BMC Emergency Medicine最新文献

{"title":"Scoping review on alternative care options for patients calling the ambulance.","authors":"Gayathri Devi Nadarajan, Brian Fu, Jemima Teo, Yean Lyi Lim, Benjamin Leong, Marcus Eng Hock Ong","doi":"10.1186/s12873-026-01672-y","DOIUrl":"10.1186/s12873-026-01672-y","url":null,"abstract":"<p><strong>Background: </strong>The modern-day population with more chronic, complex medical and social comorbidities is increasing ambulance utilisation and conveyance to emergency departments (ED). This contributes to ambulance ramping, ED overcrowding and increased hospital bed utilisation. This scoping review aims to identify alternative care paths for patients calling for ambulance services.</p><p><strong>Methods: </strong>A total of 4902 articles were identified through four databases and the gray literature. The terms 'paramedic', 'ambulance' and 'non-conveyance', 'alternative' and 'community care' were combined to yield the search terms. The population studied includes individuals calling the national emergency number while the intervention focuses on prehospital services designed to avoid ED conveyance. Independent researchers screened the titles, abstracts and full texts, yielding 59 relevant articles which were then meta-synthesised.</p><p><strong>Results: </strong>Five themes of care were identified - hear and treat, hear and refer, see and treat, see and refer and see and convey to a non-ED facility. Low-acuity patients, older patients, palliative and psychiatric patients, as well as those facing exacerbation of chronic conditions, alcoholic and frequent attenders appear to benefit from these alternative care service pathways (ACSPs). Allied health professionals such as nurses, social workers, occupational therapists, and physiotherapists collaborate with paramedics to frontload the care of these patients in the prehospital setting. Alternative conveyance destinations include general practices, geriatric wards, toxicology units, sobering centres and community hospitals.</p><p><strong>Conclusions: </strong>Implementing ACSPs and integrating healthcare approaches to enhance service efficiency and patient outcomes can alleviate pressure on emergency services by providing timely care and directing patients to appropriate services.</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/PMC13670535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468791","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":"Divergent perceptions of the emergency consultation process between emergency physicians and consultants: a cross-sectional survey with latent class and dyadic risk analysis.","authors":"Ali Cankut Tatlıparmak, Soykan Karabağ, Ahmet Taha Ergün, Yaren Su Kaya","doi":"10.1186/s12873-026-01695-5","DOIUrl":"10.1186/s12873-026-01695-5","url":null,"abstract":"<p><strong>Objectives: </strong>The emergency consultation process is a high-stakes interface between emergency and specialist physicians, yet systematic differences in how each party perceives this process remain poorly characterized. This study aimed to quantify the perception gap between emergency physicians (EPs) and consultants (CNs) across multiple consultation domains and to identify distinct perception profiles and dyadic conflict risk patterns.</p><p><strong>Methods: </strong>A cross-sectional survey was administered to 186 physicians (81 EPs, 105 CNs) in Türkiye between January 2024 and January 2026, using parallel EP- and CN-specific questionnaires. Group comparisons were performed using the Mann-Whitney U test with rank-biserial effect sizes. Perception gap analysis, latent class analysis (LCA), and Monte Carlo dyadic conflict risk simulation (n = 10,000 dyads per combination) were conducted.</p><p><strong>Results: </strong>Statistically significant between-group differences were identified in six of eight domains. The largest perception gaps were observed for frequency of unnecessary consultation requests (r = 0.723), clarity of expectations stated in requests (r = 0.658), and timeliness of responses (r = 0.624). LCA identified two latent classes: \"Dissatisfied Requesters\" (88.1% EPs) and \"Overwhelmed Responders\" (94.0% CNs; χ² = 110.49, p < 0.001). Dyadic simulation revealed the highest conflict risk in conflictual × conflictual pairings (mean risk score 3.46; 24.8% high-risk dyads), with no asymmetry between mixed-profile combinations (Δ = 0.02).</p><p><strong>Conclusions: </strong>Emergency physicians and consultants exhibit systematically divergent perceptions of the consultation process, converging only in their shared perception of workflow burden. The absence of asymmetric conflict risk in mixed profiles in this exploratory simulation may be consistent with interprofessional conflict being a bidirectional phenomenon, suggesting that system-level rather than individual-level approaches may warrant consideration. Structured consultation training and shared expectation frameworks are proposed as directions for future investigation.</p><p><strong>Clinical trial number: </strong>Not applicable.</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/PMC13670487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468775","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":"Performance of the SVEAT (Symptoms, Vascular Disease History, Electrocardiography, Age, and Troponin) score for predicting 90-day major adverse cardiac events in patients with acute chest pain.","authors":"Ali Ayvaz, Akkan Avci, Mustafa Oguz Tugcan, Muhammed Mert Can, Ahmet Burak Urfalioglu, Erdem Aksay, Yeliz Simsek, Sadiye Yolcu Seven, Begum Seyda Avci, Ecem Basak Kaya, Aysegul Sancaktar, Mehmet Bankir, Ramazan Guven","doi":"10.1186/s12873-026-01685-7","DOIUrl":"10.1186/s12873-026-01685-7","url":null,"abstract":"<p><strong>Background: </strong>In the emergency department, chest pain is a common presentation, and the primary clinical challenge is the early identification of patients at risk of major adverse cardiac events (MACE). This study aimed to evaluate the diagnostic performance of the SVEAT (Symptoms, Vascular Disease History, ECG, Age, and Troponin) score in predicting 90-day MACE in patients presenting with acute chest pain.</p><p><strong>Methods: </strong>This study included 348 patients presenting with acute chest pain. Serial high-sensitivity troponin I (HsTn-I) measurements were obtained at admission and 2 h later. Electrocardiographic and clinical data were recorded, and the SVEAT, HEART, and TIMI scores were calculated. Patients were followed for 90 days for MACE occurrence.</p><p><strong>Results: </strong>MACE occurred in 7.2% of patients during the 90-day follow-up. The second high-sensitivity troponin I (HsTn-I) measurement was significantly associated with MACE (p = 0.007). The SVEAT score demonstrated the highest discriminative performance (AUC = 0.806), compared with the HEART score (AUC = 0.756) and TIMI score (AUC = 0.753). At the optimal cut-off value of 4, the SVEAT score showed a sensitivity of 0.56 and a specificity of 0.86. In comparison, both the HEART and TIMI scores (cut-off = 3) showed higher sensitivity (0.72), with specificity values of 0.72 and 0.63, respectively.</p><p><strong>Clinical trial number: </strong>Not applicable.</p><p><strong>Conclusion: </strong>The SVEAT score may have potential as a rule-in tool for predicting 90-day MACE in emergency department patients presenting with acute chest pain, due to its higher specificity; however, this is accompanied by relatively low sensitivity, which limits its utility as a standalone screening tool.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468815","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":"Ejection fraction and absolute delta troponin in the early emergency department assessment of high coronary disease burden in NSTEMI patients: a retrospective observational study.","authors":"Remzi Çetinkaya, Mehmet Özel, Songül Doğan Araç, İsmail Başaslan, MehmetSait Coşkun","doi":"10.1186/s12873-026-01690-w","DOIUrl":"10.1186/s12873-026-01690-w","url":null,"abstract":"<p><strong>Background: </strong>Patients with non-ST-segment elevation myocardial infarction (NSTEMI) are commonly evaluated first in the emergency department, where early estimation of coronary disease burden may support clinical risk assessment before invasive coronary angiography. This study investigated whether routinely available emergency department parameters, with particular emphasis on ejection fraction (EF) and absolute delta troponin, were associated with high angiographic coronary disease burden assessed by the Gensini score.</p><p><strong>Methods: </strong>This retrospective observational study included adult NSTEMI patients admitted to the emergency department of a tertiary care hospital between January 1, 2024, and May 1, 2025, who subsequently underwent coronary angiography. Patients were divided into low and high Gensini groups using a predefined threshold of 40. Demographic characteristics, comorbidities, laboratory variables, echocardiographic findings, and absolute changes in serial troponin measurements were compared between groups. Independent associations with the high Gensini category were evaluated using multivariable binary logistic regression. Receiver operating characteristic curve analysis was used to assess the discriminatory performance of EF and absolute delta troponin/100.</p><p><strong>Results: </strong>A total of 394 patients were included in the final analysis; 209 were classified into the low Gensini group and 185 into the high Gensini group. In the adjusted model, lower EF was independently associated with the high Gensini category (OR: 0.888; 95% CI: 0.859-0.918; p < 0.001), while higher absolute delta troponin/100 showed a positive independent association (OR: 1.161; 95% CI: 1.074-1.254; p < 0.001). Diabetes mellitus was also independently associated with the high Gensini category (OR: 1.851; 95% CI: 1.096-3.127; p = 0.021). EF and absolute delta troponin/100 both showed statistically significant discrimination for the high Gensini category, with AUC values of 0.783 and 0.758, respectively.</p><p><strong>Conclusions: </strong>In NSTEMI patients evaluated in the emergency department, lower EF and higher absolute delta troponin were independently associated with high angiographic coronary disease burden. EF showed slightly higher discriminatory performance than absolute delta troponin/100. These findings suggest that EF and absolute troponin change may provide complementary information during early emergency department assessment before coronary angiography, although they should not be interpreted as validated predictors of clinical outcomes.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468799","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 necessity of CT/CTA scans on pediatric cerebrovascular injury after blunt trauma - a single center study.","authors":"Lukas Krüger, Oliver Kamp, Maximilian Wolf, Katharina Alfen, Jens Theysohn, Marcel Dudda, Lars Becker","doi":"10.1186/s12873-026-01688-4","DOIUrl":"10.1186/s12873-026-01688-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating complication of pediatric blunt trauma. Delayed or missed diagnosis may result in ischemic stroke, permanent neurological deficits, or death. To avoid missed injuries, many trauma centers apply liberal computed tomography angiography (CTA) screening strategies, although this may expose children to substantial and potentially unnecessary radiation. Several adult- and pediatric-derived screening tools have been proposed, but their applicability in pediatric trauma populations remains controversial. This study aimed to evaluate the incidence of BCVI, imaging utilization, and the diagnostic performance of pediatric BCVI screening approaches in a German Level I trauma center cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective observational cohort study included pediatric trauma patients aged 0-15 years who underwent CT imaging following blunt trauma between January 2005 and December 2020 at a Level I trauma center in Germany. Patients were identified through systematic review of electronic medical records and radiological databases. BCVI was defined as traumatic injury to the carotid or vertebral arteries detected by CTA or magnetic resonance imaging (MRI). Demographic, clinical, imaging, and outcome data were collected retrospectively. The McGovern score was calculated for patients with sufficient available data and evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) analysis. Additionally, the theoretical applicability of PECARN and Scandinavian pediatric head trauma guidelines was explored to assess potential reductions in CT utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 956 pediatric trauma patients underwent CT imaging, of whom 668 (70%) additionally received CTA. BCVI was diagnosed in 6 patients, corresponding to an incidence of 0.6%. Five injuries were identified by CTA and one by MRI. All BCVI patients presented with focal neurological deficits at initial evaluation. The McGovern score could be calculated in 896 patients. Using a cutoff value of ≥ 3 points, all BCVI cases were correctly identified, resulting in a sensitivity of 100%, specificity of 83.8%, PPV of 4.0%, and NPV of 100%. ROC analysis demonstrated excellent discriminative ability with an area under the curve of 0.960 (95% CI 0.923-0.989). However, the small number of BCVI cases limited statistical power. Theoretical application of PECARN and Scandinavian guidelines suggested that a substantial proportion of CT examinations may have been avoidable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;BCVI is an uncommon but clinically significant injury in pediatric blunt trauma. Despite its low incidence, CTA utilization was high in our cohort, raising concerns regarding potential overuse of imaging and radiation exposure. Pediatric-specific screening tools such as the McGovern s","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454595","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 relationship between violence proneness and history of violence in emergency department patients.","authors":"Oya Akpınar Oruç, Mehmet Soyugüzel, Hülya Sevil, Ayşe Ertekin, Şerife Özdınç","doi":"10.1186/s12873-026-01683-9","DOIUrl":"https://doi.org/10.1186/s12873-026-01683-9","url":null,"abstract":"<p><strong>Objectives: </strong>This study analyzed the relationship between violence tendency and history of violence in emergency department patients.</p><p><strong>Methods: </strong>The study included 384 patients presenting to the Emergency Medicine Unit at Afyonkarahisar Health Sciences University. A questionnaire containing demographic information and the Buss-Perry Aggression Scale was administered to the patients. The demographic information form included questions regarding gender, age, marital status, occupation, reason for emergency room visit, chronic disease, regular medication use, emergency room history, and nominal variables that may be associated with aggression.</p><p><strong>Results: </strong>Physical aggression, anger and hostility score were significantly higher for participants who subjected to verbal violence, use physical and verbal violence and has criminal record (p < 0.05). Verbal aggression was significantly higher for participants who use physical and verbal violence and has criminal record (p < 0.05). Physical aggression was significantly correlated with subjected to verbal violence (r = 0.139; p < 0.01), use of physical violence (r = 0.170; p < 0.01), use of verbal violence (r = 0.270; p < 0.01) and criminal record (r = 0.277; p < 0.01). Anger score was significantly correlated with subjected to verbal violence (r = 0.138; p < 0.01), use of physical violence (r = 0.169; p < 0.01), use of verbal violence (r = 0.221; p < 0.01) and criminal record (r = 0.273; p < 0.01). Hostility was significantly correlated with subjected to verbal violence (r = 0.152; p < 0.01), use of physical violence (r = 0.168; p < 0.01), use of verbal violence (r = 0.213; p < 0.01) and criminal record (r = 0.224; p < 0.01). Verbal aggression was significantly correlated with use of physical violence (r = 0.146; p < 0.01), use of verbal violence (r = 0.190; p < 0.01) and criminal record (r = 0.251; p < 0.01).</p><p><strong>Conclusion: </strong>Our research results revealed that previous verbal abuse, verbal and physical abuse, and a criminal record significantly associated the tendency of violence in emergency departments. However, these results are related to the scale's level of tendency, and further research is needed to determine predictive results. Emergency medicine history, however, did not significantly affect or differentiate violence.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454600","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":"Prognostic value of sarcopenia markers in geriatric patients presenting to the emergency department: a prospective study.","authors":"Ahmet Burak Erdem, Veysi Siber, Serdal Ateş, Ece Zengin, Sena Yılmaz, Rasime Pelin Kavak, Emine Sarcan","doi":"10.1186/s12873-026-01680-y","DOIUrl":"10.1186/s12873-026-01680-y","url":null,"abstract":"<p><strong>Background: </strong>Early risk stratification in geriatric patients presenting to the emergency department remains challenging. Sarcopenia has emerged as a potential marker of reduced physiological reserve and adverse clinical outcomes. This study aimed to evaluate the prognostic value of quadriceps muscle thickness and the paraspinal muscle index for predicting short-term mortality in geriatric emergency department patients and to examine their association with established frailty scales.</p><p><strong>Methods: </strong>In this single-center prospective observational study, consecutive patients aged ≥ 65 years presenting to the emergency department were enrolled. Rectus femoris and vastus intermedius muscle thicknesses were measured using bedside ultrasonography. The paraspinal muscle index was calculated from thoracic computed tomography images obtained for clinical indications. Frailty was assessed using the Clinical Frailty Scale (CFS), Elderly Risk Assessment (ERA), and Identification of Seniors at Risk (ISAR). The primary outcome was 30-day mortality. Receiver operating characteristic (ROC) analysis was performed to evaluate discriminatory performance.</p><p><strong>Results: </strong>A total of 139 patients were included, of whom 28 (20.1%) died within 30 days. All sarcopenia indices were significantly lower among non-survivors (p < 0.05). In ROC analysis, the paraspinal muscle index demonstrated the highest discriminatory ability for predicting 30-day mortality (AUC 0.689, 95% CI 0.584-0.795), followed by the vastus intermedius (AUC 0.633) and rectus femoris indices (AUC 0.628). In subgroup analysis, quadriceps indices were associated with mortality only in non-inflammatory patients, whereas the paraspinal muscle index remained predictive across both groups. Among frailty tools, only CFS was significantly associated with mortality.</p><p><strong>Conclusion: </strong>Muscle-based sarcopenia markers, particularly the paraspinal muscle index, are associated with short-term mortality in geriatric emergency department patients. Integration of muscle measurements with frailty assessment may enhance early risk stratification in emergency care settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454543","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":"Diagnostic capability of large language models in critically ill patients: a prospective single-centre study comparing ChatGPT, Claude, and Gemini with emergency physicians.","authors":"İbrahim Günaydın, Mutlu Yılmaz, Sinan Akpunar, Tacettin Karaman, Abdul Samet Şahin, Melih İmamoğlu, Yunus Karaca, Sinan Paslı","doi":"10.1186/s12873-026-01689-3","DOIUrl":"10.1186/s12873-026-01689-3","url":null,"abstract":"<p><strong>Background: </strong>Clinical decision-making requires integrating history, physical examination, laboratory, and imaging data. In the emergency department (ED), workload, time pressure, and cognitive burden may impair this process and affect decision quality. This study compares the diagnostic outputs of ChatGPT, Claude, and Gemini with those of emergency physicians in real-world ED cases.</p><p><strong>Methods: </strong>This prospective, single-centre observational diagnostic agreement study compared the stage-wise outputs of four Large Language Models (LLMs) (ChatGPT-4o, ChatGPT-5, Claude Opus 4.1, and Gemini 2.5 Pro) with those of emergency physicians in critically ill ED patients. Between 10 August and 10 September 2025, de-identified clinical data were entered into the models via their official web interfaces using standardised prompts. In the first stage, physicians and LLMs each generated five preliminary diagnoses based on vital signs and medical history. In the second stage, following physical examination and laboratory and imaging results, both refined their lists into three differential diagnoses. In the third stage, the physicians' final diagnosis was accepted as the reference, and each LLM was prompted to provide a final diagnosis. LLM preliminary and differential diagnoses were compared with those of the physicians at the corresponding stage, and LLM final diagnoses with the reference; the inclusion of the final diagnosis within earlier lists was also evaluated. Agreement was quantified using Cohen's κ; analyses were performed in R.</p><p><strong>Results: </strong>Of 389 screened patients, 180 were included (56.1% male; mean age 67 ± 15.9 years). Physicians contained the reference diagnosis within their top-5 preliminary and top-3 differential lists in 83.9% and 98.3% of cases, respectively, significantly exceeding every LLM (all p < 0.001). Final-diagnosis match rates were 67.2% [60.3-73.5] for ChatGPT-4o, 65.6% [58.7-71.9] for ChatGPT-5, 63.3% [56.3-69.9] for Claude Opus 4.1, and 59.4% [52.3-66.1] for Gemini 2.5 Pro (p = 0.16). Cohen's κ ranged from 0.575 (Gemini 2.5 Pro) to 0.656 (ChatGPT-4o), indicating moderate-to-substantial agreement, with no pairwise difference reaching significance.</p><p><strong>Conclusions: </strong>The LLMs achieved moderate agreement with ED reference diagnoses in critically ill patients but were consistently outperformed by physicians at the early diagnostic phases. Despite final-diagnosis match rates of 59%-67%, their current diagnostic role in the ED remains limited.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444264","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":"Post-resuscitation pre-hospital emergency anaesthesia for exchange of a supraglottic airway device with an endotracheal tube - a multicentre observational study.","authors":"Jonas Bökamp, Eugen Latka, Michael Bernhard, Martin Deicke, Daniel Fischer, Julia Grannemann, Jochen Hinkelbein, Yacin Keller, Annika Hoyer, André Kobiella, Lydia Johnson Kolaparambil Varghese, Bernd Strickmann, Mathini Vaseekaran, Vera Von Dossow, Gerrit Jansen","doi":"10.1186/s12873-026-01668-8","DOIUrl":"10.1186/s12873-026-01668-8","url":null,"abstract":"<p><strong>Background: </strong>Post-resuscitation pre-hospital emergency anaesthesia (PHEA) for changing a supraglottic airway device (SGA) to an endotracheal tube (ETT) after out-of-hospital cardiac arrest may improve airway management but carries potential risks, particularly related to haemodynamic instability. This study investigates its association with complications during post-resuscitation care.</p><p><strong>Methods: </strong>All Emergency Medical Service missions in the districts Gütersloh, Dresden and Lippe from 2019 to 2021 were analysed for out-of-hospital cardiac arrest and supplemented with data from the German Resuscitation Register. Unconscious adult, pre-hospitally resuscitated patients who had an SGA changed to an ETT following pre-hospital return of spontaneous circulation and who had spontaneous circulation on admission to hospital were included. We compared patients with and without PHEA. The primary endpoint was the occurrence of haemodynamic complications during post-resuscitation therapy, defined as re-arrest, hypotension or antihypotensive therapy. For statistical analysis, propensity score matching was performed adjusting for age, sex, pre-existing disease, shockable initial cardiac rhythm, bystander CPR and witnessed arrest.</p><p><strong>Results: </strong>Of 2,305 cardiac arrest patients in 391,305 Emergency Medical Service missions, 706 (30.6%) had return of spontaneous circulation and 202 met our inclusion criteria. 126 of those patients (62.4%) received PHEA to facilitate changing an SGA to an ETT. The propensity score analysis showed no evidence for differences in the odds of occurrence of at least one haemodynamic complication (OR=1.50 [95% CI=0.72-3.11; p=0.28]), airway complication (OR=1.00 [95% CI=0.25-4.00; p=1.00]), re-arrest (OR=0.39 [95% CI=0.14-1.08; p=0.07]), hypotension (OR=1.39 [95% CI=0.68-2.83; p=0.37]) or antihypotensive therapy (OR=1.58 [95% CI=0.77-3.26; p=0.21]) between patients having their SGA changed to an ETT following PHEA compared to patients who had their SGA changed to an ETT without PHEA.</p><p><strong>Conclusions: </strong>The study provided no statistical evidence for increased odds of complications associated with the delivery or omission of pre-hospital emergency anaesthesia during exchange from a supraglottic airway device to an endotracheal tube in resuscitated out-of-hospital cardiac arrest patients.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435144","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":"Prehospital suicide mortality in the Lake Van basin: rural-urban disparities from three-year EMS dispatch surveillance in eastern Türkiye.","authors":"Mehmet Tatlı, Kerem Dost Bilmez, İsmail Altıntop","doi":"10.1186/s12873-026-01677-7","DOIUrl":"10.1186/s12873-026-01677-7","url":null,"abstract":"<p><strong>Background: </strong>Eastern Türkiye records high suicide mortality; however, prehospital emergency medical services (EMS) dispatch records from this region have not been systematically evaluated as a surveillance source. We aimed to describe EMS-attended suicide and self-harm cases in Van Province and to quantify the association between rural residence and prehospital suicide mortality.</p><p><strong>Methods: </strong>We conducted a retrospective population-based surveillance study of all 'suicide'-coded records in the Van Province 112 EMS database (ASOS) from January 2023 to December 2025. After excluding duplicates and miscoded entries, 848 physically enacted cases formed the primary sample; 41 ideation/threat records were described separately and excluded from the primary mortality model. Prehospital death was defined as death recorded before hospital handover. Associations were estimated using multivariable logistic regression adjusted for age, sex, and method lethality, with inverse probability of treatment weighting (IPTW) as a sensitivity analysis. Daily meteorological associations were examined using Poisson regression with harmonic seasonality controls.</p><p><strong>Results: </strong>Among 848 physical-act cases (57.7% female; mean age 28.7 ± 12.7 years), the estimated crude annual EMS-attended rate was 25.7 per 100,000 population. Drug/chemical ingestion predominated (52.6%), whereas hanging accounted for 62.1% of prehospital deaths. The rural prehospital death rate was 24.7% compared with 10.8% in urban areas (adjusted odds ratio [aOR] 2.18, 95% CI 1.38-3.44, p < 0.001). Females constituted 33.9% of prehospital deaths (national average: 26.7%). Temperature showed a nominally significant but practically small association (incidence rate ratio [IRR] 1.006/°C, p = 0.022) that did not survive Bonferroni correction. No association with lunar phase was detected.</p><p><strong>Conclusions: </strong>In this dispatch-based surveillance study, rural residence was associated with approximately twofold higher odds of prehospital suicide mortality even after adjustment for age, sex, and method lethality. The findings support the value of 112 dispatch data for prehospital surveillance and generate hypotheses regarding geographic access, delayed discovery, EMS resource constraints, and method lethality that require confirmation through linked dispatch-hospital data and studies with measured response intervals.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435160","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}