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Archives of Academic Emergency Medicine
Number of Followers: 7  Open Access journalISSN (Online) 2645-4904 Published by Shahid Beheshti University of Medical Sciences  [20 journals]
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- Diagnostic Accuracy of ChatGPT for Patients’ Triage; a Systematic
Review and Meta-Analysis
Authors: Navid Kaboudi, Saeedeh Firouzbakht, Mohammad Shahir Eftekhar, Fatemeh Fayazbakhsh, Niloufar Joharivarnoosfaderani, Salar Ghaderi , Mohammadreza Dehdashti, Yasmin Mohtasham Kia, Maryam Afshari, Maryam Vasaghi-Gharamaleki, Leila Haghani, Zahra Moradzadeh, Fattaneh Khalaj , Zahra Mohammadi, Zahra Hasanabadi, Ramin Shahidi
Pages: e60 - e60
Abstract: Introduction: Artificial intelligence (AI), particularly ChatGPT developed by OpenAI, has shown the potential to improve diagnostic accuracy and efficiency in emergency department (ED) triage. This study aims to evaluate the diagnostic performance and safety of ChatGPT in prioritizing patients based on urgency in ED settings. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive literature searches were performed in Scopus, Web of Science, PubMed, and Embase. Studies evaluating ChatGPT's diagnostic performance in ED triage were included. Quality assessment was conducted using the QUADAS-2 tool. Pooled accuracy estimates were calculated using a random-effects model, and heterogeneity was assessed with the I² statistic. Results: Fourteen studies with a total of 1,412 patients or scenarios were included. ChatGPT 4.0 demonstrated a pooled accuracy of 0.86 (95% CI: 0.64-0.98) with substantial heterogeneity (I² = 93%). ChatGPT 3.5 showed a pooled accuracy of 0.63 (95% CI: 0.43-0.81) with significant heterogeneity (I² = 84%). Funnel plots indicated potential publication bias, particularly for ChatGPT 3.5. Quality assessments revealed varying levels of risk of bias and applicability concerns. Conclusion: ChatGPT, especially version 4.0, shows promise in improving ED triage accuracy. However, significant variability and potential biases highlight the need for further evaluation and enhancement.
PubDate: 2024-07-30
DOI: 10.22037/aaem.v12i1.2384
Issue No: Vol. 12, No. 1 (2024)
- Impact of Inspiratory Muscle Training and Positive Expiratory Pressure on
Lung Function and Extubation Success of ICU Patients: a Randomized
Controlled Trial
Authors: Mohammad Kazemi, Razieh Froutan, Ahmad Bagheri Moghadam
Pages: e59 - e59
Abstract: Introduction: Preparing patients for extubation from mechanical ventilation (MV) necessitates focused respiratory muscle strengthening. This study aimed to evaluate the effect of threshold inspiratory muscle training (IMT) and positive expiratory pressure (PEP) exercises on outcomes of patients who underwent MV in intensive care unit (ICU). Methods: This randomized controlled trial was conducted in 2023 at the ICUs of Imam Reza Hospital, Mashhad, Iran. Participants were allocated to either intervention or control group (each comprising 35 patients) through block randomization. The intervention group received standard daily chest physiotherapy as well as targeted inspiratory and expiratory muscle strengthening exercises using the threshold IMT/PEP device, administered twice daily over one week. The control group received standard daily chest physiotherapy alone. Finally, the outcomes (lung compliance, duration of intubation, extubation success rate, and diaphragmatic metrics) of the two groups were compared. Results: 70 patients with the mean age of 56.10 ± 14.15 (range: 28.00-85.00) years were randomly divided into two groups (50% male). Significant improvements were observed in the intervention group regarding pulmonary compliance values (35.62 ± 4.43 vs. 30.85 ± 6.93; p= 0.001), peak expiratory flow (PEF) (55.20 ± 10.23 vs. 47.80 ± 11.26; p = 0.002), and maximum inspiratory pressure (MIP) (33.40 ± 4.25 vs. 30.08 ± 6.08; p = 0.01) compared to the control group. Diaphragm inspiratory thickness (0.29 ± 0.03 vs. 0.26 ± 0.04; p = 0.001), diaphragm expiratory thickness (0.22 ± 0.03 vs. 0.20 ± 0.04; p = 0.006) and motion (1.61 ± .29 vs. 1.48 ± .21; p = 0.04) also exhibited significant differences between the two groups. Extubation success rate was higher in the intervention group (68.60% vs. 40%; p = 0.01). The duration of mechanical ventilation was 15.14±7.07 days in the intervention group and 17.34±7.87 days in the control group (p = 0.20). The mean extubation time was 7.00 ± 1.88 days for the intervention group and 9.00 ± 2.00 days for the control (p < 0.001). Conclusion: Threshold IMT/PEP device exercises effectively enhance respiratory muscle strength, diaphragm thickness, and reduce ventilator dependency. These findings support their potential for inclusion in rehabilitation programs for ICU patients.
PubDate: 2024-07-21
DOI: 10.22037/aaem.v12i1.2331
Issue No: Vol. 12, No. 1 (2024)
- Key Features in Designing an Integrated Recall System for Dispatch in Mass
Casualty Incidents; a Systematic Review
Authors: Negar Mazaheri, Mohammad Reza Khajehaminian, Saeed Fallah-Aliabadi, Omid Yousefianzadeh
Pages: e58 - e58
Abstract: Introduction: Following Mass Casualty Incidents (MCIs), the sudden surge in demand for essential services disrupts the balance between available and required resources. This study aimed to systematically identify and categorize existing systems employed for dispatching professional or lay rescuers during emergencies. Methods: Adhering to the PRISMA 2020 Checklist, the research scrutinized international databases (PubMed, Scopus, and Web of Science) using formulated search strategies. Additionally, a manual search was conducted on Google Scholar and prominent journals employing specific keywords. Original articles introducing systems for dispatching rescuers to incident sites were included. Results: Thirty-one of the 23051 initially identified documents were included for data extraction and quality assessment. The comprehensive analysis revealed twenty-two dispatch systems worldwide, contributing to life-saving efforts in emergencies. Additionally, an evaluation of the articles' quality using the Mixed Methods Appraisal Tool (MMAT) with five scores, indicated that more than two-thirds of the identified articles scored four or higher. Summarizing the data extracted from these systems, four distinct categories of recall system characteristics were identified: general, dispatcher, responder, and other features. Conclusion: Technology has the potential to revolutionize the delivery of healthcare services. This study highlights four key elements necessary for the development of dispatch systems that can effectively mobilize healthcare providers to the incident scene. These elements include general characteristics, dispatcher roles, responder requirements, and additional features, which equip researchers with the knowledge for designing effective systems to recall healthcare providers during MCI.
PubDate: 2024-07-21
DOI: 10.22037/aaem.v12i1.2330
Issue No: Vol. 12, No. 1 (2024)
- Attitude and Behavior of Road Users Responding to EMS Ambulances in
Developing Countries: a Cross-sectional Study
Authors: Mahmoud T. Alwidyan, Ahmad Alrawashdeh, Alaa O. Oteir
Pages: e57 - e57
Abstract: Introduction: Emergency medical service (EMS) providers use ambulance lights and sirens (L&S) to expedite their travel and to warn road users. This study aimed to assess the attitude and behavior of road users in response to EMS ambulances with warning L&S in use. Methods: This was a cross-sectional survey distributed to road users in Northern Jordan. The questionnaire included 19 items addressing demographics, attitudes, and behavior toward emergency ambulances. We described the participants’ responses and assessed the association between demographics and attitude statements using logistic regression. Results: A total of 1302 questionnaires were available for analysis. The mean age of participants was 34.2 (SD± 11.4) years, and the majority were males (72.6%). About half of road users (47.9%) would perform inappropriate actions in response to EMS ambulances with L&S in use. The multivariate logistic regression model showed that being female (OR: 0.63; 95% CI = 0.48-0.81), more educated (OR: 0.68; 95% CI = 0.53-0.86), or public transport driver (OR: 0.55; 95% CI = 0.34-0.90) was significantly associated with inappropriate response to EMS ambulances. Additionally, a significant proportion of road users may perform inappropriate and lawless driving practices such as following the passing by EMS ambulances. Conclusions: A large proportion of road users in Jordan may respond inappropriately to the EMS ambulances and many engage in risky driving behaviors, perhaps due to the lack of procedural knowledge. Policy-related interventions and educational programs are crucially needed to increase public awareness of the traffic law concerning EMS ambulances and to enhance appropriate driving behavior.
PubDate: 2024-07-20
DOI: 10.22037/aaem.v12i1.2262
Issue No: Vol. 12, No. 1 (2024)
- Development of a Clinical Score for Predicting 28-Day Mortality in
Geriatric Sepsis Patients; a Cohort study
Authors: Pitsucha Sanguanwit, Chaiyaporn Yuksen, Jiraporn Khorana, Krongkarn Sutham, Yuranun Phootothum, Siriporn Damdin
Pages: e56 - e56
Abstract: Introduction: Sepsis is a significant and common cause of death and burden among critically ill patients, which has increasing incidence and mortality in adults over 60 and advanced age. This study aimed to develop an easy-to-use clinical tool for assessing 28-day mortality risk in older sepsis patients upon their initial assessment in the emergency department (ED). Method: A retrospective cohort study was conducted using electronic medical records of older (≥60 years) ED patients with suspected sepsis from August 1, 2018, to December 31, 2018. A new prediction score was formulated based on the logistic coefficients of clinical predictors through multivariable regression analyses. Then, the score's screening performance was evaluated and compared to existing scoring systems; Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National early warning score (NEWS), and The Ramathibodi early warning score (REWS); using receiver operating characteristic curve analysis (AuROC). Result: The study included 599 patients with the mean age of 77.13 (range: 60-101) years (56.43% male) and an overall 28-day mortality rate of 7.01%. The newly developed prediction score had seven independent predictors of 28-day mortality: malignancy, dependent status, heart rate, respiratory rate, oxygen saturation, consciousness, and lactate, which demonstrated excellent discriminative ability (AuROC: 0.87, 95% confidence interval (CI): 0.82 - 0.92), significantly outperforming SIRS (AuROC: 0.62), qSOFA (AuROC: 0.72), NEWS (AuROC: 0.74), and REWS (AuROC: 0.71), all with p-values <0.01. The score allowed risk stratification into low-risk (positive likelihood ratio (LR+): 0.37, 95% CI: 0.24 - 0.58) and high-risk (LR+: 4.14, 95% CI: 3.14 - 5.44) groups with sensitivity of 69.0% and specificity of 83.3% at a cut-off point of 6. Conclusion: The novel prediction score demonstrates a remarkable ability to predict 28-day mortality risk in older sepsis patients during their initial ED assessment, offering potential for improved risk stratification and treatment guidance in older patients.
PubDate: 2024-06-29
DOI: 10.22037/aaem.v12i1.2269
Issue No: Vol. 12, No. 1 (2024)
- Rate and Risk Factors of Reinfection, Recurrence, and Hospital Readmission
Among SARS-Cov-2 Hospitalized Patients; a National Cohort Study
Authors: Niloufar Taherpour, Koorosh Etemad, Yaser Mokhayeri, Saeid Fallah, Sahar Sotoodeh Ghorbani, Neda Izadi, Elham Rahimi, Fatemeh Shahbazi, Arash Seifi, Ahmad Mehri, Rezvan Feyzi, Kosar Farhadi-Babadi, Seyed Saeed Hashemi Nazari
Pages: e55 - e55
Abstract: Introduction: Reinfection and hospital readmission due to COVID-19 were significant and costly during the pandemic. This study aimed to assess the rate and risk factors of SARS-Cov-2 reinfection, recurrence, and hospital readmission, by analyzing the national data registry in Iran. Methods: This study was a retrospective cohort conducted from March 2020 to May 2021. A census method was used to consider all of the possible information in the national Medical Care Monitoring Center (MCMC) database obtained from the Ministry of Health and Medical Education; the data included information from all confirmed COVID-19 patients who were hospitalized and diagnosed using at least one positive Polymerase Chain Reaction (PCR) test by nasopharyngeal swab specimens. Univariate and multivariable Cox regression analyses were performed to assess the factors related to each studied outcome. Results: After analyzing data from 1,445,441 patients who had been hospitalized due to COVID-19 in Iran, the rates of overall reinfection, reinfection occurring at least 90 days after the initial infection, recurrence, and hospital readmission among hospitalized patients were 67.79, 26.8, 41.61, and 30.53 per 1000 person-years, respectively. Among all cases of hospitalized reinfection (48292 cases), 38.61% occurred more than 90 days from the initial SARS-Cov-2 infection. Getting infected with COVID-19 in the fifth wave of the disease compared to getting infected in the first wave (P<0.001), having cancer (P<0.001), chronic kidney disease (P<0.001), and age over 80 years (P<0.001) were respectively the most important risk factors for overall reinfection. In contrast, age 19-44 years (P<0.001), intubation (P<0.001), fever (P<0.001), and cough (P<0.001) in the initial admission were the most important protective factors of overall reinfection, respectively. Conclusion: Reinfection and recurrence of COVID-19 after recovery and the rate of hospital readmission after discharge were remarkable. Advanced or young age, as well as having underlying conditions like cancer and chronic kidney disease, increase the risk of infection and readmission.
PubDate: 2024-06-22
DOI: 10.22037/aaem.v12i1.2327
Issue No: Vol. 12, No. 1 (2024)
- Prevalence of Surgical Site Infection After Hip Arthroplasty; a Systematic
Review and Meta-Analysis
Authors: Reza Salehi, Hamidreza Alizadeh-Otaghvar, Bahar Farhadi, Masoomeh Najafi, Hossein Torabi, Hamid Hojjati, Lida Garrosi, Samira Mirzaei, Ramyar Farzan, Siamak Kazemi-Sufi
Pages: e54 - e54
Abstract: Introduction: One of the worrisome complications of hip arthroplasty is surgical site infection (SSI). This study aimed to investigate the prevalence of SSI after hip arthroplasty. Methods: A comprehensive and systematic exploration was conducted across various international electronic databases, including Scopus, PubMed, and Web of Science, alongside Persian electronic databases such as Iranmedex and the Scientific Information Database (SID). This search strategy entailed the utilization of Medical Subject Headings-derived keywords such as "Prevalence," "Surgical wound infection," "Surgical site infection," and "Arthroplasty," spanning from the earliest records up to January 1, 2024. Each study’s weight was assigned based on its inverse variance. A forest plot visualization was used to assess the studies’ heterogeneity. Data on sample size and SSI frequency were compiled for each study to calculate the overall effect size. Results: The study encompassed a cumulative participant cohort of 1,070,638 hip arthroplasty procedures drawn from seventeen selected studies. Notably, the female gender constituted 59.10% of the overall participant demographic. The aggregate SSI among patients undergoing hip arthroplasty was estimated to be 1.9% (95% CI: 1.3% to 2.8%; I2=99.688%; P<0.001). The results of the meta-regression analysis unveiled a statistically significant correlation between the prevalence of SSIs after hip arthroplasty and the year of publication (Coefficient=-0.0020; 95% CI: -0.0021 to -0.0018; Z=-19.39, P<0.001). Conclusion: The study findings indicated a prevalence rate of 1.9% for SSI following hip arthroplasty. This prevalence underscores the importance of vigilance in infection prevention and management strategies within orthopedic surgery. However, it is essential to acknowledge the variability in SSI prevalence observed across diverse studies, which can be attributed to multifaceted factors, notably variances in patient populations and associated risk factors.
PubDate: 2024-06-05
DOI: 10.22037/aaem.v12i1.2308
Issue No: Vol. 12, No. 1 (2024)
- Hemodynamic Resuscitation Characteristics of Emergency Department Patients
with Sepsis and Hypotension who are and are not Admitted to ICU; a
Prospective Cross-sectional Study
Authors: Rebecca Vella, Philip Jones, Gerben Keijzers
Pages: e53 - e53
Abstract: Introduction: There is an evidence–practice gap in the optimal timing and volume of intravenous fluid as well as vasopressor administration in managing patients with sepsis. This study aimed to explore current hemodynamic resuscitation practice in emergency department (ED) for patients with sepsis and hypotension. Methods: This is a sub-analysis of the prospective multicentre ARISE FLUIDS observational study, which was conducted in 70 EDs across Australia and New Zealand. Baseline characteristics, as well as ED management and outcome of sepsis patients were compared between patients who were and were not admitted to intensive care unit (ICU) or high dependency unit (HDU). Results: A total of 587 patients with a median age of 65 years and even sex distribution (49% female) were available for analysis. Almost two-thirds of patients with sepsis (63.2%, n=371) were not admitted to ICU/HDU and were given lower intravenous (IV) fluid volumes over 24-hours, compared to those receiving critical care (4077ml vs. 5421ml, p<0.001). Patients not admitted to an ICU/HDU had a lower Acute Physiology And Chronic Health Evaluation (APACHE) II score (median 14 vs. 18, P<0.001) and serum lactate level (1.8 vs. 2.8 mmol/L, P<0.001) compared to those admitted to ICU/HDU and 5.9% received a vasopressor infusion in the first 24-hours. Females, patients aged <65 years, and those with urosepsis or sepsis of non-respiratory origin received a greater volume of IV fluids. Conclusion: Almost two-thirds of patients were not admitted to ICU/HDU. In patients not admitted to ICU/HDU, 1 in 17 received a vasopressor infusion during their ED or early hospital stay. Patients not admitted to ICU/HDU received less fluid in the first 24 hours than those who were. Greater resuscitation fluid volumes were independently associated with female sex, age <65 years, higher lactate levels, and urinary or non-respiratory source of sepsis.
PubDate: 2024-05-23
DOI: 10.22037/aaem.v12i1.2337
Issue No: Vol. 12, No. 1 (2024)
- Quality Indicators for Pediatric Bronchiolitis and Croup Care in the
Emergency Department; a Systematic Review and Meta-Analysis
Authors: Islam E. Alkhazali, Ahmad Alrawashdeh, Mohd Hashairi Fauzi, Nik Hisamuddin Nik Ab Rahman
Pages: e52 - e52
Abstract: Introduction: As the quality of care for respiratory diseases in pediatric patients in emergency departments (EDs) becomes increasingly important, this systematic review aims to evaluate the current quality indicators (QIs) specifically designed for the ED management of pediatric bronchiolitis and croup. Methods: We conducted searches in four electronic databases (Scopus, Web of Science, CINAHL, and MEDLINE) from their inception up to February 2024. We focused on English-language qualitative and quantitative publications that suggested or described at least one indicator initiative related to ED care for pediatrics with bronchiolitis and croup diseases. These publications were identified by two reviewers, independently. We extracted study characteristics, all relevant QIs reported, and the percentage of compliance with these QIs, where available. All QIs identified from expert panels and observational studies were grouped by definition and categorized by the Institute of Medicine's (IOM) and Donabedian's frameworks for healthcare quality. The percentage of compliance with the identified QIs as reported by observational studies was pooled using a random effect meta-analysis, when appropriate. Results: A total of 17 studies were identified, comprising 5 expert panel studies and 12 observational studies. Altogether, these studies reported 126 QIs for potential use in EDs for pediatric bronchiolitis and croup patients. Of these, 55 QIs were reported by expert panel studies, and 71 by observational studies. Specifically, 81 QIs were related to bronchiolitis, while 45 pertained to croup patients. In terms of the Donabedian domain, most indicators (96.5%) measured the process of care while a smaller fraction (3.5%) addressed care outcomes. In the Institute of Medicine (IOM) domain, most indicators focused on effectiveness and safety. Observational studies reported the percentage of compliance for 35 QIs identified in the expert studies. It was noted that compliance with these QIs varied significantly between studies and health sectors. Conclusions: The findings of this systematic review highlight significant disparities in compliance to the established QIs, which underscores the urgent need for dedicated strategies to enhance the treatment of pediatric bronchiolitis and croup in ED settings.
PubDate: 2024-05-20
DOI: 10.22037/aaem.v12i1.2288
Issue No: Vol. 12, No. 1 (2024)
- Early Discharge versus 6-hour Observation in Mild Traumatic Brain Injury
with Normal Brain CT Scan; a Comparative Pilot study of Outcomes
Authors: Piramon Chairattanawan, Chuenruthai Angkoontassaneeyarat, Chaiyaporn Yuksen, Chetsadakon Jenpanitpong, Malivan Phontabtim, Thanakorn Laksanamapune
Pages: e50 - e50
Abstract: Introduction: Early discharge from the emergency department (ED) or a 6-hour observation in the ED are two methods for management of patients with mild traumatic brain injury (mTBI) with normal brain computed tomography (CT) scan. This study aimed to compare the outcomes of the two management options. Methods: This study is a single-center, open-label, pilot randomized case control study conducted in the ED of Ramathibodi Hospital from June 2022 to September 2023. Eligible participants included all individuals with mTBI who had negative findings on Brain CT scans. They were randomly assigned to either the early ED discharge or 6-hour ED observation group and compared regarding the outcomes (rate of 48-hour ED revisits; occurrence of post-concussion syndrome (PCS) 1 day, 1 month, and 3 months after the initial injury; and 3-month mortality). Results: 122 patients with the mean age of 74.62 ± 14.96 (range: 25-99) years were consecutively enrolled (57.37% female). No significant differences were observed between the early discharge and observation groups regarding the severity of TBI (p=0.853), age (p=0.334), gender (p=0.588), triage level (p=0.456), Glasgow Coma Scale (GCS) score (p=0.806), comorbidities (p=0.768), medication usage (p=0.548), mechanism of injury (p=0.920), indication for brain CT scan (p=0.593), time from TBI onset to ED arrival (p=0.886), and time from ED triage to brain CT scan (p=0.333). Within 48 hours after randomization, the incidence of revisits was similar between the two groups (1.57% vs. 3.23%; p = 1.000). There were no statistically significant differences in the incidence of PCS between the early discharge and observation groups at 1 day (33.90% vs. 35.48%, p = 0.503), at 1 month (12.07% vs. 13.11%, p = 0.542), and at 3 months (1.92% vs. 5.56%, p = 0.323) after randomization. After a three-month follow-up period, four patients in the early discharge group, had expired (none of the deaths were associated with TBI). Conclusion: It seems that, in mTBI patients with normal initial brain CT scan and the absence of other injuries or neurological abnormalities, early discharge from the ED without requiring observation could be considered safe.
PubDate: 2024-05-18
DOI: 10.22037/aaem.v12i1.2245
Issue No: Vol. 12, No. 1 (2024)
- Safety and Efficacy of Incentive Spirometer in Covid-19 Pneumonia; a
Randomized Clinical Trial
Authors: Mohammad Bargahi, Mostafa Alavi-Moghaddam, Mehdi Karimi, Zahra Azizan, Fateme Jafarzadeh, Mohammad Javaherian, Hussein Soleimantabar, Seyed Hamidreza Mirbehbahani
Pages: e51 - e51
Abstract: Introduction: Various treatment protocols have been recommended since the beginning of the COVID-19 pandemic and have gradually evolved. This study aimed to assess the effectiveness and safety of incentive spirometer exercise (ISE) in outcomes of hospitalized patients with moderate-to-severe COVID-19 pneumonia. Methods: A 3-month single-blind, two parallel-armed randomized controlled trial was conducted at Imam Hossein Hospital, Tehran, Iran. Participants aged >18 years with documented COVID-19 pneumonia were randomly allocated to 2 groups of IS (ISE in addition to the usual treatment) and control (usual care alone). The IS group was also asked to perform ISE after discharge for three months. The primary outcomes were peripheral O2 saturation (SpO2), VBG parameters (pCO2, PH, HCO3), dyspnea level measured by Modified Borg Scale (MBS), length of hospital stay (LOS), and respiratory rate (RR). Secondary outcomes included mortality rate, intubation rate (IR), and ICU admission rate. Results: A total of 160 eligible patients were randomly assigned to either the IS (n = 80) or control (n=80) groups. Although there were no significant differences in primary and secondary outcomes between the groups post-intervention, adjusted analysis showed that participants allocated to the IS group had significantly higher SpO2 levels and lower RR, MBS levels, and LOS. Also, the adjusted model analysis showed a marginal statistically significant difference between groups in secondary outcomes, such as IR, the 1-month mortality rate, and the 3-month mortality rate. Conclusion: It seems that adding the ISE to usual care in the early treatment setting of COVID-19 patients resulted in a relatively significant increase in SpO2 levels, improved respiratory status, and marginally decreased LOS. Additionally, ISE minimally reduced ICU admissions and intubation rates, with no significant impact on in-hospital or long-term mortality in patients with COVID-19 pneumonia.
PubDate: 2024-05-18
DOI: 10.22037/aaem.v12i1.2244
Issue No: Vol. 12, No. 1 (2024)
- Clinical Associated Factors of Tile B/C Type of Pelvic Ring Fractures; a
Retrospective Cross-sectional study
Authors: Welawat Tienpratarn , Nucha Nakpipat, Chaiyaporn Yuksen, Sirote Wongwaisayawan, Yuranun Phootothum, Sutap Jaiboon
Pages: e49 - e49
Abstract: Introduction: Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures. Methods: This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed. Results: A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions. Conclusion: Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.
PubDate: 2024-05-12
DOI: 10.22037/aaem.v12i1.2243
Issue No: Vol. 12, No. 1 (2024)
- Therapeutic Impact of Tocilizumab in the Setting of Severe COVID-19; an
Updated and Comprehensive Review on Current Evidence
Authors: Aysa Rezabakhsh, Fatemeh Mojtahedi, Sepideh Tahsini Tekantapeh, Ata Mahmoodpoor , Alireza Ala, Hassan Soleimanpour
Pages: e47 - e47
Abstract: Introduction/aim: The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard. Methods: In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria. Results: Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear. Conclusion: Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians’ decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.
PubDate: 2024-05-09
DOI: 10.22037/aaem.v12i1.2217
Issue No: Vol. 12, No. 1 (2024)
- Associated Factors of Patients’ Survival in Out of Hospital Cardiac
Arrest; a Cross-sectional Study
Authors: Liang KE, Pui I IEONG, Kaye E Brock, Elias Mpofu, Cheng Yin, Xiuhua Feng, Pou Kuan Kou, Chi Kun Mok, Wai Seng Lei
Pages: e48 - e48
Abstract: Introduction: Chinese populations have an increasingly high prevalence of cardiac arrest. This study aimed to investigate the prehospital associated factors of survival to hospital admission and discharge among out-of-hospital cardiac arrest (OHCA) adult cases in Macao Special Administrative Region (SAR), China. Methods: Baseline characteristics as well as prehospital factors of OHCA patients were collected from publicly accessible medical records and Macao Fire Services Bureau, China. Demographic and other prehospital OHCA characteristics of patients who survived to hospital admission and discharge were analyzed using multivariate logistic regression analysis. Results: A total of 904 cases with a mean age of 74.2±17.3 (range: 18-106) years were included (78%>65 years, 62% male). Initial shockable cardiac rhythm was the strongest predictor for survival to both hospital admission (OR=3.57, 95% CI: 2.26-5.63; p<0.001) and discharge (OR=12.40, 95% CI: 5.70-26.96; p<0.001). Being male (OR=1.63, 95% CI:1.08-2.46; p =0.021) and the lower emergency medical service (EMS) response time (OR=1.62, 95% CI: 1.12-2.34; p =0.010) were also associated with a 2-fold association with survival to hospital admission. In addition, access to prehospital defibrillation (OR=4.25, 95% CI: 1.78-10.12; p <0.001) had a 4-fold association with survival to hospital discharge. None of these associations substantively increased with age. Conclusion: The major OHCA predictors of survival were initial shockable cardiac rhythm, being male, lower EMS response time, and access to prehospital defibrillation. These findings indicate a need for increased public awareness and more education.
PubDate: 2024-05-09
DOI: 10.22037/aaem.v12i1.2298
Issue No: Vol. 12, No. 1 (2024)
- Infectious Diarrhea Risks as a Public Health Emergency in Floods; a
Systematic Review and Meta-Analysis
Authors: Mohammad Shirmohammadi Yazdi, Mohammad Afshar Ardalan, Mohsen Hosseini, Mojtaba Yousefi zoshk , Zahra Hami, Reza Heidari, Reza Mosaed, Mohsen Chamanara
Pages: e46 - e46
Abstract: Introduction: Infectious diarrhea, a significant global health challenge, is exacerbated by flooding, a consequence of climate change and environmental disruption. This comprehensive study aims to quantify the association between flooding events and the incidence of infectious diarrhea, considering diverse demographic, environmental, and pathogen-specific factors. Methods: In this systematic review and meta-analysis, adhering to PROSPERO protocol (CRD42024498899), we evaluated observational studies from January 2000 to December 2023. The analysis incorporated global data from PubMed, Scopus, Embase, Web of Science, and ProQuest, focusing on the relative risk (RR) of diarrhea post-flooding. The study encompassed diverse variables like age, sex, pathogen type, environmental context, and statistical modeling approaches. Results: The meta-analysis, involving 42 high-quality studies, revealed a substantial increase (RR = 1.40, 95% CI [1.29–1.52]) in the incidence of diarrhea following floods. Notably, bacterial and parasitic diarrheas demonstrated higher RRs (1.82 and 1.35, respectively) compared to viral etiologies (RR = 1.15). A significant sex disparity was observed, with women exhibiting a higher susceptibility (RR = 1.55) than men (RR = 1.35). Adults (over 15 years) faced a greater risk than younger individuals, highlighting age-dependent vulnerability. Conclusion: This extensive analysis confirms a significant correlation between flood events and increased infectious diarrhea risk, varying across pathogens and demographic groups. The findings highlight an urgent need for tailored public health interventions in flood-prone areas, focusing on enhanced sanitation, disease surveillance, and targeted education to mitigate this elevated risk. Our study underscores the critical importance of integrating flood-related health risks into global public health planning and climate change adaptation strategies.
PubDate: 2024-05-05
DOI: 10.22037/aaem.v12i1.2284
Issue No: Vol. 12, No. 1 (2024)
- RAMA-WeRA Risk Score in Predicting the Ruptured Appendicitis in Emergency
Department; a Multicenter Study for External Validation
Authors: Welawat Tienpratarn, Guyphol Kasemlawan, Chaiyaporn Yuksen, Wanchalerm Kongchok, Nitchakarn Boonyok, Piyanuch Lowanitchai, Jeeranun Boriboon, Thidarat Rattananikom, Yuranun Phootothum, Sutap Jaiboon
Pages: e44 - e44
Abstract: Introduction: Distinguishing between ruptured and non-ruptured acute appendicitis presents a significant challenge. This study aimed to validate the accuracy of RAMA-WeRA Risk Score in predicting ruptured appendicitis (RA) in emergency department. Methods: This study was a multicenter diagnostic accuracy study conducted across six hospitals in Thailand from February 1, 2022, to January 20, 2023. The eligibility criteria included individuals aged >15 years suspected of acute appendicitis, presenting to the ED, and having an available pathology report following appendectomy or intraoperative diagnosis by the surgeon. We assessed the screening performance characteristics of RAMA-WeRA Risk Score, in detecting the ruptured appendicitis (RA) cases. Results: 860 patients met the study criteria. 168 (19.38%) had RA and 692 (80.62%) patients had non-RA. The area under the receiver operating characteristic curve (AuROC) of RAMA-WeRA Risk Score was 75.11% (95% CI: 71.10, 79.11). The RAMA-WeRA Risk Score > 6 points (high-risk group) demonstrated a positive likelihood ratio (LR) of 3.22 in detecting the ruptured cases. The sensitivity and specificity of score in > 6 cutoff point was 43.8% (95%CI: 36.2, 51.6) and 86.4% (95%CI: 83.6, 88.9), respectively. Conclusions: The RAMA-WeRA Risk Score can predict rupture in patients presenting with suspected acute appendicitis in the emergency department with total accuracy of 75% for high-risk cases.
PubDate: 2024-05-05
DOI: 10.22037/aaem.v12i1.2237
Issue No: Vol. 12, No. 1 (2024)
- Life-threatening Carotid Complications Caused by Extraluminal Migration of
Authors: Rossana Soloperto, Gabriella Festa, Michele Beatrice, Nicola Orsogna, Carmine Francesco Muccio, Pietro Crocco, Davide Razzano, Angelo Tozzi
Pages: e45 - e45
Abstract: Carotid complications resulting from extra-luminal migration of ingested foreign bodies (FB) are rare but potentially life-threatening. Previous data on the topic predominantly comprises isolated case reports, leaving a gap in comprehensive evidence necessary to guide clinical decision-making. In this article, we offer a narrative review alongside a novel case report, aimed at providing a broad, evidence-based perspective on the topic to guide clinical practice. The search strategy employed keywords related to carotid artery complications from ingested FB across the following electronic databases: PubMed, Scopus, Google Scholar, and Cochrane Central. Screening involved standardized data extraction by two independent reviewers, with a focus on abstracts meeting inclusion criteria and excluding non-English literature and non-relevant studies from further analysis. Moreover, we present a novel case report on the topic that was successfully managed using a unique surgical approach. Overall, a total of sixteen case reports were finally included, data on clinical presentations, diagnostic strategies and findings, surgical management and outcome were extracted, tabulated, and discussed. In carotid complications from extra-luminal migration of ingested FB, high clinical suspicion is crucial due to potentially mild symptoms and negative first-level examinations. Computed tomography (CT) scan plays a pivotal role for accurate diagnosis and surgical planning, along with neck ultrasound to detect complications. Tailored surgical strategies based on the severity of carotid involvement, including venous patch grafts in severe vessels involvement, are crucial for optimal patient outcomes. As a novelty, in our case report, carotid shunt was successfully employed instead of prolonged carotid clamping to reduce the risk of associated neurological sequelae. It could be concluded that, diagnosis and managing carotid complications from extra-luminal migration of ingested FB remains challenging and a multidisciplinary approach is warranted.
PubDate: 2024-05-05
DOI: 10.22037/aaem.v12i1.2306
Issue No: Vol. 12, No. 1 (2024)
- Immature Platelet Fraction and Acute Coronary Syndrome; a Systematic
Review and Meta-Analysis
Authors: Elmira Jafari Afshar, Vahid Shahnavaz, Hamed Talakoob, Parnaz Kafialqora, Aryan Madady, Shamimeh Pourbahrighesmat, Amirhossein Tayebi , Mohammadhossein MozafaryBazargany , Niloofar Gholami , Aryan Ayati , Parham Samimisedeh, Hadith Rastad , Hossein Karim
Pages: e43 - e43
Abstract: Introduction: Immature Platelet Fraction (IPF) is a measure of the proportion of reticulated platelets (RPs) to all platelets in circulation. IPF may have both prognostic and diagnostic values in patients with Acute Coronary Syndrome (ACS). This study aims to comprehensively summarize the diagnostic utility of IPF levels in patients with ACS, specifically focusing on its ability to differentiate between different subtypes of ACS. Methods: We conducted a systematic search in online databases including MEDLINE, Scopus, and Google Scholar up to March 4th 2024, to identify relevant studies. The random-effect model, employing inverse variance for mean differences (MD) and Mantel-Haenszel methods for odds ratios (OR) were utilized to combine the data. Joanna Briggs Institute (JBI) appraisal tool was employed to assess the quality of included studies. Results: Our systematic review contains 15 articles with a total sample size of 2,030 ACS patients. Pooled analysis revealed significant differences in IPF levels of ACS patients compared to healthy controls (MD (95%CI): 2.85 (0.86, 4.85), P-value = 0.004) and stable angina patients (MD (95%CI): 0.58 (0.23, 0.92), P-value < 0.001). Subgroup comparisons within ACS patients demonstrated higher IPF levels in myocardial infarction (MI) vs. unstable angina (UA) (MD (95%CI): 1.81 (0.41, 3.22), P-value = 0.01), ST elevation MI (STEMI) vs. non-ST elevation (NSTEMI) ACS (MD (95%CI): 0.74 (0.31, 1.17), P-value < 0.001), and NSTEMI vs. UA (MD (95% CI): 1.07 (0.24, 1.90), P-value = 0.01). Conclusion: IPF levels could increase in patients with ACS, particularly during the acute phase of STEMI. This suggests that IPF may be a useful biomarker for early diagnosis of ACS. Additionally, IPF levels may help differentiate between ACS subtypes.
PubDate: 2024-04-23
DOI: 10.22037/aaem.v12i1.2292
Issue No: Vol. 12, No. 1 (2024)
- Persian Translation of the Sport Concussion Assessment Tool 6 (SCAT6); a
Cross-Cultural Adaptation and Validation Study
Authors: Farzin Halabchi, Mohammad Mahdi Tavana, Reyhaneh Khazaei, Mohammad Jalili
Pages: e42 - e42
Abstract: Introduction: Sport Concussion Assessment Tool (SCAT) aids the physicians in early management of concussion among suspected athletes and its 6th version was published in 2023 in English. This study aimed to describe the translation and validation process of SCAT6 from English to Persian. Methods: The Persian translation of SCAT6 and its evaluation has been done in seven stages: initial translation, appraisal of the initial translation, back translation, appraisal of the back-translation, validation (face and content validities), final reconciliation and testing by simulation. Results: Initial translation, was done by two bilingual translators followed by an initial appraisal, which was made by both translators and one general physician. Back translation was done by two naïve translators who were unfamiliar with SCAT6, followed by its appraisal by initial translators. Face and content validity of the translation were surveyed by medical professionals and athletes and the results of the validation process were provided to the reconciliation committee and this committee made the modifications needed. Finally, the use of Persian SCAT6 was simulated and the mean time needed to complete the Persian SCAT6 was roughly a little more than 10 minutes. Conclusions: The present study provides the readers with the translation and cross-cultural adaptation process of SCAT6 from English to Persian. This translated version will be distributed among the Iranian sports community for assessing concussions among athletes.
PubDate: 2024-04-21
DOI: 10.22037/aaem.v12i1.2259
Issue No: Vol. 12, No. 1 (2024)
- High-Dose Vitamin C in the Treatment of Covid-19 Patients in Intensive
Care Unit; A Letter to the Editor
Authors: Moloud Balafar, Ata Mahmoodpoor, Houri Arjmandi, Arezou Maddah Khelejani, Hassan Soleimanpour
Pages: e41 - e41
Abstract: Vitamin C is a powerful antioxidant, which helps to improve the body's immune system. The antioxidant property of vitamin C reduces inflammation and improves the body's defense function against pathogens. In an interventional study, a total of 210 COVID-19 patients admitted to the intensive care units were randomly divided into two control and intervention groups. The intervention group received a treatment protocol including a high-dose vitamin C (12 g of vitamin C via a pump within four hours, which was repeated every 12 hours) for a week. About 60% of the patients in both groups died with no significant difference in the mortality rate between the two groups (p = 0.747). There was no improvement in the length of hospital stay, the degree of O2 saturation, and the mortality rate of the patients. No severe adverse effects were shown with this dose of vitamin C in ICU patients.
PubDate: 2024-04-20
DOI: 10.22037/aaem.v12i1.2233
Issue No: Vol. 12, No. 1 (2024)
- Incidence and Outcomes of Aortic Dissection in Tabriz, Iran; a
Longitudinal Study of 150 Cases
Authors: Gholamreza Faridaalaee, Nima Fathi, Kavous Shahsavarinia, Hamed Zarei, Mahmoud Yousefifard
Pages: e40 - e40
Abstract: Introduction: A comprehensive analysis of the epidemiological features of aortic dissections in Azerbaijan Province, Iran, and their influence on patient survival remains unexplored. This study aimed to determine the incidence of aortic dissection and identify the associated factors of mortality in these patients. Methods: A retrospective longitudinal study was conducted using hospital records of patients diagnosed with aortic dissection in Tabriz, Iran, between 2017 and 2021. The 3-month mortality was followed up via telephone calls using the contact numbers provided in the patients’ records. Then, independently associated factors of mortality were identified using a multivariate stepwise logistic regression analysis. Results: Among the 150 cases of aortic dissection identified, 74% (n = 111) were classified as type A, and 26% (n = 39) were classified as type B. The overall incidence proportion of aortic dissections was 2.35 per 100000 population. In type A dissections, 64% (71 out of 111) of patients received surgical treatment, while 21.6% (24 out of 111) received medical treatment. Among type B dissections, only 23.1% (9 out of 39) underwent surgery. The all-cause mortality rate at 3 months was 52.5% (73 out of 139 patients with complete follow-up), 47 male (54%) and 26 female (50%). Multivariate analysis showed that higher age was independently associated with increased mortality (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.00-1.06, p = 0.027). In contrast, patients with DeBakey Type III classification (OR = 0.29; 95% CI: 0.01-0.87, p = 0.027), hypothyroidism (OR = 0.12; 95% CI: 0.01-0.99, p = 0.049), and those who received either surgical treatment (OR = 0.19; 95% CI: 0.05-0.76, p = 0.019) or medical treatment (OR = 0.18; 95% CI: 0.04-0.80, p = 0.024) had a lower chance of mortality. Gender was not found to be associated with the outcome. Conclusion: The study revealed an annual incidence rate of aortic dissection as 2.35 per 100000 population. Aortic dissection, regardless of type, remains a highly fatal condition, with over half of patients dying within 3 months of the initial event. To reduce the high mortality rates associated with aortic dissections, it is crucial to implement specific measures for the early identification of patients and ensure prompt and appropriate care.
PubDate: 2024-04-18
DOI: 10.22037/aaem.v12i1.2314
Issue No: Vol. 12, No. 1 (2024)
- Comparison of a 30-year trend of incidence, prevalence, and DALY due to
low back pain in Iran with Low- and High-SDI countries; Based on GBD study
2019 Data
Authors: Aliyeh Daryabor, Alireza Akbarzadeh-Baghban
Pages: e39 - e39
Abstract: Introduction: Low back pain (LBP) represents the leading cause of disability worldwide and is a major economic and welfare problem. This study aimed to report incidence, prevalence, and disability-adjusted life years (DALY) rates of LBP in Iran by gender and different sociodemographic index (SDI) countries from 1990 to 2019. Methods: The age-standardized LBP and incidence, prevalence, and DALY were extracted based on the Global Burden of Disease (GBD) 2019 in Iran for males and females, and low- and high-SDI countries during 1990- 2019. Results: GBD 2019 data for LBP in Iran indicate a significant downward trend of incidence and prevalence from 1993 to 2019 in males, females, and both, except during the 1999-2002 period for females. A sharp reduction is seen in LBP incidence and prevalence from 1996 to 1999. Gender is not a determining factor in the LBP prevalence in Iran. Regarding the SDI categories, Iran had the highest incidence rate compared to countries with low- and high SDIs. High-SDI countries had the highest prevalence and DALY compared with Iran and low-SDI countries. Conclusion: The age-standardized incidence and prevalence of LBP in Iran showed a downward trend, from 1993 to 2019, especially from 1996 to 1999. Comparing Iran with low- and high-SDI countries, a heavier incidence of LBP was observed in Iran and heavier prevalence and DALY were seen in high-SDI countries. Therefore, more therapeutic healthcare interventions are required to reduce the LBP burden more effectively.
PubDate: 2024-03-26
DOI: 10.22037/aaem.v12i1.2257
Issue No: Vol. 12, No. 1 (2024)
- Cincinnati Prehospital Stroke Scale (CPSS) as a Screening Tool for Early
Identification of Cerebral Large Vessel Occlusions; a Systematic Review
and Meta-analysis
Authors: Yazdan Baser, Hamed Zarei, Pantea Gharin, Hamid Reza Baradaran, Arash Sarveazad, Shayan Roshdi Dizaji, Mahmoud Yousefifard
Pages: e38 - e38
Abstract: Introduction: Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO. Methods: We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke. Results: Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO. Conclusion: A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.
PubDate: 2024-03-26
DOI: 10.22037/aaem.v12i1.2242
Issue No: Vol. 12, No. 1 (2024)
- Traditional Spinal Immobilization versus Spinal Motion Restriction in
Cervical Spine Movement; a Randomized Crossover Trial
Authors: Promphet Nuanprom, Chaiyaporn Yuksen, Welawat Tienpratarn, Parunchaya Jamkrajang
Pages: e36 - e36
Abstract: Introduction: Proper cervical spine immobilization is essential to prevent further injury following trauma. This study aimed to compare the cervical range of motion (ROM) and the immobilization time between traditional spinal immobilization (TSI) and spinal motion restriction (SMR). Methods: This study was a randomized 2x2 crossover design in healthy volunteers. Participants were randomly assigned by Sequential numbered, opaque, sealed envelopes (SNOSE) with permuted block-of-four randomization to TSI or SMR. We used an inertial measurement unit (IMU) sensor to measure the cervical ROM in three dimensions focusing on flexion-extension, rotation, and lateral bending. The immobilization time was recorded by the investigator. Results: A total of 35 healthy volunteers were enrolled in the study. The SMR method had cervical spine movement lower than the TSI method about 3.18 degrees on ROM in flexion-extension (p < 0.001). The SMR method had cervical spine movement lower than the TSI method about 2.01 degrees on ROM in lateral bending (p = 0.022). The immobilization time for the SMR method was 11.88 seconds longer than for the TSI method (p < 0.001) but not clinically significant. Conclusion: SMR that used scoop stretcher resulted in significantly less cervical spine movement than immobilization with a TSI that used long spinal board. We recommend implementing the SMR protocol for transporting trauma patients, as minimizing cervical motion may enhance patient outcomes.
PubDate: 2024-03-12
DOI: 10.22037/aaem.v12i1.2263
Issue No: Vol. 12, No. 1 (2024)
- A Fatal Septic Shock Due to Aeromonas Hydrophila in a Cirrhotic Patient; a
Case Report
Authors: Hoa Do Thanh, Duc Vu Anh, Ghi Nguyen Hai, Duong Le Xuan, Anh Duong Duc
Pages: e36 - e36
Abstract: Aeromonas hydrophila has been identified as a causative agent of necrotizing fasciitis and myonecrosis, with most reported cases having a connection to aquatic-related trauma. Cases without such trauma history are rare in existing literature. Here, we present the case of a 56-year-old cirrhotic patient who lacked any prior aquatic-related trauma and arrived at the emergency department in a state of septic shock. The suspected route of entry was through necrotizing fasciitis and myonecrosis in his left forearm. Unfortunately, the patient succumbed to multi-organ failure and passed away within 12 hours of admission to the emergency department.
PubDate: 2024-03-10
DOI: 10.22037/aaem.v12i1.2270
Issue No: Vol. 12, No. 1 (2024)
- Patients’ Knowledge and Pharmacists’ Practice Regarding the Long-Term
Side Effects of Proton Pump Inhibitors; a Cross-sectional Study
Authors: Aisha Juma Alblooshi, Mirza R. Baig, Hanan S. Anbar
Pages: e35 - e35
Abstract: Introduction: Proton pump inhibitors (PPI) are a commonly prescribed medication, but recent evidence suggests that their long-term use may lead to several adverse events. To address this issue, our study aims to assess patient awareness and pharmacist practices in educating patients about the potential risks associated with prolonged PPI use. Methods: Two questionnaires were developed by researchers and administered in the United Arab Emirates from June to August 2021 to gather insights from patients and pharmacists about the use of PPIs, their knowledge of potential side effects, and their experiences and attitudes toward receiving education about PPI side effects. The patients' knowledge was evaluated based on their cumulative correct answers to questions related to PPI’s long-term adverse effects including increased fracture risk and hypocalcemia, vitamin B12 deficiency, hypomagnesemia, and the caution of abrupt withdrawal. All statistical analyses were conducted using SPSS 25.0 software. Results: Overall, 348 participants with a median age of 40 years participated in the survey, among them, 91 (26.14%) used various forms of PPI with 38% of users taking PPI as over-the-counter drugs. Patients had low knowledge about PPI side effects and their proper discontinuation with a median knowledge score of 0 (Interquartile range: 0-2) and only 22.2% of patients were familiar with at least three out of five asked harms. Those with lower knowledge were more likely to be Emirati compared to other nations (p=0.004) and aged over 30 years compared to their younger counterparts (p = 0.016). Few patients have obtained the relevant information from their physicians (25%) or pharmacists (7%). Inquiring 136 pharmacists, it was shown that the most common education was concerning vitamin B12 deficiency (62.5%) followed by fracture risk (58.09%) yet less than half (48%) of pharmacists instructed patients about the potential risk of hypomagnesemia. Almost all pharmacists (99%) agreed that there is a requirement for additional education on the possible harmful consequences of PPIs. Conclusion: The present study has established that a considerable proportion of PPI users in the UAE lack the necessary awareness about the potential adverse effects of PPI despite their extensive use in this country. The current pharmacist practice is inefficient for inculcating the potential harms of chronic PPI use and they are required to optimize their efforts to educate patients and bridge the knowledge gaps.
PubDate: 2024-03-07
DOI: 10.22037/aaem.v12i1.2305
Issue No: Vol. 12, No. 1 (2024)
- Diagnostic Indicators of ECG for Coronary Slow Flow Phenomenon; a
Systematic Review and Meta-Analysis
Authors: MohammadHossein MozafaryBazargany, Parham Samimisedeh, Niloofar Gholami, Elmira Jafari Afshar, Amirhossein Memari, Shahrooz Yazdani, Hadisth Rastad
Pages: e34 - e34
Abstract: Introduction: Currently, epicardial coronary angiography is still the only diagnostic tool for Coronary Slow Flow Phenomenon (CSFP). This study aimed to systematically review studies that compared Electrocardiogram (ECG) findings between patients with and without CSFP. Methods: Using relevant key terms, we systematically searched MEDLINE, Scopus, Embase, and Web of Science to find relevant studies up to February 5th, 2023. Effect sizes in each study were calculated as mean differences and crude odds ratio; then, random-effect models using inverse variance and Mantel-Haenszel methods were used to pool standardized mean differences (SMD) and crude odds ratios, respectively. Results: Thirty-two eligible articles with a total sample size of 3,937 patients (2,069 with CSFP) were included. CSFP patients had higher P-wave maximum (Pmax) (SMD: 1.02 (95% confidence interval (CI): 0.29 - 1.76); p=0.006) and P-dispersion (Pd) (SMD: 1.63 (95% CI: 0.99 - 2.27); p<0.001) compared to the control group. CSFP group also showed significantly longer QT wave maximum duration (SMD: 0.69 (95% CI: 0.33 - 1.06); p<0.001), uncorrected QTd (SMD: 1.89(95% CI: 0.67 - 3.11); p=0.002), and corrected dispersion (QTcd) (SMD: 1.63 (95% CI: 1.09 - 2.17), p<0.001). The frontal QRS-T angle was significantly higher in the CSFP group in comparison with the control group (SMD: 1.18 (95% CI: 0.31 - 2.04; p=0.007). While CSFP patients had a significantly higher T-peak to T-end (Tp-e) (SMD:1.71 (95% CI: 0.91, 2.52), p<0.001), no significant difference was noted between groups in terms of Tp-e to QT (p=0.16) and corrected QT ratios (p=0.07). Conclusion: Our findings suggest several ECG parameters, such as P max, Pd, QT, QTc, QTd, QTcd, Tp-e, and frontal QRS-T angle, may be prolonged in CSFP patients, and they could be employed as diagnostic indicators of CSFP before angiography.
PubDate: 2024-03-03
DOI: 10.22037/aaem.v12i1.2202
Issue No: Vol. 12, No. 1 (2024)
- Diagnostic Performance of Ultrasonography for Identification of Small
Bowel Obstruction: A Systematic Review and Meta-analysis
Authors: Mehrdad Farrokhi, Mohsen Motavaselian, Parisa Jafari Khouzani, Atousa Moghadam Fard, Fatemeh Daeizadeh, Mahya Pourrahimi, Reyhaneh Mehrabani, Reza Amani-Beni, Masoud Farrokhi, Faezeh Jalayer Sarnaghy, Asal Mir, Reza Tavakoli, Heidar Fadavian, Reza Mehdinezhad, Parisa Masoudikabir, Tohid Karami, Roozbeh Roohinezhad, Yalda Yazdani, Didar Ghasemi, Farideh Rezaeizadeh, Alireza Hadizadeh, Rojin Sarallah, Ashkan Shafigh, Solmaz Aminpour, Amirhossein Esfahani, Seyedsaber Mirabdali, Zahrasadat Hosseini, Farahnaz Saharkhiz, Mehrzad Khodsiani, Fahimeh Ebrahimi Tirtashi, Shabnam Esmailian Dehkordi, Nafise Sadat Amini, Mahsa Aran, Zohreh Abolghasemfard, Nazanin Sanjarinia, Zeynab Abdollahi, Fatemeh Abediankenari, Erfan Ghadirzadeh, Mehran Khodashenas, Ali Jahanshahi
Pages: e33 - e33
Abstract: Introduction: Small bowel obstruction (SBO) is known as a common cause of acute abdominal complaints in the emergency department (ED). The modality of choice for the diagnosis of SBO has not yet been established. This systematic review and meta-analysis aimed to investigate the accuracy of ultrasonography for the diagnosis of SBO. Methods: Systematic search was performed on five electronic databases including Medline, Scopus, Web of Sciences, Embase, and Cochrane Library, and the retrieval period was from the inception of each database to November 2023. The quality of the included studies were investigated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The pooled values of diagnostic characteristics for ultrasonography were estimated using meta-Disc and Stata statistical software. Results: Twenty-one studies with a total of 1977 patients were included in the meta-analysis. The pooled estimate for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary ROC curve of ultrasonography for diagnosing SBO were 0.93 (95% CI: 0.91–0.95), 0.8 (95% CI: 0.77–0.83), 5.69 (95% CI: 3.64–8.89), 0.1 (95% CI: 0.07–0.16), 83.51 (95% CI: 18.12–182.91) and 0.96, respectively. Conclusion: The findings of this meta-analysis showed that the utilization of ultrasonography holds promise as a diagnostic imaging for SBO with high accuracy. However, additional worldwide studies are essential to get more evidence on the value of ultrasonography for the diagnosis of SBO.
PubDate: 2024-03-03
DOI: 10.22037/aaem.v12i1.2265
Issue No: Vol. 12, No. 1 (2024)
- Knowledge, Attitude and Perceptions of Healthcare Workers in Arab
Countries Regarding Basic Life Support; a Systematic Review and
Meta-Analysis
Authors: Mohammed Alsabri Hussein Alsabri, Sarah Makram Elsayed, Alaa Ahmed Elshanbary, Mohamed Sayed Zaazouee, Basel F. Alqeeq, Syeda Alishah Zehra, Khaled Mohammed Al-Sayaghi, Sameer A. Alkubati, Gamil Ghaleb Alrubaiee
Pages: e32 - e32
Abstract: Introduction: Effective Basic Life Support (BLS) interventions, including cardiopulmonary resuscitation (CPR), are essential for enhancing survival rates. This review aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of healthcare professionals regarding BLS in Arab countries. Methods: We conducted a systematic search on PubMed, Cochrane, Scopus, Web of Science, and EMBASE, to identify relevant studies. We included studies performed in Arab countries that included healthcare workers' KAP assessment towards BLS. The meta-analysis was carried out utilizing the OpenMeta Analyst Software, and a subgroup analysis was performed for Nursing staff category. The quality of the included cross-sectional studies was assessed through Newcastle-Ottawa quality assessment scale. Results: A total of 18 studies were included in our study, and eight of them entered the analysis. The study showed that 61.3% (95% confidence interval (CI): 48.9%, 73.7%, p<0.001) of health care workers were knowledgeable about the correct CPR ratio, and 62.1% (95% CI: 51.7%, 72.5%, p<0.001) answered the location of chest compression correctly. While, only 36.5% (95% CI: 23.5%, 49.6%, p<0.001) had correct answers regarding the compression rate, 48.1% (95% CI: 38.1%, 58.0%, p<0.001) were aware of the compression depth, and 34.8% (95% CI: 22.9%, 46.7%, p<0.001) answered the sequence correctly. Conclusion: The study revealed a gap regarding the BLS KAP of healthcare workers in different Arab countries, which crucially requires taking actions, in terms of frequent certified training sessions, assessments, and clear protocols.
PubDate: 2024-02-28
DOI: 10.22037/aaem.v12i1.2223
Issue No: Vol. 12, No. 1 (2024)
- Hypo-attenuating Berry Sign as a Novel Imaging Marker of Ruptured Aneurysm
in Patients with Subarachnoid Hemorrhage; a Diagnostic Accuracy Study
Authors: Xin-Wei zhou, Shu-Feng Cai, De-Qing Zhang, Gang Xiao, Jing Liu, Wen-Jie Yang, Yi Li, Si-Yu Chen, Hao-Chen Liu, zhong-qing huang
Pages: e31 - e31
Abstract: Introduction: Aneurysmal subarachnoid hemorrhage (SAH) constitutes a life-threatening condition, and identifying the ruptured aneurysm is essential for further therapy. This study aimed to evaluate the diagnostic accuracy of hypo-attenuating berry sign (HBS) observed on computed tomography (CT) scan in distinguishing ruptured aneurysms. Methods: In this diagnostic accuracy study, patients who had SAH and underwent non-enhanced brain CT scan were recruited. The HBS was defined as a hypo-attenuating area with an identifiable border in the blood-filled hyper-dense subarachnoid space. The screening performance characteristics of HBS in identifying ruptured aneurysms were calculated considering the digital subtraction angiography (DSA) as the gold standard. Results: A total of 129 aneurysms in 131 patients were analyzed. The overall sensitivity and specificity of HBS in the diagnosis of aneurysms were determined to be 78.7% (95%CI: 73.1% - 83.4%) and 70.7% (95%CI: 54.3% - 83.4%), respectively. Notably, the sensitivity increased to 90.9% (95%CI: 84.3% - 95.0%) for aneurysms larger than 5mm. The level of inter-observer agreement for assessing the presence of HBS was found to be substantial (kappa=0.734). The diagnostic accuracy of HBS in individuals exhibited enhanced specificity, sensitivity, and reliability when evaluating patients with a solitary aneurysm or assessing ruptured aneurysms. The multivariate logistic regression analysis revealed a statistically significant relationship between aneurysm size and the presence of HBS (odds ratios of 1.667 (95%CI: 1.238 - 2.244; p < 0.001) and 1.696 (95%CI: 1.231 - 2.335; p = 0.001) for reader 1 and reader 2, respectively). Conclusions: The HBS can serve as a simple and easy-to-use indicator for identifying a ruptured aneurysm and estimating its size in SAH patients.
PubDate: 2024-02-26
DOI: 10.22037/aaem.v12i1.2154
Issue No: Vol. 12, No. 1 (2024)
- Associated Factors of Cardiopulmonary Resuscitation Outcomes; a Cohort
Study on an Adult In-hospital Cardiac Arrest Registry
Authors: Parin Rattananon, Welawat Tienpratarn, Chaiyaporn Yuksen, Supassorn Aussavanodom, Natthaphong Thiamdao, Phatcha Termkijwanich, Suraphong Phongsawad, Parama Kaninworapan, Kanda Tantasirin
Pages: e30 - e30
Abstract: Introduction: In-hospital cardiac arrest (IHCA) remains a substantial cause of morbidity and mortality for hospitalized patients worldwide. This study aimed to identify associated factors of return of spontaneous circulation (ROSC) and survival with favorable neurological outcomes of IHCA patients. Method: A two-year retrospective cohort study was conducted at a university-based tertiary care hospital in Bangkok, Thailand, studying adult patients aged ≥ 18 years with IHCA from January 2021 to December 2022. The primary endpoint was sustained ROSC, and the secondary endpoint was survival with favorable neurological outcomes defined as Cerebral Performance Categories (CPC) Scale of 1 or 2 at discharge. Pre-arrest and intra-arrest variables were collected and analyzed using multivariable logistic regression to identify independent factors associated with the outcomes. Results: During the study period, 156 patients were included in the study. 105 (67.3%) patients achieved sustained ROSC after the CPR, 28 patients (18.0%) were discharged alive, and 15 patients (9.6%) survived with a favorable neurological outcome at hospital discharge. Overall, sustained ROSC was higher in patients who had IHCA during the day shift (odds ratio (OR): 4.11; 95% confidence interval (CI): 1.05-16.06) and electrocardiogram (ECG) monitoring prior to arrest (OR: 6.38; 95% CI: 1.18-34.54). In contrast, higher adrenaline doses administrated, and increased CPR duration reduced the odds of sustained ROSC (OR: 0.72; 95% CI: 0.54-0.94 and OR: 0.92; 95% CI: 0.85-0.98, respectively). Arrest due to cardiac etiology was associated with increased discharged survival with favorable neurological outcomes (OR: 13.43; 95% CI: 2.00-89.80), while a higher Good Outcome Following Attempted Resuscitation (GO-FAR) score reduced the odds of the secondary outcome (OR: 0.89; 95% CI: 0.81-0.98). Conclusion: The sustained ROSC was higher in IHCA during the daytime shift and under prior ECG monitoring. The administration of higher doses of adrenaline and prolonged CPR durations decreased the likelihood of achieving sustained ROSC. Furthermore, patients with cardiac-related causes of cardiac arrest exhibited a higher rate of survival to hospital discharge with favorable neurological outcomes.
PubDate: 2024-02-18
DOI: 10.22037/aaem.v12i1.2227
Issue No: Vol. 12, No. 1 (2024)
- Diagnostic and Prognostic Values of S100B versus Neuron Specific Enolase
for Traumatic Brain Injury; a Systematic Review and Meta-analysis
Authors: Hamed Zarei, Shayan Roshdi Dizaji, Amirmohammad Toloui, Mahmoud Yousefifard, Alireza Esmaeili
Pages: e29 - e29
Abstract: Introduction: Traumatic brain injury (TBI) represents a significant global health burden. This systematic review delves into the comparison of S100B and Neuron-Specific Enolase (NSE) regarding their diagnostic and prognostic accuracy in TBI within the adult population. Methods: Conducted on October 21, 2023, the search identified 24 studies encompassing 6454 adult patients. QUADAS-2 and QUAPAS tools were employed to assess the risk of bias. The analyses aimed to evaluate the diagnostic and prognostic performance of S100B and NSE based on sensitivity, specificity, and area under the curve (AUC). The outcomes were detecting intracranial injury, mortality, and unfavorable outcome. Results: Pooled data analysis tended towards favoring S100B for diagnostic and prognostic purposes. S100B exhibited a diagnostic AUC of 0.74 (95% confidence interval (CI): 0.70-0.78), sensitivity of 80% (95% CI: 63%-90%), and specificity of 59% (95% CI: 45%-72%), outperforming NSE with an AUC of 0.66 (95% CI: 0.61–0.70), sensitivity of 74% (95% CI: 53%-88%), and specificity of 46% (95% CI: 24%-69%). Notably, both biomarkers demonstrated enhanced diagnostic value when blood samples were collected within 12 hours post-injury. The analyses also revealed the excellent diagnostic ability of S100B with a sensitivity of 99% (95% CI: 4%-100%) and a specificity of 76% (95% CI: 51%-91%) in mild TBI patients (AUC = 0.89 [0.86–0.91]). In predicting mortality, S100B showed a sensitivity of 90% (95% CI: 65%-98%) and specificity of 61% (95% CI: 39%-79%), slightly surpassing NSE's performance with a sensitivity of 88% (95% CI: 76%-95%) and specificity of 56% (95% CI: 47%-65%). For predicting unfavorable outcomes, S100B exhibited a sensitivity of 83% (95% CI: 74%-90%) and specificity of 51% (95% CI: 30%-72%), while NSE had a sensitivity of 80% (95% CI: 64%-90%) and specificity of 59% (95% CI: 46%-71%). Conclusion: Although neither biomarker has shown promising diagnostic performance in detecting abnormal computed tomography (CT) findings, they have displayed acceptable outcome prediction capabilities, particularly with regard to mortality.
PubDate: 2024-02-18
DOI: 10.22037/aaem.v12i1.2222
Issue No: Vol. 12, No. 1 (2024)
- Characteristics of Hospitalized Pediatric Patients Following Traumatic
Open Globe Injuries; a Cross-sectional Study
Authors: Alireza Peyman, Alireza Dehghani, Alireza Hoghooghi, Kazhaal Sheykhi, Mehri Khoshhali, Mahdi Abounoori, Hajar Khosrropour, Mohsen Pourazizi
Pages: e28 - e28
Abstract: Introduction: One of the main causes of acquired blindness and impairment in children is ocular trauma. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric patients hospitalized with open globe injuries (OGI). Methods: A retrospective cross-sectional study was conducted on children diagnosed with OGI at a referral Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran, from 2014 to 2018. Results: 375 OGI medical records were detected during the study period. The common culprits for OGI in boys were knives (21.3%), wood (19.7%), metal bodies (12.2%), and glass (11.8%). In girls, the common causes were knives (28.7%), glass (24.3%), pencils (11.3%), and wood (10.4%). Boys had a greater rate of Intraocular foreign body (IOFB) (p= 0.052but had lower odds of blindness compared to girls (OR=0.48; 95% CI: (0.24, 0.98); p = 0.04). Patients with corneal lacerations had lower chances of long-term admission than those with corneal and scleral lacerations (OR= 0.35, 95% CI: (0.17, 0.69); p = 0.02). Conclusion: Most pediatric OGIs occur in boys. knives were the principal culprit for OGI, followed by glass and wood. Boys had a greater IOFB rate but lower blindness odds than girls.
PubDate: 2024-02-17
DOI: 10.22037/aaem.v12i1.2175
Issue No: Vol. 12, No. 1 (2024)
- Quality Indicators of Pediatric Asthma Care in the Emergency Department; a
Systematic Review and Meta-Analysis
Authors: Islam E. Alkhazali, Ahmad Alrawashdeh, Mohd Hashairi Fauzi, Nik Hisamuddin Nik Ab Rahman
Pages: e26 - e26
Abstract: Introduction: The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care. Methods: We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools. Results: We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances. Conclusions: A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.
PubDate: 2024-02-13
DOI: 10.22037/aaem.v12i1.2214
Issue No: Vol. 12, No. 1 (2024)
- Ventricular Septal Defect and Mitral Regurgitation Due to Penetrating
Cardiac Trauma; a Case Report and Review of Literature
Authors: Hojjat Mortezaeian , Avisa Tabib, Hamidreza Pouraliakbar, Mohsen Anafje, Pouya Ebrahimi, Parnian Soltani
Pages: e25 - e25
Abstract: Penetrating cardiac trauma is a fatal condition and can result in the injury of various parts of the heart. Ventricular Septal Defect (VSD) following these traumas occurs only in 1-5% of cases. The patients' conditions depend on location, size, and concomitant injuries. One of the uncommon coincidences with the VSD is Mitral Regurgitation (MR) due to injury to sub-valvular structures. In this study, we report a case of concomitant traumatic-induced VSD and MR in a 14-year-old boy following a stab wound to his chest. The patient was a teenage boy coming to the Rajaei Cardiology Hospital emergency room following a stab wound to the anterior and left part of his chest. Despite primary urgent surgery, his breathlessness had continued for three more months. Evaluations with Transthoracic Echocardiography (TTE) revealed VSD with concomitant MR, but there was no papillary muscle rupture. Cardiac Magnetic Resonance Imaging (MRI) and angiographic evaluation confirmed the provisional diagnosis. The Amplatzer VSD occluder repaired the VSD, and the patient was discharged following the resolution of his symptoms. Although the MR has been present in the follow-up echocardiography, the patient has been asymptomatic. Since the initial presenting symptoms and signs of VSD and MR might be subtle or delayed, imaging modalities such as TTE and Transesophageal Echocardiogram (TEE) are beneficial in determining the diagnosis and the optimal treatment.
PubDate: 2024-02-10
DOI: 10.22037/aaem.v12i1.2267
Issue No: Vol. 12, No. 1 (2024)
- Infected Ruptured Pseudo-aneurysm in Descending Aorta; a Case Report
Authors: Morteza Sanei Taheri, Sayyed Mojtaba Nekooghadam, Zahra Sadat Tabatabaei , Sahar Rezaei
Pages: e23 - e23
Abstract: Aortitis is the inflammation of the aortic wall. It can be caused by both infectious and non-infectious etiologies. Mycotic aneurysm is a rare, serious medical condition and typically requires prompt treatment with antibiotics, surgical intervention, or endovascular procedures to prevent rupture and complications. Here we reported, a 66-year-old male patient with a medical history of diabetes and hypertension, who presented to the emergency department (ED) with left-sided hemiplegia. Brain magnetic resonance imaging (MRI) revealed infarction in the right parietooccipital and left occipital lobes, demonstrating an embolic pattern. laboratory analysis revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC).
PubDate: 2024-02-07
DOI: 10.22037/aaem.v12i1.2203
Issue No: Vol. 12, No. 1 (2024)
- Lessons Learned from COVID-19 Pandemic Management in Iran; a Commentary
Authors: Reza Gharebaghi, Fatemeh Heidary, Ali Asghar Pourezzat
Pages: e24 - e24
Abstract: Iran’s healthcare system is considered to be one of the most enduring and resilient ones in the Middle East (1). It had successful records in tackling various infectious diseases by producing vaccines at the Pasteur and Razi institutes for several years’ duration (2). However, COVID-19 has severely affected the healthcare system in Iran. From the beginning of the pandemic until January 01, 2024, over 146,000 cases lost their lives to COVID-19, with almost nine peaks resurgence (3). In this paper, the challenges regarding the control of COVID-19 in Iran are discussed, while the competences were discussed earlier (1).
PubDate: 2024-02-07
DOI: 10.22037/aaem.v12i1.2241
Issue No: Vol. 12, No. 1 (2024)
- Artificial Intelligence in Optimizing the Functioning of Emergency
Departments; a Systematic Review of Current Solutions
Authors: Szymczyk Aleksandra, Krion Robert, Krzyzaniak Klaudia, Lubian Dawid, Sieminski Mariusz
Pages: e22 - e22
Abstract: Introduction: The burgeoning burden on emergency departments is a global challenge that we have been confronting for many years. Emerging artificial intelligence (AI)-based solutions may constitute a critical component in the optimization of these units. This systematic review was conducted to thoroughly examine and summarize the currently available AI solutions, assess potential benefits from their implementation, and identify anticipated directions of further development in this fascinating and rapidly evolving field. Methods: This systematic review utilized data compiled from three key scientific databases: PubMed (2045 publications), Scopus (877 publications), and Web of Science (2495 publications). After meticulous removal of duplicates, we conducted a detailed analysis of 2052 articles, including 147 full-text papers. From these, we selected 51 of the most pertinent and representative publications for the review. Results: Overall the present research indicates that due to high accuracy and sensitivity of machine learning (ML) models it's reasonable to use AI in support of doctors as it can show them the potential diagnosis, which could save time and resources. However, AI-generated diagnoses should be verified by a doctor as AI is not infallible Conclusions: Currently available AI algorithms are capable of analysing complex medical data with unprecedented precision and speed. Despite AI's vast potential, it is still a nascent technology that is often perceived as complicated and challenging to implement. We propose that a pivotal point in effectively harnessing this technology is the close collaboration between medical professionals and AI experts. Future research should focus on further refining AI algorithms, performing comprehensive validation, and introducing suitable legal regulations and standard procedures, thereby fully leveraging the potential of AI to enhance the quality and efficiency of healthcare delivery.
PubDate: 2024-01-27
DOI: 10.22037/aaem.v12i1.2110
Issue No: Vol. 12, No. 1 (2024)
- A Look at Archives of Academic Emergency Medicine Journal in 2023
Authors: Mehrnoosh Yazdanbakhsh, Somayeh Saghaei Dehkordi
Pages: e21 - e21
Abstract: In the 11th year of Archives of Academic Emergency Medicine (AAEM)’s activity in 2023, the journal has published 70 articles, all of which are indexed by SCOPUS, Web of Science, PubMed, and some other databases. The articles have been authored by more than two hundred researchers from various countries, including but not limited to the United States, Canada, UK, Mexico, Brazil, Spain, China, Denmark, Australia, Malaysia, Russia, Hong Kong, Türkiye, Thailand, Saudi Arabia, Egypt, Syria, India, Cyprus, Brunei, Somalia, Jordan, and Iran. We would like to thank all of the authors who trusted us with their valuable works and provided us with the articles published throughout 2023.
PubDate: 2024-01-10
DOI: 10.22037/aaem.v12i1.2250
Issue No: Vol. 12, No. 1 (2024)
