Weighing in on monkeypox against the criteria of public health emergency

The monkeypox, a viral zoonotic disease usually found in forest areas of Central and Western Africa, has spread worldwide through new modes of transmission little understood. The WHO on 23 July 2022, declared the virus a Public Health Emergency of International Concern (PHEIC).The declaration has stirred criticism from leading scientists that the criteria for PHEIC as defined by International Health Regulation have not been met and it is non-transparent and contradictory. This paper reviews the criteria of PHEIC and weighs the rationales behind the declaration to increase the clarity of the WHO's decision, justifications, and legitimacy in the ongoing outbreak.

Structural empowerment of midwifery students following simulation-based training of management of obstetric emergencies

BACKGROUND

Having the ability of managing obstetric emergencies is the necessary capability for providing care during labor and delivery.Simulation is considered to be a valuable strategy for empowering midwifery students in managing emergencies. So, this study was conducted to determine the structural empowerment of midwifery students following the simulation-based training of management of midwifery emergencies.

METHODS

This semi-experimental research was conducted from August 2017 to June 2019 in the Faculty of Nursing and Midwifery, Isfahan, Iran. 42 subjects of the third-year midwifery students were included in the study through convenience sampling method (n = 22 in the intervention group, n = 20 in the control group). Six simulation-based educational sessions were considered for the intervention group. Conditions for Learning Effectiveness Questionnaire, was used at the beginning of the study, one week after it and one year later. Repeated measures ANOVA was used to analyze the data.

RESULTS

In the intervention group, the significant difference was observed between the mean score of the students' structural empowerment before and after the intervention (MD=-28.41, SD = 3.25) (p < 0.001), before and one year after the study (MD=-12.45, SD = 3.47) (p = 0.003), and immediately after and one year after the study (MD = 15.95,SD = 3.67) (p < 0.001). In the control group, no significant difference was observed. Before the intervention, there was no significant difference between the mean score of the students' structural empowerment in the control and intervention groups (MD = 2.89, SD = 3.50) (p = 0.415); but, immediately after the intervention, the mean score of structural empowerment in the students of the intervention group was significantly higher than those of the control group (MD = 25.40, SD = 4.94 ) (p < 0.001). One year after the study, there was no significant difference between the two groups in terms of the mean score of the structural empowerment (MD = 6.89, SD = 3.58 ) (p = 0.061).

CONCLUSION

Simulation contributed to the structural empowerment of midwifery students by providing the opportunity for personal and professional growth and strengthening of the formal and informal power in the area of midwifery emergency management but these benefits were not seen at one year.

A call to readjust the Israeli school feeding program

The COVID-19 pandemic challenged the food and nutrition security status of thousands of children in Israel. This commentary argues that policymakers should urgently readjust the Israeli school feeding program based on experts' advice. Children should have the right to select food items, grow the items, prepare the meals, and clean and care for the waste together. They should eat as a community in suitable school dining rooms. Access to the school feeding program should also be ensured during emergencies, school closures, isolation and quarantine, treatment, and rehabilitation of children. The food provided through the program should be integrated into the food baskets of their families, aimed at improving their households' food and nutrition security. It is important to activate a universal school feeding program that does not differentiate, separate, and stigmatize children, their households, their communities, and their schools. The United States National School Lunch Program is briefly reviewed, highlighting the importance of the program's routine monitoring, evaluation, and improvement. Engaging the children in planning the meals and in the production, preparedness, provision, and waste management processes are key to improving their involvement, health literacy and promotion, and their families' resilience. Implementing a holistic Food System Approach, including school gardening and "Farm to School," is suggested. It is recommended to urgently formulate a modern, universal, and comprehensive Israeli Food and Nutrition Security Plan, with a dedicated chapter for the upgraded School Feeding Programe with a section on its implementation in emergency preparedness, response, and Resilience. It should be anchored in the Food Systems framework and the One Health Approach.

Public alert and warning system literature review in the USA: identifying research gaps and lessons for practice

As emergencies continue to impact communities in the USA on an unprecedented scale, it is imperative for communities to look for effective ways to keep people safe and reduce future impacts. Public alert and warning systems are an effective means of accomplishing these goals. As such, researchers have studied public alert and warning systems extensively in the USA. Due to the plethora of studies on public alert and warning systems, a systematic and comprehensive synthesize is needed to understand what has been studied and their major findings and identify practical lessons that can be used to further improve public alert and warning systems. Hence, the goal of this study is to answer the following two questions: (1) What are the major findings from public alert and warning system research? (2) What policy and practical lessons can be gleaned from public alert and warning system research to improve public alert and warning system research and practice? We answer these questions by conducting a systematic and comprehensive review of the public alert and warning system literature, starting with a keyword search. The search produced 1737 studies, and we applied six criteria (e.g., the study has to be a peer-reviewed article, dissertation, or conference paper), which narrowed the number of studies to 100. After a reverse citation search, that number increased to 156 studies. Analysis of the 156 studies, the results reveal 12 emergent themes regarding the major findings from public alert and warning system research. The results also reveal eight emergent themes related to the policy and practical lessons. We then offer recommended topics for future research as well as outline some policy and practical recommendations. We conclude by summarizing the findings and discussing the limitations of the study.

Validity of the "Roth score" for hypoxemia screening

INTRODUCTION

The Roth score is an alternative strategy to estimate oxygen saturation by using a simple verbal test. We designed this clinical study to assess the validity of the Roth score (Spanish version) as a screening test for hypoxemia. A secondary objective was to evaluate the agreement and consistency between the oxygen saturation obtained via pulse oximetry (SpO₂) and arterial blood gas test (SaO₂).

METHODS

An observational study was conducted in two hospital emergency departments. Adult patients who underwent arterial blood gas tests were included in the analysis. Pulse oximetry values were determined, and the Roth score was applied in the Spanish language. The validity of the Roth score was assessed in terms of sensitivity and specificity by creating ROC curves and by calculating the area under the curve (AUC) for SpO₂, SaO₂, and oxygen pressure in the arterial blood (PaO₂). Agreement between SpO₂ and SaO₂ values was assessed by using the intraclass correlation coefficient (ICC), and consistency between both measures was calculated by following the method of Bland and Altman.

RESULTS

The ROC curve models of the Roth score results that were obtained for SaO₂ < 90%, ≤92%, and < 95% had AUCs of 0.574, 0.462, and 0.543, respectively, for the highest number that was obtained in the test, as well as AUCs of 0.403, 0.376, and 0.495, respectively, for the maximum time that was used. The AUCs for PaO₂ ≤ 60, ≤70, and ≤80 mmHg were 0.534, 0.568, and 0.512, respectively, for the maximum number that was obtained in the test, as well as AUCs of 0.521, 0.515, and 0.519, respectively, for the maximum time that was spent. The ICC between SaO₂ and SpO₂ was 0.817 (p < 0.001); additionally, the mean difference between the two measurements was -0.55.

CONCLUSION

The Roth score performed in Spanish is not a valid test for hypoxemia screening. There is sufficient agreement and consistency between SaO₂ and SpO₂ measurements.

Radiologic diagnosis of non-traumatic paediatric head and neck emergencies

Imaging plays a crucial role in evaluating paediatric patients with non-traumatic head and neck lesions in an emergency setting because clinical manifestations of these entities can overlap. For this reason, radiologists must be familiar with the clinical and imaging findings of prevalent paediatric head and neck emergencies. In this review, we present techniques and imaging clues for common complications of pathological processes in the paediatric head and neck, with a focus on the clinical scenario as a starting point for the radiologic approach.

Associations Between Care Bundles and Postoperative Outcomes After Major Emergency Abdominal Surgery: A Systematic Review and Meta-Analysis

INTRODUCTION

Care bundles were found to improve postoperative outcomes in elective surgery. However, in major emergency general surgery studies show a divergent impact on mortality and length of stay. This meta-analysis aimed to evaluate associations between care bundles and mortality, complications, and length of stay when applied in major emergency general surgery.

METHODS

A systematic literature search in PubMed and Embase was performed on the May 1, 2021. Only comparative studies on care bundles in major emergency general surgery were included. Meta-analysis and trial sequential analysis were performed on 30-d mortality. We undertook a narrative approach of long-term mortality, complications, and length of stay.

RESULTS

Meta-analysis of 13 studies with 35,771 patients demonstrated that care bundles in emergency surgery were not associated with a significant reduction in odds of 30-d mortality (odds ratio = 0.8, 95% confidence interval 0.62-1.03). Trial sequential analysis confirmed that the meta-analysis was underpowered with a minimum of 78,901 patients required for firm conclusions. Seven studies reported complication rates whereof six reported lower complication rates using care bundles.

CONCLUSIONS

Care bundles were reported to decrease postoperative complications in five out of seven studies and seven out of 11 studies reported a shortening in length of stay.

How dangerous can a small fısh be? A greater weever attack

BACKGROUND

Thraconian fish (weever fish) are poisonous fish found mostly in the eastern Mediterranean region, but also in the eastern Atlantic Ocean, the North Sea and European coastal areas. Greater weever fish belong to the Trachinus draco family; these fish have spines on their dorsal fins and gill covers that secrete a high dose of dracotoxin venom.

METHODS

This paper reports a 35-year-old female who presented with widespread body aches, respiratory distress and hoarseness following a greater weever attack. It discusses respiratory distress and other findings that occur after a greater weever attack in rare otolaryngological emergency cases.

CONCLUSION

While greater weever fish are more likely to attack limbs such as arms and legs, patients stung on the neck who develop respiratory distress are considered an ENT emergency.

Factors associated with complications of foreign body ingestion and/or aspiration in children from a Peruvian hospital

Objective

To determine the factors associated with complications of foreign body ingestion and/or aspiration in children from a hospital in the Peruvian social security program.

Materials and methods

An observational, retrospective, analytical, and transverse study was undertaken. Medical records of patients under the age of 14 years old, who were admitted to the National Hospital Edgardo Rebagliati Martins between January 2013 and May 2017, and treated with a diagnosis of foreign body in the digestive or respiratory tract, were selected. Variables that characterized the foreign body ingestion and/or aspiration were assessed. STATA v11.1 was used for all subsequent statistical analyzes.

Results

A total of 322 cases met the inclusion criteria and the median age of the cohort was 4 years old (interquartile range: 2-6). The most frequently ingested foreign bodies were coins (∼59%) and batteries (∼10%). Fifty-four cases (∼17%) were classed as having a complication. In the multivariate analysis, we observed that the frequency of complications increased when the ingested object was a battery (adjusted prevalence ratio (aPR): 2.89; 95% confidence interval (CI): 2.52-3.32; p-value<0.001), when the time elapsed prior to diagnosis was 8-16 h (aPR: 2.23; 95% CI: 2.18-2.28; p-value<0.001), and when the child was male (aPR: 1.85; 95% CI: 1.24-2.74; p-value = 0.002). However, the frequency decreased in cases where foreign bodies were lodged in the nose (aPR: 0.97; 95% CI: 0.97-0.98; p-value<0.001).

Conclusions

Whilst the most frequently ingested foreign bodies in this study were coins, complications were more common in cases of battery ingestion and in those where the diagnosis was made after 8 h.

Building a safety culture for infection prevention and control adherence at Howard Springs: A workplace survey

BACKGROUND

Building a safety culture is essential to facilitate infection prevention and control (IPC) adherence in workplaces. We aimed to explore perceptions, barriers and facilitators to IPC procedures by the Australian Medical Assistance Team (AUSMAT) at Howard Springs International Quarantine Facility (HSIQF).

METHODS

We performed a descriptive analysis of a cross-sectional survey administered to the AUSMAT employed at HSQIF from October 2020 to April 2021. We described motivation, training and compliance to IPC adherence and Likert scales described the level of agreement to the success of IPC procedures across the domains of communication, risk, trust, safety and environment, from the individual, team and organisational perspective.

RESULTS

There were 101 participants (response rate 59%, 101/170) and 70% (71/101) were clinical. There was strong agreement to the success of IPC procedures, with a median 4 (agree) or 5 (strongly agree) across each domain and perspective of the 67 Likert items. Clinical staff reported slightly higher agreement than non-clinical staff across Likert items. To improve IPC compliance, most reported that daily training should be provided (77/97, 79%) and daily training was very or extremely effective (91/97, 93%). Participants were motivated by protecting self, friends, family and the community rather than workplace pressures. Barriers to IPC compliance were the ambient environment and fatigue.

CONCLUSIONS

A safety culture was successfully built at HSQIF to optimise IPC adherence whilst managing multiple hazards including prevention of COVID-19 transmission. Strategies implemented by AUSMAT at the quarantine facility may inform the development of safety culture in other settings.

Factors Affecting the Functional Preparedness of Hospitals in Response to Disasters: A Systematic Review

Objective

This study aimed to comprehensively determine the factors that affect the hospitals' functional preparedness in response to disasters.

Methods

A systematic review of studies published in English and Persian up to the end of 2022 was performed by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that assessed hospitals' functional preparedness were searched by using a combination of medical subject heading terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022, in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed, summarized, and reported using the content analysis method.

Results

Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential factors were identified and classified into seven categories: government, coordination, control, and commanding (7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources (37 factors), education and training (8 factors), multi-layered information management and communication systems (8 factors), and contextual factors (4 factors).

Conclusion

There are different dimensions of hospital preparedness for disasters, each of which is influenced by several independent factors. Addressing these factors will enhance the actual functional preparedness of hospitals encountering disasters.

Evaluation of the antibiotic prescription in a hospital emergency department: Pilot study

OBJECTIVE

A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription.

METHOD

Observational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to 7 different days of the week, in 7 consecutive weeks.

INCLUSION CRITERIA

patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by 2 specialists in emergencies, 2 pharmacists and one specialist in infectious diseases, all unrelated to prescriptions.

RESULTS

One hundred sixty eight patients with 192 prescriptions were evaluated. 76 (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa=0.71).

CONCLUSIONS

A high rate of inappropriate antimicrobial prescriptions was obtained in a hospital emergency department according to local guidelines. The hospital pharmacist has an opportunity to improve the use of antimicrobials in this area.

[Translated article] Evaluation of the antibiotic prescription in a hospital emergency department: Pilot study

OBJECTIVE

A study about the adherence of the antimicrobial prescriptions to the local guidelines of treatment of infections was conducted in a hospital emergency department to study the clinical and epidemiological characteristics of the patients who received these treatments. Conducting a feasibility study for supporting the design and execution of future studies, addressing specific aspects of the appropriateness of the antimicrobial prescription.

METHOD

Observational, descriptive and cross-sectional pilot study, with retrospective data collection about the antimicrobial prescription in a hospital emergency department. Seven cross sections were made, corresponding to seven different days of the week, in seven consecutive weeks.

INCLUSION CRITERIA

patient over 14 years of age, with at least one first dose of antimicrobial treatment prescribed on the day of recruitment. The main variable was the inappropriate antimicrobial prescription according to the local guidelines. Epidemiological and clinical parameters of the patients were collected as secondary variables. In order to determine inappropriate prescription a revision was carried out by two specialists in emergencies, two pharmacists and one specialist in infectious diseases, all unrelated to prescriptions.

RESULTS

168 patients with 192 prescriptions were evaluated. Seventy-six (39.6%) of the prescriptions were not conformed to the local treatment guidelines. Of these, 55% were with active antimicrobial coverage against the microorganism but not recommended, 23.5% with inactive drugs, 13.7% presented an inappropriate dose and 7.8% were unnecessary treatment. The strength of agreement in the evaluation of the adequacy of treatment between doctors and pharmacists was high (kappa = 0.71).

CONCLUSIONS

A high rate of inappropriate antimicrobial prescriptions was obtained in a hospital emergency department according to local guidelines. The hospital pharmacist has an opportunity to improve the use of antimicrobials in this area.

[First- and second-line hospital management of ophthalmologic emergencies: Clinical pathway study of 1360 patients]

The general practitioner (GP) might offer a good alternative for the management of certain ophthalmologic emergencies in his or her practice, given the increasing demand for ophthalmological care and difficulties with access to ophthalmologists. The main objective of the study was to describe ophthalmological complaints and their management in general emergency departments compared to ophthalmological emergency departments in order to assess which pathologies can be treated by the GP. This was a single-center retrospective study at the University Hospital of Reims, based on consultation data from the general and ophthalmological emergency departments for all adult patients presenting for an ophthalmological problem in September 2019 and September 2020. Consultations where patients were brought back following a first emergency consultation and consultations for another non-ophthalmological reason were excluded. Out of 1360 consultations recorded, 16% of patients had initially consulted their GP. The 4 most frequent diagnoses were: "ocular trauma," "conjunctivitis," "eye pain" and "visual impairment." A prescription for medication was issued in 77% of cases, 37% of which were for antibiotics. Only 29% of consultations carried out in general emergency departments led to a request for a complementary ophthalmology consultation. The GP might therefore be able to manage certain ophthalmological emergencies in his or her practice as a first line and refer certain ophthalmologic emergencies. However, the training of GPs in this specialty must be reinforced in collaboration with ophthalmologists.

The effect of the COVID-19 pandemic on forensic cases admitted to an emergency department

The COVID-19 disease has given rise to various negative effects on human life in terms of health and economic and social well-being. We believe that these negative effects may have led to increased forensic incidents such as violence and suicide. Therefore, in this study, we sought to examine the effects of COVID-19 in forensic cases admitted to an emergency department. Methods: This is a retrospective observational study, performed at the emergency department of Fatih Sultan Mehmet Education and Research Hospital. Forensic cases admitted between March and June 2020 (pandemic period) and forensic cases admitted between March and June 2019 (pre-pandemic period) were compared in the study. Results: A total of 4296 patients were included in the study, of which 3011 were admitted during the pre-pandemic period and 1285 during the time of the COVID-19 pandemic. While the percentages of suicide attempts (3.6%), motorcycle traffic accidents (7.4%), and violent incidents (29.4%) were higher during the pandemic period, the percentages of in-vehicle traffic accidents (5.4%) and pedestrian traffic accidents (2.2%) were lower (respectively, p = 0.035, p = 0.005, p < 0.001, p = 0.015, p = 0.008). At the time of the pandemic, the percentages of incidents of violence against women (44.2%) and traffic accidents with a motorcycle involving men (9.3%) were higher than during the time before the pandemic (p < 0.001 and p < 0.001, respectively). Conclusions: The effects of the pandemic on our lifestyle are indisputable. This study reveals that the pandemic also affected patients who were admitted to the emergency department for forensic reasons. In addition, the increase in the percentages of suicide and violent events indicates that pandemics probably increase feelings of fear, loss, and hopelessness, and special precautions should be taken to maintain order in the society.

Multimodality imaging of adrenal gland pathologies: A comprehensive pictorial review

The assessment of acute abdominal and pelvic emergencies typically involves a multimodal approach consisting of plain radiographs, ultrasound, computed tomography (CT), and rarely magnetic resonance imaging (MRI). Although MRI is not traditionally employed in acute care settings, there are several instances in which MRI provides superior functional and prognostic information. In this manuscript, we highlight multimodal findings of adrenal gland emergencies: Hemorrhage, infarction, and infection. The purpose of our study is to highlight significant findings in various modalities, including CT, MRI, ultrasound, and PET/CT. Due to the scarcity of published data and limited clinical use, primary ultrasound findings are limited in our multimodal review. In conclusion, we find that synergistic use of CT, MRI, and functional imaging provides an effective tool for evaluation and management of adrenal pathology.

Anesthetic management for emergency tracheostomy in patients with head and neck cancer: a case series

Tracheostomy is a surgical procedure that is commonly used to treat upper airway obstruction. In particular, patients with head and neck cancer may require elective or emergency tracheostomy because of airway obstruction due to massive bleeding of the intraoral tumor mass and rapid growth of the tumor mass in the neck area. Here, we report four cases of tracheostomy in patients with head and neck cancer with narrowed airway space and difficulty in breathing. Based on these cases and a literature review, we recommend that oral and maxillofacial surgeons and dental anesthesiologists should cooperate closely and determine the appropriate timing to perform definitive airway management for such patients during palliative treatment, along with continuous evaluation of tumor location, risk of recurrence, and airway involvement.

Healthcare utilization after mass trauma: a register-based study of consultations with primary care and mental health services in survivors of terrorism

BACKGROUND

Knowledge on healthcare utilization after mass trauma is needed to strengthen the public health preparedness to such incidents. Using register-based data, this study had a unique opportunity to investigate how young survivors' use of primary care physicians (PCP) and mental health services (MHS) changed after a terrorist attack.

METHODS

We examined register-based data on PCP and MHS consultations among 255 survivors (52% male) of the 2011 Utøya youth camp attack in Norway 3 years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC- 2).

RESULTS

The PCP and MHS consultation rates (CR) were higher in female than male survivors both acutely and at long-term. The mean yearly CRs increased from 2.25 to 4.41 for PCP and 1.77 to 13.59 for MHS the year before and after the attack in female survivors, and from 1.45 to 3.65 for PCP and 1.02 to 11.77 for MHS in male survivors. The third year post-attack CRs for PCP were 3.55 and 2.00; and CRs for MHS were 5.24 and 2.30 in female and male survivors, respectively. Among female survivors, 76% consulted PCP and 12% MHS the year preceding the attack; post-attack 93% consulted PCP and 73% MHS the first year; decreasing to 87 and 40% the third year. Among male survivors, 61% consulted PCP and 7% MHS the year preceding the attack; post-attack 86% consulted PCP and 61% MHS the first year, and 67 and 31% the third year. As for PCP consultations, there was a particular increase in psychological reasons for encounter following the attack.

CONCLUSIONS

This study indicates that it is important to anticipate an increased healthcare utilization several years following mass trauma, particularly of MHS. Both PCP and MHS practitioners played important roles in providing healthcare for psychological problems in young survivors of terrorism in a country with universal and largely publicly financed healthcare and a gatekeeping system. The healthcare utilization could be different in countries with other health systems or psychosocial care responses to mass trauma.

Predictors of Postoperative Outcome in Emergency Laparotomy for Perforation Peritonitis; a Retrospective Cross-sectional Study

INTRODUCTION

Hollow viscus perforation is a significant cause of surgical mortality. Various attempts have been made to identify high-risk patients preoperatively and optimize and manage such patients more aggressively. This study aimed to evaluate the predictors of outcome in patients undergoing emergency laparotomy for perforation peritonitis.

METHODS

This retrospective cross-sectional study was conducted on perforation peritonitis cases admitted to the Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, India. The association between preoperative patient variables with postoperative complications, anastomotic leaks, need for intensive care unit (ICU) admission, and 30-day mortality were evaluated.

RESULTS

Tachycardia at the time of admission (t = 2.443, p = 0.020), hypotension (χ2 = 18.214, p = <0.001), lower haemoglobin (t = -4.134, p = <0.001), higher blood urea nitrogen levels (W = 1967.000, p = 0.012), International Normalised Ratio (INR) ≥ 1.5 (χ2 = 17.340, p = <0.001), the mean albumin level 2.89 ± 0.77 g/dL (t = -2.348, p = 0.027), and delay in surgery (χ2 = 28.423, p = 0.008) were significant associate factors of mortality. The association between need for ICU admission and higher pulse rate on admission (W = 2782.500, p = 0.011), lower systolic blood pressure (W = 1627.500, p = 0.029), higher blood urea nitrogen (W = 2299.000, p = 0.030) and serum creatinine levels (W = 2192.500, p = 0.045), preoperative coagulopathy (χ2 = 6.773, p = 0.017), hypoalbuminemia (t = -2.515, p = 0.016), and delay in surgery (χ2 = 17.780, p = 0.016) was significant.

CONCLUSION

Based on the results of this study, hypotension, azotaemia, coagulopathy, and delay in surgery, increase the risk of postoperative mortality of patients undergoing emergency laparotomy for perforation peritonitis. Tachycardia, hypotension, azotaemia, hypoalbuminemia, and pre-operative coagulopathy were good predictors of need for ICU admission. Shock at presentation, deranged renal function and coagulopathy were associated with an increased risk of postoperative complications.

The diagnostic capabilities of the combined cardiac and lung point of care ultrasound in shocked patients at the emergency department - Resourced limited country

Purpose

Cardiac, lung, and inferior vena cava (IVC) ultrasound are commonly performed in the care of emergency patients especially patient presented with hypotension or shock. However, the literature indicated the limitation of IVC to assess shocked patients. This study aims to determine the efficacy of combined cardiac and lung ultrasound for evaluation the etiology of shock.

Materials and Methods

A cross-sectional study was conducted on patient with shock at emergency department, Srinagarind Hospital, Thailand, from January to December 2021. Adult shocked patients who met the criteria were included in this study. Ultrasound and emergency department medical records were documented and analyzed as sensitivity, specificity, predictive value, negative predictive value, diagnostic accuracy, and Cohen's kappa coefficient (κ).

Results

One hundred and two who met the criteria were enrolled. Combined cardiac and lung scans were found to be accurate 99.02% and 93.04% in obstructive and cardiogenic shock. In patients with obstructive shock was the almost perfect agreement, (κ) = 0.85. However, distributive, and hypovolemic shock had the low concordance with the final hospital diagnosis, (κ) = 0.37 and 0.43, respectively.

Conclusions

The integration of cardiac and lung ultrasound can be effectively used to narrow differential diagnosis of shock.

[Gyneco-obstetrical emergencies at the obstetrics and gynecology department of Sousse: epidemiological study and becoming of the consultants]

Introduction

the objective of this work was to establish the clinical profile of patients consulting in gyneco-obstetrical emergencies and identify the reasons for consultation and the becoming of the consultants.

Methods

a one-center retrospective descriptive observational study was performed including patients who consulted between January 1^st and December 31^st, 2018. Obstetric emergencies after 36 weeks of amenorrhea were not included. We drew lots 4 months of the year 2018 (one month per season). Then we drew lots 2 weeks of each month. A data collection sheet was developed for the purposes of this work.

Results

a total of 2007 patients were included in our study among 15,553 gynecological emergency room consultants during 2018. We found that the largest number of consultants was recorded at the start of the week and between 7 am and 7 pm. The most frequently obstetric reasons observed for consultation were pelvic pain (39.6%), bleeding (23.8%) and vomiting (8.7%). The most frequently gynecological reasons for consultation were pelvic pain (54.2%), then metrorrhagia (18.8%) and mastodynia (7.1%). Of the study participants, 66.82% received an ultrasound, 23% received a beta HCG test. The majority of emergency room consultants were referred to their home.

Conclusion

the majority of patients visiting the emergency room do not have any emergency-related pathologies.

The effect of age on in-hospital mortality among elderly people who sustained fall-related traumatic brain injuries at home: A retrospective study of a multicenter emergency department-based injury surveillance database

BACKGROUND

People older than 65 years tend to have traumatic brain injuries (TBIs) more frequently and have a higher mortality rate after TBI than younger individuals. The aim of this study was to determine the effects of age on in-hospital mortality among patients who had fall-related TBIs at home, emphasizing the effect of specific locations in the house on the outcome.

METHODS

This cross-sectional study was conducted using the Emergency Department-based Injury In-Depth Surveillance (EDIIS) database in South Korea. Patients aged 65 years or older with a slip or fall injury, accidental injury at home, and no major diagnosis other than TBI were included. The primary outcome was in-hospital mortality. Subgroup analysis was conducted to determine the effect of locations on the relationship between age and in-hospital mortality.

RESULTS

Of the 2,571,442 patients in the EDIIS database, 9,747 were included in this study. The most common injury location was room or bedroom (29.1%), followed by living room or kitchen (23.0%), bathroom (20.2%), stairs (15.8%), and outdoor spaces of the house (11.9%). There was a significant association between increased in-hospital mortality and oldest old age. The stairs or outdoor spaces of the house was significantly associated with in-hospital mortality compared to rooms inside the house. The oldest age group showed a higher association with in-hospital mortality than the young-old group, especially in the bathroom, stairs, and outdoor spaces of the house.

CONCLUSIONS

Elderly individuals over the age of 85 are the most vulnerable to fall-related TBI mortality at home. A fall prevention strategy for the oldest-old is needed, especially for the bathroom, stairs, and the ancillary space outside the house.

Elderly trauma patients and the effect of trauma scores on hospitalization decision

Objectives

Hospitalization, mortality and trauma scores are important in trauma patients aged ≥65 years. The present study aimed to investigate the use of trauma scores in the prediction of hospitalisation and mortality in trauma patients aged ≥65 years.

Material and Methods

Patients aged ≥65 years who presented to the emergency department with trauma over a one-year period were included in the study. Baseline data of the patients together with their Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), hospitalisation and mortality were analysed.

Results

A total of 2264 patients were included in the study, of whom 1434 (63.3%) were women. The most common mechanism of trauma was simple falls. Mean GCS scores, RTSs and ISSs of the inpatients were 14.87 ± 0.99, 6.97 ± 0.343 and 7.22 ± 5.826, respectively. Furthermore, a significant negative correlation was found between the duration of hospitalisation and GCS scores (r= -0.158, p <0.001) and RTSs (r= -0.133, p <0.001), whereas a positive significant correlation with ISSs (r= 0.306, p <0.001) was observed. The ISSs (p <0.001) of the deceased individuals were significantly elevated, whereas their GCS scores (p <0.001) and RTSs (p <0.001) were significantly decreased.

Conclusion

All trauma scoring systems can be used to predict hospitalisation, but the results of the present study suggest that the use of ISS and GCS in making the decision regarding mortality is more appropriate.