BMC Emergency Medicine最新文献

{"title":"Association between video laryngoscope blade geometry and first-pass success during prehospital intubation: a prospective bicentric observational study.","authors":"Christoph Jänig, Benedikt Harmuth, Holger Meyer, Andreas Schwartz, Maja Iversen, Marc Royko, Andreas Garcia Bardon, Daniel Schroeder, Tobias Grübl, Martin Schiffarth, Willi Schmidbauer, Tim Piepho","doi":"10.1186/s12873-026-01701-w","DOIUrl":"10.1186/s12873-026-01701-w","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation (ETI) is a cornerstone of advanced prehospital airway management but remains associated with considerable procedural risk, particularly when multiple intubation attempts are required. First-pass success (FPS) is an established quality indicator because repeated attempts increase the risk of hypoxaemia, aspiration, oesophageal intubation, haemodynamic instability and cardiac arrest [1-4]. Although video laryngoscopy (VL) is recommended by international airway guidelines [5-8], evidence regarding the optimal blade geometry for prehospital airway management remains limited. We investigated the association between video laryngoscope blade geometry and FPS in a physician-staffed helicopter emergency medical service (HEMS).</p><p><strong>Methods: </strong>We conducted a prospective bicentric observational study at two German physician-staffed HEMS bases between January 2017 and December 2019. Consecutive prehospital ETIs performed using the C-MAC^® PM video laryngoscope were prospectively documented. Blade selection was at the discretion of the treating physician. The primary outcome was FPS. Secondary outcomes included glottic visualisation, intubation duration, number of attempts, airway-related adverse events and video laryngoscopy-associated technical problems.</p><p><strong>Results: </strong>A total of 283 video laryngoscopic intubations were analysed. Overall first-pass success (FPS) was 71.0% (201/283). Blade-specific FPS rates were 72.0% for Macintosh size 3, 72.6% for Macintosh size 4 and 61.9% for the hyper angulated D-Blade, without significant differences between blade geometries (p = 0.601). Adequate glottic visualisation (Cormack-Lehane grade I-II) was achieved in 96.8% of patients. Mean intubation duration was 42.5 ± 34.2 s. Airway-related adverse events occurred in 5.7% of patients and video laryngoscopy-associated technical problems in 12.6%. In an exploratory multivariable analysis, blade geometry was not independently associated with FPS, whereas difficult laryngoscopy conditions, poor glottic visualisation and technical problems were associated with failed first-pass intubation.</p><p><strong>Conclusions: </strong>Video laryngoscopy provided excellent glottic visualisation irrespective of blade geometry. Neither univariable nor exploratory multivariable analyses demonstrated an independent association between blade geometry and first-pass success. Instead, difficult airway conditions, poor glottic visualisation and video laryngoscopy-associated technical problems appeared to exert a greater influence on procedural success. Given the observational design and limited number of hyper angulated blade intubations, these findings should be regarded as hypothesis-generating and require confirmation in larger prospective multicentre studies incorporating standardised difficult-airway assessment.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583454","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":"Emergency medicine physician-led care at the patient's residence: a cohort study of a mobile emergency unit.","authors":"Masoud Moradi, Lise Waagø Christiansen, Trygve Bjørnevik, Mette Rahbek Kristensen, Johanne Overgaard Wessels, Anders Brøns Møllekær, Line Emilie Lilholm Laugesen, Peter Biesenbach","doi":"10.1186/s12873-026-01656-y","DOIUrl":"https://doi.org/10.1186/s12873-026-01656-y","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) are often overcrowded. Older adults, who are frequently multimorbid and resource-intensive, represent a growing share of acute care demand. In Denmark, mobile emergency units (MEUs) provide emergency physician-led assessment and initial treatment in the patient's residence to potentially reduce avoidable hospital transfers. However, data on real-world service delivery and medium-term outcomes after MEU contacts remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective, single-centre cohort study of MEU contacts within the Esbjerg Hospital catchment area (Region of Southern Denmark) from 1 September 2023 to 31 December 2024. Using the hospital's electronic health record, we extracted demographics, comorbidities, on-scene diagnostics and treatments, and patient disposition, and descriptively summarised immediate disposition at the index encounter, service delivery, and 180-day all-cause mortality without risk adjustment.</p><p><strong>Results: </strong>The cohort comprised 1,987 MEU contacts corresponding to 1,336 unique patients, with a median (interquartile range) age of 80.9 (71.1-87.9) years. Nearly one-third had ≥ 3 comorbidities. Point-of-care testing and ultrasound were used frequently (60.5% and 24.8%, respectively), and on-scene therapies were commonly administered (antibiotics 31.6%, intravenous fluids 18.0%, and analgesia 9.0%). 82.7% of contacts were managed at home without hospital conveyance at the index encounter, while the remaining contacts were directly admitted to hospital from the scene. 443 (33.2%) of the 1,336 unique patients died within 180 days.</p><p><strong>Conclusions: </strong>MEU home visits involved bedside diagnostics and on-scene treatments, and most contacts were managed at home without conveyance at the index encounter. Mortality over 180 days was substantial and should be interpreted cautiously in this older, multimorbid cohort. The descriptive, unadjusted design precludes causal inference regarding safety or effectiveness.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227084","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":"Intracranial lesion yield and downstream management after mild traumatic brain injury in emergency department patients receiving antiplatelet therapy: a two-center retrospective cohort study.","authors":"Fatima Di Padova, Tifany Sekulski, Dounia Hamdouche, Romain Jouffroy, Vincent Garrouste","doi":"10.1186/s12873-026-01684-8","DOIUrl":"https://doi.org/10.1186/s12873-026-01684-8","url":null,"abstract":"<p><strong>Background: </strong>Mild traumatic brain injury (mTBI) in patients receiving antiplatelet therapy is a frequent emergency department presentation. We aimed to describe the prevalence of traumatic intracranial lesions on the initial head computed tomography (CT) scan and the downstream in-hospital management of antiplatelet-treated adults with mTBI.</p><p><strong>Methods: </strong>We conducted a retrospective two-center cohort study in the emergency departments of Tours and Orléans University Hospitals, France. Adults receiving antiplatelet therapy who presented with mTBI (Glasgow Coma Scale score 13-15) and underwent an initial head CT scan were included. The primary outcome was the presence of any traumatic intracranial lesion on the initial CT scan. Secondary outcomes included downstream management during the index episode. An exploratory multivariable logistic regression analysis was performed using pre-CT variables.</p><p><strong>Results: </strong>A total of 1,912 patients were included; mean age was 80.8 ± 12.1 years and 52.1% were women. Traumatic intracranial lesions were identified in 282 patients (14.7%). Among patients with lesions, 232 (82.3%) underwent hospital admission or 24-hour emergency department observation, 16 (5.7%) required neurosurgical management, and 104 (36.9%) underwent repeat brain imaging. In exploratory multivariable analysis, falls above standing height or high-energy falls (adjusted odds ratio [aOR] 2.84, 95% confidence interval [CI] 1.95-4.14), other trauma mechanisms (aOR 1.82, 95% CI 1.30-2.54), motor deficit at presentation (aOR 3.71, 95% CI 1.95-6.81), facial fracture (aOR 2.25, 95% CI 1.51-3.31), and temporal impact (aOR 1.94, 95% CI 1.29-2.85) were independently associated with traumatic intracranial lesions.</p><p><strong>Conclusions: </strong>In antiplatelet-treated adults with mTBI, traumatic intracranial lesions were detected in approximately one in seven patients on the initial CT scan, whereas neurosurgical intervention remained uncommon. Trauma-related clinical features appeared more informative than age alone for lesion detection.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227105","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":"Reframing disaster simulation as a translational systems intervention: a design-based comparative analysis of MRMI and the Emergo Train System (ETS).","authors":"Khorram-Manesh Amir, Carlström Eric","doi":"10.1186/s12873-026-01699-1","DOIUrl":"10.1186/s12873-026-01699-1","url":null,"abstract":"<p><strong>Background: </strong>Disaster simulation is central to emergency preparedness; however, many simulation designs insufficiently represent disasters as prolonged, system-disruptive, and ethically complex events. Exercises frequently emphasize mass-casualty throughput, rely on simplified assumptions, and evaluate success primarily in terms of task completion rather than system performance and organizational learning. This study examines how disaster simulation design shapes preparedness outcomes and explores how simulation may be reframed as a translational systems intervention.</p><p><strong>Methods: </strong>A qualitative design-based research approach was used to conduct an inductive comparative framework analysis of two established disaster simulation paradigms: Medical Response to Major Incident (MRMI) and the Emergo Train System (ETS). Documentary sources included curricula, instructional materials, scenario templates, published evaluations, disaster evidence literature, and World Health Organization Emergency Medical Team standards. Simulation design features were extracted and compared using constant comparative analysis, and the findings were subsequently interpreted through socio-technical systems and resilience engineering perspectives.</p><p><strong>Results: </strong>Four recurrent design-level tensions were identified using harmonized terminology: (1) divergent disaster conceptualization (governable surge versus unstable system disruption); (2) fidelity emphasis imbalance (cognitive versus behavioral realism); (3) incident-centric temporal framing; and (4) inconsistent translation into organizational learning. Published evaluation reports suggest that MRMI may support governance alignment and coordinated surge reasoning, whereas ETS may provide greater operational realism and more opportunities to expose teamwork under stress. Neither paradigm alone appears to fully address all design requirements relevant to sustained disaster-level system resilience.</p><p><strong>Conclusions: </strong>MRMI and ETS appear complementary but individually incomplete. A staged hybrid architecture integrating governance modeling, operational stress testing, longitudinal degradation modeling, and structured reflective translation is proposed as a design-oriented framework. This framework may help position disaster simulation as a translational systems intervention that connects exercise performance to potentially measurable organizational preparedness and system resilience, while still requiring empirical validation in practical settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583490","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":"Mental health-related presentations to Australian hospital emergency departments by children and young people, before and after the onset of the COVID-19 pandemic: a systematic review and meta-analysis.","authors":"Jackson Newberry-Dupé, Simon Craig, Glenn Melvin, Kylie King, Yuxi Li, Alexander Campbell, Tom Shore, Timothy Curtis, Rohan Borschmann","doi":"10.1186/s12873-026-01700-x","DOIUrl":"https://doi.org/10.1186/s12873-026-01700-x","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 pandemic-related 'lockdowns' (i.e., measures to restrict movements) used to reduce the spread of the COVID-19 virus may have impacted how children and young people (CYP) utilised mental health services. The aim of this review was to synthesise research on COVID-19-related changes in mental health-related emergency department (ED) presentations by CYP in Australia, with reference to lockdown stringency.</p><p><strong>Methods and analysis: </strong>We searched five databases for observational studies published after 31/12/2019 examining ED mental health-related presentations by CYP (aged 0-24 years) before and after onset of COVID-19 lockdowns. Studies were stratified by location and the relative restriction stringency, obtained via the Oxford COVID-19 Government Response Tracker. Region level variation was described, with pooled effects calculated using random effects models.</p><p><strong>Results: </strong>Thirteen studies were included; five from New South Wales, four from Victoria (where lockdowns were most stringent), three from Queensland, and one including multiple Australian states. Outcome definitions and exposure periods were heterogeneous. Pooled estimates showed a moderate-to-large increase in monthly rates of eating disorder presentations, slight-to-moderate increases in overall mental health-related presentations and self-harm and suicide-related presentations, and inconclusive evidence for changes in substance-related and addictive disorder and behavioural/neurodevelopmental disorder-related presentations. Heterogeneity of pooled effects was extremely high (I² = 84.8-99.5%), and the overall certainty of evidence was very low for all outcomes. Findings differed by jurisdiction, but there was insufficient evidence to identify an association between lockdown stringency and ED presentations.</p><p><strong>Conclusions: </strong>CYP ED presentations for eating disorders appear to have increased over the pandemic period, though certainty of evidence was very low. Findings for overall mental health-related presentations and other disorder groups were mixed, with presentations appearing to be lower in Queensland than other states. Future research should prioritise high quality interrupted-time-series analyses of linked and standardised administrative data to better examine the association between specific pandemic policy measures and CYP mental health-related ED utilisation, whilst controlling for potential confounders.</p><p><strong>Systematic review registration: </strong>This review has been registered with PROSPERO (CRD42022342496).</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227164","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":"A decade of glyphosate-surfactant poisoning in India: clinical patterns and predictors of mortality.","authors":"Sanjan Asanaru Kunju, Ahlam Abdul Rahman, Sachin Nayak Sujir, Vivek Gopinathan, Bhanvi Prakash Ramchandani, Sumedha Sircar","doi":"10.1186/s12873-026-01696-4","DOIUrl":"https://doi.org/10.1186/s12873-026-01696-4","url":null,"abstract":"<p><strong>Background: </strong>Glyphosate-surfactant herbicide (GlySH) poisoning is increasingly reported in low- and middle-income countries, yet data on clinical predictors of mortality remain limited, particularly from the Indian subcontinent. This study aimed to describe the clinical profile of GlySH poisoning and to identify predictors of in-hospital mortality in a tertiary-care setting in South India.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of consecutive adult patients with documented oral GlySH ingestion presenting to a tertiary-care emergency department between January 2009 and July 2019. Demographic, clinical, and laboratory variables were extracted from electronic medical records. In-hospital mortality was the primary outcome. Associations between clinical variables and mortality were assessed using Firth's penalised likelihood logistic regression and Fisher's exact test, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. For predictors with complete separation, odds ratios were not estimable, and Fisher's exact p-values are reported. Multivariable analysis was not performed due to the small number of outcome events.</p><p><strong>Results: </strong>A total of 51 patients were included, of whom four (7.8%) died. Most patients were young adults (45.1% aged 25-44 years), male (76.5%), and had suicidal intent (64.7%). Shock (OR 14.67, 95% CI 1.50-143.74), altered sensorium (OR 14.63, 95% CI 1.34-159.23), elevated serum creatinine > 1.4 mg/dL (p = 0.0009), and dialysis requirement (p < 0.001) were associated with in-hospital mortality on univariate analysis. Elevated liver transaminases and respiratory distress were not significantly associated with mortality.</p><p><strong>Conclusion: </strong>In this 10-year cohort, mortality following GlySH poisoning was closely associated with shock, altered sensorium, and early renal dysfunction, reflecting advanced systemic toxicity. These readily identifiable features may assist in risk stratification and triage of high-risk patients in the emergency setting. Given the small number of outcome events, these findings should be interpreted as hypothesis-generating, and larger multicentric prospective studies are required to validate these predictors.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227005","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":"Cancellation case analysis of physician-staffed rapid response car activities during off-hours in the central region of Saitama prefecture, Japan: a retrospective study.","authors":"Kaoru Ogawa, Ishtiaq Ahmad, Yoshihisa Shirayama, Motohiro Tsuboi, Koichi Yasaka, Shigemasa Taguchi, Miyoko Okamoto, Kazuya Kiyota, Motoyuki Yuasa","doi":"10.1186/s12873-026-01698-2","DOIUrl":"10.1186/s12873-026-01698-2","url":null,"abstract":"<p><strong>Background: </strong>Among hospitals in the central Saitama Prefecture, only the Saitama Red Cross Hospital (SRCH) provides physician-staffed rapid response car (RRC) services during off-hours (weekday night-time, weekends, and public holidays). During off-hours, concentrated dispatch requests increase the operational and financial burden, particularly when cancellations occur. Furthermore, research on RRC cancellation in the Japanese urban emergency medical system remains limited. By examining the epidemiological characteristics of RRC cancellation, this study aimed to optimise RRC operations and enhance emergency medical response efficiency.</p><p><strong>Methods: </strong>This retrospective study analysed RRC dispatches from SRCH between January 1, 2021, and December 31, 2023, focusing on cases classified as 'cancelled' or 'treated'. Variables including age, disease type, distance from the hospital, request source, and time of request were compared using chi-square test, t-test, and Mann-Whitney U test. Logistic regression was performed to identify independent predictors of cancellation.</p><p><strong>Results: </strong>Of 4,005 dispatches, 1,091 were cancelled, and 2,417 were treated; 497 cases were excluded because of incomplete data. Cancellations were significantly associated with patients aged ≥ 65 years, requests initiated by the Command Centre, and greater distance from the hospital. Respiratory failure and anaphylactic shock had the highest cancellation rates.</p><p><strong>Conclusions: </strong>Improving dispatch strategies can enhance pre-hospital emergency care, ensuring timely medical attention for critical patients, while reducing operational and financial strain on medical institutions.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547787","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":"Examination of trauma type, severity, pattern and clinical outcomes in motorcycle accident victims admitted to the largest trauma center in Southern Iran.","authors":"Faramarz Farahmand, Ehsan Kouhi, Mehrdad Karajizadeh, Hooman Rezaei","doi":"10.1186/s12873-026-01693-7","DOIUrl":"10.1186/s12873-026-01693-7","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma in motorcycle riders usually comes with high injury severity and significant mortality and morbidity. The unique vulnerability of motorcyclists results in a high incidence of severe injuries and fatalities. Efforts to improve outcomes require profound understanding of causes and patterns of trauma, as well as trauma systems improvements focused on at-risk demographics.</p><p><strong>Method: </strong>This is a cross-sectional study designed to investigate the trauma type and treatment outcomes in motorcycle accident victims admitted to the largest trauma center in southern Iran, Shiraz, during 2022-2024. Patients who were injured in a motorcycle accident were enrolled in the study. Patients' data were collected from the Shiraz Trauma Registry, a branch of the National Trauma Registry of Iran (NTRI). Demographic, prehospital and posthospital vital signs and clinical properties, aside from injury patterns of the patients were investigated.</p><p><strong>Results: </strong>In total, 3310 patients were enrolled in the study. Deceased patients had higher median age compared to the survived ones (p-value < 0.01). patients transported by EMS had significantly higher mortality rates (p-value < 0.01). Logistic regression models revealed that prehospital GCS (p-value < 0.01, OR = 0.7), SBP in ER (p-value = 0.04, OR = 0.98), SpO2 in ER (p-value = 0.02, OR = 0.94), GCS in ER (p-value < 0.01, OR = 0.7), and ISS (p-value < 0.01, OR = 1.1) were significantly associated with mortality in the patients. Injury to head (p-value < 0.01, OR = 5.2), face (p-value < 0.01, OR = 0.3), thorax (p-value = 0.03, OR = 1.9), upper extremity (p-value = 0.03, OR = 0.4), and lower extremity (p-value < 0.01, OR = 0.3) had significantly contributed to mortality.</p><p><strong>Conclusion: </strong>This study from Southern Iran reveals young male riders bear a disproportionate burden of motorcycle accident mortality, primarily linked to critical head and thoracic injuries and high Injury Severity Scores. While extremity and facial injuries are common, they are less associated with death. The findings stress the importance of strict helmet laws, early use of trauma scoring for triage, and prioritizing critical care for severe cases. Enhancing prevention, pre-hospital care, and trauma system capacity are key to reducing deaths and improving outcomes in the region.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534950","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":"Pediatric road traffic accident - related head injury: a retrospective multicenter cohort study in Ghana.","authors":"Anthony Baffour Appiah, Till Bärnighausen, Michael Lowery Wilson, Peter Dambach, Mahsa MohammadNamdar, Alexis Dun Bo-Ib Buunaaim, Martin Tangnaa Morna, Vincent Ativor, Peter Donkor, Charles Mock","doi":"10.1186/s12873-026-01687-5","DOIUrl":"10.1186/s12873-026-01687-5","url":null,"abstract":"<p><strong>Background: </strong>Head injuries (HIs) from road traffic accidents (RTAs) are major causes of death, long-term disability, and cognitive impairment in children. Evaluating significant predictors of functional outcomes after HI can help optimize trauma care and reduce the burden of unfavorable outcomes. This study examined the pre-hospital and clinical predictors of unfavorable outcomes in pediatric road traffic crash patients with HI (0-18 years).</p><p><strong>Methods: </strong>A retrospective cohort study of 816 pediatric RTA patients with HI presented at three teaching hospitals in the Northern, Ashanti, and Central Regions in Ghana. Functional outcome was assessed using the Glasgow Outcome Scale (GOS) at discharge, and categorized as either favorable (GOS 4-5) or unfavorable (GOS 1-3). A multivariable logistic regression model was used to identify predictors of unfavorable outcomes. The receiver operating characteristic (ROC) curve was used to assess the predictive performance of the multivariable logistic regression model. Kaplan-Meier failure analysis was used to estimate the cumulative incidence of HI-related inpatient mortality.</p><p><strong>Results: </strong>A total of 211 (25.9%) patients with HIs had an unfavorable inpatient outcome, including 45 (5.5%) deaths and 166 cases (20.3%) of severe disability. Significant predictors for higher odds of unfavorable outcomes were hospital location in the Northern Region (Adjusted odds ratio [AOR], 26.89; 95% confidence interval [CI], 10.87-66.53), patients with polytrauma (AOR = 1.94; 95% CI: 1.11-3.39) and those with unspecified head injuries (AOR = 2.08; 95% CI: 1.09-3.99), and ISS (AOR 1.04, 95% CI 1.00-1.07). The ROC curve showed a sensitivity of 69.52%, specificity of 94.81%, and an area under ROC curve of 0.9107. Kaplan-Meier analysis showed a higher cumulative probability of HI-related deaths for patients with severe injury (ISS > 15) and severe HI (GCS 3-8).</p><p><strong>Conclusion: </strong>Over one-quarter of pediatric RTA patients with HI in Ghana experienced unfavorable outcomes during hospitalization. Regional treatment location, greater injury severity, poly-trauma, and non-specific HI diagnoses independently predict unfavorable outcomes. These findings underscore the need to strengthen pediatric HI care through improved diagnostic capacity and early referral pathways, particularly for children with polytrauma and in the Northern Region.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497074","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":"Explainable machine learning for early prediction and anatomical classification of pulmonary embolism in the emergency department.","authors":"Maryam Panahi, Mohanna Fallah Ghadi, Toktam Dehghani, Fatemeh Mahdizadeh, Raheleh Ghouchan Nezhad Noor Nia, Negar Saleh, Saeid Eslami","doi":"10.1186/s12873-026-01602-y","DOIUrl":"10.1186/s12873-026-01602-y","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary thromboembolism (PTE) is a life‑threatening condition that requires prompt and accurate evaluation in the emergency department (ED). Standardized clinical scoring systems, including the Wells and revised Geneva scores, form the cornerstone of initial risk stratification but have limited specificity, leading to unnecessary D‑dimer testing and frequent overuse of CT pulmonary angiography (CTPA). This study aimed to develop explainable machine‑learning (XML) models as a complementary decision‑support layer following initial clinical assessment, with the dual goals of improving PTE prediction and providing an early, non‑imaging‑based indication of clot location.</p><p><strong>Methods: </strong>Clinical and paraclinical data from 472 ED patients with suspected PTE were collected across three centers of Mashhad University of Medical Sciences (2022-2024) using structured forms aligned with Wells/Geneva criteria. CTPA served as the reference standard for diagnosis and anatomical classification. We developed classical ML models, ensemble algorithms such as Extra Trees, and hybrid stacking pipelines. Explainable AI (XAI) using SHAP values quantified global and patientlevel feature contributions. The XML models were designed to operate after Wells/Geneva-based triage: supporting D-dimer decisions in low-risk patients and refining post-triage risk estimation in intermediate - and high-risk patients to help reduce avoidable CTPA utilization.</p><p><strong>Results: </strong>In this intermediate‑ to high‑probability cohort, all patients were classified as PTE‑suspect by Wells/Geneva scoring, whereas only 24% were confirmed positive on CTPA. ML models demonstrated improved discrimination, with Extra Trees achieving the best performance (accuracy 0.82, sensitivity 0.69, specificity 0.86, AUC 0.83). Among PTE‑positive cases, the model achieved an AUC of 0.77 for central emboli and 0.67 for peripheral emboli, with an overall anatomical classification accuracy of 63%.</p><p><strong>Conclusions: </strong>The proposed XML models offer a transparent, clinically aligned framework that augments existing scoring systems, enhancing diagnostic efficiency and reducing unnecessary imaging.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468788","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}