BMC Emergency Medicine最新文献

{"title":"A randomised controlled trial of verbal guidance versus verbal guidance supplemented by a photographic aid for bystander identification of intramuscular tranexamic acid injection sites in a simulated road injury scenario.","authors":"Tim Nutbeam, Emily Foote, Lauren R Rodgers, Jessica Thomas-Mourne, Rob Fenwick","doi":"10.1186/s12873-025-01323-8","DOIUrl":"https://doi.org/10.1186/s12873-025-01323-8","url":null,"abstract":"<p><strong>Background: </strong>Non-compressible haemorrhage is a leading cause of preventable death following road injury. Tranexamic acid (TXA), when administered early, improves survival. Intramuscular (IM) administration offers a feasible route for early administration by lay bystanders. However, the ability of bystanders to correctly identify safe IM injection sites remains unclear. This study aimed to evaluate whether verbal guidance supplemented by a photographic aid improves the accuracy of site identification in a simulated road injury scenario.</p><p><strong>Methods: </strong>In this randomised controlled trial, 64 lay participants were recruited on a university campus and randomised to receive either (1) verbal guidance alone or (2) verbal guidance plus photographic aid to locate the deltoid injection site on a simulated injured person. Site identification was assessed via sticker placement, and three expert raters with diverse medical backgrounds independently reviewed standardised photographs to determine site safety using a majority agreement rule. The primary outcome was safe site identification. A binomial generalised linear model assessed the association between intervention group and correct site identification. Inter-rater reliability was measured using Fleiss' Kappa.</p><p><strong>Results: </strong>Participants in the verbal guidance plus photographic aid group were significantly more likely to identify a safe injection site compared to those receiving verbal guidance alone (87.5% vs. 62.5%; OR 4.67, 95% CI 1.33, 19.92, p = 0.03). The presence of concerns regarding site safety was also significantly lower in the photo and verbal group (18.8% vs. 53.1%, p = 0.002). No significant associations were found between accuracy and participant age, gender, prior training, or confidence.</p><p><strong>Conclusions: </strong>Supplementing verbal guidance with a photographic aid significantly improves bystander accuracy in identifying safe IM TXA injection sites in a simulated setting. This finding supports the potential integration of visual aids into emergency dispatch protocols to enhance early haemorrhage control in trauma care. Further research is needed to assess real-world application and impact.</p><p><strong>Clinical trial number: </strong>ISRCTN Registry: ISRCTN41280918.</p><p><strong>Trial registration: </strong>ISRCTN Registry: ISRCTN41280918, 08/08/2025 Retrospectively registered.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"197"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the C-reactive protein-albumin-lymphocyte (CALLY) index as a prognostic marker in patients with sepsis.","authors":"Erdal Yılmaz, Rohat Ak","doi":"10.1186/s12873-025-01356-z","DOIUrl":"10.1186/s12873-025-01356-z","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"194"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-hospital THRIVE score predicts the thrombolysis in cerebral infarction outcome post endovascular thrombectomy: an emergency medical service study.","authors":"Hui-An Lin, Sheng-Feng Lin, Chyi-Huey Bai","doi":"10.1186/s12873-025-01352-3","DOIUrl":"10.1186/s12873-025-01352-3","url":null,"abstract":"<p><strong>Background: </strong>The Totaled Health Risks in Vascular Events (THRIVE) score, which ranges from 0 to 9, incorporates factors such as age, the National Institutes of Health Stroke Scale (NIHSS), and the presence of comorbidities including atrial fibrillation, diabetes mellitus, and hypertension. This study aimed to evaluate the predictive value of the THRIVE score on immediate revascularization status following endovascular thrombectomy (IAT).</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from the ASSST dataset, covering the period from January 1, 2017, to May 31, 2022. Patients with acute ischemic stroke who underwent IAT were included in this analysis. The association between the THRIVE score and recanalization status-assessed using the Thrombosis in Cerebral Ischemia (TICI) scale (grades 2b/3)-was evaluated employing logistic regression models.</p><p><strong>Results: </strong>A total of 485 participants who received IAT were included in the analysis. Our findings revealed that a lower THRIVE score (OR 1.15, 95% CI 1.01-1.30), male sex (OR 1.81, 95% CI 1.15-2.87), and IAT performed following intravenous thrombolysis (OR 1.72, 95% CI 1.08-2.74) were significantly associated with successful revascularization. Youden's index identified a THRIVE score threshold of < 5 as optimal for predicting outcomes. Patients with a THRIVE score < 5 exhibited a higher likelihood of successful revascularization (OR 1.82, 95% CI 1.10-3.03).</p><p><strong>Conclusion: </strong>A lower THRIVE score (< 5) is associated with an increased likelihood of successful revascularization following IAT in patients with acute ischemic stroke, particularly among women.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"195"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Right patient to the right place: the impact of a 6-year regional trauma centre-led prehospital education programme on EMS triage and patient outcomes.","authors":"Donghwan Choi, Yo Huh, Byung Hee Kang, Sora Kim, Seoyoung Song, Kyoungwon Jung, Hohyung Jung","doi":"10.1186/s12873-025-01367-w","DOIUrl":"10.1186/s12873-025-01367-w","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"196"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating pain management in the Gaza Strip's conflict-affected hospitals: a prospective observational study.","authors":"Belal Aldabbour, Wasim Younis, Kareem Alrawabdeh, Anas Alhindi, Mohammed Nijem, Saleh Al Fayoumi, Mohammed Al Aidy, Othman Nassar, Abd Elkarem El Masry, Abdullah Tabaza, Diya Al Ashqar, Ibrahim Al Salhi, Latefa Ali Dardas","doi":"10.1186/s12873-025-01345-2","DOIUrl":"10.1186/s12873-025-01345-2","url":null,"abstract":"<p><strong>Background: </strong>Pain is one of the most distressing symptoms for trauma patients and serves as a cornerstone of acute trauma care. The healthcare system in the Gaza Strip has been devastated by the violent war that erupted in October 2023, further worsening the shortages and limitations it already experienced due to repeated assaults and a prolonged siege. The war-wounded are thus prone to suffer from inadequate pain management.</p><p><strong>Methods: </strong>A prospective observational study consecutively recruited 100 war trauma victims from two tertiary hospitals in the Gaza Strip. During the first four days of hospitalization (Days 0-3), the study evaluated the patients' subjective pain experiences before and after analgesia using the numerical rating scale (NRS), and assessed pain evaluation, documentation, and management practices.</p><p><strong>Results: </strong>Most participants were young males who underwent surgical interventions on their first day of hospitalization. None of the patients received a formal pain assessment, and nearly two-thirds of patient records lacked documentation of pain. The most frequently prescribed analgesics were diclofenac (33%), paracetamol 1 g (27%), and a combination of paracetamol 1 g with diclofenac 75 mg (18%), while opioid use was severely limited. Additionally, none of the patient records included on-demand analgesia. Pain relief was reported in 85%, 92%, 93%, and 91% following analgesia administration on admission days 0-3, respectively. The decrease in pain scores was significant across the studied days (p < 0.001), with average reductions of 4.26 points on admission day, 4.61 points on Day 1, 4.53 points on Day 2, and 4.27 points on Day 3.</p><p><strong>Conclusions: </strong>For most patients, the mean pain intensity decreased despite incomplete pain assessments and very limited opioid use. The study highlights the urgent need for context-specific improvements in pain assessment, documentation, and access to essential analgesics in conflict settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"189"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality predictors in pediatric emergency department presentations: a systematic review and meta-analysis.","authors":"Mohammed Alsabri, Mohamed A ELKarargy, Israa Magdy Ata, Mostafa A Khalifa, Abdulrahman Khaldoon Hamid, Ahmed Bostamy Elsnhory, Omar Ahmed Abdelwahab, Sarah Urbon","doi":"10.1186/s12873-025-01347-0","DOIUrl":"10.1186/s12873-025-01347-0","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients present to the emergency departments (EDs) with a wide range of clinical manifestations, ranging from mild to severe. A systematic approach is crucial to identify those at high risk of deterioration. However, the predictive value of such predictors remains unclear.</p><p><strong>Objectives: </strong>Our study aims to evaluate different mortality predictors used in pediatric emergency departments (PEDs) regarding the diagnostic accuracy metrics, including sensitivity, specificity, and diagnostic odds ratio.</p><p><strong>Methods: </strong>We comprehensively searched multiple databases and included all cohort studies, case-control studies, and randomized controlled trials from January 2000 to December 2024 with pediatric patients (aged 0-18 years) presenting to PEDs, where mortality predictors were used to assess for in-ED and short-term post-ED mortality. We employed a bivariate random-effects model for data synthesis and analysis to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) values.</p><p><strong>Results: </strong>329 Pediatric Early Warning Score (PEWS) thresholds were analyzed, with the model-derived optimal cutoff 2.189 (AUC) = 0.70; 95% CI: 0.63 to 0.76), high pooled sensitivity (0.95, 95% CI: 0.72 to 0.80) and specificity (0.93, 95% CI: 0.62 to 0.80). In addition, A strong negative predictive value (NPV = 0.0006) and modest positive predictive value (PPV = 0.0003) were noted. Heterogeneity was significant (I²>99%), driven by PEWS versions and clinical settings. PEWS implementation reduced mortality without increasing ICU admissions in resource-limited settings.</p><p><strong>Conclusions: </strong>PEWS is a good exclusion tool for those at low mortality risk. However, a comprehensive approach with clinical judgment is needed for the risk assessment of high-risk pediatrics.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"188"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of hospital and health system factors with emergency department length of stay in older adults with dementia.","authors":"Stephanie K Nothelle, Eric P Slade, Phillip D Magidson, Laura Prichett, Amanda Finney, Tanya Chotrani, Halima Amjad, Sarah Szanton, Cynthia M Boyd, Jennifer L Wolff","doi":"10.1186/s12873-025-01353-2","DOIUrl":"10.1186/s12873-025-01353-2","url":null,"abstract":"<p><strong>Background: </strong>Persons living with dementia (PLWD) have longer lengths of stay (LOS) in the Emergency Department (ED), which increases risk of delirium, falls and medication errors. Care of PLWD in the ED is complex and presence of dementia care specialists (geriatrics, neurology, psychiatry) may streamline care. We sought to understand the contribution of health system factors, including presence of dementia care specialists, to LOS among PLWD.</p><p><strong>Methods: </strong>We linked statewide ED visit data on patients discharged from the ED for Arkansas, Arizona, Florida and Massachusetts from the 2018 Healthcare Cost and Utilization Project State Emergency Department Database to the American Hospital Association Annual Survey and Healthcare Information Technology supplement. We included ED visit records for persons ≥ 65 years with ICD-10 dementia diagnoses. Median LOS was estimated at the hospital level and then used as a dependent measure in hospital-level Poisson multivariable models that conditioned on system characteristics.</p><p><strong>Results: </strong>We included 72,083 ED visits resulting in discharge at 225 health systems. Most EDs were in non-governmental, not-for-profit community hospitals (n = 159, 71%). Median patient age was 83 years (IQR 67, 92), females comprised a mean of 64% of visits. Median LOS was 4 h (IQR 3-7), mean LOS was 9.3 h (SD 16.3). Neurology was the most commonly available dementia care service (n = 180, 80%), followed by psychiatric services (n = 139 EDs, 62%) and geriatric services (n = 132, 59%). In Poisson models adjusting for a parsimonious set of co-variates, the presence of geriatric services was associated with a 16% lower mean LOS (IRR 0.84, 95% CI 0.73-0.97), however, this association lost significance in fully adjusted models (IRR 0.87, 95% CI 0.76-1.01).</p><p><strong>Conclusions: </strong>Availability of geriatric specialty services may offer hospitals an advantage in streamlining ED care for PLWD and in reducing visit length for this complex patient group. These findings reinforce the potential value of the Geriatrics Emergency Department Accreditation programs.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"193"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral sensitivity and professional quality of life in EMS personnel: a cross-sectional multicenter study.","authors":"Abbas Dadashzadeh, Mostafa Ghasempour, Majid Purabdollah, Javad Dehghannezhad, Neda Gilani, Fezeh Hoseini Lilab","doi":"10.1186/s12873-025-01349-y","DOIUrl":"10.1186/s12873-025-01349-y","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"190"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Criteria codes for unrecognized stroke/TIA patients by Emergency Medical Services dispatchers in Copenhagen, Denmark.","authors":"Philip Busch Andreasen, Jonathan Wenstrup, Stig Nikolaj Fasmer Blomberg, Christina Kruuse, Helle Collatz Christensen","doi":"10.1186/s12873-025-01335-4","DOIUrl":"10.1186/s12873-025-01335-4","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"191"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of two-level filtering organization on population's accessibility to an emergency medical communication centre.","authors":"Lydie Uro, Yann Penverne, Henri Delelis-Fanien, Louis Soulat, Joel Jenvrin, Paul-Georges Reuter","doi":"10.1186/s12873-025-01310-z","DOIUrl":"10.1186/s12873-025-01310-z","url":null,"abstract":"<p><strong>Background: </strong>Emergency Medical Communication Centres (EMCCs) play a critical role in the timely coordination of out-of-hospital emergency responses. As demand for emergency services continues to rise, these centres face significant challenges in maintaining operational efficiency and service quality in order to provide a priority response to life-threatening emergencies. While the two-level answering system - i.e. a two-tiered response by call takers - has shown promise in simulation studies, its effectiveness in real-world settings has yet to be fully evaluated.</p><p><strong>Objective: </strong>This study aimed to assess the impact of implementing a two-level answering system on service quality (rate of answered calls) at 30 s (QS30) across three EMCCs, marking the first evaluation of this system in everyday operations. We also investigated how variations in organizational structure among the EMCCs may influence QS30.</p><p><strong>Methods: </strong>We conducted a multicentric, observational, retrospective study analyzing call data collected between May and June of 2022 and 2023, in France. Three EMCCs-35, 44, and 86-were included, with EMCCs 35 and 44 having implemented the two-level system, while EMCC 86 served as the control. Each EMCC employed distinct organizational models for the two-level system. Key performance indicators were assessed using non-parametric statistical tests, including the Wilcoxon and Kruskal-Wallis tests. Additionally, structural equation modeling was used to explore relationships between variables affecting service quality.</p><p><strong>Results: </strong>A total of 255,438 calls were analyzed, with 152,108 calls during the two-level period. The QS30 for EMCC 35 ranged from 93% in 2022 to 91% in 2023 (p < 1e-4), while EMCC 44 saw an increase from 91 to 100% (p < 1e-4). In contrast, EMCC 86 maintained a stable QS30 of 100%, with no significant change in activity (p = 0.1). Further analysis revealed significant differences in QS30 across the three EMCCs, suggesting that the distinct organizational structures of the two-level systems influence overall service quality. Structural equation modeling also highlighted strong correlations between call volume, agent workload, and QS30, emphasizing the impact of staffing and organizational structure on service quality.</p><p><strong>Conclusion: </strong>The findings suggest that the two-level answering system may be effective in enhancing EMCC performance, particularly in managing increased call volumes. Additionally, the study highlights the potential importance of organizational differences in shaping QS30 outcomes. Future research should focus on longitudinal effects and explore innovative strategies to sustain high-quality EMCCs amidst evolving demands.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"192"},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}