Archives of Academic Emergency Medicine最新文献

{"title":"Diagnostic Accuracy of the ACT-FAST Tool for Prehospital Stroke Identification: A Systematic Review.","authors":"Mobina Yarahmadi, Mohammadhossein Vazirizadeh-Mahabadi, Pantea Gharin, Paniz Gharin, Arash Sarveazad, Nastaran Sadat Mahdavi, Mahmoud Yousefifard","doi":"10.22037/aaem.v14i1.2879","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.2879","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is the second leading cause of death globally, resulting in 5.5 million deaths annually. The ACT-FAST is a simplified, rapid assessment tool aimed at improving the early detection of stroke and may outperform existing tools in identifying large vessel occlusions (LVOs). We aimed to assess the diagnostic accuracy of this tool in this systematic review.</p><p><strong>Methods: </strong>In this systematic review, we conducted a comprehensive search of Medline, Scopus, Web of Science, and Embase. Studies with incomplete data reporting or those focusing on other triage tools were excluded. Two independent reviewers screened titles, abstracts, and full texts, and extracted relevant data using a pre-designed checklist.</p><p><strong>Results: </strong>Our systematic review identified four studies on the ACT-FAST tool, all conducted primarily in Australia with a predominantly elderly patient population. Reported findings indicate that ACT-FAST has demonstrated generally high diagnostic performance, with retrospective analyses showing accuracies above 90%. Sensitivity varied across study designs, ranging from 63% to 100%, while specificity was consistently reported above 85%. Despite concerns regarding potential bias from non-random patient selection and incomplete reporting of symptom onset, the overall methodological quality was robust.</p><p><strong>Conclusion: </strong>The ACT-FAST algorithm demonstrates generally high, though variable, sensitivity and consistently high specificity, supporting its utility as a valuable tool for paramedics and clinicians in prehospital stroke management and for effectively identifying patients with LVO. This capability facilitates timely intervention, minimizes unnecessary transfers for patients without LVO, and optimizes resource allocation, ultimately improving patient outcomes in stroke care.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e30"},"PeriodicalIF":2.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787292","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":"Explainable Artificial Intelligence in Non-Contrast Brain Computed Tomography Scan for Intracerebral Hemorrhage: A Scoping Review.","authors":"Hamed Ghorani, Seyedeh Toktam Masoumian Hosseini, Matin Noroozi, Mohammad Hossein Imani, Iman Kiani, Nastaran Sadat Mahdavi, Soleiman Ahmady","doi":"10.22037/aaem.v14i1.2997","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.2997","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI) models applied to non-contrast brain computed tomography (CT) scan have demonstrated promising performance in hematoma detection, segmentation, and outcome prediction. Explainable artificial intelligence (XAI) has been proposed as a strategy to improve transparency and facilitate clinical integration. This study aimed to map and summarize XAI methods used in CT scan-based studies of intracranial hemorrhage (ICH), and to assess their validation approaches, transparency, and clinical relevance.</p><p><strong>Method: </strong> The scoping review was conducted in accordance with the PRISMA-ScR guidelines and was registered on the Open Science Framework (osf.io/5kxbt). In this review, original studies of adult and pediatric patients with spontaneous ICH that used AI or deep learning on non-contrast brain CT scan and included an explainability or interpretability method were eligible. Reviews, editorials, conference abstracts without full text, and studies without XAI components were excluded. PubMed, Embase, and Scopus were searched from inception to September 2025. Data were extracted on study design, imaging inputs, AI task, explainability technique, validation strategy, and reported clinical relevance.</p><p><strong>Results: </strong>A total of twelve studies met inclusion criteria. Most investigations focused on hematoma detection, segmentation, or prediction of functional outcome or mortality. Gradient-based visualization techniques, particularly Grad-CAM and saliency maps, were the most commonly used explainability approaches. XAI outputs predominantly highlighted hematoma regions and perihematomal tissue; however, reporting and interpretation of explainability varied substantially across studies. External validation was infrequent, and few studies formally assessed alignment between XAI outputs and established radiological or clinical reasoning. The evidence was small, heterogeneous, and largely retrospective, with inconsistent reporting of explainability quality and limited external validation.</p><p><strong>Conclusion: </strong>Explainable AI applied to non-contrast brain CT scan in ICH cases, is an evolving field with growing methodological diversity but limited standardization. While XAI techniques offer potential to enhance transparency and clinician confidence, current evidence remains insufficient to support routine clinical implementation. Future studies should emphasize standardized reporting, external validation, and clinically grounded evaluation of explainability outputs.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e31"},"PeriodicalIF":2.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787366","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":"Nano-Formulated Apelin13 Reduces Cerebral Ischemia/Reperfusion Injury in Rats by Suppressing Activity of TLR4/MyD88/NF-кB Axis and Pro-inflammatory Cytokines; an Experimental Study.","authors":"Elham Kashafi Jahromi, Solmaz Nasseri Maleki, Michael R Hamblin, Fatemeh Ramezani, Nahid Aboutaleb","doi":"10.22037/aaem.v14i1.2941","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.2941","url":null,"abstract":"<p><strong>Introduction: </strong>Nanocarrier-mediated delivery represents a promising strategy for enhancing the therapeutic efficacy of pharmacological agents. This study investigated whether encapsulating the endogenous peptide apelin-13 in niosomes (Nano-Apelin13) could improve its protective effects against ischemic stroke injury in rats.</p><p><strong>Methods: </strong>Transient focal cerebral ischemia was induced by 60-minute middle cerebral artery occlusion (MCAO) followed by 24-hour reperfusion. Sixty rats were randomly allocated into five experimental groups: Sham, CI/R (ischemia/reperfusion), CI/R + empty niosomes, CI/R + free Apelin13, and CI/R + Nano-Apelin13. Free Apelin13 and Nano-Apelin13 (40 µg/kg) were administered intravenously 1 hour after reperfusion onset. After 24 hours, cerebral infarction size, neurological deficit scores, brain water content, and neuronal damage were evaluated. Protein expression levels of TLR4, MyD88, NF-κB, TNF-α, and IL-1β were analyzed by western blotting.</p><p><strong>Results: </strong>Both free Apelin13 and Nano-Apelin13 significantly reduced cerebral infarct volume, improved neurological scores, decreased neuronal loss, and downregulated MyD88 and NF-κB expression. However, Nano-Apelin13 demonstrated superior efficacy, normalizing several parameters to sham-operated levels. Notably, Nano-Apelin13 significantly suppressed TLR4 expression and attenuated cerebral edema and pro-inflammatory cytokine production, effects that were either significantly enhanced or absent in the free Apelin13-treated group.</p><p><strong>Conclusion: </strong>Delivery of Apelin13 in niosomes could be a good option to reduce CI/R damage by inhibiting the activity of TLR4/MyD88/NF-kB axis compared to free Apelin13.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e29"},"PeriodicalIF":2.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787454","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":"What Emergency Medicine Specialists Need to Know about Hantavirus: A Letter to the Editor.","authors":"Mostafa Alavi-Moghaddam","doi":"10.22037/aaem.v14i1.3073","DOIUrl":"https://doi.org/10.22037/aaem.v14i1.3073","url":null,"abstract":"<p><p>Hantavirus infection is an uncommon but potentially life-threatening zoonotic disease that requires early recognition in the emergency department. This letter summarizes the epidemiology, transmission, clinical manifestations, diagnostic approaches, and current management of hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). Although the initial presentation is often nonspecific, rapid progression to respiratory failure, shock, or acute kidney injury may occur, necessitating prompt diagnosis and aggressive supportive care. Serologic testing remains the primary diagnostic modality, while treatment is largely supportive, with extracorporeal membrane oxygenation reserved for selected patients with severe HPS. Increased awareness among emergency physicians and timely implementation of infection-control measures are essential to improve patient outcomes and reduce mortality.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e28"},"PeriodicalIF":2.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787475","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":"Safety and Efficacy of Therapeutic Hypothermia in Traumatic Spinal Cord Injury Management: A Systematic Review and MetaAnalysis.","authors":"Farzan Fahim, Mahdi Mehmandoost, Pouya Karami Dehkordi, Ali Khorram, Shahriar Heshmaty, Fatemeh Zolfaghari, Mobina Ghamarpour, Sayeh Oveisi, Amir Saied Seddighi, Alireza Zali","doi":"10.22037/aaem.v14i1.2929","DOIUrl":"10.22037/aaem.v14i1.2929","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic hypothermia as a neuroprotective strategy can reduce secondary injury after acute traumatic spinal cord injury (SCI). We conducted a systematic review and metaanalysis to evaluate the impact of systemic or local hypothermia on neurological outcomes, mortality, and Intensive Care Unit (ICU) stay of SCI patients.</p><p><strong>Methods: </strong>A systematic search in PubMed, Scopus, Web of Science, Embase, and The Cochrane Central Register of Controlled Trials (CENTRAL) with no limitation of time and language was performed. Following PRISMA 2020 guidelines, two independent reviewers screened records across four databases up to 20 September 2025. Eligibility was determined using PICOS criteria: adults with acute traumatic SCI (P), receiving any hypothermic protocol (I), compared with standard normothermic management (C), with reported functional, sensory, or survival outcomes (O), and original human clinical designs (S). Data extraction and risk-of-bias evaluation were performed independently using the Joanna Briggs Institute (JBI) checklist. Pooled relative risks (RR) or mean differences (MD) were calculated with randomeffects models using RevMan 4.5.1.</p><p><strong>Results: </strong>From 305 initial records, six human studies (156 patients) met inclusion criteria. There were three systemic hypothermia trials and one local extradural protocol, plus two supportive cohorts providing timing and assessment data, but only three studies met the minimum criteria for meta-analysis processes. Overall methodological quality of included studies was lowtomoderate and none of the studies were randomized. Intervention methods included surface, and endovascular techniques maintaining body temperature at 32-34 Celsius for 24-72 hours, initiated between 1.6 -70 hours postinjury. Pooled analyses showed decreased mortality with RR = 0.57 (95% CI: 0.05 -5.88; p = 0.6883), improvement in Association Impairment Scale (AIS) with RR = 2.96 (95% CI: 0.01- 939.31; p = 0.3098); and decrease in the ICU length of stay with MD = -1.27 (95% CI: -2.46 to -0.07; p = 0.9658) days in SCI patients receiving hypothermia. Complications included pneumonia, hypotension, and bradycardia. No hypothermiarelated deaths were reported. Early initiation (< 6 hours) was consistently linked with superior functional improvement.</p><p><strong>Conclusions: </strong>The findings of six human studies reveal that therapeutic hypothermia may be a feasible, safe, and effective intervention in acute traumatic SCI. While current evidence cannot yet demonstrate mortality benefit, the observed results were directed toward neurological improvement, especially when therapy is initiated early and systemically, supporting ongoing investigation.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e27"},"PeriodicalIF":2.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618255","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 Antiplatelet Therapy in Upper Gastrointestinal Bleeding with Coronary Artery Disease: A Landmark Analysis of MIMIC-IV and eICU-CRD Databases.","authors":"Xiaopeng Zhong","doi":"10.22037/aaem.v14i1.3058","DOIUrl":"10.22037/aaem.v14i1.3058","url":null,"abstract":"<p><strong>Introduction: </strong>The safety of early antiplatelet administration versus withholding in patients with concurrent upper gastrointestinal bleeding (UGIB) and coronary artery disease (CAD) or myocardial infarction (MI) remains unresolved. This study aimed to evaluate the association between early antiplatelet therapy timing and mortality in this population.</p><p><strong>Methods: </strong>This retrospective cohort study included 3,422 adults with UGIB and concurrent CAD or MI from the Medical Information Mart for Intensive Care IV (MIMIC-IV) dataset (2008-2019). Patients were classified as having antiplatelet therapy ordered within 24 hours (AP-24h; n=1,530), between 24 and 72 hours (AP-24-72h; n=368), or no antiplatelet therapy within 72 hours (No-AP; n=1,524; reference). This study quantified immortal time bias using 72-hour mortality distributions, applied landmark analysis to eliminate this bias, and externally validated findings using the eICU Collaborative Research Database (eICU-CRD). After excluding 87 patients dying within 72 hours, the MIMIC-IV landmark cohort comprised 3,335 patients. The primary outcome was 1-year all-cause mortality from the 72-hour landmark point. eICU-CRD external validation applied the same phenotype and exposure timing; after excluding 137 early deaths, the validation cohort included 2,657 patients. The eICU-CRD outcome was post-landmark hospital mortality.</p><p><strong>Results: </strong>Landmark analysis demonstrated a 72-hour mortality rate of 3.7% in No-AP versus 1.8% in AP-24h, confirming misclassification of early critically ill patients into the reference group. Adjusted landmark Cox regression showed no significant difference in 1-year all-cause mortality for AP-24h (hazard ratio (HR): 0.910, 95% confidence interval (CI): 0.806-1.027, p=0.125) or AP-24-72h (HR: 0.884, 95% CI: 0.733-1.066, p=0.197) compared with No-AP. In-hospital mortality was similar across groups (8.7-9.8%); adjusted logistic regression showed no significant differences for AP-24h (OR: 1.056, 95% CI: 0.786-1.419, p=0.718) or AP-24-72h (OR: 1.007, 95% CI: 0.646-1.568, p=0.976). Thirty-day mortality was also similar for AP-24h (HR: 0.934, 95% CI: 0.780-1.118, p=0.455) and AP-24-72h (HR: 1.027, 95% CI: 0.785-1.343, p=0.847). In the eICU-CRD validation cohort, post-landmark hospital mortality was 8.69%, 5.07%, and 8.00% for AP-24h, AP-24-72h, and No-AP, respectively. Fully adjusted validation models showed no increased in-hospital mortality for AP-24h (OR: 0.97, 95% CI: 0.62-1.53, p=0.895) or AP-24-72h (OR: 0.74, 95% CI: 0.32-1.69, p=0.469).</p><p><strong>Conclusion: </strong>After correcting for immortal time bias using landmark analysis, early antiplatelet administration in UGIB patients with CAD or MI was not associated with increased 1-year all-cause mortality or in-hospital mortality in the MIMIC-IV dataset, and this finding was externally supported in the eICU-CRD dataset.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e26"},"PeriodicalIF":2.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618246","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":"Patient-level, Temporal, and Dynamic Operational Indicators of Emergency Department Prolonged Length of Stay: A Retrospective Cohort Study.","authors":"Alexandre Vallée","doi":"10.22037/aaem.v14i1.3048","DOIUrl":"10.22037/aaem.v14i1.3048","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department length of stay (ED-LOS) is a key indicator of crowding and care quality. This study aimed to identify patient-level, temporal, and real-time operational predictors of prolonged ED-LOS.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using routinely collected data from all ED visits at Foch Hospital, France, between January and November 2025. Prolonged ED-LOS was defined as ED-LOS >8 hours. Data were split chronologically into a training period from January to September and a held-out test period from October to November. Three logistic regression models were evaluated: Model 1 included patient-level and temporal variables; Model 2 additionally included dynamic congestion indicators; and Model 3 further included early process delays.</p><p><strong>Results: </strong>Among 41,818 ED visits, 41,431 were included in the final analytic sample. Overall, 8,119 (19.6%) visits had ED-LOS >8 hours. In the test set, Model 1 showed good discrimination (area under the receiver operating characteristic curve (AUC): 0.752, 95% confidence interval (CI): 0.740 - 0.766), which improved modestly after adding dynamic congestion variables in Model 2 (AUC: 0.761, 95% CI: 0.749 - 0.775). Model 3 achieved the best performance (AUC: 0.804 (95% CI: 0.793 - 0.815); Brier score: 0.127 (95% CI: 0.122 - 0.132)). Older age, triage acuity level 3 (classification infirmière des malades aux urgences: CIMU ), weekend arrival, dynamic congestion at arrival, and early process delays were the main predictors of prolonged ED-LOS.</p><p><strong>Conclusion: </strong>Based on the findings, older age, intermediate triage acuity, weekend arrival, dynamic congestion at arrival, and early process delays were the independent predictors of prolonged ED stay. The addition of dynamic congestion variables improved prediction beyond patient-level and temporal characteristics, while the strongest performance was achieved after incorporating early delays to triage and physician assessment.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e25"},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618224","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":"Associated Factors of Intracranial Hemorrhage in Patients with Nontraumatic Headache who Underwent Anticoagulation Therapy; A retrospective study.","authors":"Shaikha Khaled Almansoor, Albatoul Hussein Alkohlani, Sameeha Abdulwali, Sarah Aldahoul, Dalia Hamdan, Sameer Desai, Danah Alobathani, Muhammad Qureshi","doi":"10.22037/aaem.v14i1.2985","DOIUrl":"10.22037/aaem.v14i1.2985","url":null,"abstract":"<p><strong>Introduction: </strong>Although anticoagulation is a well-established risk factor for intracranial hemorrhage (ICH) following trauma, its role in determining the need for neuroimaging in patients with nontraumatic headache is less clear. This study evaluated whether anticoagulation alone justifies brain computed tomography (CT) scan imaging in non-traumatic headache.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a tertiary care center in Riyadh, Saudi Arabia, including adults presenting with nontraumatic headache between January 2020 and 2023. Patients who underwent brain CT scan were assessed for hemorrhage and potential associated factors of ICH were explored.</p><p><strong>Results: </strong>Among 909 patients who presented with non-traumatic headache, 162 (17.82%) cases were on anticoagulation therapy, and 20 (2.2%) had ICH on brain CT scan. Anticoagulation use alone was not significantly associated with the risk of ICH following nontraumatic headache (p = 0.068). A history of prior ICH or ischemic stroke emerged as a predictor of ICH, in the overall cohort and among anticoagulated patients (p < 0.001 for all comparisons). No statistically significant associations were observed with antiplatelet use, anticoagulant type, combined anticoagulant-antiplatelet therapy, or neurological deficits.</p><p><strong>Conclusion: </strong>It seems that, in patients presenting with nontraumatic headache, anticoagulation use alone should not dictate the decision to perform brain CT scan. A history of prior ICH or ischemic stroke is a more reliable predictor of ICH risk and should be prioritized in imaging decisions. These findings support a more targeted imaging strategy to minimize unnecessary scans and improve emergency department resource utilization.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e23"},"PeriodicalIF":2.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618218","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":"Revisiting the Diagnostic Accuracy of Ottawa Ankle Rules for Ankle Fractures: A Systematic Review and Meta-Analysis.","authors":"Danial Sharifi Razavi, Mohammadali Seiri, Mehrdad Farrokhi","doi":"10.22037/aaem.v14i1.3051","DOIUrl":"10.22037/aaem.v14i1.3051","url":null,"abstract":"<p><strong>Introduction: </strong>The Ottawa Ankle Rules (OAR) have demonstrated conflicting results across studies, with generally high sensitivity but relatively low and variable specificity. This updated meta-analysis aims to evaluate the overall diagnostic characteristics of the OAR for early identification of ankle fractures in adult patients.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, a comprehensive literature search was conducted from database inception through May 2026 across three electronic databases, including Medline, Web of Science, and Scopus. The MIDAS package in STATA and Meta-Disc software were used to pool the findings of the diagnostic accuracy studies. Clinical application of the OAR was assessed using Fagan's nomogram and scattergram.</p><p><strong>Results: </strong>The pooled sensitivity and specificity of OAR were 0.92 (95% confidence interval (CI): 0.91-0.93) and 0.35 (95% CI: 0.34-0.36), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 1.76 (95% CI: 1.46-2.13) and 0.13 (95% CI: 0.09-0.19), respectively. Furthermore, the pooled diagnostic odds ratio (DOR) was 16.21 (95% CI: 10.15-25.89).</p><p><strong>Conclusion: </strong>In conclusion, the OAR demonstrate excellent sensitivity and a very low negative likelihood ratio, confirming their value as a reliable screening tool for ruling out ankle fractures in clinical practice. With pooled sensitivities exceeding 90% and a post-test probability reduced to approximately 1% following a negative result, the OAR can safely reduce unnecessary radiographic imaging.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e24"},"PeriodicalIF":2.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618182","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 Associated with Emergency Department Survival of Out-of-Hospital Cardiac Arrest following Traumatic Brain Injury: A Retrospective Cohort Study.","authors":"Thanakorn Laksanamapune, Chaiyaporn Yuksen, Theeradate Preechanarit, Welawat Tienpratarn, Sittichok Leela-Amornsin, Chetsadakon Jenpanitpong, Siriporn Damdin","doi":"10.22037/aaem.v14i1.2962","DOIUrl":"10.22037/aaem.v14i1.2962","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic out-of-hospital cardiac arrest (TOHCA) in patients with traumatic brain injury (TBI) is associated with exceptionally poor survival. However, prehospital prognostic factors influencing early survival in this high-risk population remain poorly defined. This study aimed to identify prehospital factors associated with survival to hospital admission among TOHCA patients with TBI in Thailand.</p><p><strong>Methods: </strong>We conducted an 11-year nationwide retrospective cohort study using the Information Technology of Emergency Medicine System (ITEMS), Thailand's national EMS registry (2012-2022). TOHCA patients with documented TBI who were transported to the emergency department (ED) by emergency medical services (EMS) were included. The primary outcome was survival to hospital admission. Multivariable logistic regression was used to identify independent prehospital factors associated with survival.</p><p><strong>Results: </strong>Of 46,760 TOHCA cases, 22,821 involved TBI, and 16,885 met inclusion criteria with recorded ED outcomes. Overall, 2,872 patients (17.0%) survived to hospital admission. Younger age, longer on scene time, and shorter hospital-to-scene distance were independently associated with improved odds of survival. Several prehospital interventions showed significant benefit, including external bleeding control (adjusted odds ratio (aOR) 1.38, 95% confidence interval (CI): 1.20-1.58), endotracheal intubation (aOR 2.09, 95% CI: 1.69-2.57), intravenous fluid administration (aOR 1.56, 95% CI: 1.24-1.96), and defibrillation (aOR 2.05, 95% CI: 1.66-2.53). In contrast, on-scene time <10 minutes (aOR 0.65, 95% CI: 0.53-0.79) and bone and joint injuries, including closed fractures, open fractures, and dislocations, were associated with reduced survival.</p><p><strong>Conclusion: </strong>Despite the generally poor prognosis of TOHCA patients, particularly those with TBI, our findings demonstrate that adequate on-scene time and the prompt delivery of critical prehospital interventions, including external bleeding control, intubation, hydration, and defibrillation, were independently associated with improved survival to hospital admission.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"14 1","pages":"e22"},"PeriodicalIF":2.8,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618227","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}