significantly improved sensitivity and diagnostic accuracy across participants, whereas specificity and precision were not significantly affected. Specialists demonstrated higher baseline sensitivity and accuracy than non-specialists. In the mixed-effects logistic regression analysis, AI assistance was independently associated with improved diagnostic accuracy (odds ratio 2.37, <i>p</i> &lt; 0.001). Additionally, the interaction between AI assistance and physician specialist status was significant (<i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI-assisted interpretation of supine chest radiographs is a potentially useful decision-support tool for detecting traumatic pneumothorax in emergency settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467606","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":"Early Oral/Enteral Feeding and Rehabilitation Are Associated With Lower PIICS Incidence: A Propensity Score-Matched Single Center Study","authors":"Kazuhiro Yoneda,&nbsp;Takeshi Ebihara,&nbsp;Hajime Nakajima,&nbsp;Kensuke Minami,&nbsp;Jun Oda","doi":"10.1002/ams2.70148","DOIUrl":"https://doi.org/10.1002/ams2.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is a pathophysiological condition that may underlie poor long-term outcomes after critical illness. We investigated whether the early combined initiation of oral/enteral feeding and rehabilitation is associated with the development of PIICS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We Retrospectively Analyzed Patients Admitted to the Emergency ICU of Osaka University Hospital During 2016–2024. PIICS Was Diagnosed on Hospital Day 14 (±3 Days) Based on CRP &gt; 2.0 mg/dL, Lymphocytes &lt; 800/μL, and Albumin &lt; 3.0 g/dL, With ≥ 2 of 3 Criteria Required for Diagnosis. Early Combined Intervention Was Defined as Oral/Enteral Feeding Initiation Within 3 Days and Rehabilitation Within 7 Days of ICU Admission. Missing SOFA Scores (45.3%) Were Multiply Imputed by Predictive Mean Matching (m = 50). Propensity Score Matching Was Performed Within Each Imputed Dataset Using a Within-Imputation Approach, With Estimates Pooled Using Rubin's Rules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5709 ICU Patients, 2860 Were Eligible for the Primary Analysis. Early Combined Intervention Was Initiated in 348 (12.2%). Propensity Score Matching Generated an Average of 347 Pairs Per Imputed Dataset (Range: 333–348). Early Combined Intervention Was Associated With Lower PIICS Incidence (OR = 0.481, 95% CI 0.337–0.686, <i>p</i> &lt; 0.001). Significance Was Retained in the Sensitivity Analysis Restricted to Patients With Observed SOFA Scores (Complete-Case Analysis, <i>n</i> = 1512; OR = 0.533, 95% CI 0.340–0.836, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early combined initiation of oral/enteral feeding and rehabilitation was associated with lower PIICS incidence in critically ill patients, suggesting the value of integrated multimodal supportive care for PIICS prevention and providing a rationale for prospective multicenter studies to establish causality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467367","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":"Author's Reply: A Machine Learning Model for Predicting Short-Term Outcomes After Rapid Response System Activation","authors":"Takaki Naito,&nbsp;Shigeki Fujitani","doi":"10.1002/ams2.70143","DOIUrl":"https://doi.org/10.1002/ams2.70143","url":null,"abstract":"&lt;p&gt;We thank the authors for their insightful comments regarding our article, “A machine learning model for predicting short-term outcomes after rapid response system activation.” We appreciate the opportunity to address their concerns.&lt;/p&gt;&lt;p&gt;We agree that longitudinal trends can enhance predictive performance. However, as our retrospective study utilized an existing multicenter registry, temporal granularity was limited. We intentionally focused on whether data available at the exact moment of RRS activation could predict outcomes. This approach aims to support bedside decisions in environments where real-time, time-series analysis is technically challenging. Our team has previously reported on the importance of temporal trajectories [&lt;span&gt;1&lt;/span&gt;], and we consider their integration a priority for future models.&lt;/p&gt;&lt;p&gt;We fully agree that model interpretability is a critical factor for successful implementation in clinical practice. Our feature importance analysis confirmed that the key predictors aligned with clinical intuition. We recognize that a key future task is to optimize the model to provide specific rationales for individual predictions to enhance clinician trust. Furthermore, machine learning models may detect subtle features that are not yet apparent to humans, potentially allowing for the identification of clinical deterioration at a very early stage [&lt;span&gt;2&lt;/span&gt;]. Therefore, beyond making models more interpretable, it is indispensable for future clinical implementation to foster “artificial intelligence (AI) literacy” among clinicians, enabling them to deeply understand and complementarily utilize the characteristics of AI-detected signs.&lt;/p&gt;&lt;p&gt;As acknowledged in our limitations section, the scope of this study was constrained by its specific sample size and registry. The concern that a model trained in a single country may not be directly applicable to other healthcare environments as a universal model is well-founded. Nonetheless, it serves as a crucial proof-of-concept for integrating AI into the RRS context. Furthermore, we propose an alternative to universal models: in an era of accessible machine learning tools, individual facilities can fit customized models to their unique clinical environments. Regardless of the developmental approach, we fully agree that prospective validation to evaluate actual clinical impact is the most critical next step.&lt;/p&gt;&lt;p&gt;The insights provided are invaluable for the evolution of our research. While this study represents an initial step with inherent limitations, we remain committed to refining these models through longitudinal data integration, explainable AI, and prospective validation.&lt;/p&gt;&lt;p&gt;The authors have nothing to report.&lt;/p&gt;&lt;p&gt;S.F. reported receipt of grants from Nihon Kohden outside the submitted work. T.N. reported honoraria for lectures from Nihon Kohden, Sompo Risk Management Inc. outside the submitted work. No other disclosures were reported.&lt;/p&gt;&lt;p&gt;The authors have nothing to rep","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467456","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}