Frontiers in Emergency Medicine

Clinical and radiographic findings in children with foreign body aspiration: a 10-year cross-sectional study in a tertiary hospital

2025-10-22T10:19:20+00:00

Objective: 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.

Diltiazem vs metoprolol for atrial fibrillation with rapid ventricular response in heart failure with reduced ejection fraction in emergency departments

2025-10-22T10:19:19+00:00

Objective: As emergency department (ED) visits for atrial fibrillation (AF) grow, comorbidities lead to challenging treatment scenarios. There are limited data evaluating the safety of diltiazem in the acute management of AF with rapid ventricular rate (RVR) in patients with heart failure with reduced ejection fraction (HFrEF). The objective of this study was to evaluate the safety of diltiazem vs metoprolol in patients presenting to the ED with AF with RVR with HFrEF.

Methods: This multicenter, retrospective, cohort study evaluated patients with AF with RVR with HFrEF who received either intravenous (IV) diltiazem or metoprolol in the ED. The primary endpoint was worsening heart failure, defined as an increase in supplemental oxygen requirement, acute kidney injury (AKI), or inotrope administration. Secondary endpoints included bradycardia, systolic blood pressure (SBP) <90 mmHg, or atropine administration.

Results: Of the 5,465 patients screened, 62 (1.1%) patients were included for analysis. Forty-nine (79%) patients received IV diltiazem and 13 (21%) received IV metoprolol. The primary endpoint of worsening heart failure occurred in 26.5% in the diltiazem cohort and 15.4% in the metoprolol cohort (P=0.493). There were no differences in increased need for supplemental oxygen, incidence of AKI, or inotropic support. There were no differences in the secondary safety endpoints.

Conclusion: For ED management of patients with AF with RVR with HFrEF, treatment with IV diltiazem did not lead to an increase in worsening heart failure compared to IV metoprolol. Future prospective trials are needed to evaluate this treatment approach in this population.

Analyzing thoracic trauma trends at Dr. Mohammad Hoesin Hospital, Indonesia: findings from 2020

2025-10-22T10:19:18+00:00

Objective: Thoracic trauma is frequently encountered in Indonesia, contributing to significant rates of mortality and morbidity. A considerable number of patients with thoracic injuries succumb before reaching medical facilities, as the prevalence of such trauma continues to escalate. Nevertheless, the risk of fatal outcomes can be mitigated through timely emergency intervention, precise diagnosis, and appropriate treatment. This study aimed to present an overview of the demographic characteristics, treatment outcomes, and duration of hospitalization for thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang during the years 2020 and 2021.

Methods:

This descriptive observational study utilized secondary data derived from the medical records of thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang from January 1, 2020, to December 31, 2021, who satisfied the established inclusion and exclusion criteria.

Results:

A total of 78 thoracic trauma patients were treated at Dr. Mohammad Hoesin Palembang Hospital during 2020–2021, with a sociodemographic profile predominantly consisting of males (91.3%) and individuals aged 45 years and older (66.3%). Penetrating injuries caused by sharp objects accounted for 45% of cases. The most prevalent diagnosis among these patients was hemopneumothorax (23.1%), followed by thoracic trauma without associated injuries (62.5%). The majority of patients (97.5%) were discharged from the hospital. Notably, 58.8% of patients arrived at the hospital more than six hours post-trauma, and nearly half (48%) had a hospital stay ranging from one to five days.

Conclusion:

The cohort of thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang hospital in 2020–2021 was primarily male, aged 45 years or older, sustained injuries from sharp objects, diagnosed with hemopneumothorax without associated thoracic injuries, arrived at the hospital after more than six hours, and were discharged within one to five days.

Effectiveness of digital consultation in reducing emergency department length of stay

2025-10-22T10:19:17+00:00

Abstract:

Objective: Emergency department length of stay (EDLOS) is a critical measure of healthcare efficiency and quality, and prolonged stays are associated with worse outcomes, particularly for patients requiring intensive care unit (ICU) admission. This study evaluates the impact of a digital consultation management system implemented at Hiwot Fana Comprehensive University Hospital in Ethiopia between May 2020 and May 2024.

Methods: A pre–post quasi-experimental design was utilized to compare EDLOS for ICU patients before and after the implementation of the new consultation system. The traditional consultation process was characterized by multi-step verbal communication among healthcare providers. The new system employed a secure Telegram channel to facilitate real-time communication, whereby all physicians in the consulting service were simultaneously notified of the patient requiring ICU care. We determined the proportion of patients admitted to the ICU staying more than 24 hours in the emergency department (ED) between pre- and post-implementation of the Telegram system using chi-squared tests and mean difference in LOS using Mann Whitney U.

Results: This study included 415 patients with 202 patients in the pre-implementation period (May 01, 2020, to May 31, 2022) and 213 in the post-implementation period (June 01, 2022, to May 31, 2024). The mean age was 43.3 years (SD: 18.75 years), and no significant demographic or clinical differences were observed between the pre- and post-intervention groups, except for payment method. Before implementation, 32.6% of patients stayed in the ED> 24 hours while after the implementation 28.8% stayed > 24 hours (P=0.03) The mean EDLOS decreased from 2.83 (SD: 2.5) days to 2.27(SD: 1.64) days following implementation (P=0.04), with a reduction of approximately 13.2 hours in EDLOS. Overall ICU mortality decreased from 31.4% to 25.8%, though this was not statistically significant.

Conclusion: A digital consultation system can reduce EDLOS in a limited-income country, consistent with findings from similar studies. Further research is needed to explore long-term impacts and scalability, especially in low-resource settings.

Detecting COVID-19-infected regions in Lung CT scan through a novel dual-path Swin Transformer-based network

2025-10-22T10:19:16+00:00

Background: Deep learning-based automatic segmentation provides significant advantages over traditional manual segmentation methods in medical imaging. Current approaches for segmenting regions of Coronavirus disease 2019 (COVID-19) infections mainly utilize convolutional neural networks (CNNs), which are limited by their restricted receptive fields (RFs) and consequently struggle to establish global context connections. This limitation negatively impacts their performance in accurately detecting complex details and boundary patterns within medical images.

Methods: This study introduces a novel dual-path Swin Transformer-based network to address these limitations and enhance segmentation accuracy. Our proposed model extracts more informative 3D input patches to capture long-range dependencies and represents both large and small-scale features through a dual-branch encoder. Furthermore, it integrates features from the two paths via the new Transformer Interactive Fusion (TIF) module. The architecture also incorporates an inductive bias by including a residual convolution (Res-conv) block within the encoder.

Results: The proposed network has been evaluated using a 5-fold cross-validation technique, alongside data augmentation, on the publicly available COVID-19-CT-Seg and MosMed datasets. The model achieved Dice coefficients of 0.872 and 0.713 for the COVID-19-CT-Seg and MosMed datasets, respectively, demonstrating its effectiveness relative to prior methodologies.

Conclusion: The significant improvements in segmentation accuracy, demonstrated by the achieved Dice coefficients on the COVID-19-CT-Seg and MosMed datasets, highlight the potential of our approach to enhance automated segmentation in medical imaging.

How does Jordanian patients’ satisfaction with emergency nursing care associated with their knowledge of the triage system and expected time to wait?

2025-10-22T10:19:15+00:00

Objective: Emergency departments (EDs) are critical to healthcare systems, yet in Jordan, overcrowding and resource limitations challenge care quality. This study assessed how Jordanian patient satisfaction with nursing care at EDs related to their understanding of triage systems and wait times.

Method: A prospective cross-sectional design was used. Data were collected from largest two healthcare hospitals in Jordan which utilizing Canadian triage system. A convenience sampling method was utilized. All adult patients (≥18 years) were included. However, patient’s triaged at level 1 (resuscitation) or 2 (emergent) based on Canadian triage system, pediatric patients, and/or those with documented history of psychiatric illness were excluded. Valid and reliable tools were used.

Result: The mean age of patients was 37.6 years (SD=11.4), with a mean satisfaction score of 15.79/20 (SD=3.22), reflecting high satisfaction. Most patients (61.3%) were unaware of triage processes; however, their satisfaction with nursing care was related with triage understanding (P<0.05). Younger patients (t=2.045, P<0.05), Jordanian nationals (t=1.817, P<0.05), unmarried individuals (F=3.32, P<0.05), and government-sector workers (F=3.42, P< 0.05) reported significantly higher satisfaction than others.

Conclusion: Enhancing patient satisfaction in EDs relies on optimizing nursing care, particularly through staff training in triage systems and patient education about triage processes. Implementing standardized protocols, along with accessible educational materials for patients while they are in the waiting room, is critical to addressing care gaps and ensuring sustainable improvements.

Beyond the obvious: spontaneous esophageal perforation mimicking flank pain

2025-10-22T10:19:14+00:00

Spontaneous esophageal perforation, also known as Boerhaave syndrome, is a rare but potentially fatal condition that classically presents with chest pain, vomiting, and subcutaneous emphysema. Atypical presentations can lead to diagnostic delays and increased morbidity and mortality rates. A 51-year-old male presented to the emergency department with isolated left flank pain. Initial clinical assessment suggested renal pathology, which prompted physicians to order a non-contrast thoracoabdominopelvic computed tomography (CT) scan. The CT scan unexpectedly revealed bilateral diffuse subcutaneous emphysema and left pleural effusion. Following chest tube insertion, food particles were recovered from the pleural drainage, which established the diagnosis of esophageal perforation. Emergency surgical repair was performed successfully with a good clinical outcome. This case highlights the importance of maintaining high clinical suspicion for esophageal perforation even in patients presenting with atypical symptoms. The absence of classic triad symptoms should not exclude this diagnosis from consideration. CT imaging can provide crucial diagnostic information when the clinical presentation is unclear or atypical.

Spontaneous coronary artery dissection (SCAD) as a rare but life-threatening emergency department presentation: a case report

2025-10-22T10:19:13+00:00

Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening cause of acute coronary syndrome, particularly in young women with few traditional risk factors for atherosclerosis. SCAD is often underrecognized due to its atypical presentation which can lead to misdiagnosis or delayed diagnosis in emergency settings. We present a case of a 40-year-old female who presented to the emergency department with acute chest pain and was found to have ST-elevation myocardial infarction (STEMI) due to SCAD. This case highlights the importance of considering SCAD in the differential diagnosis of acute coronary syndrome in young patients, especially females, and the need for increased awareness among emergency physicians to optimize patient outcomes and reduce recurrence risks. This case also emphasizes the importance of recognizing SCAD as a distinct entity from atherosclerotic ACS, as it requires a different management approach, particularly in the initial steps of care.

First aid for hypertension: potentially lifesaving but neglected domain of emergency response

2025-10-22T10:19:11+00:00

The Article Abstract is not available.