BMC Emergency Medicine最新文献

{"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}

{"title":"Trauma hospital preparedness against natural and man-made disasters: a cross-sectional study.","authors":"Leila Mohammadinia, Mehran Sardareh, Fatemeh Mousavi, Shahram Paydar, Rona Bahreini","doi":"10.1186/s12873-025-01195-y","DOIUrl":"10.1186/s12873-025-01195-y","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to investigate the trauma hospital preparedness in disasters of 2019.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in two qualitative and quantitative phases. Data were collected retrospectively in the quantitative part through census and in the qualitative part through semi-structured interviews. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis, respectively.</p><p><strong>Results: </strong>The Hazard of the trauma hospital in 2019 were divided into two categories: natural (floods) and man-made (floods, street riots, incidence of COVID-19). 93% of all hazards were attributed to the spread of COVID-19, 5.4% to disturbances and 1.6% to floods. In the quantitative part, from 227 extracted codes, two main themes were finally classified titled \" Hospital's functional experience in response \" and \"Challenges and functional corrective solutions \".</p><p><strong>Conclusions: </strong>Due to the exhaustion of hospitals, the accident proneness of Iran and as well as insufficient attention to safety, it is essential that hospitals, especially trauma hospitals, have disaster preparedness plans. By using these comprehensive preparedness, managers can reduce the consequence of disasters and achieve proper preparation.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"38"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566027","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":"Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department.","authors":"Alfredo Bardají, Oscar M Peiro, Maria Leyva-López, Juan R Delgado, Mar Rocamora-Horach, Montserrat Galofré, Isabel Fort, Anna Carrasquer, Jose Luis Ferreiro","doi":"10.1186/s12873-025-01197-w","DOIUrl":"10.1186/s12873-025-01197-w","url":null,"abstract":"<p><strong>Background: </strong>This research examines the role of systematic cardiac troponin evaluation in identifying type 1 myocardial infarction among patients presenting to the emergency department with collected blood samples.</p><p><strong>Methods: </strong>This was a prospective study of consecutive adult patients presenting to the emergency department of a university hospital between October 22, 2020, and January 11, 2021. Cardiac troponin I levels were measured in all patients, including those with suspected acute coronary syndrome (clinical testing) and a control group undergoing routine blood tests (non-clinical testing). The primary outcomes were the prevalence of type 1 myocardial infarction and the positive predictive value of cardiac troponin I, which were assessed using established statistical methods.</p><p><strong>Results: </strong>Elevated cardiac troponin levels were identified in 13.4% of the study population (382/2,853). This included 19.5% of patients with clinically guided tests and 10.1% of those with non-clinical testing. The overall prevalence of type 1 myocardial infarction was 2%, with a positive predictive value of 14.9% (95% CI: 13.6-16.2). Among clinically guided tests, type 1 myocardial infarction prevalence was 5.8%, yielding a positive predictive value of 29.5% (95% CI: 26.7-32.4). Cases from non-clinically guided tests were primarily attributed to type 2 myocardial infarction or non-ischemic myocardial injury.</p><p><strong>Conclusion: </strong>Using a generalized approach to cardiac troponin testing in emergency department patients significantly lowers the diagnostic accuracy for type 1 myocardial infarction, reducing the positive predictive value and frequently indicating non-ischemic myocardial injury.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"37"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566029","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":"Trends in analgesia in prehospital trauma care: an analysis of 105.908 patients from the multicenter database TraumaRegister DGU^®.","authors":"Davut Deniz Uzun, Jan-Philipp Stock, Richard Steffen, Jürgen Knapp, Rolf Lefering, Felix C F Schmitt, Markus A Weigand, Matthias Münzberg, Christoph G Woelfl, David Häske","doi":"10.1186/s12873-025-01186-z","DOIUrl":"10.1186/s12873-025-01186-z","url":null,"abstract":"<p><strong>Background: </strong>The management of pain in patients with traumatic injuries is a common task for emergency medicine providers, particularly in the prehospital setting. However, for sufficient and safe analgesia, correct pain recording and documentation is also necessary. The aim of this study was to assess trends in analgesia over the study period and to identify factors that may enable more sufficient pain management in trauma care.</p><p><strong>Methods: </strong>The TraumaRegister DGU^® recorded data of patients who were primarily treated at one of the participating hospitals between 2011 and 2020 and received analgesia as part of their prehospital care. This retrospective analysis included a total of 105.908 severely injured patients from Germany, Switzerland, and Austria. Patients with and without analgesia were compared, and factors associated with analgesia were investigated with logistic regression analysis.</p><p><strong>Results: </strong>The mean age of the patients enrolled was 50 ± 22 years. 71% were male and 29% were female. Out of all the patients, 66% (n = 70,257) received prehospital analgesia. The average age of patients in the analgesia group was 48 ± 21 years, the non-analgesia group had an average age of 54 ± 23 years. 67% of the male patients received analgesia compared to 64% of the female patients. The mean Injury Severity Score (ISS) in the analgesia group was 21.2 points, compared to 16.5 points in the non-analgesia group. 4% of the patients were under the age of sixteen, and of these, 65% received analgesia. 29% of patients were older than 65 years and received analgesia in 57%. Presence of an emergency physician at scene, was a remarkable independent variable for the receipt of analgesia (Odds Ratio 5.55; p < 0.001). Transportation by helicopter was also a significant predictor for analgesia (OR 1.62; p < 0.001).</p><p><strong>Conclusions: </strong>Analgesia is a crucial aspect of emergency medicine, as evidenced by relevant guidelines. Nevertheless, it is plausible that a considerable proportion of seriously injured patients do not receive optimal analgesic treatment, or at the very least, this is not documented. In this regard, both aspects require optimization.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"36"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555762","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":"Understanding oncologic emergencies and related emergency department visits and hospitalizations: a systematic review.","authors":"Sule Yilmaz, Komal Aryal, Jasmine King, Jason J Bischof, Arthur S Hong, Nancy Wood, Bonnie E Gould Rothberg, Matthew F Hudson, Sara W Heinert, Monica K Wattana, Christopher J Coyne, Cielito Reyes-Gibby, Knox Todd, Gary Lyman, Adam Klotz, Beau Abar, Corita Grudzen, Aveh Bastani, Christopher W Baugh, Daniel J Henning, Steven Bernstein, Juan Felipe Rico, Richard J Ryan, Sai-Ching Jim Yeung, Aiham Qdaisat, Aasim Padela, Troy E Madsen, Raymond Liu, David Adler","doi":"10.1186/s12873-025-01183-2","DOIUrl":"10.1186/s12873-025-01183-2","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer frequently visit the emergency department (ED) and are at high risk for hospitalization due to severe illness from cancer progression or treatment side effects. With an aging population and rising cancer incidence rates worldwide, it is crucial to understand how EDs and other acute care venues manage oncologic emergencies. Insights from other nations and health systems may inform resources necessary for optimal ED management and novel care delivery pathways. We described clinical management of oncologic emergencies and their contribution to ED visits and hospitalizations worldwide.</p><p><strong>Methods: </strong>We performed a systematic review of peer-reviewed original research studies published in the English language between January 1st, 2003, to December 31st, 2022, garnered from PubMed, Web of Science, and EMBASE. We included all studies investigating adult (≥ 18 years) cancer patients with emergency visits. We examined chief complaints or predictors of ED use that explicitly defined oncologic emergencies.</p><p><strong>Results: </strong>The search strategy yielded 49 articles addressing cancer-related emergency visits. Most publications reported single-site studies (n = 34/49), with approximately even distribution across clinical settings- ED (n = 22/49) and acute care hospital/ICU (n = 27/49). The number of patient observations varied widely among the published studies (range: 9 - 87,555 patients), with most studies not specifying the cancer type (n = 33/49), stage (n = 41/49), or treatment type (n = 36/49). Most studies (n = 31/49) examined patients aged ≥ 60 years. Infection was the most common oncologic emergency documented (n = 22/49), followed by pain (n = 20/49), dyspnea (n = 19/49), and gastrointestinal (GI) symptoms (n = 17/49). Interventions within the ED or hospital ranged from pharmacological management with opioids (n = 11/49), antibiotics (n = 9/49), corticosteroids (n = 5/49), and invasive procedures (e.g., palliative stenting; n = 13/49) or surgical interventions (n = 2/49).</p><p><strong>Conclusion: </strong>Limited research specifically addresses oncologic emergencies despite the international prevalence of ED presentations among cancer patients. Patients with cancer presenting to the ED appear to have a variety of complaints which could result from their cancers and thus may require tailored diagnostic and intervention pathways to provide optimal acute care. Further acute geriatric oncology research may clarify the optimal management strategies to improve the outcomes for this vulnerable patient population.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"40"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566028","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 the South Korean government's medical school expansion announcement on pediatric emergency department visits.","authors":"Arum Choi, Beom Joon Kim, Jooyoung Lee, Sukil Kim, Woori Bae","doi":"10.1186/s12873-025-01189-w","DOIUrl":"10.1186/s12873-025-01189-w","url":null,"abstract":"<p><strong>Background: </strong>In February 2024, the South Korean government announced a 67% increase in medical school admissions (2,000 more students), leading to the resignation of approximately 10,000 residents from major university hospitals. This study investigated the impact of these resignations on pediatric emergency department (PED) visits at a major tertiary hospital in Korea.</p><p><strong>Methods: </strong>We conducted a retrospective observational study analyzing PED visits under 15 years old at a tertiary hospital from January 2019 to May 12, 2024. After excluding cases with missing diagnostic codes or disposition records, we analyzed visits during the 12-week period from February 19 to May 12 across different years (2019-2024). We used segmented regression of Interrupted Time Series (ITS) analysis to evaluate the impact of three key events: the COVID-19 onset, lifting of mask-wearing mandates, and residents' resignation, adjusting for seasonal variations and autocorrelation.</p><p><strong>Results: </strong>Among 11,574 analyzed cases, weekly PED visits decreased significantly after residents' resignation (133.6 ± 22.4) compared to pre-COVID-19 (246.3 ± 45.2) and post-COVID-19 (263.7 ± 61.2) periods. The proportion of KTAS 3 cases increased to 67.2% during the resignation period compared to pre-COVID-19 (48.9%). ITS analysis revealed significant immediate changes in weekly visits: COVID-19 (-157.81 visits, 95% CI: -202.04 to -113.58), mask mandate removal (48.26 visits, 95% CI: 3.21 to 93.32), and residents' resignation (-77.82 visits, 95% CI: -134.85 to -20.80). Notably, the proportion of infectious diseases increased (36.9% vs. 18.6% pre-COVID-19), while respiratory diseases decreased (20.1% vs. 33.6% pre-COVID-19).</p><p><strong>Conclusion: </strong>A substantial reduction in both absolute and relative weekly patient visits was observed following the start of the nationwide resident strike at our pediatric emergency department. Additional studies are needed to better understand how this affected pediatric emergency care delivery and access.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"39"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566026","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":"Effect of non-invasive rhythm control on outcomes in patients with first diagnosed atrial fibrillation presenting to an emergency department.","authors":"Christian Salbach, Mustafa Yildirim, Hauke Hund, Matthias Müller-Hennessen, Norbert Frey, Hugo Anton Katus, Evangelos Giannitsis, Barbara Ruth Milles","doi":"10.1186/s12873-025-01194-z","DOIUrl":"10.1186/s12873-025-01194-z","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests a benefit of a rhythm control approach in patients with a recent diagnosis of atrial fibrillation (AF). This study sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF) undergoing a non-invasive rhythm control strategy in an emergency department (ED).</p><p><strong>Methods: </strong>This analysis uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB). HERA-FIB is a retrospective single-centre observational study which consecutively included patients presenting to the ED of the University Hospital of Heidelberg between June 2009 and March 2020 with a sequential follow-up for all-cause mortality, stroke, major bleeding events and myocardial infarction (MI). Outcomes of patients with FDAF were related to treatment strategy (non-invasive rhythm vs. rate control).</p><p><strong>Results: </strong>Among the 2,758 (27%) patients who presented with FDAF, a non-implementation of a non-invasive rhythm control strategy at admission was observed in 75.4% and associated with an excess of all-cause mortality hazard ratio (HR): 1.61 (95%CI 1.30-1.99), p < 0.0001 and incident MI HR: 1.88 (95% CI 1.22-2.90), p = 0.0043 during follow-up. The non-implementation of a non-invasive rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables with an adjusted HR of 1.52 (95%CI: 1.14-2.04, p = 0.0043) and 1.89 (95%CI: 1.03-3.45, p = 0.0392), respectively.</p><p><strong>Conclusion: </strong>Real-world data from FDAF patients presenting to an ED showed a benefit regarding all-cause mortality and MI favouring a non-invasive rhythm control strategy. Further prospective research is needed to validate this hypothesis.</p><p><strong>Trial registration: </strong>The trial was registered at ClinicalTrials.gov Identifier: NCT05995561.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"35"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540059","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}