The latest medical research on Emergency Medicine
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about emergency medicine gathered by our medical AI research bot.
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Request AccessTracing the Untraceables: A Joint Outbreak Investigation With Law Enforcement Using a Geographic Information System.
Health SecurityThe application of geospatial data often allows the tracing of people who are involved in activities of an illegal nature. In June 2021, we estimat...
Monocyte distribution width (MDW) and DECAF: two simple tools to determine the prognosis of severe COPD exacerbation.
Internal and emergency medicineMonocyte distribution width (MDW) has been associated with inflammation and poor prognosis in various acute diseases. Chronic obstructive pulmonary...
Mediastinitis and septic shock complicating spontaneous esophageal rupture "Boerhaave's syndrome": a case report.
International Journal of Emergency MedicineBoerhaave's syndrome, also known as spontaneous esophageal rupture, is a rare but life-threatening condition characterized by a tear in the esophag...
Acute Coronary Syndrome at Altitude: Diagnostic Dilemma on Aconcagua Using Point-of-Care Ultrasound.
Wilderness and Environmental MedicineAt the Plaza de Mulas medical tent, located at 4300 m (14,100 ft) along the Normal Route to the 6960 m (22,837 ft) summit of Aconcagua in Argentina...
Prospective derivation and validation of a NECROtizing Soft tissue InfectionS (NECROSIS) score: An EAST multicenter trial.
Journal of Trauma and Acute Care SurgeryAlthough several risk indices have been developed to aid in the diagnosis of NSTIs, these instruments suffer from varying levels of reproducibility and failure to incorporate key clinical variables in model development. The objective of this study was to derive and validate a clinical risk index score - NECROSIS - for identifying NSTIs in emergency general surgery (EGS) patients being evaluated for severe skin and soft tissue infections.
Diagnostic Tests or Criteria, Level III.
Of 362 patients, 297 (82%) were diagnosed with a NSTI. Overall mortality was 12.3%. Multivariate analysis identified 3 independent predictors for NSTI: systolic blood pressure ≤ 120 mmHg, violaceous skin, and WBC ≥15 (x103/uL). Multivariate modelling demonstrated Hosmer-Lemeshow goodness of fit (p = 0.9) with a c-statistic for the prediction curve of 0.75. Test characteristics of the NECROSIS score were similar between the derivation and validation cohorts.
NECROSIS is a simple and potentially useful clinical index score for identifying at-risk EGS patients with NSTIs. Future validation studies are warranted.
Resuscitation for injured patients requiring massive transfusion: A personal perspective.
Journal of Trauma and Acute Care SurgeryThe past century has seen many advances in the field of resuscitation. This is particularly true in the subset of patients who sustain major injuri...
Predicting blood transfusion following traumatic injury using machine learning models: A systematic review and narrative synthesis.
Journal of Trauma and Acute Care SurgeryHaemorrhage is a leading cause of preventable death in trauma. Accurately predicting a patient's blood transfusion requirement is essential but can be difficult. Machine learning (ML) is a field of artificial intelligence that is emerging within medicine for accurate prediction modelling. This systematic review aimed to identify and evaluate all ML models that predict blood transfusion in trauma.
Systematic Review Without Meta-Analysis, Level IV.
Twenty-five ML models for blood transfusion prediction in trauma were identified. Models incorporated diverse predictors and varied ML methodologies. Predictive performance was variable but eight models achieved excellent discrimination (AUROC >0.9) and nine models achieved good discrimination (AUROC >0.8) in internal validation. Only two models reported measures of calibration. Four models have been externally validated in prospective cohorts: the Bleeding Risk Index, Compensatory Reserve Index, the Marsden model and the Mina model. All studies were considered at high risk of bias often due to retrospective datasets, small sample size and lack of external validation.
This review identified twenty-five ML models developed to predict blood transfusion requirement after injury. Seventeen ML models demonstrated good to excellent performance in-silico but only four models were externally validated. To date ML models demonstrate the potential for early and individualised blood transfusion prediction but further research is critically required to narrow the gap between ML model development and clinical application.
Beyond surviving: A scoping review of collaborative care models to inform the future of post-discharge trauma care.
Journal of Trauma and Acute Care SurgeryTrauma centers demonstrate an impressive ability to save lives, as reflected by inpatient survival rates of over 95% in the United States. Neverthe...
Health service use in major trauma survivors: a population-based cohort study from Ontario, Canada.
Journal of Trauma and Acute Care SurgeryLittle is known about how major trauma survivors access health services in the years following their injury. Our study sought to characterize patterns of health services use in trauma survivors following discharge from a provincial trauma centre and to identify sociodemographic factors associated with service utilization.
Retrospective cohort study, Level IV.
The study cohort consisted of a total of 273,406 individuals: 55,060 trauma survivors and 218,346 controls. Trauma survivors were predominately males (71%) with a median age of 46 years (IQR: 26-65 years). Health service use in trauma survivors peaked within a year of hospital discharge but remained increased throughout the follow up period. Trauma survivorship was associated with a 56% increase in overall health services use (Adjusted Rate Ratio 1.56, 95% CI: 1.55-1.57), including an 88% increase in hospital admissions (Adjusted Rate Ratio 1.88, 95% CI: 1.85-1.92). Male sex and rural residence were associated with a reduced overall use of health services but greater use of ED services.
Major trauma survivors have long-term health services needs that persist for years after discharge from the trauma centre. Future research should focus on the understanding why trauma survivors have prolonged health services requirements and ensure care needs are aligned with service delivery.
Refocusing the Military Health System to Support Role 4 Definitive Care in future large-scale combat operations.
Journal of Trauma and Acute Care SurgeryThe last twenty years of sustained combat operations during the Global War on Terror generated significant advancements in combat casualty care. Im...
Perfusion index: could it be a new tool for early identification of pulmonary embolism severity?
Internal and emergency medicinePerfusion index (PI) is a promising indicator for monitoring peripheral perfusion. The present study aimed to compare the efficiency of PI and PESI...
Diphenhydramine and Migraine Treatment Failure in Pediatric Patients Receiving Prochlorperazine.
Pediatric Emergency CareThe objective are to determine whether diphenhydramine coadministered with prochlorperazine versus prochlorperazine only is associated with a difference in the risk of migraine treatment failure, as measured by the need for additional therapy, hospitalization rates, and 72-hour return rates, and to compare extrapyramidal adverse effects between groups.
Retrospective cohort of patients aged 7 to 18 years treated in the emergency department for migraines using prochlorperazine with or without diphenhydramine between 2013 and 2019. Patients were included if they had International Classification of Diseases, Ninth or Tenth Revision, codes for migraine or unspecified headache and were treated with prochlorperazine as part of their initial migraine therapy. Data collected included demographics, medications administered, pain scores, neuroimaging, disposition, return visits, and documentation of extrapyramidal adverse effects. Multivariable logistic regression was used to estimate the association between diphenhydramine coadministration and each of the outcomes.
A total of 1683 patients were included. Overall, 13% required additional therapy with a 16.7% admission rate and a 72-hour return rate of 5.3%. There was no association between initial treatment with diphenhydramine and the odds of additional therapy (adjusted odds ratio [aOR], 0.74 [95% confidence interval {CI}, 0.53-1.03]), admission rates (aOR, 1.22 [95% CI, 0.89-1.67]), or return visit rates (aOR, 0.91 [95% CI, 0.55-1.51]). Extrapyramidal adverse effects occurred in 2.4% of patients in the prochlorperazine group and 0% in the prochlorperazine with diphenhydramine group.
There was no association between diphenhydramine coadministration and the need for additional therapy, 72-hour return visit rates or admission rates. Extrapyramidal effects did not occur in patients treated with diphenhydramine.
