Emergency Care and Medicine doi: 10.3390/ecm3030026

Authors: Niti Dalal Thierry Edwards Ala Mohsen Abhinav Saxena Keya Desai Abby Tucker Nicole Jones Danielle Tatum Jose Wiley Jamil Borgi Aabha Divya

Background: Sex-based differences in complications after venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are not well defined. We compared 30-day coded acute kidney injury and other short-term outcomes between female and male patients receiving ECMO. Methods: We performed a retrospective multicenter cohort study using the TriNetX U.S. Collaborative Network from 2012 through 2025. Adults with cardiogenic shock supported with VA-ECMO were identified. Patients with a diagnosis-coded AKI (ICD-10-CM N17) recorded on or before the index ECMO procedure were excluded, and female and male cohorts were then matched 1:1 by propensity score on 23 characteristics. The primary endpoint was diagnosis-coded AKI between day 1 and day 30 after ECMO initiation. Secondary endpoints were all-cause mortality, newly diagnosis-coded sepsis, and newly diagnosis-coded ischemic stroke. Results: Among 11,229 adults meeting cohort criteria, 3773 were women, and 7456 were men. After exclusion of 8272 patients with previously coded AKI, 1152 women and 1805 men were eligible, and 1100 patients were matched in each group. Diagnosis-coded AKI occurred in 222 women (20.2%) and 276 men (25.1%) (risk ratio, 0.80; 95% confidence interval [CI], 0.69–0.94; hazard ratio [HR], 0.78; 95% CI, 0.65–0.93; p = 0.005). All-cause mortality was identical between groups (29.5% vs. 29.5%; risk ratio, 1.00; 95% CI, 0.88–1.14). Newly coded sepsis (5.1% vs. 6.3%) and newly coded ischemic stroke (4.0% vs. 3.2%) did not differ significantly. In an unadjusted Aalen–Johansen analysis performed in the unmatched eligible cohorts, the 30-day cumulative incidence of coded AKI was 21.6% among women and 27.8% among men. Conclusions: In this propensity-matched federated electronic health record cohort of adults with cardiogenic shock receiving VA-ECMO and without previously coded AKI, recorded female sex was associated with a lower 30-day risk of diagnosis-coded AKI. Mortality, newly coded sepsis, and newly coded ischemic stroke were similar. These findings are hypothesis-generating and support further investigation of sex-associated differences in datasets with granular renal and ECMO-specific variables.

Emergency Care and Medicine doi: 10.3390/ecm3030025

Authors: Rupam Mitra Jayed Hossain Mahsa Pashaeimeykola Ermias Turuse Jay J. Shen

Background: Sociodemographic and structural inequities shape the risk of alcohol-related harms among underage individuals. This study assessed disparities in alcohol-related emergency department (ED) visits, using the COVID-19 pandemic as a contextual backdrop to examine how these inequities shifted during a period of widespread disruption. Methods: This repeated cross-sectional study used pooled Nationwide Emergency Department Sample (NEDS) data (January 2019–December 2021) for individuals aged 12–20, comparing pre-COVID-19 (January 2019–March 2020) and during-COVID-19 (April 2020–December 2021) periods. Alcohol-related visits were identified via ICD-10-CM codes. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and geographic factors, with interaction terms assessing period-related changes in disparities. Results: Sociodemographic disparities were the primary drivers of alcohol-related ED visits. Native American youth had markedly higher odds than White youth (OR = 3.68, 95% CI: 3.52–3.86), while Black, Hispanic, and Asian youth had lower odds. Uninsured (OR = 1.43) and charity-care youth also showed elevated odds. COVID-19 itself was not significantly associated with overall visits (OR = 1.03, p = 0.053), but disparities widened for Native American youth (OR = 1.20) and narrowed modestly for Black (OR = 1.04) and Medicaid-insured (OR = 1.05) youth, while other disparities remained unchanged. Conclusions: Persistent structural disparities, particularly by race/ethnicity and insurance status, drive underage alcohol-related ED utilization far more than the pandemic itself, underscoring the need for equity-focused prevention strategies targeting systemic barriers to care.

Emergency Care and Medicine doi: 10.3390/ecm3030024

Authors: Catalin Dumitru Cosma Vlad-Olimpiu Butiurca Marian Botoncea Călin-Dragoș Molnar Calin Molnar

Background/Objectives: Emergency abdominal surgery is associated with substantial morbidity and mortality due to disease severity, physiological instability, and limited opportunities for preoperative optimization. Accurate risk stratification is therefore essential for guiding clinical decision-making and resource allocation. This review aims to provide a contemporary overview of predictive models and artificial intelligence (AI) applications for risk stratification in emergency abdominal surgery. Methods: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases. Studies addressing conventional risk assessment tools, predictive modeling, machine learning, deep learning, radiomics, explainable AI, and clinical implementation in emergency abdominal surgery were evaluated. Relevant publications concerning acute appendicitis, acute cholecystitis, intestinal obstruction, emergency laparotomy, abdominal sepsis, and acute mesenteric ischemia were included. Results: Conventional risk assessment systems, including ASA, APACHE II, SOFA, POSSUM, SORT, and NELA, remain widely used but are limited by static risk calculations and restricted adaptability. Recent advances in artificial intelligence have enabled machine learning and deep learning models capable of integrating complex clinical, laboratory, and imaging data to improve prediction of disease severity, postoperative complications, and mortality. The strongest evidence has been reported for acute appendicitis, acute cholecystitis, intestinal obstruction, abdominal sepsis, and emergency laparotomy, where several studies demonstrated excellent discriminative performance, frequently reporting area under the receiver operating characteristic curve (AUC) values exceeding 0.85. Emerging applications of radiomics, computer vision, and explainable artificial intelligence further enhance predictive capability and model interpretability. However, most available models remain retrospective, single-center developments with limited external validation and inconsistent reporting of calibration, highlighting the need for prospective multicenter evaluation before routine clinical implementation. Conclusions: Artificial intelligence has the potential to significantly enhance risk stratification in emergency abdominal surgery by enabling more precise and individualized prediction of adverse outcomes. Although current evidence is encouraging, robust prospective validation and responsible clinical implementation are required before AI-driven predictive models can be routinely incorporated into emergency surgical practice.

Emergency Care and Medicine doi: 10.3390/ecm3030023

Authors: Weiwei Feng Rui Yan Shuixiang Deng

Background: Critically ill patients frequently exhibit concurrent inflammatory activation, nutritional depletion, and immune dysfunction. Although several laboratory-derived indices exist, there is a growing demand for simple, multi-dimensional prognostic markers in acute settings. The CALLY index integrates inflammatory burden, protein reserve, and immune competence. For intensive care practice, its greatest potential lies in rapid, cost-effective bedside risk stratification and dynamic monitoring. Methods: We conducted a systematic narrative review of studies published from January 2021 to February 2026 in PubMed, Web of Science, and Scopus. Eligible studies evaluated the CALLY index in adult populations and reported its association with at least 1 clinical outcome. A total of 56 studies met the inclusion criteria. Given substantial heterogeneity, a structured narrative review was performed rather than meta-analysis, with particular attention to sepsis and critically ill patients. Results: Across disease settings, lower CALLY values were generally associated with worse outcomes. The strongest evidence was observed in oncology and in sepsis/critical illness. Among ICU studies, lower CALLY values were associated with higher short-term mortality and greater disease severity. However, current evidence is limited by predominantly retrospective designs, variable cutoff values, and insufficient external validation of incremental value beyond established tools such as SOFA and APACHE II. Conclusions: CALLY is a simple, accessible composite biomarker for ICU risk assessment. While useful as an adjunct tool, prospective multicenter studies are required to define its optimal timing and incremental clinical utility in critical care.

Emergency Care and Medicine doi: 10.3390/ecm3030022

Authors: Theodore C. Chan Jesse J. Brennan James P. Killeen Edward M. Castillo

Background/Objectives: Glucagon-like Peptide 1 receptor agonists (GLP-1s) have increased in popularity for obesity management and treatment of various metabolic conditions. The medications, however, have significant side effects and carry a risk for adverse events. The objective of this study was to investigate the prevalence of patients taking these medications presenting to the Emergency Department (ED). Methods: We conducted a multi-center retrospective study at two EDs: an urban level 1 trauma center and an academic quaternary medical center (combined annual census approximately 90,000) over a 9-year period (2017–2025). We collected data on all ED encounters involving patients taking GLP-1s, including dual GLP-1/GIP (Glucose-dependent Insulinotropic Polypeptide) agonists, at the time of admission, including demographic information, presenting complaints, comorbidities, and disposition. Descriptive and comparative statistics were used to characterize GLP-1 patient encounters vs. non-GLP-1 patient encounters overall and by diabetes status. The change in encounters over the study period was also assessed. p-values < 0.05 were considered statistically significant. Results: Over the 9-year study period, the proportion of ED encounters involving patients on GLP-1s increased from 0.4% in 2017 to 5.8% in 2025 (p < 0.001). Patients taking GLP-1s were more often female (53.9%), obese (59.4%), and middle-aged, ranging from 35 to 64 years of age (57.3%), and commonly presented with complaints of abdominal or other pain, weakness, or dizziness. Nearly three-quarters of all patients had a Charlson Comorbidity Index (CCI) score of 3 or higher (74.0%). These patients had a higher rate of inpatient admission from the ED (33.5% vs. 23.7%, p < 0.001). Conclusions: The number of patients presenting to the ED who were taking GLP-1s significantly increased over time as these medications became more widely utilized. Patients taking GLP-1s were more often obese with multiple comorbidities and were more likely to be admitted for inpatient care. Further studies are needed to determine whether GLP-1 use independently influences emergency care utilization and the need for hospitalization.

Emergency Care and Medicine doi: 10.3390/ecm3030021

Authors: Colton D. Wayne Sarah J. Chen Taylor H. Jacobs Ethan A. Mills Gail E. Besner Rajan K. Thakkar

Pediatric trauma accounts for 10–20% of all emergency department visits annually in the United States, and both intentional and unintentional injuries contribute significantly to the overall morbidity and mortality associated with trauma in children. Solid organ injuries are often identified, particularly in relation to blunt injury mechanisms, and can lead to serious adverse events if not diagnosed and treated expeditiously. Advancements in diagnostic tools and intervention strategies have improved outcomes for injured children. This review identifies common mechanisms for pediatric solid organ injuries, discusses advances in triage and diagnostic capabilities, and explores treatment options along with intervention innovations for these types of traumatic injuries in the pediatric population.

Emergency Care and Medicine doi: 10.3390/ecm3030020

Authors: Angus Ng Chong Ong Yijun Lim Jean Lee

Background/Objectives: Nursing home (NH) residents who become acutely unwell may frequently be conveyed to emergency departments (EDs). However, at least half of such low-acuity visits could be avoided. Telehealth-supported acute care programmes may potentially reduce unnecessary ED attendances and subsequent hospital utilization. This study aimed to describe a telehealth-based acute care programme for NH residents and to explore a pragmatic method for estimating potential inpatient bed-day savings using publicly available diagnosis-related group (DRG)-based average-length-of-stay (ALOS) data. Methods: A telehealth-based programme was implemented at Sengkang General Hospital (SKH) to support NH staff in the management of acutely unwell residents. NH residents were prospectively tracked for ED non-attendance within 14 days following teleconsultation. Potential inpatient bed-day savings were estimated by mapping teleconsultation diagnoses to relevant DRGs and referencing Singapore Ministry of Health Hospital Bill Size and Fee Benchmarks. Institution-specific and nationally derived ALOS estimates were compared using exploratory Bland–Altman agreement analysis. Results: Over two financial year periods, seven NHs participated in the programme. A total of 726 teleconsultations were conducted, of which 424 encounters were successfully managed within NHs without ED attendance within 14 days (ED non-attendance rate being 58.4%). Using DRG-based estimation, the projected inpatient bed-day savings for FY2023 were 694.31 days using institution-specific ALOS and 805.42 days using nationally derived ALOS estimates. Exploratory Bland–Altman analysis across 34 mapped diagnostic categories demonstrated a mean bias of 0.098 days (approximately 2.4 h), with 95% limits of agreement ranging from −1.31 to +1.51 days. Conclusions: The acute care programme may reduce ED attendances and hospitalizations among NH residents. Publicly available national DRG-based ALOS data may provide a pragmatic approach for estimating the potential inpatient hospital bed-day savings when institution-specific data are unavailable.

Emergency Care and Medicine doi: 10.3390/ecm3020019

Authors: Husna Moola Willem Izak Visser

Background/Objectives: Erythroderma is a rare but potentially life-threatening dermatological emergency characterised by generalised erythema and scaling involving more than 80% of the total body surface area. Erythroderma is associated with significant morbidity and mortality due to systemic complications and diverse underlying aetiologies. Methods: In this narrative review, PubMed was searched up to February 2026. Studies were screened for relevance to emergency physicians, with emphasis on epidemiology, diagnostic approach, and acute management. Non-English publications and conference abstracts were excluded. A total of 122 sources were included in the final synthesis. Results: Erythroderma most commonly results from exacerbation of pre-existing inflammatory dermatoses, drug reactions, infections, or cutaneous T-cell lymphoma. Clinical presentation includes diffuse erythema and scaling affecting ≥80–90% of body surface area, often accompanied by pruritus, systemic symptoms, and signs of organ dysfunction. Systemic complications arise from cutaneous barrier failure and include fluid imbalance, thermoregulatory dysfunction, cardiovascular strain, protein loss, and secondary infection. Initial emergency department management prioritises supportive care, fluid and nutritional optimisation, restoration of skin barrier function, and assessment for organ dysfunction. While a definitive aetiological diagnosis is not always immediately required, certain conditions—particularly severe drug reactions and infectious causes such as staphylococcal scalded skin syndrome—necessitate urgent targeted intervention. Conclusions: Erythroderma represents a syndromic emergency requiring systematic evaluation and early supportive management. Prompt recognition of high-risk aetiologies and timely dermatology referral are essential to optimise outcomes and reduce morbidity and mortality.

Emergency Care and Medicine doi: 10.3390/ecm3020018

Authors: Ryan M. Vincenzo Jacob Zane Hinchey Samantha E. Robinson Mohammod Mahmudur Rahman Hanna K. Jensen Jennifer L. Vincenzo

Background: Non-invasive, real-time hemoglobin monitoring (SpHb) may reduce blood-draw costs and accelerate clinical decision-making. This study evaluated agreement between SpHb (Masimo®) and laboratory hemoglobin (LabHb) in patients with and without dehydration. Methods/Approach: This single-center exploratory cross-sectional study included male veterans. SpHb and LabHb were measured simultaneously. Demographic data, fasting status, and laboratory markers of dehydration were extracted from the electronic health record. Descriptive statistics, correlation analyses, and Bland–Altman analyses were performed. Results: Fifty-three male veterans were included. LabHb ranged from 9.20–17.00 g·dL−1 and SpHb ranged from 9.90–15.90 g·dL−1. Patients with dehydration had higher LabHb (M = 14.54, SD = 1.60) than those without dehydration (M = 13.01, SD = 1.68; p < 0.001). SpHb and LabHb were strongly correlated in non-dehydrated patients (r = 0.82, p < 0.001) but not in dehydrated patients (r = 0.23, p = 0.275). Among non-dehydrated patients, limits of agreement were −1.67 to 2.18 g·dL−1 (~69% within threshold). In dehydrated patients, limits widened to −1.97 to 5.27 g·dL−1 (~25% within threshold), with 70.83% overestimating LabHb (>1 g·dL−1). Conclusion: This exploratory study found a strong correlation and acceptable agreement between SpHb and LabHb in non-dehydrated patients, with substantially reduced agreement in dehydrated patients. Only approximately 25% of measurements in dehydrated patients met predefined agreement limits, indicating clinically meaningful variability. These findings suggest that hydration status may significantly affect SpHb performance. While SpHb may be useful in appropriately selected, hydrated populations, caution is warranted in dehydrated states. Larger, adequately powered studies are needed to further evaluate the impact of hydration and define the optimal patient populations and clinical applications.

Emergency Care and Medicine doi: 10.3390/ecm3020017

Authors: Patience Muwanguzi Simon Isabwe Tumusiime Racheal Nabunya Mark Goodwill Turyabe Douglas Bulafu Gloria Namazzi Racheal Nalule Namutale Angel Kanyange Imelda Namatovu Lois Keren Kisakye Tom Denis Ngabirano

Background: Basic emergency care is an important component of health system strengthening in resource-limited settings in sub-Saharan Africa. Objectives: This scoping review mapped and synthesised evidence on the implementation, capacity-building approaches, and policy implications of the WHO/ICRC Basic Emergency Care (BEC) course in the region. Methods: Twenty studies from 13 countries were included. Reported facilitators of BEC implementation included perceived relevance to frontline practice, practical and structured course content, contextual adaptation, mentorship, and training-of-trainers or cascade approaches. Reported barriers included time constraints, staffing shortages, limited infrastructure and emergency care resources, and technological challenges affecting digital reinforcement strategies. Across studies, BEC was generally associated with short-term improvements in provider knowledge, confidence, and perceived competence. However, implementation outcomes were reported inconsistently and were largely limited to acceptability, feasibility, and appropriateness, with less evidence on adoption, cost, penetration, and sustainability. Evidence on longer-term retention, practice change, patient outcomes, and broader system-level impact remained limited. Conclusions: Overall, BEC appears to be a potentially useful and context-appropriate approach to strengthening frontline emergency care training, but stronger longitudinal and implementation-focused evaluations are needed.

Emergency Care and Medicine doi: 10.3390/ecm3020016

Authors: Shannon Hasara Britnee Innocent Leilani Colon Penelope Henriquez Kristy M. Shaeer

Background/Objectives: Febrile illness in returning travelers presents a diagnostic and operational challenge for emergency medicine clinicians as early symptoms of high-consequence tropical infections often overlap with common viral syndromes. This review synthesizes current evidence to guide frontline clinicians in the systematic evaluation, diagnosis, and management of internally acquired febrile illnesses with a focus on pathogen of greatest relevance to United States (US) emergency departments (ED). Methods: We conducted a narrative review of the literature addressing epidemiology, clinical presentation, diagnostic testing, and management strategies for key travel-associated infections. Special consideration was given to rapid diagnostic modalities, pediatric risk factors, and infections most frequently implicated in returning travelers, including chikungunya (CHIK), dengue virus (DENV) disease, Ebola virus (EBV) disease, malaria, Mpox, typhoid fever (TF), yellow fever (YF), and Zika virus (ZIKV) disease. Results: Effective evaluation begins with a detailed travel and exposure history, recognition of epidemiologic and clinical red flags, and targeted use of rapid diagnostic tests. Malaria remains the most common life-threatening cause of post-travel fever and the only pathogen with reliable Food and Drug Administration (FDA)-cleared rapid testing available in the ED. Arboviral infections such as DENV, CHIK, ZIKV, and YFrequire region-specific consideration and phase-appropriate molecular or serologic evaluation. Emerging and high-consequence pathogens, including Mpox and EBV, necessitate strict infection control measures and coordination with public health authorities. Pediatric travelers, particularly those visiting friends and relatives, face disproportionate risk for severe systemic infections and often require broader diagnostic testing. Conclusions: A structured approach integrating travel history, focused examination, rapid diagnostics, and early recognition of high-risk features is essential to improving outcomes for febrile returning travelers. Strengthened vector control, enhanced vaccination uptake, and global surveillance are critical to reducing future disease burden.

Emergency Care and Medicine doi: 10.3390/ecm3020015

Authors: Chihiro Mori Atsuo Maeda Yasuo Ueda Hiromi Takayasu Yasuhiro Nakajima Jun Sasaki Munetaka Hayashi Kenji Dohi

Background: Isolated gallbladder injuries are rare, especially when initial imaging is normal. Advanced imaging is required to detect delayed complications. Moreover, it is necessary to make an appropriate diagnosis while selecting the most suitable treatment option. Case Presentation: A 49-year-old man fell while cycling and developed worsening abdominal pain. Initial contrast-enhanced computed tomography (CT) scans showed no abnormalities. However, the patient later developed cholangitis and cholecystitis caused by biliary obstruction from a delayed gallbladder hematoma. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were used to diagnose this condition. The patient was initially managed conservatively with antibiotics, which led to temporary symptomatic improvement. Notably, the patient developed a delayed recurrence of suspected acute cholangitis (Grade I) on Day 12 due to hematoma migration. After recurrence, endoscopic nasobiliary drainage was performed as a step-up approach, in accordance with the Tokyo Guidelines 2018 management bundle, to achieve biliary decompression, followed by elective laparoscopic cholecystectomy. Pathological examination revealed chronic cholecystitis with hematoma. Conclusions: Isolated gallbladder injuries should be considered in patients with blunt abdominal trauma. Delayed hematoma formation can lead to biliary obstruction, even without initial CT findings. In such cases, early implementation of MRI and MRCP, along with close clinical monitoring for delayed recurrence, is essential. A strategic “step-up approach” incorporating endoscopic drainage is a safe and effective management option prior to definitive surgery.

Emergency Care and Medicine doi: 10.3390/ecm3020014

Authors: Francisco Ibarra Samantha Williams Patil Armenian Michael A. Darracq

Background: Few studies have assessed the safety and efficacy of discharging emergency department patients with alcohol withdrawal after receiving parenteral phenobarbital. This study aimed to validate this practice and delineate the role of intramuscular phenobarbital for this indication. Methods: This single-center retrospective chart review included adult patients with non-severe alcohol withdrawal, as diagnosed by treating providers based on clinical judgment, who were managed in the emergency department’s low-acuity provider at triage zone, received parenteral phenobarbital, and were discharged within 12 h of arrival. The primary safety and efficacy endpoints were the percentages of patients who expired or re-presented to the emergency department for an alcohol-related diagnosis within seven days of the initial presentation, respectively. A subgroup analysis was performed to compare outcomes between those who only received intramuscular or intravenous phenobarbital. Results: Of the 192 patient encounters included, no deaths were reported. Twenty-one (10.9%) patients re-presented after the initial visit, received treatment, and were discharged home. One (0.52%) patient was admitted following re-presentation. The percentages of patients who re-presented in the intramuscular-only and intravenous-only groups were 8% and 13.5%, respectively (p = 0.25). The total and weight-based doses received were not significantly different between those who did and did not re-present in both the intramuscular-only and intravenous-only groups. The median length of stay in the intramuscular-only and intravenous-only groups was 3.97 h and 5.87 h, respectively (p < 0.001). Conclusions: Our findings suggest that patients presenting with non-severe alcohol withdrawal symptoms may be discharged from the emergency department following receipt of parenteral phenobarbital, without requiring additional outpatient alcohol withdrawal medications. Intramuscular phenobarbital appears to be a viable alternative route of administration and warrants further investigation.

Emergency Care and Medicine doi: 10.3390/ecm3020013

Authors: Koshi Ota Hiroshi Tsuda Kanna Ota Akira Takasu

Background/Objectives: Comprehensive epidemiological studies of bicycle crashes involving all ages in Japan are limited, particularly regarding multiple-rider incidents. This study investigated the epidemiology of single- and multiple-rider bicycle crashes in a Japanese core regional city. Methods: Ambulance transport data from Takatsuki City (1 January 2014 to 31 July 2024) were retrospectively analyzed, including demographics, crash characteristics, and severity of injury for bicycle crash patients. The primary outcome was examination of the epidemiology of bicycle crashes with moderate and severe severity or severe and fatal severity, encompassing both single- and multiple-rider incidents. Statistical tests and logistic regression analysis were used. Results: For 6683 transported patients, 6377 (95.4%) involved single-rider crashes and 306 (4.6%) involved multiple riders. Single-rider crash patients were older and more often male. Moderate or greater injuries occurred in 625 single-rider and 11 multiple-rider crash patients. No severe or fatal injuries occurred in multiple-rider crashes. General roadways and intersections were common crash locations. Male sex and older age predicted greater injury severity in single-rider crashes. Fifty single-rider bicycle crashes resulted in severe or greater severity injuries, and four fatal crashes were recorded. Conclusions: This study uniquely details multiple-rider bicycle crashes in Japan, revealing a lower severity of injuries compared to single-rider crashes.

Emergency Care and Medicine doi: 10.3390/ecm3020012

Authors: José Manuel García-Álvarez Alfonso García-Sánchez

Background/Objectives: Optimization of the frequency and depth of chest compressions is considered essential for effective cardiopulmonary resuscitation in patients with cardiac arrest. Structured debriefing performed after actual or simulated cardiac arrest may help resuscitators maintain chest compression parameters within guideline-recommended ranges. The objective of the present study was to analyze whether Plus/Delta structured debriefing after clinical simulation of cardiac arrest on the duration of chest compressions performed within guideline-recommended frequency and depth ranges. Methods: A quasi-experimental study without a control group was carried out with nursing students. Compression frequency and depth parameters were analyzed in two manikin-based tests separated by the performance of a Plus/Delta structured debriefing. Results: After the intervention, the frequency and depth of chest compressions showed a slight decrease, accompanied by a statistically significant increase in the duration of cardiopulmonary resuscitation within the ranges recommended by the guidelines, although with limited clinical relevance. Conclusions: In this simulated setting, Plus/Delta structured debriefing was associated with a modest increase in the duration during which chest compressions were maintained within guideline-recommended frequency and depth ranges. Given the absence of a control group, these findings should be interpreted as exploratory but suggest a potential educational value of structured reflective debriefing in CPR training.

Emergency Care and Medicine doi: 10.3390/ecm3010011

Authors: Viet Tran

Background/Objectives: Retrospective projects including audits and observational research advance the practice of emergency medicine but face methodological challenges affecting data quality. This guideline presents an 11-step framework to guide the conduct of high-quality retrospective projects, minimizing bias and enhancing reproducibility for clinicians. Methods: The stepped approach mirrors the standard sections of a study protocol but reframes them as guiding questions to make each section’s content and purpose more practical, intuitive, and clear for users. Conclusions: This framework equips clinicians with a practical entry point to retrospective study design, distilling methodological nuances and strategies to bridge theory and application. Systematic adherence promotes rigor, reduces bias, and elevates retrospective chart review from a convenient tool to a robust method for evaluating practice patterns, interventions, and quality improvement in emergency care. Implementation also fosters a culture of evidence-based inquiry essential to advancing emergency medicine.

Emergency Care and Medicine doi: 10.3390/ecm3010010

Authors: Mark K. Hewitt Kurtis Butt Alisha Greer Alison Fox-Robichaud

Background: Lemierre’s syndrome (LS), previously termed the “forgotten disease” after the introduction of modern antibiotics, is a rare and potentially fatal infection of the neck resulting in septic thrombophlebitis of the internal jugular and other neck veins. In recent years, there has been an increased resurgence of this disease, or at least in its detection, and it remains an important diagnosis with life-threatening potential to consider when presenting with multifocal cavitary pneumonia. Fusobacterium necrophorum, an obligate anaerobic Gram-negative bacterium, is the most isolated culprit organism involved in this condition; however, it is often fastidious and difficult to culture. The use of 16s rRNA gene sequencing can aid in this diagnosis when uncertainty exists. Methods: This case report describes an otherwise healthy 17-year-old male with a history of regular vaping presenting with upper respiratory infectious symptoms who was ultimately diagnosed with multifocal necrotizing pneumonia. In this case, there was initial diagnostic uncertainty as traditional microbiologic culture mechanisms failed to identify a causative organism for tailored antimicrobial treatment. This was despite direct empyema fluid analysis and pulmonary-bronchial biopsy. Novel gene sequencing was performed using 16s rRNA typing, a promising new way to identify a catalog of host organisms, detecting F. necrophorum. This diagnosis prompted further diagnostic imaging of the neck, confirming a small internal jugular clot and diagnosis of LS. Results: This case highlights the need for suspicion of LS in patients presenting with multifocal pneumonia. Furthermore, it re-iterates the idea of culture-negative infections, whereby fastidious organisms or tissue samples do not readily provide a diagnosis. Lastly, it further introduces hypotheses regarding the use of vaping as a possible associated factor for significant infection and lung injury. Conclusions: The use of 16s rRNA sequencing for the detection of fastidious, opportunistic organisms is another tool for physicians to ensure additional diagnostic clarity and appropriate treatment.

Emergency Care and Medicine doi: 10.3390/ecm3010009

Authors: Thomas G. Lederer William C. Herring Lama A. Ammar Benjamin S. Abella Donald J. Apakama Ethan E. Abbott Aditya C. Shekhar

Introduction: Large language models (LLMs) have proven effective in many different fields, including the allocation of scarce resources. Triage within emergency departments (ED) is a core process that ensures the sickest patients are seen in a timely manner. Relatively little research has examined the use of existing LLMs in the triage process. Methods: 12 widely available LLMs were provided with real-world patient triage vital sign data from an academic trauma center in a major metropolitan area. The LLMs were asked to assign a triage score to each patient based on this information alone. The deviation between each LLM triage score and the real-world triage score for each patient was calculated, and the absolute value of the deviation was calculated and then averaged across the entire dataset per LLM. The average absolute value of deviation (AAVD) could then be used to compare LLMs against each other. All LLMs were blinded to the real-world triage score and received no additional training or instruction. Results: The models with the highest concordance with real-world triage scores were Claude Sonnet 4.5 (AAVD: 0.37; 62.37% concordance), ChatGPT-5 Instant (AAVD: 0.39; 62.89% concordance), and Claude Opus 4.1 (AAVD: 0.40; 62.37% concordance). The least accurate models were Gemini 2.5 Flash (AAVD: 0.42; 43.81% concordance), ChatGPT-4o Mini (AAVD: 0.49; 45.36% concordance), and ChatGPT-o3 (AAVD: 0.48; 48.45% concordance). Conclusions: This study analyzes the ability of LLMs to triage emergency department patients based primarily on vital sign data. Certain LLMs demonstrated moderate concordance with real-world triage scores. LLMs may be able to synthesize objective vital sign data and provide a triage recommendation. Further study could involve clinical validation against patient outcomes.

Emergency Care and Medicine doi: 10.3390/ecm3010008

Authors: Oluwaseun Adeyemi Tracy Chippendale Gbenga Ogedegbe Dowin Boatright Joshua Chodosh

Background: One in four U.S. adults aged ≥65 years experiences a fall annually, leading to substantial injury and morbidity. Functional limitations may serve as early markers of vulnerability to fall injury. We aimed to estimate temporal trends and the association between functional limitation and fall injuries among community-dwelling older adults. Methods: For this retrospective cohort study, we pooled 2006–2017 National Health Interview Survey data and identified older adult survey respondents. Functional limitation, defined as any reported difficulty performing daily activities, and fall injury, defined as occurring within three months prior to the interview, were measured as binary variables. We controlled for sociodemographic, self-rated health, healthcare access, and physical activity factors. We reported the yearly trend in fall injury and functional limitations and performed survey-weighted univariable and multivariable logistic regression analyses, accounting for potential confounders. Results: Our sample comprised 79,891 older adults, of whom 66% reported functional limitations and 2.3% reported a fall injury within 3 months of their interview. The prevalence of functional limitation increased from 61.8% in 2007 to 68.4% in 2017 (p < 0.001). Also, the fall injury rates ranged from 1.8% to 2.6% during the same period. Older adults with functional limitations were more likely to report fall injuries (3.2% vs. 1.1%, p < 0.001). After adjustment, functional limitation was associated with a two-fold higher odds of fall injury (OR = 2.03, 95% CI 1.71–2.40). Conclusions: Functional limitations are highly prevalent and increasing among older U.S. adults, doubling the likelihood of fall injury occurrence.

Emergency Care and Medicine doi: 10.3390/ecm3010007

Authors: Maya Maxym Kyra A. Len Jannet J. Lee-Jayaram

Foreign body ingestion (FBI) is a common pediatric emergency, particularly among children aged 3–6 years and those with developmental delays. While most ingestions are benign, certain high-risk objects, including button batteries, rare earth magnets, water beads, and sharp objects, require prompt identification and intervention to prevent significant morbidity and mortality. This narrative review synthesizes current epidemiology, injury mechanisms, diagnostic strategies, and evolving management guidelines for these high-risk ingestions, emphasizing the importance of timely intervention, standardized protocols, and ongoing advocacy for product safety and public education.

Emergency Care and Medicine doi: 10.3390/ecm3010006

Authors: Alexa R. Lauinger Amogh Angadi Rishi Hoskeri Brian Ellis Caleb Bowman Wedam Nyaaba Gregory M. Polites Paul M. Arnold

Introduction: Stroke remains the second leading cause of death worldwide and a major cause of long-term disability. Approximately 87% of strokes are ischemic, and 30% of these are large vessel occlusions (LVOs). Early recognition of LVOs and rapid transport to a comprehensive stroke center (CSC) capable of MT are critical to improving outcomes. Accurately predicting LVOs in prehospital settings remains chall29enging. Several triage scales have been developed to aid early detection, but their diagnostic accuracy varies across studies. This study compares the performance of commonly used prehospital LVO scales by pooling published data to identify which tools best support emergency medical services (EMS) in optimizing triage and improving outcomes. Methods: A systematic search, following the Cochrane Library, of PubMed, Scopus, and Web of Science identified studies evaluating prehospital LVO triage scales using standardized search terms. Diagnostic accuracy measurements were extracted, and a pooled analysis was completed to compare scores. Results: From 743 unique articles, 15 studies evaluating prehospital large vessel occlusion (LVO) triage scales were included. Pooled log diagnostic odds ratios (DORs) indicated that RACE demonstrated the highest discriminative performance (2.367 [1.943–2.792]), followed by LAMS (2.228 [1.987–2.470]). The lowest scores were from the PASS (1.992 [1.758–2.227]) and C-STAT (1.886 [1.652–2.119]) scales. Conclusions: Among prehospital triage scales, RACE demonstrated the highest accuracy for LVO detection, followed by LAMS and G-FAST. Variation in scores may indicate inconsistency in performing the tests or the complexity of the questions. These findings support a personalized approach to choosing an LVO identification scale based on the resources available.

Emergency Care and Medicine doi: 10.3390/ecm3010005

Authors: Jacopo Davide Giamello Bianca Miclaus Federica Durando Marco Garnero Salvatore D’Agnano Paola Vietto Mauro Giraudo Giuseppe Lauria

Background: Behavioural cues observed during emergency department (ED) triage may provide additional information on patient acuity. We conducted an exploratory pilot study to investigate whether mobile phone use observed during ED triage was associated with hospital admission. Methods: We performed a retrospective, single-centre study including all adult ED attendances between 1 January 2019 and 30 June 2025. Demographics, triage category, mobile phone use documented by nursing staff during waiting time, and hospital admission were extracted from the electronic health record. The primary outcome was hospital admission, with a secondary analysis restricted to low-priority triage categories. Results: Among 423,267 ED visits, the overall admission rate was 20.9%. Mobile phone use was documented in 171 patients (0.04%), of whom 4.7% were admitted (p < 0.001). In low-priority patients (n = 336,160), admission was 4.5% among those using a phone compared with 13.2% overall (p = 0.001). Conclusions: Mobile phone use observed during ED triage was associated with lower hospital admission rates and may represent a simple behavioural adjunct to conventional triage assessment.

Emergency Care and Medicine doi: 10.3390/ecm3010004

Authors: Giles Barrington Toni Dunbabin Simone Page Lauren Thurlow Lizette Tredoux Viet Tran

Background/Objectives: Emergency department short-stay units (ED SSUs) manage patients requiring short-term observation and treatment. For a small number of patients, a longer hospital admission is required. Care for these patients is provided by an inpatient team and the responsibility for managing acute clinical deterioration falls to a rapid response team, activated by an emergency call. While emergency calls have primarily been a feature of the inpatient setting, admitted patients are increasingly boarding within ED SSUs and the occurrence and impact of emergency calls in this setting remains largely unreported. This study aimed to determine the incidence and characteristics of emergency calls within an ED SSU, describing patient demographics, clinical triggers, and outcomes. Methods: This retrospective cohort study utilised the Tasmanian Emergency Care Outcomes Registry (TECOR) to analyse emergency calls in the ED SSU of a tertiary emergency department between 1 February 2024 and 28 February 2025. Inclusion criteria were defined as adult patients (≥14 years) admitted to an inpatient service who had emergency calls whilst in the ED SSU. Descriptive statistics were used to characterise this cohort. Results: Of 83,238 ED presentations, 11,775 adult patients were transferred to the ED SSU. 1464 (12.4%) of these patients were subsequently admitted under an inpatient service but remained boarding in the ED SSU, with 54 emergency calls occurring in 38 unique patients (2.6%). The median age was 81.5 years (IQR 65–86), older than both the main ED cohort with a median age of 71 years, and median ages of 65 to 69.5 years reported in ward-based cohorts. Most calls were medical emergency team (MET) activations (52, 96.30%) with only 2 (3.7%) code blues. The most common triggers were hypotension (20, 37.04%), reduced level of consciousness (7, 12.96%) and serious concern (7, 12.96%). Delays occurred in 18.52% of calls (mean 82 min). The median ED SSU length of stay for patients having an emergency call was 40.15 h, substantially exceeding the intended ED SSU admission criteria threshold of 24 h. Goals of care remained incomplete in 33.33% of calls, even after emergency team review. Conclusions: ED SSU emergency calls are infrequent but clinically significant, involving an elderly, vulnerable population with late sign triggers and prolonged boarding. These findings highlight fundamental mismatches between patient acuity and ED SSU environment capabilities, emphasising the need for improved monitoring, more selective admission criteria, and enhanced systems for recognising deterioration for patients boarding in ED SSUs.

Emergency Care and Medicine doi: 10.3390/ecm3010003

Authors: Kjersti Amundsen Marie Svanes Elden Lars Myrmel Jörg Assmus Audun Lange Guttorm Brattebø

Background: Not all ambulance missions result in patient transport, often referred to as non-conveyance. However, in some cases, patients discharged at the scene may require further examination and treatment. Patient sex, age, and psychiatric disease seem to be factors associated with non-conveyance. This study aimed to identify and characterise patients not transported following an urgent ambulance mission, and to examine subsequent hospital admission and mortality rates. In addition, we wanted to examine their reasons for calling the Emergency Medical Communication Centre (EMCC). Methods: This retrospective study was conducted for the emergency medical system of Norway’s second-largest city. Data, including information from non-conveyed patients involved in acute or urgent ambulance missions over 1 year, were obtained from the EMCC. The frequency of non-conveyance, patient demographics, and incidence of hospital admissions within 72 h were analysed. Furthermore, the 30-day mortality, predictive factors, and reasons for contacting the EMCC were determined. Results: Out of a total of 22,183 ambulance missions, 7.3% of patients were not conveyed, of whom 5.8% were admitted to hospital within 72 h. The 30-day mortality rate among all non-conveyed patients was 2.4%, whereas 2.1% of hospitalised patients died within 30 days. Psychiatric conditions were frequently observed in both groups. The mortality rate increased significantly with age but was not associated with the number of ambulance requests. Furthermore, 30-day mortality was not significantly associated with sex, time of day, day of the week, or rurality. Conclusions: Our data suggests that there is no difference between the short-term outcomes of non-conveyed and conveyed patients; both groups are equally likely to come to harm. Therefore, the factors influencing non-transportation decisions warrant further investigation. Subsequent events following patient discharge should be routinely collected by ambulance services and monitored for learning and to improve the quality of patient care.

Emergency Care and Medicine doi: 10.3390/ecm3010002

Authors: Natalia Figueroa Kayla Wilson Shannon Hasara Megan Nguyen Heather Schucker Jesse Dubey

Background/Objectives: Rapid sequence intubation (RSI) involves nearly simultaneous administration of a rapid-acting induction agent and a neuromuscular blocking agent (NMBA) to facilitate ideal intubation conditions. The NMBAs most commonly used for RSI are succinylcholine and rocuronium, which cause paralysis for 5–15 min and 45–70 min, respectively. Awareness with paralysis can occur in patients who are given longer-acting NMBAs with delayed initiation of post-intubation sedation or insufficient sedation depth. The previous literature has associated the use of rocuronium with a significantly longer time to sedation and analgesia. However, a recent study found no difference. The purpose of this study was to assess the association between paralytic agent choice and time to initiation of analgesia and/or sedation after RSI in the emergency department (ED) of a large tertiary care hospital. Methods: This study was an institutional review board (IRB)-approved, single-center, retrospective cohort evaluation of adult patients (≥18 years of age) who received succinylcholine or rocuronium following administration of an induction agent in the ED for RSI during the study time period. The primary outcome was time to initiation of post-intubation analgesia and/or sedation. Continuous data were analyzed by using Mann–Whitney U or Student’s t-test, and categorical data were analyzed using the Chi Square test or Fisher’s Exact test. Results: A total of 400 patients were included in this study. The median time to sedation with succinylcholine was 9 min compared to 14 min with rocuronium (p < 0.01). No significant differences were identified in the baseline characteristics or secondary outcomes related to induction agent choice or ED length of stay. Conclusions: The results of this study further support that the use of rocuronium for RSI is associated with a significantly longer time to sedation and/or analgesia, making emergency medicine provider awareness essential for minimizing the risks associated with inadequate post-intubation sedation.

Emergency Care and Medicine doi: 10.3390/ecm3010001

Authors: Rainer Spiegel

Dizziness is one of the most common reasons for presentation to emergency departments (EDs). While excellent reviews exist on distinguishing central from peripheral vestibular causes, the aim of this article is different. Instead of focusing on this classic differentiation, dizziness as a nonspecific symptom will be addressed. Practical considerations will be outlined to help avoid missing red flags. Emphasis is placed on history-taking and clinical examination, supported by statistical reasoning. It will be argued that this approach does not require additional time—an especially valuable resource in the ED—and may even reduce overall time expenditure without compromising diagnostic accuracy.

Emergency Care and Medicine doi: 10.3390/ecm2040057

Authors: Jessica T. Kent Stephen Smith Luke A. Fera

Background: Patients presenting to the Emergency Department (ED) with amphetamine-type stimulant (ATS) use can exhibit a wide range of symptoms, ranging from mild agitation to life-threatening dysrhythmias. Early identification of patients at risk for more severe medical complications after ATS use is a key challenge in emergency care. Objective: To identify clinical and demographic predictors associated with a medical condition among patients presenting to the ED after ATS use. Methods: Retrospective cohort study of patients who presented to the ED with suspected ATS use at a large academic community hospital in Ontario from 1 September 2016 to 31 August 2017. Patients were screened using ICD-10 codes and included if they had a positive drug screen and clinical suspicion for ATS use. Our primary outcome was a composite of recognized complications of ATS toxicity. Predictor variables included age, sex, employment status, mental illness or substance use history, ED administration of benzodiazepines, antipsychotics, or physical restraints. Multivariable logistic regression was used to assess associations. Results: Of 1591 charts reviewed, 128 (8%) met the inclusion criteria. The median age was 29.5 years (interquartile range [IQR]: 23–36), and 50.8% were female. In adjusted analyses, benzodiazepine administration was significantly associated with a medical condition (Odds Ratio [OR] 3.33; 95% CI: 1.31–8.45; p = 0.011) as was employment status (OR 9.30; 95% CI: 1.00–86.03; p = 0.019). Conclusions: Benzodiazepine administration and unemployment were strong predictors of a medical condition among patients presenting to the ED after ATS use. These patients should undergo thorough physical examination and diagnostic testing to identify and manage potentially life-threatening conditions.

Emergency Care and Medicine doi: 10.3390/ecm2040056

Authors: Beau Elshout Noortje Zelis Jacqueline Buijs Peter W. de Leeuw Patricia M. Stassen

Background: D-dimers are frequently elevated in older Emergency Department (ED) patients and often lead to diagnostic dilemmas as specific underlying causes remain unclear. We aimed to investigate the association of elevated D-dimer levels with serious diseases with special focus on occult malignancy in the following 6 months. Methods: In this Dutch prospective cohort study in older (≥65 years) medical ED patients, D-dimer levels were routinely measured upon ED arrival but blinded to clinicians. Associations with serious medical conditions were evaluated using Cox regression, in a real-life clinical context. Results: Among 407 patients (median age 79 years), 69.8% had elevated age-adjusted D-dimers (AADD). Sepsis, ischemia, and venous thromboembolism (VTE) were all associated with AADD, although VTE was present in only 4.2% of patients. In 336 patients without active malignancy, occult malignancy was diagnosed in 9.2% within 6 months, with a time to diagnosis of 5 days. D-dimer levels ≥2000 µg/L predicted occult malignancy (HR of 2.61) and interval likelihood ratios (LRs) increased with higher D-dimer levels (highest LR 2.88). Low D-dimers (<500 µg/L) had very low LR 0.21. Conclusions: Older ED patients frequently have elevated D-dimer levels, and these levels are often associated with non-thrombotic conditions including sepsis, ischemia, and occult malignancy. While elevated levels are associated with an increased risk of occult malignancy, the absolute risk increment is modest. Consequently, routine screening for occult malignancy solely based on D-dimers is not recommended, as most malignancies were diagnosed within a short timeframe. Interestingly, occult malignancy is extremely unlikely in patients with low D-dimer levels.

Emergency Care and Medicine doi: 10.3390/ecm2040055

Authors: Vivek Ganesh Sonar Muhammad Tanveer Jan Abhijit Pandya Mike Wells Gabriella Engstrom Richard Shih Borko Furht

Background/Objectives: Accurate patient weight estimation is critical for safe and effective drug dosing in emergency and critical care settings. Inaccurate estimates exceeding a 10% deviation from true weight can result in significant dosing errors in time-sensitive treatments such as thrombolysis for stroke or urgent sedation. In situations where direct weight measurement is impractical, reliable alternative estimation methods are essential. Methods: We propose a three-dimensional (3D) depth-camera system that employs a convolutional neural network (CNN) pipeline to automatically estimate total body weight (TBW), ideal body weight (IBW), and lean body weight (LBW) from volumetric features derived from a single supine patient image. Our approach was evaluated in a prospective pilot study to assess feasibility and accuracy. CNNs were selected because of their ability to extract spatial features from complex image data, outperforming regression and tree-based models in preliminary comparisons. Results: The results demonstrated that our 3D camera system was more accurate than conventional techniques, including clinician visual estimation (Mean Absolute Percentage Error [MAPE]: 12%), tape-based methods (±8.5%), and anthropometric formulas (±9.2%), achieving a mean error of ±5.4%. Conclusions: Future work will extend this technology to pediatric populations, support integration with automated dosing systems, and explore prehospital applications to further reduce medication errors and enhance patient safety.

Emergency Care and Medicine doi: 10.3390/ecm2040054

Authors: Anwar Al Sayani Abdlnasser Munibari Tayeb Bafadhl Eiman Andragiri Yasser Elghoneimy Mohammed Al-Hariri

Background: This study represents the first registry to assess patients’ clinical characteristics and key predictors of 30-day post-cardiovascular surgery mortality in wartime Yemen. Methods: This study retrospectively analyzed 2169 patients who underwent cardiac surgery. Comprehensive patient data were extracted from Nabdh Al-Hayat Cardiac Center registries across Hadhramaut Governorate, Republic of Yemen, over 7 years from 2018 to 2024. Results: The study cohort comprised predominantly adult patients, with 69% aged 18 years and above, while 31% were under 18 years of age. The overall survival rate was high (95%), yet 5% of the patients experienced 30-day postoperative mortality. Cold cardioplegia and certain solution types were associated with increased mortality. Heart failure and ventricular dysfunction accounted for most mortality, though non-cardiac factors, such as cerebral hemorrhage and multi-organ failure, contributed as well. Conclusions: While Yemen’s crises have devastated healthcare delivery, the 30-day postoperative mortality data highlight the resilience of coordinated efforts. However, current standards remain far from universal benchmarks, highlighting the urgent need to rebuild local capacity and ensure equitable access to cardiac surgical services nationwide.

Emergency Care and Medicine doi: 10.3390/ecm2040053

Authors: Amelia Bevins Catriona Parker Muhuntha Sri-Ganeshan Andrew Underhill Claire Charteris Fergus McGee Biswadev Mitra Gerard O’Reilly Peter Cameron Darshini Ayton

Background: Emergency department (ED) demand is increasing due to rising patient complexity and an aging population complicated by limited access to general practitioners. Virtual emergency departments (VEDs) have been proposed as an alternative to deliver high-quality care for some ED presentations. This qualitative study explores stakeholder experiences with the Southeast Melbourne Virtual Emergency Department to inform future development of telehealth services. Methods: A qualitative study was conducted utilising semi-structured interviews with 24 stakeholders, including emergency physicians, geriatricians, general practitioners, and residential aged care staff. Content analysis was performed to identify key enablers, challenges, and opportunities for improvement. Results: Stakeholders reported that the VED facilitated high-quality care in the community and worked well by coordinating with follow-up services. Themes identified were that the services were particularly beneficial for older adults and palliative care patients. Challenges included technological limitations and some clinician scepticism about delivering care via telehealth. Further integration with community services and standardised telehealth training were identified as opportunities for enhancement. Conclusions: The VED was perceived as an effective model for community-based emergency care. Future implementations should prioritise clinician training, technological infrastructure, and service integration to optimise patient outcomes.

Emergency Care and Medicine doi: 10.3390/ecm2040052

Authors: Panagiotis K. Stefanopoulos Gustavo A. Breglia Christos Bissias Alexandra S. Nikita Chrysovalantis Papageorgiou Nikolaos E. Tsiatis Efrem Serafetinides Dimitrios A. Gyftokostas Stavros Aloizos Georgios Mikros

Gunshot injuries are challenging conditions because of the unique characteristics of the wounding agents producing soft tissue damage that may be compounded by the formation of an expanding temporary cavity (cavitation). Variations in ballistic performance leading to higher energy transfer by the projectile, including bullet tumbling, deformation, and fragmentation, cause increased soft tissue injury and may also lead to more extensive bone comminution compromising local blood supply. Once life-threatening injuries have been excluded or properly addressed, the emergency management of localized trauma from bullets and shotgun pellets may be complicated due to progressive tissue necrosis within the zone of injury. Additionally, the risk of infection should be tackled, especially in high energy bone injuries. War experience suggests a baseline separation between wounds with limited tissue destruction which can routinely be managed as simple penetrating injuries and those resulting from high energy transfer to the tissues involving a substantial amount of necrotic elements surrounding the wound channel which call for a more aggressive surgical approach. A further justification for such a distinction is the need for antibiotic therapy, which varies according to most studies depending on the wounding mechanism, the nature of the wound, and the extent of tissue injury. The emergency physician should also be aware of the possibility of “bizarre” bullet paths resulting in occult injuries of important anatomic structures.

Emergency Care and Medicine doi: 10.3390/ecm2040051

Authors: Amandeep Kaur Revin Thomas

Background: Gerstmann syndrome (GS) is characterised by the tetrad of agraphia, acalculia, finger agnosia, and right-left disorientation, which was first described by Josef Gerstmann in 1924 and is conventionally linked to lesions of the dominant angular gyrus. Contemporary neuroimaging and lesion mapping research indicates that a more dispersed parietal and occipito-temporal network may be involved. Bilateral parietal lobe infarcts are uncommon and usually arise from embolic events or small artery pathology, frequently resulting in multifocal cognitive and perceptual impairments. Method: This case report describes a 52-year-old male presented with acute confusion, perseverative speech, and an inability to follow commands. The neurological examination indicated the presence of the complete Gerstmann tetrad. The Magnetic Resonance Imaging (MRI brain) revealed bilateral parieto-occipital infarcts, with greater severity on the left, indicative of ischaemia in the territory of the posterior cerebral artery (PCA). The medical team provided supportive care and implemented secondary stroke prevention, leading to partial neurocognitive recovery over a period of three weeks. Results: This case highlights a rare presentation of Gerstmann syndrome due to bilateral parieto-occipital infarcts and emphasises that the syndrome can arise from bilateral or widespread parietal injury rather than lesions limited to the angular gyrus. Conclusions: The prompt identification of the Gerstmann constellation helps localise the lesion, enhances diagnostic accuracy, and aids in rehabilitation planning.

Emergency Care and Medicine doi: 10.3390/ecm2040050

Authors: Koulla Parpa Marcos Michaelides

Background/Objectives: This study aimed to assess the anthropometric and body composition characteristics, blood profiles and fitness-related parameters of emergency medical services (EMS) professionals. Methods: A total of 39 EMS professionals participated in the study, consisting of 18 males (age: 37.78 ± 10.62 years, height 180.87 ± 6.00 cm, weight 105.42 ± 25.40 kg) and 21 females (age: 33.05 ± 7.44 years, height 167.29 ± 3.89 cm, weight 90.63 ± 21.20 kg). The testing included anthropometric measurements, blood profiling, handgrip and low back strength assessments, vertical jump evaluation, flexibility testing, sit-up and push-up assessments, as well as timed performance measurements for a 300 m sprint and a 1.5-mile run. Results: According to the body mass index (BMI), 41% of the EMS professionals were classified as obese. Self-reported data indicated a smoking prevalence of 23%, while diabetes (n = 3), asthma (n = 2), and hypertension (n = 2) were also reported. Our results reveal that a great proportion of EMS professionals demonstrated suboptimal body composition and performance levels, with many failing to meet recommended health and performance standards. Elevated BMI, waist and hip circumferences, and body fat percentages were observed, along with relatively low performance in the strength and endurance tests. Conclusions: These findings highlight the need for targeted interventions among EMS professionals, who are expected to maintain adequate levels of aerobic capacity, flexibility, muscular strength and endurance.

Emergency Care and Medicine doi: 10.3390/ecm2040049

Authors: William Mulrooney Caitlin Wilson Richard Pilbery Ruth Fisher Sarah Whiterod Heather Smith Emily Turner Heather Edmonds Peter Webster Graham Prestwich Fiona Bell Rebecca McLaren

Background: Falls in older adults are a leading cause of morbidity, particularly when compounded by polypharmacy. There is mixed evidence of the efficacy of medicine reviews, but there is little work exploring this in the ambulance setting. A new referral pathway enabling ambulance staff to connect patients to primary care pharmacists aimed to address this. This study explored staff and patient experiences with the pathway and its potential to improve medication safety after a fall. Methods: A mixed-method service evaluation was conducted to assess the implementation and impact of this pathway. Routine data from an ambulance trust and pharmacist proformas were used to address objectives relating to referral rates, clinical appropriateness, and fall recurrence. Patient and staff stakeholder perspectives were gathered through two cross-sectional surveys designed to explore emotional, behavioral, and practical responses to the intervention. Quantitative data were analyzed descriptively and using ordinal logistic regression where appropriate. Free-text responses were analyzed thematically. Results: Between May 2019 and March 2020, referrals were initiated for 775 older adults after ambulance attendance for a fall, with pharmacists completing medicine reviews on 340 patients. Survey data revealed improvements in patients’ emotional responses to their medicines. Ambulance clinicians identified patient disclosure, stockpiling, and the presence of expired medicines as key indicators of poor medicines management and valued the ability to refer patients. Conclusions: Overall, referral to the pathway demonstrates a marginal improvement in recontact rates in the short-term but does not necessarily represent an improvement in overall patient safety. The cost of such an intervention and patient expectations need further exploration to prove efficacy and patient satisfaction.

Emergency Care and Medicine doi: 10.3390/ecm2040048

Authors: Abigail Fallas-Mora Jeaustin Mora-Jiménez Kevin Cruz-Mora José Miguel Chaverri-Fernández José Pablo Díaz-Madriz Guillermo Fernández-Aguilar Esteban Zavaleta-Monestel

Background/Objectives: In-hospital cardiac arrest (IHCA) remains a critical event with high mortality, requiring coordinated multidisciplinary response. Return of spontaneous circulation (ROSC) and hospital discharge rates are key quality indicators in resuscitation efforts. In Costa Rica, there is limited published data on team performance, protocol adherence, and the pharmacist’s role in code blue events, despite similar evidence gaps across Latin America. This study aimed to evaluate clinical outcomes and operational performance of in-hospital cardiac arrest events at a Costa Rica hospital. Methods: This retrospective cohort study included 77 adult patients who experienced IHCA at Clínica Bíblica between 2020 and 2024. Data collection was conducted between February and May 2025 from electronic medical records and code blue activation logs. Clinical variables, comorbidities, pharmacologic interventions, and outcomes were analyzed. Predictive models (Charlson Comorbidity Index [CCI], IHCA-ROSC, RISQ-PATH) and Kaplan–Meier survival analysis were applied. Results: ROSC was achieved in 55.8% of patients, and 21% were discharged alive. Asystole was the predominant initial rhythm (76.6%), and comorbidities such as renal disease and myocardial infarction were most frequent. A higher comorbidity burden was significantly associated with lower discharge rates (p = 0.032). Despite 98.7% of patients being classified as low probability for ROSC by the IHCA-ROSC model, observed outcomes exceeded expectations (predicted: 5.53% vs. actual: 55.84%; p < 0.000001). The code team adhered to institutional protocols in 100% of cases, with clinical pharmacists playing a key role in documentation and medication tracking. Conclusions: Structured multidisciplinary response was associated with ROSC rates notably higher than predicted by validated models. Opportunities for improvement include post-event laboratory testing, pharmacist-led documentation, and therapeutic hypothermia in shockable rhythms.

Emergency Care and Medicine doi: 10.3390/ecm2040047

Authors: Kate Kloot Blake Peck Daniel Terry

Background/Objectives: The COVID-19 pandemic caused a widespread shift to remote work, significantly altering child supervision. In Australia, prolonged lockdowns created unique conditions where many parents were working from home while simultaneously caring for children. This study aimed to investigate potential changes in the epidemiology of paediatric injury-related presentations to emergency health services among children in Southwest Victoria, Australia, during the COVID-19 pandemic. Methods: A retrospective cross-sectional study was conducted using deidentified emergency presentation data from ten health services in regional Victoria for children aged 0–14 years between 2018 and 2023. Injury data were analysed across three timeframes (Pre-COVID, COVID, Post-COVID). Chi-squared tests assessed differences in injury presentations by age, gender, and service type. Significance was determined at p < 0.05. Results: A total of 21,072 child injury-related presentations occurred. Males accounted for 57.6% of presentations, with the 10–14 age group comprising 39.8% of cases. During lockdown, injury presentations increased among 0–4-year-old females (from 30.2% to 32.0%), likely reflecting reduced supervision as parents juggled work-from-home responsibilities. Conversely, rates declined among older children, particularly 10–14-year-olds, potentially due to reduced participation in sports and outdoor activities. More than half of all cases (59.1%) were presented to Victorian Emergency Minimum Dataset (VEMD)-reporting emergency departments. Conclusions: The shift to working from home during the pandemic had a measurable impact on childhood injury patterns, particularly among younger children. These findings highlight the importance of considering parental work and childcare arrangements in injury prevention strategies and highlight the benefits of additional regional data to provide a more accurate picture of regional health service use.

Emergency Care and Medicine doi: 10.3390/ecm2030046

Authors: Kyvan Irannejad Logan Hubbard Aditya Narashim Ruben Mora Beshoy Iskander Natdanai Punnanithinont Keishi Ichikawa April Kinninger Suvasini Lakshmanan Sion Roy Donald Chang Matthew Budoff Srikanth Krishnan

Introduction: Chest pain is one of the most common and high-risk presentations in the emergency department (ED), necessitating timely and accurate evaluation to prevent adverse cardiovascular outcomes. Coronary Computed Tomography Angiography (CCTA) has emerged as a promising non-invasive modality with high sensitivity (90–100%) and a negative predictive value (98–100%) for ruling out significant coronary artery disease (CAD), as evidenced by trials such as ROMICAT II and ACRIN-PA. Despite its expanding role in ED triage, further evaluation of its impact on patient-centered outcomes is essential. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between January 2010 and June 2025 were identified from PubMed, Embase, and the Cochrane Library. Eligible studies included randomized controlled trials and prospective cohort studies assessing CCTA in ED patients with suspected acute coronary syndrome (ACS), compared with alternative diagnostic strategies, and reporting outcomes, including diagnostic accuracy, time to diagnosis, ED discharge rates, hospital admissions, and cost-effectiveness. Results: Twenty-three studies comprising over 60,000 patients were included. CCTA in low- to intermediate-risk patients significantly reduced diagnostic time (up to 54%), increased early ED discharges, and lowered unnecessary admissions. It consistently demonstrated excellent diagnostic performance, with pooled sensitivity ≥90% and near-perfect negative predictive value. Economic evaluations showed reduced costs due to shorter ED stays and less downstream testing. Challenges included radiation exposure, contrast use, and incidental findings. Conclusions: CCTA enhances ED efficiency and safety in ACS evaluation, offering accurate CAD exclusion and resource optimization. Future studies should explore its long-term cost-effectiveness and integration into high-sensitivity troponin protocols.

Emergency Care and Medicine doi: 10.3390/ecm2030045

Authors: Giacomo Spaziani Gloria Rozzi Silvia Baroni Benedetta Simeoni Simona Racco Fabiana Barone Mariella Fuorlo Francesco Franceschi Marcello Covino

Mild traumatic brain injury (mTBI) remains a clinical challenge, particularly in cases with normal computed tomography (CT) findings but persistent or evolving symptoms. Conventional diagnostic approaches relying solely on clinical criteria and neuroimaging often lack adequate sensitivity and may lead to unnecessary radiation exposure. Recent advances in biomarker research have identified several blood-based proteins such as glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), S100 calcium-binding protein B (S100B), Tau protein, neuron-specific enolase (NSE), and neurofilament light chain (NFL) as potential tools for improving diagnostic precision and guiding clinical decisions. In this study, we synthesize current evidence evaluating the diagnostic and prognostic utility of these biomarkers using sensitivity, specificity, negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). GFAP and UCH-L1 have shown high sensitivity in detecting intracranial lesions and are now FDA-cleared for emergency department triage within 12 h of injury. While S100B remains widely investigated, its low specificity limits its application beyond select clinical scenarios (i.e., in patients without polytrauma). Additionally, Tau, NSE, and NFL are emerging as prognostic markers, with studies suggesting associations with persistent symptoms and long-term neurocognitive outcomes. Overall, the integration of biomarker-based data into clinical workflows may enhance early mTBI diagnosis, reduce reliance on imaging, and enable individualized follow-up and prognostic stratification. Future research should refine optimal sampling windows and explore multimarker panels to maximize diagnostic and prognostic performance.

Emergency Care and Medicine doi: 10.3390/ecm2030044

Authors: Anne Marie Lund Jesper Juul Larsen Thomas A. Schmidt

Background: Brain computed tomography (CT) is the primary imaging modality for patients with acute neurological complaints in emergency departments, despite having a low diagnostic yield for many conditions. This study aimed to assess the common indications for brain CT, evaluate the prevalence of acute pathologies, and explore whether certain patient groups may be overexposed to unnecessary scans, impacting both patient safety and healthcare costs. Methods: We conducted a retrospective review of brain CT requests from the General Emergency Department in a single center over a one-month period. We recorded patient demographics (sex, age), scan indications, presence of focal neurological symptoms, acute pathology on CT, and final diagnoses. Descriptive statistics, including means ± SEM, were calculated using GraphPad Prism version 10.4.1. Results: A total of 584 brain CT scans were requested, of which 532 (91.1%) were normal, and 52 (8.9%) showed acute pathology. The age of all included patients were 70.8 ± 0.7 years with women (n = 304, 52.1%) being 71.9 ± 1.0 years old and men (n = 280, 47.9%) 69.7 ± 1.0 years old (p > 0.1). The most common indication for CT was head trauma (265, 45.4%) followed by ischemic stroke (130, 22.3%). The most frequent pathologies were ischemic stroke (2.7%), subdural hematoma (1.7%), and other traumatic bleeds (1.7%). Of the 52 patients with acute pathology, 42 (80.8%) exhibited focal neurological deficits. Conclusions: 91.1% of the brain CT scans in the emergency department were normal and did not lead to further intervention. While this may indicate a low diagnostic yield in certain patient groups—particularly those presenting with mild or nonspecific neurological symptoms—it does not alone confirm overuse. These findings highlight the importance of careful clinical evaluation to optimize imaging decisions. Reducing potentially unnecessary brain CT scans could lower healthcare costs and minimize radiation exposure, but the health-economic impact depends on balancing the savings with the potential costs of missing critical diagnoses and the associated societal consequences.

Emergency Care and Medicine doi: 10.3390/ecm2030043

Authors: Boon Ping Ting Corinne Yee Lyn Lau Puneet Seth Jean Mui Hua Lee Shao Hui Koh

Background: Dengue fever is a global health problem and is endemic in Singapore, with a high economic burden. Neurological manifestations of dengue fever, although rare, are being increasingly reported. Ischemic stroke as a complication of dengue fever has rarely been reported. Methods: This case report describes a case of ischemic cerebellar infarct during the recovery phase of secondary dengue fever with a review of similar cases previously described in the literature. Results: This is the first known case report of cerebellar ischemic stroke in Singapore following dengue fever, where Magnetic Resonance Angiography (MRA) demonstrated a possible occlusion or severe stenosis of a cerebral artery as the underlying pathophysiology of dengue-associated stroke. Dengue fever has been shown to increase the incidence of stroke. Conclusions: Physicians in dengue-endemic areas need to have a high index of suspicion to consider this diagnosis, especially in patients with dengue fever who present with neurologic deficits.

Emergency Care and Medicine doi: 10.3390/ecm2030042

Authors: Jessica Wimberly Clates Adams Chad Gorbatkin

Precipitous deliveries in the emergency department are one of the highest-acuity events that emergency providers manage. These deliveries can range from uncomplicated to wrought with difficulty. They require emergency care providers to manage intrapartum complications, such as nuchal cords, shoulder dystocia, and breech presentation, and maternal complications such as uterine atony, birth canal trauma, and postpartum hemorrhage. Delivery may additionally necessitate resuscitative hysterotomy or neonatal resuscitation. Our narrative review discusses preparatory practices, normal labor and delivery progression, and brief guidelines for managing complications of precipitous deliveries for emergency medicine providers.

Emergency Care and Medicine doi: 10.3390/ecm2030041

Authors: Sara Fouad Mahmoud Ashraf El Malik Ziad Ibdah Mohamed Saudi Guillaume Alinier Mohamed Omar Saad

Objectives: Body packing is one of the methods used to smuggle illicit drugs and items. Identifying the drug and eradicating drug packs are essential tasks to complete in the shortest possible time to reduce the risk of toxicity. Polyethylene glycol is one of the safer laxatives to use if surgical exploration is not indicated. The objective of this study is to evaluate the association of the dose of polyethylene glycol (PEG) and the length of hospital stay and/or time for body packers to evacuate drug packs. Methods: This is a retrospective analysis completed at Hamad Medical Corporation in Qatar, studying adult patients who received polyethylene glycol to evacuate drug packs from January 2018 to September 2019. Results: The primary and secondary outcomes are association between PEG doses and length of hospital stay and time to drug pack clearance, respectively. There were a total of 39 patients included in this study. A minority of patients developed signs of systemic toxicity. The average hospital length of stay for all patients was 86.2 h. The results show that the PEG dose at 12 h is inversely proportional to the length of hospital stay where each extra 1 g will decrease length of hospital stay by 0.098 h. The results are even more statistically significant when analyzed compared to time to clearance with a regression coefficient of −0.136 (p = 0.022). Conclusions: This study shows that a higher polyethylene glycol dose, especially at 12 h, is safe and reduces the time needed to clear drug packs and reduces length of hospital stay.

Emergency Care and Medicine doi: 10.3390/ecm2030040

Authors: Colton D. Wayne Taylor H. Jacobs Kyle Alexander Zachary Dumbauld Siddharth Narayanan Omar Rokayak Forrest O. Moore

The ability to provide ambulatory and mobile surgery services in rural and austere environments has seen tremendous growth in recent decades due to innovations in surgical techniques and equipment. These advances have been implemented in both civilian and military settings, increasing the capabilities of surgeons and surgical subspecialists across the globe. This review aims to briefly explore the history of ambulatory and mobile surgery and describe the recent efforts to make advancements in this field to improve global surgery opportunity and access, as well as to provide an overview of both military and civilian utilizations of mobile surgical teams and strategies.

Emergency Care and Medicine doi: 10.3390/ecm2030039

Authors: Cesar Jiménez-Méndez Ana Lara-Palomo Ana Pérez-Asensio Luis Martín-Alfaro Mauricio Urgiles Rafael Vázquez-García Livia Gheorghe

Cardiogenic shock is a life-threatening, time-sensitive syndrome characterized by clinical and biochemical tissue hypoperfusion caused by circulatory failure secondary to inadequate cardiac output. Inadequate cardiac contractility secondary to acute myocardial infarction appears on the top of the list of the most prevalent etiologies of this syndrome. Despite some advances in its management, this primary cardiac disorder still has an extremely high mortality. In addition to treating the main etiology, immediate hemodynamic support is necessary to reduce the risk of developing multi-organ dysfunction and to preserve cell metabolism, as soon as we suspect it, even when needed in the catheterization laboratory. The cardiac catheterization laboratory has become a pivotal setting for implementing rapid hemodynamic support measures, such as pharmacological interventions and mechanical circulatory support, during critical procedures. Despite inotrope pharmacological treatment, mechanical circulatory support has recently garnered significant interest in this field. The aim of this review is to analyze hemodynamic support in cardiogenic shock in the most common contemporary scenario: the cardiac catheterization laboratory.

Emergency Care and Medicine doi: 10.3390/ecm2030038

Authors: Simone Gianazza Marika Morabito Davide Inversini Sabrina Garbarino Marta Ripamonti Giuseppe Ietto Giulio Carcano

In the original publication [...]

Emergency Care and Medicine doi: 10.3390/ecm2030037

Authors: Salma Guerrero Miranda Ifoma Ofoegbuna Maicuc Tran Ada Selina Jutba Christine Vo

Background/Objectives: This study aims to compare the safety of tenecteplase versus alteplase for acute ischemic stroke. Methods: This was a multicenter, retrospective cohort study including 11 Memorial Hermann Health System hospitals in Houston from 7 December 2022 to 7 June 2023. Adults presenting with an acute ischemic stroke who received alteplase or tenecteplase were included in this study. The primary outcome was the incidence of hemorrhagic conversion after 24 h of thrombolytic administration. Secondary outcomes included door-to-needle time, incidence of a major or minor bleed, length of hospital stay, incidence of any adverse effect, modified Rankin score at discharge, patient discharge disposition, medication cost, and mortality. Results: A total of 173 patients were reviewed, with 87 patients in the tenecteplase group and 86 patients in the alteplase group. Gender, actual body weight, and use of aspirin or dual antiplatelet therapy within 24 h of thrombolytic administration were statistically disproportionate between both groups. Hemorrhagic conversion occurred in seven patients in the tenecteplase group and eight patients in the alteplase group (p = 0.79). Medication cost was statistically significant between both groups. All other secondary outcomes were similar between tenecteplase and alteplase. Conclusions: In this underpowered study, we did not observe a statistically significant difference in the rate of 24 h hemorrhagic conversion between the tenecteplase and alteplase groups. Further studies with a large sample size are warranted to assess safety outcomes.

Emergency Care and Medicine doi: 10.3390/ecm2030036

Authors: Adithya Shyamala Pandian Bhavesh Patel Karam Abi Karam Amelia Lowell Kelly McKay Sabrina Jimena Mora Piyush Hota Gabriel Pyznar Sandra Batchelor Charles Peworski David Rivas Devang Sanghavi Ngan Anh Nguyen Aliaa Eltantawy Xueqi Li Xiaojun Xian Michael Serhan Erica Forzani

Objectives: This study evaluates the efficacy of existing and new aerosol mitigation methods during nebulization (Neb) in combination with high-flow nasal cannula (HFNC) oxygen supplementation and non-invasive ventilation (NIV). Methods: We recorded fugitive aerosol particle concentrations over time and assessed the peak (P) and area (A) efficacy of active and passive mitigation methods, comparing them to a no-mitigation condition. Peak efficacy was measured by the reduction in maximum aerosol concentration, while area efficacy was quantified by the reduction of the area under the aerosol concentration–time curve. Results: For HFNC with Neb, we found that active mitigation using a mask with a biofilter and a fan (referred to as the aerosol barrier mask) significantly outperformed passive mitigation with a face mask. The peak and area efficacy for aerosol reduction were 99.0% and 96.4% for active mitigation and 35.9% and 7.6% for passive mitigation, respectively. For NIV with Neb, the active mitigation method, using a box with a biofilter and fan, also outperformed passive mitigation using only the box. The peak and area efficacy for aerosol reduction were 92.1% and 85.5% for active mitigation and 53.7.0% and 25.4% for passive mitigation, respectively. Conclusion: We concluded that active mitigation set up systems advantageous for effective reduction of airborne aerosols during aerosol generated procedures.

Emergency Care and Medicine doi: 10.3390/ecm2030035

Authors: Santiago Cardona-Collazos Sandra Olaya-Perea Laura Fernández Dylan Griswold Alvaro Villota Sarita Aristizabal Elizabeth Ginalis Diana Sanchez Angelos Kolias Peter Hutchinson Andres M. Rubiano

Background/Objectives: Traumatic brain injury (TBI) is a global public health concern, affecting over 60 million people annually. It is associated with high rates of mortality and disability, particularly among young and economically active individuals, and remains the leading cause of death in people under 40 years of age. Although computed tomography (CT) is the standard method for excluding intracranial bleeding (ICB), it is frequently unavailable in resource-limited settings where the burden of TBI is greatest. The InfraScanner 2000 is a near-infrared spectroscopy (NIRS) device designed to detect ICB and may serve as a triage tool in environments without access to CT imaging. This study aimed to evaluate the diagnostic performance of the InfraScanner 2000 for detecting ICB in the emergency department (ED) of a trauma center in a cohort of Colombian patients with TBI. Methods: This prospective study was conducted in Cali, Colombia, between December 2019 and February 2021. Adult patients presenting to the ED with blunt TBI were enrolled. InfraScanner assessments were performed according to a standardized protocol, and all participants underwent head CT within 6 h of injury. Results: A total of 140 patients were included. Of these, 66% were male and 34% were female. Most patients (63.57%) were between 18 and 39 years old, with a median age of 39 years (IQR: 18–86). The InfraScanner demonstrated a sensitivity of 60.0% (95% CI: 32.5–84.8), specificity of 78.4% (95% CI: 71.2–85.6), positive predictive value (PPV) of 25.0%, and negative predictive value (NPV) of 94.2% for detecting ICB. Conclusions: The InfraScanner 2000 showed good specificity and high NPV in identifying ICB among Colombian patients with TBI. These findings suggest it could serve as a useful triage tool to support decision-making in emergency settings with limited access to CT imaging.

Emergency Care and Medicine doi: 10.3390/ecm2030034

Authors: Alan Wang

There was an error in the original publication [...]

Emergency Care and Medicine doi: 10.3390/ecm2030033

Authors: Davide Inversini Sara El Adla Andrea Vigezzi Simone Gianazza Marika Morabito Andrea Rizzi Andrea Palillo Giuseppe Ietto Giulio Carcano

Background: Several studies have suggested that laparoscopic peritoneal lavage for the treatment of diverticulitis might be associated with an increased event rate. The WSES (World Society of Emergency Surgery) guidelines recommend performing laparoscopic peritoneal lavage only in highly selected patients; however, selection criteria remain poorly described. This study, based on a single-center retrospective cohort of patients presenting with acute diverticulitis and undergoing surgery, aimed to assess the complication and long-term outcomes of the lavage group and to report our experience with the treatment of acute diverticulitis. Methods: Operative management of acute sigmoid diverticulitis was involved, in particular, laparoscopic peritoneal lavage, primary resection, and the Hartmann procedure. Results: Six-month follow-ups showed the occurrence of Clavien–Dindo complications in ≥2 in 21.9% of patients in the sigmoidectomy group versus 61.1% of patients in the lavage group (p = 0.0028). Among the 11 patients with complications after laparoscopic lavage, 9 required a second surgery. After a comparison between the patients with complications and those without who were managed with laparoscopic lavage, descriptive differences were found regarding the BMI (95% CI, 21.7–24.3 vs. 95% CI, 24.7–31.3, p = 0.0419). In analysis, a BMI of ≥27 kg/m2 (OR, 16 p = 0.049) was associated with short- and long-term complications in the lavage group. There was no evidence for an association between complications and a BMI of ≥27 kg/m2 in the primary resection (OR, 1.61 p = 1) or the Hartmann procedure group (OR, 4.25 p = 0.1438). Perforated colonic diverticulitis treated with laparoscopic peritoneal lavage was associated with a high morbidity rate. Conclusions: The choice of surgical strategy for acute diverticular pathology is complex, influenced by various conditions. BMI could be a prognostic factor for long-term outcomes, including recurrent diverticulitis and the occurrence of abscesses.

Emergency Care and Medicine doi: 10.3390/ecm2030032

Authors: Niharika Goparaju Danielle P. Yarbrough Gretchen Fuller

Background/Objectives: A 2-year-old male presented to the emergency department (ED) with vomiting and abdominal discomfort following ingestion of multiple magnets from a sibling’s bracelet. This case highlights the risks associated with magnet ingestion and the need for coordinated multidisciplinary care and public health intervention. Methods: Radiographs revealed magnets in the oropharynx, stomach, and small bowel. Emergency physicians coordinated care with otolaryngology, gastroenterology, and general surgery. Results: Laryngoscopy successfully removed two magnets from the uvula, and endoscopy retrieved 30 magnets from the stomach. General surgery performed a diagnostic laparoscopy, identifying residual magnets in the colon. Gastroenterology attempted a colonoscopy but was unable to retrieve magnets due to formed stool, leading to bowel preparation and serial imaging. The patient eventually passed 12 magnets per rectum without surgical intervention. Conclusions: This case emphasizes the importance of multidisciplinary collaboration in managing magnet ingestion, a preventable cause of serious gastrointestinal injury. Recent studies highlight the increasing incidence and severity of such cases due to accessibility and inadequate regulation. These findings underscore the need for public awareness and adherence to management protocols to mitigate morbidity and mortality in pediatric patients.

Emergency Care and Medicine doi: 10.3390/ecm2030031

Authors: Samuel Ayala Eric R. Abrams Lawrence A. Melniker Laura D. Melville Gerardo C. Chiricolo

Background/Objectives: The goal of educators is to leave no learner behind. Ultrasounds require dexterity and 3D image interpretation. They are technologically complex, and current medical residency programs lack a reliable means of assessing this ability among their trainees. This prompts consideration as to whether background characteristics or certain pre-existing skills can serve as indicators of learning aptitude for ultrasounds. The objective of this study was to determine whether these characteristics and skills are indicative of learning aptitude for ultrasounds. Methods: This prospective study was conducted with third-year medical students rotating in emergency medicine at the New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA. First, students were given a pre-test survey to assess their background characteristics. Subsequently, a psychomotor task (Purdue Pegboard) and visual–spatial task (Revised Purdue Spatial Visualization Tests) were administered to the students. Lastly, an ultrasound task was given to identify the subxiphoid cardiac view. A rubric assessed ability, and proficiency was determined as a 75% or higher score in the ultrasound task. Results: In total, 97 students were tested. An analysis of variance (ANOVA) was used to ascertain if any background characteristics from the pre-test survey was associated with the ultrasound task score. The student’s use of cadavers to learn anatomy had the most correlation (p-value of 0.02). Assessing the psychomotor and visual–spatial tasks, linear regressions were used against the ultrasound task scores. Correspondingly, the p-values were 0.007 and 0.008. Conclusions: Ultrasound ability is based on hand–eye coordination and spatial relationships. Increased aptitude in these abilities may forecast future success in this skill. Those who may need more assistance can have their training tailored to them and further support offered.

Emergency Care and Medicine doi: 10.3390/ecm2030030

Authors: Christoph Strauss Michael Schmid Daniel Kliem Martin Müller

There was an error in the original publication [...]

Emergency Care and Medicine doi: 10.3390/ecm2030029

Authors: Nick D. Clement Rosie Clement Abigail Clement

Background: Hip fractures are a major cause of morbidity and mortality, particularly in the elderly, and the incidence is expected to rise significantly in the coming years. One of the key challenges in managing hip fracture patients is perioperative blood loss, which often necessitates allogeneic blood transfusion. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has been shown to reduce blood loss in various surgical settings, including elective orthopaedics. However, unlike elective surgery where bleeding begins intraoperatively, bleeding in hip fracture patients starts at the time of injury. This scoping review aimed to evaluate the existing literature on the use of early TXA administration, specifically at the point of admission, in patients with hip fractures. Methods: A comprehensive search of EMBASE and PubMed was conducted up to March 2025, and eight studies were identified that met the inclusion criteria, including three randomised controlled trials (RCTs). Six of these studies compared patients receiving TXA on admission to controls who received no TXA, involving a total of 840 patients. Most studies focused on extracapsular fractures in elderly, predominantly female patients. Results: Findings were mixed: four of the six studies found no statistically significant differences in haemoglobin levels or transfusion rates, while two RCTs demonstrated significantly reduced transfusion needs in the TXA group. Trends across studies suggested reduced blood loss and transfusion risk with TXA administered on admission. Importantly, no increase in complications, including venous thromboembolism, were observed. Conclusion: Early TXA administration in hip fracture patients appeared to be safe and may reduce transfusion requirements. Further high-quality research is warranted to determine the optimal timing and dosing strategy for TXA in this setting and to confirm the efficacy in reducing perioperative blood loss and transfusion risk.

Emergency Care and Medicine doi: 10.3390/ecm2020028

Authors: Isabel Rabiais Adília Rosas Luís Sousa Susana Gonçalves Paulo Monteiro Sérgio Deodato Sandy Severino

Background/Objectives: The objective of this review is to map nurses’ responsibilities in addressing individuals who are victims of violence, specifically in the preservation of forensic evidence in both intra- and extra-hospital contexts. The research question is as follows: What are a nurse’s responsibilities regarding the care of victims of violence for the preservation of forensic evidence in in-hospital and out-of-hospital emergencies? Methods: The mnemonic PCC (P-Population, C-Concept, and C-Context) method was followed according to the recommendations of the Joanna Brigs Institute (2024). The population is defined as “individuals who are victims of violence”, the concept (phenomenon of interest) as “nursing interventions determining responsibilities in forensic evidence preservation”, and the context as “intra- and extra-hospital emergencies”. A search was conducted in the following databases: CINAHL Complete via EBSCO Host, Medline Complete via EBSCO Host, PubMed, Web of Science, and RCAAP via B-ON. From the total articles retrieved, 18 were selected for analysis. Results: The 18 articles emphasized the critical role of nurses in preserving forensic evidence in both intra- and extra-hospital contexts. These findings were grouped into six domains to clarify the topic: (1) knowledge and training of nurses on forensic evidence preservation and the implementation of standardized protocols; (2) collection of biological and non-biological samples to preserve evidence on the victim’s body; (3) collection of biological and non-biological samples to preserve evidence on the victim’s objects and belongings; (4) documentation of forensic traces and evidence; (5) maintenance of the chain of custody; and (6) ongoing interprofessional collaboration between nurses, law enforcement, and judicial authorities. Conclusions: Intra- and extra-hospital emergencies, teams must be proficient in recognizing victims of violence and in conducting appropriate evidence preservation to ensure their legal admissibility.

Emergency Care and Medicine doi: 10.3390/ecm2020027

Authors: Raimundas Lunevicius

After organisational and preparatory work in 2023, Emergency Care and Medicine (ECM) was launched in 2024, culminating in the journal’s formal recognition by the Directory of Open Access Journals (DOAJ) on 17 January 2025, https://doaj [...]

Emergency Care and Medicine doi: 10.3390/ecm2020026

Authors: Maryum Merchant Scott B. Hu Chris Miller Tamana Ahmadi Edwin Garcia Malcolm I. Smith

Severe burns are among the most traumatic injuries, characterized by tissue damage, systemic inflammation, significant fluid shifts, and a high risk of complications such as infections, organ failure, anemia, malnutrition, and psychological trauma. This article reviews recent literature from the PubMed and Google Scholar databases to outline critical components of burn care, from initial resuscitation and stabilization through rehabilitation. Key topics include early airway management to prevent respiratory compromise, meticulous fluid resuscitation to maintain tissue perfusion while avoiding complications like fluid overload, and optimal pain management. It also discusses nutritional support tailored to the burn patient’s hypermetabolic state and surgical techniques like early debridement and skin grafting. Beyond physical recovery, the review emphasizes the importance of addressing the psychological impact of burn injuries, including depression, anxiety, and post-traumatic stress, which can significantly affect long-term outcomes. By integrating the expertise of a multidisciplinary team with a personalized approach and practical recommendations, this review aims to provide clinicians with a comprehensive framework for managing severe burns, from the initial emergency response to the challenges of inpatient care and, finally, rehabilitation.

Emergency Care and Medicine doi: 10.3390/ecm2020025

Authors: Som Singh Kiera Borthwick Rebecca Martin Demetrius Collins Christopher Shaw

Background: Concussion education for athletes can improve long-term outcomes in injury prevention. As a contact sport, Quadball has seen tremendous growth in its player population over the past decade. However, there is a paucity of understanding of sports injury epidemiology in these sports compared to other contact sports in the world. The aim of this study is to describe the attitude, knowledge, and awareness of concussions among Quadball players in the United States. Methods: This study implemented a cross-sectional methodology. Specifically, a modified version of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) was introduced to Quadball participants to address the primary aim of this study. Results: A total of 237 Quadball players participated in this study. In this cohort, 57.8% of participants reported having some form of prior concussion training or education. A cumulative 77.0% accuracy of concussion knowledge index questions was found among participants. Conclusions: The findings of this study indicate that the knowledge of sports concussions in Quadball may be greater than or comparable to that of other contact sports in the United States.

Emergency Care and Medicine doi: 10.3390/ecm2020024

Authors: Silvia Fattori Gabriele Bellio Matteo Maria Cimino Hayato Kurihara

Pneumothoraces are a common and potentially severe condition in the emergency setting. Various pathophysiological mechanisms (spontaneous and traumatic) could be involved, consequently defining the diagnostic–therapeutic pathway. Understanding these underlying etiologies is essential for advancing diagnostic strategies and guiding therapeutic measures. Recent insights into diagnostic and therapeutic strategies focus on the role of ultrasound and the effectiveness of small-bore chest tubes in managing all types of pneumothoraces with a reduced risk of complications. Moreover, observation is emerging as a possible conservative approach in hemodynamically stable patients regardless of the etiology of the pneumothorax. This review aims to provide a valuable resource to improve diagnostic and therapeutic management, comparing traditional methods and promising, less invasive therapeutic interventions.

Emergency Care and Medicine doi: 10.3390/ecm2020023

Authors: Justin Grad Keean Nanji Reese Kapusta Tony Jin Merve Kulbay Stuti M. Tanya Femida Kherani

Background: Musculoskeletal (MSK) discomfort is a significant occupational hazard for eye care professionals, including ophthalmologists, who report high rates of MSK discomfort. This systematic review investigated the impact of various interventions, such as regular exercise, posture-correcting aids, and surgical heads-up displays, on reducing MSK pain in the operating room. Methods: This review was reported following PRISMA guidelines and was prospectively registered in the PROSPERO database (CRD42024559189). A systematic literature search was conducted of Embase, MEDLINE, and Web of Science from inception to 2024. Included studies were categorized as exercise modifications, equipment modifications, or training aids. All MSK pain-related outcomes from any time point were extracted. Risk of bias was assessed using the Murad tool, the Cochrane risk-of-bias tool for randomized trials (RoB 2), and the Risk Of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) tool. Results: The systematic search strategy identified 2276 studies, of which 53 qualified for full-text screening with 13 resultant studies including 712 eyecare specialists. Physical activity was found unanimously to reduce MSK pain, with favourable evidence for the utilization of posture-correcting aids. There was mixed—but mostly favourable—evidence for the use of surgical heads-up displays. Conclusions: Exercise modifications, such as yoga and regular exercise; equipment modification with heads-up displays during surgery; and training aids for posture correction were shown to be beneficial for MSK-related pain among ophthalmologists. Future studies should strive to improve the certainty of evidence on ergonomics-related interventions for ophthalmologists, which will better support practice and guideline development.

Emergency Care and Medicine doi: 10.3390/ecm2020022

Authors: Ali A. Aalam Nofel Iftikhar Hoor ul Ain Fahama Batool William Mulkerin Tyler J. Loftus Catherine W. Striley

Background/Objectives: This study examines trends in appendectomy utilization in US emergency departments (EDs) from 2012 to 2021 using National Emergency Department Sample (NEDS) data. The objective is to explore appendectomy frequency, appendicitis management, disease progression, and resource distribution in EDs. A predictive model was developed to forecast trends from 2022 to 2032, aiming to improve patient outcomes and support operational planning in EDs. Methods: A cross-sectional analysis was conducted using NEDS data from 2012 to 2021. Appendectomy trends were assessed in four ways: first, comparing the total number of appendectomies with total ED visits to determine relative frequencies; second, comparing trends in Complicated Appendicitis (CA) and Uncomplicated Appendicitis (UA) patients; third, categorizing each appendicitis type based on clinical complications and comorbidities; and finally, using a linear regression model to predict trends through 2032. Results: During the study period, the overall appendectomy rate decreased, while the proportion of patients with Complicated Appendicitis rose. Appendectomies in patients without complications or comorbidities showed a decline, while those in patients with complications or comorbidities increased. Predictive modeling suggests that trends in all subgroups will continue to rise until 2032. Conclusions: This study highlights evolving appendicitis management trends in EDs. The results advocate for fast-track appendectomy pathways and better resource allocation to enhance efficiency, reduce complications, and improve patient care. These findings assist healthcare systems in preparing for ED throughput challenges and refining surgical management strategies.

Emergency Care and Medicine doi: 10.3390/ecm2020021

Authors: Christian Claudi André Worm Norma J. Diel Martin Juenemann Donata Schmohl Hendrik Lösche Hagen B. Huttner Patrick Schramm

Objectives: Stroke is a leading cause of disability worldwide, requiring timely intervention with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT). This study evaluates real-world stroke management in a regional stroke unit, focusing on IVT administration and EVT transfer logistics. Design: A sub-analysis was performed using prospectively collected data from an observational study. Setting: This study took place at a regional, non-university stroke unit in Germany, serving approximately 253,000 inhabitants. Participants: A total of 2436 patients were admitted for suspected stroke between May 2019 and June 2021. Outcome Measures: Outcome measures included IVT administration rates, reasons for IVT non-administration, and EVT transfer logistics for acute ischemic stroke (AIS) patients. Results: Of 952 stroke cases, 14.8% received IVT, with a mean door-to-needle time (DNT) of 41 ± 36 min. The most common reasons for IVT non-administration were unclear or elapsed symptom onset (51.8%), anticoagulation (7.9%), resolving symptoms (18.4%), and intracranial hemorrhage (7.1%). EVT transfers occurred in 6.7% of AIS patients, with a mean door-in-door-out (DIDO) time of 81 ± 36 min. Conclusions: This study highlights the low IVT rate, primarily due to delayed hospital presentation, and the limited number of EVT transfers. The prolonged DIDO times emphasize the urgent need for streamlined transfer protocols to optimize stroke care delivery.

Emergency Care and Medicine doi: 10.3390/ecm2020020

Authors: Najah Queenland Matthew D. Holmes Paxton Prather Brian P. Murray Simranjit Gill

Background: Gastrointestinal bleeding (GIB) is a frequent emergency department (ED) presentation with rare but life-threatening causes, including arterio-enteric fistulas (AEF), which account for less than 1% of GIB cases. Ilio-enteric fistulas are even more rare but have similar morbidity and mortality. Methods: This case report describes a 51-year-old male with a history of type 2 diabetes mellitus, diabetic retinopathy, and pancreas–kidney transplantation who presented to the ED with a massive hemorrhage from an ilio-enteric fistula. Despite initial stability, the patient became hypotensive and deteriorated to pulseless electrical activity (PEA) arrest. Despite multiple arrests, he survived and was discharged to a rehabilitation facility. Results: AEFs, particularly iliac-enteric fistulas, are diagnostically challenging and often present with nonspecific symptoms. Diagnostic imaging, especially CT angiography, is crucial, although initial non-contrast CT may miss the diagnosis. Early consultation with vascular surgery is essential for managing these patients. Conclusions: This case underscores the need to consider AEF in the differential diagnosis of GIB, particularly in post-transplant patients, and highlights the importance of prompt intervention.

Emergency Care and Medicine doi: 10.3390/ecm2020019

Authors: Vishnunarayan Girishan Prabhu Ronald Pirrallo Kevin Taaffe Sudeep Hegde Steven Foster William Jackson Michael Ramsay Jess Hobbs

Background/Objectives: Among the factors contributing to medical errors and misdiagnosis, patient handoffs play a significant role. The negative impact of handoffs includes miscommunications, omissions, and information loss. Patient handoffs are inherent to emergency department (ED) patient care and are recognized as high-risk events. The aim of this study was to use a mixed-methods approach, incorporating a retrospective chart review and qualitative analysis, to understand emergency physicians’ perceptions of handoffs, including their impact on patient safety, patient flow, and patient satisfaction, as well as the strategies employed to manage handoffs and their perceived efficacy. Methods: A seven-question online survey was distributed to 120 attending ED physicians employed across a large academic health system comprising six hospitals. Additionally, a 3-year retrospective chart review provided insights into avoidable handoffs in the ED. Results: The survey responses showed that 69% of physicians believed that handoffs reduced patient safety, 55% felt that they reduced patient satisfaction, and 66% perceived them as contributing to longer patient stays. Additionally, 86% of physicians preferred to hand off no more than two patients, while 79% preferred to receive no more than two. Thematic content analysis identified key factors influencing physician preferences, including ownership, patient safety, patient flow, cooperation and colleagueship, and the challenges of continuing workups. To minimize handoffs, ED physicians primarily reported strategies such as staying late after shifts, restricting patient signups, and planning patient disposition toward the end of their shifts. Lastly, retrospective data analysis suggested that implementing one-hour overlapping shifts and restricting patient signups could reduce ED handoffs by 30%. Conclusions: ED physicians perceive handoffs as affecting patient safety, patient satisfaction, and patient flow negatively and prefer fewer handoffs. Overlapping shifts and selective patient signup strategies may reduce handoffs.

Emergency Care and Medicine doi: 10.3390/ecm2020018

Authors: Muralidhar Varma Robin Sudandiradas Mauli Mahendra Patel Trini Ann Mathew Marcus Zervos Shashikiran Umakanth Asha Kamath Mahadev Rao Vandana Kalwaje Eshwara Chiranjay Mukhopadhyay Vijaya Arun Kumar

Background/Objectives: The COVID-19 pandemic overwhelmed many health care facilities with patients, leading to an increased risk of potential transmission. Though the disease process was identical, the triaging system was unique at different sites, without a unified system for emergency department triaging globally. Proper implementation of pre-screening and triaging is of paramount importance in tertiary care settings to prevent nosocomial spread of infection. Methods: Each country has its own triage guidelines and Infection, Prevention, and Control policies developed by its health ministry and may face significant challenges in implementing them. Triage guidelines followed by two tertiary care hospitals in Detroit, United States of America and Manipal, India are compared during the early phases of the COVID-19 pandemic. Results: This paper offers a unique perspective of the challenges experienced with the hospital triage practices and provides solutions to address them. The future trajectory of COVID-19 epidemiology in both countries will be determined by the adherence to best practices in Infection Prevention and Control and triage protocols. The healthcare facility triage algorithm is constantly evolving in both settings as new evidence is being added to hospital epidemiology and infection prevention practices. Conclusions: Training healthcare workers on new triage protocols is required. It is critical for infectious disease doctors, clinical microbiologists, hospital epidemiologists, and Infection Prevention and Control (IPC) staff to collaborate with clinicians, nurses, and other ancillary staff in order to successfully implement the triage protocols. Developing and modifying guidelines for cleaning hospital triage areas and providing high throughput for patient care are also important lessons learned. Usage of face shields and the quality of Personal Protective Equipment (PPE) should be ensured for all healthcare workers (HCWs). Resilient staff and resilient hospital infrastructure are crucial for a sustainable response to future pandemics.

Emergency Care and Medicine doi: 10.3390/ecm2020017

Authors: Bui Hai Hoang Dinh Hung Vu Michael M. Dinh Nguyen Dai Nghia Phan Thi Huong Thao Bui Giang Phuc Do Lan Hieu Nguyen

Background: ST-elevation myocardial infarction (STEMI) is a life-threatening emergency. Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy, provided it is performed promptly (within 120 min of the ECG-based diagnosis). However, the failure rate of PPCI remains high, particularly in patients with more severe conditions, potentially leading to serious complications. Objective: Through this case, we want to introduce coronary fibrinolysis as a rescue therapy after failing with primary PPCI. Methods: Case report. Results: We reported a clinical case of a STEMI patient who underwent coronary fibrinolysis as a rescue therapy after PPCI failure. The patient was a 62-year-old male patient who was a 40-pack-year smoker. He was diagnosed with STEMI and immediately received PPCI, but the aspiration process and angioplasty were unsuccessful. Subsequently, we decided to use coronary fibrinolysis and the follow-up coronary angiography showed coronary revascularization, and chest pain was resolved. Conclusions: This case highlighted a potential therapeutic approach of coronary fibrinolysis for patients experiencing PPCI failure.

Emergency Care and Medicine doi: 10.3390/ecm2020016

Authors: Jessica T. Kent Rishi Ghosh

Background: “Do Not Resuscitate” (DNR) status has been implicated as an independent risk factor for mortality in patients admitted to the ICU. The implications of DNR status in older, critically ill patients for whom these conversations are often most relevant are less known. Objective: To determine the relationship between code status and mortality in a subset of critically ill, older ICU patients. Methods: Retrospective cohort study of critically ill older adults as defined by an APACHE II score ≥20 and age ≥70, admitted to the ICU at a large community hospital in Ontario from 1 January 2013 to 31 December 2018. Results: Of 613 patients admitted to the ICU, 163 met the inclusion criteria. Of these, 64 (39.3%) had a DNR order, while the remaining 99 (60.7%) did not and were considered full code. We found a strong association between DNR status and mortality (OR 2.61; 95% CI 1.33 to 5.09). Patients with a DNR order stayed fewer days in the ICU (7.7 days (±3.6) vs. 9.9 days (±8.3)) and used fewer resources than similarly ill patients who were full code with no difference in discharge morbidity. Patients with a DNR order had lower average costs of hospital and ICU admissions in comparison to patients who were full code (CAD 49,589.10/pt. vs. CAD 59,704.70/pt. (Canadian dollars)). Conclusions: Among critically ill, older ICU patients, DNR status is strongly associated with in-hospital mortality. Those in the full code group used more resources, resulting in higher costs of hospitalization without any difference in discharge morbidity.

Emergency Care and Medicine doi: 10.3390/ecm2010015

Authors: Yu Li Zhen Chen Xin Guo Yifan Liang Jueyan Wang Jinglei Li Xianting Yang Fen Ai

Objective: Sudden Death (SD) is a high-mortality emergency event that typically occurs within one hour of symptom onset. Accurate risk prediction is essential for optimizing post-resuscitation care. This study aims to enhance the survival rate of patients experiencing sudden death by developing and validating a risk prediction model for in-hospital mortality following successful resuscitation. Method: This study is a retrospective analysis of data that were collected prospectively from a standardized clinical database. All data were recorded at the time of patient admission using a predefined protocol to ensure consistency and accuracy. We retrospectively analyzed the data collected from 295 patients who experienced sudden death and achieved successful resuscitation at Wuhan Central Hospital from January 2017 to June 2024. The patients were assigned to groups using a randomization process into training and validation sets using k-fold cross-validation and further categorized within these sets based on in-hospital mortality as the outcome. A prediction model was constructed, and its efficacy was validated using logistic regression analysis, which was visualized with nomograms. Results: The results of this regression analysis of the training set demonstrated the actual length of hospital stay, in-hospital norepinephrine dosage, post-resuscitation respiratory rate, and sinus rhythm after resuscitation as independent influencing factors (p < 0.05), which formed the basis of the prediction model. The analysis of the training set exhibited high discriminative ability, with an area under the ROC curve (AUC) of 0.860, which exceeds the commonly accepted threshold for good classification performance, and the calibration, applicability, and reasonableness were all favorable. When the model was applied to the validation set, the AUC was 0.758, and the discrimination, calibration, applicability, and reasonableness of the validation set were also satisfactory. Conclusions: the main conclusion is that a risk prediction model for in-hospital mortality following resuscitation from sudden death was successfully developed and internally validated, offering a significant advancement in clinical decision-making support.

Emergency Care and Medicine doi: 10.3390/ecm2010014

Authors: Jesse H. Wells Joel M. Town Samuel G. Campbell

Background: Somatic symptom disorder (SSD) involves physical symptoms that cannot entirely be explained by an organic medical cause, accompanied by persistent thoughts, feelings and behaviours relating to one’s health. SSD is common yet underdiagnosed in emergency departments (EDs). This study aimed to assess emergency physician (EP) readiness, attitudes and perceptions toward diagnosing SSD and explore demographic trends. Methods: In total, 1339 Canadian EPs were invited to respond to a survey collecting demographic information and assessing attitudes toward SSD in four domains: perceptions of SSD, attitudes toward patients, diagnostic confidence, and physician–patient communication. Data were analyzed using t-tests and ANOVA to determine associations with demographic information. Results: Of the 96 survey respondents, 75 met the eligibility criteria. In total, 44% estimated that emotional stress was the primary cause of symptoms in 11–20% of their patients. Most felt that SSD was underdiagnosed and that effective therapies exist. Concerns included medico-legal implications, managing patients’ emotions, and potential negative reactions to non-organic diagnoses. Most respondents felt prepared and confident broaching the diagnosis. More experienced EPs felt that there was time to broach the topic of SSD, while rural EPs were less concerned about patient offence than urban counterparts. Conclusions: EPs recognize SSD as common and underdiagnosed, acknowledging its diagnosis as part of their role. Challenges identified include managing patients’ emotions, time constraints, and reliance on only diagnosing SSD once an organic etiology is excluded. Training pathway, experience, and practice setting impact perceptions and attitudes around SSD. The findings suggest opportunities for improving SSD care through targeted interventions, communication training, and enhanced diagnostic education.

Emergency Care and Medicine doi: 10.3390/ecm2010013

Authors: Haider Al Saadi Reyam Al Zubaidi Hervé O. Zender Eric P. Heymann Chiheb Said

Background: Spontaneous rupture of the liver capsule secondary to the progression of hepatocellular carcinoma is a rare complication with high mortality. Case Description: This article presents the case of a 73-year-old male with no prior HCC diagnosis who presents acute abdominal pain and hemodynamic instability. Computed tomography reveals a heterogeneous liver lesion with capsular rupture and hemoperitoneum. Discussion: Management strategies focus on hemodynamic stabilization and bleeding control through transcatheter arterial embolization (TAE), surgical hemostasis or liver resection, the treatment selection is based on disease severity and patient condition. Conclusions: This case highlights the importance of considering HCC rupture in patients with acute abdominal pain and risk factors for liver disease, as early recognition and appropriate intervention significantly impact survival outcomes.

Emergency Care and Medicine doi: 10.3390/ecm2010012

Authors: Pedro García-Benavides Félix Gustavo Mora-Ríos Nancy Daniela Zavala-Luna Emilio Ignacio Pérez-Jimenez Carlos Alberto Castro-Fuentes

Background: Femoral shaft fractures are very common in the pediatric population; however, information is scarce. Methods: A total of 189 pediatric patient records were reviewed to identify the characteristics of diaphyseal fractures, including origin, type, pattern, surgical technique, and complications. Descriptive statistics were used to calculate frequencies and percentages. Meanwhile, continuous and categorical variables were analyzed using logistic regression to compare the different types of fractures in the population. Results: The proportion of males was higher compared to females (2:1). The highest prevalence was observed in the 10–14-year-old age group (n = 71; 37.5%). The primary mechanism of injury was traffic accidents (n = 93; 49.2%). Left femoral shaft fractures (n = 101; 53.4%) were the most prevalent. Transverse patterns predominated among the identified fractures (n = 105; 55.6%), most of which were closed fractures. Among the complications, non-union was the most frequent (n = 13; 6.9%), followed by wound infections (n = 3; 1.5%). Obesity (p < 0.001) and overweight (p < 0.001) were statistically significant in the left-sided femoral shaft fracture group. Conclusions: Non-union was the main complication identified in our study population. Obesity and overweight were identified as predictive variables for left-sided femoral shaft fractures. Meanwhile, none of the injury mechanisms showed statistical significance. Diaphyseal fractures in the pediatric population are underestimated, as well as the predictors causing them. Therefore, it is necessary to establish better management strategies for this type of fracture in pediatric patients.

Emergency Care and Medicine doi: 10.3390/ecm2010011

Authors: Yan Gao Sunku Srivatsava Hong Choon Oh Siang Hiong Goh Hoon Chin Steven Lim

Background/Objectives: This study aimed to explore the feasibility of predicting short stays among urgent admissions to an acute hospital in Singapore. With an increase in the average length of stay (LOS) in hospitals in recent years, accurately predicting short stays could enable hospitals to better manage inpatient demand and reduce emergency department (ED) overcrowding. Methods: This was a retrospective study of urgent admissions to Changi General Hospital, Singapore, from 1 January 2016 to 30 June 2022. To identify potential short stayers, a total of 25 features comprising demographic characteristics, admission and clinical characteristics, and healthcare utilization history were analyzed for each admitted patient at the point when the ED physician decided to admit the patient. The dataset was further split into a development dataset and an external validation dataset based on the year of admission. A CatBoost classifier was trained using 75% of the development dataset. Apart from reporting the model’s prediction accuracy, we conducted various analyses and simulations to study the effects of the features crucial to the prediction output. Results: The prediction accuracy of the model was evaluated on both the development test dataset (25%) and the external validation dataset. On the former, the area under the receiver operating characteristic (AUROC) and the area under the precision-recall curve (AUPRC) were 0.803 (95% CI: 0.799, 0.808) and 0.755 (95% CI: 0.749, 0.762), respectively, with the precision = 0.700 (95% CI: 0.694, 0.707) and recall = 0.692 (95% CI: 0.685, 0.699). On the external validation dataset, the performance was similar. The ED diagnosis and whether the admission required a surgical procedure were the most important features for making the prediction. Conclusions: The LOS prediction model could help providers to identify short stayers early in the course of their inpatient journeys so they could make interventions to better manage the overall utilization of hospital beds.

Emergency Care and Medicine doi: 10.3390/ecm2010010

Authors: Justin Koh Debra Chalmers Roman Hryniv Angharad King Grant Cave

Introduction: Sedative and antipsychotic (SAP) agents are amongst the most common overdoses seen clinically, with few available antidotes. The proposed “lipid shuttle” mechanism of action for intravenous lipid emulsion (ILE) could augment the redistribution of SAP agents from the central nervous system in overdoses. We reviewed randomised controlled clinical trials to evaluate the effect of intravenous lipid emulsion when the indication for use was a reduction in the level of consciousness in SAP overdoses. Methods: We searched for human randomized controlled trials comparing the use of ILE to placebos in SAP drug overdoses. Animal and non-randomised human studies were excluded. Relevant databases were searched with two independent reviewers assessing studies for inclusion and risk of bias using the ROB 2 tool. Results: Five identified studies enrolled 270 patients in total, of whom 226 had isolated tramadol or clozapine toxicity. One study was assessed as having serious concerns for bias, and the other four as having some potential for bias. In all studies, there was a statistically significant increase in the Glasgow Coma Scale (GCS), favouring the ILE groups. This effect does not appear to have been due to changes in haemodynamics. Secondary outcomes on length of stay and QT interval were also positive. No patient died in any study. Conclusions: In the five reported randomised human trials of the effect of ILE on level of consciousness post-SAP overdose, patients receiving ILE had a greater increase in GCS over time. The potential for bias existed in all studies, and trial results may be true but specific to the intoxicants and situations studied, which prevents the generalisability of findings. More research is both feasible and necessary in this area.

Emergency Care and Medicine doi: 10.3390/ecm2010009

Authors: Mariana Duarte Cristina Costeira

Self-awareness among nurses involved in inter-hospital transport is crucial, as recognizing their limitations helps them improve their skills and make better use of tools that support inter-hospital transport, ultimately resulting in more efficient care. Objectives: To evaluate nurses’ self-perceived competences in an emergency department in Portugal regarding the inter-hospital transport of critically ill patients, implement interventions to facilitate the development of nurses’ competences, and evaluate the interventions carried out. Methods: A quality improvement project was conducted in three phases. The first phase involved a diagnostic study, the second phase focused on implementing interventions to improve nurses’ performance, and the third phase consisted of a descriptive study to evaluate the interventions implemented. Results: A total of 40 nurses participated in the study, with an average age of 39 (39.10 ± 11.83) years old, an average of 16 (16.09 ± 11.06) years of professional nursing experience, and an average of 11 (10.94 ± 10.91) years of experience in inter-hospital transport of critically ill patients. The nursing records during inter-hospital transport received the lowest self-perception rating, prompting the implementation of an intervention in the form of a nursing records checklist. Conclusions: The interventions implemented led to a change in self-perceptions of competence. Nurses’ self-awareness of their competences and limitations is crucial to deliver safe and quality nursing care. Providing opportunities for reflection on skills is therefore crucial to improving care delivery and encouraging the development of professional skills, attitudes, and behaviors.

Emergency Care and Medicine doi: 10.3390/ecm2010008

Authors: Ning Lu Imad S. Dandan Gail T. Tominaga Frank Z. Zhao Fady Nasrallah James Schwendig Hung Truong Anthony Ferkich Matthew R. Castelo Dunya Bayat Walter L. Biffl

Background/Objectives: During the early phase of the coronavirus disease 2019 (COVID-19) pandemic, people were advised to stay at home and the American College of Surgeons suggested the nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that patients presented with more cases of complicated appendicitis during the early phase of COVID-19 compared with the previous year; we further hypothesized that more patients had NOM. Methods: Adults diagnosed with appendicitis were retrospectively reviewed from electronic medical records throughout a single county-wide hospital system. The pre-pandemic period (3 January 2019–30 June 2019, PRE) was compared with the pandemic period (3 January 2020–30 June 2020, POST). The primary outcome was AAST grade of appendicitis. Results: There were 278 cases of appendicitis in PRE and 269 in POST. The rate of complicated appendicitis (grades II–V) was higher in POST (39% vs. 30%, p = 0.0375), most prominently in the northern hospitals in the county (41% vs. 27%, p = 0.004), with non-operative management in six (3.2%) cases. Grades III–V, consistent with perforation, were seen in 33% of POST vs. 27% of PRE cases (p = 0.098). Grade I appendicitis was managed non-operatively in only six (1.6%) patients. There were fewer readmissions in POST (4% vs. 8%, p = 0.0427) and no mortalities during the study period. Conclusions: There was a significant increase in presentation with complicated appendicitis during the early phase of the COVID-19 pandemic in the northern hospitals in the county. There was no increase in NOM of uncomplicated appendicitis and no change in hospital LOS but there were fewer readmissions during COVID-19.

Emergency Care and Medicine doi: 10.3390/ecm2010007

Authors: Zeina Barca-Ruso Néstor Montoro-Pérez Raimunda Montejano-Lozoya Ángela Sanjuán-Quiles Juana Perpiñá-Galvañ

Background: Overcrowding in emergency services (ESs) is an escalating issue in many countries worldwide, and it is also evident in the paediatric context. Specifically, in paediatric emergency departments (PEDs) in Europe, there has been a noticeable upward trend in demand for care over the past decade, peaking at 9.1 million visits in 2020. Objectives: To identify interventions aimed at reducing non-urgent presentations (NUPs) and attendance rate PEDs. Methods: A systematic review of the last five years was conducted using various databases (Web of Science, PubMed, Scopus, and CINAHL) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 15 articles were included in the final review, detailing five types of interventions: (1) telemedicine-based interventions, (2) the continuity of care interventions, (3) health literacy-based interventions, (4) interventions focused on establishing a point of access prior to emergency care, and (5) multidisciplinary interventions. Conclusions: The results of this review suggest the implementation of telemedicine-based interventions, the promotion of continuity of care, and the enhancement of parental health literacy as strategies to address the issue of overcrowding in PEDs.

Emergency Care and Medicine doi: 10.3390/ecm2010006

Authors: Carol Nash

Post-COVID-19, significant triage modifications were made in emergency hospital medical care. Previous scoping reviews investigated triage changes during COVID-19. This scoping review uniquely considers post-pandemic effects. It searches the parameters “COVID-19, triage, hospital, emergency medical care” in four primary databases, one register, and a supplementary database to determine the range of emergency hospital triage changes. Following PRISMA guidelines, studies included are post-2023 publications, those in English, and research studies. Excluded were duplicates, reviews, books, and reports lacking research studies or including irrelevant information on COVID-19, triage, hospital, or emergency medical care. Identified are 1071 records: OVID (n = 20), PubMed (n = 2), Scopus (n = 46), Web of Science (n = 20), Cochrane COVID-19 Register (n = 18), and Google Scholar (n = 965). Six studies are included from the Web of Science (n = 1) and Google Scholar (n = 5). One study includes reports from six different countries; thus, there are 11 reports. The modification of triage was concerning four ways, with each country focusing on a specific triage change. Adaptive changes were proactive rather than reactive. Triage-related future research suggestions include the four triage aspects, international comparisons, and longitudinal change. The recommendation is for research assessing Google Scholar.

Emergency Care and Medicine doi: 10.3390/ecm2010005

Authors: Dionysios Prevezanos Christos Doudakmanis Stamatios Theocharis Stylianos Kykalos Nikolaos I. Nikiteas Gerasimos Tsourouflis

Background: Abnormalities in the canal of the Nuck are rare clinical entities with presentation in the early adulthood of females. Given their rarity, they can be misdiagnosed with a strangulated inguinal hernia. Methods: Herein, we report a young female with painful swelling of the right inguinal hernia and its surgical approach. Results: A 37-year-old female presented to the emergency department with pain in the right lower abdominal quadrant and an edematous inguinal mass. Physical examination showed a palpable inguinal mass, setting the suspicion for possible incarcerated inguinal hernia. Laboratory exams were within normal ranges. The patient was subsequently treated surgically. During the operation, a cystic well-rounded mass was identified and completely excised. The mesh and plug technique was the chosen technique for the restoration of the inguinal canal. The hospitalization length was one day, and the post-operative course was uneventful. Conclusions: Although a Nuck cyst is a rare entity, it should be taken into consideration in female adults who present with an inguinal mass.

Emergency Care and Medicine doi: 10.3390/ecm2010004

Authors: Martina Petrucci Stefania Gemma Luigi Carbone Andrea Piccioni Davide Antonio Della Polla Benedetta Simeoni Francesco Franceschi Marcello Covino

Intensive Care Unit-Acquired Weakness (ICU-AW) is a common and severe complication in critically ill patients, characterized by profound and often prolonged muscle weakness. The complexity of its diagnosis and management requires a multidimensional approach that integrates clinical, electrophysiological, and imaging tools. This review focuses on the challenges in diagnosing ICU-AW, emphasizing the limitations of traditional methods such as manual muscle testing and electrophysiological studies, and highlights the emerging role of neuromuscular ultrasound (NMUS) as a promising, non-invasive diagnostic aid. Despite its utility, no gold standard exists for NMUS, making it an evolving area of research. The pathophysiological basis of ICU-AW involves multiple mechanisms, including critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and muscle atrophy due to disuse. Understanding these underlying mechanisms is crucial for advancing diagnostic strategies and informing therapeutic interventions. Recent insights into the molecular and cellular pathways involved, such as the role of oxidative stress, mitochondrial dysfunction, and the ubiquitin-proteasome system, have opened new avenues for targeted therapies. Management of ICU-AW remains challenging as no specific treatment has been proven fully effective. Current strategies focus on early mobilization, minimizing sedation, and optimizing nutritional support. Emerging therapies targeting molecular pathways involved in muscle degradation are under investigation, highlighting the potential to translate pathophysiological understanding into therapeutic innovations. This review underscores the need for ongoing research to establish standardized diagnostic protocols and develop targeted treatments for ICU-AW.

Emergency Care and Medicine doi: 10.3390/ecm2010003

Authors: Rainer Christoph Miksch Sonja Talwar Christoph Gassner Wolfgang Böcker Boris Michael Holzapfel Fabian Gilbert

Background: Geriatric trauma patients often present with multiple comorbidities, which can complicate their treatment and impact outcomes. This study examines the effect of common pre-existing comorbidities on mortality and recovery in polytrauma patients, comparing them to polytrauma patients without these conditions. Methods: We conducted a retrospective cohort study of patients with an Injury Severity Score (ISS) ≥ 16, admitted to a Level I trauma center between 2006 and 2019. A total of 315 patients were analyzed, including 235 with at least one comorbidity (COPD, type II diabetes, or anticoagulation due to atrial fibrillation) and 80 patients without any comorbidities, who served as the control group. Results: While comorbid patients had similar ISS scores compared to controls, they experienced significantly longer hospital and ICU stays. No significant difference in overall survival was found between the groups. However, patients with comorbidities were more prone to secondary complications, such as sepsis and thrombosis. Conclusions: The presence of common comorbidities, while associated with longer recovery times and increased complication rates, did not significantly impact mortality in polytrauma patients.

Emergency Care and Medicine doi: 10.3390/ecm2010002

Authors: Raffaele Conforti

In recent years, the integration of informatics in emergency medicine has led to significant improvements in clinical decision-making, patient management, and overall healthcare delivery. This literature review explores the most recent trends and applications of informatics in the field of emergency medicine, including electronic health records, telemedicine, artificial intelligence, and mobile health technologies. The goal is to provide a comprehensive overview of the state-of-the-art technologies, their current implementations, and the challenges that remain to be addressed.

Emergency Care and Medicine doi: 10.3390/ecm2010001

Authors: Iacopo Cappellini Alessio Baldini Maddalena Baraghini Maurizio Bartolucci Stefano Cantafio Antonio Crocco Matteo Zini Simone Magazzini Francesco Menici Vittorio Pavoni Franco Lai

Introduction: Non-compressible torso hemorrhage (NCTH) is a major cause of preventable mortality in trauma, particularly when immediate surgical intervention is not available. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a promising technique to control severe hemorrhaging and stabilize patients until definitive surgical care can be performed. Case Presentation: We report the case of a 45-year-old woman who sustained multiple traumatic injuries—including thoracic, pelvic, and aortic damage—after a fall from approximately 5 m in an apparent suicide attempt. She arrived at a secondary-level trauma center in profound hemorrhagic shock, unresponsive to standard resuscitation. Interventions: As the patient’s condition deteriorated to cardiac arrest, an emergent REBOA procedure was performed by emergency physicians. This intervention rapidly restored hemodynamic stability, enabling damage control resuscitation and safe transfer to a Level 1 Trauma Center for definitive surgical management, including thoracic endovascular aortic repair and splenectomy. Outcomes: After prolonged intensive care, the patient recovered sufficiently to be discharged for rehabilitation. This case illustrates the life-saving potential of early REBOA deployment in a non-surgical, resource-limited setting to bridge patients to definitive care. Conclusions: This case supports integrating REBOA into emergency trauma protocols, particularly in centers without immediate surgical capabilities. Further research is warranted to refine REBOA deployment strategies, balloon positioning, patient selection, and the role of imaging guidance.

Emergency Care and Medicine doi: 10.3390/ecm1040045

Authors: Mahnoor Mahnoor Syeda Aina Ali Saira Nasir Moiz Azmat Hafiz Muhammad Umer Farooqi

Background: Emphysematous pyelonephritis (EPN) is an infectious disease of the renal system caused by gas-producing microorganisms harboring the kidneys. Patients with diabetes mellitus (DM), an endocrine disease with hyperglycemia, are particularly susceptible to the EPN as their immune system is compromised in fighting against infections. Case Description: We present a case of a 50-year-old female with a history of chronic diabetes and persistent hypertension. She presented with symptoms of pyrexia and flank pain. Following findings from ultrasound, she was advised to undergo computed tomographic (CT) scans that reveal air-filled hypodense areas at the upper and mid pole of the right kidney and in the renal pelvis of the right ureter, which confirms the class I EPN in the patient. Urine culture identifies Escherica coli as the causative agent for EPN. The patient was managed with third-generation antibiotics over two weeks, leading to full recovery without surgical intervention. Discussion: The availability of CT imaging makes early diagnosis and reduces mortality associated with EPN. Conservative medical management should be the initial treatment strategy for EPN. However, severe cases require immediate therapeutic action. In our case, the patient was treated with antibiotic therapy and recovered. Conclusions: CT scan seems to be the optimal diagnosis in patients with acute emphysematous pyelonephritis. Patients with EPN class I respond well to medical treatment with excellent outcomes.

Emergency Care and Medicine doi: 10.3390/ecm1040044

Authors: Eric Scheier Khaled Khalilia Pavel Peslin Stav Amir Luba Pasherstnik Bizer

Introduction: The literature has suggested two variants of appendicitis: a simple variant that may even resolve spontaneously and a more aggressive variant that may proceed to complication. We review two cohorts compatible with “mild” appendicitis: children with acute appendicitis that presented with normal inflammatory markers (NIMs), and confirmed on pathological examination, and children with sonographically confirmed appendicitis that resolved without medical or surgical intervention. Methods: We identified all children diagnosed with appendicitis from June 2016 to June 2024. To confirm the accuracy of the initial sonographic diagnosis of appendicitis in children with spontaneous resolution, two study radiologists, blinded to clinical data, reviewed the images for signs of appendiceal inflammation. We compared cases of NIM with cases presenting with elevated inflammatory markers, and cases of spontaneous resolution with cases of uncomplicated appendicitis treated medically. Results: A total of 999 children were diagnosed with appendicitis, with 845 confirmed on pathology. Of these 845, 17 had NIMs and were less likely to present with vomiting than children with elevated inflammatory markers (24% versus 61%, p = 0.002). Fourteen had spontaneous resolution and twenty-five were treated medically. White blood cell count (14.1 versus 10.2, p = 0.005) and appendiceal diameter (8.6 mm versus 7.6 mm, p = 0.078) were higher for children with conservative treatment. Children receiving medical treatment received intravenous analgesia more frequently (88% versus 50%, p = 0.009). More resources were used for medical treatment—these children had longer hospitalizations (3.5 versus 1.6 days, p = 0.001) and more frequently received repeat bloodwork (68% versus 36%, p = 0.051). Conclusions: Appendicitis that resolves spontaneously, and appendicitis that presents with normal inflammatory markers, may represent rare, low-risk forms of appendicitis that may not be associated with progression to complication. While pediatric appendicitis should not be ruled out in the presence of a normal laboratory evaluation, cases that present without gastrointestinal symptoms, without severe pain, and with an appendiceal diameter and inflammatory markers below a certain threshold may warrant continued observation and serial ultrasound to evaluate for progression prior to initiating therapy.

Emergency Care and Medicine doi: 10.3390/ecm1040043

Authors: Donna Mendez Krishna Paul Jerome L. Yaklic Dietrich Jehle

Background: This study compared outcomes of pregnant females with and without COVID-19 and their fetuses/newborns. Methods: This is a retrospective study from 2020 to 2023 utilizing the United States Collaborative Network of the TriNetX Database. We compared the outcomes of pregnant females with COVID-19 and pregnant females without COVID-19. Maternal outcomes evaluated were death, intubation, intensive care unit (ICU) admission, and premature rupture of membranes (PROM) within 9 months of the diagnosis of pregnancy. Fetal outcomes included preterm birth and intrauterine death (IUD). A subgroup analysis of outcomes was performed based on the mother’s vaccine status. Results: The risks of maternal death (RR = 1.97), maternal intubation (RR = 3.33), and maternal (ICU) admission (RR = 1.76) were significantly higher in pregnant females with COVID-19. For the neonate, there was a higher risk of preterm birth (RR = 1.12). When the confounders were eliminated with propensity matching, there was still an increase in maternal intubation (RR = 3.24) and maternal ICU admission (RR = 1.60). For the neonate/fetus, there was a decreased risk of PROM (RR = 0.83) and IUD (RR = 0.74) for the fetuses of the mothers with COVID-19. For the subgroup analysis, the mother was at an increased risk of ICU admission (RR = 0.04) when unvaccinated. Conclusions: There is an increased risk of poor outcomes for pregnant women infected with COVID-19; however, fetal outcomes are generally favorable. When unvaccinated, there was an increased risk of ICU admission for the mother.

Emergency Care and Medicine doi: 10.3390/ecm1040042

Authors: Jin Kook Kang Matthew Acton Bo Soo Kim

Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed with venovenous extracorporeal membrane oxygenation (VV-ECMO). Case Presentation: A 40-year-old patient with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing, where the patient was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Their pulmonary function quickly declined, necessitating mechanical ventilation (MV). After all conventional therapies failed, the patient was transferred to a tertiary medical center for VV-ECMO therapy. The patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of their respiratory symptoms. The patient was discharged on hospital day 82. Conclusions: HIV-positive patients with ARDS that is complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO.

Emergency Care and Medicine doi: 10.3390/ecm1040041

Authors: Elizabeth W. Pollio Samir Abu-Hamad Jennifer Wang Carol S. North David E. Pollio

Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it and efforts to derive meaning from it. Methods: From an initial random sample of 182 survivors of the Oklahoma City bombing, narrative descriptions of this experience were collected 7 years after the bomb blast from 116 of the original sample, for the purpose of examining persistent as well as newly evolving content through qualitative analysis. The narrative content was analyzed for the evolution of thematic content in narrative data also collected at 6 months post-disaster and 1 year later. Results: The thematic content of the bombing experience was structured in a chronological fashion from the bomb blast (sensory, cognitive, and emotional), its immediate aftermath (e.g., escaping danger), and later experiences, (e.g., leaving the bomb site and receiving hospital treatment). During the time between interviews, the focus and general content of the narratives changed minimally, despite considerable compression of detail. Conclusions: The consistency of the material in these narratives over 7 years may reflect the persistence and salience of disaster memories, with the potential for its continuation for the rest of their lives.

Emergency Care and Medicine doi: 10.3390/ecm1040040

Authors: Sydney Asper Hailey Allen Maryam Soltanolkotabi

Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular IOM injury without associated fractures or distal syndesmotic disruption. The observed injury patterns, along with the blunt, non-rotational trauma reported in each case, suggest that the mechanism behind this unique presentation may involve sudden traction or direct impact to the lower leg. Conclusion: Isolated tibiofibular IOM injury should be considered in patients with lower leg pain after blunt trauma. MRI of the entire tibia and fibula can be instrumental in characterizing and confirming the injury and should be considered when clinical and injury mechanism indicators are present.

Emergency Care and Medicine doi: 10.3390/ecm1040039

Authors: Efrat Blitstein-Mishor

Background: In the crucible of disasters, civic engagement emerges as a dynamic force that channels individual strength and collective willpower toward the common good. Although it has been recognized as a necessary precondition for community resilience, studies on the motivators for citizens’ activities during disasters are relatively limited. This study underscores the interplay of personal resilience, risk perception, and coping strategies in the context of emergency-oriented civic engagement. It provides a robust framework for comprehending the cognitive and emotional processes that drive individuals’ responses to threats and risks to improve knowledge about public behavior, psychological conditions, and mental health during man-made disasters. Method: an online survey was conducted with a sample of 1514 citizens in Israel. A model incorporating both moderation and mediation effects was proposed. Results: The results reveal a consistent positive relationship between personal resilience and emergency-oriented civic engagement and point to the importance of both the intervening role of risk perception and the moderating role of coping strategies. Conclusions: discuss the importance of resilience-building programs and the promotion of positive coping strategies which can empower individuals to navigate the complexities of risk perception and engage actively in civic activities during disasters.

Emergency Care and Medicine doi: 10.3390/ecm1040038

Authors: Wei Ye Shirong Lin Chengquan Zheng Chunshui Cao

Current research is mostly focused on the impact of fertilizers on human health when they are ingested through food; the main form of this is chronic damage. Intoxication through oral ingestion of fertilizer is an extremely rare situation. We report a case of a 38-year-old man that attempted to commit suicide by ingesting only 20 mL of a water-soluble fertilizer. Acute kidney injury occurred early, which showed that the toxicity could not be ignored. It was necessary to seek medical attention as soon as possible. In addition, the patient experienced gastrointestinal dysfunction and a severe inflammatory response; inflammatory markers increased rapidly. Physicians implemented antimicrobial stewardship to reduce antimicrobial drug resistance and the risk of hospital infection, and the patient’s inflammatory response was well controlled. Although the damage was severe, the patient quickly recovered to normal after appropriate treatment. The prognosis is very good. This successful case provides guidance for clinical treatment.

Emergency Care and Medicine doi: 10.3390/ecm1040037

Authors: Getachew Wuhib Shumye Melatwork Assefa Wolle Mekuriaw Wuhib Shumye Leul Mekonnen Zeru

Background: Open knee joint injury is a deep traumatic laceration violating the joint capsule. This study aimed to assess outcomes and associated factors of open knee joint injuries in trauma patients at Tibebe-Ghion Specialized Hospital, Bahirdar, Ethiopia, 2021. Methods: An institution-based retrospective cross-sectional study was conducted by reviewing the medical records of 43 patients treated for open knee joint injuries from January 2019 to July 2021, with an 86% response rate. Data were entered and exported using Epidata Manager Version 4.4 and analyzed using SPSS version 25. Results: Fourteen (32.5%) of the study subjects developed either infections or limping during follow-up due to open knee injuries, with the majority of injuries (58.1%) being caused by car accidents. The presence of associated injuries, wound size, time to wound closure, debridement as a management option, sex, and diagnostic methods showed a significant association with complication outcomes. Among the diagnosed infections, 90% were cases of septic arthritis. During the study period, eight patients (18.6%) developed limping during follow-up. The complication rate among open knee injury patients in the study area was significantly high, with one-third of patients experiencing complications. Targeted public awareness campaigns like car accidents should be conducted to educate the population about orthopedic emergencies and strategies to reduce complication risks, aiming for more favorable outcomes.

Emergency Care and Medicine doi: 10.3390/ecm1040036

Authors: Christoph Strauss Michael Schmid Daniel Kliem Martin Müller

Prehospital care, and especially emergency medical services (EMSs), are facing an increasing demand, while experiencing financial pressure. Strategies aimed at improving prehospital care management emphasize the efficient utilization of resources, but often overlook the long-term implications for the prehospital healthcare system, encompassing emergency medical services, emergency departments, and healthcare authorities. This paper draws on almost ten years of improvement in EMS’ key performance indicators such as response time or overtime in Switzerland, using Discrete Event Simulation. Three representative simulation studies are used to reflect on the optimization potential of alternative bases and rosters, methodological limitations, and the uptake of the derived recommendations. The results demonstrate that EMSs’ efficiency gains in resource utilization increasingly come into conflict with emergency departments’ and healthcare authorities’ policies, indicating a need to enrich Discrete Event Simulation with a systemic perspective. A new methodology that conceptualizes long-term prehospital care planning as an interdisciplinary and iterative process utilizing a novel combination of System Dynamics and Discrete Event Simulation is proposed.

Emergency Care and Medicine doi: 10.3390/ecm1040035

Authors: Kelvin Le Jiahang Chen Deon Mai Khang Duy Ricky Le

Large Language Models (LLMs) are becoming increasingly adopted in various industries worldwide. In particular, there is emerging research assessing the reliability of LLMs, such as ChatGPT, in performing triaging decisions in emergent settings. A unique aspect of emergency triaging is the process of trauma triaging. This process requires judicious consideration of mechanism of injury, severity of injury, patient stability, logistics of location and type of transport in order to ensure trauma patients have access to appropriate and timely trauma care. Current issues of overtriage and undertriage highlight the potential for the use of LLMs as a complementary tool to assist in more accurate triaging of the trauma patient. Despite this, there remains a gap in the literature surrounding the utility of LLMs in the trauma triaging process. This narrative review explores the current evidence for the potential for implementation of LLMs in trauma triaging. Overall, the literature highlights multifaceted applications of LLMs, especially in emergency trauma settings, albeit with clear limitations and ethical considerations, such as artificial hallucinations, biased outputs and data privacy issues. There remains room for more rigorous research into refining the consistency and capabilities of LLMs, ensuring their effective integration in real-world trauma triaging to improve patient outcomes and resource utilisation.

Emergency Care and Medicine doi: 10.3390/ecm1040034

Authors: Bogdan Oprita Ruxandra Oprita Teodor-Nicolae Berea Ionut Olaru Marian Alexandru Draghici

Background: The recent earthquakes that occurred in Southern Turkey on the 6th of February 2023, were the most devastating earthquakes that have occurred in Turkey in the modern era. Teams of rescuers from 19 EU states quickly responded and carried out rescue missions across the affected area. This article is a report of a case series of rescues performed by the Romanian response team RO-USAR 1, with its aim being to assess the need of an internation consensus regarding immediate first-care in patients that are victims of natural or human-made catastrophes. Operations: A total of five victims were extracted alive from under the debris by our team and transported to the nearest available hospital by ambulance. A total of eight deceased victims were also extracted to facilitate access to the aforementioned alive victims. Conclusions: Quickly recognizing life-threatening situations and rapidly instating rapid fluid resuscitation is an essential step in reducing mortality in patients affected by major natural or human-made disasters. The need for an international consensus for the prehospital care of these patients is needed now more than ever in order to further ameliorate morbidity and mortality that largely occurs due to crush syndrome and its derived complications.

Emergency Care and Medicine doi: 10.3390/ecm1040033

Authors: Yui Okamura Parames Ngeabngamsri Ami Iwano Thanachit Krikeerati Kotaro Yanagisawa Thanut Jansirirat Moeko Ohkoshi Tomonari Shimoda Thomas Mayers Praew Kotruchin Pattarapong Makarawate

The global health crisis caused by the COVID-19 pandemic severely restricted in-person international events and clinical exposure opportunities for medical students. As a result, fostering global collaborations and providing hands-on experiences for future healthcare professionals has become increasingly challenging. The Khon Kaen University International Challenge of Emergency Medicine (KKU ICEM) is the world’s first international emergency medicine (EM)-focused competition for medical students. Since 2016, it has been held eight times and attracted participation from approximately 500 students across 18 countries spanning Asia, Europe, North America, and Africa. The KKU ICEM not only equips medical students with essential EM knowledge but also cultivates international friendships and cross-cultural competence. Initiatives like the KKU ICEM can play a crucial role in preparing the next generation of healthcare professionals for the challenges ahead.

Emergency Care and Medicine doi: 10.3390/ecm1030032

Authors: Simon Lehtimäki Joonas Lahelma Anssi Aunola Hilla Nordquist

Inter-hospital transfers remain a significant part of emergency care service missions, even though efforts have been made to change this. We examined the use of prehospital emergency care units in inter-hospital patient transfers in one wellbeing services county in Finland. We evaluated the potential strain they place on regional prehospital emergency care readiness, and examined how these transfers arise between different regions, populations, and healthcare centers. This was a register-based pilot study using prehospital emergency care inter-hospital transfer mission statistics within the wellbeing services county of Pirkanmaa, Finland during 2020 and 2021. The data were extracted from the emergency care service’s field management program. A descriptive analysis of the data was performed, in which interdependencies between several variables were examined. During the two years, there were 5812 prehospital emergency care inter-hospital transfer missions dispatched to prehospital emergency care units. The number of prehospital emergency care inter-hospital transfer missions was especially notable in rural regions, where there were also fewer units available. Based on the results, the criteria for prehospital emergency care use in inter-hospital transfers require clarification, since there is an observable strain caused by these transfers on regional emergency care readiness. The results of this pilot study encourage further studies on the use of prehospital emergency care units in inter-hospital patient transfers.

Emergency Care and Medicine doi: 10.3390/ecm1030031

Authors: Tracey Lutz Andrew Berry Angela McGillivray Kathryn Browning-Carmo

Background: Neonatal hypoxic respiratory failure (HRF) secondary to PPHN (persistent pulmonary hypertension of the newborn) is an uncommon but life-threatening complication. Despite advances in therapeutic interventions, there are neonates who may require ECMO (extracorporeal membrane oxygenation), which improves survival. In establishing the capability of ECMO in transport in New South Wales, significant variation in referral thresholds and management of PPHN in referring hospitals has been noted. Aim: To review cases referred to the Newborn and paediatric Emergency Transport Service (NETS) for consideration of ECMO due to HRF in neonates. The aetiology of HRF, the number of retrievals and their short-term outcomes were reported. Methods: A retrospective audit of referrals to NETS (January 2019 to December 2022) of infants aged <28 days with HRF for ECMO. Patient demographics, management, advice at the time of call and the outcome are described. Results: The mean weight was 3511 g, mean gestation was 37.1 weeks and 69% of the patients were male. The main diagnoses were MAS/PPHN (50%), and there was variation in inotropes and ventilation strategies at the time of the referral. Six (25%) of the fifteen babies who were transported by NETS to paediatric intensive care were placed on ECMO at the referring hospital. A further six babies were stabilised at the referral centre following NETS co-ordinated specialist advice and did not require retrieval or ECMO. All the babies who received ECMO and survived had normal early development (<6 months) with normal head US or MRI imaging. Conclusions: Optimising ventilation and inotrope management can eliminate the need for ECMO prior to or following retrieval. Early referral for the consideration of ECMO and a collaborative discussion can assist in optimising conventional therapy, thus eliminating the need for ECMO. Neonates requiring ECMO for HRF have good survival rates with good short-term neurological outcomes.

Emergency Care and Medicine doi: 10.3390/ecm1030030

Authors: Wei Hao Lee

Methaemoglobinaemia (MetHb) is a functional anaemia that can be life-threatening in severe cases. MetHb in adults and older children usually results from exposure to toxins from ingestion or skin exposure, whereas MetHb in infants under six months old usually occurs due to exposure to well water, severe metabolic acidosis from diarrhoea, or, in rare cases, secondary to cow’s milk protein allergy (CMPA). In this case report, a young infant presented acutely with shock secondary to profuse diarrhoea and MetHb requiring intravenous fluids and methylene blue and was subsequently diagnosed with CMPA. The early recognition and prompt treatment of CMPA may prevent the recurrence of MetHb symptoms and excessive diagnostic testing in this vulnerable population.

Emergency Care and Medicine doi: 10.3390/ecm1030029

Authors: Ryo Oikawa Akio Doi Tomonori Itoh Toshiaki Sakai Osamu Nishiyama

Prehospital electrocardiogram (PH-ECG) transmission is an important technology for reducing door-to-balloon time, but the decision to transmit often depends on the discretion of emergency medical technicians (EMTs). Additionally, studies based on real-world data remain insufficient. This study reports a machine learning-based method for classifying the severity of PH-ECG images and explores its feasibility. PH-ECG data were compiled from 120 patients between September 2017 and September 2020. The model we created from these data was the first classification model for PH-ECG images using data from a Japanese study population and showed a weighted F1-score of 0.85 and an Area Under the Curve (AUC) of 0.93. This result can be interpreted as having an excellent balance of sensitivity and specificity. The Cohen’s Kappa coefficient between AI’s inferences and the correct labels created by two cardiologists was 0.68 (p < 0.05), which is considered “substantial” according to the guidelines presented by Landis and Koch. In this study, although we were not able to remove noise caused by patient movement or electrode detachment, the results indicate that image-based abnormality detection from PH-ECGs is feasible and effective, particularly in regions like Japan where ECG data are often stored and transmitted as images. In addition, in our region, paramedics follow a multi-step process to decide whether to transmit an ECG, which takes time for the first screening. However, if the ECG is transmitted when either the paramedics or the deep learning model detects an abnormality, it is expected to reduce reading time and door-to-balloon time, as well as decrease false negatives.