Archives of Academic Emergency Medicine最新文献

{"title":"Development of a Clinical Score for Predicting 28-Day Mortality in Geriatric Sepsis Patients; a Cohort study.","authors":"Pitsucha Sanguanwit, Chaiyaporn Yuksen, Jiraporn Khorana, Krongkarn Sutham, Yuranun Phootothum, Siriporn Damdin","doi":"10.22037/aaem.v12i1.2269","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2269","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a significant and common cause of death and burden among critically ill patients, which has increasing incidence and mortality in adults over 60 and advanced age. This study aimed to develop an easy-to-use clinical tool for assessing 28-day mortality risk in older sepsis patients upon their initial assessment in the emergency department (ED).</p><p><strong>Method: </strong>A retrospective cohort study was conducted using electronic medical records of older (≥60 years) ED patients with suspected sepsis from August 1, 2018, to December 31, 2018. A new prediction score was formulated based on the logistic coefficients of clinical predictors through multivariable regression analyses. Then, the score's screening performance was evaluated and compared to existing scoring systems; Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National early warning score (NEWS), and The Ramathibodi early warning score (REWS); using receiver operating characteristic curve analysis (AuROC).</p><p><strong>Result: </strong>The study included 599 patients with the mean age of 77.13 (range: 60-101) years (56.43% male) and an overall 28-day mortality rate of 7.01%. The newly developed prediction score had seven independent predictors of 28-day mortality: malignancy, dependent status, heart rate, respiratory rate, oxygen saturation, consciousness, and lactate, which demonstrated excellent discriminative ability (AuROC: 0.87, 95% confidence interval (CI): 0.82 - 0.92), significantly outperforming SIRS (AuROC: 0.62), qSOFA (AuROC: 0.72), NEWS (AuROC: 0.74), and REWS (AuROC: 0.71), all with p-values <0.01. The score allowed risk stratification into low-risk (positive likelihood ratio (LR+): 0.37, 95% CI: 0.24 - 0.58) and high-risk (LR+: 4.14, 95% CI: 3.14 - 5.44) groups with sensitivity of 69.0% and specificity of 83.3% at a cut-off point of 6.</p><p><strong>Conclusion: </strong>The novel prediction score demonstrates a remarkable ability to predict 28-day mortality risk in older sepsis patients during their initial ED assessment, offering potential for improved risk stratification and treatment guidance in older patients.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e56"},"PeriodicalIF":2.9,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279640","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":"Rate and Risk Factors of Reinfection, Recurrence, and Hospital Readmission Among SARS-Cov-2 Hospitalized Patients; a National Cohort Study.","authors":"Niloufar Taherpour, Koorosh Etemad, Yaser Mokhayeri, Saeid Fallah, Sahar Sotoodeh Ghorbani, Neda Izadi, Elham Rahimi, Fatemeh Shahbazi, Arash Seifi, Ahmad Mehri, Rezvan Feyzi, Kosar Farhadi-Babadi, Seyed Saeed Hashemi Nazari","doi":"10.22037/aaem.v12i1.2327","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2327","url":null,"abstract":"<p><strong>Introduction: </strong>Reinfection and hospital readmission due to COVID-19 were significant and costly during the pandemic. This study aimed to assess the rate and risk factors of SARS-Cov-2 reinfection, recurrence, and hospital readmission, by analyzing the national data registry in Iran.</p><p><strong>Methods: </strong>This study was a retrospective cohort conducted from March 2020 to May 2021. A census method was used to consider all of the possible information in the national Medical Care Monitoring Center (MCMC) database obtained from the Ministry of Health and Medical Education; the data included information from all confirmed COVID-19 patients who were hospitalized and diagnosed using at least one positive Polymerase Chain Reaction (PCR) test by nasopharyngeal swab specimens. Univariate and multivariable Cox regression analyses were performed to assess the factors related to each studied outcome.</p><p><strong>Results: </strong>After analyzing data from 1,445,441 patients who had been hospitalized due to COVID-19 in Iran, the rates of overall reinfection, reinfection occurring at least 90 days after the initial infection, recurrence, and hospital readmission among hospitalized patients were 67.79, 26.8, 41.61, and 30.53 per 1000 person-years, respectively. Among all cases of hospitalized reinfection (48292 cases), 38.61% occurred more than 90 days from the initial SARS-Cov-2 infection. Getting infected with COVID-19 in the fifth wave of the disease compared to getting infected in the first wave (P<0.001), having cancer (P<0.001), chronic kidney disease (P<0.001), and age over 80 years (P<0.001) were respectively the most important risk factors for overall reinfection. In contrast, age 19-44 years (P<0.001), intubation (P<0.001), fever (P<0.001), and cough (P<0.001) in the initial admission were the most important protective factors of overall reinfection, respectively.</p><p><strong>Conclusion: </strong>Reinfection and recurrence of COVID-19 after recovery and the rate of hospital readmission after discharge were remarkable. Advanced or young age, as well as having underlying conditions like cancer and chronic kidney disease, increase the risk of infection and readmission.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e55"},"PeriodicalIF":2.9,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279661","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":"Prevalence of Surgical Site Infection After Hip Arthroplasty; a Systematic Review and Meta-Analysis.","authors":"Reza Salehi, Hamidreza Alizadeh-Otaghvar, Bahar Farhadi, Masoomeh Najafi, Hossein Torabi, Hamid Hojjati, Lida Garrosi, Samira Mirzaei, Ramyar Farzan, Siamak Kazemi-Sufi","doi":"10.22037/aaem.v12i1.2308","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2308","url":null,"abstract":"<p><strong>Introduction: </strong>One of the worrisome complications of hip arthroplasty is surgical site infection (SSI). This study aimed to investigate the prevalence of SSI after hip arthroplasty.</p><p><strong>Methods: </strong>A comprehensive and systematic exploration was conducted across various international electronic databases, including Scopus, PubMed, and Web of Science, alongside Persian electronic databases such as Iranmedex and the Scientific Information Database (SID). This search strategy entailed the utilization of Medical Subject Headings-derived keywords such as \"Prevalence,\" \"Surgical wound infection,\" \"Surgical site infection,\" and \"Arthroplasty,\" spanning from the earliest records up to January 1, 2024. Each study's weight was assigned based on its inverse variance. A forest plot visualization was used to assess the studies' heterogeneity. Data on sample size and SSI frequency were compiled for each study to calculate the overall effect size.</p><p><strong>Results: </strong>The study encompassed a cumulative participant cohort of 1,070,638 hip arthroplasty procedures drawn from seventeen selected studies. Notably, the female gender constituted 59.10% of the overall participant demographic. The aggregate SSI among patients undergoing hip arthroplasty was estimated to be 1.9% (95% CI: 1.3% to 2.8%; I²=99.688%; P<0.001). The results of the meta-regression analysis unveiled a statistically significant correlation between the prevalence of SSIs after hip arthroplasty and the year of publication (Coefficient=-0.0020; 95% CI: -0.0021 to -0.0018; Z=-19.39, P<0.001).</p><p><strong>Conclusion: </strong>The study findings indicated a prevalence rate of 1.9% for SSI following hip arthroplasty. This prevalence underscores the importance of vigilance in infection prevention and management strategies within orthopedic surgery. However, it is essential to acknowledge the variability in SSI prevalence observed across diverse studies, which can be attributed to multifaceted factors, notably variances in patient populations and associated risk factors.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e54"},"PeriodicalIF":2.9,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279648","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":"Hemodynamic Resuscitation Characteristics of Emergency Department Patients with Sepsis and Hypotension who are and are not Admitted to ICU; a Prospective Cross-sectional Study.","authors":"Rebecca Vella, Philip Jones, Gerben Keijzers","doi":"10.22037/aaem.v12i1.2337","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2337","url":null,"abstract":"<p><strong>Introduction: </strong>There is an evidence-practice gap in the optimal timing and volume of intravenous fluid as well as vasopressor administration in managing patients with sepsis. This study aimed to explore current hemodynamic resuscitation practice in emergency department (ED) for patients with sepsis and hypotension.</p><p><strong>Methods: </strong>This is a sub-analysis of the prospective multicentre ARISE FLUIDS observational study, which was conducted in 70 EDs across Australia and New Zealand. Baseline characteristics, as well as ED management and outcome of sepsis patients were compared between patients who were and were not admitted to intensive care unit (ICU) or high dependency unit (HDU).</p><p><strong>Results: </strong>A total of 587 patients with a median age of 65 years and even sex distribution (49% female) were available for analysis. Almost two-thirds of patients with sepsis (63.2%, n=371) were not admitted to ICU/HDU and were given lower intravenous (IV) fluid volumes over 24-hours, compared to those receiving critical care (4077ml vs. 5421ml, p<0.001). Patients not admitted to an ICU/HDU had a lower Acute Physiology And Chronic Health Evaluation (APACHE) II score (median 14 vs. 18, P<0.001) and serum lactate level (1.8 vs. 2.8 mmol/L, P<0.001) compared to those admitted to ICU/HDU and 5.9% received a vasopressor infusion in the first 24-hours. Females, patients aged <65 years, and those with urosepsis or sepsis of non-respiratory origin received a greater volume of IV fluids.</p><p><strong>Conclusion: </strong>Almost two-thirds of patients were not admitted to ICU/HDU. In patients not admitted to ICU/HDU, 1 in 17 received a vasopressor infusion during their ED or early hospital stay. Patients not admitted to ICU/HDU received less fluid in the first 24 hours than those who were. Greater resuscitation fluid volumes were independently associated with female sex, age <65 years, higher lactate levels, and urinary or non-respiratory source of sepsis.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e53"},"PeriodicalIF":2.9,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279642","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":"Quality Indicators for Pediatric Bronchiolitis and Croup Care in the Emergency Department; a Systematic Review and Meta-Analysis.","authors":"Islam E Alkhazali, Ahmad Alrawashdeh, Mohd Hashairi Fauzi, Nik Hisamuddin Nik Ab Rahman","doi":"10.22037/aaem.v12i1.2244","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2244","url":null,"abstract":"<p><strong>Introduction: </strong>As the quality of care for respiratory diseases in pediatric patients in emergency departments (EDs) becomes increasingly important, this systematic review aims to evaluate the current quality indicators (QIs) specifically designed for the ED management of pediatric bronchiolitis and croup.</p><p><strong>Methods: </strong>We conducted searches in four electronic databases (Scopus, Web of Science, CINAHL, and MEDLINE) from their inception up to February 2024. We focused on English-language qualitative and quantitative publications that suggested or described at least one indicator initiative related to ED care for pediatrics with bronchiolitis and croup diseases. These publications were identified by two reviewers, independently. We extracted study characteristics, all relevant QIs reported, and the percentage of compliance with these QIs, where available. All QIs identified from expert panels and observational studies were grouped by definition and categorized by the Institute of Medicine's (IOM) and Donabedian's frameworks for healthcare quality. The percentage of compliance with the identified QIs as reported by observational studies was pooled using a random effect meta-analysis, when appropriate.</p><p><strong>Results: </strong>A total of 17 studies were identified, comprising 5 expert panel studies and 12 observational studies. Altogether, these studies reported 126 QIs for potential use in EDs for pediatric bronchiolitis and croup patients. Of these, 55 QIs were reported by expert panel studies, and 71 by observational studies. Specifically, 81 QIs were related to bronchiolitis, while 45 pertained to croup patients. In terms of the Donabedian domain, most indicators (96.5%) measured the process of care while a smaller fraction (3.5%) addressed care outcomes. In the Institute of Medicine (IOM) domain, most indicators focused on effectiveness and safety. Observational studies reported the percentage of compliance for 35 QIs identified in the expert studies. It was noted that compliance with these QIs varied significantly between studies and health sectors.</p><p><strong>Conclusions: </strong>The findings of this systematic review highlight significant disparities in compliance to the established QIs, which underscores the urgent need for dedicated strategies to enhance the treatment of pediatric bronchiolitis and croup in ED settings.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e52"},"PeriodicalIF":2.9,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11407541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279660","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 Discharge versus 6-hour Observation in Mild Traumatic Brain Injury with Normal Brain CT Scan; a Comparative Pilot study of Outcomes.","authors":"Piramon Chairattanawan, Chuenruthai Angkoontassaneeyarat, Chaiyaporn Yuksen, Chetsadakon Jenpanitpong, Malivan Phontabtim, Thanakorn Laksanamapune","doi":"10.22037/aaem.v12i1.2245","DOIUrl":"10.22037/aaem.v12i1.2245","url":null,"abstract":"<p><strong>Introduction: </strong>Early discharge from the emergency department (ED) or a 6-hour observation in the ED are two methods for management of patients with mild traumatic brain injury (mTBI) with normal brain computed tomography (CT) scan. This study aimed to compare the outcomes of the two management options.</p><p><strong>Methods: </strong>This study is a single-center, open-label, pilot randomized case control study conducted in the ED of Ramathibodi Hospital from June 2022 to September 2023. Eligible participants included all individuals with mTBI who had negative findings on Brain CT scans. They were randomly assigned to either the early ED discharge or 6-hour ED observation group and compared regarding the outcomes (rate of 48-hour ED revisits; occurrence of post-concussion syndrome (PCS) 1 day, 1 month, and 3 months after the initial injury; and 3-month mortality).</p><p><strong>Results: </strong>122 patients with the mean age of 74.62 ± 14.96 (range: 25-99) years were consecutively enrolled (57.37% female). No significant differences were observed between the early discharge and observation groups regarding the severity of TBI (p=0.853), age (p=0.334), gender (p=0.588), triage level (p=0.456), Glasgow Coma Scale (GCS) score (p=0.806), comorbidities (p=0.768), medication usage (p=0.548), mechanism of injury (p=0.920), indication for brain CT scan (p=0.593), time from TBI onset to ED arrival (p=0.886), and time from ED triage to brain CT scan (p=0.333). Within 48 hours after randomization, the incidence of revisits was similar between the two groups (1.57% vs. 3.23%; p = 1.000). There were no statistically significant differences in the incidence of PCS between the early discharge and observation groups at 1 day (33.90% vs. 35.48%, p = 0.503), at 1 month (12.07% vs. 13.11%, p = 0.542), and at 3 months (1.92% vs. 5.56%, p = 0.323) after randomization. After a three-month follow-up period, four patients in the early discharge group, had expired (none of the deaths were associated with TBI).</p><p><strong>Conclusion: </strong>It seems that, in mTBI patients with normal initial brain CT scan and the absence of other injuries or neurological abnormalities, early discharge from the ED without requiring observation could be considered safe.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e50"},"PeriodicalIF":2.9,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496942","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 Incentive Spirometer in Covid-19 Pneumonia; a Randomized Clinical Trial.","authors":"Mohammad Bargahi, Mostafa Alavi-Moghaddam, Mehdi Karimi, Zahra Azizan, Fateme Jafarzadeh, Mohammad Javaherian, Hussein Soleimantabar, Seyed Hamidreza Mirbehbahani","doi":"10.22037/aaem.v12i1.2244","DOIUrl":"https://doi.org/10.22037/aaem.v12i1.2244","url":null,"abstract":"<p><strong>Introduction: </strong>Various treatment protocols have been recommended since the beginning of the COVID-19 pandemic and have gradually evolved. This study aimed to assess the effectiveness and safety of incentive spirometer exercise (ISE) in outcomes of hospitalized patients with moderate-to-severe COVID-19 pneumonia.</p><p><strong>Methods: </strong>A 3-month single-blind, two parallel-armed randomized controlled trial was conducted at Imam Hossein Hospital, Tehran, Iran. Participants aged >18 years with documented COVID-19 pneumonia were randomly allocated to 2 groups of IS (ISE in addition to the usual treatment) and control (usual care alone). The IS group was also asked to perform ISE after discharge for three months. The primary outcomes were peripheral O2 saturation (SpO2), VBG parameters (pCO2, PH, HCO3), dyspnea level measured by Modified Borg Scale (MBS), length of hospital stay (LOS), and respiratory rate (RR). Secondary outcomes included mortality rate, intubation rate (IR), and ICU admission rate.</p><p><strong>Results: </strong>A total of 160 eligible patients were randomly assigned to either the IS (n = 80) or control (n=80) groups. Although there were no significant differences in primary and secondary outcomes between the groups post-intervention, adjusted analysis showed that participants allocated to the IS group had significantly higher SpO2 levels and lower RR, MBS levels, and LOS. Also, the adjusted model analysis showed a marginal statistically significant difference between groups in secondary outcomes, such as IR, the 1-month mortality rate, and the 3-month mortality rate.</p><p><strong>Conclusion: </strong>It seems that adding the ISE to usual care in the early treatment setting of COVID-19 patients resulted in a relatively significant increase in SpO2 levels, improved respiratory status, and marginally decreased LOS. Additionally, ISE minimally reduced ICU admissions and intubation rates, with no significant impact on in-hospital or long-term mortality in patients with COVID-19 pneumonia.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e51"},"PeriodicalIF":2.9,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279662","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 Associated Factors of Tile B/C Type of Pelvic Ring Fractures; a Retrospective Cross-sectional study.","authors":"Welawat Tienpratarn, Nucha Nakpipat, Chaiyaporn Yuksen, Sirote Wongwaisayawan, Yuranun Phootothum, Sutap Jaiboon","doi":"10.22037/aaem.v12i1.2243","DOIUrl":"10.22037/aaem.v12i1.2243","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures.</p><p><strong>Methods: </strong>This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed.</p><p><strong>Results: </strong>A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions.</p><p><strong>Conclusion: </strong>Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e49"},"PeriodicalIF":2.9,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496941","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 Patients' Survival in Out of Hospital Cardiac Arrest; a Cross-sectional Study.","authors":"Liang Ke, Pui I Ieong, Kaye E Brock, Elias Mpofu, Cheng Yin, Xiuhua Feng, Pou Kuan Kou, Chi Kun Mok, Wai Seng Lei","doi":"10.22037/aaem.v12i1.2298","DOIUrl":"10.22037/aaem.v12i1.2298","url":null,"abstract":"<p><strong>Introduction: </strong>Chinese populations have an increasingly high prevalence of cardiac arrest. This study aimed to investigate the prehospital associated factors of survival to hospital admission and discharge among out-of-hospital cardiac arrest (OHCA) adult cases in Macao Special Administrative Region (SAR), China.</p><p><strong>Methods: </strong>Baseline characteristics as well as prehospital factors of OHCA patients were collected from publicly accessible medical records and Macao Fire Services Bureau, China. Demographic and other prehospital OHCA characteristics of patients who survived to hospital admission and discharge were analyzed using multivariate logistic regression analysis.</p><p><strong>Results: </strong>A total of 904 cases with a mean age of 74.2±17.3 (range: 18-106) years were included (78%>65 years, 62% male). Initial shockable cardiac rhythm was the strongest predictor for survival to both hospital admission (OR=3.57, 95% CI: 2.26-5.63; p<0.001) and discharge (OR=12.40, 95% CI: 5.70-26.96; p<0.001). Being male (OR=1.63, 95% CI:1.08-2.46; p =0.021) and the lower emergency medical service (EMS) response time (OR=1.62, 95% CI: 1.12-2.34; p =0.010) were also associated with a 2-fold association with survival to hospital admission. In addition, access to prehospital defibrillation (OR=4.25, 95% CI: 1.78-10.12; p <0.001) had a 4-fold association with survival to hospital discharge. None of these associations substantively increased with age.</p><p><strong>Conclusion: </strong>The major OHCA predictors of survival were initial shockable cardiac rhythm, being male, lower EMS response time, and access to prehospital defibrillation. These findings indicate a need for increased public awareness and more education.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e48"},"PeriodicalIF":2.9,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496940","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":"Therapeutic Impact of Tocilizumab in the Setting of Severe COVID-19; an Updated and Comprehensive Review on Current Evidence.","authors":"Aysa Rezabakhsh, Fatemeh Mojtahedi, Sepideh Tahsini Tekantapeh, Ata Mahmoodpoor, Alireza Ala, Hassan Soleimanpour","doi":"10.22037/aaem.v12i1.2217","DOIUrl":"10.22037/aaem.v12i1.2217","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard.</p><p><strong>Methods: </strong>In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria.</p><p><strong>Results: </strong>Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear.</p><p><strong>Conclusion: </strong>Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians' decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e47"},"PeriodicalIF":2.9,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11239185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589503","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}