BMC Emergency Medicine最新文献

{"title":"A comparative study on the efficacy of dexketoprofen and methylprednisolone in the treatment of acute low back pain.","authors":"Mehmet Meral, Ali Gur","doi":"10.1186/s12873-025-01276-y","DOIUrl":"10.1186/s12873-025-01276-y","url":null,"abstract":"<p><strong>Background: </strong>Many methods have been used in to treat low back pain. In this study, we aimed to investigate the efficacy of dexketoprofen alone and in combination with methylprednisolone in the treatment of low back pain in the emergency department using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI).</p><p><strong>Methods: </strong>This prospective, randomized, single-blind study included 150 patients admitted to the emergency department of a university hospital. Patients with low back pain were divided in to two groups: those receiving intravenous dexketoprofen treatment (Group D) and those receiving dexketoprofen + methylprednisolone treatment (Group DM). The efficacy of the treatments received by the patients was evaluated with the VAS at minutes 0, 15, 30, and 60 and hour 48. Statistical evaluations were also undertaken on the ODI results evaluated at minute 0 and hour 48.</p><p><strong>Results: </strong>The VAS scores decreased in both groups at all follow-up evaluations performed throughout the treatment (p = 0.000). The mean VAS score evaluated 48 h after treatment was 1.69 ± 1.71 (Median:1) cm in Group DM and 4.13 ± 2.27 (Median:4) cm in Group D (p = 0.000). The decrease in the ODI score was greater in Group DM than in Group D (p = 0.000).</p><p><strong>Conclusion: </strong>Dexketoprofen showed analgesic efficacy in the treatment of non-traumatic low back pain and decreased disability. When combined with methylprednisolone, dexketoprofen treatment exhibit a greater analgesic effect and further reduced disability.</p><p><strong>Trial registration: </strong>Current Controlled Trials NCT06932367 (Retrospectively registered).</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"147"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788201","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":"Shared decision-making for pediatric acute otitis media in the United States: a randomized emergency department trial.","authors":"Jana L Anderson, Lucas Oliveira J E Silva, Erik P Hess, Derek E Vanmeter, Aidan Mullan, Juan P Brito, Ian G Hargraves, Fernanda Bellolio","doi":"10.1186/s12873-025-01305-w","DOIUrl":"10.1186/s12873-025-01305-w","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making is increasingly utilized when multiple reasonable options exist. In the emergency department, however, several perceived barriers-such as time constraints, illness complexity, and varying levels of acceptance-limit its use. In cases of acute otitis media (AOM) in children, parental expectations for immediate antibiotic treatment often conflict with national guidelines recommending a trial of analgesics for 48 to 72 h prior to initiating antibiotics. As a result, antibiotic prescribing rates in the emergency department remain high, reaching up to 96%. Our aim was to measure the impact of the ear pain decision aid on parental knowledge, engagement and antibiotic use.</p><p><strong>Methods: </strong>We conducted a randomized trial in the Emergency Department and affiliated Urgent Care setting comparing shared decision-making with a web-based decision aid (earpaindecisionaid.org) to usual care for parents of children aged 6 months and older with non-severe AOM. Outcomes included parental knowledge of AOM, clinician/parent engagement, interaction time, and antibiotic use.</p><p><strong>Results: </strong>One hundred-one parents were enrolled; 42 participated in the Ear Pain Decision Aid (EPDA) arm using shared decision-making, while 59 received usual care (UC). Fifty-one interactions were videotaped. Parents in the EPDA arm scored greater in knowledge: EPDA 6.1 (1.74) vs. UC 5.1 (1.79), mean difference 1.0 (95% CI 0.3, 1.7), p = 0.004. They also scored high in decision-making: EPDA 14.7 (2.86) vs. UC 8.75 (3.68), mean difference 6.0 (95% CI 1.9, 10.0), p = 0.005. There was no significant difference in interaction time: EPDA 4.2 min (3.2, 5.6) vs. UC 3.0 min (2.4, 4.4), p = 0.059. No difference was detected in immediate antibiotic prescriptions: EPDA 36% vs. UC 42%, odds ratio 0.76 (95% CI 0.33, 1.71), p = 0.50. Similarly, no significant difference was found in wait-and-see prescription use: EPDA 64% vs. UC 6a8%, odds ratio 1.32 (95% CI 0.59, 2.99), p = 0.50.</p><p><strong>Conclusion: </strong>Shared decision-making with the Ear Pain Decision Aid (EPDA) improved parental knowledge and engagement without significantly increasing interaction time in the emergency department. Although no significant reduction in antibiotic prescribing was observed, this may be due to the study's limited sample size, which increases the risk of Type II error. These findings support the feasibility of integrating shared decision-making tools into emergency care. Larger, multicenter studies are needed to further evaluate the EPDA's effectiveness in promoting antibiotic stewardship for pediatric acute otitis media.</p><p><strong>Clinical trials number: </strong>NCT02872558 26/03/2017.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"146"},"PeriodicalIF":2.3,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768297","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":"Major medical events in patients with acute coronary syndrome during helicopter emergency medical service operations.","authors":"Julian Ganter, Hans-Jörg Busch, Alina Henis, Florian Reifferscheid, Jörg Braun, Sebastian Heinrich","doi":"10.1186/s12873-025-01308-7","DOIUrl":"10.1186/s12873-025-01308-7","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndromes (ACS) are a leading cause of helicopter emergency medical services (HEMS) operations in Germany. Complications that arise during HEMS operations are challenging due to limited resources. However, the National Advisory Committee for Aeronautics (NACA) score and National Early Warning Score (NEWS) provide potential for risk stratification. Nevertheless, there is an absence of data concerning the incidence and risk of medical events (e.g. malignant arrhythmia, cardiac arrest, cardiogenic shock) in ACS patients during HEMS operations. The objective of this study is to evaluate the incidence of medical events and to assess risk stratification using scoring systems.</p><p><strong>Methods: </strong>This retrospective observational cohort study analyzed prehospital records from 38,473 HEMS operations with \"ACS\" coding conducted between 2012 and 2024 in Germany. Routine data were systematically recorded using a standardized digital form that captured patient demographics, clinical presentation, and medical interventions. Major medical events (MME) were defined using surrogate markers, including defibrillation, resuscitation, airway management, ventilation, and new ST-elevation myocardial infarction (STEMI) findings. Scores (NACA, NEWS, and a combined MME-score) were calculated, with the MME-score integrating NACA and NEWS. Ethical approval was obtained from the Albert-Ludwigs-University Freiburg Ethics Committee (No: 24-1082-S1, 25 April 2024).</p><p><strong>Results: </strong>MME occurred in 8.8% of the 38,473 HEMS operations. They occurred more frequently during secondary missions (interfacility transports) (11.8%) than primary missions (6.7%), and at night (15.3%) than during the day (8.2%) (both p < 0.001). The NACA, NEWS, and MME-scores were significantly higher in cases with medical events (p < 0.001). The risk stratification exhibited areas under the curve in the receiver operating characteristics (ROC) curve, with values of 0.831 for NACA, 0.866 for NEWS, and 0.895 for the MME-score.</p><p><strong>Conclusion: </strong>The incidence of MMEs is subject to variation depending on the operational context. Established scoring systems such as the NACA and NEWS are available for the purpose of risk stratification of medical events in patients with ACS during air rescue operations. The combination of these scores may indicate potential for improved risk stratification.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"145"},"PeriodicalIF":2.3,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768296","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":"Perceptions of mental health literacy, stigma, empathy, and confidence in managing patients with psychiatric disorders among doctors and nurses working in a Singapore emergency department.","authors":"Joo Shiang Ang, Howard Cai Hao Khoe, Jinghui Huang, Gabrielle Wann Nii Tay, Cyrus Su Hui Ho","doi":"10.1186/s12873-025-01290-0","DOIUrl":"10.1186/s12873-025-01290-0","url":null,"abstract":"<p><p>In line with the global rise in mental health disorders, Singapore has experienced a notable increase in prevalence, from 13.4% in 2020 to 17% in 2022. Despite strategic efforts to strengthen mental health services, such as expanding the workforce of psychiatrists and psychologists and integrating care into primary healthcare settings, the Emergency Department (ED) faces escalating numbers of patients with psychiatric disorders. This surge leads to heightened workloads, stress, and burnout among healthcare professionals. This study explores the perceptions of mental health literacy, stigma, empathy, and confidence in managing patients with psychiatric disorders among doctors and nurses working in Singapore's EDs. Questionnaires used include the Mental Health Literacy Scale (MHLS) to assess mental health literacy, the Opening Minds Scale for Health Care Providers-15 (OMS-HC-15) to measure attitudes toward mental illness, and the Jefferson Scale of Empathy (JSE) to measure empathy. In the last quarter of 2021, 47 doctors and 63 nurses from the ED at a general restructured hospital in Singapore, who had worked for at least 4 months in the ED, completed the survey. The anonymous survey included the above-validated questionnaires and two original questionnaires that assessed confidence in managing patients with psychiatric disorders and their familiarity with the local Mental Health Care and Treatment Act (MHCTA). Differences between doctors and nurses for all categorical variables, including demographic data and the questionnaire responses of interest, were analysed. Findings reveal that doctors scored higher in mental health literacy (MHLS score of 121.89 to 118.27) and empathy (JSE score of 109.32 to 101.44) and lower in stigma than nurses (OMS-HC-15 score of 41.98 to 43.57). Furthermore, Singaporean ED professionals scored lower on these dimensions than their counterparts in Western countries but outperformed those in East Asia. The unique roles of doctors and nurses, coupled with Singapore's distinct sociocultural context, likely contribute to these variations. Both groups demonstrated moderate confidence in handling patients with psychiatric disorders but emphasised the need for further training. These insights underscore the importance of implementing systemic policies and targeted training programmes to improve mental health care, reduce stigma, and enhance empathy and confidence among ED professionals.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"143"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764481","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 role of vital signs in predicting mortality risk in elderly patients visiting the emergency department.","authors":"Karin Erwander, Björn Agvall, Kjell Ivarsson","doi":"10.1186/s12873-025-01307-8","DOIUrl":"10.1186/s12873-025-01307-8","url":null,"abstract":"<p><strong>Background: </strong>Accurate risk stratification in older adults presenting to the emergency department (ED) is essential but challenging due to atypical presentations and age-related physiological changes. While vital signs are central to triage, their predictive value for short-term mortality in this population remains unclear. This study aimed to explore the association between initial vital signs and 7-day mortality among older ED patients.</p><p><strong>Method: </strong>This retrospective cohort study included patients aged ≥ 65 years who visited two EDs in Region Halland, Sweden, during 2018. Vital signs, systolic blood pressure (SBP), heart rate (HR), peripheral oxygen saturation (SpO₂), respiratory rate (RR), body temperature, and level of consciousness (LOC), were extracted from the regional health information system. Descriptive statistics, ROC curve analysis, and logistic regression were used to assess associations between categorized vital signs and 7-day mortality, adjusting for age, sex, and comorbidity.</p><p><strong>Results: </strong>Of 30 327 ED visits, 25 450 patients had at least one recorded vital sign. The mean age was 78 years; 50% were female. The 7-day mortality rate was 2%. ROC analysis showed limited discriminative ability of individual vital signs (AUC range: 0.49-0.70). Low SBP, high HR, low SpO₂, and impaired LOC were statistically significantly associated with mortality. Multivariable logistic regression confirmed these associations, with SBP (≤ 80 mmHg, AOR 7.79; 95% CI 3.27-18.54), high HR (> 125 bpm, AOR 6.37; 95% CI 1.26-32.16), low SpO₂ (≤ 80%, AOR 3.64; 95% CI 1.75-7.58), and impaired LOC (GCS < 13 (AOR 9.30-18.36)) showing the strongest effects.</p><p><strong>Conclusion: </strong>Low SBP, elevated HR, reduced SpO₂, and impaired LOC were independently associated with short-term mortality in older ED patients, though their individual predictive performance was modest. LOC, despite being a strong predictor, was frequently missing, underscoring challenges in routine assessment. These findings highlight the need for more comprehensive, geriatric-informed triage systems that incorporate age-related physiological changes and ensure consistent evaluation of LOC. As frailty and functional status was not available in this dataset, future studies should focus on integrated models that include these factors to improve early risk identification in emergency care for older adults.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"144"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764482","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":"Can AI match emergency physicians in managing common emergency cases? A comparative performance evaluation.","authors":"Mehmet Gün","doi":"10.1186/s12873-025-01303-y","DOIUrl":"10.1186/s12873-025-01303-y","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) such as ChatGPT are increasingly explored for clinical decision support. However, their performance in high-stakes emergency scenarios remains underexamined. This study aimed to evaluate ChatGPT's diagnostic and therapeutic accuracy compared to a board-certified emergency physician across diverse emergency cases.</p><p><strong>Methods: </strong>This comparative study was conducted using 15 standardized emergency scenarios sourced from validated academic platforms (Geeky Medics, Life in the Fast Lane, Emergency Medicine Cases). ChatGPT (GPT-4) and a physician independently evaluated each case based on five predefined parameters: diagnosis, investigations, initial treatment, clinical safety, and decision-making complexity. Cases were scored out of 5. Concordance was categorized as high (5/5), moderate (4/5), or low (≤ 3/5). Wilson confidence intervals (95%) were calculated for each concordance category.</p><p><strong>Results: </strong>ChatGPT achieved high concordance (5/5) in 8 cases (53.3%, 95% CI: 27.6-77.0%), moderate concordance (4/5) in 4 cases (26.7%, CI: 10.3-55.4%), and low concordance (≤ 3/5) in 3 cases (20.0%, CI: 6.0-45.6%). Performance was strongest in structured, protocol-based conditions such as STEMI, DKA, and asthma. Lower performance was observed in complex scenarios like stroke, trauma with shock, and mixed acid-base disturbances.</p><p><strong>Conclusion: </strong>ChatGPT showed strong alignment with emergency physician decisions in structured scenarios but lacked reliability in complex cases. While AI may enhance decision-making and education, it cannot replace the clinical reasoning of human physicians. Its role is best framed as a supportive tool rather than a substitute.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"142"},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759066","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 seat position on survival outcomes and anatomically specific severe injury patterns in four-wheeled motor vehicle accidents: a retrospective cohort study at a community emergency department in Japan.","authors":"Tasuku Uzawa, Yuko Ono, Jun Sugiyama, Kazushi Takayama, Nobuto Nakanishi, Takeyasu Kakamu, Tokiya Ishida, Nozomi Tomita, Kazuaki Shinohara, Joji Kotani","doi":"10.1186/s12873-025-01302-z","DOIUrl":"10.1186/s12873-025-01302-z","url":null,"abstract":"<p><strong>Background: </strong>Road traffic accidents are a major healthcare concern worldwide. To improve outcomes for patients injured in motor vehicle crashes, it is crucial to understand the factors associated with mortality and anatomically specific injury severity. Seat position is one of the possible determinants of road traffic injury fatality; however, evidence regarding which seat positions are linked to impaired survival outcomes and anatomically severe injuries remains scarce.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients injured in four-wheeled vehicle accidents between 2000 and 2022 and admitted to a community teaching hospital in Japan. Seat position was classified as driver seat, front passenger seat, or rear passenger seat. The primary endpoint was in-hospital mortality. Other outcomes included severe trauma, defined as an Injury Severity Score (ISS) of > 15, and anatomically specific severe injuries of the head and neck, chest, abdomen, pelvis, and extremities, defined as an Abbreviated Injury Scale score of ≥ 3.</p><p><strong>Results: </strong>Among 5,906 eligible patients, 4,104 (69.5%) were driver seat occupants, 1,009 (17.1%) were front passenger seat occupants, and 793 (13.4%) were rear passenger seat occupants. After adjusting for potential confounders such as age, sex, admission year, season, presentation time, presentation day, prehospital length of stay, vehicle configuration, collision type, seatbelt use, airbag deployment, and involvement in high-energy trauma using logistic regression analysis, rear passenger seat occupants had a lower risk of hospital mortality (adjusted odds ratio [AOR], 0.396; 95% confidence interval [CI], 0.216-0.727) and a lower risk of severe trauma with an ISS of > 15 (AOR, 0.428; 95% CI, 0.308-0.596) than driver seat occupants. Additionally, rear seat occupants were less likely to sustain serious injuries to the chest (AOR, 0.474; 95% CI, 0.333-0.673) and abdominal or pelvic contents (AOR, 0.373; 95% CI, 0.218-0.639) than driver seat occupants.</p><p><strong>Conclusion: </strong>Our results suggest that driver seat occupants require special attention because of their higher risk of adverse outcomes and anatomically severe injuries. These findings will be useful for vehicle occupants, emergency medical professionals, and automobile manufacturers.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"139"},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752162","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":"Could low-acuity emergency medical services patients be redirected to primary care? Findings from a multi-center survey in Berlin, Germany.","authors":"Felix Holzinger, Lisa Kümpel, Rebecca Resendiz Cantu, Anja Alberter, Martin Möckel, Christoph Heintze","doi":"10.1186/s12873-025-01295-9","DOIUrl":"10.1186/s12873-025-01295-9","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical services (EMS) are frequently used by low-acuity patients, which contributes to emergency department (ED) crowding. The feasibility of EMS transporting low-acuity patients directly to general practitioner (GP) practices remains a matter of debate. We therefore investigated the circumstances of EMS utilization in patients who subsequently receive ambulatory treatment in the ED. We wanted to find out how often a primary care (PC) consultation could have been a suitable alternative in such cases.</p><p><strong>Methods: </strong>Low-acuity ED utilizers transported by EMS were surveyed on demographics and medical characteristics and asked about the appropriateness and acceptability of a potential PC redirection, supplemented with case assessments by EMS personnel. Additionally, treatment documentation from both the ED and EMS was analyzed. Descriptive statistics were conducted. Associations between categorical variables were examined by Chi² tests.</p><p><strong>Results: </strong>A total of n = 358 low-acuity EMS participants were recruited. Participants had a mean age of 47.6 years; gender f/m: 58.1%/41.9%. In the hospital, 71.8% were assigned to the Manchester triage system (MTS) category 3 and 28.0% to category 4. A third of the patients had decided to alert EMS at their discretion, while other people (e.g., relatives, colleagues) had been involved twice as often. Patients most commonly cited severe symptoms and related fears as reasons for engaging EMS services. EMS personnel categorized the complaints as treatable by a GP in 37.0%, while 44.5% of patients would have been open to PC management. However, these assessments exhibited substantial discrepancies, as evidenced by a Cohen's Kappa coefficient of approximately 0.1. From a preclinical perspective, only 24.4% of cases met the criteria for potentially realistic diversion. These encompassed both patient openness to alternative care pathways and EMS discernment of cases as potentially appropriate.</p><p><strong>Conclusions: </strong>PC diversion is estimated to be feasible for a maximum of a quarter of ED outpatients. Markers for potential management in PC show highly discrepant results, and there is no validated system or score for preclinical identification of patients eligible for safe redirection. As EMS is intended for high-acuity emergencies, such patients could potentially also benefit from options like telemedicine care at home or alternative transportation.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS00023480); date: 27/11/2020.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"138"},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752161","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":"Non-clinical factors influencing discharge and admission decisions in the emergency department: a focus group study among Israeli physicians.","authors":"Ofer Kobo, Itay Itzhaki, Michael J Drescher, Jacob Glazer, Avi Israeli, Bruce E Landon, Shuli Brammli-Greenberg","doi":"10.1186/s12873-025-01304-x","DOIUrl":"10.1186/s12873-025-01304-x","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) physicians frequently make high-stakes decisions under time constraints. While clinical indicators are essential, non-clinical factors often shape whether a patient is admitted or discharged. However, the specific non-clinical influences and how physicians perceive them remain underexplored.</p><p><strong>Objective: </strong>To identify and categorize non-clinical factors that influence admission decisions among ED physicians.</p><p><strong>Methods: </strong>This qualitative study involved five focus groups with 42 participants (specialists, residents, and physician assistants) across five Israeli hospitals. A semi-structured discussion guide, informed by literature and expert interviews, was used. Audio-recordings were transcribed and analyzed thematically using a mixed inductive and deductive approach.</p><p><strong>Results: </strong>Three overarching domains of non-clinical influences emerged: (1) patient-related factors (preferences, social support, functional status, access to care), (2) physician-related factors (experience, risk tolerance, workload, prior errors), and (3) system-level factors (bed capacity, ED protocols, communication gaps, resource availability). Physicians often weighed these elements alongside clinical indications for admission, particularly in borderline cases. Functional status and family support frequently influenced safe discharge decisions. Physician experience emerged as a buffer against risk-averse behaviors. System-level pressures, such as ED crowding and administrative policies, further shaped clinical discretion.</p><p><strong>Conclusion: </strong>Non-clinical factors substantially influence ED disposition decisions. These findings highlight the need for policy reforms, decision-support tools, and further research to guide when and how non-clinical factors should inform care. This study offers a framework for understanding such influences and can inform interventions aimed at improving ED efficiency and patient outcomes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"141"},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752163","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 rumination and job fatigue in pre-hospital emergency personnel: a cross-sectional study.","authors":"Ehsan Kamalifar, Hosein Asadi, Saeid Mehri","doi":"10.1186/s12873-025-01301-0","DOIUrl":"10.1186/s12873-025-01301-0","url":null,"abstract":"<p><strong>Background: </strong>This study examines the relationship between rumination and job Fatigue among pre-hospital emergency personnel in Ardabil Province, as well as the role of demographic and occupational factors in shaping these outcomes.</p><p><strong>Methods: </strong>This cross-sectional descriptive study included 338 pre-hospital emergency personnel from Ardabil Province, selected through census sampling. Data were collected using the Nolen-Hoeksema and Morrow Rumination Questionnaire, which measures general rumination, and the Swedish Job Fatigue Inventory to assess Job fatigue. Descriptive statistics, t-tests, and ANOVA were performed using SPSS software.</p><p><strong>Results: </strong>The mean total score for job fatigue was 93.14 ± 10.32, while the mean score for rumination was 53.12 ± 10.34, both indicating moderate levels. Significant correlations were found between job fatigue and demographic or occupational factors such as age (p = 0.02), work experience (p < 0.001), workplace (p < 0.001), and shift type (p < 0.001). Regarding rumination, significant associations were also observed with age (p = 0.03), work experience (p < 0.001), and workplace (p < 0.001). Additionally, shift type showed a significant relationship with rumination (p < 0.001).</p><p><strong>Conclusions: </strong>Demographic and job-related factors, including age, work experience, workplace, and shift type, significantly affect the levels of rumination and job fatigue in pre-hospital emergency personnel. Implementing targeted support programs and optimizing shift management may help reduce psychological strain in this workforce.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"140"},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752164","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}