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A comparison of handheld and standard ultrasound in Swiss medical students Mark Slader, Hayley Young, Margot Barker, Kylie Prentice, Katherine Bogaard, Charlene Yuan, Soheil Saadat, Shadi Lahham World Journal of Emergency Medicine    2022, 13 (2): 85-90.   DOI: 10.5847/wjem.j.1920-8642.2022.017 Abstract （756）   HTML （1563787796）    PDF（pc） （404KB）（1046）       Knowledge map    Save BACKGROUND: The use of ultrasound (US) within healthcare has inspired the development of new US technology. There have been few studies comparing the use of handheld US to standard US for medical education. This research aims to determine whether a handheld US device can provide a comparable primary learning experience to that of a standard US machine. METHODS: Over two days of instruction, participants were taught and evaluated on core US fundamentals. The standard group received instruction on standard US machines, while the handheld group received instruction on handheld US devices. Participants completed a qualitative survey regarding their experience. Six hundred and four images were obtained and graded by two emergency medicine physicians. RESULTS: A total of 119 Swiss medical students were enrolled in our study. There was no statistically significant difference in the US assessment measurements, except for faster endpoint septal separation (EPSS) vascular setup time in the handheld group (P=0.001). There was no statistically significant difference in participants’ perceived difficulty of US learning (P=0.198), comfort level (P=0.188), or self-estimated capability to perform US in the future (P=0.442). There was no statistically significant difference in the percentage of correctly obtained images (P=0.211) or images that were clinically useful (P=0.256). The median quality score of images obtained by the standard group was eight compared to seven in handheld group (P<0.01). CONCLUSION: Our data suggest a handheld US machine can perform as well as a standard US machine as an educational tool despite sacrifices in image quality. Table and Figures | Reference | Related Articles | Metrics

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Tranexamic acid for major trauma patients in Ireland Kieran Walsh, Francis O’Keeffe, Louise Brent, Biswadev Mitra World Journal of Emergency Medicine    2022, 13 (1): 11-17.   DOI: 10.5847/wjem.j.1920-8642.2022.003 Abstract （725）   HTML （1782792228）    PDF（pc） （243KB）（1311）       Knowledge map    Save BACKGROUND: The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2 (CRASH-2) is the largest randomized control trial (RCT) examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid (TXA) within 3 hours of injury. Since the publication of CRASH-2, significant geographical variance in the use of TXA for trauma patients exists. This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2. METHODS: A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network (TARN). All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation (as defined by systolic blood pressure [SBP] <100 mmHg [1 mmHg=0.133 kPa] and administration of blood products) were eligible for inclusion. Death at hospital discharge was the primary outcome. RESULTS: During the study period, a total of 234 patients met the inclusion criteria. Among injured patients presenting with hemorrhagic shock, 133 (56.8%; 95% confidence interval [CI] 50.2%-63.3%) received TXA. Of patients that received TXA, a higher proportion of patients presented with shock index >1 (70.68% vs.57.43%) and higher Injury Severity Score (ISS >25; 49.62% vs. 23.76%). Administration of TXA was not associated with mortality at hospital discharge (odds ratio [OR] 0.86, 95% CI 0.31-2.38). CONCLUSIONS: Among injured Irish patients presenting with hemorrhagic shock, TXA was administered to 56.8% of patients. Patients administered with TXA were on average more severely injured. However, a mortality benefit could not be demonstrated. Table and Figures | Reference | Related Articles | Metrics

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Management of difficult intravenous access: a qualitative review Mingwei Ng, Leong Kwok Fai Mark, Lateef Fatimah World Journal of Emergency Medicine    2022, 13 (6): 467-478.   DOI: 10.5847/wjem.j.1920-8642.2022.104 Abstract （681）   HTML （1211118192）    PDF（pc） （1306KB）（1560）       Knowledge map    Save BACKGROUND: A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other “tricks-of-the-trade” and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. METHODS: We conducted a literature search on PubMed using the keywords “difficult intravenous access”, “peripheral vascular access” and “peripheral venous access” and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESULTS: We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept: starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. CONCLUSION: DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon. Table and Figures | Reference | Related Articles | Metrics

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Emergency department electric scooter injuries after the introduction of shared e-scooter services: A retrospective review of 3,331 cases Ittai Shichman, Or Shaked, Shai Factor, Ahuva Weiss-Meilik, Amal Khoury World Journal of Emergency Medicine    2022, 13 (1): 5-10.   DOI: 10.5847/wjem.j.1920-8642.2022.002 Abstract （671）   HTML （1635779070）    PDF（pc） （221KB）（1447）       Knowledge map    Save BACKGROUND: To determine the frequency, characteristics, and use of resources related to electric scooter (e-scooter) injuries in the emergency department (ED) of a major metropolitan area hospital. METHODS: We performed a retrospective review of all ED presentations related to e-scooter injuries at a level I trauma center between May 2017 and February 2020. We identified ED presentation data, injury-related data, patients’ clinical course after evaluation, injury diagnosis, surgical procedures, and ED readmissions. RESULTS: A total of 3,331 patients with e-scooter injuries presented to the ED over a 34-month period. There was a 6-fold increase in e-scooter-related injuries presenting to the ED, from an average of 26.9 injuries per month before the introduction of shared e-scooter services in August 2018 to an average of 152.6 injuries per month after its introduction. The average injury rate during weekdays was 3.27 per day, with the majority of injuries occurring in the afternoon. The most common mechanism of injury was rider fall (79.1%). There were a total of 2,637 orthopedic injuries, of which 599 (22.7%) were fractures. A total of 296 (8.9%) patients were hospitalized following the initial ED admission, and 462 surgeries were performed within 7 days of ED arrival. CONCLUSIONS: The introduction of the shared e-scooter services is associated with a dramatic increase in e-scooter injuries presenting to the ED. E-scooter use carries considerably underestimated injury risks of high-energy trauma and misunderstood mechanisms of injuries. These injuries challenge the healthcare system, with a major impact on both EDs and surgical departments. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Fatal and non-fatal injuries due to suspension trauma syndrome: A systematic review of definition, pathophysiology, and management controversies Patrizio Petrone, Sofía Espinoza-Villalobos, Gerard A. Baltazar, Kjetil Søreide, Adam Stright, Collin E.M. Brathwaite, D’Andrea K. Joseph World Journal of Emergency Medicine    2021, 12 (4): 253-260.   DOI: 10.5847/wjem.j.1920-8642.2021.04.001 Abstract （641）   HTML （1867580182）    PDF（pc） （215KB）（1411）       Knowledge map    Save BACKGROUND: Suspension trauma syndrome is a life-threatening event that occurs when a person is “trapped” in a prolonged passive suspension. It is most commonly seen in people who engage in occupational or sport activities that require harness suspension. The aim of this study is to identify the predisposing factors, pathophysiology, and management of suspension trauma. METHODS: A review and analysis of the literature published in English and Spanish from 1972 to 2020 on suspension trauma were performed. Search sources were PubMed, Medline, Cochrane Library, MeSH, UpToDate, and Google Scholar. Articles referring to suspension trauma associated with other injury mechanisms (traumatic impact injuries, drowning, asphyxiation, or bleeding), case reports, and pediatric population were excluded. RESULTS: Forty-one articles were identified. Of these, 29 articles related to mechanism, pathophysiology, and management of individuals who suffered prolonged suspension trauma without associated traumatic injuries were included in the study. We encountered several controversies describing the putative pathophysiology, ranging from blood sequestration in the lower extremities versus accumulation of metabolic waste and hyperkalemia to dorsal hook-type harness as a trigger cause of positional asphyxia; to vascular compression of femoral vessels exerted by the harness causing decreased venous return. Pstients suspended in a full-body harness with dorsal hook showed more hemodynamic alterations in response to the compressive effect on the rib cage, causing a reduction in perfusion by presenting a decrease in pulse pressure. Management strategies varied across studies. CONCLUSIONS: Progress has been made in individualizing the population at risk and in the management of suspension trauma. We recommend the formation of consensus definitions, larger cohort or registry studies to be conducted, and experimental animal models to better understand the mechanisms in order to develop management and life support guidelines from a trauma and emergency medicine perspective. Table and Figures | Reference | Related Articles | Metrics

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Intestinal microcirculation dysfunction in sepsis: pathophysiology, clinical monitoring, and therapeutic interventions A-ling Tang, Mei-jia Shen, Guo-qiang Zhang World Journal of Emergency Medicine    2022, 13 (5): 343-348.   DOI: 10.5847/wjem.j.1920-8642.2022.031 Abstract （615）   HTML （1424497274）    PDF（pc） （183KB）（1213）       Knowledge map    Save BACKGROUND: Intestinal microcirculation dysfunction is an important factor that causes poor prognosis in sepsis patients and is an important pathophysiological basis for the occurrence and development of sepsis. DATA RESOURCES: PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) were searched from inception to August 1, 2021. The search was limited to the English language only. Two reviewers independently identified studies related to intestinal microcirculation dysfunction in sepsis. Exclusion criteria were duplicate articles according to multiple search criteria. RESULTS: Fifty articles were included, and most of them were animal studies. These studies reported pathogenesis, including endothelial dysfunction, leukocyte recruitment and adhesion, microthrombus formation, microcirculation hypoperfusion, and redistribution of intestinal wall blood flow. The monitoring methods of intestinal microcirculation were also diverse, including handheld microscopes, intravital microscopy (IVM), laser Doppler blood flow instruments, laser speckle contrast imaging, tissue reflectance spectrophotometry, biochemical markers of intestinal ischemia, and histopathological examination. In view of the related pathogenesis of intestinal microcirculation disorder in sepsis, existing studies also have different opinions on its treatment. CONCLUSIONS: Limited by monitoring, there are few clinical studies on intestinal microcirculation dysfunction in sepsis. Related research mainly focuses on basic research, but some progress has also been made. Therefore, this review may provide a reference for future research on intestinal microcirculation dysfunction in sepsis. Table and Figures | Reference | Related Articles | Metrics

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Patient care during interfacility transport: a narrative review of managing diverse disease states Quincy K. Tran, Francis O’Connell, Andrew Hakopian, Marwa SH Abrahim, Kamilla Beisenova, Ali Pourmand World Journal of Emergency Medicine    2023, 14 (1): 3-9.   DOI: 10.5847/wjem.j.1920-8642.2023.009 Abstract （517）   HTML （1448175643）    PDF（pc） （220KB）（953）       Knowledge map    Save BACKGROUND: When critically ill patients require specialized treatment that exceeds the capability of the index hospitals, patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care. Therefore, appropriate and efficient care for patients during the process of transport between two hospitals (interfacility transfer) is an essential part of patient care. While medical adverse events may occur during the interfacility transfer process, there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport. METHODS: We conducted searches from the PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and Scopus databases up to June 2022. Two reviewers independently screened the titles and abstracts for eligibility. Studies that were not in the English language and did not involve critically ill patients were excluded. RESULTS: The search identified 75 articles, and we included 48 studies for our narrative review. Most studies were observational studies. CONCLUSION: The review provided the current evidence-based management of diverse disease states during the interfacility transfer process, such as proning positioning for respiratory failure, extracorporeal membrane oxygenation (ECMO), obstetric emergencies, and hypertensive emergencies (aortic dissection and spontaneous intracranial hemorrhage). Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Global research trends in cardiac arrest research: a visual analysis of the literature based on CiteSpace Shi-jiao Yan, Mei Chen, Jing Wen, Wen-ning Fu, Xing-yue Song, Huan-jun Chen, Ri-xing Wang, Mei-ling Chen, Xiao-tong Han, Chuan-zhu Lyu World Journal of Emergency Medicine    2022, 13 (4): 290-296.   DOI: 10.5847/wjem.j.1920-8642.2022.071 Abstract （467）   HTML （1325139194）    PDF（pc） （839KB）（1196）       Knowledge map    Save BACKGROUND: The high morbidity, high mortality and low survival rate of cardiac arrest (CA) cause a heavy global burden. We aimed to analyze the changes in scientific output related to CA over the past two decades. METHODS: We analyzed the scientific output related to CA from 2000 to 2020 via the Web of Science. The data were analyzed using CiteSpace software. RESULTS: In total, 28,312 articles relating to CA were identified in the Web of Science. The volume of scientific research output in the field of global CA research was mainly distributed in the Americas, Europe and Asia, covering a wide range. Of the 28,312 articles, the research content of the highly cited literature mainly focused on CA, mild hypothermia treatment, and prognosis of CA patients. CONCLUSION: Various scientific methods were applied to reveal scientific productivity, collaboration, and research hotspots in the CA research field. Cardiopulmonary resuscitation (CPR), extracorporeal membrane oxygenation (ECMO), survival and target temperature management are research hotspots. Future research on CA will continue to focus on its treatment and prognosis to improve the survival rate of CA patients. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/ contemporary cardiac troponin for the early diagnosis of acute myocardial infarction Guang-mei Wang, Yong Li, Shuo Wu, Wen Zheng, Jing-jing Ma, Feng Xu, Jia-qi Zheng, He Zhang, Jia-li Wang, Yu-guo Chen World Journal of Emergency Medicine    2022, 13 (3): 163-168.   DOI: 10.5847/wjem.j.1920-8642.2022.033 Abstract （464）   HTML （1865449741）    PDF（pc） （7951KB）（1009）       Knowledge map    Save BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) remains challenging, especially for institutions without the high-sensitive cardiac troponin (hs-cTn) assay. Herein, we aim to assess the value of creatine kinase-myocardial band isoenzyme (CK-MB) combined with different cardiac troponin (cTn) assays in AMI diagnosis. METHODS: This multicenter, observational study included 3,706 patients with acute chest pain from September 1, 2015, to September 30, 2017. We classified the participants into three groups according to the cTn assays: the point-of-care cTn (POC-cTn) group, the contemporary cTn (c-cTn) group, and hs-cTn group. The diagnostic value was quantified using sensitivity and the area under the curve (AUC). RESULTS: Compared to the single POC-cTn/c-cTn assays, combining CK-MB and POC-cTn/c-cTn increased the diagnostic sensitivity of AMI (56.1% vs. 63.9%, P<0.001; 82.7% vs. 84.3%, P=0.025). In contrast, combining CK-MB and hs-cTn did not change the sensitivity compared with hs-cTn alone (95.0% vs. 95.0%, P>0.999). In the subgroup analysis, the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset <6 h compared with c-cTn alone (72.8% vs. 75.0%, P=0.046), while the sensitivity did not increase with time from symptom onset >6 h (97.5% vs. 98.3%, P=0.317). The AUC of the combination of CK-MB and POC-cTn significantly increased compared to the single POC-cTn assay (0.776 vs. 0.750, P=0.002). The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h. CONCLUSIONS: The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI, especially when hs-cTn is not available. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Artificial intelligence computed tomography helps evaluate the severity of COVID-19 patients: A retrospective study Yi Han, Su-cheng Mu, Hai-dong Zhang, Wei Wei, Xing-yue Wu, Chao-yuan Jin, Guo-rong Gu, Bao-jun Xie, Chao-yang Tong World Journal of Emergency Medicine    2022, 13 (2): 91-97.   DOI: 10.5847/wjem.j.1920-8642.2022.026 Abstract （443）   HTML （1883856938）    PDF（pc） （718KB）（1111）       Knowledge map    Save BACKGROUND: Computed tomography (CT) is a noninvasive imaging approach to assist the early diagnosis of pneumonia. However, coronavirus disease 2019 (COVID-19) shares similar imaging features with other types of pneumonia, which makes differential diagnosis problematic. Artificial intelligence (AI) has been proven successful in the medical imaging field, which has helped disease identification. However, whether AI can be used to identify the severity of COVID-19 is still underdetermined. METHODS: Data were extracted from 140 patients with confirmed COVID-19. The severity of COVID-19 patients (severe vs. non-severe) was defined at admission, according to American Thoracic Society (ATS) guidelines for community-acquired pneumonia (CAP). The AI-CT rating system constructed by Hangzhou YITU Healthcare Technology Co., Ltd. was used as the analysis tool to analyze chest CT images. RESULTS: A total of 117 diagnosed cases were enrolled, with 40 severe cases and 77 non-severe cases. Severe patients had more dyspnea symptoms on admission (12 vs. 3), higher acute physiology and chronic health evaluation (APACHE) II (9 vs. 4) and sequential organ failure assessment (SOFA) (3 vs. 1) scores, as well as higher CT semiquantitative rating scores (4 vs. 1) and AI-CT rating scores than non-severe patients (P<0.001). The AI-CT score was more predictive of the severity of COVID-19 (AUC=0.929), and ground-glass opacity (GGO) was more predictive of further intubation and mechanical ventilation (AUC=0.836). Furthermore, the CT semiquantitative score was linearly associated with the AI-CT rating system (Adj R2=75.5%, P<0.001). CONCLUSIONS: AI technology could be used to evaluate disease severity in COVID-19 patients. Although it could not be considered an independent factor, there was no doubt that GGOs displayed more predictive value for further mechanical ventilation. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Development of an intensive simulating training program in emergency medicine for medical students in China Xin Lu, Shi Feng, Shi-gong Guo, Mu-bing Qin, Xiang-ning Liu, Shi-yuan Yu, Li-na Zhao, Zeng-zheng Ge, Jing-jing Chai, Sheng-yong Xu, Di Shi, Ji-hai Liu, Hua-dong Zhu, Yi Li World Journal of Emergency Medicine    2022, 13 (1): 23-26.   DOI: 10.5847/wjem.j.1920-8642.2022.004 Abstract （440）   HTML （1426063881）    PDF（pc） （170KB）（1120）       Knowledge map    Save BACKGROUND: A national standardized emergency medicine (EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students. METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning (CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital (PUMCH). Medical students from Peking Union Medical College (PUMC) and Tsinghua University (THU) participated in the training. Three written tests were cautiously designed to examine the short-term (immediately after the program) and long-term (6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat (a mobile messaging App commonly used in China) to achieve anonymous self-evaluation. RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program (pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63 (64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later (15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful. CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study David Vandroux, Thomas Aujoulat, Bernard-Alex Gaüzère, Bérénice Puech, Bertrand Guihard, Olivier Martinet World Journal of Emergency Medicine    2022, 13 (4): 283-289.   DOI: 10.5847/wjem.j.1920-8642.2022.070 Abstract （438）   HTML （1963622412）    PDF（pc） （479KB）（836）       Knowledge map    Save BACKGROUND: Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure. In order to decrease the mortality rate, the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation (ECMO) center. However, the predictive factors showing the need for venous-arterial ECMO (VA-ECMO) had never been evaluated. METHODS: A retrospective, descriptive, and single-center cohort study. All consecutive patients admitted in the largest ICU of Reunion Island (Indian Ocean) between January 2013 and September 2018 for beta-blockers (BB), calcium channel blockers (CCB), renin-angiotensin-aldosterone system blockers, digoxin or anti-arrythmic intentional poisonings were included. ECMO implementation was the primary outcome. RESULTS: A total of 49 consecutive admissions were included. Ten patients had ECMO, 39 patients did not have ECMO. Three patients in ECMO group died, while no patients in the conventional group died. The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure, heart rate, arterial lactate concentration, liver enzymes and left ventricular ejection fraction (LVEF) at ICU-admission. Only pulse pressure at first medical contact and LVEF were significant after logistic regression. CONCLUSION: A transfer to an ECMO center should be considered for a pulse pressure < 35 mmHg at first medical contact or LVEF < 20% on admission to ICU. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Comparing the precision of the pSOFA and SIRS scores in predicting sepsis-related deaths among hospitalized children: a multi-center retrospective cohort study Chun Zhao, Mei-yun Xin, Jing Li, Jin-fang Zhao, Yu-juan Wang, Wei Wang, Qian Gao, Jie Chen, Qi-wei Wang, You-peng Jin World Journal of Emergency Medicine    2022, 13 (4): 259-265.   DOI: 10.5847/wjem.j.1920-8642.2022.060 Abstract （437）   HTML （1357905939）    PDF（pc） （508KB）（992）       Knowledge map    Save BACKGROUND: The latest sepsis definition includes both infection and organ failure, as evidenced by the sequential organ failure assessment (SOFA) score. However, the applicability of the pediatric SOFA score (pSOFA) is not yet determined. This study evaluated the effectiveness of both pSOFA and system inflammatory reaction syndrome (SIRS) scores in predicting sepsis-related pediatric deaths. METHODS: This is a retrospective multi-center cohort study including hospitalized patients <18 years old with diagnosed or not-yet-diagnosed infections. Multivariate analyses were carried out to evaluate risk factors for in-hospital mortality. According to Youden index (YI), three sub-categories of pSOFA were screened out and a new simplified pSOFA score (spSOFA) was formed. The effectiveness and accuracy of prediction of pSOFA, SIRS and spSOFA was retrieved from the area under the receiver operating characteristic curve (AUROC) and Delong’s test. RESULTS: A total of 1,092 participants were eligible for this study, and carried a 23.4% in-hospital mortality rate. The 24-h elevated pSOFA score (24 h-pSOFA), bloodstream infection, and mechanical ventilation (MV) requirement were major risk factors associated with sepsis-related deaths. The AUROC analysis confirmed that the spSOFA provided good predictive capability in sepsis-related pediatric deaths, relative to the 24 h-pSOFA and SIRS. CONCLUSIONS: The pSOFA score performed better than SIRS in diagnosing infected children with high mortality risk. However, it is both costly and cumbersome. We, therefore, proposed spSOFA to accurately predict patient outcome, without the disadvantages. Nevertheless, additional investigations, involving a large sample population, are warranted to confirm the conclusion of this study. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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A cadaveric model for transesophageal echocardiography transducer placement training: A pilot study Ryan W. Horton, Kian R. Niknam, Viveta Lobo, Kathryn H. Pade, Drew Jones, Kenton L. Anderson World Journal of Emergency Medicine    2022, 13 (1): 18-22.   DOI: 10.5847/wjem.j.1920-8642.2022.005 Abstract （431）   HTML （1377829071）    PDF（pc） （174KB）（1219）       Knowledge map    Save BACKGROUND: Transesophageal echocardiography (TEE) is used in the emergency department to guide resuscitation during cardiac arrest. Insertion of a TEE transducer requires manual skill and experience, yet in some residency programs cardiac arrest is uncommon, so some physicians may lack the means to acquire the manual skills to perform TEE in clinical practice. For other infrequently performed procedural skills, simulation models are used. However, there is currently no model that adequately simulates TEE transducer insertion. The aim of this study is to evaluate the feasibility and efficacy of using a cadaveric model to teach TEE transducer placement among novice users. METHODS: A convenience sample of emergency medicine residents was enrolled during a procedure education session using cadavers as tissue models. A pre-session assessment was used to determine prior knowledge and confidence regarding TEE manipulation. Participants subsequently attended a didactic and hands-on education session on TEE placement. All participants practised placing the TEE transducer until they were able to pass a standardized assessment of technical skill (SATS). After the educational session, participants completed a post-session assessment. RESULTS: Twenty-five residents participated in the training session. Mean assessment of knowledge improved from 6.2/10 to 8.7/10 (95% confidence interval [CI] of knowledge difference 1.6-3.2, P<0.001) and confidence improved from 1.6/5 to 3.1/5 (95% CI of confidence difference 1.1-2.0, P<0.001). There was no relationship between training level and the delta in knowledge or confidence. CONCLUSIONS: In this pilot study, the use of a cadaveric model to teach TEE transducer placement methods among novice users is feasible and improves both TEE manipulation knowledge and confidence levels. Table and Figures | Reference | Related Articles | Metrics

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Clinical effectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients: A single-center retrospective cohort study Peng-chao Guo, Nan Li, Hui-ming Zhong, Guang-feng Zhao World Journal of Emergency Medicine    2022, 13 (3): 189-195.   DOI: 10.5847/wjem.j.1920-8642.2022.040 Abstract （428）   HTML （79429647）    PDF（pc） （9211KB）（947）       Knowledge map    Save BACKGROUND: To investigate the clinical effectiveness of a pneumatic compression device (PCD) combined with low-molecular-weight heparin (LMWH) for the prevention and treatment of deep vein thrombosis (DVT) in trauma patients. METHODS: This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020. Patients treated with only LMWH served as the control group, and patients treated with a PCD combined with LMWH as the observation group. The incidence of DVT, postoperative changes in the visual analogue scale (VAS) score, and coagulation function were observed and compared between the two groups. Excluding the influence of other single factors, binary logistic regression analysis was used to evaluate the use of a PCD in the patient's postoperative coagulation function. RESULTS: After excluding 34 patients who did not meet the inclusion criteria, 252 patients were were included. The incidence of DVT in the observation group was significantly lower than that in the control group (5.6% vs. 15.1%, χ2=4.605, P<0.05). The postoperative VAS scores of the two groups were lower than those before surgery (P<0.05). The coagulation function of the observation group was significantly higher than that of the control group, with a better combined anticoagulant effect (P<0.05). There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores, intraoperative blood loss, postoperative infection rate, or length of hospital stay (P>0.05). According to logistic regression analysis, the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD (P<0.05). The area under the receiver operating characteristic (AUROC) curve of partial thromboplastin time (APTT) and platelet (PLT) were greater than 0.5, indicating that they were the influence indicators of adding PCD to prevent DVT. Excluding the influence of other variables, LMWH+PCD effectively improved the coagulation function of patients. CONCLUSIONS: Compared with LMWH alone, LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture, reduce the incidence of DVT, shorten the length of hospital stay, and improve the clinical effectiveness of treatment. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Neutrophils inhibit CD8 + T cells immune response by arginase-1 signaling in patients with sepsis Xiao-kang Dai, Zhen-xing Ding, Yuan-yuan Tan, Hua-rui Bao, Dong-yao Wang, Hong Zhang World Journal of Emergency Medicine    2022, 13 (4): 266-273.   DOI: 10.5847/wjem.j.1920-8642.2022.068 Abstract （425）   HTML （1246232659）    PDF（pc） （1952KB）（1063）       Knowledge map    Save BACKGROUND: Patients with sepsis often exhibit an acute inflammatory response, followed by an immunosuppressive phase with a poor immune response. However, the underlying mechanisms have not been fully elucidated. METHODS: We sought to comprehensively characterize the transcriptional changes in neutrophils of patients with sepsis by transcriptome sequencing. Additionally, we conducted a series of experiments, including real-time quantitative polymerase chain reaction (RT-qPCR) and flow cytometry to investigate the role of arginase-1 signaling in sepsis. RESULTS: Through the analysis of gene expression profiles, we identified that the negative regulation of T cell activation signaling was enriched, and the expression of arginase-1 was high in neutrophils from patients with sepsis. Furthermore, we conducted flow cytometry and found that the function of CD8+ T cells in septic patients was impaired. Moreover, neutrophils from septic patients inhibited the percentage of polyfunctional effector CD8+ T cells through arginase-1. Additionally, the proportions of granzyme B+IFN-γ+CD8+ T and TNF-α+IFN-γ+CD8+ T cells increased after inhibition of arginase-1 signaling. CONCLUSION: The impaired effector function of CD8+ T cells could be restored by blocking arginase-1 signaling in patients with sepsis. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance? Lori Stolz, Elaine Situ-LaCasse, Josie Acuña, Matthew Thompson, Nicolaus Hawbaker, Josephine Valenzuela, Uwe Stolz, Srikar Adhikari World Journal of Emergency Medicine    2021, 12 (3): 169-173.   DOI: 10.5847/wjem.j.1920-8642.2021.03.001 Abstract （418）   HTML （1646329881）    PDF（pc） （217KB）（1290）       Knowledge map    Save BACKGROUND: Traditionally performed using a subxiphoid approach, the increasing use of point-of-care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fluid, and likely obstructions or complications. METHODS: A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial effusions. The images were reviewed for technical quality, distance of effusion from skin surface, and predicted complications. RESULTS: A total of 166 pericardial effusions were identified during the study period. The mean skin-to-pericardial fluid distance was 5.6 cm (95% confidence interval [95% CI] 5.2-6.0 cm) for the subxiphoid views, which was significantly greater than that for the parasternal (2.7 cm [95% CI 2.5-2.8 cm], P<0.001) and apical (2.5 cm [95% CI 2.3-2.7 cm], P<0.001) views. The subxiphoid view had the highest predicted complication rate at 79.7% (95% CI 71.5%-86.4%), which was significantly greater than the apical (31.9%; 95% CI 21.4%-44.0%, P<0.001) and parasternal (20.2%; 95% CI 12.8%-29.5%, P<0.001) views. CONCLUSIONS: Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach. The distance from skin to fluid collection is the least in both of these views. Table and Figures | Reference | Related Articles | Metrics

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The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial Johan L. van Nieuwkerk, M. Christien van der Linden, Rolf J. Verheul, Merel van Loon-van Gaalen, Marije Janmaat, Naomi van der Linden World Journal of Emergency Medicine    2023, 14 (4): 257-264.   DOI: 10.5847/wjem.j.1920-8642.2023.054 Abstract （412）   HTML （1537）    PDF（pc） （414KB）（825）       Knowledge map    Save BACKGROUND: In patients with chest pain who arrive at the emergency department (ED) by ambulance, venous access is frequently established prehospital, and could be utilized to sample blood. Prehospital blood sampling may save time in the diagnostic process. In this study, the association of prehospital blood draw with blood sample arrival times, troponin turnaround times, and ED length of stay (LOS), number of blood sample mix-ups and blood sample quality were assessed. METHODS: The study was conducted from October 1, 2019 to February 29, 2020. In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome (ACS), outcomes were compared between cases, in whom prehospital blood draw was performed, and controls, in whom blood was drawn at the ED. Regression analyses were used to assess the association of prehospital blood draw with the time intervals. RESULTS: Prehospital blood draw was performed in 100 patients. In 406 patients, blood draw was performed at the ED. Prehospital blood draw was independently associated with shorter blood sample arrival times, shorter troponin turnaround times and decreased LOS (P<0.001). No differences in the number of blood sample mix-ups and quality were observed (P>0.05). CONCLUSION: For patients with acute chest pain with low suspicion for ACS, prehospital blood sampling is associated with shorter time intervals, while there were no significant differences between the two groups in the validity of the blood samples. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study Ahmed Faidh Ramzee, Ayman El-Menyar, Mohammad Asim, Ahad Kanbar, Khalid Ahmed, Bahaa Daoud, Saji Mathradikkal, Ahmad Kloub, Hassan Al-Thani, Sandro Rizoli World Journal of Emergency Medicine    2023, 14 (2): 96-105.   DOI: 10.5847/wjem.j.1920-8642.2023.016 Abstract （406）   HTML （103574）    PDF（pc） （416KB）（709）       Knowledge map    Save BACKGROUND: We aimed to explore the impact of the emergency department length of stay (EDLOS) on the outcome of trauma patients. METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS (<4 h, 4-12 h,12-24 h, and >24 h). Data were analyzed using Chi-square test (categorical variables), Student’s t-test (continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality. RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. One-fifth of patients had a short EDLOS (<4 h) and had higher level trauma team T1 activation (TTA-1), higher Injury Severity Score (ISS), higher shock index (SI), and more head injuries than the other groups (P=0.001). Patients with an EDLOS >24 h were older (P=0.001) and had more comorbidities (P=0.001) and fewer deaths (P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1 (odds ratio [OR]=4.081, 95%CI: 2.364-7.045), head injury (OR=3.920, 95%CI: 2.413-6.368), blood transfusion (OR=2.773, 95%CI: 1.668-4.609), SI (OR=2.132, 95%CI: 1.364-3.332), ISS (OR=1.077, 95%CI: 1.057-1.096), and age (OR=1.040, 95%CI: 1.026-1.054). CONCLUSIONS Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes; however, the burden of prolonged boarding in the ED needs further elaboration. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Risk factors for computed tomography interpretation discrepancy in emergently transferred patients Hyun Sim Lee, Jinwoo Myung, Min Ji Choi, Hye Jung Shin, Incheol Park, Sung Phil Chung, Ji Hoon Kim World Journal of Emergency Medicine    2022, 13 (1): 54-58.   DOI: 10.5847/wjem.j.1920-8642.2022.001 Abstract （395）   HTML （1946157841）    PDF（pc） （165KB）（975）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics