BMC Emergency Medicine最新文献

{"title":"Factors associated with 30-day drug-related emergency department re-attendance among methamphetamine users: a territory-wide retrospective study in Hong Kong.","authors":"Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Eric Ho Yin Lau, Matthew Sik Hon Tsui, Sherry Kit Wa Chan, Timothy Hudson Rainer","doi":"10.1186/s12873-025-01325-6","DOIUrl":"https://doi.org/10.1186/s12873-025-01325-6","url":null,"abstract":"<p><strong>Background: </strong>Methamphetamine use is associated with frequent emergency department (ED) utilization, but factors associated with drug-related ED re-attendance are understudied. We aimed to characterize the pattern of 30-day drug-related ED re-attendance and evaluate the impact of the severity of acute toxicity and psychosocial interventions on such re-attendances.</p><p><strong>Methods: </strong>We conducted a secondary analysis of 815 episodes of acute methamphetamine toxicity reported to the Hong Kong Poison Control Centre from all local public EDs between January 1, 2010, and December 31, 2019. We defined the index attendance as the first ED presentation related to methamphetamine within the study period, and drug-related ED re-attendance as a presentation directly related to the acute toxicities or sequelae of drug misuse. The primary outcome was 30-day drug-related ED re-attendance after hospital discharge. We performed univariate and multivariable Cox regression analyses to identify factors associated with the primary outcome.</p><p><strong>Results: </strong>Within 30 days of hospital discharge, 131 (16.1%) patients re-attended the ED for drug-related problems, with 119 re-attendances (90.8%) involving methamphetamine and 76 (58.0%) for psychiatric complaints. In multivariable Cox regression analysis, failed previous detoxification treatment (HR 1.61, 95% CI 1.08-2.39, P = 0.019) and a history of drug-induced psychosis (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.16-2.68, P = 0.008) remained significantly associated with the primary outcome.</p><p><strong>Conclusions: </strong>Drug-related ED re-attendance is common among methamphetamine users. Failed previous detoxification treatment and drug-induced psychosis are factors significantly associated with such re-attendances. The limited impact of the severity of acute toxicity and psychosocial interventions underscores the importance of primary prevention of methamphetamine misuse through public education and drug-control policy, and early multidisciplinary interventions before progression to drug-induced psychosis.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"166"},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941649","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":"Violence and its effects on the job satisfaction of healthcare staff in paediatric emergency departments.","authors":"Ahmet Butun, Mehmet Ozyurt","doi":"10.1186/s12873-025-01330-9","DOIUrl":"https://doi.org/10.1186/s12873-025-01330-9","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"167"},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941607","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":"Improving chest pain risk assessment: validation of HEART, TIMI, GRACE, EDACS-ADP, and HET for MACE prediction in the emergency department.","authors":"Mehdi Nasr Isfahani, Hamidreza Mohseni, Elahe Nasri Nasrabadi, Nizal Sarrafzadegan","doi":"10.1186/s12873-025-01327-4","DOIUrl":"https://doi.org/10.1186/s12873-025-01327-4","url":null,"abstract":"<p><strong>Background: </strong>Chest pain is a common and challenging complaint in emergency departments (EDs), necessitating accurate risk stratification to identify patients at risk for major adverse cardiac events (MACE) while avoiding unnecessary admissions. Several scoring systems have been developed for this purpose, yet their external validity in Middle Eastern populations remains understudied.</p><p><strong>Objective: </strong>To compare and validate the prognostic accuracy of HEART, TIMI, GRACE, EDACS-ADP, and HET scoring systems in predicting 6-week MACE among patients with chest pain presenting to two tertiary care centers in Isfahan, Iran.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients (aged > 18 years) who presented with non-traumatic chest pain to two tertiary referral centers in Isfahan between February and June 2024. Patients' clinical data, laboratory results, and electrocardiograms (ECGs) were retrieved to calculate standardized cardiac risk scores. The primary outcome was the occurrence of major adverse cardiac events (MACE) within 6 weeks following emergency department (ED) presentation. A 6-week evaluation window was selected based on institutional follow-up protocols, data availability, and existing literature that supports this timeframe as a critical period for early cardiac risk stratification. Diagnostic performance of the risk scores was evaluated using receiver operating characteristic (ROC) curve analysis, including calculation of sensitivity, specificity, positive and negative predictive values, and likelihood ratios at clinically relevant cut-off thresholds.</p><p><strong>Results: </strong>A total of 274 patients were finally included. Among them 68 (24.8%) met the MACE at presentation or within 6 weeks. The HEART score demonstrated the highest AUC: 0.925 and sensitivity: 97.1%; NPV: 98.18% at cut-off ≤ 3, followed closely by the HET score with AUC: 0.906 and sensitivity: 92.6%; NPV: 95.58% at cut-off ≤ 1. TIMI also performed well in identifying very low-risk patients (AUC: 0.868; sensitivity: 98.5%, NPV: 98.17%, though with limited specificity (26.7%). GRACE and EDACS-ADP showed moderate predictive ability, with AUCs of 0.815 and 0.803, respectively. Performance variations were attributed to differences in population demographics, and study design.</p><p><strong>Conclusion: </strong>The HEART and TIMI scores at the cut-offs of 3 and 1, respectively demonstrated superior discriminative ability in predicting 6-week MACE in this tertiary care cohort, supporting their use in ED settings for early discharge decisions. HET score also showed utility for ruling out MACE in high-risk patients, however, needs further validation due to its novelty and discrepancies observed among studies. These findings support the local implementation of HEART or TIMI in ED protocols, with further multicenter prospective validation recommended.</p><p><strong>Clinical trial number: </strong>Not applic","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"165"},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941594","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":"Influence of on-scene time and prehospital interventions on inhospital mortality in trauma patients.","authors":"Meng-Yu Wu, Giou-Teng Yiang, Sy-Jou Chen, Hon-Ping Ma, Mau-Roung Lin","doi":"10.1186/s12873-025-01324-7","DOIUrl":"10.1186/s12873-025-01324-7","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the impact of the type and number of prehospital interventions, in addition to prehospital time intervals, on inhospital mortality among trauma patients.</p><p><strong>Methods: </strong>According to a 13-year prospective trauma registry, three prehospital time intervals of response time, on-scene time, and transport time were assessed. Prehospital interventions were classified into four categories: stop bleeding strategies, immobilization, basic airway management, and advanced resuscitation.</p><p><strong>Results: </strong>A total of 13,533 patients were included. Relative to patients not receiving prehospital interventions, there was longer on-scene time for those who received immobilization (10.4 vs. 8.68 min), basic airway management (11.4 vs. 9.40 min), and advanced resuscitation (12.6 vs. 9.53 min). Furthermore, relative to patients who survived in hospital, those who died significantly had longer on-scene time (11.4 vs. 9.64 min) and sustained immobilization (74.7% vs. 52.5%), basic airway management (30.7% vs. 7.6%), advanced resuscitation (32.0% vs. 0.1%), and ≥ 4 prehospital interventions (30.4% vs. 4.6%). Results of the multivariable logistic regression analysis shows that without adjustment for type and number of prehospital interventions, longer on-scene time (odds ratio [OR] = 1.03; 95% confidence interval [CI], 1.01-1.04) were significantly associated with increased mortality; however, after additional adjustment for type and number of prehospital interventions, no significant association between each of the three prehospital time intervals and mortality was detected. Furthermore, compared to patients who did not receive prehospital interventions, those who received wound packing/compression had a significantly lower risk of mortality (OR = 0.54; 95% CI, 0.36-0.80), whereas those who received basic airway management (OR = 1.73; 95% CI, 1.15-2.60), advanced resuscitation (OR = 33.4; 95% CI, 14.9-75.0), and three (OR = 2.60; 95% CI, 1.01-6.93) and ≥ 4 (OR = 2.97; 95% CI, 1.01-9.63) prehospital interventions had a significantly higher risk of mortality.</p><p><strong>Conclusions: </strong>There exists a tradeoff between prehospital trauma interventions and shortening on-scene time for mortality risk; however, implementing some interventions for hemorrhage control and hemostatic resuscitation can benefit the survival of trauma patients the most.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"163"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882007","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":"Association of lung ultrasound score with 72-hour intubation needs in pneumonia patients presenting to the emergency department.","authors":"Tanyaporn Nakornchai, Apichaya Monsomboon, Panrada Pathomkajonkul, Ronnapop Jaluspikultip, Rathachai Kaewlai, Nattakarn Praphruetkit, Tipa Chakorn, Sattha Riyapan, Usapan Surabenjawong, Wansiri Chaisirin, Netiporn Thirawattanasoot","doi":"10.1186/s12873-025-01317-6","DOIUrl":"10.1186/s12873-025-01317-6","url":null,"abstract":"<p><strong>Background: </strong>The lung ultrasound (LUS) score is a semi-quantitative tool used to predict clinical outcomes in conditions such as congestive heart failure and acute respiratory distress syndrome. However, its role in pneumonia remains unclear. This study aimed to determine whether the LUS score is associated with the need for intubation within 72 h of emergency department (ED) presentation.</p><p><strong>Methods: </strong>This prospective observational study enrolled adults (≥ 18 years) who were diagnosed with pneumonia in the ED. The LUS score was calculated by summing findings from 12 thoracic regions. We then examined the relationship between the total LUS score and the need for endotracheal intubation (ETI).</p><p><strong>Results: </strong>Forty-five patients were included. The median LUS score was 13.0 (IQR: 5.5‒19.0). Patients who required ETI had a significantly higher median LUS score (19.0, IQR: 17.0‒26.0) compared with those who did not require ETI (12.0, IQR: 4.25‒18.0; P = 0.002). The LUS score demonstrated strong predictive ability for ETI, with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.71‒0.95). The optimal cutoff value of 16 yielded a sensitivity of 88.9%, specificity of 69.4%, positive predictive value of 42.1%, and negative predictive value of 96.2%. Higher LUS scores were significantly associated with increased 28-day mortality (P = 0.04).</p><p><strong>Conclusions: </strong>Among patients with pneumonia presenting to the ED, the LUS score was associated with the need for ETI and was linked to higher 28-day mortality.</p><p><strong>Trial registration: </strong>This study was registered in Thai clinical trial registry (TCTR20230518003) on May 18, 2023.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"162"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882004","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":"Outcomes and prognostic factors in patients with combined severe traumatic brain injury and abdominal trauma: a retrospective observational study.","authors":"Hohyung Jung, Inhae Heo, Kyoungwon Jung","doi":"10.1186/s12873-025-01320-x","DOIUrl":"10.1186/s12873-025-01320-x","url":null,"abstract":"<p><strong>Purpose: </strong>Severe traumatic brain injury (TBI) is a leading cause of death and disability. Approximately one-third to one-half of cases of TBI are associated with severe extracranial injuries, particularly abdominal trauma. This combination is associated with high mortality rates. However, studies describing the outcomes and prognostic factors of patients with combined severe head and abdominal trauma are lacking. Therefore, this study aimed to compare the clinical characteristics and outcomes and identify prognostic factors in this patient population.</p><p><strong>Methods: </strong>This single-centre, retrospective observational study included patients with major trauma, TBI, and abdominal injury admitted to a Level 1 trauma centre from 2016 to 2020. The inclusion criteria were TBI with an Abbreviated Injury Scale (AIS) score ≥ 3 and abdominal injury with an AIS score ≥ 3. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores at discharge.</p><p><strong>Results: </strong>Of 4,554 patients screened, 160 met the inclusion criteria. The in-hospital mortality rate was 20.6%, and 63.1% of the patients had favourable functional outcomes. Multivariate analysis identified factors associated with increased mortality: lower initial mean arterial pressure (OR: 0.95, 95% CI: 0.91-0.98, p = 0.006), higher base deficit (OR: 1.22, 95% CI: 1.03-1.45, p = 0.022), lower initial Glasgow Coma Scale (GCS) score (OR: 0.75, 95% CI: 0.62-0.91, p = 0.004), prolonged activated partial thromboplastin time (OR: 1.03, 95% CI: 1.00-1.05, p = 0.029), lower platelet count (OR: 0.99, 95% CI: 0.98-1.00, p = 0.008), and lower fibrinogen level (OR: 1.01, 95% CI: 1.00-1.01, p = 0.014). For unfavorable functional outcomes, independent predictors included lower initial GCS score (OR: 0.86, 95% CI: 0.78-0.95, p = 0.002), head AIS score of 5 (OR: 3.52, 95% CI: 1.32-9.40, p = 0.012), lower platelet count (OR: 0.99, 95% CI: 0.99-1.00, p = 0.012), and massive transfusion requirement (OR: 2.92, 95% CI: 1.23-6.95, p = 0.015).</p><p><strong>Conclusion: </strong>This study demonstrates a 20.6% mortality rate in patients with combined severe head and abdominal injuries. The findings identified key prognostic factors, including initial GCS score and platelet count. These results suggest that platelet dysfunction plays a crucial role in both mortality and functional outcomes. Early recognition and management of these factors are crucial for improving outcomes in critically injured patients.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"161"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882009","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":"Disaster response self-efficacy and disaster preparedness levels of Turkish nurses: A cross-sectional study.","authors":"Nilay Ercan Şahin, Türkan Karaca","doi":"10.1186/s12873-025-01299-5","DOIUrl":"10.1186/s12873-025-01299-5","url":null,"abstract":"<p><strong>Aim: </strong>This study was conducted to assess disaster response self-efficacy and disaster preparedness levels of Turkish nurses.</p><p><strong>Methods: </strong>This is a cross-sectional descriptive study involving a total of 195 nurses in Turkiye. A convenience sampling approach was used to reach nurses and the sampling criteria were full-time employment, being a university graduate, and voluntary participation. The data were collected online via a questionnaire created in Google Forms, using the Sociodemographic Information Form, the Disaster Preparedness Scale, and the Disaster Response Self-Efficacy Scale between September and December 2024.</p><p><strong>Results: </strong>The study revealed that nurses' levels of disaster preparedness and disaster response self-efficacy were slightly above the maximum possible mean score. Significant differences were found between disaster preparedness and disaster response self-efficacy levels and factors such as gender, prior experience of a disaster, knowledge of the hospital's emergency assembly area, and awareness of the hospital disaster plan. Furthermore, a moderate positive correlation was identified between disaster preparedness and disaster response self-efficacy levels.</p><p><strong>Conclusion: </strong>It was determined that nurses' levels of disaster preparedness and disaster response self-efficacy were slightly above the maximum possible mean score. In line with these results, it could be suggested that disaster preparedness and self-efficacy in disaster response are associated with factors that enable nurses to intervene more effectively in disaster situations, highlighting the importance of training and awareness programs to ensure that nurses are adequately prepared for disasters.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"158"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882005","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":"Right patient to the right place: the impact of a 6-year regional trauma centre-led prehospital education programme on EMS triage and patient outcomes.","authors":"Donghwan Choi, Yo Huh, Byung Hee Kang, Sora Kim, Seoyoung Song, Kyoungwon Jung, Hohyung Jung","doi":"10.1186/s12873-025-01321-w","DOIUrl":"10.1186/s12873-025-01321-w","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"159"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882010","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":"Moderate and severe traumatic brain injury: abbreviated injury scale scoring and coding of traumatic axonal injury from early MRI.","authors":"Ingrid Aune Bergstrøm, Oddvar Uleberg, Anne Vik, Anne-Mari Holte Flusund, Anne Katharina Köster, Sozaburo Hara, Marianne Dahlhaug, Kent Gøran Moen","doi":"10.1186/s12873-025-01319-4","DOIUrl":"10.1186/s12873-025-01319-4","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"160"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882008","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 and comparison of SAFE QUAKE and dialysis score in earthquake related crush injuries.","authors":"Suleyman Alpar, Sarper Yilmaz, Çağrı Safa Buyurgan, Akif Yarkaç, Neslihan Ergun Suzer, Ali Cankut Tatlıparmak","doi":"10.1186/s12873-025-01322-9","DOIUrl":"10.1186/s12873-025-01322-9","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the predictive accuracy of two scoring systems-Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement (SAFE-QUAKE) and the Dialysis Score-developed to assess the need for dialysis in patients with crush injuries admitted to the emergency department (ED) following the February 6 Türkiye earthquakes.</p><p><strong>Methods: </strong>In this retrospective observational study, the performance of the SAFE-QUAKE and Dialysis Score systems were evaluated using data from a university hospital that was independent from the centers where these scores were originally developed. The study included patients admitted to the ED after the same earthquakes.</p><p><strong>Results: </strong>The SAFE-QUAKE score demonstrated a higher negative predictive value (NPV) for ruling out dialysis (93.4%), whereas the Dialysis Score had superior positive predictive value (PPV) (71.0%). Although the area under the receiver operating characteristic curve (AUROC) was higher for SAFE-QUAKE [0.894 (95% CI: 0.831-0.957)] than for the Dialysis Score [0.836 (95% CI: 0.738-0.934)], this difference was not statistically significant (Z = 1.415; p = 0.157). According to the Net Reclassification Index (NRI), SAFE-QUAKE provided a clear advantage in correctly reclassifying non-dialysis patients to a lower-risk category [NRI⁻ = 0.491 (95% CI: 0.321-0.643)], correctly downgrading 74.5% of such patients while misclassifying only 25.5%. Across various hypothetical prevalence rates, SAFE-QUAKE consistently provided higher NPVs (e.g., 98.9% at 5% prevalence), while the Dialysis Score maintained higher PPVs (e.g., 28% at 5% prevalence; 88.0% at 50% prevalence).</p><p><strong>Conclusion: </strong>Following catastrophic disasters such as the February 6 Türkiye earthquakes, the capacity of healthcare facilities to provide dialysis becomes a key factor in ED decision-making. When patients are to be transferred to facilities without dialysis capabilities, triage based on the SAFE-QUAKE score can help safely identify those at low risk for dialysis. Conversely, if the receiving center has dialysis capacity, the Dialysis Score can be used to prioritize patients more likely to require dialysis. The sequential use of both scores may enhance triage accuracy by prioritizing SAFE-QUAKE for rapid ED assessment and Dialysis Score for refining interfacility transfer decisions based on resource intensity.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"164"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882006","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}