BMC Emergency Medicine最新文献

{"title":"Adolescent emergency department visits for self-harm after COVID-19-related social distancing in the Republic of Korea: a 7-year retrospective study.","authors":"Kwang Yul Jung","doi":"10.1186/s12873-026-01663-z","DOIUrl":"10.1186/s12873-026-01663-z","url":null,"abstract":"<p><strong>Background: </strong>Adolescent suicide is a major public health concern and self-harm-related emergency department (ED) visits are key predictors. Although social distancing during and after the pandemic likely affected the incidence of self-harm, few studies have explored these changes. We examined the variations in the incidence of adolescent self-harm-related ED visits before, during, and after social distancing.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of data from the ED‑Based Injury In‑Depth Surveillance registry in the Republic of Korea from January 2017 to December 2023. Injured patients aged 10 - 17 years were included in this study. The incidence rate of self-harm was recorded quarterly. Data on demographic, pre-hospital, and clinical characteristics were compared across three periods: pre-pandemic; pandemic; and post-pandemic, using data from Quarter 1 of 2020 (when social distancing was implemented) and Quarter 2 of 2022 (when it was fully lifted) as reference points. Multinomial logistic regression analyses were performed for each group to evaluate the association with changes in the incidence of self-harm.</p><p><strong>Results: </strong>We included 109,929 adolescent patients with injuries, 6,316 (5.75%) of whom presented with self-harm. The incidence of self-harm increased significantly during the pandemic (from 3.6% to 8.8%), although this immediate increase was attenuated to borderline significance in a sensitivity analysis incorporating seasonal variation, and decreased modestly after social distancing was lifted (to 7.8%). Self-harm occurring at home, among individuals with medical-aid insurance, and in those with psychiatric problems was significantly associated with these overall changes.</p><p><strong>Conclusions: </strong>Adolescent self-harm increased with the onset of the pandemic and social distancing, followed by a modest relative decline in incidence after the restrictions were lifted; however, the absolute number of self-harm presentations did not return to pre-pandemic levels. This suggests that social distancing measures may have had a greater impact on adolescents, whose daily lives largely revolve around home and school environments.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of the ROSIER scale for detecting acute ischemic stroke: a comparison with FAST-ED, CPSS, and reference criteria.","authors":"Farhad Heydari, Mobina Marzban, Mehrdad Esmailian, Amir Bahador Boroumand, Afshin Najafi, Mehdi Nasr Isfahani, Elahe Nasri Nasrabadi, Ali Emamjomeh","doi":"10.1186/s12873-026-01654-0","DOIUrl":"10.1186/s12873-026-01654-0","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) requires rapid diagnosis and treatment. While neuroimaging remains the gold standard, it is often unavailable in early emergency or prehospital settings. Clinical stroke scales may bridge this gap. Thus, this study aimed to compare the diagnostic accuracy of the ROSIER scale with the Cincinnati Prehospital Stroke Scale (CPSS), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and National Institutes of Health Stroke Scale (NIHSS) for the detection of AIS in patients with suspected stroke, using MRI as the imaging reference standard.</p><p><strong>Methods: </strong>This prospective cross-sectional study was performed on adult patients admitted to the emergency department (ED) between June 2021 and 2023, with acute neurological symptoms and underwent brain MRI for a suspected stroke. After data gathering, receiver operating characteristic (ROC) curve analysis was performed, and sensitivity, specificity, positive predictive value, and negative predictive value of ROSIER for detecting of AIS were calculated and compared with CPSS, FAST-ED, and NIHSS. MRI was considered the gold standard for the diagnosis of AIS.</p><p><strong>Results: </strong>A total of 655 patients were included, and 477 (72.8%) were diagnosed with AIS. The mean age was 68.43 ± 13.01 years, and 57.3% were male. The AUROC values for ROSIER, CPSS, FAST-ED, and NIHSS were 0.813, 0.860, 0.811, and 0.822, respectively. No significant differences were found between the tools. Sensitivities for ROSIER ≥ 2, CPSS ≥ 2, FAST-ED ≥ 3, and NIHSS ≥ 8 were 86.8%, 90.7%, 74.7%, and 73.5%, respectively. Their specificities were 58.1%, 67.7%, 77.4%, and 81.5%, respectively.</p><p><strong>Conclusion: </strong>All four tools showed good diagnostic accuracy. CPSS was the most sensitive and suitable for prehospital detection, whereas NIHSS offered the best specificity for in-hospital confirmation. Selection of the tool should be context-dependent, based on resources, time, and examiner expertise.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359402","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":"Psychological wellbeing of healthcare professionals in regional, rural and remote emergency departments: an integrative review.","authors":"Nimali Lakmini Munasinghe, Renee Fiolet, Alison M Hutchinson","doi":"10.1186/s12873-026-01660-2","DOIUrl":"10.1186/s12873-026-01660-2","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals working in regional, rural, and remote emergency departments are at increased risk of psychological distress, burnout, and emotional exhaustion due to demanding work environments and ongoing workforce pressures. Poor psychological wellbeing contributes to reduced workforce retention and may compromise the delivery of safe, equitable emergency care. However, evidence regarding their psychological wellbeing in these settings remains fragmented and lacks comprehensive synthesis.</p><p><strong>Methods: </strong>An integrative review of global evidence on the psychological wellbeing of healthcare professionals working in regional, rural, and remote emergency departments was undertaken, focusing on challenges, contributing factors, supports, and reported outcomes. Five electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, and Scopus) were systematically searched from inception to June 2025.</p><p><strong>Results: </strong>Seventeen primary studies from ten countries met inclusion criteria and were appraised using the Mixed Methods Appraisal Tool. Findings revealed multifactorial stressors, including workplace violence, excessive workloads, professional isolation, inadequate leadership, moral distress, and limited access to training, with nurses and female staff most affected. Supports were clustered into four domains: education and professional development, peer and social support, organizational support, and individual coping strategies. Most supports were descriptively reported, with outcomes identified as both positive and negative. In only two studies, structured interventions were formally evaluated, including a self-care program and the implementation of a Serenity Room.</p><p><strong>Conclusion: </strong>The review highlights that psychological distress among healthcare professionals working in regional, rural, and remote emergency departments is influenced by context-specific, systemic, and individual factors, yet evidence-based interventions addressing these issues remain scarce. Multi-level, co-designed strategies integrating organisational safety, training, and wellbeing supports are recommended as potential approaches to support healthcare staff psychological wellbeing, workforce sustainability, and equitable, high-quality emergency care in regional, rural, and remote settings.</p><p><strong>Prospero registration number: </strong>CRD420251079431.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350609","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":"Temporal improvements in prehospital systems-of-care for ST-elevation myocardial infarction patients in Victoria, Australia: a retrospective study.","authors":"Andrew Bishop, Ziad Nehme, Dion Stub, Karen Murdoch, Ashanti Dantanarayana, Jesslyn Wijaya, Benjamin Meadley","doi":"10.1186/s12873-026-01666-w","DOIUrl":"10.1186/s12873-026-01666-w","url":null,"abstract":"<p><strong>Background: </strong>Prehospital care is central to outcomes in ST-elevation myocardial infarction (STEMI), yet how systems of care evolve over time remains incompletely described. This study aimed to evaluate the statewide temporal trends in prehospital ST-elevation myocardial infarction (STEMI) care in Victoria, Australia, examining changes in epidemiology, clinical management, time metrics, and adverse events.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using data from the Victorian Ambulance STEMI Quality Initiative (VASQI). Adults with suspected STEMI treated by paramedics between January 2018 and December 2023 were included. Patient demographics, clinical presentation, and compliance with a prehospital bundle of care (aspirin administration, First Medical Contact [FMC] to ECG ≤ 10 min, hospital notification, and transport to percutaneous coronary intervention [PCI] facility) were analysed and further stratified into patients who received prehospital thrombolysis (PHT) or primary PCI (pPCI) reperfusion pathways. Descriptive statistics and nonparametric tests for trends were used.</p><p><strong>Results: </strong>A total of 18,075 patients were included (median age 67 years, IQR 56-78; 69.7% men). The incidence of suspected STEMI was 58.2 cases per 100,000 person-years (≥ 18 years), increasing from 49.0 in 2018 to 59.5 in 2023 (p = 0.102). Bundle of care compliance was achieved in 69.1% of patients, increasing from 59.5% to 78.2% (+ 18.7% mean difference [MD], 95% CI 16.3-21.1; p for trend < 0.001). Improvements were observed in both PHT (MD, + 22.7%; 95% CI 13.9-31.4; p for trend < 0.001) and non-PHT reperfusion pathways (MD, + 18.4%; 95% CI 15.8-20.9; p for trend < 0.001). All bundle elements showed improvement: aspirin administration by 0.9% (95% CI 0.3-1.4; p for trend = 0.002), FMC to ECG ≤ 10 min by 8.7% (95% CI 6.6-10.8; p for trend < 0.001), hospital notification by 12.6% (95% CI 10.8-14.4; p for trend < 0.001), and direct transport to PCI by 0.9% (95% CI 0.0-1.9; p for trend = 0.046).</p><p><strong>Conclusions: </strong>Paramedic compliance with the STEMI processes of care improved significantly over the study period. Although key clinical interventions for patients with STEMI have been delivered at high rates, opportunities remain to further optimise care, highlighting the importance of ongoing monitoring of clinical quality performance.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350672","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":"Time-dependent predictive value of the HACOR score for non-invasive ventilation failure in the emergency department: a prospective cohort study.","authors":"B Doğan, M Yazla, B Kaya, E Çelikel, A Kablan, A B Erdem","doi":"10.1186/s12873-026-01665-x","DOIUrl":"10.1186/s12873-026-01665-x","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of non-invasive ventilation failure in patients with acute respiratory failure in the emergency department is essential to prevent delayed intubation and its associated adverse outcomes. The HACOR score is a pragmatic bedside tool developed to predict non-invasive ventilation failure, most prior investigations have been conducted in intensive care settings and have predominantly relied on single time-point measurements or simple change analyses. In this study, we aimed to evaluate predictive value of early change in the HACOR score for non-invasive ventilation failure in emergency department patients with acute respiratory failure and to examine the temporal nature of this association using Generalized Estimating Equations models.</p><p><strong>Methods: </strong>This prospective observational cohort study included 106 adult patients. HACOR, National Early Warning Score, National Early Warning Score 2, and Modified Early Warning Score were calculated immediately before and at 1 h after non-invasive ventilation initiation. ΔHACOR was defined as the difference between 1-hour and baseline HACOR scores. The primary outcome was non-invasive ventilation failure. Discriminative performance was assessed using ROC analysis. Logistic regression was used to evaluate the independent association between ΔHACOR and non-invasive ventilation failure. Generalized estimating equations models were constructed to analyze the time-dependent relationship between HACOR and non-invasive ventilation failure.</p><p><strong>Results: </strong>Non-invasive ventilation failure occurred in 50.9% of patients. Baseline clinical variables and scores did not significantly discriminate between success and failure groups. In contrast, 1-hour HACOR (AUC = 0.760, 95% CI 0.667-0.854) and ΔHACOR (AUC = 0.798, 95% CI 0.711-0.885) demonstrated significant predictive performance. Patients with ΔHACOR ≥ 0 exhibited a substantially higher failure rate (74.4%) compared to those with ΔHACOR < 0 (34.9%). Each one-point increase in ΔHACOR was independently associated with failure (OR 1.63, 95% CI 1.31-2.03; p < 0.001). In Generalized Estimating Equations analysis, the HACOR × time interaction remained statistically significant across adjusted models, supporting the prognostic value of serial HACOR assessment.</p><p><strong>Conclusions: </strong>In emergency department patients receiving non-invasive ventilation, early dynamic changes in HACOR provide superior prognostic information compared with baseline measurements alone. Serial HACOR assessment demonstrated through Generalized Estimating Equations modeling supports potential value of response-guided risk stratification and highlights importance of early reassessment in emergency non-invasive ventilation management.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343864","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":"Pediatric pre-hospital emergencies in a rural region in northern Germany: frequency, urgency, patterns of utilization, and comparison with adult cases.","authors":"Janina Dombrowski, Ulrike Stentzel, Heiko Krause, Mona Ebermann, Christian Oehlke, Lutz Fischer, Berthold Henkel, Timm Laslo, Wolfgang Hoffmann, Bibiana Metelmann, Olaf Schoffer, Neeltje van den Berg","doi":"10.1186/s12873-026-01653-1","DOIUrl":"10.1186/s12873-026-01653-1","url":null,"abstract":"<p><strong>Background: </strong>Pediatric emergencies are rather rare in pre-hospital care. The aim of this study was to analyze the frequency and urgency of pediatric emergency medical service (EMS) missions and to identify age-specific characteristics in EMS utilization in the rural district of Vorpommern-Greifswald in northeastern Germany.</p><p><strong>Methods: </strong>In this retrospective observational study, all emergency protocols from ambulance vehicles and emergency physician vehicles from January 1, 2022, to December 31, 2023, in the study region were analyzed using descriptive statistical methods. Patients were categorized into age groups: infants (< 1 year), toddlers (1-5 years), schoolchildren (6-13 years), adolescents (14-17 years), adults (18-64 years), and seniors (≥ 65 years).</p><p><strong>Results: </strong>Over the study period, 71,446 patients had an EMS contact, thereof 255 infants (0.4%), 976 toddlers (1.4%), 1,437 schoolchildren (2.0%), 1,395 adolescents (2.0%), 25,220 adults (35.3%), and 42,163 seniors (59.0%). The annual emergency rate among adults ≥ 18 years was nearly three times higher than among minors < 18 years (169 vs. 58 patients per 1,000 inhabitants within the respective age groups). Pediatric cases accounted for 5.7% of all missions. Vehicle dispatches for minors followed a bimodal temporal distribution with peaks between 12:00 and 1:00 p.m. and between 6:00 and 7:00 p.m. Seasonal variation was observed, with the highest dispatch volume in June (10.5% of all pediatric dispatches) and the lowest in February (5.3%). Trauma was more common in minors compared to adults (41.8% vs. 23.1%), with the highest proportion among schoolchildren (52.2%). The proportion of critically ill or injured patients (NACA IV-VII) was lower in minors than in adults (10.2% vs. 20.8%). Physician involvement was more frequent in pediatric missions than in adult missions (39.4% vs. 32.9%). Infants showed the highest physician involvement (53.5%).</p><p><strong>Conclusions: </strong>In pediatric missions, the involvement of physicians is high, however, critically ill children are rare. Low exposure to pediatric cases may contribute to insecurity among paramedics and emergency physicians in pediatric emergencies. Therefore, hands-on training in pediatric emergency care is essential. Given the rising demand for EMS, telemedicine could be a valuable addition in rural settings to reduce the burden on physician resources and ensure comprehensive pediatric care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350583","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":"Development of a novel clinical decision support tool for determining the need for whole-body computed tomography in pediatric trauma patients: the WHOLE score.","authors":"Enes Çay, Gül Pamukçu Günaydın, Çağdaş Yıldırım, Alp Şener","doi":"10.1186/s12873-026-01658-w","DOIUrl":"10.1186/s12873-026-01658-w","url":null,"abstract":"<p><strong>Background: </strong>Whole body computed tomography (WBCT) is widely used in the initial assessment of pediatric trauma patients to rapidly identify injuries; however, its routine use exposes children to substantial ionizing radiation. Clear guidance on which pediatric trauma patients truly benefit from WBCT is lacking, leading to practice variability and potential overuse in emergency departments. The proposed score is intended to complement existing pediatric imaging decision frameworks that emphasize selective and risk-based use of computed tomography.</p><p><strong>Methods: </strong>This retrospective, single-center observational study included trauma patients under 18 years of age who underwent WBCT in a tertiary pediatric trauma center between June 2021 and June 2022. The primary outcome was the presence of traumatic injuries involving ≥ 2 anatomical regions on WBCT not necessarily the clinical need for WBCT. Candidate predictors were identified from the literature and clinical practice and evaluated using multivariable logistic regression. Continuous variables were dichotomized based on receiver operating characteristics (ROC) analysis. Independent predictors were used to develop a clinical decision support tool, the WHOLE score. Model performance was assessed using ROC analysis and diagnostic accuracy metrics.</p><p><strong>Results: </strong>A total of 407 pediatric trauma patients who underwent WBCT were included; 37.6% (n = 153), had injuries involving two or more anatomical regions. Independent predictors of multi-region injury were age ≥ 133 months, tachycardia, hypoxia, positive physical examination findings in the head, thoracic, pelvic, or lower extremity regions, and aspartate aminotransferase (AST) ≥ 50 U/L. These variables were incorporated into the WHOLE score (range 0-8). The WHOLE score demonstrated good discrimination (AUC 0.84; 95% CI 0.80-0.88). Using a cut-off of ≥ 2 points, sensitivity was 96.7% (CI 92.5-98.9) and NPV was 94.8% for detecting multi-region injuries.</p><p><strong>Conclusions: </strong>The WHOLE score is a simple clinical decision support tool designed to identify pediatric trauma patients at low risk for multi-region injuries, thereby supporting emergency physicians in safely withholding WBCT in appropriately selected cases. The score functions as a rule-out tool: a low score (0-1) may support a decision to forego WBCT, whereas a high score does not independently mandate it. By reducing unnecessary WBCT in low-risk patients, the score has the potential to decrease radiation exposure while maintaining diagnostic safety. This is a preliminary single-center derivation study, and external prospective validation is required before routine clinical implementation.</p><p><strong>Trial registration: </strong>The study protocol was registered retrospectively at clinicaltrials.gov (Clinical Trials Identifier: NCT07411235, Date:11/02/2026).</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315749","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":"Aetiology-dependent short- and long-term survival after paediatric out-of-hospital cardiac arrest: a multicentre, retrospective, cohort study.","authors":"Romana Erblich, Matthias Noitz, Marius Knöll, Helmut Trimmel, Wolfgang Voelckel, Dominik Jenny, Jens Meier, Martin W Dünser","doi":"10.1186/s12873-026-01651-3","DOIUrl":"10.1186/s12873-026-01651-3","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) in children is rare and associated with poor outcomes. Data on aetiology-specific differences in short- and long-term survival are limited.</p><p><strong>Methods: </strong>This multicentre, retrospective study included children (< 18 years) with OHCA managed by a nationwide helicopter emergency medical service. Patient characteristics, OHCA-related variables, resuscitation interventions, and outcomes were collected. The primary objective was to compare sustained return of spontaneous circulation (ROSC), 30-day survival, and 1-year survival rates across different OHCA aetiologies.</p><p><strong>Results: </strong>Among 9,018 patients with OHCA, 247 [2.7% (95% CI, 2.2-3.1%)] were children, of whom 200 were included. External or traumatic aetiologies accounted for 129 cases (64.5%). Non-traumatic OHCA occurred in 71 children (35.6%). Trauma was the most frequent aetiology [n = 78 (39.0%)], followed by drowning [n = 34 (17.0%)], non-cardiac non-traumatic causes [n = 27 (13.5%)], suspected cardiac causes [n = 27 (13.5%)], Sudden Infant Death Syndrome (SIDS) [n = 17 (8.5%)], and asphyxiation [n = 17 (8.5%)]. Sustained ROSC, 30-day survival, and 1-year survival differed significantly across aetiology groups (all p < 0.001). Drowning was associated with the highest sustained ROSC (77.4%), 30-day (55.9%), and 1-year survival rates (50.0%), followed by non-cardiac non-traumatic causes (ROSC, 54.2%; 30-day survival, 38.5%; 1-year survival, 34.6%), and asphyxiation (ROSC, 57.1%; 30-day survival, 20.0%; 1-year survival, 20.0%). Outcomes were poorest in SIDS (ROSC, 20.0%; 30-day survival, 5.9%; 1-year survival, 5.9%). OHCA aetiology was independently associated with ROSC, 30-day, and 1-year survival rates in multivariable analyses.</p><p><strong>Conclusions: </strong>Paediatric OHCA was rare and demonstrated marked heterogeneity in both aetiology and outcomes. Short- and long-term survival rates varied significantly across OHCA aetiologies.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315736","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":"Deployed national healthcare services in Hajj mass gathering settings: emergency department experience of Makkah Diyanet Hospital during the 2025 Hajj period.","authors":"Ömer Faruk Turan, Zeynep Kekeç, Muhammed Fatih Baran, Mehmet Rıdvan Yalçın","doi":"10.1186/s12873-026-01661-1","DOIUrl":"10.1186/s12873-026-01661-1","url":null,"abstract":"<p><strong>Background: </strong>Clinical and operational data from independent national Hajj health missions are extremely limited. This study aimed to analyze the demographic and clinical characteristics, presentation patterns, and clinical outcomes of patients presenting to the emergency department of the Makkah Diyanet Turkey Hospital during the 2025 Hajj season.</p><p><strong>Methods: </strong>A retrospective, cross-sectional, analytical study was conducted at a hospital serving 84,942 Turkish pilgrims between April and July 2025. Diagnoses were coded using the International Classification of Diseases, 10th Revision (ICD-10). Referral, admission, and mortality data were analyzed, and independent risk factors were identified through multivariable logistic regression.</p><p><strong>Results: </strong>A total of 9,902 pilgrims (11.7%) presented to the emergency department with 13,360 visits. The mean age was 61.3 ± 11.5 years, and 54.1% of the patients were male. The most common diagnosis was respiratory diseases (49.4%). The overall referral rate was 2.76% on a patient basis (n = 273/9,902) and 2.04% on a visit basis (n = 273/13,360). While cardiovascular diseases constituted 7.1% of presentations, they represented 22.3% of referrals; neurological diseases constituted 0.2% of presentations but accounted for 13.6% of referrals. Advanced age was the strongest independent risk factor for referral, increasing approximately 14-fold in the ≥ 75 age group (adjusted odds ratio [aOR]: 13.64; 95% confidence interval [CI]: 6.22-29.93). The revisit rate was 23.0%, with a 3.7-fold higher referral risk in this group. The transition of the service model from secondary to primary care was associated with a 44% increase in referral risk (relative risk [RR]: 1.44; p = 0.009). The overall mortality rate was 34 per 100,000.</p><p><strong>Conclusions: </strong>This study is among the first to report the emergency service utilization rate (11.7%) of a national Hajj health mission. Although respiratory diseases dominated presentations, critical disease burden and mortality were driven by cardiovascular and neurological emergencies. Among referred patients, trauma-related referrals were 2.7-fold higher in females than males (21.5% vs. 7.9%), supporting gender-specific injury prevention. These findings support age-based risk stratification, strengthening advanced life support capacity, planned coordination with the host country's healthcare system during service model transitions, and resource planning based on approximately 12,000 emergency department presentations per 100,000 pilgrims.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315751","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 between arterial to end-tidal carbon dioxide gradient and prehospital hemodynamic status in patients with moderate-to-severe traumatic brain injury.","authors":"Lucas Petit Navarro, Xavier Combes, Michel Galinski, Laurent Petit, Emeline Angles, Matthieu Biais, Cédric Carrie","doi":"10.1186/s12873-026-01649-x","DOIUrl":"10.1186/s12873-026-01649-x","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess the relationship between arterial partial pressure of carbon dioxide (PaCO₂) and end-tidal carbon dioxide (EtCO₂) according to three prehospital hemodynamic status and to evaluate whether hemodynamic-based EtCO₂ targets could improve agreement with PaCO₂.</p><p><strong>Methods: </strong>Over a 4-year period, 100 adult patients with moderate-to-severe TBI admitted to a level 1 trauma center under mechanical ventilation were retrospectively included. Patients were classified into three clusters based on prehospital hemodynamic status (Cluster 1: Stable without vasopressors; Cluster 2: Stabilized with low-dose vasopressors; Cluster 3: Not stabilized with low-dose vasopressors). Correlation and agreement between paired PaCO₂ and EtCO₂ values were assessed overall and across clusters. Agreement was compared between non-adjusted and cluster-adjusted EtCO₂ thresholds.</p><p><strong>Results: </strong>The mean PaCO₂ - EtCO₂ gradient increased according to the hemodynamic status (Cluster 1: 3.5 ± 5.5 mmHg, Cluster 2: 9.9 ± 7.3 mmHg, Cluster 3: 12.6 ± 9.5 mmHg). The agreement between paired PaCO₂ and non-adjusted EtCO₂ levels decreased between the three clusters (61% [95%CI: 44-77%] in Cluster 1, 42% [95%CI: 25-59%] in Cluster 2, 31% [95%CI: 16-46%] in Cluster 3). Adjusting EtCO₂ targets according to hemodynamic status did not improve agreement between pairs (53% vs. 44%, p = 0.204).</p><p><strong>Conclusion: </strong>In moderate-to-severe TBI, there is a strong relationship between the PaCO₂-EtCO₂ gradient and prehospital hemodynamic status. However, our results did not support the relevance of a prehospital ventilation strategy guided by cluster-adjusted EtCO₂ targets.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306971","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}