Archives of Academic Emergency Medicine最新文献

{"title":"Rapid Arterial Occlusion Evaluation (RACE) Tool in Detecting Large Cerebral Vessel Occlusions; a Systematic Review and Meta-Analysis.","authors":"Iman Chehregani Rad, Amir Azimi","doi":"10.22037/aaem.v12i1.2152","DOIUrl":"10.22037/aaem.v12i1.2152","url":null,"abstract":"<p><strong>Introduction: </strong>Large vessel occlusion (LVO) strokes are linked to higher mortality rates and a greater risk of long-term disability. This study aimed to evaluate the diagnostic performance of the Rapid Arterial Occlusion Evaluation (RACE) tool in detecting LVO through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search was conducted across online databases including PubMed, Embase, Scopus, and Web of Science, up to June 25th, 2023. Additionally, a manual search on Google and Google Scholar was performed to identify studies that assessed the diagnostic accuracy of the RACE scale in detecting LVO among patients with stroke symptoms.</p><p><strong>Results: </strong>Data extracted from 43 studies were analyzed. The optimal cut-off points were determined to be 3 and 4, with a sensitivity of 0.86 (95% confidence interval (CI): 0.78, 0.91) and specificity of 0.57 (95% CI: 0.49, 0.67) for cut-off ≥3, and a sensitivity of 0.78 (95% CI: 0.70, 0.84) and specificity of 0.68 (95% CI: 0.59, 0.75) for cut-off ≥4. Subgroup meta-regression analysis revealed significant variations in sensitivity and specificity. RACE scale's sensitivity was significantly higher in LVO detection in suspected stroke cases, in pre-hospital settings, prospective design studies, and when considering both anterior and posterior occlusions for LVO definition. RACE scale's specificity was significantly higher when evaluating confirmed stroke cases, in-hospital settings, and considering only anterior occlusions for LVO definition and retrospective design studies. Notably, RACE exhibited higher sensitivity and specificity when utilized by neurologists and physicians compared to other emergency staff. Despite these variations, our study found comparable diagnostic accuracy across different conditions.</p><p><strong>Conclusion: </strong>A high level of evidence indicates that the RACE scale lacks promising diagnostic value for detection of LVOs. A sensitivity range of 0.69 to 0.86 is insufficient for a screening tool intended to aid in the diagnosis of strokes, considering the substantial morbidity and mortality associated with this condition.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e10"},"PeriodicalIF":5.4,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073199","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, Complications, and Risk Factors of Falls and Fear of Falling Among Older Adults; Based on Ardakan Cohort Study on Aging (ACSA).","authors":"Ahmad Delbari, Amirali Azimi, Morvarid Najafi, Mohammad Saatchi, Mohammad Bidkhori, Mohammad Ebrahim Mousavi, Fatemeh-Sadat Tabatabaei, Elham Hooshmand","doi":"10.22037/aaem.v12i1.2084","DOIUrl":"10.22037/aaem.v12i1.2084","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to assess the prevalence of falls, fear of falling (FOF), complications arising from falls, and identify possible sociodemographic and health-related factors associated with these outcomes among older adults.</p><p><strong>Methods: </strong>This cross-sectional study was based on the first wave of the Ardakan Cohort Study on Aging (ACSA), which includes participants over 50 years of age residing in Ardakan, Iran. Fall history, number of fall events, FOF, hospitalizations, and fractures in the past 12 months were assessed through a face-to-face interview. Health-related factors were recorded on a self-expressed basis. Associations were assessed using multiple logistic regression.</p><p><strong>Results: </strong>Among the 4,990 participants, fall history in the past 12 months was prevalent in 19.9%, with 10.1% reporting more than two fall events. Women (p < 0.001) and older participants (p< 0.001) had a higher prevalence. In females, 28.8% reported moderate to severe FOF, while 21% experienced disruptions in their daily activities as a result of this fear. The prevalence of fractures following falls was 5.1% in males and 8.6% in females. After adjusting for confounding factors, FOF (OR: 1.59, 95% CI: 1.33-1.91, p<0.001), imbalance (OR: 2.45, 95% CI: 1.68-3.58, p<0.001), urinary incontinence (OR: 1.44, 95% CI: 1.04-1.9, p=0.025), cognitive impairment (OR: 1.21, 95% CI: 1.01-1.46, p=0.049), vertigo or dizziness (OR: 1.39, 95% CI: 1.15-1.68, p<0.001), osteoporosis (OR: 1.24, 95% CI: 1.03-1.50, p=0.023), osteoarthritis (OR: 1.33, 95% CI: 1.13-1.56, p=0.001), depression (OR: 1.30, 95% CI: 1.06-1.60, p=0.010), and Central Nervous System (CNS)-affecting diseases (OR: 1.99, 95% CI: 1.33-2.97, p=0.001) were found to have positive associations with falls.</p><p><strong>Conclusion: </strong>This study showed that about one-fifth of those over 50 in Iran have experienced at least one fall within a year. Self-expressed imbalance, FOF, and urinary incontinence were the most prominent risk factors. Due to resulting in hospitalization and fractures, falls also lead to fear of falling and the associated limitation of activities.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e9"},"PeriodicalIF":5.4,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073198","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":"Health Data Sharing with the Goal of Value Creation; Trying to Develop a Framework Using Qualitative Content Analysis.","authors":"Mojtaba Zonoobi, Shaban Elahi, Mohammad Khansari, Alireza Hassanzadeh, Tahereh Saheb","doi":"10.22037/aaem.v12i1.2091","DOIUrl":"10.22037/aaem.v12i1.2091","url":null,"abstract":"<p><strong>Introduction: </strong>Within the field of data sharing, discussions surrounding privacy concerns and big data management are extensive. This study aimed to provide a comprehensive framework for health data sharing with the objective of creating value.</p><p><strong>Methods: </strong>This study is a qualitative content analysis, which was conducted using a combination of written sources through a systematic review method, in conjunction with content derived from interviews with experts in information technology and healthcare within hospital and emergency settings. Grounded theory serves as the qualitative methodology, involving three coding phases: open, axial, and selective, facilitated by MAXQDA software.</p><p><strong>Results: </strong>Qualitative content analysis of the interviews revealed seven main (core) categories and 44 subcategories as driving factors in promoting healthcare data sharing. Simultaneously, inhibiting factors resulted in six main categories and 36 subcategories. The driving factors encompassed technology, education, patient management improvement, data utilization for various purposes, data-related considerations, legal and regulatory aspects, and health-related factors. Conversely, inhibiting factors encompassed security and privacy concerns, legal issues, external organizational influences, monitoring and control activities, financial considerations, and inter-organizational challenges.</p><p><strong>Conclusion: </strong>This study has identified key driving and inhibiting factors that influence the sharing of healthcare data. These factors contribute to a more comprehensive understanding of the dynamics surrounding data sharing within the healthcare information system.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e6"},"PeriodicalIF":5.4,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073187","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 23-year-old Female with Abdominal Pain in the Emergency Department; a Photo Quiz.","authors":"Mehdi Hashemi, Newsha Sardarzadeh, Afrooz Moradkhani, Mohammad Reza Abyaz","doi":"10.22037/aaem.v12i1.2128","DOIUrl":"10.22037/aaem.v12i1.2128","url":null,"abstract":"","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e8"},"PeriodicalIF":5.4,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072543","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 Delirium and Its Related Factors in Burn Patients; a Systematic Review and Meta-Analysis.","authors":"Hamidreza Alizadeh Otaghvar, Ramyar Farzan, Parham Tamimi, Aliasghar Ghaderi, Masoomeh Najafi, Mobina Tohidian, Fatemeh Izadi, Seyed Amirhossein Mazhari","doi":"10.22037/aaem.v12i1.2136","DOIUrl":"10.22037/aaem.v12i1.2136","url":null,"abstract":"<p><strong>Introduction: </strong>Considering the importance of delirium disorder in burn patients and its complications, the present systematic review and meta-analysis aimed to determine the prevalence of delirium and its related factors in burn patients.</p><p><strong>Methods: </strong>A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, and Web of Science, as well as Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as \"Prevalence\", \"Delirium\", and \"Burns\" from the earliest to the 17th of July, 2023.</p><p><strong>Results: </strong>In total, 2,710 burn patients participated in ten original studies. Among the participants, 64.6% were male. In the ten studies, the reported pooled prevalence of delirium among burn patients was 20.5% (95% CI: 10.9% to 35.0%; I²=96.889%; P<0.001). Also, factors such as total body surface area, duration of hospitalization, mortality, days on ventilator, alcoholism, benzodiazepine dose, methadone dose, age, male gender, ICU days, operation days, wound care under anesthesia, and opioid dose had a significant correlation with the prevalence of delirium in burn patients.</p><p><strong>Conclusion: </strong>Health managers and policymakers can reduce the prevalence of delirium in burn patients by eliminating or reducing factors associated with it.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"12 1","pages":"e7"},"PeriodicalIF":5.4,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073197","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":"Mental Health Triage from the Viewpoint of Psychiatric Emergency Department Nurses; a Qualitative Study.","authors":"Fatemeh Rajab Dizavandi, Razieh Froutan, Hossein Karimi Moonaghi, Abbas Ebadi, Mohammad Reza Fayyazi Bordbar","doi":"10.22037/aaem.v11i1.2080","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2080","url":null,"abstract":"<p><strong>Introduction: </strong>Mental health triage is a new nursing practice concept that is less studied and defined, especially among Iranian nurses. Therefore, this study aimed to explain the concept of mental health triage from the perspective of psychiatric emergency department (ED) nurses.</p><p><strong>Methods: </strong>This qualitative study collected data using semi-structured interviews with psychiatric ED nurses. Sampling was purposive and continued until data saturation. Analysis was conducted using conventional content analysis, as described in Griesheim and Landman approach.</p><p><strong>Results: </strong>15 psychiatric ED nurses with the mean age of 35.13 ± 8.44 years were interviewed (60% male). Finally, two themes, five categories, and 16 sub-categories emerged from data analysis. Two themes emerged, including mental health triage meaning and mental health triage structure. The former included two categories of the nature and characteristics of mental health triage, and the latter consisted of three categories of mental state exploration from surface to depth, safety control measures, and the degree of emergency. According to the \"degree of emergency\" category, nurses could not make triage decisions based on their perceptions in an acceptable way.</p><p><strong>Conclusion: </strong>Psychiatric ED nurses have an appropriate understanding of mental health triage meaning. However, according to these nurses, its structure is associated with shortcomings that limit the provision of mental health triage services and reduce their quality.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e70"},"PeriodicalIF":5.4,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457400","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":"Characteristics and Outcomes of Patient Transport to the Hospital by Emergency Medical Services (EMS); a Cross-sectional Study.","authors":"Pariwat Phungoen, Lap Woon Cheung, Kamonwon Ienghong, Korakot Apiratwarakul","doi":"10.22037/aaem.v11i1.2112","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2112","url":null,"abstract":"<p><strong>Introduction: </strong>To enhance the efficiency, it is essential to understand the patterns of service users and develop policies that facilitate effective personnel and resource management. This study aimed to compare the characteristic and outcomes of patients who were transferred to emergency department (ED) by emergency medical services (EMS) and patients transported by other means.</p><p><strong>Methods: </strong>This retrospective cross-sectional study was conducted at Srinagarind Hospital, Thailand, over a 5-year period from 2017-2021. The baseline characteristics, treatment modalities, and outcomes of patients who were transported to ED using EMS and Non-EMS were gathered and compared using STATA software.</p><p><strong>Results: </strong>The study included 15,501 patients with the median age of 51 (interquartile range (IQR): 23-71) years who were referred by EMS over the five-year period (51.72% male). EMS patients had significantly higher median age (51 (23 - 71) vs. 37 (21 - 60); p < 0.001) with male preference (p < 0.001). In the EMS group, the triage level 1 (need for resuscitation) was higher than the non-EMS group (p < 0.001), most of the patients referred following trauma (p < 0.001), and the frequency of cardiac arrest was considerably higher than non-EMS group (2.54% vs 0.05%; p < 0.001). Patients in the EMS group received a higher number of blood tests (p < 0.001), plain radiographic exams (p < 0.001), computerized tomography (CT) scans (p < 0.001), and complex procedures (p < 0.001) than the non-EMS group. The EMS group had a greater number of hospital admissions (p < 0.001) and intensive care unit (ICU) admissions (p < 0.001) compared to the non-EMS group. The EMS group exhibited a significantly higher mortality rate compared to the non-EMS group (p < 0.001).</p><p><strong>Conclusion: </strong>The population utilizing EMS services had higher median age, higher frequency of emergency cases and trauma related complaint, higher need for treatment interventions and imaging procedures, higher rate of hospital and ICU admissions, as well as higher rate of mortality compared to the non-EMS group.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e69"},"PeriodicalIF":5.4,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457399","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 Pain Scales in Predicting Critical Diagnoses in Non-Traumatic Abdominal Pain Cases; a Cross-sectional Study.","authors":"Supapilai Ueareekul, Chanon Changratanakorn, Parinya Tianwibool, Nattikarn Meelarp, Wachira Wongtanasarasin","doi":"10.22037/aaem.v11i1.2131","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2131","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate assessment and management of abdominal pain in the emergency department (ED) is crucial, as it can indicate potentially life-threatening conditions requiring timely treatment. This study aimed to evaluate the ability of pain scales to predict critical diagnoses in patients with non-traumatic abdominal pain.</p><p><strong>Methods: </strong>This cross-sectional study was conducted at a tertiary university hospital and involved individuals aged 15 years and above who presented to the ED with non-traumatic abdominal pain. Pain severity was evaluated using subjective pain scales, including the Numerical Rating Scale (NRS) and the Face Pain Scale (FPS), as well as objective pain scales, including the Critical Care Pain Observation Tool (CPOT) and the Non-verbal Pain Score (NVPS). The area under the receiver operating characteristic curve (AuROC) was employed to determine the discriminative ability of each pain scale to predict critical diagnosis.</p><p><strong>Results: </strong>264 cases with the mean age of 47.2±19.4 years were studied (53.0% male). The most common location of abdominal pain was epigastric pain (43.9%). Most patients presented with dull-aching pain, and those with critical diagnoses had more of this characteristic than those with non-critical diagnoses. (52.5% vs. 28.3%, p = 0.01). The overall median NRS, FPS, CPOT, and NVPS of included participants were 8 (interquartile range (IQR) 7-10), 8 (IQR 6-8), 3 (IQR 1-4), and 3 (IQR 2-4), respectively. Patients with critical diagnoses had a higher NVPS score than patients with non-critical diagnoses (median score of 4 vs. 3, p = 0.02). The AuROC of NRS, FPS, CPOT, and NVPS were 0.53 (95% CI: 0.45-0.62), 0.55 (95% CI: 0.46-0.63), 0.59 (95% CI: 0.50-0.68), and 0.62 (95% CI: 0.53-0.71), respectively. The correlation coefficients among these scales were considered moderately correlated or higher.</p><p><strong>Conclusion: </strong>In evaluating patients with non-traumatic abdominal pain, the NVPS demonstrated the highest accuracy in predicting critical diagnoses. However, all pain scales, whether subjective or objective, exhibited suboptimal performance in predicting critical diagnoses.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e68"},"PeriodicalIF":5.4,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457398","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":"Recognition of Stroke in the Emergency Room (ROSIER) Scale in Identifying Strokes and Transient Ischemic Attacks (TIAs); a Systematic Review and Meta-Analysis.","authors":"Iman Chehregani Rad,&nbsp;Amir Azimi","doi":"10.22037/aaem.v11i1.2135","DOIUrl":"10.22037/aaem.v11i1.2135","url":null,"abstract":"<p><strong>Introduction: </strong>A range of screening tools has been developed to assist emergency healthcare providers in rapidly and accurately diagnosing strokes. In this study, we investigated the diagnostic value of the Recognition of Stroke in the Emergency Room (ROSIER) scale in identifying individuals with stroke and transient ischemic attack (TIA).</p><p><strong>Methods: </strong>We conducted a systematic search across online databases of PubMed, Embase, Scopus, and Web of Science until June 12th, 2023, aiming to identify studies that assessed the diagnostic performance of the ROSIER scale in detecting strokes and TIAs among individuals with suspected stroke symptoms.</p><p><strong>Results: </strong>Data extracted from 34 studies were analyzed, demonstrating that the ROSIER score, with a cut-off value of ≥ 1, has sensitivity of 0.89 (95% confidence interval (CI): 0.86-0.92), specificity of 0.76 (95% CI: 0.69-0.81), diagnostic odds ratio (DOR) of 25.41 (95% CI: 17.2-37.54), and area under the curve (AUC) of 0.91 (95% CI: 0.85-0.90) in detection of strokes and TIAs. Meta-regression subgroup analysis revealed variations in sensitivity and specificity based on different settings and assessors. Sensitivity was higher in pre-hospital settings when the test was administered by emergency medical services (EMS) and emergency department (ED) paramedic staff, whereas specificity was higher in emergency department settings and when physicians and neurologists conducted the test.</p><p><strong>Conclusion: </strong>A moderate level of evidence shows that the ROSIER scale is considered an excellent tool for identifying strokes and TIAs. As a valid method for identifying strokes, it holds applicability across diverse settings and can be effectively used by assessors with different specialties.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e67"},"PeriodicalIF":5.4,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/74/aaem-11-e67.PMC10568950.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231921","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":"NEXUS vs. Canadian C-Spine Rule (CCR) in Predicting Cervical Spine Injuries; a Systematic Review and Meta-analysis.","authors":"Alireza Baratloo,&nbsp;Koohyar Ahmadzadeh,&nbsp;Mohammad Mehdi Forouzanfar,&nbsp;Mahmoud Yousefifard,&nbsp;Mehri Farhang Ranjbar,&nbsp;Behrooz Hashemi,&nbsp;Seyed Hadi Aghili","doi":"10.22037/aaem.v11i1.2143","DOIUrl":"10.22037/aaem.v11i1.2143","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical decision tools have been shown to reduce imaging rates for clearance of suspected cervical spine injury (CSI). This review provides more comprehensive evidence on the diagnostic capabilities of National Emergency X-Radiography Utilization Study (NEXUS) and Canadian C-spine rule (CCR) in this regard.</p><p><strong>Method: </strong>A systematic review of the current literature was performed on studies published until Jan 26^th, 2023, in databases of Medline, Scopus, Web of Science, and Embase, investigating the performance of NEXUS and CCR in blunt trauma patients. QUADAS-2 and GRADE guidelines were used to assess the quality and certainty of evidence. All analyses were performed using the STATA 14.0 statistical analysis software.</p><p><strong>Results: </strong>35 articles comprising 70000 patients for NEXUS and 33000 patients for CCR were included in this review. NEXUS and CCR were evaluated to have a sensitivity of 0.94 (95% confidence interval (CI): 0.88 to 0.98) and 1.00 (95% CI: 0.98 to 1.00) in the detection of any CSI and 0.95 (95% CI: 0.89 to 0.98) and 1.00 (95% CI: 0.95 to 1.00) in the detection of clinically important CSI. The area under the curve (AUC) of NEXUS and CCR was 0.85 and 0.97 for any CSI and 0.78 (95% CI: 0.74 to 0.81) and 0.94 (95% CI: 0.91 to 0.96) for clinically important CSI.</p><p><strong>Conclusion: </strong>Our study demonstrates that both NEXUS and CCR can be used in ruling out patients with low risk of CSI, and CCR was shown to have superior performance. Even though these tools have low specificity, their application can still greatly reduce the number of radiographic imaging performed in emergency departments.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e66"},"PeriodicalIF":5.4,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/0c/aaem-11-e66.PMC10568954.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231905","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}