Objectives:To assess interrater agreement between the Canadian triage and acuity scale (CTAS) scores assigned by paramedics and those assigned by a paramedic rater using an electronic smartphone application, aiming to identify training gaps and potential patient safety risks associated with CTAS scoring in Canadian hospital emergency departments (CEDs). Methods:A retrospective analysis was conducted using 192,326 CTAS-level call data collected from electronic patient care records of nine paramedic services. Data were entered into an electronic CTAS smartphone app. The calls were categorized based on contact level and the sample size. Minitab software and VassarStats were used to calculate the quadratic-weighted Cohen's kappa (k) coefficient. Results:A retrospective analysis of 1651 paramedic call reports from across Eastern Ontario compared paramedic-assigned CTAS scores with those generated using an eCTAS smartphone tool. Overall agreement between raters was substantial (k = 0.78), with 55.24% (95% CI: 52.8, 57.66) agreement for CTAS on contact and 52.88% (95% CI: 50.44, 55.31) for CTAS on departure (k = 0.76). Paramedics assigned more low-acuity CTAS 4-5 scores than the eCTAS tool on both contact (39% vs. 31%) and departure (40% vs. 31%). Additionally, 11%-12% of CTAS 2 calls were downgraded by paramedics to CTAS 4 or 5, compared with 7% when eCTAS was used. Cohen's kappa demonstrated near-perfect agreement for CTAS 1 scores, fair agreement for CTAS 2 and 3, slight agreement for CTAS 4, and moderate agreement for CTAS 5 categories. Complaint-specific analyses showed the greatest disagreement in the gastrointestinal and substance overdose/misuse categories. Conclusions:This study found near-perfect agreement between paramedic documentation and the paramedic smartphone application for CTAS-1 in acute patients, with moderate agreement for other levels. Further studies should include multiple raters to better understand the implications of using a smartphone application.
Background:Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is increasingly recognized as a major cause of acute pancreatitis in China. Acute respiratory distress syndrome (ARDS), a severe and early complication, significantly worsens prognosis and increases intensive care unit (ICU) burden. This study aimed to identify early predictive markers of ARDS in patients with HTG-AP, enabling timely risk stratification and clinical intervention to improve outcomes. Methods:A retrospective analysis was conducted on 111 patients who were diagnosed with HTG-AP and admitted to the emergency ICU (EICU) between August 2022 and December 2024. Patients were categorized into ARDS (n = 61) and non-ARDS (n = 50) groups according to the complications associated with ARDS throughout the progression of the illness. Clinical variables were compared between groups. The Boruta technique was used to choose predictors, and then multivariate logistic regression was used. To assess prediction ability, receiver operating characteristic (ROC) curve analysis was carried out. We performed internal validation using five-fold cross-validation and bootstrap resampling (1000 iterations) to evaluate the model's capacity for generalization and stability. The clinical utility of the model was assessed using decision curve analysis (DCA). Results:Patients in the ARDS group had lower serum calcium (Ca2+) levels (p < 0.05) and longer ICU stays, as well as greater 24 h intra-abdominal pressure (IAP), interleukin-6 (IL-6), lactate dehydrogenase (LDH), and lactate (Lac) levels (p < 0.05) compared to the non-ARDS group. NEU, Lac, Cr, 24 h IAP, IL-6, and LDH are important possible risk factors, according to the Boruta algorithm. Multivariate logistic regression analysis identified 24 h IAP, IL-6, and LDH as independent predictors of concurrent ARDS (p < 0.05). The areas under the ROC curves (AUC) for 24 h IAP, IL-6, and LDH were 0.796 (95% CI: 0.715-0.877), 0.770 (95% CI: 0.683-0.858), and 0.868 (95% CI: 0.880-0.936), respectively (p < 0.05). When combined, the predictive model yielded an AUC of 0.907 (95% CI: 0.849-0.957), with a specificity of 90.00% and a sensitivity of 78.70%, and demonstrated noninferior predictive performance to the existing scoring systems. With an average AUROC score of 0.890 from five-fold cross-validation and a bootstrap-corrected C-index of 0.894, the model shows good discriminatory power. The model's clinical net benefit was verified by the DCA. Additionally, we have created a free online risk calculator for the general public (https://ardsprediction.streamlit.app/). Conclusions:LDH, IL-6, and 24 h IAP are valuable early indicators of ARDS development in patients with HTG-AP. The integrated predictive model demonstrates excellent diagnostic performance and can support early clinical decision-making.
This retrospective evaluation examined the theoretical impact of alternative D-dimer thresholds (age-adjusted and 1000 µg/L) in patients aged ≥ 50 years who underwent computed tomography pulmonary angiography (CTPA) after D-dimer testing. Among 291 patients with positive D-dimer and subsequent CTPA, the age-adjusted threshold maintained 100% observed sensitivity (95% CI 89.7%-100%), while the 1000-µg/L threshold missed three pulmonary emboli (sensitivity 91.2%, 95% CI 76.3%-98.1%). Applying these thresholds would have reduced CTPA use by 21.7% and 46.7%, respectively. These findings suggest that age-adjusted D-dimer thresholds may improve diagnostic efficiency in selected older patients; however, the absence of prospectively recorded pretest probability, verification bias and a lack of follow-up prevents conclusions about clinical safety.
Objective:To develop and compare three machine learning models for identifying factors associated with workplace violence (WPV) among emergency department nurses. Methods:A total of 1540 emergency department nurses from various regions of China were examined between December 2023 and January 2024. Data were collected using scales measuring WPV, work-family conflict, occupational stress, occupational burnout, nursing practice environment, and self-rated sleep quality. Three analytical models (logistic regression, decision tree, and random forest) were developed and compared to classify nurses with and without WPV experiences among emergency department nurses. Model performance was evaluated using sensitivity, specificity, PPV, NPV, F1-score, balanced accuracy, and area under the receiver operating characteristic curve (AUC). Results:Among the 1540 nurses, 1309 individuals (85.0%) had experienced WPV in the past year. All three models indicated that work-family conflict, occupational burnout, and occupational stress were significantly associated with WPV experiences among emergency department nurses (p < 0.05). In the random forest and decision tree models, sleep disorders and the nursing practice environment were also identified as significant associated factors. The accuracy of the logistic regression, decision tree, and random forest models was 0.829, 0.851, and 0.859; the specificity was 0.667, 0.605, and 0.593; the sensitivity was 0.864, 0.903, and 0.916; and the F1 score was 0.893, 0.909, and 0.915, respectively, with AUC values of 0.832 (95% CI: 0.781-0.883), 0.768 (95% CI: 0.711-0.826), and 0.834 (95% CI: 0.783-0.885). Conclusions:Work-family conflict, burnout, occupational stress, the nursing practice environment, and sleep disorders were consistently associated with WPV experiences among emergency department nurses. Random forest achieved the highest sensitivity, F1-score, and overall accuracy, whereas logistic regression showed the highest specificity and balanced accuracy. Logistic regression and random forest demonstrated similar discrimination.
Background:Cardiac arrest (CA) causes systemic circulatory failure, leading to postcardiac arrest syndrome (PCAS) and high mortality. Lactic clearance rate (LCR) and albumin-corrected anion gap (ACAG) reflect metabolic status but lack combined validation for predicting short-term mortality in CA patients. Objective:This study explores the predictive value of LCR at different time points and ACAG for 7-day mortality in post-CA patients and constructs a predictive model. Methods:Using the MIMIC-IV 3.0 database, we included eligible CA patients and calculated LCR at 6, 12, and 24 h, along with initial ACAG. ROC curves and logistic regression were used to assess predictive value, while restricted cubic splines (RCS) explored mortality risk. The best predictors were selected for model construction, with multivariate logistic regression identifying independent risk factors. Internal and external validations were performed. Results:A total of 821 patients were included, with a 7-day mortality rate of 34.47%. LCR was lower, and ACAG was higher in nonsurvivors (p < 0.05). The 24-h LCR combined with ACAG had the highest predictive efficacy (area under the ROC curve [AUC] = 0.716). Independent risk factors included 24-h LCR, ACAG, CK-MB, shockable rhythm, and CA etiology. The final model achieved an AUC of 0.775 (internal) and 0.743 (external). Conclusion:The 24-h LCR combined with ACAG predicts short-term mortality in post-CA patients who survive the first 24 h, supporting risk stratification after early postresuscitation stabilization.
Objectives:The optimal rate and duration of isotonic hydration therapy for preventing contrast-associated acute kidney injury (CA-AKI) remain poorly established. As prolonged hydration therapy is impractical due to the urgency of diagnostic imaging and the limited time available for monitoring in the emergency departments (EDs), this study evaluated whether bolus hydration regimens are noninferior to prolonged hydration protocols. Methods:This single-center, prospective, open-label, randomized controlled, noninferiority trial was conducted at the ED of a training and research hospital between August 10, 2024, and April 26, 2025. 257 patients undergoing contrast-enhanced computed tomography (CT) with baseline creatinine levels above the reference range (1.2 mg/dL in men and 1.1 mg/dL in women) were included. Patients were stratified by age and sex and randomized to bolus or continuous hydration. The bolus group received 500 mL of isotonic fluid within 30 min before the procedure, followed by 500 mL/hour for 2 h postprocedure. The continuous group received 150 mL/hour for 2 h before and 8 h after the procedure. The primary outcome was the development of CA-AKI, defined as an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL at 48-72 h following contrast administration. Secondary outcomes included 30-day all-cause mortality and the need for dialysis. Results:The two groups were well-matched in terms of demographic, clinical, or biochemical parameters. The mean baseline creatinine was 1.4 ± 0.21 mg/dL, and the eGFR was 45.6 ± 9.8 mL/min/1.73 m2. CA-AKI occurred in 1.7% of the continuous group and 4.9% of the bolus group (absolute risk difference 3.2%; 95% CI -1.3% to 7.7%). As the upper confidence interval limit was below the predefined noninferiority margin of 8%, bolus hydration was noninferior to continuous hydration for CA-AKI prevention. No patients required dialysis. Thirty-day all-cause mortality was comparable (7.6% vs. 7.9%; p = 0.928). Significant improvements were observed in urea, creatinine, and eGFR values in both groups at 48-72 h (p < 0.001). Conclusion:In this single-center noninferiority trial, a bolus hydration regimen was noninferior to a prolonged continuous regimen for preventing CA-AKI in ED patients with moderately impaired baseline renal function. Bolus hydration may offer a practical alternative in time-constrained ED settings; however, multicenter confirmation is warranted before routine adoption. Trial Registration: ClinicalTrials.gov.identifier: NCT07286526.
Background:High mortality rates following out-of-hospital cardiac arrest (OHCA) make identification of its etiology vital for prevention. In low-resource settings, limited access to diagnostics and clinical autopsy often prevents definitive conclusions. This study aimed to describe the presumed etiology of OHCA cases presenting to a tertiary emergency department (ED) in Bhutan. Methods:A prospective cohort study was conducted from August 1, 2023, to July 31, 2024, in the ED of the National Referral Hospital, Bhutan. All patients presenting with OHCA were included and followed until hospital discharge, death, or the end of the study period. Data were extracted from patient records and analyzed using STATA Version 18. Results:Of the 110 OHCA patients, 59.1% (n = 65) were male, and 90.9% (n = 100) were adults, with a median age of 53 years (IQR: 32-69). Prehospital emergency medical services (EMS) attended 27.3% (n = 30) of cases, and resuscitation was attempted in the ED in 93.6% (n = 103). Using the 2024 Utstein OHCA framework, medical causes accounted for 91.8% (n = 101) of presumed etiologies and trauma for 6.4% (n = 7). Within medical causes, presumed cardiac/unknown was most common (68.3%, n = 69), followed by other medical (26.7%, n = 27) and respiratory causes (5.0%, n = 5). One case each was attributed to drowning/electrocution and asphyxiation (0.9%). Among the 69 presumed cardiac/unknown causes, 94.2% (n = 65) had no specific etiology identified after available evaluation, while 5.8% (n = 4) had clinical features suggestive of a cardiac etiology. No clinical autopsies were performed. In multivariable logistic regression, increasing age was independently associated with presumed cardiac/unknown with no specific etiology identified after available evaluation (aOR: 1:02; 95% CI: 1.00-1.03; p = 0.022), and no other variables were significantly associated with this outcome. Conclusion:Most OHCA cases were medical in origin, with the majority classified as presumed cardiac/unknown due to the absence of a specific etiology after available evaluation. These findings highlight challenges in etiological classification in resource-limited settings. Strengthening postresuscitation diagnostic evaluation, standardized post-ROSC protocols, access to clinical autopsy where feasible, and development of a nationwide OHCA registry may improve etiological classification and guide future preventive strategies.
Introduction:The total bilirubin-to-serum albumin ratio (TBAR) has been proposed as an indicator of hepatic dysfunction and systemic inflammation, yet its prognostic relevance in critically ill patients with gastrointestinal bleeding (GIB) remains unclear. This study evaluated the association between TBAR and mortality and developed a TBAR-based prognostic model. Methods:Data were extracted from the MIMIC-IV v3.1 database, with external validation using the eICU-CRD v2.0. Adult patients with GIB were included after applying predefined eligibility criteria, yielding a final cohort of 1627 individuals. The primary outcomes were 28-day all-cause mortality. Cox regression, Kaplan-Meier analyses, restricted cubic splines (RCS), ROC curves, and subgroup analyses were performed. A prediction nomogram was constructed using variables selected through the Boruta algorithm and evaluated using AUC, C-index, calibration performance, and decision curve analysis. Results:Nonsurvivors exhibited markedly greater physiological instability, more severe organ dysfunction, and substantially higher TBAR levels. TBAR was independently associated with mortality across all Cox models (fully adjusted HR for 28-day mortality: 1.10, 95% CI 1.06-1.15). High TBAR was associated with more than a twofold increased risk of death. TBAR demonstrated superior discriminatory ability compared with TBIL or ALB alone and provided incremental predictive value when combined with the SOFA score. RCS analysis supported a linear dose-response association. Subgroup analyses showed no significant interactions. The final nomogram-which incorporated SOFA, APTT, TBAR, vasopressor use, CRRT, and anion gap-achieved an AUC of 0.794 and a bootstrap-corrected C-index of 0.789. External validation in the eICU cohort confirmed the robustness of the association and the strong performance of the model (AUC 0.805). Conclusions:TBAR is an independent predictor of mortality in critically ill patients with GIB. The TBAR-based nomogram demonstrates reliable discrimination and calibration and may facilitate individualized mortality risk stratification in clinical practice.
Objective:Although abdominal drainage (AD) tubes have become an effective means to prevent and observe complications after laparoscopic appendectomy (LA), there are still controversies, and no standardized nursing process (SNP) is shown for the management of drainage tube care. This investigation aims to assess the effectiveness of SNP management in AD tubes after LA. Methods:This retrospective cohort investigation comprised individuals who had LA surgery with abdominal drain placement for acute appendicitis from July 2021 to June 2024. Individuals were classified into the SNP and non-SNP groups. A comparison of the outcomes was conducted, while univariate and multivariate analyses were conducted to assess the factors related to the SNP. p-value < 0.05 was regarded as significant. Results:A total of 367 patients were enrolled in this investigation, and no significant variations were shown in baseline characteristics between the SNP (n = 199) and non-SNP groups (n = 168). Multivariable logistic regression analysis displayed that SNP management was an important factor in decreasing postoperative 24-h pain scores (OR = 0.22, 95% CI: 0.12-0.42, p < 0.001), improving the out-of-bed activity rate (OR = 2.33, 95% CI: 1.37-3.96, p < 0.05) and patient's degree of satisfaction after surgery (OR = 16.02, 95% CI: 9.06-28.32, p < 0.001). However, SNP had no significant effect on the incidence of postoperative drainage tube dislodgement (OR = 0.49, 95% CI: 0.16-1.51, p > 0.05). Conclusions:In this retrospective cohort, the implementation of SNP was associated with significantly lower postoperative 24-h pain scores, a higher out-of-bed activity rate, and greater patient satisfaction after LA surgery. These findings suggest that SNP may be a beneficial component of postoperative care and warrant further investigation.
Background:This original research study evaluates the utility of pulmonary point-of-care ultrasound (POCUS) within the extended focused assessment with sonography in trauma (eFAST) exam to detect asymptomatic COVID-19 in emergency department trauma patients. Specifically, it examines whether lung findings, such as B-lines, pleural thickening, and subpleural consolidations, can indicate a COVID-19 infection. Methods:This retrospective review includes trauma patients aged 18 years or older who underwent eFAST and COVID-19 swab testing at the University of California, Irvine Medical Center, from December 2020 to October 2022. Two blinded reviewers analyzed eFAST scans for more than two B-lines, irregular pleural interface, or subpleural consolidations, with discrepancies resolved by ultrasound fellows. Sensitivity, specificity, and predictive values were calculated with 95% confidence intervals (CIs). Results:A total of 152 patients were included. Of 41 eFAST scans positive for COVID-19 findings, six were confirmed by PCR testing, yielding a positive predictive value of 15.6% (CI: 7.9%-25.6%). Among the 111 eFAST scans negative for COVID-19, 10 were PCR-positive, giving a negative predictive value of 91.0% (CI: 84.1%-95.6%). Sensitivity was 37.5% (CI: 15.2%-64.6%), and specificity was 74.3% (CI: 66.1%-81.4%). Conclusion:Lung POCUS within the eFAST exam is not a reliable tool for detecting asymptomatic COVID-19 infection in trauma patients due to limited sensitivity and low positive predictive value. Standard diagnostic methods, such as PCR testing, and the use of personal protective equipment should remain the primary approach to protect healthcare providers.
Background:Age-adjusted D-dimer (AAD) thresholds are used to reduce false positives in older patients evaluated for pulmonary embolism (PE). However, evidence is limited regarding test behavior near the individualized cutoff ("near-threshold" zone) and the safety of excluding PE in AAD-negative cases. Methods:We conducted a retrospective diagnostic accuracy study of adults ≥ 50 years presenting to a tertiary emergency department (2015-2019) with suspected PE who underwent D-dimer testing and definitive imaging (CT pulmonary angiography or V/Q scintigraphy). Diagnostic performance of the standard threshold (0.5 µg/mL, FEU) and AAD (age × 0.01 µg/mL) was assessed using ROC analysis. Accuracy metrics are reported with 95% confidence intervals (CIs) via bootstrap; AUC CIs and between-curve comparisons used the DeLong method. The near-threshold zone was defined as ±0.1 µg/mL around the AAD cutoff. Clinical charts of AAD-negative PE cases were reviewed. Results:Among 979 patients, 162 (16.5%) had imaging-confirmed PE. Standard D-dimer showed sensitivity 99.4% (95% CI 98.0-100.0) and specificity 4.0% (2.7-5.4); AAD showed sensitivity 97.5% (94.8-99.4) and specificity 11.8% (9.6-13.9). AUCs were 0.734 and 0.727, with no significant difference (DeLong p = 0.41). Within the near-threshold window, PE prevalence was 7.7%, increasing with age (28.6% in ≥ 80 years). Three patients had PE despite AAD-negative results; all had segmental or subsegmental emboli, and no in-hospital complications were documented in the available records. Conclusion:In this imaging-selected retrospective cohort, AAD improved specificity with minimal sensitivity loss. However, AAD should not be used as a stand-alone rule-out strategy and should be applied only within clinical probability-guided diagnostic pathways. Near-threshold results are not risk-free, particularly in older adults, and should prompt careful clinical reassessment when overall probability remains concerning.
Out-of-hospital cardiac arrest (OHCA) is a critical public health issue, with survival rates varying widely due to multiple well-established factors, including emergency medical service (EMS) system structure, bystander response, initial cardiac rhythm, and patient-level characteristics. This study evaluates the Utstein-Based Return of Spontaneous Circulation (UB-ROSC) score's performance in predicting sustained Return of Spontaneous Circulation (ROSC > 2 h) in a midsized Asian city where EMS delivery is standardized and geographic variation in access is minimal. A total of 209 OHCA cases from Chiayi City in 2024 were analyzed, using Utstein-aligned data to compute UB-ROSC scores. Predictive performance was assessed via receiver operating characteristic (ROC) curves, calibration intercept and slope, the Hosmer-Lemeshow goodness-of-fit test, and bootstrap internal validation, focusing on sustained return of spontaneous circulation (ROSC) (> 2 h). After excluding pediatric and traumatic cases, 209 cases were analyzed. The cohort was 60.3% male, with 47.8% witnessed arrests and 67.0% receiving bystander CPR. The UB-ROSC score demonstrated fair discrimination, with an area under the ROC curve (AUC) of 0.78 (95% confidence interval [CI]: 0.70-0.85), stable on bootstrap and cross-validation. The calibration slope was 0.90 (95% CI: 0.62-1.18) but the calibration intercept was +0.71 (95% CI: 0.36-1.05), and the Hosmer-Lemeshow test was significant (χ 2 = 28.6, p < 0.001), indicating systematic underprediction of observed survival. Risk stratification yielded a low-risk group (n = 109) with a 15.6% ROSC rate, a medium-risk group (n = 94) with a 48.9% rate, and a high-risk group (n = 6) with an 83.3% rate. The Chiayi cohort showed a slightly higher observed ROSC rate in the low-risk group, whereas the medium- and high-risk groups fell within the predicted ranges although estimates in the high-risk group were imprecise because of the small sample size. Local recalibration may be needed before applying absolute probability estimates in clinical settings.
Background:Dyspnea is a common and complex symptom in patients presenting to the emergency department, with multiple possible underlying diseases and a high risk of tracheal intubation or even death as the condition progresses. Therefore, an easily accessible, quick, and convenient index is needed to predict patient prognosis at emergency. A single measurement of peripheral capillary oxygen saturation (SpO2) or respiratory rate (RR) is not sufficiently accurate, while other related indices are relatively complex. This study investigated the predictive value of the SpO2/RR ratio (SR) in patients with acute dyspnea without oxygen therapy presenting to the emergency department. Methods:This single-center retrospective analysis was conducted in the emergency department of Jiangsu Provincial Hospital of Traditional Chinese Medicine. Patients diagnosed with acute dyspnea without oxygen therapy who were presented to the emergency triage by the 120 ambulance were included. SR was calculated from the first vital signs obtained at the 120 ambulance real-time transmission system for vehicles. Patients were divided into three groups based on terciles. Kaplan-Meier analysis, Cox regression models, and restricted cubic splines (RCS) were used to examine the associations between SR and clinical outcomes. Results:In total, 1339 patients were included. The rates of 7-day intubation and 28-day mortality differed significantly across SR groups (22.77%, 15.28%, 15.25%; p = 0.003) and (24.55%, 15.06%, 11.88%; p < 0.001), respectively. Cox regression and Kaplan-Meier analyses showed that lower SR was significantly associated with greater intubation and mortality risk (log-rank p = 0.003, p < 0.001). Subgroup and sensitivity analyses supported these findings, with the effect more pronounced in patients with an RR of ≥ 30 breaths/min. RCS nonlinear analysis revealed L-shaped associations between SR and 7-day intubation and 28-day mortality, with inflection points identified at 4.85 and 3.53. Conclusion:A lower SR was associated with increased 7-day intubation and 28-day mortality in emergency department patients with acute dyspnea without oxygen therapy. Inflection points of 4.85 and 3.53 suggest that SR may serve as a useful prognostic indicator for identifying high-risk patients with acute dyspnea.Yuwei Tan and Sicheng Yuan contributed equally to this work and both as co-first authors.
Background:Pulmonary embolism (PE) remains a major diagnostic and prognostic challenge in emergency departments due to its heterogeneous clinical presentation and potentially high mortality. Although echocardiography and conventional cardiac biomarkers are commonly used in clinical practice, the additional prognostic value of novel biomarkers such as copeptin and heart-type fatty acid-binding protein (H-FABP) requires further investigation. Methods:This exploratory prospective study (March 2021-September 2022) included adult patients (≥ 18 years) diagnosed with acute PE confirmed by radiological imaging in the emergency department. Patients with chronic/unconfirmed PE, incomplete data, or those referred from external centers were excluded. The primary analysis compared survivors and nonsurvivors at 30 days to evaluate the prognostic value of copeptin, H-FABP, and echocardiographic parameters. Transthoracic echocardiography (TTE) was performed after diagnosis to assess right heart function and pulmonary artery pressure (PAP), right ventricular/left ventricular ratio (RV/LV), right and left ventricular end-diastolic diameters (RV-EDD and LV-EDD), and tricuspid annular plane systolic excursion (TAPSE). Biomarkers (troponin, pro-BNP, D-dimer, copeptin, and H-FABP) were analyzed using standard laboratory assays and enzyme-linked immunosorbent assay (ELISA). The primary outcome was 30-day mortality. Results:A total of 88 patients were analyzed. Although H-FABP and copeptin levels were higher in nonsurvivors, these differences were not statistically significant for predicting 30-day mortality. Echocardiographic parameters-particularly PAP, RV-EDD, and RV/LV-were significantly associated with the severity of right ventricular dysfunction and clinical outcomes (p < 0.05). In multivariable logistic regression analysis copeptin, H-FABP, PESI score, ICU admission, RV-EDD, and LV-EDD remained independently associated with 30-day mortality. Cut-off values were determined by ROC analysis using the Youden index. Conclusions:Although biomarkers were not significant as continuous variables, exploratory categorized analysis based on cut-off values suggested a potential association with mortality. Rapid bedside echocardiography combined with appropriate biomarker testing may improve risk stratification in patients with PE in emergency settings, while larger studies are needed to clarify the role of these biomarkers.
Background:The SADFUL score is developed to identify bacteremia in emergency department revisits (EDR), but its generalizability in various healthcare facilities and superiority over other scores remain unclear. This study aims to validate the SADFUL score in two hospitals with different levels of care. Method:This retrospective cohort study included adult EDR patients from an academic medical center (Hospital A) and a rural regional hospital (Hospital B) between March 1, 2019, and December 31, 2022. The SADFUL, quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) criteria, and shock index (SI) scores were compared using the area under the receiver operating characteristic curve (AUROC). Results:The prevalence of bacteremia in the EDR cohort was 2.2% (120/5455). The SADFUL score's performance was inconsistent across the two hospitals. In Hospital A, its AUROC of 0.64 was significantly higher than those of the SIRS criteria, qSOFA, and the SI. In contrast, in Hospital B, its numerically higher AUROC of 0.72 was not statistically superior to the other scores. The optimal cutoff also differed between the two settings (≥ 2 in Hospital A and ≥ 4 in Hospital B). Conclusion:The SADFUL score demonstrated only modest accuracy and was not consistently superior to other commonly used clinical scoring systems. Overall, all evaluated tools exhibited limited utility in identifying bacteremia among EDR patients, highlighting the need for further research in this area.
Background:Children are particularly vulnerable to road traffic injuries (RTIs) leading to morbidity and mortality. Despite the high incidence of pediatric RTIs in Ethiopia, data on the patterns and consequences of pediatric RTIs are limited. Objective:To assess the characteristics and ED disposition among pediatric patients (age ≤ 18 years old) with RTI admitted to emergency department of Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital, Addis Ababa, Ethiopia. Methods:A hospital-based cross-sectional study was conducted, focusing on pediatric patients with RTIs who presented it to the emergency department of AaBET Hospital from December 12, 2021, to December 30, 2023, retrospectively. Data were collected using a standardized structured data collection checklist from hospital data records and medical charts. A sample size of 279 pediatric RTI patients was included from registered hospital records. After data cleaning, data were analyzed using SPSS Version 21. Descriptive statistics were used to describe the dependent variables. Result:Out of 279 patients, the median age was thirteen (IQR: 9-17). A total of 54.1% of the patients were male. One hundred and fourteen (40.9%) of those were from age 15-18. Two hundred and eight (74.6%) patients were pedestrians. Forty-eight percent of the patients sustained injury while in transit to work or school. Seventy six (27.2%) came to the hospital with private cars or trucks, while 63 (22.6%) came with an ambulance. One-hundred thirty five (48.4%) of the patients sustained extremity and pelvis injuries, while 41.9% sustained head injuries. Two-hundred fifty-five (91.4%) patients were discharged home from the emergency department. The emergency department mortality was 0.7%. Conclusion:In this study, children from the ages of 15-18 were more affected by RTIs. Pedestrians and while in transit to school or work were more injured. Head and extremity injuries were the predominant injuries that happened to children. Children and schools should be prioritized in targeted road safety initiatives, supported by stricter enforcement of traffic laws near school zones.
Background:Acute myocardial infarction (AMI) is a major global cause of morbidity and mortality. Large language models (LLMs) are emerging tools for patient education. This study evaluated the performance of three LLMs in delivering accurate, reliable, and readable educational content regarding AMI. Methods:In this cross-sectional study (February-March 2025), a clinical case of a patient with an inferior STEMI ECG was presented to three LLMs: ChatGPT-4o, Claude 3.7 Sonnet, and Gemini Advanced 2.0 Flash. Each model answered 30 patient-focused questions across three domains: general disease knowledge, diagnostic processes, and treatment approaches. Responses were assessed by four emergency medicine associate professors (10-20 years of experience) using a 5-point Likert scale for accuracy, DISCERN and EQIP tools for reliability and quality, and standard readability indices. Results:ChatGPT-4o achieved the highest accuracy score (4.38 ± 0.38), followed by Claude 3.7 (4.09 ± 0.55) and Gemini 2.0 (3.92 ± 0.41) (p < 0.001). ChatGPT-4o performed significantly better in general information (p = 0.002) and diagnostics (p = 0.009), while Claude 3.7 excelled in treatment-related content (p = 0.015). Claude 3.7 produced significantly more readable responses than both ChatGPT-4o and Gemini 2.0 across all indices (Flesch-Kincaid, p = 0.002, Gunning Fog, p ≤ 0.001, Coleman-Liau, p = 0.003). ChatGPT-4o scored "excellent" on the DISCERN scale; all models were rated as "good quality with minor shortcomings" on EQIP. Reliability scores did not differ significantly (DISCERN, p = 0.188; EQIP, p = 0.935). Conclusions:LLMs show promise in supporting patient education on AMI. While ChatGPT-4o offers superior accuracy and reliability, Claude 3.7 enhances accessibility through clearer language. This is the first study comparing three LLMs for AMI education in an emergency context, underscoring that physician oversight remains essential for educational applications in emergency medicine.
Introduction:It is common knowledge that the correct application of cardiopulmonary resuscitation (CPR) requires technical skills such as defibrillation, high-quality chest compressions, and efficient airway management. However, scientific research is increasingly underlining the role of appropriate training in nontechnical skills (NTS). Research Aim:This exploratory study aimed to assess the relationship between NTS and the quality of advanced CPR among paramedics. Materials and Methods:The research involved 51 paramedics randomly assigned to 17 three-person teams. Each team participated in a 15-min cardiac arrest scenario. After the first session, the teams were divided into two groups: the intervention group (Group 1), which underwent specialized NTS training, and the control group (Group 2), which did not receive the initial training. Directly after the training phase, all teams from both groups carried out a second attempt during a simulated sudden cardiac arrest (SCA) scenario identical to the first one. Results:The lowest CPR result in the intervention group (Group 1) was Min = -3.00, and the highest Max = 13.00, while in the control group (Group 2), the lowest result was Min = -42.00, and the highest Max = 8.00 (p < 0.05). In Group 1, a statistically significant correlation (p < 0.05) was noted between the change in the NTS score and the change in the CPR result. A higher NTS score was accompanied by a higher CPR score. Conclusions:A short NTS training session was associated with improved NTS application by paramedic resuscitation teams. Furthermore, higher chest compression quality positively correlated with NTS proficiency.
Purpose:Sepsis is a heterogeneous clinical syndrome, and identification of its subphenotypes is essential. We aimed to investigate the correlation between the different trajectories of temperature and outcomes in septic patients. Patients and methods:This was a retrospective cohort study that included sepsis patients admitted to the intensive care unit (ICU) of a tertiary care hospital. Patients' temperature data were collected during the first 48 h after ICU admission, and patients' temperature trajectories were identified using growth-based trajectory modeling (GBTM). A multivariable logistic regression model was performed to assess the independent association of clinical outcomes. External validation was conducted using the MIMIC-IV database. Results:A total of 312 patients with sepsis were included. Four temperature trajectories were identified: hypothermia group (n = 33), fever and rapid temperature drop group (n = 45), persistently elevated temperature group (n = 63), and normothermia group (n = 171). Hypothermia patients exhibited the highest mortality and incidence of hospital-acquired bloodstream infections (HA-BSIs). Multivariable logistic regression showed that compared with the normothermia group, patients in the hypothermia group (OR 2.73; 95% CI 1.10-6.73; p = 0.030) and the persistently elevated temperature group (OR 3.40; 95% CI 1.74-6.67; p < 0.001) had significantly higher in-hospital mortality. Similar subphenotypes were observed in the MIMIC-IV cohort. Further analysis reached similar results in the MIMIC-IV dataset. Conclusion:This study used longitudinal body temperature data to identify the subphenotypes of sepsis, with significant variability in in-hospital mortality and HA-BSI. A better understanding of the temperature trajectory may be helpful in identifying deteriorating septic patients in advance.
Background:The number of patients with implantable cardioverter-defibrillators (ICDs) is steadily increasing, making encounters with ICD-related emergencies more frequent in prehospital care. Paramedics are often the first healthcare professionals to manage these situations; however, data on their exposure to ICD-related emergencies and access to appropriate equipment remain limited. This study aimed to describe Polish paramedics' self-reported experience with ICD-related emergencies and the availability of ICD deactivation magnets in prehospital settings. Methods:A descriptive cross-sectional survey was conducted among Polish paramedics between April and November 2024 using an anonymous online questionnaire. The survey assessed demographic and professional characteristics, self-reported exposure to ICD-related emergencies, perceived familiarity with selected ICD-related concepts, and access to ICD deactivation magnets. Data were analyzed descriptively, with exploratory subgroup analyses performed for selected variables. Results:A total of 340 paramedics participated in the survey. Most respondents reported having assisted patients experiencing ICD discharges, including during cardiopulmonary resuscitation. Self-reported familiarity with ICD-related terminology and ECG features varied across items. Only 7.93% of respondents reported access to an ICD deactivation magnet in their ambulance, most often self-provided rather than officially supplied. Greater professional experience was associated with more frequently reported exposure to ICD-related emergencies. Conclusions:Our study suggests that ICD-related emergencies are commonly encountered in prehospital practice, while access to ICD deactivation magnets remains limited. The findings reflect self-reported experience and perceived familiarity rather than objectively assessed competence and highlight potential system-level considerations for prehospital emergency care.
