Frontiers in Emergency Medicine (E-Journal)
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Development and psychometric testing of the quality of care for trauma patients scale using exploratory and confirmatory factor analysis
No full textObjective: Identifying trauma care quality from the trauma victims' viewpoints is key to patient-centered care, identifying service gaps, developing effective protocols, and building trust in medicine. The current study aims to establish a new quality of trauma care questionnaire and to assess its psychometric characteristics within the hospital context in Iran. Methods: First, items were developed through a combination of literature review and interviews. Then, the validity of the items, including content, face, and internal consistency, was evaluated. Construct validity was assessed using exploratory factor analysis (EFA) on a sample of 220 patients, followed by confirmatory factor analysis (CFA) with a separate group of 253 patients from August to October 2022. Results: Content validity, as measured using modified Kappa, was 0.95. Cronbach's alpha for internal consistency was 0.91, and test-retest reliability over two weeks was 0.94. The EFA revealed four factors: interpersonal quality, technical quality, outcome quality, and non-medical quality, which collectively accounted for 67% of the total variance in measuring the quality of care in trauma victims. Using CFA, researchers validated the final version of the trauma quality scale from patients' perspective (TQS-PP), which includes 22 items across four dimensions. The CFA model of the TQS-PP demonstrated an acceptable fit, with χ2/df = 2.064, RMSEA=0.058, CFI=0.912, and NNFI=0.920. Conclusion: Psychometric evaluations demonstrated sufficient validity and reliability for TQS-PP application in quality research involving trauma victims in Iran. The developed and evaluated TQS-PP serves as a reliable measure of health care quality from the perspective of trauma victims. The new tool could assist public health researchers in assessing the quality of care in emergency departments (EDs) and similar contexts
Impact of verbal pressure on CPR and AED performance: a randomized simulation study
No full textObjective:The aim of this randomized-controlled simulation study was to evaluate the impact of external verbal pressure on the effectiveness and safety of automatic external defibrillator (AED) use and hands-on cardiopulmonary resuscitation (CPR). Methods: Sixty-two first-year nursing students were recruited. Participants were split into pairs (n=31), randomly assigned to the study and control groups. Subsequently, each pair took part in a brief simulation scenario. One student was responsible for performing chest compressions, whilst the second was responsible for using an AED. The researcher verbally pressed the participants responsible for AED use in the study group. Students performing chest compressions were not the addressee of any comments. Participants in the control group acted without the researcher's pressure. Results: Only 2 participants in the control group used AED incorrectly, compared with 8 participants in the study group who incorrectly performed defibrillation. The rate of hands-on CPR was significantly faster in the study group compared to the control group (124±29.7 versus 104±20.8; P=0.028). Conclusion: Verbal pressure in simulation settings significantly diminishes the quality of performance during AED use. The pressure affected not only the participants to whom it was directly addressed but also their teammates, who performed worse compared to those without additional stressors
Unethical leadership can lower the quality in resuscitation teams: a randomized simulation study
No full textObjective: The aim of this study was to evaluate whether verbal pressure from the team leader distracted students during a critical care simulation scenario. Particularly, examining the influence of unethical leadership on CPR quality was the objective of this work. Methods: Eighty students were randomized into study (n=40) and control group (n=40). They participated in a short cardiac arrest simulation scenario, each one separately. The scenario consisted of two tasks. Firstly, they were asked to bring to the team leader one ampule of a particular drug. A variety of drugs in their original packaging were placed on a shelf, but the handicap of this task was that the ampullae were mixed up between boxes. The second task was to perform 30 good-quality chest compressions. Study group participants were experiencing verbal pressure during the first part. Results: Study group participants fulfil the first task faster (require less time to bring the ampulla), but fewer of them find out that medications are mistaken (in comparison with the control group). Moreover, the study group reports higher stress levels (as assessed in 1 - 10 scores), and more participants perform too fast chest compressions (faster than 120 times per minute) in this group. Conclusion: Verbal pressure from a team leader increases participants' stress levels and decreases their effectiveness (chest compression quality and the ability to identify that ampullae are mistaken)
Patient presentations at medical clinics during the martyrdom anniversary of Imam Ali bin Abi Talib mass gathering, Najaf, Iraq, 2024: a cross-sectional study
No full textObjective: Religious mass gatherings in Iraq attract millions of pilgrims and have significant public health challenges. The martyrdom anniversary of Imam Ali bin Abi Talib (peace be upon him) in Najaf involves high population density and potential health risks. However, limited data exists on the spectrum of patient presentations during this event. Methods: It was a cross-sectional study in 12 health facilities (10 temporary mobile clinics and 2 fixed centers) established in Najaf for the event. The study was conducted from March 29 to April 1, 2024 (18–21 Ramadan 1445H). Data was collected by convenience sampling, entered via KoboToolbox, and analyzed in SPSS version 26 using descriptive statistics and chi-squared tests. Results: A total of 8,959 patients were registered. Most were aged 31–60 years (58.2%) and Iraqi nationals (80.8%). The most common acute infectious presentation was pharyngitis (16.7%: 95% CI: 15.9,17.4), followed by acute diarrhea (3.2%: 95% CI: 2.9,3.6). Noncommunicable conditions included hypertension (11.5%; 95% CI: 10.9,12.2), and diabetes mellitus (7.9%; 95% CI: 7.3,8.4). Patient presentations varied significantly by age group and nationality (P< 0.001). Conclusion: Pharyngitis was the leading acute presentation, suggesting a risk of respiratory disease transmission. Chronic conditions, particularly hypertension and diabetes, especially among adults over 31 years. These findings highlight the need for preparedness of temporary clinics to manage both communicable and noncommunicable diseases during religious mass gatherings in Iraq
Serum IGF-1 level as a prognostic marker for acute ischemic stroke: a systematic review
Get PDFObjective: Assessing the risk levels of patients with acute ischemic stroke (AIS) can assist in making informed choices about their treatment and rehabilitation. To assess the prognostic value of serum insulin-like growth factor-1 (IGF-1) in neurological deficit (National Institutes of Health Stroke Scale [NIHSS]), functional independence (Modified Rankin Scale [mRS]), and mortality following AIS. Methods: The search encompassed Medline, Embase, Scopus, and Web of Science until June 2023. Two autonomous researchers incorporated articles by the established inclusion and exclusion criteria. The quality of the included studies were assessed using the quality assessment of prognostic accuracy studies (QUAPAS) tool. Results: Ten articles were included, with evidence suggesting that IGF-1 may have prognostic value in AIS outcomes. Several studies reported positive associations between IGF-1 levels, reduced neurological deficits, improved functional independence, and lower mortality. Additionally, intraindividual fluctuations in IGF-1 after AIS were identified as a potential predictor of recovery in functional independence, though significant inconsistencies exist in the findings. Conclusion: The available studies with a very low level of evidence are not sufficient to firmly endorse the applicability of IGF-1 as a prognostic factor for mortality, neurological disability, and functional independence
Elderly patients with emergency department return visit: descriptive analysis of adverse events
Get PDFObjective: An emergency department (ED) visit is a critical event for elderly patients, often associated with an increased likelihood of early return visits (RVs), functional decline, and adverse events (AEs). This study aimed to investigate the proportion of ED RVs within 72 hours that were due to AE among elderly patients. Methods: We conducted a retrospective review of hospital records for elderly patients aged 65 years and older who returned to the ED within 72 hours of discharge. The study focused on identifying AEs as a primary cause of RV and characterizing their type, severity, and preventability. Results: Over a 6-month period, 69,557 patients presented to the ED, of whom 9,439 patients (13.6%) were aged 65 years and older, with a median age of 75. Among these elderly patients, 373 (3.9%) returned within 72 hours. Of these, 201 patients underwent a secondary review to detect AEs which revealed that 49 RVs (24.4%) were attributed to AEs. Diagnostic errors were the most common type of AEs, accounting for 34.7% of cases. Severe AE occurred in 36.7% of patients, and more than half (63.4%) were deemed preventable. Conclusion: The results of our study indicate a concerning correlation between RV and AE in elderly patients. A substantial portion of these AEs is due to diagnostic and management errors, highlighting the necessity for strategies to enhance the quality of care for this vulnerable group. The study advocates for utilizing 72-hour ED RV as a trigger for identifying AEs
Clinical and radiographic findings in children with foreign body aspiration: a 10-year cross-sectional study in a tertiary hospital
Get PDFObjective: Aspiration of a foreign body in the airways of children is one of the important emergencies in children, which is associated with high mortality and morbidity if not diagnosed promptly or managed effectively. The aim of this study was to investigate the clinical and radiographic findings in children with foreign body aspiration. Methods: In a large cross-sectional retrospective study at a tertiary hospital from 2009 to 2019, children with foreign body aspiration were evaluated. The required information (demographics, clinical examination findings, and results of radiological and bronchoscopy reports) was extracted from the medical records of the patients in the hospital archive. Results: In this study, 330 patients were enrolled, 61.2% of whom were male. The mean age of the patients was 2.65±2.68 years. The average time interval from the onset of symptoms to the final diagnosis was 11.54 days. The most common location and type of aspirated foreign body were the right main bronchus (60%) and seeds (39.1%), respectively. Cough and decreased unilateral lung sounds were the most common clinical symptoms (91.5%) and physical findings (50.6%), respectively. The most common finding on chest X-ray was local emphysema (43%). Conclusion: Foreign body aspiration can lead to irreparable injuries if it is not recognized and managed promptly. Aspiration of a foreign body can result in serious harm if not quickly diagnosed and properly managed. Clinical suspicion of aspiration and the management of these children are critical
Quality of YouTube Videos on Focused Assessment with Sonography in Trauma Protocol
Get PDFObjective: The Focused assessment with sonography in trauma (FAST) protocol is one of the most critical steps in trauma assessment in current emergency department practices. The contribution of video-based learning to medical education is increasingly recognized. This study aims to evaluate the quality of videos related to e-FAST ultrasonography as well as the factors influencing video quality. Methods: The study encompassed conducting searches on YouTube using the keywords "FAST," "E-FAST," and "Trauma USG," followed by a comprehensive analysis of the retrieved videos. The quality of these videos was evaluated using JAMA, GQS, and DISCERN scores. Results: The study included 93 videos. The mean mDISCERN score was 3.1 (0.9), the mean JAMA score was 2.1 (0.7), and the mean GQS score was 3.4 (1.0). Sixty-five (69.9%) of the videos were recorded by individuals, and 60 (64.5%) used only the US image in the video. The median video length was 639 seconds (s) (range: 250–1305 s), median number of comments was 0 (range 0–4), median upload date (days) was 1675 (range: 976-2750), number of views was 2250 (range: 467-14187), and number of likes was 28 (range: 8-162). The mean mDISCERN and JAMA scores of institutional videos were 3.2 (0.9) and 2.2 (0.7), respectively, and the mean mDISCERN and JAMA scores of individual videos were 2.7 (0.8) and 1.9 (0.7) (P values = 0.008 and 0.018, respectively). The mean GQS score of institutional videos was 3.5 (0.1), and the mean GQS score of individual videos was 3.3 (0.8) (P=0.325). The median number of comments in individual videos was 4.0 (range: 0.0–12.5), while the median number of comments in institutional videos was 0.0 (range: 0.0–2.0; P= 0.011). There is a significant difference in the number of likes (P=0.043). No significant difference was found in video length, date, and number of views between individual and institutional videos (P values = 0.236, 0.974, and 0.255, respectively). Conclusion: Upon reviewing e-FAST/FAST protocol videos on social networks, it becomes apparent that institutional videos exhibit better quality. Institutional videos are not only more target-oriented, but they also provide reliable information and are optimized for timeliness
Comparison of penthrox (methoxyflurane) inhalation and intravenous morphine for acute limb fracture pain management in the emergency department: a randomized controlled trial
Get PDFObjective: Effective pain management is crucial in emergency settings, and both penthrox (methoxyflurane) inhalation and intravenous morphine are commonly used analgesics. This study aimed to compare the analgesic efficacy, adverse effects, and patient satisfaction associated with penthrox spray and morphine for acute limb fracture pain management in the emergency department. Methods: This prospective, double-blinded, randomized controlled trial included 50 patients aged 20-55 years with acute limb fracture pain, randomly assigned to receive either penthrox spray or intravenous morphine. The primary outcome was pain intensity assessed using the visual analog scale (VAS) over 60 minutes. Secondary outcomes included adverse effects, vital signs, and patient satisfaction. Results: Both groups experienced significant pain relief over time, with a similar reduction in VAS scores (P<0.001). However, the penthrox spray group showed a trend toward more rapid pain reduction, although not statistically significant. The frequency of vomiting and nausea tended to be lower in the penthrox spray group (24% vs. 40%, P=0.225). There were no significant differences in patient satisfaction scores between groups. While both groups experienced a decrease in blood pressure, the heart rate remained stable in the penthrox spray group but decreased significantly in the morphine group (P<0.001). Conclusion: Penthrox spray and intravenous morphine demonstrated comparable analgesic efficacy for acute limb fracture pain in the emergency department. Penthrox sprays trended toward faster pain relief and potentially lower risk of vomiting and nausea. The stable heart rate observed with penthrox may be advantageous in certain clinical scenarios. Consideration of factors such as onset of action, adverse effects, and patient preferences may guide the choice between these analgesics
Liver abscess due to appendicitis: a case report
Get PDFPyogenic liver abscess (PLA) is a rare but serious condition that can be life-threatening. Recent developments in diagnostic techniques and treatment have resulted in earlier detection and intervention and hence reduction in mortality rates. Despite these improvements, PLA remains a clinical challenge due to its hidden symptoms and associated health risks. PLA may be caused by seeding from appendicitis. We present a 52-year-old woman presented with PLA due to appendicitis. Upon physical examination, laboratory study and imaging, an acute appendicitis with pyogenic liver abscess were found. The patient underwent percutaneous drainage of the abscesses with a catheter and an interval appendectomy