BMC Emergency Medicine最新文献

{"title":"Preparedness dimensions and components of emergency medical services in chemical hazards: a systematic review.","authors":"Abed Khanizade, Shandiz Moslehi, Mohsen Dowlati, Parisa Moradimajd, Mohammad Javad Moradian","doi":"10.1186/s12873-025-01180-5","DOIUrl":"10.1186/s12873-025-01180-5","url":null,"abstract":"<p><strong>Background: </strong>EMS providers are often the only emergency workers with medical knowledge at the scene of chemical hazards and are exposed to severe risks. They should always be prepared to face chemical hazards to be able to provide an effective response to them. Therefore, this study identified the dimensions and components of emergency medical services system preparedness in chemical hazards.</p><p><strong>Methods: </strong>We searched the relevant electronic databases, including ProQuest, Embase, PubMed, Web of Science, and Scopus. The search included articles in English published up to November 2, 2023. In addition, organizational websites, including WHO, CDC, OSHA, NIOSH, FEMA, IFRC, NFPA, OECD, and OPCW, were searched to find gray literature. Studies were selected using the PRISMA checklist, and thematic analysis was used to analyze the findings.</p><p><strong>Results: </strong>Finally, of 8193 selected records, 16 papers were included in the final analysis. Using thematic analysis, two main themes, 15 categories, and 57 subcategories were revealed. The categories for management measures included Plans and guidelines, Communication and coordination, Risk management, Management of physical spaces and Sources of funding, and for technical measures were recognition of chemical release, incident scene management, personal protection, casualty management, ambulance equipment and drugs, decontamination, psychological support, supporting units, Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) ambulances, and training.</p><p><strong>Conclusions: </strong>Due to the importance and extent of the effects of chemical hazards, EMS systems need to develop their preparedness using more specific approaches to provide medical services in chemical hazards. EMS systems should provide medical equipment and antidotes, chemical ambulances, chemical protective equipment, and necessary physical spaces with appropriate financing. Also, preparedness and response plans should be prepared and practiced regularly based on previous lessons learned and with the cooperation and participation of other organizations involved in chemical disasters.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"24"},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412852","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":"Predicting high-risk return at emergency department presentation for patients who undergo short-term revisits: the HANDLE-24 score.","authors":"Chung-Ting Chen, Po-Hsiang Liao, Meng-Chen Lin, Hsien-Hao Huang, Chorng-Kuang How, Yu-Chi Tung","doi":"10.1186/s12873-025-01184-1","DOIUrl":"10.1186/s12873-025-01184-1","url":null,"abstract":"<p><strong>Background: </strong>The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify high-risk patients and improve resource management.</p><p><strong>Methods: </strong>This study was conducted via an electronic health records system at a tertiary center in Taiwan. We derived a risk model via logistic regression and bootstrapping methods using a retrospective cohort of adults who underwent 72-h ED revisits between January 2019 and December 2020. The study population was divided into development (2019: 1224) and validation datasets (2020: 985). The primary outcome was high-risk return, defined as intensive care unit (ICU) admission or in-hospital mortality after 72-h ED return.</p><p><strong>Results: </strong>On the basis of the odds ratio, eight variables were independently associated with high-risk ED returns and subsequently included in the HANDLE-24 score (hypertension; symptoms of acute coronary syndrome; dysnatremia; dyspnea; liver disease; triage level escalation; and revisits within 24 h). The area under the receiver operating characteristic curve was 0.816 (95% CI: 0.760-0.871, p < 0.001) in the development dataset and 0.804 (0.750-0.858) in the validation dataset. Patients can be divided into three risk categories on the basis of the HANDLE-24 score: low [0-8.5], moderate [9-11.5] and high [12-22] risk groups. The ability of our risk score to predict the rates of hospital admission, ICU admission and in-hospital mortality was significant according to the Cochran‒Armitage trend test.</p><p><strong>Conclusion: </strong>The HANDLE-24 score represents a simple tool that allows early risk stratification and suggests more aggressive therapeutic strategies for patients experiencing ED revisits. The risk of adverse outcomes in ED adults after revisiting can be swiftly assessed via easily available information.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"23"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405535","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":"Leveling of triggers: a comprehensive summative content analysis of factors contributing to physical violence in emergency medical services.","authors":"Mohammad Torabi, Ali Afshari, Rasoul Salimi, Afshin Khazaei","doi":"10.1186/s12873-025-01181-4","DOIUrl":"10.1186/s12873-025-01181-4","url":null,"abstract":"<p><strong>Background: </strong>The literature has identified numerous factors that contribute to workplace violence, ranging from environmental stressors to interpersonal conflict. However, a gap remains in our understanding of the specific factors associated with physical violence, particularly concerning its frequency and perceived significance.</p><p><strong>Methods: </strong>A summative content analysis was conducted via the electronic survey platform Porsline in Iran for data collection. In April 2024, EMTs working in urban, road, and air bases in western Iran participated in the study. In total, 358 EMTs were selected via convenience sampling. They provided open-ended responses to the following question: \"What do you believe are the most significant factors contributing to physical violence in your workplace?\"</p><p><strong>Results: </strong>The analysis resulted in a comprehensive list of 1,407 descriptions, organized into 20 subcategories and further consolidated into ten main categories. The category with the highest frequency was \"legal and policy deficiencies,\" with a frequency of 3103, and the category with the lowest frequency was \"workplace culture and professional satisfaction,\" with 579. The categories based on frequency and significance included \"legal and policy deficiencies,\" \"cultural and societal barriers,\" \"insufficient training and practical skills,\" \"shortcomings in organizational safety and support,\" \"interpersonal and operational pressures,\" \"organizational culture and workforce dynamics,\" \"barriers to effective prehospital care,\" \"resource and infrastructure limitation,\" \"challenges in interagency coordination and support,\" and \"workplace culture and professional satisfaction.\"</p><p><strong>Conclusion: </strong>Legal reforms addressing legal inadequacies, enhancing organizational support systems, and implementing targeted training programs to mitigate conflicts are essential for fostering a safer working environment. By addressing these pressing issues, healthcare facilities can enhance emergency care, safeguard the well-being of emergency responders, and increase the quality of emergency medical services for communities.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"22"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398094","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":"Does the \"state of disaster\" response have a downside? Hospital incident command group leaders' experiences of a terrorist-induced major incident: a qualitative study.","authors":"Jason P Murphy, Anna Hörberg, Monica Rådestad Rn, Lisa Kurland, Maria Jirwe","doi":"10.1186/s12873-025-01173-4","DOIUrl":"10.1186/s12873-025-01173-4","url":null,"abstract":"<p><strong>Aim: </strong>This study explores HICGs' experience of disaster response during a terrorist-induced major incident major incident.</p><p><strong>Design: </strong>A qualitative descriptive design with individual semi-structured interviews was used.</p><p><strong>Methods: </strong>This was a qualitative study based on seven individual interviews. Participants were members of hospital incident command groups during a terror attack. The interviews were transcribed verbatim and analyzed using deductive content analysis. The SRQR checklist was used to report the findings.</p><p><strong>Results: </strong>The data created from the interviews identified barriers and facilitators for hospital response as well as aligned with previously established categories: Expectations, prior experience, and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Experiences of hospital incident command group response (containing two subcategories). In addition, the results suggest that an exaggerated response may have led to unanticipated adverse events.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"21"},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122026","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":"External validation of the SCARE score in identifying acute coronary syndromes during medical regulation of chest pain.","authors":"Lemoine Augustine, Fontaine Xavier, Duval Camille, Quirin Mathilde","doi":"10.1186/s12873-025-01178-z","DOIUrl":"10.1186/s12873-025-01178-z","url":null,"abstract":"<p><strong>Background: </strong>Medical regulation of chest pain is challenging due to the multitude of potential diagnoses. The key challenge is to avoid misdiagnosing acute coronary syndrome while preventing over-triage. The SCARE score (based on age, sex, smoking, typical coronary pain, inaugural pain, sweats, and dispatcher's conviction) classifies patients as low, intermediate, or high risk of acute coronary syndrome. This study aimed to determine the diagnostic performance of the SCARE score among patients calling with chest pain.</p><p><strong>Methods: </strong>This single-center prospective study was conducted at the Charleville-Mézières Emergency Medical Communication Centre. Data collection included standardized questionnaires and call tape reviews. The SCARE score was compared with final diagnoses from medical records.</p><p><strong>Results: </strong>From October 2 to November 16, 2023, 194 patients were included, with 32 (16%) diagnosed with acute coronary syndrome. Of these, 24 patients (75%) were managed by a prehospital medical team. The AUROC for the SCARE score was 0.80 [95% CI 0.73-0.87]. At a low-risk threshold (26), sensitivity was 100% [95% CI 89-100] and specificity was 45% [95% CI 37-53]. At a high-risk threshold (36), sensitivity was 72% [95% CI 53-86] and specificity was 70% [95% CI 63-77].</p><p><strong>Conclusion: </strong>The SCARE score exhibited excellent sensitivity and overall acceptable performance in predicting acute coronary syndrome in patients calling with non-traumatic chest pain.</p><p><strong>Trial registration: </strong>ID-RCB 2023-A01672-43.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"20"},"PeriodicalIF":2.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073747","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":"Investigating BLS instructors' ability to evaluate CPR performance: focus on compression depth, rate, and recoil.","authors":"Shih-Jhan Lin, Chih-Jan Chang, Shao-Chung Chu, Ying-Hsin Chang, Ming-Yuan Hong, Po-Chang Huang, Chia-Lung Kao, Chih-Hsien Chi","doi":"10.1186/s12873-024-01162-z","DOIUrl":"10.1186/s12873-024-01162-z","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) presents significant challenges with low survival rates, emphasizing the need for effective bystander CPR training. In Basic Life Support (BLS) training, the role of instructors is pivotal as they assess and correct learners' cardiopulmonary resuscitation (CPR) techniques to ensure proficiency in life-saving skills. This study evaluates the concordance between CPR quality assessments by Basic Life Support (BLS) instructors and those determined through Quantitative CPR (QCPR) devices, utilizing data from BLS courses conducted at National Cheng Kung University Hospital from October 2017 to April 2018.</p><p><strong>Methods: </strong>The study analyzed existing data from BLS courses, comparing CPR quality assessments made by instructors with those recorded by QCPR devices. Key metrics such as chest compression speed, depth, and recoil were examined to identify the degree of consistency between human and automated evaluations.</p><p><strong>Results: </strong>In this study, CPR performance was analyzed using QCPR devices and BLS instructors across metrics like speed, depth, and recoil. Employing the Cohen kappa statistic revealed moderate to low interrater reliability, the kappa value is 0.65 (95% C.I. 0.65-0.65) for depth, 0.56 (95% C.I. 0.33-0.79) for speed, and 0.50 (95% C.I.0.28-0.71) for recoil. Correlation analysis visualized in a heatmap indicated a higher consistency in depth evaluations (correlation coefficient = 0.7) compared to speed and recoil, suggesting a need for improved alignment in CPR training assessments.</p><p><strong>Conclusions: </strong>The study underscores the importance of refining CPR training methods and adopting advanced technological aids to enhance the reliability of CPR skill assessments. By improving the accuracy of these evaluations, the training can be better tailored to increase the effectiveness of life-saving interventions, potentially boosting survival rates in out-of-hospital cardiac arrest scenarios.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063584","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":"Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study.","authors":"Leonhard M von Beck, Gabriella Anna Rapszky, Veronika E Kiss, Szilard Sandor, Szabolcs Gaal-Marschal, Tamas Berenyi, Csaba Varga, Bank G Fenyves","doi":"10.1186/s12873-025-01177-0","DOIUrl":"10.1186/s12873-025-01177-0","url":null,"abstract":"<p><strong>Background: </strong>Timely management of sepsis in the emergency department, including the use of appropriate antimicrobials, is crucial for improving patient outcomes. Inadequate empiric antimicrobial treatment is associated with potential changes in patient outcomes. We aimed to pinpoint risk factors, characterize antibiotic resistance trends, and investigate the association between antibiotic resistance and mortality among patients with bacteremia admitted to the emergency department.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of emergency department patients admitted between 15/06/2016 and 30/09/2022. Patients with a positive blood culture receiving emergency department-initiated antibiotic therapy were included. Antibiotic administration, resistance, and survival data were collected. Descriptive statistics, survival analysis, and Cox proportional hazards models were performed.</p><p><strong>Results: </strong>Of 157,884 emergency department visits, 1,136 patients had a positive blood culture and received antibiotic therapy initiated in the emergency department. Resistance against empiric antibiotics was 14.5%. The overall 30-day and one-year mortality was 38.6% and 61.8%, respectively. In adjusted Cox models, patients with Escherichia coli or Staphylococcus aureus infection had 36% lower and 44% higher risk of death, respectively. Although resistance to emergency department-administered antibiotic therapy was not associated with overall mortality, one-year mortality of patients with Escherichia coli bacteremia was higher in those with antibiotic resistance (69.0% vs. 49.4%, p = 0.011); these patients had a 1.5-fold increased risk of death in an adjusted Cox model.</p><p><strong>Conclusion: </strong>The mortality of patients with bloodstream infection is high. The association of mortality with empiric emergency department-initiated antibiotic adequacy is pathogen-dependent.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"18"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051474","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":"Predictors of specialist care referrals (SCR) following emergency department review or hospital admission in adults with previous acute COVID-19: a prospective UK cohort study.","authors":"Anita Saigal, Songyuan Xiao, Owais Siddique, Prasheena Naran, Heba M Bintalib, Camila Nagoda Niklewicz, George Seligmann, Sindhu Bhaarrati Naidu, Amar J Shah, Chibueze Ogbonnaya, John R Hurst, Marc Ci Lipman, Swapna Mandal","doi":"10.1186/s12873-024-01164-x","DOIUrl":"10.1186/s12873-024-01164-x","url":null,"abstract":"<p><strong>Background: </strong>Long-COVID research to date focuses on outcomes in non-hospitalised vs. hospitalised survivors. However Emergency Department attendees (post-ED) presenting with acute COVID-19 may experience less supported recovery compared to people admitted and discharged from hospital (post-hospitalised group, PH).</p><p><strong>Objective: </strong>We evaluated outcomes and predictors of specialty care referrals (SCR) in those with ongoing symptomatic Long-COVID, comparing post-ED and PH adults.</p><p><strong>Methods: </strong>This prospective observational cohort study evaluates 800 PH and 484 post-ED adults from a single hospital in London, United Kingdom. Participants had either confirmed laboratory-positive SARS-CoV-2 infection or clinically suspected acute COVID-19 and were offered post-COVID clinical follow-up at approximately six weeks after their ED attendance or inpatient discharge, to assess ongoing symptoms and support recovery. Multiple logistic regression determined associations with specialist care referrals (SCR) to respiratory, cardiology, physiotherapy (including chest physiotherapy), and mental health services.</p><p><strong>Results: </strong>Presence of at least one Long-COVID symptom was lower in adults attending ED services with acute COVID-19 compared to those hospitalised (70.1% post-ED vs. 79.5% PH adults, p < 0.001). Total number of Long-COVID symptoms was associated with increased SCR in all patients (adjusted odds ratio (aOR) = 1.26, 95%CI:1.16, 1.36, p < 0.001), with post-ED adults more likely to need a SCR overall (aOR = 1.82, 95%CI:1.19, 2.79, p = 0.006). Post-ED adults had higher SCR to both physiotherapy (aOR = 2.59, 95%CI:1.35, 4.96, p = 0.004) and mental health services (aOR = 3.84, 95%CI:2.00, 7.37, p < 0.001), with pre-existing mental illness linked to the latter (aOR = 4.08, 95%CI:1.07, 15.6, p = 0.04).</p><p><strong>Conclusions: </strong>We demonstrate greater specialist care referrals to mental health and physiotherapy services in patients attending the ED and discharged with acute COVID-19, compared to those admitted, despite lower ongoing COVID-19 symptom burden. Total number of symptoms, pre-existing co-morbidity such as smoking status, cardiac co-morbidities, and mental health illnesses may predict those requiring healthcare input. This information may enable better post-COVID support for ED attendees, a distinct group who should not be neglected when preparing for future pandemics.</p><p><strong>Trial registration: </strong>This study had HRA approval (20/HRA/4928).</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"11"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027877","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":"Incidence and outcomes of dysnatremia in crush injury patients admitted to Türkiye's largest hospital following the Kahramanmaraş earthquake.","authors":"Merve Yazla, Fatih Mehmet Aksoy","doi":"10.1186/s12873-024-01165-w","DOIUrl":"10.1186/s12873-024-01165-w","url":null,"abstract":"<p><strong>Objectives: </strong>Dysnatremia is a critical electrolyte disturbance that can significantly impact the prognosis of trauma patients by influencing fluid balance, neurological function, and hemodynamics. Although sodium disorder is common in hospitalized patients, few studies have specifically examined the incidence of dysnatremia in patients presenting to the emergency department for post-earthquake trauma. The aim of this study is to evaluate the incidence of dysnatremia and the prognosis of patients with dysnatremia in trauma patients admitted to our center after the Kahramanmaraş earthquake.</p><p><strong>Materials and methods: </strong>Between February 6th, 2023 and February 20th, 2023, a total of 422 patients with earthquake-related crush injuries after the Kahramanmaras earthquake were retrospectively analyzed. Patients were divided into two groups: the survivor group and the exitus group. Then, patients with dysnatremia were evaluated. Age, gender, the city where patients came from, type of presentation, injured organ systems and extremities, laboratory findings, ward admission, intensive care admission, GCS, MESS, ISS, RTS, TRISS, and hemodialysis sessions were analyzed.</p><p><strong>Results: </strong>A total of 422 earthquake victims with crush injuries were included in the study. Dysnatremia was present in 28% of the patients, and these patients had a longer hospital stay. GCS was lower, MESS and ISS values were higher, and survival rates according to TRISS were lower. Multiple extremity trauma, crush syndrome, and dialysis rates were more common in the dysnatremia group. Additionally, fasciotomy, amputation and mortality rates were higher in the dysnatremia group.</p><p><strong>Conclusion: </strong>Dysnatremia is a common finding in patients with crush injuries and is associated with more severe trauma and poorer clinical outcomes. This study highlights the need for close monitoring and management of sodium disturbances in trauma patients, not only in the context of earthquakes but across various disaster scenarios. Recognizing and addressing dysnatremia can contribute to improved patient outcomes in disaster and emergency settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"16"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027872","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":"Construction and evaluation of a triage assessment model for patients with acute non-traumatic chest pain: mixed retrospective and prospective observational study.","authors":"Xuan Zhou, Gangren Jian, Yuefang He, Yating Huang, Jie Zhang, Shengfang Wang, Yunxian Wang, Ruofei Zheng","doi":"10.1186/s12873-025-01176-1","DOIUrl":"10.1186/s12873-025-01176-1","url":null,"abstract":"<p><strong>Background: </strong>Acute non-traumatic chest pain is one of the common complaints in the emergency department and is closely associated with fatal disease. Triage assessment urgently requires the use of simple, rapid tools to screen patients with chest pain for high-risk condition to improve patient outcomes.</p><p><strong>Methods: </strong>After data preprocessing and feature selection, univariate and multiple logistic regression analyses were performed to identify potential predictors associated with acute non-traumatic chest pain. A nomogram was built based on the predictors, and an internal evaluation was performed using bootstrap resampling methods. The model was also externally validated in this center. Furthermore, the model results were risk-stratified using the decision tree analysis to explore the corresponding triage level. Subsequently, we developed an online visualization tool based on the model to assess the risk of high risk in patients with chest pain.</p><p><strong>Results: </strong>Multiple logistic regression analysis showed that age, smoking, coronary heart disease, hypertension, diabetes, hyperlipidemia, pain site, concomitant symptoms, and electrocardiograph, all of which are independent predictors of high-risk chest pain patients. The AUC of our model in the development and validation groups was 0.919 (95%CI: 0.891 ~ 0.974) and 0.904 (95%CI: 0.855 ~ 0.952). Moreover, our model demonstrated better outcomes in terms of accuracy/sensitivity in both cohorts (81.9%/85.2% and 94.8%/78.5%). The calibration curve shows a high degree of agreement between the predicted and actual probabilities. Decision curve analysis clarified that our model had higher net gains across the entire range of clinical thresholds. Afterward, we developed an online tool, which is used in the triage link to facilitate nurses to screen people with high-risk chest pain.</p><p><strong>Conclusion: </strong>We proposed an accurate model to predict the high-risk populations with chest pain, based on which a simple and rapid online tool was developed and provided substantial support for its application as a decision-making tool for the emergency department.</p><p><strong>Registration: </strong>The study protocol was approved by the Ethics Committee Board of Fujian Provincial Hospital.</p><p><strong>Clinical trial registration number: </strong>ChiCTR2200061918.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"12"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027831","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}