World Journal of Emergency Medicine

Hai Hu, Ni Yao, Xiao-qin Lai

2022, 13(6): 425-432. doi:10.5847/wjem.j.1920-8642.2022.099

Asbtract

HTML

PDF (434KB)

BACKGROUND: There is limited evidence for emergency physicians and emergency trauma surgeons regarding the determinants of early and rapid assessment of older adult in-hospital mortality due to earthquakes. This study explored factors related to the early and rapid assessment of the mortality among older adult earthquake trauma patients (OAETPs) and created a screening model.

METHODS: Data on 7,308 OAETPs from the West China Earthquake Patients Database were analyzed retrospectively. The 35 variables that can be obtained rapidly on arrival at the hospital were collected. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed. Then, the nomogram for assessing the mortality of OAETPs was constructed.

RESULTS: We identified 10 independent mortality-related factors that contributed to the in-hospital mortality of OAETPs. The 10 factors included age (odds ratio [OR]=1.061, 95% confidence interval [CI]:1.031-1.090), dementia (OR=5.146, 95%CI: 1.169-17.856), coronary heart disease (CHD; OR=23.441, 95%CI: 4.799-83.927), malignant tumor (OR=8.497, 95%CI: 3.583-17.967), deep vein thrombosis (DVT; OR=7.110, 95%CI: 1.369-27.168), chronic kidney disease(CKD; OR=11.783, 95%CI: 5.419-24.407), pulse rate (PR; OR=1.036, 95%CI: 1.022-1.048), mean artery pressure (MAP; OR=0.960, 95%CI: 0.945-0.975), Glasgow Coma Scale (GCS; OR=0.864, 95%CI: 0.760-0.972), and Triage Revised Trauma Score (T-RTS, OR=0.485, 95%CI: 0.351-0.696).

CONCLUSION: The 10 mortality-related factors could be quickly obtained on hospital arrival and should be the focal point of future earthquake response strategies regarding hospitalized older adults with trauma. A nomogram was constructed based on the factors for screening OAETPs with a higher risk of in-hospital mortality.

Comparing the demographic data and outcomes of septic shock patients presenting to teaching or non-teaching metropolitan hospitals in the United States

Ralph Bou Chebl, Nadim Kattouf, Mohamad Assaf, Saadeddine Haidar, Gilbert Abou Dagher, Sarah Abdul Nabi, Rana Bachir, Mazen El Sayed

2022, 13(6): 433-440. doi:10.5847/wjem.j.1920-8642.2022.101

Asbtract

HTML

PDF (382KB)

BACKGROUND: Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking. The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States.

METHODS: This was a retrospective observational study, using the Nationwide Emergency Department Sample Database (released in 2018). All patients with septic shock were included. Complex sample logistic regression was performed to assess the impact of hospital teaching status on patient mortality.

RESULTS: A total of 388,552 septic shock patients were included in the study. The average age was 66.93 years and 51.7% were males. Most of the patients presented to metropolitan teaching hospitals (68.2%) and 31.8% presented to metropolitan non-teaching hospitals. Septic shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities, were more likely to be intubated and placed on mechanical ventilation (50.5% vs. 46.9%) and had a longer average length of hospital stay (12.47 d vs. 10.20 d). Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals (adjusted odd ratio [OR]=1.295, 95% confidence interval [CI]: 1.256-1.335).

CONCLUSION: Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching hospitals. They also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals.

The procalcitonin-to-cortisol ratio is a potential prognostic predictor in sepsis with abdominal source: a retrospective observational study

Hui Liu, Jie Hu, Jian-guo Xiao, Hong-jun Kang, Fei-hu Zhou

2022, 13(6): 441-447. doi:10.5847/wjem.j.1920-8642.2022.095

Asbtract

HTML

PDF (521KB)

BACKGROUND: The aim of the study was to investigate the procalcitonin-to-cortisol ratio (P/C ratio) as a prognostic predictor among septic patients with abdominal source.

METHODS: We retrospectively enrolled 132 post-surgery patients between 18 and 90 years old with sepsis of the abdominal source. On the second day of sepsis onset, cortisol, procalcitonin (PCT), Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, C-response protein (CRP), and other baseline characteristics were collected. In addition, the length of ICU stay, length of mechanical ventilation (MV) days, length of shock days, and 28-day mortality were also recorded. Univariate analysis was performed to screen potential risk factors. Stratified analysis was used to identify the interaction among the risk factors. Multivariate analysis was also utilized to demonstrate the relationship between the risk factors and mortality. The receiver operator characteristic (ROC) curve analysis was conducted to evaluate the risk factors. A restricted cubic spline (RCS) demonstrated the association between survival outcome and the P/C ratio variation.

RESULTS: A total of twenty-nine patients died, and 103 patients survived within 28 d. There were significant differences in cortisol, PCT, P/C ratio, interleukin (IL)-6, SOFA, and APACHE II scores between the survival and non-survival groups. No significant interaction was observed in the stratified analysis. Logistic regression analysis revealed that P/C ratio (P=0.033) was significantly related to 28-day mortality. Based on ROC curves, P/C ratio (AUC=0.919) had a higher AUC value than cortisol or PCT. RCS analysis depicted a positive relationship between survival possibility and P/C ratio decrement.

CONCLUSION: P/C ratio might be a potential prognostic predictor in septic patients with abdominal sources.

Early changes in white blood cell, C-reactive protein and procalcitonin levels in children with severe multiple trauma

Cai-fang Xu, Ming-chao Huo, Jin-hui Huang, Chun-feng Liu, Wei Xu

2022, 13(6): 448-452. doi:10.5847/wjem.j.1920-8642.2022.093

Asbtract

HTML

PDF (494KB)

BACKGROUND: To analyze early changes in white blood cells (WBCs), C-reactive protein (CRP) and procalcitonin (PCT) in children with multiple trauma, before secondary inflammation develops.

METHODS: This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit (PICU). According to the prognostic outcome of 28 d after admission to the PICU, patients were divided into survival group (n=141) and non-survival group (n=36). Characteristics between the two groups were compared. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.

RESULTS: The percentages of children with elevated WBC, CRP, and PCT levels were 81.36%, 31.07%, and 95.48%, respectively. Patients in the non-survival group presented a statistically significantly higher injury severity score (ISS) than those in the survival group: 37.17±16.11 vs. 22.23±11.24 (t=6.47, P<0.01). WBCs were also higher in non-survival group than in the survival group ([18.70±8.42]×10⁹/L vs. [15.89±6.98] ×10⁹/L, t=2.065, P=0.040). There was no significant difference between the survival and non-survival groups in PCT or CRP. The areas under the ROC curves of PCT, WBC and ISS for predicting 28-day mortality were 0.548 (P=0.376), 0.607 (P=0.047) and 0.799 (P<0.01), respectively.

CONCLUSIONS: Secondary to multiple trauma, PCT levels increased in more patients, even if their WBC and CRP levels remained unchanged. However, early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Exploratory COVID-19 death risk score based on basic laboratory tests and physiological clinical measurements

Gui-ying Dong, Fei-fei Jin, Qi Huang, Chun-bo Wu, Ji-hong Zhu, Tian-bing Wang

2022, 13(6): 453-458. doi:10.5847/wjem.j.1920-8642.2022.103

Asbtract

HTML

PDF (482KB)

BACKGROUND: In the event of a sudden shortage of medical resources, a rapid, simple, and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19.

METHODS: This retrospective study compared the characteristics of the survivals and non-survivals of 278 patients with COVID-19. Logistic regression analysis was performed to obtain the “COVID-19 death risk score” (CDRS) model. Using the area under the receiver operating characteristic (AUROC) curve and Hosmer-Lemeshow goodness-of-fit test, discrimination and calibration were assessed. Internal validation was conducted using a regular bootstrap method.

RESULTS: A total of 63 (22.66%) of 278 included patients died. The logistic regression analysis revealed that high-sensitivity C-reactive protein (hsCRP; odds ratio [OR]=1.018), D-dimer (OR=1.101), and respiratory rate (RR; OR=1.185) were independently associated with 30-day mortality. CDRS was calculated as follows: CDRS=-10.245+(0.022×hsCRP)+(0.172×D-dimer)+(0.203×RR). CDRS had the same predictive effect as the sequential organ failure assessment (SOFA) and “confusion, uremia, respiratory rate, blood pressure, and age over 65 years” (CURB-65) scores, with AUROCs of 0.984 for CDRS, 0.975 for SOFA, and 0.971 for CURB-65, respectively. And CDRS showed good calibration. The AUROC through internal validations was 0.980 (95% confidence interval [CI]: 0.965-0.995). Regarding the clinical value, the decision curve analysis of CDRS showed a net value similar to that of CURB-65 in this cohort.

CONCLUSION: CDRS is a novel, efficient and accurate prediction model for the early identification of COVID-19 patients with poor outcomes. Although it is not as advanced as the other models, CDRS had a similar performance to that of SOFA and CURB-65.

Medical services for sports injuries and illnesses in the Beijing 2022 Olympic Winter Games

Peng-da Han, Ding Gao, Jie Liu, Jing Lou, Si-jia Tian, Hui-xin Lian, Sheng-mei Niu, Lu-xi Zhang, Yong Wang, Jin-jun Zhang

2022, 13(6): 459-466. doi:10.5847/wjem.j.1920-8642.2022.106

Asbtract

HTML

PDF (503KB)

BACKGROUND: Beijing 2022 Olympic Winter Games was the second Games held amid the COVID-19 pandemic. To a certain extent, it has altered the way sporting activities operate. There is a lack of knowledge on injury risk and illness occurrence in elite winter sport athletes amid the COVID-19 pandemic. This study aimed to describe the incidence of injuries and illnesses sustained during the XXIV Olympic Winter Games in Beijing from February 4 to 20, 2022.

METHODS: We recorded the daily number of injuries and illnesses among athletes reported by Beijing 2022 medical staff in the polyclinic, medical venues, and ambulance. We calculated injury and illness incidence as the number of injuries or illnesses occurring during competition or training, respectively, with incidence presented as injuries/illnesses per 100 athlete-days.

RESULTS: In total, 2,897 athletes from 91 nations experienced injury or illness. Beijing 2022 medical staff reported 326 injuries and 80 illnesses, equaling 11.3 injuries and 2.8 illnesses per 100 athletes over the 17-day period. Altogether, 11% of the athletes incurred at least one injury and nearly 3% incurred at least one illness. The number of injured athletes was highest in the skating sports (n=104), followed by alpine skiing (n=53), ice track (n=37), freestyle skiing (n=36), and ice hockey (n=35), and was the lowest in the Nordic skiing disciplines (n=20). Of the 326 injuries, 14 (4.3%) led to an estimated absence from training or competition of more than 1 week. A total of 52 injured athletes were transferred to hospitals for further care. The number of athletes with illness (n=80) was the highest for skating (n=33) and Nordic skiing (n=22). A total of 50 illnesses (62.5%) were admitted to the department of dentistry/ophthalmology/otolaryngology, and the most common cause of illness was other causes, including preexisting illness and medicine (n=52, 65%).

CONCLUSION: Overall, 11% of athletes incurred at least one injury during the Games, which is similar to the findings during the Olympic Winter Games in 2014 and 2018. Regarding illness, 2% of athletes were affected, which is approximately one-third of the number affected in the 2018 Olympic Winter Games.

Management of difficult intravenous access: a qualitative review

Mingwei Ng, Leong Kwok Fai Mark, Lateef Fatimah

2022, 13(6): 467-478. doi:10.5847/wjem.j.1920-8642.2022.104

Asbtract

HTML

PDF (1306KB)

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.

The effectiveness of emotion-focused art therapy on the resilience and self-image of emergency physicians

Soo Kyung Eo, Chanwoong Kim, Kyung Hye Park, Eun Kyung Eo

2022, 13(6): 479-484. doi:10.5847/wjem.j.1920-8642.2022.098

Asbtract

HTML

PDF (384KB)

Vaccine-associated myocarditis: a case report and summary of the literature

Joshua Davis, Lauren Jennings

2022, 13(6): 485-487. doi:10.5847/wjem.j.1920-8642.2022.102

Asbtract

HTML

PDF (1952KB)