Archives of Academic Emergency Medicine最新文献

{"title":"Associated Factors of the Need for Mechanical Ventilation Following Traumatic Injuries; a Registry-Based Study on 2,708 Cases in Iran.","authors":"Zahra Ramezani, Vali Baigi, Mohammadreza Zafarghandi, Vafa Rahimi-Movaghar, Reza Farahmand-Rad, Akram Zolfaghari Sadrabad, Seyed-Mohammad Piri, Mahgol Sadat Hassan Zadeh Tabatabaei, Khatereh Naghdi, Payman Salamati","doi":"10.22037/aaemj.v13i1.2511","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2511","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic injuries can affect respiration both directly and indirectly. This study aimed to evaluate the predictive factors of need for mechanical ventilation (MV) following traumatic injuries.</p><p><strong>Methods: </strong>This Retrospective registry-based cross-sectional study comprised trauma patients admitted to a major referral trauma center in Iran, from March 28, 2019, to January 31, 2023, identified within the National Trauma Registry of Iran (NTRI). Logistic regression analysis was used to assess the association between demographic and clinical variables with the need for MV.</p><p><strong>Results: </strong>A total of 2708 trauma patients with a mean age of 41.79 ± 21.84 (range:1-98) years were included (73.4% male). A total of 251 (9.3%) patients were admitted to the Intensive Care Unit (ICU); 113 (4.2%) experienced MV. The significant associated factors of need for MV based on the univariable analysis were age ≥ 65 years (p <0.001); penetrating trauma (p < 0.001) and falling (p = 0.01); private mode of transportation to ED (p < 0.001); site of injury (p < 0.001); heart rate ≥ 100/ minutes (p = 0.04); O2 saturation < 90 % on room air (p < 0.01); Glasgow Coma Scale (GCS) < 13 (p< 0.001); and injury Severity Score (ISS) ≥ 9 (p< 0.001). Based on the multivariate logistic regression analysis, the independent predictors of the need for MV in trauma patients were the site of injury (p < 0.001), GCS < 13 (p < 0.001), and ISS ≥ 9 (p < 0.001).</p><p><strong>Conclusion: </strong>Based on the findings, ISS ≥ 9, GCS < 13, and site of injury were among the independent predictors of the need for MV following trauma.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e34"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539850","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":"Accuracy of Lung Ultrasonography for Diagnosis of Heart Failure; a Systematic Review and Meta-analysis.","authors":"Erfan Rahmani, Masoud Farrokhi, Mehrdad Farrokhi, Shadi Nouri, Atousa Moghadam Fard, Behnam Hoorshad, Ramin Atighi, Erfan Ghadirzadeh, Michael Tajik, Habibollah Afshang, Aida Naseri, Mohadeseh Asoudehfard, Shiva Samami Kojidi, Arsham Ebnemehdi, Mehdi Rezaei, Maziar Daneshvar, Amirali Makhmalbaf, Sepideh Hassanpour Khodaei, Shirin Farsi, Saber Barazandeh Rad, Fateme Nozari, Pouya Rezaei, Negar Babapour, Salman Delavar, Babak Goodarzy, Lida Zare Lahijan, Sanam Mohammadzadeh, Helena Mehran, Fatemeh Gheibi, Ramtin Shemshadigolafzani, Behnaz Dalvandi, Amir Abderam","doi":"10.22037/aaemj.v13i1.2555","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2555","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the evident impact of ultrasonography on diagnosis in acute care settings, there is still a great deal of uncertainty regarding its accuracy. This study aimed to assess the diagnostic performance of lung ultrasonography (LUS) for the identification of acute heart failure in patients with suggestive manifestations.</p><p><strong>Methods: </strong>Medline, Scopus, and Web of Science were comprehensively searched from their inception to November 2024 to identify original studies investigating accuracy of LUS for diagnosis of heart failure. Data extraction and quality assessment were performed by two independent reviewers. The statistical analysis for pooling the results of diagnostic performance parameters was conducted using Stata and Meta-DiSc softwares.</p><p><strong>Results: </strong>Thirty-eight included studies in this meta-analysis were published between 2006 and 2024, encompassing a total of 6,783 patients. There was significant heterogeneity between included studies with respect to sensitivity (I²=92.51 and P<0.01) and specificity (I²=93.79 and P<0.01). The pooled sensitivity, specificity, and accuracy of LUS for detection of heart failure were 0.92 (95% CI, 0.87-0.95), 0.90 (95% CI, 0.86-0.93), and 0.96 (95% CI, 0.94-0.98), respectively. In addition, pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 7.87 (95% CI, 5.60-11.07), 0.14 (95% CI, 0.10-0.19), and 70.74 (95% CI, 41.98-119.21), respectively.</p><p><strong>Conclusion: </strong>Our meta-analysis demonstrates that LUS is a highly practical imaging for diagnosing acute heart failure, with excellent sensitivity, specificity, and accuracy. It is particularly valuable for excluding the heart failure when the result is negative. However, the influence of outlier and influential studies warrants caution, and future studies should aim to further validate these findings in diverse clinical contexts.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e33"},"PeriodicalIF":2.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539906","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":"Point-of-Care Testing (POCT) for Blood Gas and Electrolyte Analysis in Out-of-Hospital Cardiac Arrests' Management; a Cross-sectional Study.","authors":"Welawat Tienpratarn, Chaiyaporn Yuksen, Lunlita Chukaew, Chetsadakon Jenpanitpong, Chavin Triganjananun, Suteenun Seesuklom","doi":"10.22037/aaemj.v13i1.2590","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2590","url":null,"abstract":"<p><strong>Introduction: </strong>Hypokalemia, hyperkalemia, and acidosis are among the reversible causes of out-of-hospital cardiac arrest (OHCA) that can be promptly identified using point-of-care testing (POCT) for blood gas and electrolyte analysis. This study aimed to evaluate the efficacy of POCT in the prehospital setting for OHCA management.</p><p><strong>Methods: </strong>In this cross-sectional study the management and outcomes of OHCA patients were compared before and after implementing the POCT for blood gas and electrolyte analysis by EMS in the prehospital setting of Ramathibodi Hospital, Thailand.</p><p><strong>Results: </strong>217 OHCA patients with a mean age of 61 ± 17.07 (range: 58.72-63.28) years were studied (64.06 % male). 148 (68.2%) patients received POCT in the prehospital setting. Patients in the POCT group received higher administration of sodium bicarbonate (p < 0.001) and calcium gluconate (p < 0.001) compared to those without POCT. Sustained ROSC was achieved in 25% of the POCT group, compared to 11.59% in the no POCT group (p = 0.030). POCT blood gas analysis was identified as an independent predictor of sustained ROSC based on multivariable analysis (adjusted Odds: 4.60, 95% CI: 1.35-15.69; p = 0.015).</p><p><strong>Conclusions: </strong>It seems that POCT for blood gas and electrolyte analysis in the prehospital setting could improve sustained ROSC in OHCA patients by enabling rapid and targeted management of cardiac arrest's reversible causes.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e32"},"PeriodicalIF":2.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539941","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":"Application of Refill, Recoil, Rebound (3R) as a Novel Chest Compression Technique in Cardiopulmonary Resuscitation; Report of Two Cases.","authors":"Georgia Tsoungani, Sayed Nour","doi":"10.22037/aaemj.v13i1.2447","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2447","url":null,"abstract":"<p><p>Cardiopulmonary resuscitation (CPR) remains controversial with dismal outcomes for cardiac arrest (CA) victims. Inadequate organ perfusion and frequent CPR-related trauma most likely occur due to inappropriate adaptation to hemostatic conditions, electrophysiology, cardiotorsal anatomy, and thoracic biomechanics. Alternatively, we propose a new technique compromising chest compressions through the 5^th intercostal space while placing the victim in the left lateral decubitus position with wrapped abdomen and raised legs, allowing to: bypass the sternal barrier, <i>refill</i> the heart, and then <i>recoil</i>-<i>rebound</i> the chest (3R /CPR), within the axis of the cylindrical ribcage. Our goal is to evaluate the technique following its necessary application on two drowning victims. It seems that, 3R/CPR adapts the pathophysiological conditions of CA victims promoting a less traumatic return of spontaneous circulation (ROSC), making it worthy of further investigation and study.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e30"},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539844","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":"Neurological Crisis Following Intravenous Ozone Therapy; a Case Report.","authors":"Chloe Y Y Wong, Komal Saxena, John Meneer, Koshy George, Gerben Keijzers","doi":"10.22037/aaemj.v13i1.2592","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2592","url":null,"abstract":"<p><p>Ozone therapy, often marketed as an immune-boosting alternative treatment, lacks robust evidence of efficacy and poses significant safety risks. Despite claims of therapeutic benefits, Regulatory agencies, such as the U.S. Food and Drug Administration (FDA), warn against its use due to its toxic properties and lack of proven benefits at tolerable exposure levels. This case report highlights severe neurological complications, including ischemic infarcts and persistent cognitive deficits, following intravenous ozone (O₃) therapy in a previously healthy patient. A 36-year-old woman presented to the emergency department with chest pain, syncope, and generalized seizure shortly after receiving intravenous ozone therapy. Diagnostic imaging revealed multiple ischemic infarcts in the thalamus and cerebellum, consistent with an embolic event. The patient required intensive care unit (ICU) admission, and despite improved neurological function experienced lasting cognitive impairments necessitating long-term rehabilitation.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e31"},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539982","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":"Care Complexity Factors and Discharge Destination in an Emergency Department: A Retrospective Cohort Study.","authors":"Andrea Urbina, Jordi Adamuz, Maria-Eulàlia Juvé-Udina, Judith Peñafiel-Muñoz, Virginia Munoa-Urruticoechea, Maribel González-Samartino, Pilar Delgado-Hito, Javier Jacob, Marta Romero-García","doi":"10.22037/aaemj.v13i1.2517","DOIUrl":"10.22037/aaemj.v13i1.2517","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department discharge destination is an important topic in both clinical practice and management. This study aimed to analyze the association of Care Complexity Individual Factors (CCIFs) with discharge destinations in patients who visit the emergency department (ED).</p><p><strong>Methods: </strong>This is a retrospective cohort study with consecutive sampling, including all patients who visited the ED of a tertiary hospital during 2021-2022. Data were collected from electronic health records. The main study outcomes were discharge destinations (mortality, intensive care unit admission, hospitalization, left without being seen/discharge against medical advice, and home discharge) and 26 CCIFs. Independent multinomial logistic regression was used for assessing the association of each factor and the discharge destinations, adjusted for age, sex, and triage level. All analyses were performed with R, version 4.3.2.</p><p><strong>Results: </strong>A total of 35,383 patients were included. Of these, 60.8% were home discharged, 34.1% were hospitalized, 2.6% were transferred to the intensive care unit, 2.1% were left without being seen, and 0.4% died. The presence of CCIFs was a risk factor of ED mortality (odds ratio (OR): 13.49 [95% confidence interval (CI): 4.99;36.46]), intensive care unit admission (OR:1.26 [95%CI:1.08;1.47]), and hospitalization (OR: 1.62 [95%CI:1.53;1.71]), whilst the presence of care complexity factors was a protective factor of discharge against medical advice (OR:0.64 [95%CI:0.55;0.74]).</p><p><strong>Conclusion: </strong>The discharge destinations from the ED showed strong associations with the patient's complexity factors. Health professionals should consider these relationships for the design of early detection strategies and as an aid in decision-making, to ensure equity and quality of care.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e27"},"PeriodicalIF":2.9,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432235","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 Factors of Surgical Site Infection After Knee Arthroplasty; a Systematic Review and Meta-Analysis.","authors":"Ayub Bagheri, Alireza Sharifi Niknafs, Bahar Farhadi, Seyed Amirhossein Mazhari, Parnia Karimian, Nafiseh Hekmati Pour, Hamid Hojjati, Iman Nosratabadi, Azadeh Emami, Reza Salehi","doi":"10.22037/aaemj.v13i1.2543","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2543","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infection (SSI) constitutes a substantial complication after knee arthroplasty, contributing to notable morbidity. This study aimed to review the existing literature on the incidence and risk factors of SSI following knee arthroplasty.</p><p><strong>Methods: </strong>A systematic search was undertaken across various international electronic databases, including Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and the Scientific Information Database. The search strategy involved the use of keywords derived from Medical Subject Headings, such as \"incidence\", \"Surgical wound infection\", \"Surgical site infection\", and \"Arthroplasty\", covering records from the earliest available up to March 17, 2024.</p><p><strong>Results: </strong>The study incorporated a collective participant group of 1,366,494 knee arthroplasty procedures from twenty-three chosen studies. The pooled incidence rate of SSI after knee arthroplasty was 1.7% (95% confidence interval (CI): 1.1% to 2.6%; I²=99.687%; P<0.001). The Odds Ratio (OR) for the incidence of SSI in males was observed to be significantly higher than that in females (OR: 1.617; 95% CI: 1.380 to 1.894; Z=5.951; P<0.001). The pooled incidence of SSI among diabetic patients was 1.3% (95% CI: 0.6% to 2.8%; I²=99.126%; P<0.001).</p><p><strong>Conclusion: </strong>Based on the main findings, SSIs continue to be a significant complication of knee arthroplasty, with an incidence of 1.1% to 2.6%. Male gender and diabetes mellitus were associated with an augmented probability of SSIs following knee arthroplasty.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e28"},"PeriodicalIF":2.9,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539888","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":"Optic Nerve Sheath Diameter in Predicting the Neurological Outcomes of Cardiac Arrest Survivors: A Systematic Review and Meta-analysis.","authors":"Parisa Jafari Khouzani, Erfan Rahmani, Mehdi Rezaei, Sasan Pohrbagher Benam, Atousa Moghadam Fard, Reza Amani-Beni, Maziar Daneshvar, Faezeh Jalayer Sarnaghy, Naghme Masoomi Goodarzi, Ramila Abedi Azar, Amirhossein Mirbolook, Peyman Bashghareh, Elham Bibak, Babak Goodarzi, Zahra Salarinezhad, Reza Zahedpasha, Marzieh Hajizaman, Negar Pourhossein Rahmani, Azam Darvishi, Alireza Hadizadeh, Fatemeh Zandi, Ashkan Azizi, Armin Naderi, Sepideh Shah Hosseini, Asie Sanjary, Mozhdeh Mohammadi Visroudi, Habibollah Afshang, Seyedsaber Mirabdali, Navid Fathalian, Pouria Momeni, Mahsan Valizadeh, Fateme Nozari, Hamed Ghorbani, Sanam Mohammadzadeh, Seyed Kiavash Sajadi, Azam Abdollahi, Mehrdad Farrokhi","doi":"10.22037/aaemj.v13i1.2486","DOIUrl":"https://doi.org/10.22037/aaemj.v13i1.2486","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have investigated different methods for estimating neurological outcomes after cardiac arrest. However, there is still much uncertainty about using optic nerve sheath diameter (ONSD) measurement as an indirect method for predicting neurological outcomes following cardiac arrest. In this meta-analysis, we aimed to investigate the value of ONSD for predicting the neurological outcomes of cardiac arrest survivors.</p><p><strong>Methods: </strong>We comprehensively performed a systematic search in three main electronic databases, including Scopus, Medline, and Web of Science Cochrane, from inception to August 2024. Based on the heterogeneity evaluation results, fixed or random effects models were used to estimate the pooled diagnostic parameters. Meta-regressions were performed for subgroup analysis.</p><p><strong>Results: </strong>The pooled sensitivity and specificity of ONSD for predicting the neurological outcomes were 0.56 (95% CI, 0.35-0.74) and 0.92 (95% CI, 0.85-0.96), respectively. Meta-regression revealed that as the cutoff level of ONSD increases, the sensitivity significantly decreases (P < 0.01), while the specificity significantly increases (P = 0.01). Furthermore, meta-regression analysis revealed that ONSD measurement using CT scans is significantly associated with lower sensitivity and higher specificity compared to ultrasound (P = 0.009 and P = 0.01).</p><p><strong>Conclusion: </strong>Our meta-analysis showed that ONSD has low sensitivity and high specificity for predicting neurological outcomes in survivors of cardiac arrest. However, since the cut-off values and methods of ONSD measurement affect its predictive performance, further studies will be required to standardize these factors to achieve optimal predictive parameters.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e29"},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539984","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":"Urinary Liver-Type Fatty Acid Binding Protein (L-FABP) in Early Detection and Outcome Prediction of Sepsis-Associated Acute Kidney Injury.","authors":"Ghi Nguyen Hai, Binh Nguyen Gia, Hoa Do Thanh, Cuong Nguyen Thai, Duc Vu Anh, Anh Duong Duc, Duong Le Xuan","doi":"10.22037/aaemj.v13i1.2525","DOIUrl":"10.22037/aaemj.v13i1.2525","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is one of the most frequent complications in septic shock cases, and has a high mortality rate. The aim of this study was to determine the value of urinary liver-type fatty acid binding protein (L-FABP) in early detection and outcome prediction of AKI in patients with sepsis and septic shock.</p><p><strong>Methods: </strong>This prospective cohort study was conducted on patients who presented to the emergency department (ED) with sepsis or septic shock. Urinary L-FABP levels were measured at the time of admission and patients were classified into AKI and non-AKI groups within 7 days according to the KIDGO Criteria. The screening performance characteristics of urinary L-FABP in early detection of AKI within seven days of admission and need for renal replacement therapy (RRT) were calculated and reported.</p><p><strong>Results: </strong>212 patients with the mean age of 66.5 ± 16.2 (range 18-99) years were included (60.4% male). 54 (25.5%) patients had sepsis, and septic shock was developed in 158 (74.53%) cases. 143 (67.5%) patients were complicated with AKI. The area under the receiver operating characteristic (ROC) curve (AUC) of urinary L-FABP in early detection of sepsis-associated AKI was 0.94 (95% confidence interval (CI): 0.90 - 0.97), compared to the AUC of 0.64 (95% CI: 0.54-0.74) for serum creatinine. The sensitivity and specificity of urinary L_FABP at its best cutoff point (13.90 μg L-FABP/g Cr) were 89.9% and 86.3%, respectively. The area under the ROC curve of urinary L-FABP in predicting the need for RRT in sepsis-associated AKI patients was 0.74 (95% CI: 0.64-0.85), compared to the AUC of 0.53 (95% CI: 0.41-0.64) for serum creatinine. The sensitivity and specificity of urinary L-FABP at its best cutoff point (22.05 μg L-FABP/g Cr) were 63.6% and 71.4%, respectively.</p><p><strong>Conclusions: </strong>It seems that, L-FABP could be considered as a valuable biomarker for early detection and predicting the severity of AKI in septic patients.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e26"},"PeriodicalIF":2.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432151","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":"Modified National Early Warning Scores (MNEWS) for Predicting the Outcomes of Suspected Sepsis Patients; A Prospective Cohort Study.","authors":"Nipon Diskumpon, Busabong Ularnkul, Winchana Srivilaithon, Pariwat Phungoen, Kiattichai Daorattanachai","doi":"10.22037/aaemj.v13i1.2407","DOIUrl":"10.22037/aaemj.v13i1.2407","url":null,"abstract":"<p><strong>Introduction: </strong>The National Early Warning Score (NEWS) is commonly used to identify patients at high mortality risk. However, it has notable limitations. In this study, to enhance the accuracy, we revised it and evaluated the performance of modified NEWS (MNEWS) in predicting the outcomes of suspected sepsis patients.</p><p><strong>Methods: </strong>This single-center, prospective cohort study was conducted on patients with suspected sepsis to evaluate the accuracy of MNEWS in predicting mortality, survival to discharge, vasopressor requirements, and the need for mechanical ventilation. The MNEWS comprises the NEWS variables plus age, chronic major organ dysfunction, malignancy, functional status, and specific infected organ involvement. Sensitivity, specificity, likelihood ratio (LR), and area under the receiver operating characteristic curve (AUROC) were used to evaluate the performance of the MNEWS in predicting the studied outcomes.</p><p><strong>Results: </strong>Of the 1,393 patients included in this study, 209 died. Mean MNEWS was significantly higher in non-survivors than survivors (19.8 vs. 14.9, p<0.001). The AUROC of MNEWS in predicting 30-day mortality was 0.82 (95% CI: 0.79-0.85). MNEWS ≥ 18 had the highest accuracy for 30-day mortality prediction with 76.1% sensitivity, 75% specificity, positive LR of 3.13, and AUROC of 0.76 (95% CI: 0.73-0.79). The AUROC of MNEWS ≥18 for predicting survival until discharge, need for vasopressors, and need for mechanical ventilation were 0.75 (95% CI: 0.72-0.78), 0.72 (95% CI: 0.69-0.75), and 0.76 (95% CI: 0.73-0.79), respectively. Additionally, MNEWS ≥18 demonstrated superior predictive performance, compared with NEWS ≥7 and qSOFA ≥2 for various clinical outcomes.</p><p><strong>Conclusions: </strong>The MNEWS was similar to the NEWS in overall predictive accuracy for 30-day mortality but exhibited a higher predictive accuracy than did the qSOFA score. Notably, MNEWS ≥18 was a significant indicator of 30-day mortality risk, as well as the likelihood of requiring vasopressors, survival to discharge, and 7-day mortality.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"13 1","pages":"e24"},"PeriodicalIF":2.9,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432144","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}