Abstract: OBJECTIVES: Pediatric pain is frequently under-recognized and undertreated in prehospital emergency care despite guideline-based recommendations, and practice variation may persist even within standardized emergency medical services (EMS) systems. METHODS: We conducted a prospective, cross-sectional survey of paramedics working in a nationally standardized EMS system in Türkiye to identify latent attitudinal (self-reported) profiles related to pediatric prehospital analgesia and to examine whether profile membership differed by demographic or professional characteristics. Attitudinal items underwent exploratory dimensionality assessment and were then modeled using latent class analysis. RESULTS: Among 129 paramedics, two profiles were identified: proactive/system-oriented (57.4%) and conservative/low-engagement (42.6%). The proactive/system-oriented profile reported higher endorsement of decision-support tools (mobile drug-dosing applications and in-ambulance analgesia algorithms), more consistent self-reported post-analgesia vital sign monitoring, and greater self-reported use of non-pharmacologic adjuncts. The conservative/low-engagement profile reported lower intended engagement with these self-reported practices and greater reliance on perceived barriers. Profile membership was not associated with age, sex, years of EMS experience, or prior training. CONCLUSİON: Distinct attitudinal (self-reported) profiles regarding pediatric prehospital analgesia were identified; whether these profiles translate into objectively observed analgesia delivery requires validation using routine documentation and, where feasible, linked ED outcomes.
Abstract: OBJECTIVES: Undifferentiated prolonged fever presenting to the emergency department (ED) poses significant diagnostic and prognostic challenges, particularly in low- and middle-income countries. We aimed to describe the clinical spectrum and in-hospital outcomes of adults presenting to the ED with undifferentiated prolonged fever and to identify the baseline predictors of mortality. METHODS: In this prospective observational study, consecutive patients aged ≥13 years who fulfilled Durack and Street’s criteria for fever of unknown origin were enrolled between March 2022 and September 2024 at the ED of a tertiary care center in North India. Patients with immunosuppressive states or nosocomial fever were excluded. All patients underwent a standardized diagnostic evaluation guided by potentially diagnostic clues. Baseline demographic, clinical, and laboratory variables recorded at ED presentation, including complete blood count-derived inflammatory indices, were evaluated as potential predictors of in-hospital mortality using receiver operating characteristic (ROC) analysis and multivariable logistic regression. RESULTS: A total of 100 patients were enrolled (mean age: 39 years; 57% male), with a median fever duration of 45 days (interquartile range: 30–90). Infections were the most common etiology (37%), with tuberculosis predominating, followed by malignancies (21%), predominantly advanced hematological malignancies, and noninfectious inflammatory diseases (19%), which frequently presented with multisystem involvement, most commonly systemic lupus erythematosus and Still’s disease. Despite extensive evaluation, 19 patients (19%) remained undiagnosed. Overall, 25 patients (25%) died during hospitalization, with the highest mortality observed among undiagnosed cases (8/19, 42%). In the univariate analysis, neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), aspartate transaminase, and lactate dehydrogenase levels were significantly higher in the mortality group, whereas total protein and albumin levels were significantly lower. ROC analysis demonstrated modest discriminatory ability for NLR (area under the curve: 0.651). In multivariable analysis, admission NLR emerged as the only independent baseline predictor of in-hospital mortality (odds ratio: 1.089 per one-unit increase; 95% confidence interval: 1.006–1.178; P = 0.034). CONCLUSION: Undifferentiated prolonged fever presenting to the ED is associated with substantial in-hospital mortality and diagnostic uncertainty. Admission NLR was independently associated with mortality, but discrimination was modest; it may have adjunctive value for early risk stratification pending external validation.
Abstract: Accurate interpretation of medical literature is essential for evidence-based clinical practice. Among statistical measures, the P value remains one of the most frequently used and most frequently misunderstood concepts in clinical research. Conventionally, a P < 0.05 was considered the primary criterion for determining statistical significance. However, reliance on this threshold alone may lead to overestimation of clinically unimportant findings or failure to recognize clinically meaningful effects in underpowered studies. Recent recommendations emphasize the importance of interpreting P values together with confidence intervals, effect sizes, and study design characteristics. This review discusses the basic principles of P values, common misconceptions, statistical errors, practices that threaten scientific validity, and complementary statistical approaches that can improve clinical interpretation. The aim is to provide clinicians and researchers with a practical framework for evaluating statistical findings in medical studies.
Abstract: Pneumomediastinum is the presence of free air within the mediastinum and may be primary or secondary. Secondary pneumomediastinum typically follows trauma, invasive procedures, mechanical ventilation, or dental interventions using pressurized air; odontogenic causes without prior intervention are exceptionally rare. We report the case of a 52-year-old male with liver cirrhosis who presented with chest and neck pain 2 days after being diagnosed with a dental abscess and receiving antibiotics, with no dental procedure performed. He had fever, cervical swelling with crepitus, odynophagia, and dysphagia. Computed tomography revealed extensive subcutaneous emphysema tracking from the cervical region into the mediastinum, and inflammatory markers were elevated. He was diagnosed with secondary pneumomediastinum complicated by descending necrotizing mediastinitis and underwent mediastinal exploration and surgical drainage. Cultures grew Parvimonas micra . Postoperatively, he required intensive care and mechanical ventilation for 8 days. With culture-directed antibiotics and multidisciplinary management, he recovered fully and was discharged without sequelae. Anaerobic bacterial gas production may contribute to this rare complication. Clinicians should consider secondary pneumomediastinum in patients with chest and neck pain in the setting of odontogenic infection, even without preceding dental procedures, as early recognition, prompt imaging, surgical drainage, and definitive source control are critical for favorable outcomes.
