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Effects of Trauma Life Support Training on Patient Outcomes: A Pilot Cluster Randomised Trial medRxiv. Emerg. Med. Pub Date : 2024-03-15 Martin Gerdin Warnberg, Trauma life support training Effectiveness Research Network (TERN) collaborators
Introduction Trauma life support training programmes aim to improve trauma outcomes but there is no evidence from controlled trials to show that they work. We conducted a pilot study to assess the feasibility of conducting a cluster randomised controlled trial comparing the effect of Advanced Trauma Life Support (ATLS) and Primary Trauma Care (PTC) with standard care on patient outcomes. Methods and
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The Impact of Alcohol Misuse in Trauma Patients: A Scoping Review Protocol medRxiv. Emerg. Med. Pub Date : 2024-03-15 Chantae Garland, Nhayan Abdulla, Donghyun Lee, Rae Spiwak, Sarvesh Logsetty, Jordan Nantais
Background Alcohol use is a contributing factor in many cases of traumatic injury. There is conflicting evidence on the impact of alcohol use at the time of physical trauma on severity of injury and hospital course. Similarly, the significance of alcohol use disorder on outcomes in hospitalized trauma patients is unclear. This scoping review aims to provide a concise overview of the current literature
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The hospital burden of critical illness across global settings: a point-prevalence and cohort study in Malawi, Sri Lanka and Sweden. medRxiv. Emerg. Med. Pub Date : 2024-03-15 Carl Otto Schell, Raphael Kayambankadzanja, Abigail Beane, Andreas Wellhagen, Chamira Kodippily, Anna Hvarfner, Grace Banda-Katha, Nalayini Jegathesan, Christoffer Hintze, Wageesha Wijesiriwardana, Martin Gerdin Warnberg, Mtisunge Kachingwe, Petronella Bjurling-Sjoberg, Annie Kalibwe Mkandawire, Hampus Sjostedt, Surenthirakumaran Rajendra, Cecilia Stalsby Lundborg, Miklos Lipcsey, Lisa Kurland, Rashan
Key Points Question: What is the burden of critical illness in hospitals in different global settings, and where are critically ill patients being cared for? Findings: Among 3652 hospitalized patients in countries of different socio-economic levels (Malawi, Sri Lanka, and Sweden) we found a point-prevalence of critical illness of 12.0% (95% CI, 11.0-13.1), with a hospital mortality of 18.7% (95% CI
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Improving out-of-hospital incident severity assessment from changing clinical features with Deep Continual Learning medRxiv. Emerg. Med. Pub Date : 2024-03-14 Pablo Ferri, Carlos Sáez, Antonio Félix-De Castro, Purificación Sánchez-Cuesta, Juan M García-Gómez
When developing Machine Learning models to support emergency medical triage, it is important to consider how changes over time in the data can negatively affect the models' performance. The objective of this study was to assess the effectiveness of novel Deep Continual Learning pipelines in maximizing model performance when input features are subject to change over time, including the emergence of
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Comparison of Deep Learning Approaches for Conversion of International Classification of Diseases Codes to the Abbreviated Injury Scale medRxiv. Emerg. Med. Pub Date : 2024-03-08 Ayush Doshi, Thomas Hartka
The injury severity classifications generated from the Abbreviated Injury Scale (AIS) provide information that allows for standardized comparisons in the field of trauma injury research. However, the majority of injuries are coded in International Classification of Diseases (ICD) and lack this severity information. A system to predict injury severity classifications from ICD codes would be beneficial
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The predictive value of heparin-binding protein for bacterial infections in patients with severe multiple trauma medRxiv. Emerg. Med. Pub Date : 2024-03-07 Li Li, Xiao-xi Tian, Gui-long Feng, Bing Chen
Abstract Introduction: Heparin-binding protein is an inflammatory factor with predictive value and participates in the inflammatory response through antibacterial effects, chemotaxis, and increased vascular permeability. The role of heparin-binding protein in sepsis has been progressively demonstrated, but few studies have been conducted in the context of multiple trauma combined with bacterial infections
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Development of a clinical risk score to risk stratify for a serious cause of vertigo: A prospective cohort study medRxiv. Emerg. Med. Pub Date : 2024-03-04 Robert Ohle
Objectives: Identify highrisk clinical characteristics for a serious cause of vertigo in patients presenting to the emergency department. Design: Multicentre prospective cohort study over 3 years. Setting: Three university affiliated tertiary care emergency departments. Participants: Patients presenting with vertigo, dizziness or imbalance. A total of 2078 of 2618 potentially eligible patients (79
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Call Me Dr. Ishmael: Trends in Electronic Health Record Notes Available at ED Visits and Admissions medRxiv. Emerg. Med. Pub Date : 2024-02-27 Brian W Patterson, Daniel J Hekman, Frank Liao, Azita Hamedani, Manish N Shah, Majid Afshar
Objective: Numerous studies have identified information overload as a key issue for electronic health records (EHRs). This study describes the amount of text data across all notes available to emergency physicians in the EHR, trended over the time since EHR establishment. Materials and Methods: We conducted a retrospective analysis of EHR data from a large healthcare system, examining the number of
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Clinical Pattern and Outcome of Patients with Acute Kidney Injury in the Emergency Department of Saint Paul`s Hospital Millennium Medical College: A Cross-Sectional Study medRxiv. Emerg. Med. Pub Date : 2024-02-27 Berihu Assefa, Yemane Gebremedhin Tesfay, Benyam Bahta Gebrehiwot, Frehiwot Worku, Dirijit Mamo Alemu, Menbeu Sultan Mohammed, Mohammed Kalifa Nuguse
Background: Worldwide, 13.3 million people experience Acute Kidney Injury (AKI) each year. 85% of individuals impacted are thought to reside in underdeveloped nations. AKI continues to be one of the most widespread diseases in the world, although little is known about its clinical profile or outcome. The ability to pinpoint particular causes enables the implementation of targeted therapy and the development
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Evaluation value of bedside ultrasound monitoring of peak flow velocity of abdominal aorta and its branches in volume status of patients with septic shock medRxiv. Emerg. Med. Pub Date : 2024-02-24 Chen Wenchong
[Abstract] Objective To explore the value of bedside ultrasound in monitoring peak flow velocity of abdominal aorta and its branches in assessing the volume status of patients with septic shock.Methods A total of 80 patients with septic shock admitted to the Foshan Rehabilitation Hospital(The Fifth People's Hospital of Foshan) and the Guangdong Provincial People's Hospital from June 2022 to June 2023
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Drone-delivered Automated External Defibrillators for out-of-hospital cardiac arrest. A simulation study. medRxiv. Emerg. Med. Pub Date : 2024-02-24 Christopher Smith, Joseph Phillips, Carl Powell, Anthony Sheehan, Mary O Sullivan, Nigel Rees
Background: Cardiopulmonary resuscitation (CPR) and defibrillation at least doubles survival to hospital discharge following out-of-hospital cardiac arrest. Members of the public can perform both before the ambulance service arrives. However, bystanders use a public-access Automated External Defibrillator (AED) in around 5% of cases. Using Unmanned Aerial Vehicles (drones) to deliver AEDs may overcome
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Safety and efficacy of the Plasma Directed Electron Beam (PDEB ™) - implications for enhanced wound healing treatment in military operational medicine and beyond medRxiv. Emerg. Med. Pub Date : 2024-02-23 Joseph A Bauer, Adrianne R Blocklin, Annette M Sysel, Thomas J Sheperak
Introduction: Wound healing presents a critical challenge in military operational medicine and combat casualty care, especially for soldiers in high-risk environments such as combat zones and training exercises. In these scenarios, wounds often result from bullets, shrapnel, burns, and blasts, affecting soft tissue, bone, and internal organs, and are frequently contaminated with hazardous substances
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Impact of COVID-19 on Emergency Medical Services Utilization and Severity in the U.S. Upper Midwest medRxiv. Emerg. Med. Pub Date : 2024-02-17 Brett Boggust, Rozalina McCoy, Moshe Shalom, Lucas Myers, Carson Rogerson
The COVID-19 pandemic has claimed nearly one million lives and has drastically changed how patients interact with the healthcare system. Emergency medical services (EMS) are essential for emergency response, disaster preparedness, and responding to everyday emergencies. We therefore examined differences in EMS utilization and call severity in 2020 (pandemic period) compared to trends from 2015-2019
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Does practice match protocol? A comparison of "triage-to-provider" time among more- vs. less-acute ED patients. medRxiv. Emerg. Med. Pub Date : 2024-02-13 Temesgen T Tsige, Rida Nasir, Daisy Puca, Kevin Charles, Sandhya Scarlet LoGalbo, Lisa Iyeke, Lindsay Jordan, Melva Morales Sierra, David Silver, Mark Richman
Abstract Introduction: The Emergency Severity Index (ESI) stratifies Emergency Department (ED) patients for triage, from 'most-acute' (level 1) to 'least-acute' (level 5). Many EDs have a split-flow model where less-acute (ESI 4 and 5) are seen in a Fast Track, while more-acute (ESI 1, 2, and 3) are seen in the acute care area. As a core principle of Emergency Medicine is to attend to more-acute patients
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Incidence of Mortality and Predictors Among Patients with Shock Managed in the Emergency Room of a Large Tertiary Referral Hospital in Ethiopia medRxiv. Emerg. Med. Pub Date : 2024-02-11 Kalsidagn Girma Asfaw (MD), Abel Getachew Adugna (MD, Nahom Mesfin Mekonen (MD), Tigist Workneh Leulseged (MD, MPH), Merahi Kefyalew Merahi (MD, MPH), Segni Kejela (MD), Fekadesilassie Henok Moges (MD)
Background: Shock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, such as Ethiopia, which hinders the provision of quality care for improved patient outcomes. Hence, the aim of the study was to determine the incidence of death and predictors among adult patients
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Implementation of Smart Triage combined with a quality improvement program for children presenting to facilities in Kenya and Uganda: An interrupted time series analysis. medRxiv. Emerg. Med. Pub Date : 2024-02-11 J Mark Ansermino, Yashodani Pillay, Abner Tagoola, Cherri Zhang, Dustin Dunsmuir, Stephen Kamau, Joyce Kigo, Collins Agaba, Ivan Aine Aye, Bella Hwang, Stefanie K Novakowski, Charly Huxford, Matthew O. Wiens, David Kimutai, Mary Ouma, Ismail Ahmed, Paul Mwaniki, Florence Oyella, Emmanuel Tenywa, Harriet Nambuya, Bernard Opar Toliva, Nathan Kenya-Mugisha, Niranjan Kissoon, Samuel Akech
PLOS DH (298/300 word limit) Sepsis occurs predominantly in low-middle-income countries. Sub-optimal triage contributes to poor early case recognition and outcomes from sepsis. We evaluated the impact of Smart Triage using improved time to intravenous antimicrobial administration in a multisite interventional study. Smart Triage was implemented (with control sites) in Kenya (February 2021-December
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Severe Acute Respiratory Syndrome Coronavirus 2 – Reactive Salivary Antibody Detection in South Carolina Emergency Healthcare Workers: September 2019–March 2020 medRxiv. Emerg. Med. Pub Date : 2024-02-06 Haley C. Meltzer, Jane L. Goodwin, Lauren A. Fowler, Thomas W. Britt, Ronald G. Pirrallo, Jennifer T. Grier
Background On 19 January 2020, the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was identified in the US, with the first cases in South Carolina (SC) confirmed on 06 March 2020. Due to initial limited testing capabilities and potential for asymptomatic transmission, it is possible that the virus was present earlier than previously thought while preexisting immunity
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The CoLab-score rapidly and efficiently excludes COVID-19 at the emergency department without need for SARS-CoV-2 testing: a multicenter case-control study medRxiv. Emerg. Med. Pub Date : 2024-01-31 Arjen-Kars Boer, Ruben Deneer, Maaike Maas, Heidi Ammerlaan, Roland H.H. van Balkom, Mathie PG Leers, Remy J.H. Martens, Madelon M. Buijs, Jos J. Kerremans, Muriël Messchaert, Jeroen D.E. van Suijlen, Natal A.W. van Riel, Volkher Scharnhorst
Background Rapid identification of emergency department (ED) patients with a possible COVID-19 infection is needed. PCR-testing all ED patients is neither feasible nor effective in most centers, therefore a rapid, objective, low-cost screening tool to triage ED patients is necessary. Methods Results from all routine lab tests from ED patients at the Catharina Hospital were collected from July 2019
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Factors Associated with Delayed Hospital Arrival after Stroke Onset: An Observational Study in Thanh Hoa Province, Vietnam medRxiv. Emerg. Med. Pub Date : 2024-01-30 Hoa Thi Truong, Sam Hoanh Guyen, Cuong Van Le, Shinichi Tokuno, Aya Kuchiba, Shinji Nakahara
Background: Delayed hospital arrival lowers the proportion of patients with stroke receiving recanalization therapy and results in poor outcomes. This study investigated the factors associated with pre-hospital delays in hospital arrival after stroke onset in the Thanh Hoa Province, Vietnam. Methods: Clinical data were collected from stroke patients within 7 days of symptom onset who were prospectively
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Community first response for cardiac arrest: comparing phased dispatch policies through Monte Carlo simulation medRxiv. Emerg. Med. Pub Date : 2024-01-20 Pieter L. van den Berg, Shane G. Henderson, Hemeng Li, Bridget Dicker, Caroline J. Jagtenberg
Background Advanced Community First Responder (CFR) systems send so-called phased alerts: notifications with built-in time delays. The policy that defines these delays affects response times, CFR workload and the number of redundant CFR arrivals.
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Survey on emergency care utilization in tertiary care hospitals in Indonesia medRxiv. Emerg. Med. Pub Date : 2024-01-18 Mineto Fujisawa, Kiyomitsu Fukaguchi, Akio Tokita, Yuta Iwamoto, Takanori Takeda, Lukito Condro, Monalisa Tobing, Bobi Prabowo, Rarasanti Rania Qodri, S.Tr. Battra, Tadahiro Goto
Objective Indonesia’s emergency care system remains suboptimal despite rising demand due to socio-economic changes and increased life expectancy. This study aims to examine patient and family perceptions of the current emergency care system, identify potential needs, and provide a foundation for its development and improvement.
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Prevalence and Outcomes Associated with Idarucizumab Administration in Trauma Patients on Preinjury Dabigatran Therapy: Analyzing Clinical Utilization in 942 Patients from 74 Hospitals medRxiv. Emerg. Med. Pub Date : 2024-01-13 Rebecca L. Moore, Ransom J. Wyse, Justin Jacobs, Samir M. Fakhry, Nina Y. Wilson, Jeneva M. Garland
Background Increasing numbers of injured patients taking dabigatran are presenting to trauma centers raising an important clinical question: Does reversal with idarucizumab outweigh potential bleeding risks associated with dabigatran? The purpose of this study was to describe the prevalence of idarucizumab administration in trauma patients and compare outcomes for those who received reversal to those
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Analysis of 193,618 trauma patient presentations in war-affected Syria from July 2013 to July 2015 medRxiv. Emerg. Med. Pub Date : 2024-01-11 Hani Mowafi, Mahmoud Hariri, Baobao Zhang, Houssam Alnahhas, Basil Bakri, Adam Eldahan, Moustafa Moustafa, Maher Saqqur, Anas Al-Kassem
Introduction Since 2011, the Syrian war has produced a mounting toll in terms of deaths and displaced persons. We present an analysis of demographic and temporal patterns of trauma patient presentations to Syrian hospitals in non-governmental, non-Islamic State (NGNI) regions from 2013 – 2015.
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A comparison of self-triage tools to nurse driven triage in the emergency department medRxiv. Emerg. Med. Pub Date : 2024-01-07 Sachin V Trivedi, Rachit Batta, Nicolas Henao – Romero, Prosanta Mondal, Tracy Wilson, James Stempien
INTRODUCTION Canadian patients presenting to the emergency department (ED) typically undergo a triage process where they are assessed by a specially trained nurse and assigned a Canadian Triage and Acuity Scale (CTAS) score, indicating their level of acuity and urgency of assessment. We sought to assess the ability of patients to self-triage themselves through use of one of two of our proprietary self-triage
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How do Emergency Departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alert in six UK Emergency Departments medRxiv. Emerg. Med. Pub Date : 2023-12-21 Jaqui Long, Fiona Clare Sampson, Joanne E Coster, Rachel O'Hara, Fiona Bell, Steve Goodacre
Background: Whilst prealerts have been shown to improve outcomes for some patients requiring immediate time-critical treatment (e.g. stroke), little is known about their usefulness for other patients and what processes are used by Emergency Department (EDs) to respond to them. In the current context of high demand, it is important to understand how pre-alerts affect EDs. Methods: We undertook non-participation
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Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis medRxiv. Emerg. Med. Pub Date : 2023-12-17 Javier Arredondo Montero, Blanca Paola Pérez Riveros, Oscar Emilio Bueso Asfura
Background This study aimed to analyze the diagnostic performance of serum CA-125 in acute appendicitis (AA).
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What influences ambulance clinician decisions to pre-alert Emergency Departments: a qualitative exploration of decision-making in three UK Ambulance Services medRxiv. Emerg. Med. Pub Date : 2023-12-15 Rachel O’Hara, Fiona Sampson, Jaqui Long, Joanne Coster, Richard Pilbery
Background Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving Emergency Department or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert
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Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians medRxiv. Emerg. Med. Pub Date : 2023-12-15 Joanne Coster, Fiona Sampson, Rachel O’Hara, Jaqui Long, Fiona Bell, Steve Goodacre
Background Ambulance clinicians use pre-alerts calls to alert emergency departments (EDs) about the arrival of critically ill patients. We explored ambulance clinician’s views and experiences of pre-alert practice and processes using a national online survey.
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Time of surgery for aneurysmal subarachnoid hemorrhage in patients ≥70 years medRxiv. Emerg. Med. Pub Date : 2023-12-15 Hengrui Zhang, Bangyue Wang, Ruyi Wang, Chao Peng, Changkai Hou, Yan Zhao, Linchun Huan, Yanfen Chai, Xinyu Yang, Jianjun Yu
Objective To establish a time-to-surgery threshold for elderly aneurysmal subarachnoid hemorrhage patients before the risk of mortality increases.
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What factors predict ambulance pre-alerts to the emergency department? Analysis of routine data from 3 UK ambulance services. medRxiv. Emerg. Med. Pub Date : 2023-12-08 Fiona C Sampson, Richard Pilbery, Esther Herbert, Steve Goodacre, Fiona Bell, Rob Spaight, Andy Rosser, Peter Webster, Mark Millins, Andy Pountney, Joanne Coster, Jacqui Long, Rachel O'Hara, Alexis Foster, Jamie Miles, Janette Turner, Aimee Boyd
Objective Ambulance clinicians use pre-alert calls to advise emergency departments (EDs) of the arrival of patients requiring immediate review or intervention. Consistency of pre-alert practice is important in ensuring appropriate EDs response. We used routine data to describe pre-alert practice and explore factors affecting variation in practice. Methods We undertook an observational study using a
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Development and Evaluation of a Digital Scribe: Conversation Summarization Pipeline for Emergency Department Counseling Sessions towards Reducing Documentation Burden medRxiv. Emerg. Med. Pub Date : 2023-12-07 Emre Sezgin, Joseph Sirrianni, Kelly Kranz
Objective: We present a proof-of-concept digital scribe system as an ED clinical conversation summarization pipeline and report its performance. Materials and Methods: We use four pre-trained large language models to establish the digital scribe system: T5-small, T5-base, PEGASUS-PubMed, and BART-Large-CNN via zero-shot and fine-tuning approaches. Our dataset includes 100 referral conversations among
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Normobaric Hyperoxia Combined with Endovascular Treatment Based on Temporal Gradient: A dose-escalation study medRxiv. Emerg. Med. Pub Date : 2023-12-07 Weili Li, Sifei Wang, Lan Liu, Jiaohao Chen, Jing Lan, Jiayue Ding, Zhiying Chen, Shuhua Yuan, Zhifeng Qi, Ming Wei, Xunming Ji
BACKGROUND: Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke (AIS). Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment (EVT). METHODS: Patients with acute stroke who had an indication for EVT at Tianjin Huanhu Hospital were included and randomly assigned to four groups (1:1 ratio) based on NBO therapy duration: 1) Sham-NBO
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ChatGPT Provides Inconsistent Risk-Stratification of Patients With Atraumatic Chest Pain medRxiv. Emerg. Med. Pub Date : 2023-11-30 Thomas F. Heston, Lawrence M. Lewis
BACKGROUND ChatGPT is a large language model with promising healthcare applications. However, its ability to analyze complex clinical data and provide consistent results is poorly known. This study evaluated ChatGPT-4’s risk stratification of simulated patients with acute nontraumatic chest pain compared to validated tools.
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Protecting Emergency Medical Services (EMS) Staff from Aggression and Violence in Conflict Encounters (PEACE1): A survey of Wales Adults attitudes in 2022 medRxiv. Emerg. Med. Pub Date : 2023-11-30 Nigel Rees, Daniel Todd, Francesca Fiorentino, Peter O’Meara, Lauren Williams, Julia Williams, Claire Hawkes
Background Emergency Medical Services (EMS) staff frequently encounter violence and aggression (V&A) directed towards them, which negatively affects their wellbeing and provision of services. This is an international problem and employers and others are tackling it through policy, education, legislation, and public information campaigns. The aim of this study was to explore the Welsh public’s views
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Psychological impact of COVID-19 on frontline healthcare workers during the early months of the pandemic and responses to reduce the burden, helping to prepare for Disease X: A systematic review medRxiv. Emerg. Med. Pub Date : 2023-11-28 Jarryd S. Ludski
Objective The COVID-19 pandemic placed enormous strain on healthcare workers (HCW) and systems. With currently over 766 million cases, a high risk of workplace-acquired infection and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies from previous pandemics highlight significant psychological distress in these workers, yet mental health remained
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Rationale and Design of the BECA Project: Smartwatch-based Activation of the Chain of Survival for Out-of-Hospital Cardiac Arrest medRxiv. Emerg. Med. Pub Date : 2023-11-24 Roelof G. Hup, Emma C. Linssen, Marijn Eversdijk, Bente Verbruggen, Marieke A.R. Bak, Mirela Habibovic, Willem J. Kop, Dick L. Willems, Lukas R.C. Dekker, Reinder Haakma, Carlijn A. Vernooij, Tom A. Kooy, Hanno L. Tan, Rik Vullings
Introduction Out-of-hospital cardiac arrest (OHCA) is a major health problem, and the overall survival rate is low (4.6%-16.4%). The initiation of the current chain of survival depends on the presence of a witness of the OHCA, which is not present in 29.7%-63.4% of the cases. Furthermore, a delay in starting this chain is common in witnessed OHCA. This project aims to reduce morbidity and mortality
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Management and outcomes of fractures over cranial venous sinuses: A scoping review protocol medRxiv. Emerg. Med. Pub Date : 2023-11-21 Berjo D. Takoutsing, Ubraine Wunde Njineck, Praise Senyuy Wah, Lorraine Sebopelo, Josiane Ngouanfo Tchoffo, Ella Shiynyuy Bah, Ignatius Esene
Introduction Fractures over venous sinuses (FOVS) are associated with difficulties in diagnosis, and treatment resulting in a high level of morbidity, and mortality. Despite its importance, there is limited aggregate data to guide the management of these fractures ultimately inflicting a major challenge to neurosurgeons. This protocol describes the methodology of a scoping review that aims to synthesise
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Speedy and satisfying: Real-time Location System increases Emergency Department efficiency and decreases frustration with finding medical equipment medRxiv. Emerg. Med. Pub Date : 2023-11-20 Sandhya LoGalbo, Sophia Trojanowski, Alexandria Slusser, Lisa Iyeke, Lindsay Jordan, Mark Richman
INTRODUCTION We evaluated the impact of a real-time locating system on emergency department efficiency and frustration locating mobile otoscope/ophthalmoscope carts.
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sLOX-1 as a differential diagnostic biomarker for acute pulmonary embolism medRxiv. Emerg. Med. Pub Date : 2023-11-02 Jianing Wu, Wei Rong, Ke Ma, Jie Ma, Yuhong Mi, Zhi-Cheng Jing, Hui Zhang, Ping Li, Jie Du, Yulin Li
Objective: Diagnosing acute pulmonary embolism (PE) is challenging because of nonspecific clinical symptoms. Soluble lectin-type oxidized low-density lipoprotein receptor (sLOX-1) has differential expression in arterial and venous disease. This study aimed to evaluate the relevance of soluble lectin-type oxidized low-density lipoprotein receptor (sLOX-1) as a diagnostic biomarker for acute PE. Methods:
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The magnitude, determinants, and outcome of shock among pediatric patients: A cross-sectional hospital-based study. medRxiv. Emerg. Med. Pub Date : 2023-10-28 Mebrahtu G. Kidanu, Engdaeshet Tazebe, Alemseged Birhane, Marta Yemane, Mebrihit M. Kahsay, Mebrahtu Tedla
Background: Pediatric shock, a potentially fatal illness, develops after a systemic circulatory system failure. It appears to be a common emergency in children and produces substantial morbidity and mortality particularly if there is no early identification and therapy. The extent and causes of shock-induced death among children in Ethiopia have not been sufficiently studied. Objective: This study
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Identifying Signs and Symptoms of Urinary Tract Infection from Emergency Department Clinical Notes Using Large Language Models medRxiv. Emerg. Med. Pub Date : 2023-10-26 Mark Iscoe, Vimig Socrates, Aidan Gilson, Ling Chi, Huan Li, Thomas Huang, Thomas Kearns, Rachelle Perkins, Laura Khandjian, R Andrew Taylor
Objectives: Symptom characterization is critical to urinary tract infection (UTI) diagnosis, but identification of symptoms from the electronic health record (EHR) is challenging, limiting large-scale research, public health surveillance, and EHR-based clinical decision support. We therefore developed and compared two natural language processing (NLP) models to identify UTI symptoms from unstructured
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Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting medRxiv. Emerg. Med. Pub Date : 2023-10-25 Sahil Sethi, Gene Hobbs, Devin K. Hubbard, Kenneth Donnelly, Joseph M. Grover, Imran Rizvi
BACKGROUND: Capnography is one of the most important respiratory monitoring tools used in EMS because changes to end-tidal CO2 (ETCO2) generally precede blood oxygen desaturation, and waveform morphology can be used to assess bronchial patency. Many of capnography's indications overlap with those of continuous positive airway pressure (CPAP) therapy. However, there are currently no convenient methods
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Leveraging Artificial Intelligence and Data Science for Integration of Social Determinants of Health in Emergency Medicine: A Scoping Review medRxiv. Emerg. Med. Pub Date : 2023-10-18 Ethan Abbott, Donald Apakama, Lynne Richardson, Lili Chan, Brendan Carr, Girish Nadkarni
Objective: Social Determinants of Health (SDOH) are critical drivers of health disparities and patient outcomes. However, accessing and collecting patient level SDOH data can be operationally challenging in the emergency department clinical setting requiring innovative approaches. This scoping review examines the potential of artificial intelligence (AI) and data science for modeling, extraction, and
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Threat awareness and counter-terrorism preparedness of Dutch hospitals: a cross-sectional survey medRxiv. Emerg. Med. Pub Date : 2023-10-14 Dennis Barten, Maud Janssen, Harald De Cauwer, Dennis Keereweer, Edward Tan, Frits van Osch, Luc Mortelmans
ABSTRACT Background Workplace violence, including violent extremism, is a growing concern in the healthcare environment. Furthermore, there has been a disproportionate rise in the rate of terrorist attacks on hospitals during the past two decades. Hospitals are vulnerable targets due to their easy accessibility and their high density of patients, staff and visitors. Nonetheless, little is known about
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Cohort profile: A multicenter evaluation of clinical decision rules applied to emergency department triage of patients presenting with acute respiratory infection or infectious diarrhea medRxiv. Emerg. Med. Pub Date : 2023-10-13 Simon Berthelot, Maurice Boissinot, Michel G. Bergeron, Marie-Louise Vachon, Sylvie Trottier, Ann Huletsky, Rodica Gilca, Jason Robert Guertin, Cecile Tremblay, Yves Longtin, Marc Afilalo, Eric Mercier, Eve Dube, David Simonyan, Narcisse Mahukpe Ulrich Singbo, Ariane Bluteau
Purpose Emergency department (ED) patients suffering from acute respiratory infection or infectious diarrhea often present with self-limiting conditions. The study objective was to evaluate the performance of triage clinical decision rules consisting of a rapid molecular test and a self-administered patient questionnaire to identify ED patients who can self-treat at home without consulting an emergency
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Identifying Incarceration Status in the Electronic Health Record Using Natural Language Processing in Emergency Department Settings medRxiv. Emerg. Med. Pub Date : 2023-10-12 Thomas T Huang, Vimig Socrates, Aidan Gilson, Conrad Safranek, Ling Chi, Emily Wang, Lisa Puglisi, Cynthia Brandt, Richard Andrew Taylor, Karen Wang
Background: Incarceration is a highly prevalent social determinant of health associated with high rates of morbidity and mortality and racialized health inequities. Despite this, incarceration status is largely invisible to health services research due to poor electronic health record capture within clinical settings. Our primary objective is to develop and assess natural language processing (NLP)
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Inequalities in Accident and Emergency department attendance by socio-economic characteristics: population based study. medRxiv. Emerg. Med. Pub Date : 2023-10-12 Owen Gethings, Perrine Machuel, Vahe Nafilyan
Objectives To examine the relationship between deprivation and Accident and Emergency department attendance. Design Retrospective cohort study. Setting England, United Kingdom, from 21 March 2021 to March 2022 Participants All individuals in the 2021 Census, aged 0 to 95 with an Emergency Department attendance record within the Emergency Care Dataset (ECDS). Our full sample included 51,776,958 individuals
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Respiratory viral infections do not increase risk of venous thromboembolism medRxiv. Emerg. Med. Pub Date : 2023-10-03 Steven J Korzeniewski, Samantha J. Bauer, Christopher Kabrhel, Daniel Courtney, Ngai Ka ming, Christopher Kelly, Carlos A. Camargo, Jeffrey A Kline
Background: A major concern in emergency departments is whether acute respiratory illness (ARI) is associated with increased risk of venous thromboembolism (VTE). Methods: This prospective cohort study includes ARI patients from the 91-hospital, U.S. CDC-sponsored Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) program from January 2022 to June 2023. We calculated
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Trajectories of Neurologic Recovery after Traumatic Brain Injury medRxiv. Emerg. Med. Pub Date : 2023-09-30 Henry E Wang, Chengcheng Hu, Bruce Barnhart, Jan Jansen, Daniel V Spaite
BACKGROUND: Little is known about the trajectory over time of neurologic recovery after traumatic brain injury (TBI). We sought to determine long-term changes in neurologic status after prehospital clinical trial interventions for acute TBI. METHODS: We used data from the Resuscitation Outcomes Consortium Hypertonic Saline (ROC HS) TBI Trial. The trial included adult TBI, with Glasgow Coma Scale (GCS)≤8
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IMpact of a Point-of care UltraSound Examination on the management of acute respiratory or circulatory failure patients in the emergency department: The IMPULSE before-and-after implementation study medRxiv. Emerg. Med. Pub Date : 2023-09-29 Thierry Fumeaux, Sandra Bieler, Damien Tagan, olivier grosgurin
Background: Despite its diagnostic accuracy, the clinical impact of the use of Point-of-care Ultrasound (POCUS) in the emergency department (ED) is not well described, especially when performed by junior in-training residents. Aim of the study: to assess the effect of a short, structured POCUS training program on the management of ED patients by in-training residents. Method: IMPULSE is a before-and-after
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Oral Anticoagulant Use by Emergency Medical Services Patients in the United States medRxiv. Emerg. Med. Pub Date : 2023-09-29 Henry Wang, Mengda Yu, Ching Min Chu, Travis P. Sharkey-Toppen, Michelle Nassal, Alix Delamare, Jonathan Powell, Lai Wei, Ashish Panchal
OBJECTIVE: Oral anticoagulant (OAC) use raises the risk of death in life-threatening conditions such as hemorrhagic stroke, trauma and traumatic brain injury. We sought to describe the national characteristics of Emergency Medical Services patients with a history of OAC use. METHODS: We used prehospital electronic medical record data from 2018-2020 from the ESO Data Collaborative. We included adults
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Alternative Defibrillation Strategies for Refractory Ventricular Fibrillation: A Systematic Review and Meta-Analysis medRxiv. Emerg. Med. Pub Date : 2023-09-29 Benedetta Perna, Matteo Guarino, Roberto De Fazio, Ludovica Esposito, Andrea Portoraro, Federica Rossin, Francesca Remelli, Caterina Trevisan, Valeria Raparelli, Giovanni Marasco, Giovanni Barbara, Stefano Petrini, Milo Vason, Michele Domenico Spampinato, Roberto De Giorgio
Background: Cardiac arrest with refractory ventricular fibrillation (rVF) represents a dramatic medical emergency. Despite recent advances, its treatment is challenging and burdened by limited evidence. This systematic review and meta-analysis aims at establishing whether alternative defibrillation strategies (ADS), i.e. double sequential external defibrillation (DSED) or vector-change defibrillation
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Analyzing Pain Patterns in the Emergency Department: Leveraging Clinical Text Deep Learning Models for Real-World Insights medRxiv. Emerg. Med. Pub Date : 2023-09-25 James A Hughes, Yutong Wu, Lee Jones, Clint Douglas, Nathan J Brown, Sarah Hazelwood, Anna-Lisa Lyrstedt, Rajeev Jarugula, Kevin Chu, Anthony Nguyen
Objective: To estimate the prevalence of patients presenting in pain to an inner-city emergency department (ED), describing this population, their treatment, and the effect of the COVID-19 pandemic. Materials and Methods: We applied a clinical text deep learning model to the free text nursing assessments to identify the prevalence of pain on arrival to the ED. Using interrupted time series analysis
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The use and outcomes of non-pharmacological analgesia in the adult emergency department medRxiv. Emerg. Med. Pub Date : 2023-09-25 Aisha Amzaidy M Assiry, Nathan J Brown, Sarah Hazelwood, Anna-Lisa Lyrstedt, Lee Jones, Kevin Chu, James A Hughes
Background: The treatment of pain in the emergency department (ED) has historically relied on pharmacological analgesia. However, little is known about the concurrent use of non-pharmacological analgesia. Aims/Objectives: This research explores the self-reported use and outcomes of non-pharmacological analgesia in adult ED patients with moderate to severe pain. Methods: This is a cross-sectional study
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Work Status, Functional Recovery, and Quality of Life of Cardiac Arrest Survivors After Hospital Discharge medRxiv. Emerg. Med. Pub Date : 2023-09-01 Yi-Wen Wu, Tai-Yuan Chen, Chien-Hua Huang, Yu-Jen Chu, Wei-Ting Chen, Kuan-Ting Lu, Wei-Tien Chang, Hooi-Nee Ong, Wen-Jone Chen, Min-Shan Tsai
Background To investigate the work status, neurological recovery, and quality of life of cardiac arrest survivors within 1 year after hospital discharge. Methods A retrospective single center study included 71 non-traumatic adult cardiac arrest patients between 2017 and 2020, who survived more than 1 year after hospital discharge and agreed to participate the study. Questionnaire interviews through
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Attacks on Ukrainian healthcare facilities during the first year of the full-scale Russian invasion of Ukraine medRxiv. Emerg. Med. Pub Date : 2023-08-29 Dennis Barten, Derrick Tin, Fredrik Granholm, Diana Rusnak, Frits van Osch, Gregory Ciottone
Background Although the Geneva Conventions and Rome Statute demand protections for healthcare facilities during war, breaches of these protections are frequently reported. The ongoing war in Ukraine is no exception, with several healthcare attacks eliciting widespread condemnation. The Ukrainian Healthcare Center (UHC) has been collecting, verifying and documenting attacks on health infrastructure
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The current quality and requirements of prehospital and emergency care in Indonesia and Malaysia: a cross-sectional multicenter survey medRxiv. Emerg. Med. Pub Date : 2023-08-21 Akio Tokita, Hanako Nunokawa, Keibun Liu, Yuta Iwamoto, Tomohiro Sonoo, Konan Hara, Mikio Nakajima, Kiyomitsu Fukaguchi, Takanori Takeda, Amirudin Sanip, Dafsah A. Juzar, Gurjeet Singh a/l Harvendhar Singh, Lukito Condro, Monalisa Tobing, Muhammad Abdus-Syakur bin Abu Hasan, Nik Hisamuddin NA Rahman, Orizanov Mahisa, Ramdinal Aviesena Zairinal, Mohd Khairulizwan bin Ramli, Mohd Afiq Mohd Nor, Tadahiro
Background Rapid economic growth in Southeast Asian countries has led to a significant gap between supply and demand of emergency care, which may negatively affect the health outcomes of local populations. The purpose of this study was to identify current challenges faced by emergency care systems in Indonesia and Malaysia. Methods An online survey was conducted between August and November 2022. Survey
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The effect of sepsis recognition on telemedicine use and bundle completion in rural emergency department sepsis treatment medRxiv. Emerg. Med. Pub Date : 2023-08-13 Anna M. Kaldjian, J. Priyanka Vakkalanka, Uche Okoro, Cole Wymore, Karisa K. Harland, Kalyn Campbell, Morgan B. Swanson, Brian M. Fuller, Brett Faine, Anne Zepeski, Edith A. Parker, Luke Mack, Amanda Bell, Katie DeJong, Kelli Wallace, Keith Mueller, Elizabeth Chrischilles, Christopher R. Carpenter, Michael P. Jones, Marcia M. Ward, Nicholas M. Mohr
Objective: Sepsis has high mortality, but it is often not recognized due to varied and vague presentations. Provider-to-provider emergency department telehealth (tele-ED) has been proposed to improve rural sepsis care, but we hypothesized that its use and effectiveness is dependent on local sepsis recognition. The objective of this study was to measure the association between sepsis documentation and
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Comparative Analysis of a Large Language Model and Machine Learning Method for Prediction of Hospitalization from Nurse Triage Notes: Implications for Machine Learning-based Resource Management medRxiv. Emerg. Med. Pub Date : 2023-08-10 Dhavalkumar Patel, Prem Timsina, Larisa Gorenstein, Benjamin S Glicksberg, Ganesh Raut, Satyanarayana Cheetirala, Fabio Santana, Julessaurelpericle Tamegue, Arash Kia, Eyal zimlichman, Matthew Levin, Robert Freeman, Eyal Klang
Predicting hospitalization from nurse triage notes has significant implications in health informatics. To this end, we compared the performance of the deep-learning transformer-based model, bio-clinical-BERT, with a bag-of-words logistic regression model incorporating term frequency-inverse document frequency (BOW-LR-tf-idf). A retrospective analysis was conducted using data from 1,391,988 Emergency
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Association of neighborhood social determinants of health, race and ethnicity, and severe maternal morbidity on the frequency of emergency department visits and preventable emergency department visits among pregnant individuals. medRxiv. Emerg. Med. Pub Date : 2023-08-09 Richard Holtzclaw, Seuli Bose Brill, Naleef Fareed
Background: The relationship between emergency department (ED) use and SDoH (both individual or neighborhood) factors is complex, and critical factors such as racioethnicity and obstetric comorbidities may moderate this relationship among pregnant individuals. The public health implications of this complex relationship are important for pregnant women because frequent ED visits (both non-preventable