The Fibrosis-4 (FIB-4) index combines age, aminotransferase levels, and platelet count. Although developed for chronic liver fibrosis, its components may reflect acute hepatic and systemic injury after cardiac arrest. The primary aim of this study was to characterize early changes in FIB-4 from admission to an approximately 72-hour repeat assessment after out-of-hospital cardiac arrest (OHCA). Secondarily, we evaluated the association of FIB-4 values with 28-day mortality and whether repeat measurement provided additional prognostic information. This single-center retrospective cohort study included adults admitted to the intensive care unit after sustained return of spontaneous circulation between May 1, 2023, and May 1, 2026. After a record-level eligibility audit, 188 patients were included; 28-day vital status was available for 182. FIB-4 was calculated from the first laboratory set obtained at intensive care unit admission and from the complete laboratory set closest to 72 h after the admission laboratory sample within a 48–96-hour window. The primary analysis assessed paired change in FIB-4. Secondary analyses examined the association of admission FIB-4 with 28-day mortality and, using a 72-hour landmark approach, the association of repeat FIB-4 with subsequent mortality through day 28 and its incremental contribution beyond the admission value. A valid repeat FIB-4 measurement was available in 122 patients. In paired analysis, median FIB-4 decreased from 5.21 at admission to 3.16 at approximately 72 h (p < 0.001). Of the 182 patients with known 28-day vital status, 82 died (45.1
While the Modified Early Warning Score (MEWS) is widely used for early detection of clinical deterioration, reliance on physiological thresholds alone may miss subtle changes in Emergency Observation Unit (EOU) patients. The Nurse Intuition Patient Deterioration Scale (NIPDS), which captures nurses’ clinical gestalt, has shown promise in ward settings but remains to be validated in the EOU. This study primarily aimed to evaluate the incremental predictive value of adding NIPDS to MEWS for 24-hour deterioration risk among EOU patients; a secondary, exploratory aim was to describe the association between the implementation period and event rates. This retrospective before-after study included 9,595 EOU patients from a tertiary hospital in two sequential periods: Period 1 (January–December 2024, MEWS alone, n = 4,881) and Period 2 (February 2025–January 2026, MEWS + NIPDS, n = 4,714). The primary analysis was a paired comparison within Period 2, where both MEWS and NIPDS were recorded for the same patients, to assess the incremental discrimination of the combined score. The secondary exploratory analysis compared event rates across periods using multivariable logistic regression. The primary outcome was a 24-hour composite of process/escalation events (unplanned transfer to the resuscitation room or ICU) and hard clinical events (cardiac arrest or death), which were also analysed separately because escalation decisions may themselves be influenced by the NIPDS assessment. Within Period 2 (n = 4,714), the combined score demonstrated significantly better discrimination than MEWS alone (AUC 0.899, 95
Digital Electronic Medical Records (DEMRs) have become vital tools for enabling faster, evidence-based decision-making in high-income countries by offering immediate access to patient histories, diagnostic results, and treatment plans. In contrast, their integration in Emergency Departments (EDs) in low- and middle-income countries (LMICs) is still evolving. At the time of this study, no dedicated DEMR system had yet been implemented in the participating public ED. This study explores stakeholders’ perspectives on the need, usability, and usefulness of DEMRs in a public sector ED in Karachi, Pakistan, and assesses their potential impact on the quality of emergency care. Using a qualitative exploratory design, the study employed purposive sampling to conduct five Focus Group Discussions (FGDs)-two with healthcare providers (n = 12), which included a mix of doctors, nurses, and paramedics, and three with patients and caregivers (n = 18)-along with three Key Informant Interviews (KIIs) with hospital administrators. While separate FGDs for different provider roles were considered, a mixed-group format was used to encourage interdisciplinary dialogue and capture overlapping and contrasting views. Data were transcribed, translated, and thematically analyzed using an inductive approach. All ethical and trustworthiness protocols were maintained. Healthcare providers highlighted the anticipated usefulness of DEMRs in enabling faster access to patient information in the future, improving clinical decision-making, and reduced ED congestion. Patients and caregivers described current challenges such as long waiting times, repeated tests, and communication gaps, and anticipated that DEMRs could help improve these aspects of their emergency care experience. However, both groups noted barriers, including digital literacy gaps, unreliable internet, and power outages. Providers, patients, and caregivers perceived substantial potential value in integrating DEMRs into EDs in LMICs to improve care quality. Participants believed that if effectively implemented, DEMRs could streamline workflows, reduce delays, and contribute to improved emergency care. Successful implementation would likely depend on reliable infrastructure, targeted training, and supportive policies tailored to the local context.
Early prediction of short-term mortality among older adult trauma patients in prehospital settings remains challenging. This study aimed to develop and internally validate a simple emergency medical services (EMS)-based clinical score for predicting 24-hour mortality among older adult trauma patients using routinely available prehospital variables. This retrospective, registry-based, single-center cohort study included 665 trauma patients aged ≥ 60 years who were transported by EMS to a tertiary trauma center in Bangkok, Thailand, between January 2018 and December 2025. Patients were classified under Thailand Emergency Medical Triage Protocol symptom groups 21–25 with red-level severity. Candidate predictors were screened using univariate analyses and entered into multivariable logistic regression to derive a simplified clinical score. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), calibration was evaluated using the Hosmer–Lemeshow goodness-of-fit test, and internal validation was performed using 500 bootstrap resamples. Risk groups were defined according to the optimal cutoff identified using Youden’s index. The 24-hour mortality rate was 5.7
In China, prehospital emergency medical services (EMS) frequently employ nurses as frontline triage personnel, a practice that differs from EMS systems in many Western countries where paramedics typically fulfill this role. However, existing triage tools such as ATLS and CRAMS were not specifically designed for nursing-assessable variables in the Chinese prehospital context. This study aimed to develop and internally validate a nursing-oriented triage tool for prehospital trauma patients in a Chinese metropolitan setting. This retrospective cohort study was conducted at 12 EMS stations affiliated with three tertiary hospitals in Sichuan Province, China (January 2020–December 2022). The study followed STROBE and TRIPOD-AI reporting guidelines. A total of 2,864 patients were randomly split into development (n = 1,909, 66.7
Head trauma is a common presentation to the emergency department, and non-contrast head computed tomography (CT) is the choice modality for evaluating suspected traumatic brain injury (TBI). This study evaluated the diagnostic yield and distribution of initial CT findings and factors independently associated with CT-positive examinations in adult head trauma patients. We conducted a retrospective cross-sectional study of adults with head trauma who underwent initial non-contrast head CT at a Level I trauma center in Shiraz, Iran, from March to September 2024. Patients with non-diagnostic imaging, contrast-enhanced CT, prior head trauma or cranial surgery, intracranial neoplasm, or other prespecified criteria were excluded. CT examinations were initially interpreted by a senior radiology resident and a board-certified radiologist, with adjudication by a senior attending radiologist when interpretations differed. Patients were classified as CT-positive if at least one acute traumatic intracranial or skull abnormality was identified. Group comparisons used chi-square or Fisher’s exact tests and independent-samples t-tests or Mann–Whitney U tests, as appropriate. Multivariable logistic regression identified factors independently associated with CT-positive status. Among 1,808 eligible patients, 164 (9.1
Abdominal aortic pathologies (aneurysm, rupture, or dissection) are among the most critical and life threatening diagnoses in patients presenting to the emergency department (ED) with abdominal or back pain. This study aimed to evaluate the agreement between bedside handheld ultrasonography (HHUS) measurements of abdominal aortic diameter performed by ED physicians and the reference standard, contrast enhanced computed tomography (CT), while also assessing inter rater reliability between clinicians. This prospective, single centre, observational, single blind study involved 69 patients who underwent contrast enhanced abdominal CT or CT angiography for clinical indications in the ED. Aortic measurements in both transverse and longitudinal planes were performed using HHUS by an emergency medicine specialist and a resident. Reference CT measurements were recorded by a third blinded emergency medicine specialist. Data were analysed using the intraclass correlation coefficient (ICC), Bland–Altman analysis, and Spearman’s correlation. Sixty nine patients (mean age 52.29 ± 21.12 years; 52.2
Prolonged prehospital transport intervals, which are common in the Canadian context due to large geographic catchment areas, are associated with increased risk and severity of acute traumatic coagulopathy. We sought to describe the incidence of acute traumatic coagulopathy (international normalised ratio [INR] > 1.5) and hypofibrinogenemia (fibrinogen < 1.5 g/L) at trauma centre admission in trauma patients transported by helicopter air ambulance who received prehospital transfusion in this context. We conducted a retrospective cohort study of trauma patients transported by Ornge air ambulance to either of two adult trauma centres in Toronto, Canada, between August 2021 and July 2024 who received prehospital transfusion from Ornge’s blood-on-board program. This study was intended as a pilot for future larger-scale studies of this nature. We identified patients from Ornge’s health administrative database and linked them to hospital trauma registries using indirect identifiers. Patient characteristics, prehospital interventions, admission laboratory parameters, hospital interventions and patient outcomes were analysed. A total of 70 patients were analysed. Blunt trauma was predominant (69/70, 99
Helicopter Emergency Medical Services (HEMS) provide rapid medical care in geographically challenging and time-critical situations. This study explored the challenges experienced by HEMS personnel in western Iran. A qualitative study using the conventional content analysis approach of Graneheim and Lundman was conducted between April and October 2023. Semi-structured interviews were conducted with 17 HEMS personnel in Hamadan and Kermanshah provinces. Data were analyzed using MAXQDA software. Five major themes emerged: operational and environmental challenges (e.g., logistical delays and adverse weather conditions), communication and coordination challenges (e.g., inter-team miscommunication and protocol gaps), clinical and technical demands (e.g., rapid decision-making and equipment limitations), psychological and emotional challenges (e.g., trauma exposure and threats from patients’ relatives), and systemic and contextual obstacles (e.g., inadequate training and outdated helicopters). Participants described substantial challenges related to patient management, interagency communication, flight safety, and psychological well-being, which were further exacerbated by resource limitations and organizational constraints. HEMS personnel in western Iran experience complex and interrelated operational, clinical, psychological, and systemic challenges that affect both patient care and workforce well-being. Strengthening specialized HEMS training, integrated communication systems, infrastructure, and psychological support programs may improve the effectiveness and sustainability of HEMS services in resource-limited settings. Not applicable.
Dengue fever (DF) is a viral infection spread by mosquitoes and is one of the most frequently reported infectious diseases in Saudi Arabia, particularly in Jeddah. Despite recurring outbreaks, recent data on the clinical characteristics, seasonal variation, and outcomes of affected patients in the region remain limited. This study aimed to assess the clinical symptoms, laboratory findings, and outcomes of patients diagnosed with dengue fever who presented to the emergency department of King Abdulaziz Medical City (KAMC) in Jeddah, a tertiary care center. A retrospective review was conducted on all medical records of all patients aged ≥ 14 years with serologically confirmed dengue fever who presented to the emergency department of King Abdulaziz Medical City (KAMC), Jeddah, between August 2022 and August 2024. Demographic characteristics, clinical presentation, laboratory findings, and patient outcomes were extracted from electronic records and analysed using descriptive statistics with exploratory inferential analyses where appropriate, with statistical significance set at p < 0.05. The study included 319 patients (mean age 45.7 ± 18.4 years; 53.3
Middle-to-older-age trauma patients may experience persistent functional dependence after injury. Explainable machine-learning methods may reveal clinically coherent patterns across frailty, pre-injury function, injury characteristics, and subsequent care. We explored the feasibility of an explainable machine-learning framework for 3-month functional recovery and the hypotheses generated by its apparent performance and explanation outputs. We analyzed 588 patients aged ≥ 45 years from a prospective single-center trauma cohort; 73 (12.4
The 2021 European Society of Cardiology (ESC) guidelines classify acute heart failure (AHF) into four phenotypes: acute decompensated heart failure (ADHF), acute pulmonary oedema (APO), isolated right ventricular failure (IRVF), and cardiogenic shock (CS). However, differences in clinical characteristics and long-term outcomes among these phenotypes in the emergency department (ED) remain unclear. This study aimed to evaluate their characteristics and prognostic implications in the ED setting. In this prospective–retrospective observational real-world study, adults presenting with AHF in the ED were consecutively enrolled and categorized according to ESC-defined phenotypes. The study endpoints were 1-year all-cause and cardiovascular mortality. Associations between phenotypes and mortality were assessed using Cox regression models with progressive adjustment. A total of 2,960 patients were included. Clinical characteristics and treatment patterns differed substantially across phenotypes. The 1-year all-cause mortality rates were 10.3
The management of anemia in hemodynamically stable emergency department (ED) patients frequently involves transfusion of red blood cells units (RBCs), although the benefit of administering more than one unit at a time remains uncertain. Current recommendations advocate a “single-unit” strategy, but evidence supporting long-term outcomes in the ED is limited. This study aimed to assess whether transfusion of more than one RBC unit in the ED impacts one-year mortality in stable anemic patients. We conducted a retrospective, observational, single-center study including adult patients who received at least one non-emergency RBC transfusion in the ED between 2020 and 2022. Patients with hemorrhagic shock, massive bleeding, urgent transfusion orders, or chronic transfusion-dependent hematologic disease were excluded. The primary endpoint was one-year mortality. Survival was assessed using Kaplan–Meier analysis and Cox proportional hazards modeling adjusted for age, sex, Charlson index, hemoglobin level at admission, and hospitalization. A propensity score–matched analysis served as a sensitivity analysis. Secondary outcomes included factors associated with receiving > 1 RBC unit and early adverse events. Among 338 included patients, 93 (28
Emergency Department In-Hospital Cardiac Arrest (EDIHCA) constitutes a critical and life-threatening clinical event, characterized by notable seasonal variation in its incidence. This study seeks to identify the peak seasonal distribution of EDIHCA cases within a temperate climate zone and to investigate the clinically relevant factors associated with these events. A retrospective observational study was conducted involving patients who experienced EDIHCA at the Second Affiliated Hospital of Kunming Medical University between March 2021 and February 2025. Patients were divided into peak season and non-peak seasons groups based on the distribution of EDIHCA cases. Clinical influencing factors contributing to the increased volume of EDIHCA during the peak season were assessed using multivariable logistic regression after an assessment of collinearity. During the study period, 246 EDIHCA cases were recorded during the peak season (winter), compared to 422 cases in other seasons. Univariate and multivariate logistic regression analyses identified severe pneumonia (OR = 6.53, 95
Trauma remains a leading cause of mortality worldwide. Among patients with blunt trauma, factors associated with in-hospital mortality may vary according to geographic and injury-specific characteristics. This study aimed to identify factors associated with in-hospital mortality among patients with blunt trauma treated at a Level 1 trauma centre in South Korea, with particular attention to differences based on trauma event location (urban vs. rural) and injury severity. This retrospective cohort study included 1,409 adult patients with blunt trauma admitted between January 2022 and December 2024. Multivariable logistic regression was performed to identify factors associated with in-hospital mortality in the overall cohort and in subgroups stratified by trauma event location (urban vs. rural) and injury severity (moderate injury: Injury Severity Score [ISS] 16–24; severe injury: ISS ≥ 25). The overall in-hospital mortality rate was 17.2
Abnormal vital signs at emergency department (ED) discharge may raise concerns about patient safety, yet physicians may respond differently to individual physiological abnormalities when making disposition decisions. This study examined physicians’ willingness to discharge patients with isolated abnormal vital signs under otherwise standardized clinical conditions. We conducted a multicountry vignette-based study among physicians in Turkey, Somalia, and Liberia. Five standardized primary vignettes used an identical clinical stem and response format, with only one abnormal vital sign varying in each scenario: heart rate of 110 beats/min, systolic blood pressure of 95 mmHg, oxygen saturation of 93
Early triage of emergency calls at dispatch centres relies mainly on verbal information, which may not reflect the complexity and severity of a situation, limiting dispatchers situational awareness and early decision-making. Real-time live-video could potentially be provided by drones before the arrival of emergency medical services and fire department. The aim was to evaluate feasibility and operational value of automated beyond visual line of sight (BVLOS) drones delivering early live-video to emergency dispatch centres during time-critical incidents. This prospective interventional feasibility study was conducted in the region of western Sweden between 7th May–7th November 2025. One drone system with automated external defibrillator and a high-resolution camera was integrated into regional medical/fire dispatch centers, covering a 141 km2 suburban area (population approx 63 000) enabling real-time videofeed during emergency 112-calls. The drone was dispatched to consecutive alerts meeting predefined criteria (out-of-hospital cardiac arrest, traffic accidents, fires). Outcomes included time delays, characteristics of drone- and video transmission together with dispatcher-perceived value assessed through surveys. Of 169 alerts, the drone system was operational in 120 (71
Studies on factors associated with emergency department (ED) use, including demographic and contextual factors such as the remoteness of the area of residence and the availability of home support programs, are scarce but may better explain ED demand than studies based only on demographic factors. Furthermore, most studies are based on the nonplausible assumption that there is no geographical variation in factors associated with ED use across states or territories. This study aimed to assess whether contextual factors related to context or the environment, in addition to demographic factors, can improve our understanding of ED use in Queensland, Australia. Spatial analyses were performed to understand the factors more likely to drive ED demand and access block (AB) in different areas of the state. Data on all ED visits in Queensland in 2021 were aggregated by 1-year age groups for each postcode of patients’ residential area and matched to the corresponding denominator population as well as to demographic and contextual factors. When assessing factors associated with ED demand and AB, including contextual factors improved model fit compared with models comprising demographic factors only. The associations between ED visits and age appeared nonlinear. The highest rates of ED visits were observed among residents aged > 75 years, followed by those aged < 5 years and those aged 20–35 years. Across the state, a 1-year increase in patient age was associated with a 2
Rapid recognition of stroke/transient ischaemic attack (TIA) in the emergency telephone is crucial to ensure timely intervention and direct transport to stroke centres. Our study investigated the diagnostic accuracy via the 1-1-2 emergency line (1-1-2) call-takers in Region Zealand, Denmark, and examined whether recognised cases had a higher chance of referral to a primary stroke centre and receiving thrombolysis. We retrospectively analysed calls linked to hospital discharge codes for stroke/TIA. Call-taker stroke/TIA suspicion was documented. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Additionally, we calculated the relative risk of receiving intravenous thrombolysis and direct stroke-centre transport for recognised versus unrecognised calls. Among 196,235 calls to 1-1-2 from 2021 to 2024, 2581 patients had confirmed stroke/TIA. Dispatcher sensitivity was 0.75, with a PPV of 0.18. Recognised patients compared to unrecognised cases had a higher chance of direct admissions to primary stroke units with a RR of 1.46 (95
Emergency departments (EDs) are critical components of healthcare systems and serve as the primary entry point for medical care during disasters and mass gatherings (MGs). Sporting MGs, particularly football matches, occur frequently in urban settings and can significantly influence patterns of healthcare demand. However, the broader impact of these events on ED utilization, beyond the immediate vicinity of stadiums, remains underexplored. This multicenter, retrospective descriptive study analyzed ED admissions from three hospitals in Trabzon, Türkiye, during 47 official Trabzonspor football matches held between August 2021 and June 2022, and on 47 corresponding non-match days. A total of 214,535 ED admissions were analyzed, of which 104,597 occurred on match days and 109,938 on corresponding non-match days. No significant differences were observed in patient age (34.83 ± 22.32 vs. 34.85 ± 22.33; p = 0.848), sex distribution (female: 60.0
