BMC Emergency Medicine最新文献

{"title":"Diagnostic agreement between prehospital and in-hospital diagnoses for dyspnea: a retrospective study in a French prehospital emergency medical service.","authors":"Malik El-Boudali, Prabakar Vaittinada Ayar, Geoffroy Rousseau, Dounia Hamdouche, Romain Jouffroy, Vincent Garrouste","doi":"10.1186/s12873-026-01657-x","DOIUrl":"10.1186/s12873-026-01657-x","url":null,"abstract":"<p><strong>Background: </strong>Dyspnea is a common, high-acuity presentation in emergency medicine and is associated with substantial short-term mortality. Early etiological diagnosis remains challenging in the prehospital setting, particularly in physician-staffed mobile intensive care unit (MICU) systems.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study of adults managed by a physician-staffed MICU for dyspnea in Orléans, France, between 2023 and 2024. Agreement between the prehospital MICU working diagnosis and the first in-hospital coded diagnosis was assessed among patients with paired diagnostic data using percent agreement and Cohen's kappa with bootstrap 95% confidence intervals. Prehospital management was retrospectively assessed against key principles of acute dyspnea management. Modified Poisson regression with robust variance was used to explore 28-day mortality.</p><p><strong>Results: </strong>Among 318 patients, 313 had paired diagnostic data. Overall agreement was 83.4% (261/313) with a Cohen's kappa of 0.79 (95% bootstrap CI 0.74-0.84). The most frequent prehospital diagnostic categories were acute heart failure, acute COPD exacerbation, pneumonia, and asthma exacerbation. Among patients with paired diagnoses, 45 died within 28 days (14.4%). Mortality was higher in discordant than concordant cases (23.1% [12/52] vs. 12.6% [33/261]; crude RR: 1.83, 95% CI 1.01-3.29). In adjusted complete cases analysis (n = 269; 41 deaths), the association was attenuated aRR: 1.59 (95% CI 0.83-3.05). Prehospital management was judged consistent in 75.0% of discordant cases.</p><p><strong>Conclusions: </strong>In this selected MICU population, agreement between prehospital working diagnoses and first in-hospital coded diagnoses was substantial. Most discordant cases still received consistent prehospital management. The association between discordance and 28-day mortality was attenuated after adjustment.</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/PMC13548562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307019","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":"Prognostic value of the systemic immune-inflammation index in acute non-variceal upper gastrointestinal bleeding: a retrospective single-center cohort study.","authors":"Rumeysa İnci, Nurhayat Başkaya","doi":"10.1186/s12873-026-01659-9","DOIUrl":"10.1186/s12873-026-01659-9","url":null,"abstract":"<p><strong>Background: </strong>Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a life-threatening emergency associated with significant morbidity and mortality. Current risk stratification tools have limitations in predicting short-term outcomes. The Systemic Immune-Inflammation Index (SII), a composite biomarker integrating platelet, neutrophil, and lymphocyte counts, has shown prognostic value across various acute conditions; however, its utility in NVUGIB remains unexplored.</p><p><strong>Methods: </strong>In this retrospective single-center cohort study, 812 adults presenting with NVUGIB to the emergency department of Kartal Dr. Lütfi Kırdar City Hospital (Istanbul, Turkey) were analyzed. SII was calculated as (platelet count × neutrophil count) / lymphocyte count. Primary outcome was 28-day all-cause mortality; secondary outcome was 72-hour rebleeding. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis and compared with established risk scores (Glasgow-Blatchford Score, pre-endoscopic Rockall Score, complete Rockall Score, and AIMS65). Independent predictors were identified using multivariable logistic regression and Cox proportional hazards analyses.</p><p><strong>Results: </strong>The 28-day mortality rate was 6.5% (n = 53) and the 72-hour rebleeding rate was 11.1% (n = 90). Median SII was significantly higher in non-survivors compared to survivors [1,714.9 (IQR: 980.5-3,776.0) vs. 910.5 (IQR: 599.3-1,501.0); p < 0.001]. For 28-day mortality, SII achieved an AUC of 0.704 (95% CI: 0.622-0.785), comparable to established scoring systems (all p > 0.05 by DeLong test). Notably, SII demonstrated superior discriminative performance for 72-hour rebleeding (AUC = 0.767; 95% CI: 0.714-0.820), significantly outperforming GBS (AUC = 0.540), AIMS65 (AUC = 0.541), pre-endoscopic Rockall Score (AUC = 0.561), and complete Rockall Score (AUC = 0.554). In multivariable logistic regression, SII (per 100 units; OR = 1.02, 95% CI: 1.02-1.03; p < 0.001) was an independent predictor of mortality. Decision curve analysis demonstrated that adding SII to existing scores improved net clinical benefit.</p><p><strong>Conclusions: </strong>SII is an independent prognostic marker in NVUGIB, offering discriminative performance for 28-day mortality comparable to established risk scores and superior performance for 72-hour rebleeding prediction. As a simple, routinely available laboratory index, SII may complement existing risk stratification tools in the emergency management of NVUGIB.</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/PMC13548536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306963","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":"Acute intoxication and trauma severity in emergency department patients: a systematic review.","authors":"Marie Emilie Hjorth Lutambi, Laura Andrea Juul Petersen, Ann Merete Møller","doi":"10.1186/s12873-026-01623-7","DOIUrl":"10.1186/s12873-026-01623-7","url":null,"abstract":"<p><strong>Background: </strong>Every day, trauma patients under the influence of alcohol and/or psychotropic drugs are treated in Emergency Departments (EDs). Psychoactive substances alter cognition, judgment, and behavior and may influence injury severity, clinical management, and outcomes following trauma. Although numerous observational studies have examined intoxication among trauma patients, only a limited number of reviews have synthesized evidence on its association with injury severity and clinical outcomes.</p><p><strong>Objective: </strong>To evaluate the association between acute alcohol and/or psychotropic drug intoxication and trauma severity and outcomes, and to determine the prevalence of intoxication among trauma patients presenting to EDs.</p><p><strong>Methods: </strong>A systematic literature search of MEDLINE and Embase was conducted in January 2024 with a top-up search in November 2025. Prospective cohort studies including patients aged ≥ 15 years presenting to hospital-based EDs were eligible. After screening 2,132 records, 88 articles underwent full-text review, and 18 studies met the inclusion criteria.</p><p><strong>Results: </strong>Across the included studies, the prevalence of alcohol intoxication ranged from 8.3% to 65.9%, drug intoxication from 14.5% to 22.1%, and combined alcohol and drug intoxication from 6.0% to 38.8%. The average prevalence was 24.7% (range 8.3-65.9%) for alcohol intoxication, 17.3% (range 14.5-22.1%) for drug intoxication and combined alcohol and drug intoxication had an average prevalence of 13.1% (range 6.0-38.8%). Nine studies reported higher injury severity scores (ISS) or a higher proportion of severely injured patients among intoxicated individuals compared with non-intoxicated patients, while other studies reported no difference or lower injury severity. Trauma outcomes, including hospital length of stay and mortality, varied substantially across studies. Male sex and younger age were consistently associated with intoxicated trauma presentations.</p><p><strong>Conclusion: </strong>This systematic review found inconsistent evidence regarding the association between intoxication and trauma severity and outcomes. However, a majority of the included studies in this review reported higher injury severity among intoxicated patients, particularly in those under the influence of alcohol and/or drugs. Intoxicated trauma patients were predominantly male and younger, highlighting key risk groups for targeted prevention strategies.</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/PMC13548624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation and comparative performance of Marshall, Rotterdam, and Helsinki computed tomography scores in adult traumatic brain injury.","authors":"Usame Rakip, Serhat Yıldızhan, İhsan Canbek, Ayşe Ertekin, Mehmet Gazi Boyacı, Serhat Korkmaz, Kazım Hazım Öztürk, Adem Aslan","doi":"10.1186/s12873-026-01655-z","DOIUrl":"10.1186/s12873-026-01655-z","url":null,"abstract":"<p><strong>Purpose: </strong>Computed tomography (CT)-based scoring systems enable standardized quantification of intracranial pathology following traumatic brain injury (TBI). Despite widespread clinical application, external validation studies comparing the Marshall, Rotterdam, and Helsinki CT scores remain limited, particularly in middle-income settings. This study aimed to externally validate these three CT scoring systems and evaluate their incremental prognostic value beyond clinical variables.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with traumatic brain injury requiring hospitalization beyond 24 h at a tertiary neurosurgical center between 2022 and 2024. Two neurosurgeons independently scored admission CT scans using the Marshall, Rotterdam, and Helsinki CT scoring systems. The primary outcome was in-hospital mortality, and the secondary outcome was poor functional outcome (Glasgow Outcome Scale 1-3) at hospital discharge. Discriminative performance was assessed using area under the receiver operating characteristic curve (AUC) with DeLong test comparisons. Multivariable logistic regression evaluated incremental prognostic value beyond age and admission Glasgow Coma Scale (GCS).</p><p><strong>Results: </strong>Among 657 patients (mean age 45.9 years, 74.9% male; mild TBI 59.4%, moderate 25.1%, severe 15.5%), in-hospital mortality was 11.0% and poor functional outcome occurred in 23.9%. Among CT-based scores, the Helsinki CT score showed the highest standalone discriminative performance for mortality (AUC 0.793, 95% CI 0.731-0.855), followed by Rotterdam (AUC 0.766, 0.700-0.832) and Marshall (AUC 0.682, 0.625-0.739); Helsinki and Rotterdam both outperformed Marshall. However, when added to a baseline clinical model (age + GCS, AUC 0.876), all CT scores provided minimal to negligible incremental discrimination, with no clinically meaningful improvement in model performance (ΔAUC < 0.005 across all models, all p > 0.20). Similar patterns were observed for poor functional outcome.</p><p><strong>Conclusion: </strong>The Helsinki CT score demonstrated the highest standalone discriminative performance; however, all three CT-based scoring systems provided limited incremental prognostic value beyond clinical assessment (age and GCS), supporting their role as complementary rather than independent tools in TBI evaluation. These findings support the use of CT-based scores primarily for early risk stratification and standardized communication in emergency settings, rather than as standalone prognostic tools.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300845","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":"Agitation severity and emergency department outcomes in substance-related behavioral emergencies: a retrospective cohort study.","authors":"Asli Bahar Ucar, Nurseli Bayram, Gizem Bozkurt, Mustafa Aytemiz, Ezgi Hilal Ozan, Arzu Denizbası Altinok","doi":"10.1186/s12873-026-01646-0","DOIUrl":"10.1186/s12873-026-01646-0","url":null,"abstract":"<p><strong>Background: </strong>Substance-related emergency department (ED) visits increasingly present with agitation and behavioral instability rather than discrete toxidromes. Early decisions regarding escalation and disposition may be influenced by observable behavioral severity in addition to suspected substance category and initial pharmacologic regimen. We evaluated predictors of pharmacologic escalation and psychiatric admission among adults requiring psychoactive medication for substance-related behavioral disturbance.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted in a tertiary ED between January 2024 and January 2025. Adult patients with clinician-judged substance-related presentations who received antipsychotics or benzodiazepines for immediate behavioral control were included. Agitation severity was assessed using the Overt Agitation Severity Scale (OASS) and categorized as mild (0), moderate (1), or severe (≥ 2). The primary outcome was pharmacologic escalation, defined as the addition of a second antipsychotic or benzodiazepine. The secondary outcome was psychiatric admission. Predictors were evaluated using multivariable logistic regression. Model discrimination was assessed using bootstrap internal validation (1,000 resamples). An exploratory receiver operating characteristic (ROC) analysis was performed to evaluate the discriminative performance of OASS.</p><p><strong>Results: </strong>Ninety encounters were analyzed (median age 32 years; 86.7% male), of which 61.1% had severe agitation (OASS ≥ 2). Pharmacologic escalation occurred in 23.3% and psychiatric admission in 71.1% of cases. Both outcomes increased across OASS strata (p = 0.012 and p = 0.016, respectively). In multivariable analysis, severe agitation independently predicted psychiatric admission (adjusted OR 7.87, 95% CI 2.28-27.17), while increasing age was inversely associated (adjusted OR 0.91 per year, 95% CI 0.86-0.96). The optimism-corrected AUC for psychiatric admission was 0.76 (95% CI 0.66-0.85). In exploratory analysis, OASS ≥ 2 demonstrated a sensitivity of 81.8% and a negative likelihood ratio of 0.36.</p><p><strong>Conclusions: </strong>Agitation severity was independently associated with psychiatric admission and showed a graded association with pharmacologic escalation in unadjusted analyses across OASS strata. Structured behavioral assessment using OASS may support early risk stratification and disposition planning in substance-related agitation.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270113","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":"Crowding in real-time: an artificial intelligence-based model to manage crowding in the emergency department (CRAMMED Study).","authors":"E E Schippers, S P Willemsen, L A M Collée, K L M Koenraadt, S Schol-Gelok","doi":"10.1186/s12873-026-01647-z","DOIUrl":"10.1186/s12873-026-01647-z","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) crowding is a global challenge with adverse effects on patient outcomes and staff well-being. Traditional crowding scores, such as the National ED Overcrowding Study (NEDOCS) score, have limited ability to predict imminent crowding. The aim of this study is to develop and validate a real-time, artificial intelligence (AI)-driven prediction model using a long short-term memory (LSTM) neural network to predict ED crowding, using ambulance diversion status as the reference standard and comparing performance with the (modified) NEDOCS score.</p><p><strong>Methods: </strong>In this single-centre, retrospective cohort study, we extracted parameters related to crowding from electronic health records and workforce data. Ambulance diversion status served as the reference standard for crowding. The LSTM model was trained and evaluated with walk-forward validation and performance was assessed using the area under the receiver operating characteristic curve (AUC). Model calibration was assessed using Brier score and expected calibration error (ECE).</p><p><strong>Results: </strong>The optimal LSTM model used the previous hour of data to predict one hour ahead, yielding an AUC of 0.84 (95% CI 0.81-0.86). Key features contributing to the predictive quality of our model included the number of pre-notified arrivals, patients in the yellow and orange triage categories, and the number of ED supervisors. Compared with the modified NEDOCS score (AUC of 0.73 (95% CI 0.70-0.76)), the LSTM model showed higher discriminative performance in internal validation within this single-centre study.</p><p><strong>Conclusions: </strong>Our AI-driven prediction model demonstrated good predictive performance for ED crowding in internal validation. These findings highlight the potential of real-time prediction models to support ED clinical workflow.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270100","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-stratified HEART score discrimination and calibration in emergency chest pain: a retrospective cohort study.","authors":"Şebnem Zeynep Eke Kurt, Uğur Durmuş, Erdem Kurt, Suphi Bahadırlı","doi":"10.1186/s12873-026-01652-2","DOIUrl":"10.1186/s12873-026-01652-2","url":null,"abstract":"<p><strong>Aims: </strong>We compared HEART score discriminative performance and calibration for 30-day major adverse cardiac events (MACE) between off-hours and on-hours emergency department chest pain presentations.</p><p><strong>Methods: </strong>A single-center retrospective cohort study was conducted at Istanbul Medipol Mega University Hospital from January 2020 through December 2025, enrolling 2,800 patients (off-hours n = 2,133; on-hours n = 667). Off-hours comprised evenings, nights, weekends, and public holidays. The primary outcome was 30-day MACE, defined as acute myocardial infarction, unplanned coronary revascularization, cardiac arrest, or all-cause death. Discrimination was compared by the DeLong method; an absolute between-group AUC difference below 0.08, set a priori, was used as the margin of clinical similarity. Calibration was assessed by the Hosmer-Lemeshow test, observed-to-expected ratio, and calibration slope.</p><p><strong>Results: </strong>30-day MACE occurred in 14.4% of 2,800 patients. The HEART score AUC was 0.830 (95% CI 0.805-0.855) in off-hours and 0.821 (95% CI 0.778-0.865) in on-hours patients; ΔAUC was + 0.009 (95% CI -0.041 to + 0.058; p = 0.736), with the confidence interval contained within the a priori margin. At the rule-out threshold (HEART ≥ 4), off-hours sensitivity was 95.7% (95% CI 92.8-97.5%) and negative predictive value (NPV) was 97.7% (95% CI 96.2-98.7%). No differential shift effect was detected (interaction OR 1.039; 95% CI 0.867-1.247; p = 0.676). Both groups demonstrated systematic overestimation of absolute MACE risk relative to Backus 2013 probabilities (off-hours calibration intercept - 0.352; 95% CI -0.495 to -0.208; p < 0.001), with no between-group difference (p = 0.998).</p><p><strong>Conclusion: </strong>The HEART score showed clinically similar discrimination for 30-day MACE regardless of presentation time, supporting its use across different presentation times in tertiary-care settings with comparable infrastructure, pending prospective multicenter confirmation. Local recalibration of absolute risk estimates should be considered before probability-guided triage protocols are implemented in comparable settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270108","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":"Emergency department eCPR: an exploratory observational study of human factors.","authors":"Andrew R Coggins, Jeremiah E Cho, Henry Crayton, Amelia Scott, Natalie Kruit, Matthew Oliver","doi":"10.1186/s12873-026-01650-4","DOIUrl":"10.1186/s12873-026-01650-4","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal cardiopulmonary resuscitation (eCPR) is a low-frequency, high-acuity intervention requiring technical skills and coordinated team performance. This exploratory study observed eCPR cases for elements of teamwork, provider stress, and environmental factors in the Emergency Department (ED). Reid's conceptual framework domains for human factors in healthcare teams were used as an analytical lens for interpreting the data.</p><p><strong>Methods: </strong>An exploratory two-phase study was conducted across two eCPR hospital sites over 32 months, with an initial simulation and non-eCPR observation phase used to refine study methods. A subsequent eCPR case phase used convenience sampling of adult cardiac arrests to observe actual eCPR events. Following consent, eCPR team members allocated to key roles (such as team leadership and cannulation) were observed in detail during each case. Patient outcomes included Utstein measures and eCPR timings. Provider outcomes included mobile heart rate monitoring, salivary cortisol, and validated psychometric measures. Teamwork was assessed using the Mayo High-Performance Team Score (MHPTS). Environmental outcomes included measurements of ambient noise levels, team headcounts, and observations of eCPR workflow.</p><p><strong>Results: </strong>Eighteen providers were observed during six eCPR events. The mean case age was 44.7 years and most patients presented with a shockable rhythm. System features consistently observed in the eCPR cases included predefined roles, individuals assigned to crowd control, and team leader summaries. Causal interpretations are limited by the small sample size and risk of observational bias. Within these limitations, individual provider salivary cortisol measurements were higher after eCPR copared with paired baseline samples. Teamwork scores (MHPTS) were in a moderate to high range (median = 12; IQR 10-13) and environmental observations reflected noisy ED spaces and crowding (headcount median = 20; IQR 18-29).</p><p><strong>Conclusion: </strong>This exploratory study found that human factors outcomes can be feasibly assessed during ED eCPR. Predefined roles and structured communication were observed and warrant further study.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270165","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":"Comparison of the effectiveness of clinical judgment, wells score and revised geneva score in suspected pulmonary embolism.","authors":"Muhammed Ikbal Sasmaz, Mustafa Yorgancioglu, Abdurrahman Oral, Ismail Uzkuc, Osman Acar, Akkan Avci, Mustafa Uçar","doi":"10.1186/s12873-026-01648-y","DOIUrl":"10.1186/s12873-026-01648-y","url":null,"abstract":"<p><strong>Background: </strong>Shortness of breath and chest pain are the most common presenting symptoms of pulmonary embolism (PE); however, these findings lack both sensitivity and specificity. Therefore, clinical probability assessment remains a key component in the diagnostic evaluation of suspected PE. Clinical prediction rules such as the Wells and Revised Geneva scores are widely used to estimate pre-test probability.</p><p><strong>Objective: </strong>This study aimed to compare emergency physicians' clinical judgment with the Wells and Revised Geneva scores in predicting pulmonary embolism in patients presenting to the emergency department with suspected PE.</p><p><strong>Methods: </strong>This prospective dual-center study included patients presenting to the emergency departments of two tertiary care hospitals with suspected PE. The evaluating emergency physician first assessed the clinical probability of PE (low, intermediate, or high) based solely on clinical judgment. Subsequently, the Wells and Revised Geneva scores were calculated independently by a second physician who was blinded to the initial clinical assessment. The diagnostic performance of clinical judgment, Wells score, and Revised Geneva score was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>A total of 248 patients with suspected PE were included in the study. Pulmonary embolism was confirmed in 38 patients (15.3%). Clinical judgment showed a numerically higher AUC compared with both the Wells and Revised Geneva scores. The area under the ROC curve (AUC) was 0.834 for clinical judgment, 0.766 for the Wells score, and 0.757 for the Revised Geneva score.</p><p><strong>Conclusion: </strong>In patients presenting with suspected pulmonary embolism, emergency physicians clinical judgment showed favorable diagnostic discrimination and a numerically higher AUC than the Wells and Revised Geneva scores. These findings suggest that clinical assessment remains a valuable component of the diagnostic approach to suspected PE.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270132","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":"Pain has limited predictive value for fractures following falls in older people: insight from a retrospective study.","authors":"Vera Pedersen, Alina Lampart, Rebecca Wania, Isabelle Arnold, Nina Maeder, Sandra Niedermeier, Robert Stahl, Christoph Trumm, Christian Kammerlander, Wolfgang Boecker, Christian H Nickel, Roland Bingisser, Matthias Klein","doi":"10.1186/s12873-026-01644-2","DOIUrl":"10.1186/s12873-026-01644-2","url":null,"abstract":"<p><strong>Background: </strong>In the emergency department (ED), decisions regarding radiological imaging for older patients who have experienced low-energy falls (LEF) are frequently complicated by inconsistencies between the reported mechanism of injury, the patients' symptoms, and the findings on physical examination. Our study aimed to investigate the coherence between physician-documented complaints, the implementation of radiological imaging and the diagnosis of fractures of the vertebral column, rib cage and pelvic ring.</p><p><strong>Methods: </strong>This is a secondary analysis of a retrospective consecutive sample of 2882 patients presenting with LEF to two urban Level I trauma centers between 1 January 2016 and 31 December 2016, who underwent radiological imaging to diagnose their fractures. Physician-documented complaints were abstracted from electronic health records.</p><p><strong>Results: </strong>A total of 2882 patients were included. Mild signs of concussion (e.g. headache) (22.0%), extremity pain (18.0%) and pain of the pelvic ring (14.2%) occurred most frequently. Physician-documented complaints were significantly associated with radiological imaging in the respective regions. True prevalence of fractures ranged from 0.14 (95%CI: 0.09, 0.20) in the cervical spine to 0.36 (95%CI: 0.30, 0.41) in the pelvic ring. The sensitivity of documented pain for fractures ranged from 0.78 (95%CI: 0.56, 0.93) in the thoracic spine to 0.98 in the rib cage (95%CI: 0.88, 1.00) and the pelvic ring (95%CI: 0.94, 1.00). Specificity was poor to moderate in all regions of interest. Positive likelihood ratios (LR+) were of poor value, ranging from 1.48 (95%CI: 1.09, 2.02) in the thoracic spine to 1.08 (95%CI: 1.03, 1.13) in the pelvic ring. Negative likelihood ratios (LR-) were of moderate to good value, ranging from 0.07 in the rib cage (95%CI: 0.01, 0.50) to 0.46 in the thoracic spine (95%CI: 0.20, 1.04). Area under the curve (AUC) values ranged from 0.51 (95%CI: 0.48-0.54) for the lumbar spine to 0.62 (95%CI: 0.59-0.65) for the rib cage.</p><p><strong>Conclusion: </strong>The presence of physician-documented complaints pertaining to the trunk skeleton have a relevant probability of triggering imaging studies in older persons with LEF in the ED. Nevertheless, these complaints do not safely enable discrimination between individuals with and without fractures and are of limited value modifying the subsequent diagnostic imaging process.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263144","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}