Frontiers in Emergency Medicine (E-Journal)
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Utilizing injury severity score, Glasgow coma scale, and revised trauma score for trauma-related in-hospital mortality and ICU admission prediction; originated from 7-year results of a nationwide multicenter registry
Get PDFObjective: During the past few decades, many scoring systems have been developed to evaluate the severity of injury and predict the outcome in trauma patients. This study aimed to assess the capacity of three common trauma scoring systems: injury severity score (ISS), Glasgow coma scale (GCS), and revised trauma score (RTS) in predicting in-hospital mortality and ICU admission in patients with traumatic injury. Methods: This is a multicenter study of the hospital-based national trauma registry of Iran (NTRI), an ongoing registry-based trauma database. This study included trauma cases from 12 major trauma centers throughout the country admitted between July 2016 and November 2023. The inclusion criteria were all patients admitted to the emergency department due to trauma, hospitalized for at least 24 hours, deceased within the first 24 hours of admission, and patients transferred from the intensive care unit (ICU)s of other hospitals. Results: A total of 50,458 traumatic patients, with 38,740 (76.9%) being male, were included in this study. After adjustment for confounders, head, face, and neck injuries were associated with the highest odds of death (OR: 7.51, P-value<0.001), whereas abdominal injuries were associated with the highest odds of ICU admission (OR: 4.58, P-value<0.001). Each Unit increase in RTS score was accompanied by a 61% decrease in odds of death (OR: 0.39, P-value<0.001). The area under the ROC curve for predicting in-hospital mortality was 0.81 (0.79 to 0.82) in ISS, 0.78 (0.77 to 0.80) in GCS, and 0.75 (0.73 to 0.76) in RTS. There was a significant difference between RTS and GCS, as well as RTS and ISS for in-hospital mortality prediction (P-values< 0.001). The area under the ROC curve for the prediction of ICU admission was 0.75 (0.74 to 0.75) in ISS, 0.63 (0.62 to 0.63) in GCS, and 0.62 (0.61 to 0.63) in RTS. There was a statistically significant difference between ISS and GCS, as well as ISS and RTS, for ICU admission prediction (P-value<0.001). Conclusion: ISS is the best predictor of in-hospital mortality and ICU admission, compared to GCS and RTS
The diagnostic value of T-wave to R–wave amplitude ratio on electrocardiogram in the diagnosis of hyperkalemia
Get PDFObjective: The aim of this study is determining the diagnostic value of the T-wave to R–wave amplitude ratio (T/R ratio) in the electrocardiogram (ECG) at the time of admission in terms of the diagnosis of hyperkalemia in patients who are at risk for hyperkalemia who apply to the emergency department (ED). Methods: This cross-sectional study was conducted with patients over 18 years of age who presented to the ED and have an estimated glomerular filtration rate (eGFR) below 60ml/min/1.73m2. The patients were divided into 2 groups according to the potassium value; hyperkalemia and normokalaemia groups. T/R ratios were measured on the ECG. All measurements were made in these precordial leads; V2, V3, and VT highest (is defined as precordial lead where the T wave is measured the highest). Results: A total of 345 patients with low eGFR were included. Hyperkalemia was detected in 115 (33.3%) of these patients, while 230 patients (66.6%) were in the normokalaemia group. T wave amplitude and T/R ratio were found to be statistically significantly increased in the hyperkalemia group in all leads (V2, V3, and VT highest). Area under the curve (AUC) values are 0.778 for T/R ratio and 0.717 for T wave amplitude. Conclusion: The presence of increased T/R ratio in the ECG of patients with known low eGFR may be more helpful for the diagnosis of hyperkalemia than the classical hyperkalemia ECG findings
An almost forgotten neurological entity: man in a barrel syndrome
Get PDFMan in a barrel syndrome (MIBS) presents with bilateral upper extremity weakness but preserved strength in face, neck, and lower extremities. In this case report, two cases of MIBS were admitted to the emergency department (ED) presented. The first patient injured his neck after falling off a ladder. The second patient was a victim of a traffic accident. Bilateral upper extremity weakness was examined in the first patient at first admission to the ED. On the other hand, progressive weakness was shown in the second patient during ED follow-up. The cervical imaging findings consisted with MIBS. This case report and review of literature highlights that physicians should consider every possible cause, even the rarest ones when a patient complains of neck trauma with non-specific symptoms. Rapid identification and treatment of treatable causes such as cerebral hypoperfusion are vital for patient prognosis
Hyponatremia as an underdiagnosed postpartum headache emergency: a case report
Get PDFPostpartum headache is a common emergency department complaint with a wide differential diagnosis. Distinguishing primary from secondary, more sinister, causes of headache is an important skill for the emergency physician. We present a case of a 31-year-old G1P1 woman who presented at five days postpartum with a 48-hour headache and an otherwise uncomplicated pregnancy. She had several precipitating postpartum risk factors, including use of hypotonic fluids in labour, oxytocin to augment labour, changes in food and drink patterns, and was mildly hypertensive. Urgent investigations in the emergency department found her to be severely hyponatremic (sodium: 121 mmol/L (normal: 136-144)) without evidence of preeclampsia. She was admitted to hospital to correct her electrolyte imbalance. This case highlights the importance of remaining vigilant in differentiating concerning causes of postpartum headache, as well as identifying key precipitants which may put women at risk for postpartum hyponatremia
Incidence and predictors of delirium among the intensive care unit patients at Jimma Medical Center, Southwest Ethiopia
Get PDFObjective: Delirium is characterized by impaired attention and awareness, accompanied by cognitive deficits. It develops rapidly and poses a considerable burden on healthcare systems. Patients in the intensive care unit (ICU) are particularly vulnerable to developing delirium. This study aims to determine the incidence and predictors of delirium among ICU patients at Jimma Medical Center in southwest Ethiopia in 2023. Methods: A prospective observational cohort study was conducted on 403 patients aged≥18 years admitted to emergency, surgical, and medical ICUs at Jimma Medical Center in southwest Ethiopia. Patients were assessed twice daily for delirium using the Richmond agitation sedation scale (RASS) and confusion assessment method (CAM). The association between independent variables and delirium incidence was analyzed using Cox proportional hazards (PH) regression. A univariate Cox PH model screened variables at a 0.25 significance level, followed by a multivariable Cox PH model for significant variables. Variables with a P-value≤0.05 were considered significantly associated with delirium incidence among ICU patients. Results: The findings of this study revealed that the overall occurrence of delirium among critically ill ICU patients was 118 (29.3%) (95% CI: 25%,34%), and the rest, 70.7% of the participants, were censored (95% CI: 66,75). The incidence rate of delirium among intensive care unit patients was 21.2 (95% CI: 17.8,25.4) per 1000 person-days of observation. Chronic obstructive pulmonary disease (AHR: 1.94; 95% CI: 1.23,3.56), stroke (AHR: 1.8; 95%CI: 1.98,3.73), Oxygen Saturation less than 90% (AHR:1.61; 95% CI: 1.11,2.34) and Obesity (AHR: 0.35; 95%CI: 0.13,0.84) were independent predictors of delirium among ICU patients. conclusion: This study found that, with an incidence rate of 21.2 occurrences per 1000 person-days of observation, delirium greatly affects the outcome of intensive care unit patients in the Jimma Medical Center. The study identifies several factors that independently predict the occurrence of delirium in ICU patients, including obesity, stroke, low oxygen saturation levels, and COPD. Interestingly, our findings suggest that admission for heart failure may have a protective effect against delirium. Therefore, health professionals ought to give special attention to patients with identified predictors
Prevalence of cardiovascular diseases following man-made disasters; a systematic review
Get PDFObjective: Disasters increase the incidence of infectious and contagious diseases, non-communicable diseases, and trauma. This systematic review aims to investigate the impact of man-made disasters on cardiovascular diseases (CVDs). Methods: This is a systematic review conducted following the PRISMA protocol. The population, intervention, control, outcome (PICO) framework utilized for this research is as follows: P: people with CVDs; I: various man-made disasters; C: no intervention is being compared; O: prevalence, treatment, and management of the disease. In the present study, English-language articles published until November 9, 2022 that investigated CVDs in human-made disasters were included. We conducted an extensive search in Medline, Web of Science, Embase, and SCOPUS. Results: The primary search of the databases resulted in 1878 articles, from which 1219 non-duplicate records. Finally, 18 articles were included; 13 studies were in the area of nuclear and atomic accidents, four studies were related to the sulfur mustard gas, and one was related to methyl chloride. Conclusion: CVDs increased in prevalence after man-made disasters, particularly among high-risk individuals. The likelihood of developing CVDs is higher with increasing dose, intensity, and duration of exposure
Confusion about the cause of constipation in milder types of congenital anal malformations
Get PDF As a pediatric surgeon, I have read your case titled "Giant megacolon caused by anterior displacement of the anus in a 71-Year-old woman" (1) with great interest. I would like to extend my congratulations to the authors and editors for this successful article and offer some contributions. There is limited information in the literature about the long-term follow-up of patients with an anteriorly located anus. This case appears to be the oldest patient in the literature to be diagnosed with this anomaly and to have had the longest follow-up. In this respect, the case holds significant value
Measuring the effect of vehicle safety on road traffic crash severity in Iran: using structural equation modeling
Get PDFObjective: Vehicle safety plays a key role in reducing the number of road traffic deaths and serious injuries. This study aims to investigate the effect of vehicle safety on the severity of traffic crashes in Iran using structural equation modeling (SEM). Methods: This was a comparative cross-sectional study of all imported vehicles with Aras free trade zone license plate as well as all domestic vehicles (cars produced in Iran) commuting on Tabriz-Jolfa road. The study population included drivers who had accidents on Tabriz-Jolfa road over a period of one year from September 22, 2020 to September 21, 2021 and were injured or their vehicles had been damaged (n=652). Data was collected using set of questionnaires with 10 sections. The effect of independent variables, as exogenous latent variables (human, vehicle, and environmental factors), on a dependent variable, as an endogenous latent variable (crash severity) was measured using SEM. All data were analyzed using Mplus 8.0 software. Results: In the structure part of the model with foreign vehicles group, the effect sizes of three exogenous variables, i.e., human, environmental, and vehicle factors, on the dependent variables were found to be 0.412, 0.396 and 0.358, respectively. The effect sizes in the model with domestic vehicles were found to be 0.312, 0.702 and 0.820, respectively. Conclusion: Vehicle factors (variables related to car safety) had a high impact on crash severity in the national license plate and domestically manufactured vehicle group, indicating the necessity of improving vehicle safety
Assessing the risk perception of COVID-19 among non-infected people attending emergency departments of selected hospitals in western Iran
Get PDFObjective: It is important to know people’s perceptions of the risks related to coronavirus disease 2019 (COVID-19) for controlling the pandemic. This study aims to assess the risk perception of COVID-19 among non-infected people referred to emergency departments (ED) of hospitals in Khorramabad, Iran during the pandemic and its related demographic factors. Methods: This is descriptive/analytical study with a cross-sectional design. Participants were 380 adults referred to the ED of four hospitals (Shohadaye Ashayer, Shahid Rahimi, Asali, and Shahid Madani) in Khorramabad city in 2021 who were not infected by COVID-19. For data collection, the risk perception of COVID-19 questionnaire was used. Data were described using mean, standard deviation, frequency, and percentage. Chi-squared test was used in SPSS v.22 software to find the related demographic factors. Results: It was found that 5 people (1.3%) had a moderate perception, 206 (54.2%) had good perception, and 169 (44.5%) had high perception. No one had poor risk perception. According to them, “own knowledge and experience” was the most effective factor in preventing COVID-19 followed by “the advice of experts in the media” and “the advice of friends and family”. Chi-squared test results showed a significant difference in risk perception among people in terms of age (P=0.002) and marital status (P=0.001); the age group <25 years and single people had lower risk perceptions. Conclusion: The risk perception of COVID-19 in people referred to the EDs in western Iran is at good level but is not high. It is necessary to improve their risk perception by education and increasing awareness on social media
Evaluation of renal function with renography in patients with renal colic
Get PDFObjective: Urolithiasis is responsible for the majority of urological emergencies. Although computed tomography (CT) scan can identify urinary obstruction caused by stones, there is a growing concern about exposure to radiation made by this method. Renal scintigraphy can provide valuable insights regarding the functional status of kidneys and can significantly reduce exposure to radiation. The goal of present study was to assess renal function through renal scintigraphy in patients with acute renal colic and it explores the association between renal scintigraphy performance and ultrasound in terms of detecting hydronephrosis. Methods: For this study, 20 patients with acute renal colic were chosen. Each patient underwent renal ultrasonography and subsequently received renal scintigraphy with Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA). Cohen's Kappa coefficient and Cramer's V correlation were employed to demonstrate the extent of agreement between ultrasound and renal scintigraphy. Results: 12 (60%) patients were male. Glomerular filtration rate (GFR) values were correlated with Cockcroft-Gault equation and the Gates method (P=0.002, r=0.642). There was a good agreement and a statistically significant relationship between ultrasound and renal scintigraphy in terms of detecting obstructive uropathy in both kidneys. Conclusion: To conclude, GFR values were correlated between Cockcroft-Gault equation and the Gates method in patients with acute renal colic. There was a good agreement and statistically significant relationship between ultrasound and obstructive renography results in both kidneys. However, we found no association between perfusion phase of renal scintigraphy and ultrasonography in terms of hydronephrosis detection