Frontiers in Emergency Medicine

Frontiers in Emergency Medicine in 2025, a quick look

Reza Ghasemi — 2026-07-14

The Article Abstract is not available.

Vital signs monitoring critically ill patients in traditional triage: room for improvement and innovation

Mohammad Reza Kardan — 2026-07-14

Objective: In traditional triage, there is often a challenge in accurately assessing the severity of a patient's condition, which can result in under-triage or over-triage. The purpose of this study is to compare traditional and innovative vital signs in predicting possible mortality in critically ill patients.

Methods: This is a cross-sectional study conducted over a three-month period. Patients presenting emergency severity index (ESI) level 1 and 2 triage were divided into two groups: those with and without mortality. Subsequently, the role of traditional triage vital signs [blood pressure, heart rate, oxygen saturation (SpO2), mean arterial pressure (MAP), pulse pressure (PP)] was compared with that of innovative vital signs [shock index (SI), reverse shock index (RSI), modified shock index (MSI), age-shock index (ASI)] in predicting mortality in two groups.

Results: A total of 360 patients were included in the study. A statistically significant association was observed between all innovative and traditional vital signs (with the exception of heart rate) and mortality. In logistic regression, the univariate model revealed a significant association between age, triage level, innovative and traditional vital signs with the occurrence of mortality. In the multivariate model, only MAP, PP, SI, RSI×SpO2, and ASI were found to have a significant association with mortality.

Conclusion: The combination of innovative and traditional vital signs, including MAP, PP, SI, MSI, RSI×SpO2, and ASI in triage may be capable of predicting critically ill patients with a higher probability of mortality.

HEART Score, an optimal tool for predicting cardiovascular events in chest pain patients in emergency department: a prospective single-center study

Latife Jabbari — 2026-07-14

Objective: Chest pain is a prevalent and potentially life-threatening presentation in emergency departments, necessitating prompt and precise risk stratification to identify patients at high risk, particularly those with acute coronary syndrome (ACS). This study evaluates the predictive accuracy of the HEART score in stratifying short-term major adverse cardiac events (MACE) risk among chest pain patients in Bandar Abbas, aiming to enhance clinical decision-making and resource utilization in emergency departments.

Method: This prospective observational study was conducted on patients presenting with chest pain at Shahid Mohammadi Hospital’s emergency department. Patients aged ≥18 years with chest pain were included, while those with STEMI or incomplete records were excluded. The HEART score was used for risk stratification, and patients were classified into low, moderate, or high-risk groups. The primary outcome was MACE within six weeks, confirmed via follow-up calls. Data analysis included logistic regression and ROC curve analysis.

Result: A total of 1,501 individuals participated in the study, with a mean age of 48.99±14.71 years. Among the participants, 28.6% were diagnosed with MACE. The most common risk factors for MACE included a history of coronary artery disease (79.1%) and hypertension (77.2%). Based on the HEART score, patients were categorized into low-risk (≤ 3), moderate-risk (4-6), and high-risk (≥ 7) groups. The majority of non-MACE patients were classified as low-risk (78.3%), while 65.6% of MACE patients fell into the moderate-risk category. The mean HEART score was significantly higher in the MACE group (5.73±1.68) compared to the non-MACE group (2.31± 1.54). The optimal HEART score cutoff for predicting MACE was determined to be 3.5, with the ROC curve demonstrating strong predictive performance (AUC=0.932).

Conclusion: The HEART score is a reliable tool for risk stratification in chest pain patients in the emergency department. Our study shows that a score of ≤ 3.5 indicates low risk, while higher scores predict a greater likelihood of MACE. The HEART score effectively guides clinical decisions, highlighting its high sensitivity and specificity for identifying low- and high-risk patients, making it an essential tool for patient management in emergency settings.

Accessibility and regional features of the emergency medical system in Kazakhstan

Adenova Gulzhan — 2026-07-14

Objective: The study aimed to evaluate the accessibility and performance of emergency medical service

(EMS) in Kazakhstan, with a focus on regional disparities and implications for health system development.

Methods: A retrospective study on ambulance services in Kazakhstan for 2024 used data from the medical information system. The study found that the ambulance service has 100% automated call management in cities like Astana, Almaty, Shymkent, and 17 regions. The dispatcher processes calls within 5 minutes, categorizing challenges into four types: direct threats to life, potential threats, potential health threats, and acute conditions without danger. The time of arrival for ambulances varies between 10 minutes and 60 minutes.

Results: The ambulance service has 20 stations, 96 urban substations, and 195 district offices. 1,499 mobile EMS teams operate in one shift, with a ratio of 18/82. In 2024, 914 city and 585 district brigades operate consultations without team departure, accounting for 10.27% of calls. Kazakhstan has a high proportion of urgent category one calls, accounting for 86% of the total number. This raises concerns about the accuracy of the assessment of urgency, as it may indicate system errors in triage or overloading ambulances with tasks not within their competence. The Ulytau region, North Kazakhstan, East Kazakhstan, Mangystau, Kyzylorda, and Karaganda regions have the highest percentages of urgent calls (94-96%). The study recorded 8,531,652 calls, with 70.8% coming from urban areas and 29.2% of rural regions. The highest urbanization rates were found in republican significance towns like Almaty, Shymkent, and Astana. In all regions, the distribution of calls between urban and rural areas differs significantly from the overall structure for the country (χ² = 3,210,171.3, P< 0.001).

Conclusion: The study shows that Kazakhstan's EMS system has fully automated call management, but regional disparities persist. Urgent category one calls are predominant, with urban areas like Almaty, Astana, and Shymkent generating the majority. This highlights structural imbalances in EMS utilization and calls need improvement in triage protocols, resource allocation, and health system capacity

Diagnostic accuracy of inverted grayscale radiography for detection of tibial plateau fractures

Shakiba Mohammadi — 2026-07-14

Objective: This study aimed to quantitatively evaluate the diagnostic performance of inverted grayscale radiography for detecting tibial plateau fractures.

Methods: In this retrospective diagnostic accuracy study, two emergency physicians independently assessed one-view (anteroposterior) knee radiographs in both conventional and inverted grayscale modes in separate, blinded sessions. Spiral knee computed tomography (CT) scans served as the reference standard for fracture confirmation. Sensitivity, specificity, and area under the receiver operating characteristic curve values were calculated. Inter-observer agreement was also assessed using Cohen's kappa.

Results: Of 112 included cases, 31 (27.67%) had tibial plateau fractures confirmed on CT. For the first physician, sensitivity and specificity were 54.84% (36.00%-72.70%, CI 95%) and 85.19% (75.60%-92.10%, CI 95%) with conventional images, compared with 35.48% (19.20%-54.60%, CI 95%) and 83.95% (74.10%-91.20%, CI 95%) with inverted grayscale images. For the second physician, sensitivity was identical for both modalities (38.71% (21.90%-57.80%, CI 95%)) while specificity was higher with conventional radiography (100.00% (95.60%-100.00%, CI 95%)) than inverted grayscale radiography (90.12% (81.50%-95.60%, CI 95%)). The area under the operating characteristic curve values were consistently higher for conventional imaging: 0.70 (0.60–0.78, CI 95%) versus 0.59 (0.50–0.68, CI 95%) for the first physician (P-value=0.03) and 0.69 (0.57–0.81, CI 95%) versus 0.64 (0.52–0.76, CI 95%) for the second physician (P-value=0.18). Inter-observer agreement was moderate for conventional radiographs (κ = 0.51) and lower for inverted grayscale images (κ = 0.38).

Conclusion: Inverted grayscale radiography did not improve the detection of tibial plateau fractures and was associated with reduced inter‑observer reliability.

Clinical efficacy of oral pregabalin in alleviating chronic pain following blunt thoracic trauma

Shiva Bahrehmand — 2026-07-14

Objective: Chronic pain after blunt thoracic trauma remains a frequent and debilitating problem driven by complex neuropathic mechanisms and insufficient acute pain control. Pregabalin has emerged as a potential non‑opioid option, though evidence remains inconsistent. Given these gaps, the present study aims to evaluate the therapeutic efficacy of oral pregabalin in managing chronic post‑traumatic thoracic pain.

Methods: This randomized, double‑blind clinical trial was conducted from early 2024 to the end of September 2025 at Shahid Bahonar Hospital in Kerman. A total of 50 patients (25 in each group) were enrolled through convenience sampling. Participants received pregabalin or a placebo alongside naproxen for 12 weeks. The primary outcome was chronic pain intensity, while secondary outcomes included changes in pain scores, additional naproxen use, the 30% treatment‑response rate, adverse events, and quality of life.

Results: Across the 12‑week follow‑up, additional naproxen use remained consistently lower in the pregabalin group, with significant between‑group differences from week 2 onward (P=0.042 to P=0.001). Pain intensity similarly declined more steeply with pregabalin (repeated measures P=0.001) compared with the control group (P=0.236). Persistent chronic pain was markedly less frequent with pregabalin (8 vs. 19 patients; P=0.001). SF‑36 scores improved significantly across all subscales in the pregabalin group (P<0.05) and remained higher than in controls post‑treatment (P=0.018–0.025).

Conclusion: Adjunctive pregabalin significantly reduced the severity and persistence of chronic post‑traumatic chest pain when added to naproxen therapy. Its effects are likely mediated through modulation of neuropathic pathways and central sensitization, resulting in decreased analgesic requirements. While no major safety concerns emerged, conclusions regarding tolerability are limited by sample size and warrant confirmation in larger trials.

Ruptured hemorrhagic pheochromocytoma mimicking panic disorder: a care report

Moojan Shabani — 2026-07-14

Rare tumors that release catecholamines and originate in the adrenal medulla are called pheochromocytomas. They usually manifest as headaches, diaphoresis, palpitations, and hypertension, but occasionally they can resemble panic disorder. We report the case of a 51-year-old man who had dyspnea, chest pain, and a hypertensive crisis. Despite treatment with antihypertensives and anxiolytics, his symptoms persisted. Imaging revealed a large hemorrhagic adrenal mass consistent with a ruptured pheochromocytoma. Following laparoscopic adrenalectomy, histopathological analysis confirmed pheochromocytoma with a Zellballen pattern and vascular invasion but no capsular invasion. This case highlights the importance of considering secondary causes of hypertension, particularly pheochromocytoma, in patients with refractory symptoms and overlapping psychiatric features.

Acute uvulitis: a rare cause of stridor in adults

Ahmad Abbasian — 2026-07-14

A 34-year-old man presented to the emergency department with a chief complaint of shortness of breath and sore throat. On examination, the patient exhibited stridor and noisy breathing with the rest of the physical examination being within normal range, ultimately leading to a diagnosis of acute uvulitis. We present a case of acute uvulitis in this report.

Beyond the code: reconstructing meaning for EMS providers in the aftermath of collective trauma

Hesam Seyedin — 2026-07-14

The Article Abstract is not available.