Frontiers in Emergency Medicine

Hospital safety index: evaluation of the readiness and safety of hospitals in Isfahan province, Iran

Farhad Heydari — 2024-05-12

Objective: Hospitals play a vital role in disaster management and their function must be maintained during crises. Isfahan province is susceptible to major crises and disasters at any time of the year. The study aimed to investigate the hospital safety index (HSI) in hospitals in Isfahan province.

Methods: This cross-sectional study was conducted using the HSI questionnaire of the world health organization. The safety of all 55 hospitals in Isfahan province was evaluated with the Persian version of the questionnaire from 2017 to 2022. In this study, all hospitals were evaluated by a group of experts from the emergency operations center (EOC) of Isfahan University of Medical Sciences, and the checklists were completed with the cooperation of the hospital disaster committee, visiting the hospitals, and interviewing the personnel.

Results: The safety level of hospitals has improved from 2017 to 2022 so in 2022, 38 hospitals (69.09%) had a high safety level, and 17 hospitals (30.91%) had a medium safety level. This increase in safety has happened in all three components of safety (functional, non-structural, and structural safety). There was no significant difference in the overall hospital safety score between academic-educational, non-academic governmental, social security and military, and private and charity hospitals (P<0.05).

Conclusion: Although the safety in the hospitals of Isfahan province has improved due to the continuous disaster prevention and preparedness activities, hospitals still need to improve to achieve higher levels of safety. The HSI shows how well a hospital can maintain its organization and performance during disasters. This index will be useful for decision-making and policy-making to prioritize administrative and civil interventions.

A mortality indicator in acute pulmonary embolism: the inferior vena cava contrast reflux score feasibility

Mümin Murat Yazici — 2024-05-12

Objective: Acute pulmonary embolism (APE) is frequently associated with high morbidity and mortality rates. Numerous studies have investigated the prognostic significance of cardiovascular computed tomography (CT) parameters. This study aimed to investigate potential CT scan predictors of 24-hour mortality in APE and to evaluate the value of the inferior vena cava (IVC) reflux score calculated on CT scan in predicting mortality.

Methods: This study was a single-center, retrospective study. Approval from the local ethics committee (decision no. 2023/76) was obtained before patients’ data scanning. Patients who were admitted to the emergency department (ED) of a tertiary education and research hospital in Turkey between January 1, 2019, and December 31, 2021, who were diagnosed with APE at CT scan in the ED and whose treatment was started, and who did not meet the exclusion criteria were included in the study. The relationship between CT scan findings and early and late mortality was evaluated.

Results: The study population comprised 226 patients, meeting the inclusion and exclusion criteria. Of the 226 patients, a total of 39 (17.3%) patients died, 16 (7.1%) within the first 24 hours. In evaluating CT scan parameters, the inferior vena cava (IVC) reflux score showed a statistically significant difference between the groups with and without mortality (24-hour P=0.001; 30-day P=0.001). Patients who died within the first 24-hour and 30-day after admission showed a reflux grade 3 into IVC more often than survivors (24-hour odds ratio (OR): 14.57, 95% confidence interval (CI): 3.64,58.1; P=0.001); 30-day (OR: 6.54, 95% CI: 2.51,16.98; P=0.001). However, other CT parameters were evaluated, and no statistical relationship was found between the groups with and without mortality.

Conclusion: The cardiovascular CT scan findings may not be suitable for use as predictors of mortality. However, the IVC reflux score may be a good indicator of both early and late mortality.

Experiences of emergency medical services personnel about barriers and facilitators in prehospital childbirth missions in Iran: a qualitative study

Sirvan abbasi ghocham — 2024-05-12

Objective: In Iran, the majority of emergency medical services (EMS) personnel are male; hence, one of their distinct and crucial missions is the prehospital childbirth mission, which might be significantly challenging for both personnel and patients. To obtain in-depth and authentic data, the present study was conducted to elucidate the barriers and facilitators of prehospital childbirth missions based on the experiences of EMS personnel.

Methods: A qualitative study employing conventional content analysis was conducted in 2023. Participants were selected through purposive sampling from EMS personnel willing to participate in the study and who have experiences with missions leading to childbirth. Data saturation was reached through in-depth semi-structured interviews with 14 participants. Data accuracy and credibility were confirmed using the Lincoln & Guba criteria.

Results: The results included two main themes including barriers and facilitators. Barriers were categorized into "gender-related barriers" and "personnel barriers." While "appropriate communication" and "efforts to preserve privacy" were the primary facilitator themes.

Conclusion: The findings revealed that EMS personnel face considerable barriers in the process of these missions. Therefore, for optimal performance quality in this prominent mission, it is recommended that clinical and educational policymakers consider actively recruiting female personnel, focusing on enhancing communication and practical skills and securing the patient's privacy. These approaches can result in childbirth missions with lower stress levels for patients, families, and personnel who provide the service.

Does a given abbreviated injury scale value in different body regions contribute to the same risks of in-hospital mortality and ICU admission in trauma patients?

Armin Khavandegar — 2024-05-12

Objective: We aimed to investigate the hypothesis that identical abbreviated injury scale (AIS) scores may lead to varying risks of in-hospital mortality and admission to the intensive care unit (ICU) depending on the specific body region affected.

Methods: This study focused on hospitalized trauma patients with moderate to serious injuries (AIS=2, 3). The final sample was stratified based on the injured body regions. To determine the impact of these injuries on mortality and ICU admission, we conducted binary logistic regression after adjusting for confounding factors.

Results: Overall, 16,040 trauma patients with moderate injury (AIS=2) and 1,338 trauma patients with serious injury (AIS=3) were included in this study. When comparing outcome of trauma patients in different body region, there was no significant difference in the odds of two main outcomes in various injury sites, except for extremities (P values>0.05). When the AIS=2 patients were controlled for confounding factors, the adjusted odds of mortality were significantly higher for head, face, and neck injuries, as well as spine/back, thoracic, and abdominal injuries, compared to extremity injuries (adjusted odds ratio (aOR)s=9.81,8.78, 8.11, and 3.96, respectively; P-values<0.05). Among those with AIS=3, the odds of mortality were significantly greater for abdominal (aOR=7.05, P-value=0.009) and head, face, and neck injuries (aOR=2.73, P-value=0.001) than for extremity injuries.

Conclusion: Injuries with the same AIS (=2, 3) value almost indistinguishably confer the same mortality risk and ICU admission, except for extremities. The unique AIS value assigned to various body sites almost consistently indicate the same likelihood of negative outcomes.

The diagnostic value of T-wave to R–wave amplitude ratio on electrocardiogram in the diagnosis of hyperkalemia

Resul Çinpolat — 2024-05-12

Objective: 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 V_{T 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 V_{T 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.

Incidental findings in brain CT scans of patients with head trauma

Marzieh Alinezhad — 2024-05-12

Objective: Incidental findings (IFs) are newly discovered abnormal findings unrelated to the primary purpose of imaging. Brain computed tomography (CT) scan is one of the most essential and initial imaging evaluations for head trauma patients, which may also have nontraumatic IFs. We aim to investigate the prevalence and nature of IFs in brain CT scans of head trauma patients.

Methods: We conducted a cross-sectional study to evaluate brain CT scans of 1006 head trauma patients over one year (April 2021 to March 2022), to identify incidental findings by consensus agreement of two radiologists. We categorized the incidental findings into four categories based on appropriate follow-up recommendations.

Results: We included 1006 head trauma patients who underwent brain CT scan, of which 126 incidental findings were discovered in brain CT scan of 107 patients. The prevalence of incidental findings was 10.6% (107/1006). The most common incidental finding was brain atrophy (n=15, 11.9%). The mean age of patients with IFs was significantly higher than those without IFs, but there was no difference between the two groups regarding gender.

Conclusion: The discovery rate of incidental findings of brain CT scans in head trauma patients was considerable. Serious medical findings that need immediate evaluation were found in 5.6% of patients, mostly over the age of 40. Therefore, patients who have clinically significant incidental findings need improved documentation and follow-up to evaluate the long-term outcomes and reliability of imaging results.

An almost forgotten neurological entity: man in a barrel syndrome

Egemen Yildiz — 2024-05-12

Man 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.

Navigating perils at the US-Mexico border: an illustrated exploration of trauma among southern border migrants

Mark Greenhill — 2024-05-12

Surge in migrants at the US-Mexico border, intensified by Coronavirus disease 2019 (COVID-19), has led to over 2.7 million U.S. Border patrol encounters in 2022. This article explores trauma among Southern border migrants, categorizing injuries from desert crossing, border wall traversal, fleeing, and train travel.

Desert migration poses risks from harsh terrain, extreme temperatures, and dehydration. The border wall, covering a quarter of the border, results in varying falls, correlating with increased morbidity at greater heights. Motor vehicle use introduces dangers, including high-speed chases and altercations, causing significant morbidity. "La Bestia," cargo trains, expose passengers to assault, coercion, and injuries during boarding attempts.

The study details organ-based injuries, emphasizing distinct patterns in facial trauma, thoracic injuries, abdominopelvic injuries, and lower extremity injuries. Controlled and uncontrolled falls have diverse outcomes, with pediatric populations facing increased morbidity.

In conclusion, migrants face serious risks, including heat-related illnesses, violent crimes, and traumatic injuries. Southern border migrants, often deported without complete care, represent an underserved population. This exploration sheds light on their unique healthcare needs, urging attention to their challenges in a concise manner.

Trauma fellowship for emergency physicians: a necessity or demand?

Maryam Bahreini — 2024-05-12

The Article Abstract is not available.

The level of education of drivers is a main human factor in road traffic crashes

Payman Salamati — 2024-05-12

The Article Abstract is not available.