BMC Emergency Medicine最新文献

{"title":"Barriers to recruitment of an observational SARS-CoV-2 emergency department cohort at Boston Medical Center.","authors":"Sarah J Thomson, Roxanne Mistry, Henry Bayly, Victoria Overbeck, Manish Sagar, Elissa M Schechter-Perkins, Laura F White, Karen R Jacobson, Tara C Bouton","doi":"10.1186/s12873-025-01224-w","DOIUrl":"https://doi.org/10.1186/s12873-025-01224-w","url":null,"abstract":"<p><strong>Background: </strong>Successful recruitment of study participants is a challenging component of research, and recruitment barriers are amplified in safety-net hospital (SNH) settings. However, engaging historically underrepresented groups in research is critically important to improve health disparities and outcomes. We summarize challenges we encountered while recruiting patients with COVID-19 from the emergency department (ED), actions to improve inclusivity, and implementation hurdles in an SNH setting.</p><p><strong>Methods: </strong>We conducted an observational study at the largest safety-net hospital in New England, recruiting patients in the ED with confirmed COVID-19. Investigators prioritized recruitment inclusivity through language translations of study materials, compensation (including transport and travel reimbursement), flexible sample delivery options, and clinical staff engagement. We identified and categorized major impediments to recruitment success.</p><p><strong>Results: </strong>Recruitment and retention efforts were largely unsuccessful (n = 4 enrolled of n = 113 eligible by electronic medical record (EMR) review). Barriers to recruitment success included clinical teams' perception of good candidacy, persistent language barriers, limited consent capacity, burden of participation, and ED discharge logistics.</p><p><strong>Conclusions: </strong>Despite efforts to improve opportunities to participate in research, SNH EDs present unique challenges for recruitment. Study teams should prioritize clinical staff engagement and work with institutions to promote inclusivity and community engagement efforts to improve research engagement in these settings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"68"},"PeriodicalIF":2.3,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969890","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":"Triage decisions and health outcomes among oncology patients: a comparative study of medical and surgical cancer cases in emergency departments.","authors":"Anas Alsharawneh, Rami A Elshatarat, Ghaida Shujayyi Alsulami, Mahmoud H Alrabab'a, Majed S Al-Za'areer, Bandar Naffaa Alhumaidi, Wesam T Almagharbeh, Tahany Fareed Al Niarat, Khaled M Al-Sayaghi, Zyad T Saleh","doi":"10.1186/s12873-025-01191-2","DOIUrl":"https://doi.org/10.1186/s12873-025-01191-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cancer-related emergencies are a significant challenge for healthcare systems globally, including Jordan. Effective triage is critical in ensuring timely and accurate prioritization of care, especially for surgical cancer patients requiring urgent intervention. However, under-triage-misclassification of high-acuity patients into lower urgency categories-can lead to significant delays and worsened outcomes. Despite the recognized importance of accurate triage, limited research has evaluated its impact on cancer patients in Jordan, particularly those requiring surgical care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to evaluate the timeliness and prioritization of care for cancer patients admitted through the emergency department (ED) in Jordan. The specific objectives were to examine the association between under-triage and treatment delays and assess its impact on key outcomes, including time to physician assessment, time to treatment, and hospital length of stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort design was used to analyze data from 481 cancer patients admitted through the ED in four governmental hospitals across Jordan. Two cohorts were established: surgical cancer patients requiring emergency interventions and non-surgical cancer patients presenting with other oncological emergencies. Triage accuracy was assessed using the Canadian Triage and Acuity Scale (CTAS), and under-triage was identified when patients requiring high urgency care (CTAS I-III) were misclassified into lower urgency categories (CTAS IV-V). Data were collected from electronic health records and analyzed using multiple linear regression to evaluate the association between under-triage and treatment outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The majority of patients were elderly, with a mean age of 62.6 years (± 10.7), and a significant proportion presented with advanced-stage cancer (83.4% in stages III and IV). Surgical patients frequently exhibited severe symptoms such as acute pain (51.6%) and respiratory discomfort (41.1%). Under-triage rates were 44.1% for surgical patients and 39.4% for non-surgical patients. Among surgical patients, under-triage significantly delayed time to physician assessment (β = 34.9 min, p &lt; 0.001) and time to treatment (β = 68.0 min, p &lt; 0.001). For non-surgical patients, under-triage delays were even greater, with prolonged physician assessment times (β = 48.6 min, p &lt; 0.001) and ED length of stay (β = 7.3 h, p &lt; 0.001). Both cohorts experienced significant increases in hospital length of stay (surgical: β = 3.2 days, p = 0.008; non-surgical: β = 3.2 days, p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Under-triage in Jordanian EDs is strongly associated with significant delays in care for both surgical and non-surgical cancer patients, highlighting systemic gaps in acuity recognition and triage processes. These findings underscore the need for targeted interventions to improve triag","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"69"},"PeriodicalIF":2.3,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977989","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":"Translation and psychometric evaluation of the Witness Perceived Safety Scale of prehospital emergency care.","authors":"Farzad Vagrimogadam, Mansoore Karimollahi, Saeid Mehri","doi":"10.1186/s12873-025-01226-8","DOIUrl":"https://doi.org/10.1186/s12873-025-01226-8","url":null,"abstract":"<p><strong>Background: </strong>Timely, effective and safety out-of hospital care and transfer to hospital by prehospital emergency medical services significantly impacts patient outcomes. This study aimed at translation and psychometric evaluation of the witness perceived safety scale of prehospital emergency care.</p><p><strong>Methods: </strong>The methodological design was utilized to verify the validity and reliability of the Witness Perceived Safety Scale across two phases: the translation process and an assessment of its validity and reliability. Construct validity was assessed using confirmatory factor analysis. The convergent validity, discriminant validity, and reliability of the scale were also evaluated.</p><p><strong>Results: </strong>The Witness Perceived Safety Scale comprises 10 items that were retained following cross-cultural translation. Both face and content validity were deemed acceptable. The fit indices from the confirmatory factor analysis supported the model's appropriate fit (χ²/df = 2.41; IFI = 0.96; CFI = 0.96; RMSEA = 0.075). Cronbach's α coefficient for the total scale was 0.899.</p><p><strong>Conclusion: </strong>The Persian version of the Witness Perceived Safety Scale provides a reliable assessment of witnesses' perceptions of safety during emergency assistance and transfers.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"65"},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma referral audit impact assessment on the outcomes of injured patients via an interrupted time-series analysis: an 11-year before-and-after study of trauma cases at the Maharaj Nakorn Chiang Mai hospital, Thailand.","authors":"Patrinee Traisathit, Kaweesak Chittawatanarat, Kamtone Chandacham, Pimwarat Srikummoon, Areerat Kittikhunakon, Chalermrat Nontapa, Narain Chotirosniramit","doi":"10.1186/s12873-025-01220-0","DOIUrl":"https://doi.org/10.1186/s12873-025-01220-0","url":null,"abstract":"<p><strong>Background: </strong>Overcrowding in emergency departments (EDs) due to injured patients who do not need urgent treatment can lead to less efficacious healthcare outcomes for those that do. The trauma referral audit (TRA) was developed to support medical staff and ensure that the injured receive treatment timely and efficiently.</p><p><strong>Methods: </strong>Data on 14,399 injured patients referred to Maharaj Nakorn Chiang Mai Hospital between 2007 and 2017 were analyzed to examine the impact of the full TRA program implemented at the end of 2010. Injury severity was measured by using the injury severity score (ISS) whereby a score > 9 points infers severe injury. The impact of the establishment of TRA was examined using the trend of referrals and an interrupted time-series analysis of monthly mortality among patients with severe injury.</p><p><strong>Results: </strong>The median ISS of the patients in 2010 was 9 [4-18] and slightly increased to the highest score of 16 [8-25] in 2017. The proportion of patients with less severe injuries (ISS ≤ 9) decreased after the full implementation of TRA (55.4% in 2010 compared to 42.3% in 2017). Overall mortality was 6% (5.5% vs. 6.2% for the pre- and post-full TRA periods, respectively), and the mortality rate tended to increase from 4.77% in 2011 to 7.59 in 2017. The monthly mortality rate was estimated at 7.22% [95% confidence interval (CI) = 5.89-8.56%] with a significant increase of mortality in the post-full TRA period by 1.57% [0.16-2.98%] and in the annual trend of 0.11% [0.05-0.16%]. However, when considering severely injured patients only, the level and trend of the mortality rate were no different.</p><p><strong>Conclusions: </strong>Although the TRA program could help reduce patient overcrowding in EDs, it does not reduce the risk of mortality. Revision of the referral and in-hospital care guidelines accounting for these relevant factors might lead to a decrease in mortality.</p><p><strong>Trial registration: </strong>Clinical trial number: Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"64"},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952969","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":"CT imaging in post-resuscitation care of non-traumatic resuscitation room patients in German hospitals.","authors":"Akvile Juskeviciute, Milda Aleknonyte Resch, Bernhard Kumle, Hans Jörg Busch, Uwe Janssens, Guido Michels, Lars Roman Herda, Martin Faber, Sabine Merz, Michael Reindl, Christoph Wasser, Stefan Kornstaedt, Patrick Langguth, Kevin Schulte, Michael Bernhard, Martin Pin, Domagoj Schunk","doi":"10.1186/s12873-025-01216-w","DOIUrl":"https://doi.org/10.1186/s12873-025-01216-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The procedures and locations where patients are admitted to hospitals and subsequently diagnosed after out-of-hospital cardiac arrest (OHCA) in Germany exhibit considerable heterogeneity. Specifically, advanced imaging diagnostic methods via computed tomography (CT) show significant variation in both timing and execution. However, echocardiography (ECHO) is not an alternative to CT in this setting, as both modalities serve distinct diagnostic purposes. This study aimed to comprehensively analyze the status quo analysis of current procedures in German emergency departments (EDs) regarding early-phase (within the first six hours) CT imaging diagnostics after resuscitation and the treatment of critically ill patients in the ED resuscitation room.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anonymized cross-sectional study was conducted from November 28, 2023, to February 18, 2024, using an online survey platform ( https://www.surveymonkey.de ) with a standardized questionnaire. The survey targeted 994 medical directors of German EDs and was distributed through the mailing lists of the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). The Medical Faculty of Christian-Albrechts-University Kiel granted ethical approval (D 586/22). An expert panel reviewed the questionnaire to ensure validity and minimize bias. All statistical analyses, including both descriptive and inferential statistics, were conducted using R software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 994 hospitals contacted, 182 hospitals from 15 German federal states participated, yielding a response rate of 18.3%. The overall completion rate for the whole questionnaire was 12.2% (n = 121/994). In the survey, 9.6% (n = 15/157) of hospitals reported having CT within the resuscitation room, while 70.1% (n = 119/157) had CT within a range of 50 m of the resuscitation room. A standard operating procedure (SOP)/postresuscitation protocol for patients suffering from OHCA was available for 61.1% (n = 88 yes, n = 56 no) of the hospitals. A specific postresuscitation CT protocol (postrCT protocol) was used by 30.0% (n = 48 yes, n = 93 no) of the hospitals, with 59.2% (n = 29) receiving a head-to-pelvis CT (whole-body CT). In hospitals without a CT protocol (n = 84), echocardiography (82.1%, n = 69), abdominal ultrasound (61.9%, n = 52), and non-contrast CT of the head (47.6%, n = 40) are used for distinctive diagnostics. Cardiac Arrest Center (CAC)-certified hospitals were significantly more likely to have a SOP/postresuscitation protocol (91.9 vs. 49.0%, p &lt; 0.001) and a specific postrCT protocol (63.2 vs. 22.1%, p &lt; 0.001) than noncertified hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Currently, there is no nationwide standardized protocol for imaging diagnosis in patients after OHCA in German EDs. Protocols are more often used in CAC hospitals in Germany th","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"63"},"PeriodicalIF":2.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062112","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":"Prevalence and determinant of poor treatment outcome of poisoning in Ethiopia: systematic review and meta-analysis.","authors":"Gemechu Gelana Ararame, Birbirsa Sefera Senbeta, Alex Ayenew Chereka","doi":"10.1186/s12873-025-01223-x","DOIUrl":"https://doi.org/10.1186/s12873-025-01223-x","url":null,"abstract":"<p><strong>Background: </strong>Acute poisoning is a medical emergency that can be caused by exposure to significant levels of any chemical and has toxic consequences that typically manifest within hours of exposure, leading to significant morbidity and mortality.</p><p><strong>Objectives: </strong>This study aims to determine the pooled prevalence and determinant of poor treatment outcomes of poisoning in Ethiopia.</p><p><strong>Methods: </strong>The searches were conducted in electronic databases such as PubMed, MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Original studies were selected and published until the end of December 2024, addressing the prevalence and determinant of poor treatment outcomes (death and disability) among patients. Endnote X-8 reference manager software was used to collect and organize the search outcomes and remove duplicate articles. Important data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 17.0 software for outcome measure analyses. The Higgins I² test statistics were used to examine heterogeneity, and a random-effects model was used to analyze the pooled prevalence and determinant of poor treatment outcomes.</p><p><strong>Result: </strong>Eleven research articles and 10,089 poisoned patients were included in the final analysis. This study finding showed that the pooled prevalence of poor treatment outcomes among poisoned patients was 16.13% (95% CI: 9.20, 23.05). This meta-analysis study revealed that patients living in rural areas (AOR: 2.79, 95% CI: 1.44, 5.42) and delayed time to arrival (AOR = 6.15, 95%CI: 2.46, 15.34) were determinant factors of poor treatment outcome for poisoned patients in hospitals.</p><p><strong>Conclusion and recommendation: </strong>This study findings stated that the pooled prevalence of poor treatment outcomes among patients was high. Patients living in rural areas and delayed time to arrival at health facilities were independent determinants of poor treatment outcomes.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"62"},"PeriodicalIF":2.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963484","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":"First responders' experiences with major earthquakes in Türkiye: a qualitative study of innovation needs and challenges.","authors":"Zeynep Sofuoglu, Aysel Başer, Turhan Sofuoglu, Ömer Faruk Sönmez","doi":"10.1186/s12873-025-01217-9","DOIUrl":"https://doi.org/10.1186/s12873-025-01217-9","url":null,"abstract":"<p><strong>Background: </strong>The response phase is a phase of disaster management that begins when a disaster occurs. The experience of the First Responders who responded in the first days to the 2023 earthquake in Turkey, which killed more than fifty thousand people, is expected to inform and add value to the preparations for subsequent disasters.</p><p><strong>Methods: </strong>A qualitative approach was used; focus group interviews were conducted with 15 first responders (8 fire fighters and 7 medical personnel) that responded in the first moments of the devastating Kahramanmaraş and Hatay earthquakes. The interviews conducted in June 2023. A qualitative approach with the thematic analysis method was employed.</p><p><strong>Results: </strong>Based on the analyses the research six main themes and 13 subthemes were identified. The identified themes were resources, needs, collaboration, innovation, disaster management and challenges. The participants emphasized the need for better communication tools, protective equipment, and technologies such as drones and advanced sensors to enhance disaster response efforts. The findings also highlight the critical role of collaboration between different organizations and the necessity for integrated disaster management practices and applications. The findings obtained from the views of experienced first responders will inspire national and international disaster crisis managers, policy makers and technology providers to develop more effective disaster response methods. Through technological solutions and better training, the safety and effectiveness of first responders can be significantly improved in future disaster scenarios.</p><p><strong>Conclusions: </strong>This study fills an important gap in the literature by investigating the innovation needs and challenges faced by first responders during the 2023 earthquakes in Türkiye. In this study, the gap analysis was determined through interviews conducted with teams that responded to the 2023 major Turkey earthquake in the initial hours following the disaster. These findings are of significant value in guiding the improvement of the approaches and development of technological products in the field of disaster management.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"60"},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978270","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":"Appropriate cardiopulmonary resuscitation duration and predictors of return of spontaneous circulation in traumatic cardiac arrest.","authors":"Dongmin Seo, Inhae Heo, Kyoungwon Jung, Hohyung Jung","doi":"10.1186/s12873-025-01219-7","DOIUrl":"https://doi.org/10.1186/s12873-025-01219-7","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in trauma care, traumatic cardiac arrest (TCA) shows significantly poorer outcomes compared to non-traumatic cardiac arrest, with mortality rates exceeding 96%. However, no standardized protocol exists for appropriate cardiopulmonary resuscitation (CPR) duration in TCA. This study aimed to establish evidence-based CPR duration thresholds and identify factors associated with return of spontaneous circulation (ROSC) in TCA patients.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using a single-centre trauma registry of adult patients with TCA between January 2021 and December 2023. Univariate analysis was used to identify differences in the baseline and outcome variables between the ROSC and no-ROSC groups. We performed multivariable logistic regression analysis to identify factors independently associated with ROSC. We also investigated the appropriate cutoff time of pre-hospital and total CPR duration for ROSC (the CPR duration that has maximum sensitivity and specificity for ROSC).</p><p><strong>Results: </strong>In total, 422 patients with TCA were included, of whom 250 were eligible for analysis. The proportion of patients with ROSC was 22.4% (n = 56), and trauma bay/emergency department mortality and in-hospital mortality rates were 80.8% (n = 202) and 97.2% (n = 243), respectively. Factors associated with ROSC included alert mental status in the field, as indicated by verbal response (adjusted odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-1.12; p = 0.06), pain response (OR, 0.03; 95% CI, 0.01-0.43; p = 0.009), and unresponsiveness (OR, 0.04; 95% CI, 0.01-0.44; p = 0.009) and non-asystolic initial rhythms, such as pulseless electrical activity (OR, 4.26; 95% CI, 1.92-9.46; p < 0.001), shockable rhythm (OR, 14.26; 95% CI, 1.44-141.54; p = 0.023), pre-hospital CPR duration (OR, 0.90; 95% CI, 0.85-0.95), and total CPR duration (OR, 0.88; 95% CI, 0.84-0.92; p < 0.001). The upper limits of pre-hospital and total CPR durations for achieving a probability of ROSC < 1% were 23 and 30 min, respectively, whereas those for a cumulative portion of ROSC > 99% were 27 and 38 min, respectively. Among the survivors (n = 7), six had favourable functional outcomes at discharge.</p><p><strong>Conclusions: </strong>This study provides evidence-based CPR duration thresholds in TCA, demonstrating that resuscitation efforts beyond 27 min in prehospital settings and 38 min in total were futile. Additionally, an alert mental status in the field and non-asystolic initial rhythm were identified as positive predictors of ROSC. These findings may help guide appropriate duration of resuscitation efforts in TCA.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"61"},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974332","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":"How much time do nurses in Norwegian emergency departments spend on different work tasks with and without a clinical pharmacist present-a time and motion study.","authors":"Renata Vesela Holis, Beate Hennie Garcia, Elin Christina Lehnbom, Marie Fagerli, Ashrak Majeed, Tine Johnsgård, Birgitte Zahl-Holmstad, Kristian Svendsen, Eirik Hugaas Ofstad, Torsten Risør, Scott R Walter, Marit Waaseth, Frode Skjold, Renate Elenjord","doi":"10.1186/s12873-025-01207-x","DOIUrl":"https://doi.org/10.1186/s12873-025-01207-x","url":null,"abstract":"<p><strong>Background: </strong>The emergency department (ED) is a demanding work environment where nurses undertake a variety of clinical and administrative tasks, including medication-related tasks. The integration of a clinical pharmacist into the ED team represents a complex intervention with potential implications for nurses' distribution of work time, particularly concerning medication-related tasks. This study examined the distribution of work time among ED nurses and assessed the impact of a clinical pharmacist's presence on this distribution, with an emphasis on medication-related work tasks.</p><p><strong>Methods: </strong>A direct observational time and motion study was conducted to evaluate the work time distribution of nurses in three Norwegian EDs, applying the Work Observation Method By Activity Timing (WOMBAT) methodology. Time distributions were measured for non-medication-related tasks, medication-related tasks, standby and movement, both in the absence and presence of a clinical pharmacist in the same ED.</p><p><strong>Results: </strong>A total of 298 h of nursing work time were observed, comprising 138 h without pharmacists present and 160 h with pharmacists present. In the absence of a pharmacist, nurses spent 62.7% of their time on non-medication-related tasks, 34.7% on standby and movement, and 3.3% on medication-related tasks. The introduction of a clinical pharmacist did not significantly change the overall distribution of nurses' work time, although some variations were noted across the EDs.</p><p><strong>Conclusion: </strong>ED nurses in three Norwegian EDs dedicated only 3.3% of their work time to medication-related tasks. The presence of clinical pharmacists did not substantially affect the distribution of nurses' work time.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"59"},"PeriodicalIF":2.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with overall and high-risk return visits to the emergency department: a vital sign trajectory approach.","authors":"Hsiao-Chia Wang, Cheng-Chung Fang, Chien-Hua Huang, Jun-Wan Gao, Jiann-Hwa Chen, Chu-Lin Tsai","doi":"10.1186/s12873-025-01211-1","DOIUrl":"https://doi.org/10.1186/s12873-025-01211-1","url":null,"abstract":"<p><strong>Background: </strong>For patients and emergency department (ED) physicians, return visits to the ED represent a potentially detrimental issue. In this study, our goal was to examine factors associated with overall and high-risk ED revisits. Specifically, as vital signs during the ED stay may provide important clues for subsequent revisits, we also examined the association between vital sign trajectories and post-ED revisits.</p><p><strong>Methods: </strong>This retrospective cohort study utilized electronic clinical warehouse data from a tertiary medical center. We retrieved data from 454,330 ED visits over four years. The data included patient demographics, triage data, and repeated vital sign measurements. Group-based trajectory modeling was used to identify vital sign trajectories. A high-risk return ED visit was defined as a revisit within 72 h of the index visit with intensive care unit admission, receiving emergency surgery, or with in-hospital cardiac arrest. Multivariable logistic regression analysis was performed to evaluate the associations between vital sign trajectories and revisits.</p><p><strong>Results: </strong>A total of 39,138 potential index ED visits were analyzed. Of these, 3,201 resulted in revisits, accounting for an 8.2% overall revisit rate and a 0.2% high-risk revisit rate. A high but resolving body temperature trajectory was associated with overall revisits (adjusted odds ratio [aOR], 1.32; 95% confidence interval [95% CI], 1.13-1.53). By contrast, high-risk revisits were associated with a low/fluctuating oxygen saturation trajectory (aOR, 2.40; 95% CI, 1.15-4.99). Older age (aOR, 1.27 per 10-year increase; 95% CI, 1.11-1.46) and having a chronic major disease (aOR, 2.30; 95% CI, 1.38-3.84) were also associated with high-risk revisits.</p><p><strong>Conclusions: </strong>In addition to older age and having a chronic major disease, a low and fluctuating oxygen saturation trajectory during the index ED stay may signal subsequent high-risk revisits. Thus, discharge decisions should be carefully re-evaluated in these high-risk populations.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"57"},"PeriodicalIF":2.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962500","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}