BMC Emergency Medicine最新文献

{"title":"Acute behavioral changes as a diagnostic factor of intracranial injuries among the elderly population with mild traumatic brain injury - retrospective cross-sectional study.","authors":"Marian Sedlak, Satria Nur Sya'ban, Jozef Dragasek, Kornelia Hutnanova, Eva Sedlakova, Radoslav Morochovic, Rastislav Burda","doi":"10.1186/s12873-025-01208-w","DOIUrl":"https://doi.org/10.1186/s12873-025-01208-w","url":null,"abstract":"<p><strong>Purpose: </strong>Mild traumatic brain injury (mTBI) is one of the most common trauma-related diagnoses treated in emergency departments, especially among the geriatric population. Higher age alone is often an indication for a computed tomography (CT) scan, even when, approximately 90% of these scans do not reveal intracranial injuries. Incorporation of new diagnostic parameters into indication schemes for CT scans could improve the efficiency and reduce unnecessary imaging. The primary outcome of this study was to evaluate the association of acute behavioral changes among elderly patients treated for mTBI with the prevalence of intracranial injuries diagnosed by CT scans.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted at Louis Pasteur University Hospital in Košice. All patients aged 65 and older who presented during the period of 12 months with suspected mTBI and underwent CT imaging were included in the study. Electronic health records were used as a data source.</p><p><strong>Results: </strong>A total of 586 patients were included in the study. Acute behavioral changes were observed among 60 (10.2%) patients. Intracranial injury was diagnosed in 35 patients (6.0%). There was a statistically significant association between acute behavioral changes and the presence of intracranial injuries (p < 0.05), with those exhibiting behavioral changes having higher odds of injury (OR: 6.51; 3.01-13.7; p < 0.001).</p><p><strong>Conclusion: </strong>Elderly patients with mTBI who present with acute behavioral changes are more likely to have intracranial injuries detected by CT scans. Incorporating these symptoms into indication schemes for head CT scans may improve strategies aimed at more effective and judicious use of imaging.</p><p><strong>Trial registration: </strong>Clinical trial number: Not applicable, retrospectively registered.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"50"},"PeriodicalIF":2.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742045","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":"Comparison of Standardized Mortality Ratios in seven Dutch EDs based on presenting complaints.","authors":"Wouter Raven, Bart G J Candel, Nabila Wali, Menno I Gaakeer, Ewoud Ter Avest, Ozcan Sir, Heleen Lameijer, Roger A P A Hessels, Resi Reijnen, Christian H Nickel, Evert de Jonge, Erik van Zwet, Bas de Groot","doi":"10.1186/s12873-025-01200-4","DOIUrl":"https://doi.org/10.1186/s12873-025-01200-4","url":null,"abstract":"<p><strong>Background: </strong>Comparison of emergency departments (EDs) becomes more important, but differences are difficult to interpret because of the heterogeneity of the ED population regarding reason for ED presentation. The aim of this study was two-fold: First to compare patient characteristics (including diagnoses) across 7 EDs. Secondly, to compare Standardized Mortality Ratios (SMRs) across 7 EDs and in subgroups of ED patients categorized by presenting complaints (PCs).</p><p><strong>Methods: </strong>Observational multicenter study including all consecutive visits of 7 Dutch (two tertiary care centre and 5 teaching hospitals) EDs. Patient characteristics, including PCs as part of triage systems, and SMRs (observed divided by expected in-hospital mortality) per ED and for the most common PCs (PC-SMRs) were compared across EDs and presented as funnel plots. The expected mortality was calculated with a prediction model, which was developed using multivariable logistic regression in the overall population and for PCs separately. Demographics, disease severity, diagnoses, proxies for comorbidity and complexity, and PCs (overall population only) were incorporated as covariates.</p><p><strong>Results: </strong>We included 693,289 ED visits from January 1, 2017 to June 31, 2023, with a median age of 56 years, of which 47.9% were women and 1.9% died. Patient characteristics varied markedly among EDs. Expected mortality was similar in prediction models with or without diagnoses as covariate. SMRs differed across EDs, ranging from 0.80 to 1.44. All EDs had SMRs within the 95%-Confidence Intervals of the funnel plot apart from one ED, which had an higher than expected SMR. However, PC-SMRs showed more variation and more EDs had SMRs falling outside the funnel, either higher or lower than expected. The ranking of SMRs across EDs was PC-dependent and differences across EDs are present only for specific PC-SMRs, such as in \"dyspnea\" and \"feeling unwell\".</p><p><strong>Conclusion: </strong>In summary, patient characteristics and mortality varied largely across Dutch EDs, and expected mortality across EDs is well assessed in PC subgroups without adjustment for final diagnoses. Differences in SMRs across EDs are PC-dependent. Future studies should investigate reasons of the differences in PC-SMRs across EDs and whether PC-targeted quality improvement programs can improve outcomes.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"49"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742055","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":"Can we trust naked eye assessments of the capillary refill test in children? An experimental study.","authors":"Frida Meyer, Jonatan Stahre, Joakim Henricson, Daniel B Wilhelms","doi":"10.1186/s12873-025-01204-0","DOIUrl":"https://doi.org/10.1186/s12873-025-01204-0","url":null,"abstract":"<p><strong>Background: </strong>The capillary refill test is widely used in pediatric emergency medicine and critical care although its validity and reliability are debated. Naked eye estimation is the recommended method for capillary refill time (CR time) assessment. The goal of this study was to compare naked eye estimations of the CR time in pediatric patients to quantified capillary refill time (qCR time) using polarized reflectance imaging as an objective reference, and to investigate interobserver and intra-observer consistency of naked eye assessments of CR time.</p><p><strong>Method: </strong>A film sequence comprising videos of capillary refill tests from 15 emergency pediatric patients was shown under standardized conditions to 62 observers (pediatricians, nurses, assistant nurses, and medical secretaries). The observers' estimations of CR time in seconds and in descriptive categorizations were compared to objectively derived qCR time. Three tests were shown twice without the observers' knowledge.</p><p><strong>Results: </strong>There was poor interobserver agreement in all professions, with limits of agreement ranging from 1.17 s (assistant nurses) to 2.00 s (secretaries). Intra-observer agreement for estimations of both time and descriptive categorizations was limited. The correlation between naked eye assessments and qCR time was weak.</p><p><strong>Conclusion: </strong>This study shows that naked eye assessment of CR time in children is highly subjective with poor reproducibility in pediatric nurses and pediatricians, as well as in comparison to a quantitative method. Based on the lack of both inter- and intra-observer consistency in the assessments, these findings suggest that CR time assessed by naked eye should be questioned as a routine test in pediatric emergencies.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"48"},"PeriodicalIF":2.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742046","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":"Nurses' lived experiences of self-control in emergency settings: a qualitative study.","authors":"Mehraban Shahmari, Seemin Dashti, Mahsa Jafari, Fatemeh Ebrahimi Belil","doi":"10.1186/s12873-025-01205-z","DOIUrl":"10.1186/s12873-025-01205-z","url":null,"abstract":"<p><strong>Background: </strong>Given nurses' vital role in emergencies, it is essential to understand their perceptions and strategies for self-control. This study examines nurses' experiences and insights regarding self-control during high-pressure scenarios. The findings could inform the development of effective stress management strategies and enhance nursing training programs, ultimately improving patients' overall quality of care.</p><p><strong>Methods: </strong>This study utilized a qualitative, descriptive design with a content analysis approach. Data was collected through semi-structured interviews with 24 nurses in various wards of five university-affiliated hospitals, including [specific wards, e.g., emergency, intensive care, internal, etc.]. The nurses were selected using a purposive sampling technique, and the data were analyzed through qualitative content analysis.</p><p><strong>Findings: </strong>Nurses' lived experiences and understanding of self-control in emergencies revealed three main categories, each comprising several sub-categories: Managing Emotional Intelligence in Crisis Situations (Emotion Regulation in Critical Situations, Using Resources and Experiences for Emotion Management, and Control of Individual Emotions), Adherence to Principles in Crisis Situations (Compliance with Ethical Standards, Ethical Decision-Making, Patient-Centered Focus, and Effective Communication), and Self-Control in Managing Stress and Fatigue (Fatigue Management and Interpersonal Interaction and Collaboration).</p><p><strong>Conclusion: </strong>This study highlights the importance of self-control for nurses working in high-stress environments. It emphasizes that enhancing emotional intelligence, adhering to professional standards, and effectively managing stress are crucial for overcoming workplace challenges. These factors not only foster resilience but also support self-control, which is essential for maintaining composure and making informed decisions during emergencies. The findings advocate for creating supportive work environments and implementing evidence-based policies to improve nurses' self-control skills, ultimately leading to better patient outcomes. These insights can guide enhancements in nursing education and overall care quality.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"46"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699451","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":"The effect of a new in-hospital trauma care model on the outcomes of severely injured trauma patients in the emergency department: a retrospective observational study in China.","authors":"Qiu Zhao, Yue Zhao, Tingting Ke, Caili Lin, Yao Xu, Yuanyuan Xu, Shuli Liu, Xinqun Li","doi":"10.1186/s12873-025-01203-1","DOIUrl":"10.1186/s12873-025-01203-1","url":null,"abstract":"<p><strong>Background: </strong>The mortality and disability rates among severely injured trauma patients are very high. This study aimed to investigate whether a new in-hospital trauma care model can improve emergency care efficiency and enhance the prognosis of severely injured trauma patients.</p><p><strong>Methods: </strong>This retrospective observational study included 366 severely injured trauma patients (ISS ≥ 16) who were admitted to the emergency department of a tertiary hospital between 2023 and 2024. Based on the emergency care model used, patients were divided into the traditional model group (n = 213) from January to April 2023 and the new model group (n = 153) from January to April 2024. The general clinical data, prognosis information, as well as seven emergency quality control indicators for both groups were collected and analyzed.</p><p><strong>Results: </strong>The study included 270 male patients (73.8%) and 96 female patients (26.2%), with a mean age of 56 (44, 69) years. No significant differences were found between the two groups regarding gender, age, time since injury, mechanism of injury, and vital signs upon admission (P > 0.05). The new model group had significantly shorter times for establishing effective circulation access (15.66 ± 3.36 vs. 9.44 ± 3.18 min), establishing an artificial airway (36.90 ± 12.23 vs. 23.91 ± 9.07 min), preparing blood transfusion (48.84 ± 5.73 vs. 31.0 ± 64.67 min), completing whole-body CT scans (57.18 ± 8.26 vs. 42.17 ± 7.28 min), and developing a definitive treatment plan (77.45 ± 6.26 vs. 56.50 ± 6.35 min) compared to the traditional model group. Additionally, the new model group had a significantly higher rate of bedside FAST completion (92.8% vs. 53.1%) and a higher success rate of resuscitation within the first hour (70.9% vs. 85.0%) than the traditional model group. Regarding prognosis, the new model group had a lower overall in-hospital mortality rate (12.1% vs. 5.9%) and a lower incidence of complications such as DIC and ARDS (23.9% vs. 9.2%, all P < 0.05).</p><p><strong>Conclusion: </strong>The new in-hospital trauma care model significantly enhanced the in-hospital emergency care efficiency, reduced in-hospital mortality, and decreased the incidence of complications for severely injured patients, which may serve as a useful reference for developing countries in similar settings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"47"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699455","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":"Rural hospital incident command leaders' perceptions of disaster preparedness.","authors":"Jason P Murphy, Clara Bergström, Lina Gyllencruetz","doi":"10.1186/s12873-025-01201-3","DOIUrl":"10.1186/s12873-025-01201-3","url":null,"abstract":"<p><strong>Background: </strong>Recent trends indicate that the frequency of major incidents (MIs) is increasing. Healthcare systems are vital actors in societies' responses to MIs. Well-prepared healthcare systems may mitigate the effects of MIs. Disaster preparedness is based on region-specific risk and vulnerability analyses (RVAs). Hospital incident command groups (HICGs) are commonly formed per hospital's contingency plan MI to aid in disaster response. Acquiring situational awareness and decision-making in the face of uncertainty are known challenges for HICGs during MIs. However, the remoteness of rural hospitals presents unique challenges.</p><p><strong>Aim: </strong>The aim of this study was to explore HICG leaders' perceptions of disaster preparedness in rural hospitals.</p><p><strong>Methods: </strong>A qualitative study with semi-structured, focus group, and individual interviews was used. The data were analyzed through inductive content analysis.</p><p><strong>Results: </strong>The analysis generated the main category, HICGs' confidence in handling major incidents and four categories. These were Uncertainty and level of recognition (containing two subcategories); Awareness of challenges and risks (containing two subcategories); Factors that facilitate preparedness, response, and leadership (containing three subcategories); and Prerequisites for decision-making (containing three subcategories and four subcategories).</p><p><strong>Conclusions: </strong>HICG leaders generally perceived their hospital's disaster preparedness as adequate. However, preparedness was found to be influenced by several factors. The findings revealed a complex interplay of factors influencing preparedness and response, particularly highlighting challenges related to geographical isolation and resource constraints. Effective preparedness requires a comprehensive understanding of local contexts, hospital capabilities, and risks, which directly impacts training, decision-making, and resource allocation. Addressing the identified vulnerabilities necessitates targeted interventions focused on situational awareness, decision-making, collaboration, and training.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"45"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656094","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":"Indications for extracorporeal membrane oxygenation in older adult patients with accidental hypothermia and hemodynamic instability.","authors":"Shuhei Takauji, Mineji Hayakawa, Ryo Yamamoto","doi":"10.1186/s12873-025-01202-2","DOIUrl":"10.1186/s12873-025-01202-2","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) indications in patients with accidental hypothermia (AH) and hemodynamic instability before cardiac arrest (CA) are unclear. We aimed to identify a subgroup of these patients who would benefit from ECMO rewarming.</p><p><strong>Methods: </strong>This study was a post-hoc analysis of the ICE-CRASH study (2019-2022), a prospective, multicenter, observational study throughout Japan. Among the 499 patients (core temperature < 32 °C, age > 18 years), 175 with AH and hemodynamic instability were selected. The primary outcome was 28-day mortality. We examined the effect of ECMO on 28-day mortality after risk stratification based on age, activities of daily living (ADLs), core temperature, Glasgow coma scale (GCS) score, systolic blood pressure (SBP), arrhythmia, pH, and lactate levels. The secondary outcomes were rewarming rate, event-free days (ICU-, ventilator-, and catecholamine-free days), and complications.</p><p><strong>Results: </strong>The patients were divided into ECMO (N = 17) and non-ECMO (N = 158) groups. No significant difference was observed in the 28-day survival rates between the ECMO (13/17, 77%) and non-ECMO (120/158, 76%) groups (p = 0.96). The restricted cubic spline curve showed that the 28-day mortality increased with a GCS score ≤ 8; no relationship was observed between 28-day mortality and decreased SBP or core temperature. No significant difference was observed in the effectiveness of ECMO based on age (< 80 vs. ≥ 80 years), ADLs (independent vs. assistance needed/unknown), core temperature (≥ 26 vs. < 26 °C), GCS (> 8 vs. ≤ 8), SBP (≥ 60 vs. < 60 mmHg), arrhythmia (sinus rhythm vs. arrhythmia), pH (≥ 7.1 vs. < 7.1), and serum lactate level (< 3.0 vs. ≥ 3.0 mmol/L). The rewarming rate was significantly higher in the ECMO group than in the non-ECMO group (2.5 °C/h vs. 1.3 °C/h, p < 0.001), and ICU-, ventilator-, and catecholamine-free days were significantly higher in the non-ECMO group than in the ECMO group. Bleeding complications were significantly more common in the ECMO group than in the non-ECMO group (77% vs. 26%, p < 0.001).</p><p><strong>Conclusions: </strong>We were unable to identify a subgroup of older adult patients with AH and hemodynamic instability who would benefit from ECMO. The ICE-CRASH study was registered with the University Hospital Medical Information Network Clinical Trial Registry on April 1, 2019 (UMIN-CTR ID: UMIN000036132).</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"44"},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623287","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":"AI-assisted decision-making in mild traumatic brain injury.","authors":"Yavuz Yigit, Mahmut Firat Kaynak, Baha Alkahlout, Shabbir Ahmed, Serkan Günay, Asim Enes Ozbek","doi":"10.1186/s12873-024-01159-8","DOIUrl":"10.1186/s12873-024-01159-8","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the potential use of ChatGPT in aiding clinical decision-making for patients with mild traumatic brain injury (TBI) by assessing the quality of responses it generates for clinical care.</p><p><strong>Methods: </strong>Seventeen mild TBI case scenarios were selected from PubMed Central, and each case was analyzed by GPT-4 (March 21, 2024, version) between April 11 and April 20, 2024. Responses were evaluated by four emergency medicine specialists, who rated the ease of understanding, scientific adequacy, and satisfaction with each response using a 7-point Likert scale. Evaluators were also asked to identify critical errors, defined as mistakes in clinical care or interpretation that could lead to morbidity or mortality. The readability of GPT-4's responses was also assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level tools.</p><p><strong>Results: </strong>There was no significant difference in the ease of understanding between responses with and without critical errors (p = 0.133). However, responses with critical errors significantly reduced satisfaction and scientific adequacy (p < 0.001). GPT-4 responses were significantly more difficult to read than the case descriptions (p < 0.001).</p><p><strong>Conclusion: </strong>GPT-4 demonstrates potential utility in clinical decision-making for mild TBI management, offering scientifically appropriate and comprehensible responses. However, critical errors and readability issues limit its immediate implementation in emergency settings without oversight by experienced medical professionals.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"43"},"PeriodicalIF":2.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613355","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":"The triage performance of emergency medical dispatch prioritisation compared to prehospital on-scene triage in the Western Cape Province of South Africa.","authors":"Faisal Binks, Lee A Wallis, Willem Stassen","doi":"10.1186/s12873-025-01198-9","DOIUrl":"10.1186/s12873-025-01198-9","url":null,"abstract":"<p><strong>Introduction: </strong>The emergency medical service (EMS) response is dependent on the emergency medical dispatch (EMD) and the operations response team to ensure that the patient receives the required EMS resources and treatment in the appropriate time. EMS resources must be dispatched to calls of appropriate patient acuity. Overtriage and undertriage impact the appropriate response and optimization of EMS resources and, most importantly, patient outcomes. This study examines overtriage and undertriage rates in ambulance dispatch operations in the Western Cape Government (WCG), South Africa.</p><p><strong>Aim: </strong>Determine undertriage and overtriage rates of EMD priority allocation compared to on-scene ambulance triage.</p><p><strong>Methods: </strong>This was a retrospective descriptive study conducted with data received separately for dispatching emergency calls through computer-aided dispatch records and triage information from electronic patient care records. The data were derived from 1^st October 2018 to 30^th September 2019 and included primary response calls only. Using the South African Triage Scale, overtriage and undertriage of the priority rating of the incident at dispatch were calculated using the Cribari matrix for each incident type.</p><p><strong>Results: </strong>A total of 242,576 primary emergency responses were analysed. Overall, the overtriage rate was 62.28% (95% CI: 61.94%-62.63%), and the undertriage rate was 15.29% (95% CI: 15.10%-15.47%). The sensitivity was 53.71% (95% CI: 53.29%-54.13%), and the specificity was 74.31% (95% CI: 74.11%-74.51%). The incident types with the highest overtriage rates were obstetric (89%) and gynaecological (86%) complaints and allergic reactions (79%); while the incident types with the highest undertriage rates were respiratory complaints (31%), diabetes (30%), and chest pain (29%).</p><p><strong>Conclusion: </strong>This study revealed substantial overtriage and undertriage across all incident types. The results of this study provide a good reference point for future comparisons of triage rates in the Western Cape. It can be used to inform the development of policies, processes, guidelines, triage and training in dispatching systems, which may contribute to the optimization of prehospital resource management and patient care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"42"},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571880","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":"Developing and evaluating a Disaster Management Assessment Tool for Health Care Practitioners.","authors":"Sara Elshami, Mohamed Izham Mohamed Ibrahim, Manar E Abdel-Rahman, Hanan Abdul Rahim, Banan Mukhalalati","doi":"10.1186/s12873-025-01199-8","DOIUrl":"10.1186/s12873-025-01199-8","url":null,"abstract":"<p><strong>Background: </strong>Over the last fifty years, the frequency and intensity of disasters have escalated, highlighting the importance of healthcare practitioners (HCPs) being thoroughly prepared for disaster management. Despite this pressing need, there is a notable lack of well-developed and rigorously evaluated assessment tools to evaluate disaster preparedness among HCPs across various disciplines and disaster scenarios. This study aims to develop and evaluate a Disaster Management Assessment Tool for Health Care Practitioners (DMAT_HCP).</p><p><strong>Methods: </strong>The DMAT_HCP was designed following the four stages of the Disaster Management Framework and a literature review of similar previously validated tools. Content validity was assessed through two rounds of review by nine and six experts, whereas face validity was assessed by 11 HCPs. DMAT_HCP was tested on 107 HCPs from different health disciplines and settings to evaluate the structural (factor analysis) and construct (convergent and divergent) validities as well as internal consistency reliability.</p><p><strong>Results: </strong>DMAT_HCP comprised five Likert scales that assess the preparedness and readiness of HCPs for disaster, with satisfactory content validity indices (CVI > 0.83 for six experts). Factor analysis of the entire set of DMAT_HCP items suggested six factors: knowledge, two sub-domains of attitude, practice, willingness to practice, and organization-based management, which together accounted for 77.9% of the variance in the data. Convergent and divergent validity analyses showed that all items within a section had a correlation coefficient greater than 0.4 with their corresponding section score, and they were more strongly correlated with their own section than with scores from other sections. Cronbach's alpha values for the individual sections ranged from 0.89 (attitude) to 0.97 (organization-based management), and the overall Cronbach's alpha for the DMAT_HCP was 0.90.</p><p><strong>Conclusions: </strong>This study substantiated that DMAT_HCP is both conceptually and methodologically valid and reliable. It has demonstrated strong content validity, accurately measures the intended constructs, and effectively distinguishes between unrelated constructs. The tool also exhibited excellent internal consistency reliability across its components. The tool offers a comprehensive, globally applicable assessment of disaster management, suitable for use across various healthcare professions, settings, disaster contexts, and management phases.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"41"},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571873","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}