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International Journal of Emergency Medicine
Journal Prestige (SJR): 0.416

Citation Impact (citeScore): 1
Number of Followers: 10

This is an Open Access Journal

Open Access journal
ISSN (Print) 1865-1380 - ISSN (Online) 1865-1372
Published by SpringerOpen

[229 journals]

The association of early antibiotic exposure with subsequent development
of late-onset sepsis in preterm infants: a systematic review and
meta-analysis studies
- Abstract: Background Early antibiotic exposure in preterm infants may disrupt gut microbiome development, affecting health. However, its link to late-onset sepsis (LOS) remains unclear. This meta-analysis aims to clarify the association while addressing confounding bias. Methods This systematic review and meta-analysis, conducted per PRISMA guidelines, utilized PubMed, Scopus, Google Scholar, and Web of Science for comprehensive literature retrieval. Studies comparing preterm infants with sterile blood cultures who received early antibiotics (short or prolonged) to those without, using LOS as the primary outcome, were included. Comparisons between short- and prolonged-course antibiotics were also considered. Only studies with adjusted analyses for confounders were considered. Adjusted odds ratios (aOR) were meta-analyzed, and the prediction interval (PI) was calculated using R software. Results Ten studies met the eligibility criteria, comprising a total sample size of 55,089 preterm infants. Among these, nine studies included 33,549 preterm infants and compared prolonged antibiotic exposure to short exposure. Prolonged exposure was not significantly associated with LOS (pooled aOR = 1.2, 95% CI 0.99–1.46, P = 0.066, PI = 0.66 to 2.19, I² = 67%). Limiting the analysis to five studies with sample sizes over 1,000 reduced heterogeneity (I² = 30%) and provided a more precise confidence interval (pooled aOR = 1.03, 95% CI 0.91–1.15). Four studies, involving 41,938 preterm infants, examined preterm infants exposed to prolonged antibiotics versus those not exposed and found no significant association (aOR = 0.91, 95% CI 0.82–1.02, P = 0.1, PI = 0.72 to 1.16, I² = 0). All four studies had sample sizes exceeding 1,000. Additionally, these studies compared preterm infants with short antibiotic exposure to non-exposure, revealing a slightly lower risk of LOS (aOR = 0.87, 95% CI 0.77–0.98, P = 0.024, I² = 0) and a PI of 0.76 to 1.14. Conclusions Our findings indicate that prolonged early antibiotic exposure in preterm infants with sterile cultures does not significantly increase the risk of LOS compared to no antibiotic exposure. Interestingly, a shorter duration of antibiotic exposure might be associated with a slightly lower risk of LOS.
  PubDate: 2025-04-18
Implementation of autonomous decision protocols for emergency medical
dispatchers: caller satisfaction survey and evolution of practices
- Abstract: Background Access to emergency care is becoming increasingly challenging due to rising demand and limited resources, such as shortage of general practitioners (GP). In France, emergency medical services (EMS) have experienced a 23% increase in call volume over the past decade. To address this, French dispatch systems are evolving, with Emergency Medical Dispatchers (EMDs) empowered to make certain medical decisions through Autonomous Decision Protocols (ADP). These ADP were designed for most frequent and simple emergency situations such as low back pain, epistaxis, head and limb injury, anxiety, and allowed EMDs to recommend medical advice, send an ambulance or refer the caller to a dispatching doctor. Aim This study aimed to assess callers’ satisfaction with decisions made by EMDs using ADPs compared to decisions made by medical doctors with similar chief complaint. Material & method The study was prospective, involving all ADP calls from September to October 2023. All calls concerning ADPs and dispatched by EMDs were included. Callers were called back within a few days of the call in order to obtain their experience using a questionnaire. Retrospective patient files concerning similar chief complaints handled in the traditional way, over the same period in the previous year, were used for comparison. Results A total of 358 calls were analyzed, with 217 (61%) callers completing a satisfaction survey. The results showed high satisfaction, with an average score of 8.6/10. The most common chief complaints were head and limb injuries, and the vast majority (90%) of callers felt their expectations were met. Only a small percentage (4%) required a second opinion or follow up due to worsening symptoms. Conclusion The findings suggest that ADPs improved efficiency by providing standardized medical advice, reducing unnecessary ambulance dispatches, and saving medical resources. Callers who benefited from ADPs were generally satisfied with the service, with satisfaction rates comparable to those found in international studies. Expanding ADPs to cover additional medical conditions could further enhance emergency dispatch systems, especially in light of increasing demand and reduced medical resources.
  PubDate: 2025-04-17
Rapid testicular salvage in the emergency department using point of care
ultrasound [POCUS]
- Abstract: Background Testicular torsion is a time-sensitive urological emergency characterized by twisting of the spermatic cord, leading to ischaemia and, if untreated, necrosis. Young males under 25 are at the highest risk due to congenital defects like the Bell Clapper deformity. Prompt diagnosis and management are crucial. Case presentation A 30-year-old male presented with severe right testicular pain, and point-of-care ultrasound (POCUS) in the Emergency Department confirmed torsion within a few minutes upon arrival to Emergency Department. Manual detorsion restored blood flow, confirmed by bedside Doppler imaging using POCUS within 15 min of arrival. The patient underwent successful bilateral orchidopexy. Conclusion This case emphasizes the importance of early targeted emergency POCUS in recognizing and managing testicular torsion, ensuring optimal outcomes.
  PubDate: 2025-04-17
Epidemiology and management of urological emergencies in a tertiary care
setting in Scandinavia
- Abstract: Objective To develop a baseline database detailing the distribution of urological emergencies and to define their epidemiological profile in a tertiary care setting, with the hope of providing important data for health planning. Design, settings and participants A retrospective study was conducted on all patients presenting with urological emergencies at the Emergency Department (ED) of the NU Hospital Group in Trollhättan, Sweden throughout 2019. Medical records of identified patients were reviewed retrospectively to summarize pertinent information. Main results In 2019, 2 433 patients visited the ED with urological complaints, with 71% being male. Most patients (83%) were self-referred and 15% referred by general practitioners (GPs). Loin pain, infectious symptoms, and lower urinary tract symptoms were the most common complaints. Urinary and genital infections (UGIs) were the most frequent diagnoses (37%), followed by urolithiasis (24%). 28% of patients required admission, particularly for UGIs (42%). Self-referred patients had a higher admission rate compared to those referred by GPs. Radiological investigations were performed in 48% of cases, though 65% showed no urological pathology. Conclusions Most patients self-referred to the ED, and many required hospitalization, particularly for UGIs. Enhancing the management of urological emergencies in primary care and refining guidelines for acute imaging could contribute to more efficient use of healthcare resources.
  PubDate: 2025-04-15
Predictors of pre-hospital delay among stroke patients in Yekatit-12
hospital Addis Ababa, Ethiopia: unmatched case-control study
- Abstract: Background Timely detection and early medical interventions are critical in reducing complications and mortality related to stroke. The duration from onset to hospital presentation is an essential factor in determining the outcome of stroke treatment. The sooner a stroke patient receives medical attention, the better the chances of preventing long-term complications. Pre-hospitalization delays can significantly decrease the chances of successful therapy and recovery from stroke. Objective The study aims to assess predictors of delayed hospital presentation after a stroke attack. Method An unmatched case-control study was conducted from September 2021 to November 2023 at Yekatit 12 Hospital Medical College. Descriptive statistics were used to describe study variables. Bivariable and multivariable logistic regression were used to identify the predictors of delay hospital presentation after stroke attack. All statistical tests were run with a significance threshold of 5%. Result A total of 83 cases (presenting after four hours) and 166 controls (presenting within four or fewer hours) of an acute stroke patients were included in this study. The median duration of symptoms from the onset of stroke to hospital arrival were 24 h (IQR, 12 h) and 2 h(IQR,1 h) for cases and controls respectively. The study found that age 60 or less (AOR 1.75, 95% CI 1–3.09, p
  PubDate: 2025-04-15
The effect of music therapy on treating patients pain and anxiety in
emergency department: a randomized controlled trial
- Abstract: Background Music therapy (MT) is a recognized modality for pain and anxiety reduction. Although its efficacy has been demonstrated in various clinical settings, its application in emergency departments (ED) remains controversial. This study aims to study the effects of MT in reducing pain and anxiety among patients visiting the ED with pain complaints. Methods A single-center, randomized controlled trial was conducted at Ramathibodi Hospital, Bangkok, from July 2023 to September 2024. During each month of the study period, three days were randomly selected for the MT group, and another three days were designated for the non-MT group. All participants received standard analgesia and completed pre- and post-session questionnaires to assess pain, anxiety, satisfaction, and ED service quality before and one hour after analgesia. The MT group received MT sessions, each lasting 30–40 min. Results Sixty-three patients participated (31 MT group, 32 control group). The MT group showed a significant reduction in pain scores of 1.52 points compared to 0.09 in the non-MT group (p 0.002). Anxiety score was also significantly reduced in the MT group by 1.87 points compared to 0.44 points in the non-MT group (p 0.026). The most significant improvements were observed in non-trauma-related pain and anxiety. Satisfaction scores increased in both groups (0.48 vs. 0.47 points; p 0.946), with no significant difference. However, MT significantly improved perceived ED service quality (0.98 vs. 0.10 points; p 0.001). Conclusion In this study, we found that music therapy, when combined with standard analgesia, effectively reduced pain and anxiety in patients presenting to the ED, particularly those with non-trauma-related pain. Clinical trial number TCTR20231109003. Registration site Thai Clinical Trials Registry. URL: https://www.thaiclinicaltrials.org/show/TCTR20231109003. Date of approval: 20 June 2023.
  PubDate: 2025-04-11
Reaching the right facility for emergency patients - destinations of
patients transported by emergency medical services in Kigali, Rwanda
- Abstract: Background Ensuring that emergency patients reach the right healthcare facility at the right time is a key component of providing quality emergency care. Rwanda’s prehospital emergency care system, Service D’Aide Médicale Urgente (SAMU), was established in 2007 to provide prehospital emergency care services, but a formal assessment of the receiving facilities has not been done. We explored the characteristics of patients transported by SAMU to identify factors influencing the choice of destination health facilities. Methods We retrospectively analyzed SAMU data documenting patients transported in Kigali in 2022. The main dataset included patient sex, age, emergency condition, insurance status, and destination facility. For a subset of patients, additional data were available on clinical variables such as Glasgow Coma Score (GCS), variables to permit derivation of the Triage Early Warning Scores (TEWS), and an assessment of urgency made by the ambulance team. Facilities receiving patients transported by SAMU were categorised into health centers, district hospitals, and tertiary hospitals. Results are described for the main dataset, and associations between facility type and patient characteristics were determined using multinomial logistic regression on the subset of patients with additional clinical variables. Results Data was available for 7,221 patients. The majority were male (65%), with a mean age of 34 years (SD = 16). The leading three emergency conditions were trauma (66%), gynecological and obstetric conditions (9%), and medical conditions (17%). Most patients were received by district hospitals (47%), followed by health centers (36%), and tertiary hospitals (17%). We also found that patients with urgency classified as “extreme” had a 49%, 37%, and 14% probability of being transferred to tertiary hospitals, district hospitals, and health centers respectively. Similarly, patients with TEWS of 7 or higher had a 53%, 29%, and 18% chance of being transported to tertiary hospitals, district hospitals, and health centers respectively. Age, sex, and insurance status were not associated with facility type. In the multinomial analysis, patients with trauma had a 44%, 38%, and 18% probability of being transferred to district hospitals, health centers, and tertiary hospitals respectively. Women with obstetrics and gynecology conditions had a 56%, 35%, and 8% probability of being transported to district hospitals, health centers, and tertiary hospitals respectively. Conclusion We identified that patients’ age and urgency of the condition were associated with destination; however, insurance and TEWS scores were found to have less influence.
  PubDate: 2025-04-10
Herbicide poisoning causing multiple colonic perforations: case report
- Abstract: Introduction Herbicide poisoning, particularly from 2,4-dichlorophenoxyacetic acid (2,4-D), is an uncommon yet significant cause of systemic toxicity, especially in agricultural regions such as Ethiopia. Patients exposed to 2,4-D frequently exhibit symptoms associated with gastrointestinal, muscular, renal, and neurological toxicity. In this report, we describe a case of 2,4-D ingestion that resulted in systemic complications and the exceptionally rare occurrence of multiple colonic perforations. Case presentation A 19-year-old male farmer presented with a loss of consciousness three hours after attempting suicide by ingesting 25 ml of 72% 2,4-D solution. This was preceded by vomiting and epigastric pain. The patient was treated for hypovolemic shock, aspiration pneumonia, and coma secondary to herbicide poisoning. Despite initial stabilization and recovery, the patient developed signs of peritonitis 14 days post-ingestion, which led to the discovery of multiple colonic perforations. Surgical intervention included total colectomy with ileostomy, which was later reversed. This case is notable as the first documented instance of multiple colonic perforations due to 2,4-D poisoning in humans, as confirmed through an extensive literature review. Conclusion This case highlights the importance of vigilance in patients presenting with herbicide poisoning, as early detection and prompt management are essential for improving outcomes in individuals with multiple colonic perforations. Raising community awareness and establishing guidelines for the safe use of herbicides are vital to preventing such incidents.
  PubDate: 2025-04-10
Successful management of life-threatening spontaneous inferior thyroid
artery rupture in neurofibromatosis type 1: a rare case report
- Abstract: Background Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder associated with cutaneous and vascular complications. Arterial rupture, including the rare involvement of the subclavian artery, can be life-threatening. We present a case of a ruptured inferior thyroid artery in a patient with NF1, presenting with a rapidly expanding neck hematoma. Case presentation A 35-year-old male with a history of NF1 presented to the emergency department with sudden-onset right-sided neck swelling and pain. The swelling rapidly expanded, leading to severe dyspnea, irritability, and hoarseness, necessitating emergent intubation. After failed attempts of intubation, a surgical tracheostomy was performed. Imaging revealed active arterial extravasation at the inferior thyroid artery near the thyrocervical trunk, with a large neck hematoma extending into the mediastinum. Coil embolization was performed, resulting in a favorable outcome. Postoperative follow-up confirmed successful embolization and resolution of symptoms. Discussion and conclusion NF1 is commonly associated with cutaneous manifestations but can also lead to vascular complications, including arterial stenosis and aneurysms, due to impaired vascular endothelial and smooth muscle cell function. Rupture of the inferior thyroid artery in NF1 is extremely rare and can present with symptoms such as hoarseness, dysphagia, and swelling, complicating initial diagnosis. Management of vascular complications in NF1 can be challenging due to the fragility of affected vessels. Endovascular interventions, such as coil embolization, offer a less invasive treatment option with promising outcomes. In this case, rapid airway management followed by angiographic embolization led to a successful resolution.
  PubDate: 2025-04-10
A fatal case of acute Marchiafava-Bignami disease complicated by acute
abdomen– a case report
- Abstract: Background Marchiafava-Bignami Disease (MBD) is a rare disorder characterized by demyelination and necrosis of the corpus callosum, with only 300 documented cases worldwide. Chronic alcohol consumption and vitamin B-complex deficiencies are contributing factors. Acute cases may present with a range of neurological symptoms, including seizures and coma. Subacute and chronic forms can lead to interhemispheric disconnection syndrome and progressive dementia. Case presentation We present the case of a young male patient’s first hospital admission due to an acute decline in conscious level. A detailed history revealed regular alcohol consumption and substandard living conditions. The deterioration in consciousness was attributed to the diagnosis of MBD based on neurological signs, characteristic brain imaging findings, and a history of alcohol use. In addition, a small bowel perforation was also diagnosed. Supportive therapy and thiamine were initiated, and the patient was transferred to surgery for an operation. After two surgeries, the perforation was covered. The patient’s level of consciousness showed slight improvement; however, the psychiatrist noted severe cognitive deficits. Ultimately, the patient entered a septic state and passed away. Conclusion Acute MBD can potentially cause altered mental state, coma, and death; however, cases can be complicated by other emergency conditions. This case demonstrates the importance of a multidisciplinary approach.
  PubDate: 2025-04-08
Characterizing stroke presenting to a regional referral hospital before
and during the COVID-19 pandemic in Uganda: a retrospective analysis
- Abstract: Introduction Stroke, a leading cause of global morbidity and mortality, disproportionately impacts low and middle-income countries, particularly in sub-Saharan Africa (SSA) which reports the highest stroke burden. The COVID-19 pandemic further complicated this situation, emerging as a significant stroke risk factor. The pandemic also disrupted healthcare systems worldwide, affecting stroke management and care accessibility, and leading to deteriorated conditions in stroke patients upon hospital admission. In this pre/during COVID-19 pandemic analysis of acute stroke cases presenting to a Ugandan hospital, we investigated the relationship between stroke admissions, management and treatment outcomes. Methods This was a retrospective medical record review in which we analyzed medical charts of stroke patients admitted to Mbarara Regional Referral Hospital in 2019 (pre-COVID-19) and 2020 (during COVID-19). Socio-demographic data, stroke subtypes, medical history, and physical examination findings were extracted from the hospital records. Data analysis was performed using R-Studio, employing descriptive statistics and inferential analyses to compare stroke characteristics and outcomes across the two periods. Results Data from 175 stroke patients was analyzed, with higher admission numbers in 2020 (69.7%), but a slightly higher mortality rate in 2019 as compared to 2020 (22.6% versus 18.9%, p = 0.711). A significant increase in acute ischemic stroke cases was observed in 2020, with no significant differences in stroke severity or functional ability between the two years. Clinical parameters such as admission oxygen saturation, blood sugar, temperature, and Glasgow Coma Scale (GCS) score, along with complications like aspiration pneumonia and infections, correlated with mortality. There was no significant difference in survival probability between pre- and during-pandemic periods. Admission GCS, pulse rate, and aspiration pneumonia were significant predictors of 14-day in-hospital mortality. Conclusions The surge in acute ischemic stroke cases during the pandemic highlights the need for robust stroke care systems, especially in high-burden regions like SSA. Some key predictors of mortality are potentially modifiable, suggesting that early intervention and vigilant monitoring of risk parameters could improve survival rates. Findings also highlight the need for tailored care strategies and health system improvements especially during public health emergencies to enhance patient outcomes. Trial registration Not Applicable.
  PubDate: 2025-04-07
Recurrent Wunderlich syndrome in systemic lupus erythematosus: a case
report
- Abstract: Background Wunderlich syndrome (WS) is a rare condition characterized by spontaneous renal hemorrhage in the absence of obvious trauma or iatrogenic injury. Given that most WS cases are life-threatening and require prompt intervention, timely identification and resolution are essential. Patients with connective tissue diseases (CTDs) account for a small proportion of reported WS cases; however, owing to the specific pathogenic mechanisms and treatments associated with CTDs, these patients exhibit distinctive pathological traits and clinical features in WS. Case presentation We present the identification and treatment process of WS in a patient with systemic lupus erythematosus. This patient suffered from sudden abdominal pain and a drastic decline in hemoglobin level accompanied by confusion of consciousness. After the abdominal computerized tomography scan revealed the presence of a renal hematoma, transcatheter arterial embolization was performed on her. Unexpectedly, three days later, the patient had severe anemia and consciousness disorders again. Highly suspecting renal rebleeding, we performed a repeated angiography for the patient. After confirming the bleeding, embolization was carried out again. The renal bleeding stopped, and the patient’s hemoglobin level gradually stabilized. Regrettably, this patient ultimately died due to multiple systemic infections. Conclusions WS that occurs in CTDs can evolve into critical and severe conditions. Infection, immune complex deposition, thrombocytopenia, abnormal coagulation function, complement activation, autoantibodies production, and glucocorticoid treatment in patients with CTDs are potentially linked to the development of WS. The treatment strategies for WS should be guided by hemodynamic status.
  PubDate: 2025-04-07
Low-moderate alcohol use effects on glycemic control of patients
presenting in the ED
- Abstract: Background The prevalence of Type 2 Diabetes Mellitus (DM2) is rising, affecting 462 million globally, including 21 million in the U.S. Emergency Department (ED) visits by adults with diabetes in the U.S. increased by 54% from 2012 to 2021 and represent a significant portion of global ED visits. Concurrently, 62% of U.S. adults report lifetime alcohol consumption. This study aimed to correlate AUDIT-C scores to changes in glucose and HbA1c levels in patients with DM2. Previous research has produced mixed results on whether light-to-moderate alcohol use improves or worsens glycemic control. Using a large urban ED dataset, this study seeks to better define this relationship and guide interventions for alcohol use in patients with DM2. Methods Data from Long Island Jewish ED (January 2022–October 2023) was analyzed. Patients were included based on an HbA1c ≥ 6.5 or a secondary discharge diagnosis of DM2. AUDIT-C scores were treated as a categorical variable, as no dose-dependent relationship was observed. Statistical analysis was conducted using SPSS 26. Results Non-zero AUDIT-C scores were significantly associated with increases in POCT-Blood Glucose, estimated average glucose, and HbA1c. A linear regression model showed an R-value of 0.047 (p
  PubDate: 2025-04-03
Prothrombin time predicting time-dependent and risk-stratified mortality
in polytrauma patients
- Abstract: Background Polytrauma is associated with a high mortality rate and often accompanied by coagulopathy. Prothrombin time (PT) is a prognostic factor for mortality in polytrauma patients. The aim was to analyze the time- and severity-dependent role of PT in polytrauma patients related to mortality. Methods Patients (≥ 16 years) with an Injury Severity Score ≥ 16 were retrospectively included, yielding 2890 cases after exclusion criteria. PT was measured at admission and 1, 2, 3, 4, 6, 8, 12, 24, and 48 h thereafter, reported as percentage activity of the reference reagence [%]. According to survival status, two groups were formed and compared. Binary logistic regression was used to test PT as an independent predictor for mortality. A closest top-left threshold method served for calculating threshold values between the survivor and non-survivor group. Patients were divided into subgroups according to PT levels and mortality was assessed for each subgroup at each time point. Results PT values in the non-survivor group were lower throughout the measuring period (p
  PubDate: 2025-04-02
Trends in CT pulmonary angiography utilization and recurrent imaging in
sickle cell disease: a longitudinal study
- Abstract: Background Sickle cell disease (SCD) is a common inherited hemoglobinopathy associated with vaso-occlusive events that can mimic pulmonary embolism (PE), leading to the frequent use of computed tomography pulmonary angiography (CTPA). However, trends in CTPA utilization over time remain unclear. This study aims to evaluate temporal trends and recurrent imaging patterns. Methods A retrospective cohort study was conducted at Salmaniya Medical Complex, Bahrain, including SCD patients who underwent CTPA for suspected PE between April 15, 2013, and April 15, 2024. Descriptive statistics were used to report the frequency of recurrent scans, whereas linear regression analysis was employed to assess trends in CTPA utilization over the study period. Results The study included 1,084 patients (median age: 35 years, 55.7% male) with SCD who underwent a total of 1,934 CTPA scans. CTPA utilization remained stable from 2014 to 2020, averaging 10.0–13.6 scans per month. However, a significant surge was observed post-2020, coinciding with the COVID-19 pandemic, peaking in 2023, with an average of 31.3 scans per month, indicating a 2.9-fold increase (p = 0.03). During the study period, 415 patients (38.3%) underwent recurrent CTPA scans, with one-third (32.5%, n = 276) of these scans occurring within a 6-month interval. Although the PE positivity rate was lower in recurrent scans than in initial scans, the difference was not statistically significant (8.8% vs. 10.5%; p = 0.22). Conclusions CTPA utilization among SCD patients remained stable for several years but increased significantly after 2020, coinciding with the COVID-19 pandemic. A substantial proportion of scans were recurrent, with many occurring within a short interval. Moving forward, efforts should focus on mitigating radiation exposure through low-dose protocols and investigating potential factors contributing to the recent increase in scan utilization.
  PubDate: 2025-04-02
Small cell lung cancer case report: acute tumor lysis syndrome after
chemotherapy and management strategies for high-risk patients
- Abstract: Background In the treatment of small cell lung cancer (SCLC), acute tumor lysis syndrome (ATLS) is one of the oncologic emergencies that requires particular attention. Previous studies have generally indicated that ATLS increases mortality risk during treatm ent. Therefore, early identification of ATLS, along with proactive prevention and symptomatic management, is particularly crucial. Methods In this report, we detail the clinical management of a patient with SCLC and multiple metastases who was identified as being at relatively high risk for ATLS due to a large tumor burden and concurrent liver and kidney dysfunction. Results Despite rapid tumor progression, the treatment team implemented aggressive hydration and urine alkalinization as pretreatment measures and personalized dose-reduced chemotherapy based on the standard EC regimen. Nevertheless, the patient developed ATLS, which progressed rapidly, and despite intensive treatment, the condition remained irreversible. Conclusion This case highlights that in some SCLC patients, pre-chemotherapy evaluation reveals a higher risk for tumor lysis syndrome, and adjusting treatment strategies for these patients requires further investigation. This suggests that managing such high-risk patients in clinical practice requires more cases and optimized treatment strategies to guide management. Therefore, this case is presented to offer insights into this perspective. Clinical trial number Not applicable.
  PubDate: 2025-04-02
Traumatic facial arteriovenous fistula: a rare case report and literature
review
- Abstract: The formation of facial arteriovenous fistula (AVF) directly between the facial artery and vein after trauma is very rare. Compared with intracranial AVF, understanding of this condition is limited. This paper reported the case of a 49-year-old male who had a metallic foreign object impaled on his left neck while weeding 6 months prior to admission. However, 3 months prior to admission, he developed a gradual throbbing of the left neck and swelling on the left side of his face. Auscultation revealed a vascular murmur in front of the mandibular angle on the left side of the face. Digital subtraction angiography (DSA) showed an AVF between the left lateral facial artery and vein, resulting in retrograde blood flow into cavernous sinus though the ophthalmic vein. The authors discuss the management of a traumatic AVF through combined transarterial embolization using coils and Onyx liquid embolic agent. A 3-month follow-up indicated no recurrence of AVF, and the patient had a great recovery with normal-appearing left face and eye. It was the isolated involvement of the facial artery and vein in a post-traumatic setting makes this case particularly instructive. In addition, we summarized the clinical symptoms and treatment of AVF in the face and neck regions.
  PubDate: 2025-04-01
Emergency medical services utilization in acute stroke in Qatar - an
observational cohort study
- Abstract: Introduction Timely recanalization improves long-term outcomes in acute ischemic stroke (IS) patients, but most patients present outside the therapeutic window. Emergency Medical Services (EMS) can reduce pre-hospital delay and increase the likelihood of recanalization. We aim to determine the characteristic variations amongst suspected acute stroke patients using EMS. Methods This retrospective observational study included all suspected acute stroke patients admitted to a national tertiary care hospital in Qatar from January 2014 to September 2020. We evaluated demographics, clinical features, treatment impact, and associated factors in EMS versus non-EMS transported groups. Results During the study period, 11,892 patients presented with suspected stroke. Of these, 65.1% used EMS (EMS group) for transportation to the hospital. Median age was comparable between EMS and non-EMS group [52 years; IQR 43–63 vs. 43–62, p
  PubDate: 2025-03-31
Early neurological wake-up test in intubated patients with traumatic brain
injury
- Abstract: Background Daily wake-up has been implemented widely in intensive care units (ICU) and could improve the patients’ prognosis. However, little is known about the benefit of early neurological wake-up test (ENWT) in patients with acute traumatic brain injury (TBI). We aimed to investigate the role of ENWT as a clinical monitoring tool for TBI and its association with prognosis. Methods This is an observational retrospective study included intubated and continuously sedated TBI in ICU, and all data were extracted from three tertiary hospitals from China. The main exposure of interest was ENWT, defined as cessation of sedation within 24 h after admission. The primary outcome was 28-day mortality. Propensity score matching (PSM) was performed at a 1:1 ratio. Multivariable analyses were further used to adjust for residual confounders. Results The pre-matched and propensity score-matched cohorts included 1386 and 704 patients, respectively. In the PSM analysis, 28-day mortality was 24.7% (87/352) in the ENWT group and 37.2% (131/352) in the control group. ENWT was associated with lower 28-day mortality (hazard ratio [HR], 0.57; 95% CI, 0.44–0.76; P
  PubDate: 2025-03-31
Complication management in percutaneous dilatational tracheostomy: a case
of tracheal needle sheath retrieval
- Abstract: Background Percutaneous dilatational tracheostomy (PDT) is a widely performed procedure in intensive care units (ICUs) for patients requiring prolonged mechanical ventilation. Although generally safe, PDT carries risks of complications, some of which may be life-threatening. Foreign body aspiration is a well-known concern, but the iatrogenic migration of procedural components, such as a tracheostomy needle sheath, has received little attention. Case presentation We report the case of a male patient with intracerebral hemorrhage (ICH) who underwent a percutaneous dilatational tracheostomy. During the procedure, the sheath of the tracheostomy needle became dislodged and migrated into the tracheobronchial tree. Urgent intervention was required to prevent further complications. Bronchoscopy was promptly performed at the bedside, revealing the foreign body in the right main bronchus. Initial retrieval attempts using biopsy forceps were unsuccessful due to the sheath’s positioning. The sheath was eventually maneuvered into the endotracheal tube (ETT) and extracted in a coordinated manner with the simultaneous removal of the ETT and forceps. The tracheostomy tube was then successfully placed under bronchoscopic guidance, and the patient remained stable without further complications. Conclusion This case highlights a rare and potentially life-threatening complication of PDT, emphasizing the essential role of bronchoscopy in managing intraprocedural complications. It underscores the importance of procedural expertise and vigilance in ICU settings.
  PubDate: 2025-03-31

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