BMC Emergency Medicine最新文献

{"title":"Developing a clinical decision tool to support paramedics when assessing and managing children with minor head injury.","authors":"Alyesha Proctor, Mark D Lyttle, Sarah Voss, Jonathan Benger","doi":"10.1186/s12873-025-01362-1","DOIUrl":"10.1186/s12873-025-01362-1","url":null,"abstract":"<p><strong>Background: </strong>Head-injured children are commonly transported to the Emergency Department (ED) by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Hospital clinicians use clinical decision tools to support their assessment of head-injured children; however, this is generally to determine whether a computed tomography (CT) scan is indicated. Currently, there is no pre-hospital clinical decision tool designed to support paramedics when assessing and managing head-injured children at scene. The aim of this study was to determine consensus amongst experts and stakeholders to inform the development of a new tool to support paramedics in safely assessing and managing children with minor head injury.</p><p><strong>Methods: </strong>A consultation process using a modified online Delphi technique comprising two rounds and a consensus meeting was completed between September 2023 and January 2024. A 5-point Likert scale was used to assess consensus, set a-priori at 67%. Free text survey responses arising from the Delphi were studied and concepts were developed. Data were analysed anonymously, and feedback was given after each round.</p><p><strong>Results: </strong>An expert stakeholder group comprising 36 participants took part in Round One, and 34 participants in Round Two of the online Delphi. The participants included parents/grandparents/caregivers, paramedics, primary care clinicians, ED doctors, ED nurses and Paediatricians. Consensus was reached in 36 statements following Rounds One and Two. The remaining eight statements were discussed at a consensus meeting, which was attended by 12 stakeholders. Seven of the eight statements reached agreement.</p><p><strong>Conclusion: </strong>This Delphi study has established consensus amongst a group of experts and stakeholders on the content and format of a pre-hospital paediatric head injury clinical decision tool, designed for use by paramedics: PATCH (Pre-hospital Assessment Tool for Children with Head injury). Future research should include an evaluation of the acceptability and usability of PATCH by paramedics.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"203"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257291","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 antibiotic post-prescription authorization in resource-limited emergency rooms and acute care units during the COVID-19 pandemic.","authors":"Natthanan Kingsuvangul, Witranut Boonchaikamonarkorn, Pinyo Rattanaumpawan","doi":"10.1186/s12873-025-01363-0","DOIUrl":"10.1186/s12873-025-01363-0","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial overuse is a major problem in various healthcare settings, including emergency rooms (ERs) and acute care units (ACUs). This study aimed to evaluate the impact of the post-prescription authorization (PPA) of antibiotics in these settings.</p><p><strong>Methods: </strong>This retrospective observational study included ER and ACU patients at Siriraj Hospital. In August 2020, a PPA for piperacillin/tazobactam, meropenem, imipenem/cilastatin, and ertapenem was implemented. These antibiotics were unrestricted for the first 72 h; thereafter, infectious disease physician approval was required. Data from pre-implementation (July 2020) and post-implementation (September 2020) periods were compared.</p><p><strong>Results: </strong>Two-hundred and six patients were included in the study (103 patients each from the pre- and post-implementation periods). There were no significant differences between the groups regarding male sex (49.5% vs. 47.6%;p = 0.78) and age (67.63 ± 22.9 vs. 66.94 ± 17.4 years;p = 0.27). The respiratory tract was the most common infection site, and piperacillin/tazobactam was the most frequently first-prescribed antibiotic. Using too narrow-spectrum antibiotics was the most common reason for inappropriate antibiotic use. The day of therapy/outpatient-day of the target antibiotics was significantly lower in the post-implementation group (0.85 ± 0.41 vs. 0.72 ± 0.39;p = 0.02). Favorable clinical outcomes were significantly higher in the post-implementation group (42.7% vs. 62.1%;p = 0.005).</p><p><strong>Conclusions: </strong>This study demonstrates the positive impact of PPA in emergency settings, with a 15% reduction in antibiotic consumption and a 20% increase in favorable clinical outcomes. Future studies should evaluate PPA early in the course of treatment to identify the most effective interventions for improving the quality of care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"202"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257317","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":"Comparative descriptive analysis of hospital disaster preparedness using WHO safety index: a multi-center study from Eastern India.","authors":"Kumar Guru Mishra, Nabnita Patnaik, Nihar Ranjan Pradhan, Adityananda Mohapatra, Sheikh Mohd Saleem","doi":"10.1186/s12873-025-01248-2","DOIUrl":"10.1186/s12873-025-01248-2","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital disaster preparedness is crucial for maintaining healthcare delivery during emergencies, yet significant gaps persist in developing nations. This study evaluated disaster preparedness levels across thirteen tertiary care hospitals in Eastern India using the World Health Organization (WHO) Hospital Safety Index framework.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted in thirteen tertiary care hospitals (400-550 beds each) in Khordha District, Odisha, during January 2020-December 2023. Assessment utilized Module-4 of the WHO Safe Hospital Checklist, comprising seven sub-modules and 40 evaluation criteria. Data collection involved direct observation, document review, and semi-structured interviews. A three-tier scoring system (0-2.5 points) was employed to calculate safety indices.</p><p><strong>Results: </strong>Overall safety indices ranged from 0.412 to 0.782, with significant inter-hospital variations. Four hospitals demonstrated high preparedness (indices > 0.66), while three hospitals showed critical deficiencies (indices < 0.45). Logistics and finance management showed uniform high preparedness (8.75/10) across all facilities. Major gaps were identified in emergency response planning, with the lowest mean score (4.60) and highest variability (CV = 67.2%). Communication systems and evacuation protocols showed considerable variation (scores ranging 1.25-7.5/10).</p><p><strong>Conclusion: </strong>The study reveals substantial disparities in disaster preparedness among regional tertiary care facilities. While some hospitals demonstrate robust emergency management systems, others require significant improvements. Findings suggest the need for standardized protocols, regular assessment, and knowledge sharing between institutions to enhance regional healthcare disaster resilience.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"201"},"PeriodicalIF":2.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249582","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":"Key factors impacting morning report learning in emergency residency training: a multicenter qualitative study.","authors":"Omar Alghamdi, Salman Alotaibi, Ali Alkhulaif, Sarah Alqahtani, Ali Basfar, Muna Aljahany","doi":"10.1186/s12873-025-01358-x","DOIUrl":"10.1186/s12873-025-01358-x","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"198"},"PeriodicalIF":2.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237746","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":"Alcohol poisoning, in the shadow of a COVID-19 pandemic: a 5-year review of methanol/ethanol toxicity in Northern Iran.","authors":"Yahya Salehtabari, Mohsen Salehtabari, Kimia Khonakdar, Zeinab Sajjadi, Kobra Gholami, Hassan Talebi Ghadicolaei, Zoya Hadinejad","doi":"10.1186/s12873-025-01346-1","DOIUrl":"10.1186/s12873-025-01346-1","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"199"},"PeriodicalIF":2.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237727","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":"Assessment of physicians' ethical dilemmas and decision-making in emergency departments in resource-limited settings: a study of selected public hospitals in Sidama regional state, Ethiopia, 2024.","authors":"Sisay Tesfaye, Fikru Tadesse, Mekdes Shifeta","doi":"10.1186/s12873-025-01359-w","DOIUrl":"10.1186/s12873-025-01359-w","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"200"},"PeriodicalIF":2.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237802","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487021/pdf/","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":"OA","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}