BMC Emergency Medicine最新文献

{"title":"Developing and evaluating a Disaster Management Assessment Tool for Health Care Practitioners.","authors":"Sara Elshami, Mohamed Izham Mohamed Ibrahim, Manar E Abdel-Rahman, Hanan Abdul Rahim, Banan Mukhalalati","doi":"10.1186/s12873-025-01199-8","DOIUrl":"10.1186/s12873-025-01199-8","url":null,"abstract":"<p><strong>Background: </strong>Over the last fifty years, the frequency and intensity of disasters have escalated, highlighting the importance of healthcare practitioners (HCPs) being thoroughly prepared for disaster management. Despite this pressing need, there is a notable lack of well-developed and rigorously evaluated assessment tools to evaluate disaster preparedness among HCPs across various disciplines and disaster scenarios. This study aims to develop and evaluate a Disaster Management Assessment Tool for Health Care Practitioners (DMAT_HCP).</p><p><strong>Methods: </strong>The DMAT_HCP was designed following the four stages of the Disaster Management Framework and a literature review of similar previously validated tools. Content validity was assessed through two rounds of review by nine and six experts, whereas face validity was assessed by 11 HCPs. DMAT_HCP was tested on 107 HCPs from different health disciplines and settings to evaluate the structural (factor analysis) and construct (convergent and divergent) validities as well as internal consistency reliability.</p><p><strong>Results: </strong>DMAT_HCP comprised five Likert scales that assess the preparedness and readiness of HCPs for disaster, with satisfactory content validity indices (CVI > 0.83 for six experts). Factor analysis of the entire set of DMAT_HCP items suggested six factors: knowledge, two sub-domains of attitude, practice, willingness to practice, and organization-based management, which together accounted for 77.9% of the variance in the data. Convergent and divergent validity analyses showed that all items within a section had a correlation coefficient greater than 0.4 with their corresponding section score, and they were more strongly correlated with their own section than with scores from other sections. Cronbach's alpha values for the individual sections ranged from 0.89 (attitude) to 0.97 (organization-based management), and the overall Cronbach's alpha for the DMAT_HCP was 0.90.</p><p><strong>Conclusions: </strong>This study substantiated that DMAT_HCP is both conceptually and methodologically valid and reliable. It has demonstrated strong content validity, accurately measures the intended constructs, and effectively distinguishes between unrelated constructs. The tool also exhibited excellent internal consistency reliability across its components. The tool offers a comprehensive, globally applicable assessment of disaster management, suitable for use across various healthcare professions, settings, disaster contexts, and management phases.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"41"},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma hospital preparedness against natural and man-made disasters: a cross-sectional study.","authors":"Leila Mohammadinia, Mehran Sardareh, Fatemeh Mousavi, Shahram Paydar, Rona Bahreini","doi":"10.1186/s12873-025-01195-y","DOIUrl":"10.1186/s12873-025-01195-y","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to investigate the trauma hospital preparedness in disasters of 2019.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in two qualitative and quantitative phases. Data were collected retrospectively in the quantitative part through census and in the qualitative part through semi-structured interviews. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis, respectively.</p><p><strong>Results: </strong>The Hazard of the trauma hospital in 2019 were divided into two categories: natural (floods) and man-made (floods, street riots, incidence of COVID-19). 93% of all hazards were attributed to the spread of COVID-19, 5.4% to disturbances and 1.6% to floods. In the quantitative part, from 227 extracted codes, two main themes were finally classified titled \" Hospital's functional experience in response \" and \"Challenges and functional corrective solutions \".</p><p><strong>Conclusions: </strong>Due to the exhaustion of hospitals, the accident proneness of Iran and as well as insufficient attention to safety, it is essential that hospitals, especially trauma hospitals, have disaster preparedness plans. By using these comprehensive preparedness, managers can reduce the consequence of disasters and achieve proper preparation.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"38"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unselected cardiac troponin testing and the diagnosis of myocardial infarction in the emergency department.","authors":"Alfredo Bardají, Oscar M Peiro, Maria Leyva-López, Juan R Delgado, Mar Rocamora-Horach, Montserrat Galofré, Isabel Fort, Anna Carrasquer, Jose Luis Ferreiro","doi":"10.1186/s12873-025-01197-w","DOIUrl":"10.1186/s12873-025-01197-w","url":null,"abstract":"<p><strong>Background: </strong>This research examines the role of systematic cardiac troponin evaluation in identifying type 1 myocardial infarction among patients presenting to the emergency department with collected blood samples.</p><p><strong>Methods: </strong>This was a prospective study of consecutive adult patients presenting to the emergency department of a university hospital between October 22, 2020, and January 11, 2021. Cardiac troponin I levels were measured in all patients, including those with suspected acute coronary syndrome (clinical testing) and a control group undergoing routine blood tests (non-clinical testing). The primary outcomes were the prevalence of type 1 myocardial infarction and the positive predictive value of cardiac troponin I, which were assessed using established statistical methods.</p><p><strong>Results: </strong>Elevated cardiac troponin levels were identified in 13.4% of the study population (382/2,853). This included 19.5% of patients with clinically guided tests and 10.1% of those with non-clinical testing. The overall prevalence of type 1 myocardial infarction was 2%, with a positive predictive value of 14.9% (95% CI: 13.6-16.2). Among clinically guided tests, type 1 myocardial infarction prevalence was 5.8%, yielding a positive predictive value of 29.5% (95% CI: 26.7-32.4). Cases from non-clinically guided tests were primarily attributed to type 2 myocardial infarction or non-ischemic myocardial injury.</p><p><strong>Conclusion: </strong>Using a generalized approach to cardiac troponin testing in emergency department patients significantly lowers the diagnostic accuracy for type 1 myocardial infarction, reducing the positive predictive value and frequently indicating non-ischemic myocardial injury.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"37"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding oncologic emergencies and related emergency department visits and hospitalizations: a systematic review.","authors":"Sule Yilmaz, Komal Aryal, Jasmine King, Jason J Bischof, Arthur S Hong, Nancy Wood, Bonnie E Gould Rothberg, Matthew F Hudson, Sara W Heinert, Monica K Wattana, Christopher J Coyne, Cielito Reyes-Gibby, Knox Todd, Gary Lyman, Adam Klotz, Beau Abar, Corita Grudzen, Aveh Bastani, Christopher W Baugh, Daniel J Henning, Steven Bernstein, Juan Felipe Rico, Richard J Ryan, Sai-Ching Jim Yeung, Aiham Qdaisat, Aasim Padela, Troy E Madsen, Raymond Liu, David Adler","doi":"10.1186/s12873-025-01183-2","DOIUrl":"10.1186/s12873-025-01183-2","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer frequently visit the emergency department (ED) and are at high risk for hospitalization due to severe illness from cancer progression or treatment side effects. With an aging population and rising cancer incidence rates worldwide, it is crucial to understand how EDs and other acute care venues manage oncologic emergencies. Insights from other nations and health systems may inform resources necessary for optimal ED management and novel care delivery pathways. We described clinical management of oncologic emergencies and their contribution to ED visits and hospitalizations worldwide.</p><p><strong>Methods: </strong>We performed a systematic review of peer-reviewed original research studies published in the English language between January 1st, 2003, to December 31st, 2022, garnered from PubMed, Web of Science, and EMBASE. We included all studies investigating adult (≥ 18 years) cancer patients with emergency visits. We examined chief complaints or predictors of ED use that explicitly defined oncologic emergencies.</p><p><strong>Results: </strong>The search strategy yielded 49 articles addressing cancer-related emergency visits. Most publications reported single-site studies (n = 34/49), with approximately even distribution across clinical settings- ED (n = 22/49) and acute care hospital/ICU (n = 27/49). The number of patient observations varied widely among the published studies (range: 9 - 87,555 patients), with most studies not specifying the cancer type (n = 33/49), stage (n = 41/49), or treatment type (n = 36/49). Most studies (n = 31/49) examined patients aged ≥ 60 years. Infection was the most common oncologic emergency documented (n = 22/49), followed by pain (n = 20/49), dyspnea (n = 19/49), and gastrointestinal (GI) symptoms (n = 17/49). Interventions within the ED or hospital ranged from pharmacological management with opioids (n = 11/49), antibiotics (n = 9/49), corticosteroids (n = 5/49), and invasive procedures (e.g., palliative stenting; n = 13/49) or surgical interventions (n = 2/49).</p><p><strong>Conclusion: </strong>Limited research specifically addresses oncologic emergencies despite the international prevalence of ED presentations among cancer patients. Patients with cancer presenting to the ED appear to have a variety of complaints which could result from their cancers and thus may require tailored diagnostic and intervention pathways to provide optimal acute care. Further acute geriatric oncology research may clarify the optimal management strategies to improve the outcomes for this vulnerable patient population.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"40"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in analgesia in prehospital trauma care: an analysis of 105.908 patients from the multicenter database TraumaRegister DGU^®.","authors":"Davut Deniz Uzun, Jan-Philipp Stock, Richard Steffen, Jürgen Knapp, Rolf Lefering, Felix C F Schmitt, Markus A Weigand, Matthias Münzberg, Christoph G Woelfl, David Häske","doi":"10.1186/s12873-025-01186-z","DOIUrl":"10.1186/s12873-025-01186-z","url":null,"abstract":"<p><strong>Background: </strong>The management of pain in patients with traumatic injuries is a common task for emergency medicine providers, particularly in the prehospital setting. However, for sufficient and safe analgesia, correct pain recording and documentation is also necessary. The aim of this study was to assess trends in analgesia over the study period and to identify factors that may enable more sufficient pain management in trauma care.</p><p><strong>Methods: </strong>The TraumaRegister DGU^® recorded data of patients who were primarily treated at one of the participating hospitals between 2011 and 2020 and received analgesia as part of their prehospital care. This retrospective analysis included a total of 105.908 severely injured patients from Germany, Switzerland, and Austria. Patients with and without analgesia were compared, and factors associated with analgesia were investigated with logistic regression analysis.</p><p><strong>Results: </strong>The mean age of the patients enrolled was 50 ± 22 years. 71% were male and 29% were female. Out of all the patients, 66% (n = 70,257) received prehospital analgesia. The average age of patients in the analgesia group was 48 ± 21 years, the non-analgesia group had an average age of 54 ± 23 years. 67% of the male patients received analgesia compared to 64% of the female patients. The mean Injury Severity Score (ISS) in the analgesia group was 21.2 points, compared to 16.5 points in the non-analgesia group. 4% of the patients were under the age of sixteen, and of these, 65% received analgesia. 29% of patients were older than 65 years and received analgesia in 57%. Presence of an emergency physician at scene, was a remarkable independent variable for the receipt of analgesia (Odds Ratio 5.55; p < 0.001). Transportation by helicopter was also a significant predictor for analgesia (OR 1.62; p < 0.001).</p><p><strong>Conclusions: </strong>Analgesia is a crucial aspect of emergency medicine, as evidenced by relevant guidelines. Nevertheless, it is plausible that a considerable proportion of seriously injured patients do not receive optimal analgesic treatment, or at the very least, this is not documented. In this regard, both aspects require optimization.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"36"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the South Korean government's medical school expansion announcement on pediatric emergency department visits.","authors":"Arum Choi, Beom Joon Kim, Jooyoung Lee, Sukil Kim, Woori Bae","doi":"10.1186/s12873-025-01189-w","DOIUrl":"10.1186/s12873-025-01189-w","url":null,"abstract":"<p><strong>Background: </strong>In February 2024, the South Korean government announced a 67% increase in medical school admissions (2,000 more students), leading to the resignation of approximately 10,000 residents from major university hospitals. This study investigated the impact of these resignations on pediatric emergency department (PED) visits at a major tertiary hospital in Korea.</p><p><strong>Methods: </strong>We conducted a retrospective observational study analyzing PED visits under 15 years old at a tertiary hospital from January 2019 to May 12, 2024. After excluding cases with missing diagnostic codes or disposition records, we analyzed visits during the 12-week period from February 19 to May 12 across different years (2019-2024). We used segmented regression of Interrupted Time Series (ITS) analysis to evaluate the impact of three key events: the COVID-19 onset, lifting of mask-wearing mandates, and residents' resignation, adjusting for seasonal variations and autocorrelation.</p><p><strong>Results: </strong>Among 11,574 analyzed cases, weekly PED visits decreased significantly after residents' resignation (133.6 ± 22.4) compared to pre-COVID-19 (246.3 ± 45.2) and post-COVID-19 (263.7 ± 61.2) periods. The proportion of KTAS 3 cases increased to 67.2% during the resignation period compared to pre-COVID-19 (48.9%). ITS analysis revealed significant immediate changes in weekly visits: COVID-19 (-157.81 visits, 95% CI: -202.04 to -113.58), mask mandate removal (48.26 visits, 95% CI: 3.21 to 93.32), and residents' resignation (-77.82 visits, 95% CI: -134.85 to -20.80). Notably, the proportion of infectious diseases increased (36.9% vs. 18.6% pre-COVID-19), while respiratory diseases decreased (20.1% vs. 33.6% pre-COVID-19).</p><p><strong>Conclusion: </strong>A substantial reduction in both absolute and relative weekly patient visits was observed following the start of the nationwide resident strike at our pediatric emergency department. Additional studies are needed to better understand how this affected pediatric emergency care delivery and access.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"39"},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of non-invasive rhythm control on outcomes in patients with first diagnosed atrial fibrillation presenting to an emergency department.","authors":"Christian Salbach, Mustafa Yildirim, Hauke Hund, Matthias Müller-Hennessen, Norbert Frey, Hugo Anton Katus, Evangelos Giannitsis, Barbara Ruth Milles","doi":"10.1186/s12873-025-01194-z","DOIUrl":"10.1186/s12873-025-01194-z","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests a benefit of a rhythm control approach in patients with a recent diagnosis of atrial fibrillation (AF). This study sought to evaluate clinical characteristics, treatment strategies and outcomes in patients with first diagnosed AF (FDAF) undergoing a non-invasive rhythm control strategy in an emergency department (ED).</p><p><strong>Methods: </strong>This analysis uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB). HERA-FIB is a retrospective single-centre observational study which consecutively included patients presenting to the ED of the University Hospital of Heidelberg between June 2009 and March 2020 with a sequential follow-up for all-cause mortality, stroke, major bleeding events and myocardial infarction (MI). Outcomes of patients with FDAF were related to treatment strategy (non-invasive rhythm vs. rate control).</p><p><strong>Results: </strong>Among the 2,758 (27%) patients who presented with FDAF, a non-implementation of a non-invasive rhythm control strategy at admission was observed in 75.4% and associated with an excess of all-cause mortality hazard ratio (HR): 1.61 (95%CI 1.30-1.99), p < 0.0001 and incident MI HR: 1.88 (95% CI 1.22-2.90), p = 0.0043 during follow-up. The non-implementation of a non-invasive rhythm control remained an independent predictor for all-cause mortality and MI even after adjustment for significant univariate variables with an adjusted HR of 1.52 (95%CI: 1.14-2.04, p = 0.0043) and 1.89 (95%CI: 1.03-3.45, p = 0.0392), respectively.</p><p><strong>Conclusion: </strong>Real-world data from FDAF patients presenting to an ED showed a benefit regarding all-cause mortality and MI favouring a non-invasive rhythm control strategy. Further prospective research is needed to validate this hypothesis.</p><p><strong>Trial registration: </strong>The trial was registered at ClinicalTrials.gov Identifier: NCT05995561.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"35"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with early return visits to the emergency department in patients with vaso-occlusive crisis.","authors":"Mohammed Khalid Alageel, Hassan Mohammad Aloraini, Alanoud Mansour Alessa, Alanoud Binmethem, Ghada Alsaleh, Sarah Abdullah Almubrik, Abdulaziz Alalshaikh, Kholood K Altassan","doi":"10.1186/s12873-025-01192-1","DOIUrl":"10.1186/s12873-025-01192-1","url":null,"abstract":"<p><strong>Background and aim: </strong>One of the most common presentations of sickle cell disease (SCD) in the emergency department (ED) is acute severe pain episodes due to a vaso-occlusive crisis (VOC). Management of these episodes is primarily through intravenous pain control, but patients often return to the ED with the same complaint a few days after discharge. While some global studies have explored the risk factors for ED revisits due to VOC, the literature is lacking in the adult population, specifically in Saudi Arabia where SCD prevalence is high. The goal of this study is to measure the incidence of ED 72-hour early revisit (ERV) among SCD patients due to a VOC episode and to identify factors that might be associated with an ERV in this population. We conducted a retrospective cohort study using the electronic medical records, retrieving all patients who presented to the ED with a VOC from the period of 2017 to 2022.</p><p><strong>Results: </strong>This study included 120 VOC visits. The percentage of 72-hour ERV to the ED among VOC patients was 39.2%, in which 91.5% received opioids, and 31.9% were admitted during the return visit. Return visitors' median age was 29, most of them were male. There was no statistically significant correlation found between the patients' 72-hour ERV to the ED and their age, gender, comorbidities, history of exchange transfusion, pain score, or dose of opiates received. Of the variables measured at the index visit only the direct bilirubin level, and time to first opioid dose was associated with 72-hour ERV with an OR of 1.08 (95%CI: 1.0 to 1.16, P = 0.022) and 0.99 (95%CI: 0.99 to 0.99, P = 0.012) respectively.</p><p><strong>Conclusion: </strong>We found that 39.2% of VOC episodes discharged from the ED had an ERV. This rate is higher than what is reported internationally. Additionally, the lack of clear predictors for revisits raises doubts regarding the efficacy of the ED ''treat and release'' approach in this population.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"33"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536487","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":"Enhancing clinical risk assessment in pediatric blunt abdominal trauma: A novel scoring system using ultrasound and laboratory data.","authors":"Mehdi Nasr Isfahani, Elahe Nasri Nasrabadi, Zahra Rabiei, Neda Al-Sadat Fatemi, Farhad Heydari","doi":"10.1186/s12873-025-01196-x","DOIUrl":"10.1186/s12873-025-01196-x","url":null,"abstract":"<p><strong>Background: </strong>Given the importance of diagnosing intra-abdominal injury (IAI) in children with blunt abdominal trauma (BAT) and preventing radiation exposure to children by avoiding CT scans, this study aimed to evaluate a scoring criterion based on ultrasound (US) findings and laboratory data in assessing the clinical risk of IAI in children with BAT.</p><p><strong>Materials and methods: </strong>In this retrospective study, baseline and clinical information of 180 children (under 18 years of age) with BAT including physical examination, hemodynamic parameters, and laboratory data, were extracted from medical records. US findings were considered abnormal if any report of mild free fluid or solid organ injury was noted. The presence or absence of IAI was assessed through medical records or telephone interviews to inquire about the patients' outcome within the two-week period post-discharge. The primary outcome was the identification of IAI, assessed through a combination of US findings, physical examination (abdominal tenderness), and laboratory parameters (WBC count and hematuria). The measurement methods included Chi-squared tests, Fisher's exact test, independent samples t-test, logistic regression, and ROC analysis.</p><p><strong>Results: </strong>The current study showed that 153 (85%) and 27 (15%) patients were without and with IAI, respectively. The positive US finding with sensitivity and specificity of 92.59% and 44.44%, respectively, abdominal tenderness with sensitivity and specificity of 81.48% and 87.58%, respectively, hematuria with sensitivity and specificity of 62.96% and 50.33%, respectively, and high WBC level with sensitivity and specificity of 85.19% and 76.47%, had a significant diagnostic value in detecting the presence of IAI (P value < 0.001). A cutoff point ≥ 2 from the sum of the scores of these four criteria can predict the presence of IAI with a sensitivity of 81.48% and a specificity of 94.12% (AUC = 0.94; P value < 0.001).</p><p><strong>Conclusion: </strong>This study shows that a scoring system based on positive US findings, abdominal tenderness, hematuria, and high WBC levels effectively diagnoses IAI in BAT children. A score of 2 or more strongly indicates the presence of IAI, improving decision-making for further imaging and treatment. Implementing this system can reduce unnecessary CT scans and radiation exposure, enhancing pediatric trauma care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"34"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536483","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":"Clinical factors associated with the use of NIV in the pre-hospital setting in adult patients treated for acute COPD exacerbation: a single-center retrospective cohort study.","authors":"Stephan von Düring, Benjamin Chevalley, Hannah Wozniak, Thibaut Desmettre, Hervé Quintard, Laurent Suppan, Christophe A Fehlmann","doi":"10.1186/s12873-025-01193-0","DOIUrl":"10.1186/s12873-025-01193-0","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive ventilation (NIV) is a cornerstone in the management of acute chronic obstructive pulmonary disease (COPD) exacerbations with respiratory failure. While extensively studied in hospital settings, limited data exist on its use in the pre-hospital setting and clinical factors influencing its application. This study aimed to identify predictors of NIV use in the pre-hospital setting and to assess its association with patient-centered outcomes.</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed data from a pre-hospital emergency medical service registry in Geneva, Switzerland. Adult patients with a presumptive diagnosis of acute COPD exacerbation were included, spanning a control period (2007-2010, before NIV implementation) and an intervention period (2013-2017, after NIV implementation). For the primary analysis, multivariable logistic regression was used to identify predictors of NIV use during the intervention period. For the secondary analysis, coarsened exact matching balanced patients treated with NIV during the intervention period with those from the control period, followed by conditional regression analyses to assess patient-centered outcomes.</p><p><strong>Results: </strong>Among 270 included patients, 84 (46%) received NIV during the intervention period. Age ≥ 70 years (aOR 2.49, 95% CI 1.11, 5.76), female sex (aOR 2.48, 95% CI 1.13, 5.60), and systolic blood pressure (SBP) ≥ 140 mmHg (aOR 2.75, 95% CI 1.19, 6.62) were independent predictors associated with receiving NIV in the pre-hospital setting. In the matched cohort, pre-hospital NIV use was significantly associated with increased ICU admission rates, but was not associated with transport time, emergency department length of stay, hospital length of stay, or 28-day mortality. Sensitivity analyses demonstrated consistent results across different modeling approaches.</p><p><strong>Conclusions: </strong>Age ≥ 70 years, female sex, and SBP ≥ 140 mmHg were independent predictors associated with receiving NIV in the pre-hospital management of acute COPD exacerbation. The association between NIV use and increased ICU admissions may reflect its application in more severely ill patients. Pre-hospital NIV was not associated with short- or long-term outcomes beyond ICU admission. These findings underscore the need for prospective studies to clarify the role of pre-hospital NIV in patient outcomes.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"32"},"PeriodicalIF":2.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522647","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}