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Almubayyidh M, Alghamdi I, Parry-Jones AR, Jenkins D. Prehospital identification of intracerebral haemorrhage: a scoping review of early clinical features and portable devices. BMJ Open 2024; 14:e079316. [PMID: 38643005 PMCID: PMC11033659 DOI: 10.1136/bmjopen-2023-079316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Prehospital identification of intracerebral haemorrhage (ICH) in suspected stroke cases may enable the initiation of appropriate treatments and facilitate better-informed transport decisions. This scoping review aims to examine the literature to identify early clinical features and portable devices for the detection of ICH in the prehospital setting. METHODS Three databases were searched via Ovid (MEDLINE, EMBASE and CENTRAL) from inception to August 2022 using prespecified search strategies. One reviewer screened all titles, abstracts and full-text articles for eligibility, while a second reviewer independently screened 20% of the literature during each screening stage. Data extracted were tabulated to summarise the key findings. RESULTS A total of 6803 articles were screened for eligibility, of which 22 studies were included for analysis. Among them, 15 studies reported on early clinical features, while 7 considered portable devices. Associations between age, sex and comorbidities with the presence of ICH varied across studies. However, most studies reported that patients with ICH exhibited more severe neurological deficits (n=6) and higher blood pressure levels (n=11) at onset compared with other stroke and non-stroke diagnoses. Four technologies were identified for ICH detection: microwave imaging technology, volumetric impedance phase shift spectroscopy, transcranial ultrasound and electroencephalography. Microwave and ultrasound imaging techniques showed promise in distinguishing ICH from other diagnoses. CONCLUSION This scoping review has identified potential clinical features for the identification of ICH in suspected stroke patients. However, the considerable heterogeneity among the included studies precludes meta-analysis of available data. Moreover, we have explored portable devices to enhance ICH identification. While these devices have shown promise in detecting ICH, further technological development is required to distinguish between stroke subtypes (ICH vs ischaemic stroke) and non-stroke diagnoses.
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Affiliation(s)
- Mohammed Almubayyidh
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Department of Aviation and Marine, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alghamdi
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Department of Emergency Medical Services, College of Applied Medical Sciences, Khamis Mushait Campus, King Khalid University, Abha, Saudi Arabia
| | - Adrian Robert Parry-Jones
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David Jenkins
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
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Tsuboi H, Takahashi K, Sugano N, Nishiyama K, Komoribayashi N, Itabashi R, Nishimura Y. Effect of early mobilization in patients with stroke and severe disturbance of consciousness: Retrospective study. J Stroke Cerebrovasc Dis 2022; 31:106698. [PMID: 35952553 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the effectiveness and safety of early mobilization with a physiatrist and registered therapist Operating rehabilitation (PROr) for patients with stroke and severe disturbance of consciousness (DoC). MATERIALS AND METHODS We retrospectively screened records from patients with stroke admitted to our hospital from January 2015 to June 2021. Eligible patients with severe DoC were classified into two groups: patients who received standard rehabilitation (control group) and patients who received PROr (PROr group). We studied longitudinal change in the level of consciousness using the Japan Coma Scale (JCS) during hospital stay and compared in-hospital mortality, the incidence of respiratory complication, and modified Rankin Scale of discharge between the two groups. RESULTS Among the 2191 patients screened for inclusion, 16 patients were included in the PROr group, and 12 patients were included in the control group. Early mobilization was more promoted in the PROr group compared to the control group, but there were no significant differences in in-hospital mortality, the incidence of respiratory complication, or modified Rankin Scale at discharge between the two groups. In patients who survived during their hospital stay, JCS scores 2 weeks after the onset of stroke and JCS scores at discharge significantly improved from the start of rehabilitation in the PROr group, but not in the control group. CONCLUSIONS Early mobilization provided with the PROr program appears to be a safe treatment and may contribute to the improvement of consciousness level for patients with acute stroke and severe DoC.
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Affiliation(s)
- Hiroyuki Tsuboi
- Rehabilitation Division, Iwate Medical University Hospital, Japan
| | | | - Naruki Sugano
- Rehabilitation Division, Iwate Medical University Hospital, Japan
| | - Kazunari Nishiyama
- Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
| | - Nobukazu Komoribayashi
- Iwate Prefectural Advanced Critical Care and Emergency Center, Iwate Medical University, Japan
| | - Ryo Itabashi
- Division of Neurology and Gerontology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan.
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Katayama Y, Kiyohara K, Kitamura T, Hayashida S, Shimazu T. Influence of the COVID-19 pandemic on an emergency medical service system: a population-based, descriptive study in Osaka, Japan. Acute Med Surg 2020; 7:e534. [PMID: 32685173 PMCID: PMC7300695 DOI: 10.1002/ams2.534] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim Novel coronavirus infection (COVID‐19) was confirmed in Wuhan, China in December 2019, and the COVID‐19 pandemic has spread around the world. However, no clinical studies on the impact of the COVID‐19 pandemic on emergency medical service (EMS) systems have been carried out. Methods This was a retrospective study with a study period from 1 January 2020 to 14 April 2020. We included the patients transported by ambulance for acute diseases and traffic accidents in Osaka city, Japan. The main outcome of this study was the difficulty in hospital acceptance. We calculated the rate of difficulty of hospital acceptance for each month for acute diseases and traffic accidents. Results Between 1 January and 14 April 2020, 36,981 patients were transported to hospitals by ambulance for acute diseases and 3,096 patients for traffic accidents. There was no difference in the proportion of the difficulty in hospital acceptance due to traffic accidents between 2019 and 2020, but there was an increase in the proportion of the difficulty in hospital acceptance due to acute disease after the 13th week (25–31 March) of 2020 compared to that of 2019. The odds ratio in April was 2.17 (95% confidence interval, 1.84–2.58) for acute disease. Conclusion We assessed the impact of the COVID‐19 pandemic on the EMS system in Osaka City, Japan and found that, since April 2020, the EMS system in Osaka City has been facing difficulty in terms of hospital acceptance of patients transported to hospital for acute diseases.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Kosuke Kiyohara
- Department of Food Science Faculty of Home Economics Otsuma Women's University Tokyo Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Suita Japan
| | | | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
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Kiyohara K, Katayama Y, Kitamura T, Kiguchi T, Matsuyama T, Ishida K, Sado J, Hirose T, Hayashida S, Nishiyama C, Iwami T, Shimazu T. Gender disparities in the application of public-access AED pads among OHCA patients in public locations. Resuscitation 2020; 150:60-64. [PMID: 32199903 DOI: 10.1016/j.resuscitation.2020.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/21/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Female out-of-hospital cardiac arrest (OHCA) patients have been reported to be less likely to receive cardiopulmonary resuscitation by bystanders compared with male patients in prehospital settings. However, no clinical studies have investigated gender disparities in the application of public-access automated external defibrillator (AED) pads among OHCA patients in public locations. METHODS OHCA data from 2011 to 2018 were obtained from the OHCA registry in Osaka City, Japan and OHCAs that occurred in public locations were included. Gender differences in receiving public-access AED pad application by bystanders were assessed according to the age of the OHCA patient (<15, 15-49, 50-74, and ≥75 years) after controlling confounders. RESULTS The analysis included 4358 OHCA patients (3313 male and 1045 female patients). The multivariable logistic regression analyses found no significant gender differences in the likelihood of public-access AED pad application among patients aged <15 years (5.3% in male patients vs 6.3% in female patients; adjusted OR = 1.00, p = 1.000), 50-74 years (16.8% vs 12.7%; adjusted OR = 0.96, p = 0.796), and ≥75 years (12.3% vs 14.8%; adjusted OR = 1.45, p = 0.098). In contrast, among patients aged 15-49 years, female patients were significantly less likely to receive public-access AED pad application compared with male patients (12.1% vs 5.2%; adjusted OR = 0.54, p = 0.032). CONCLUSION In this population, female OHCA patients of reproductive age (15-49 years) were less likely to receive public-access AED pad application compared with male patients of the same age group.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Katayama Y, Matsuyama T, Kitamura T, Hirose T, Kiguchi T, Sado J, Kiyohara K, Takahashi H, Adachi S, Noda T, Izawa J, Ohnishi M, Shimazu T. Prehospital characteristics, incidence trends, and outcome of emergency self-inflicted injury patients with gas substances: a population-based descriptive study in Osaka, Japan. Acute Med Surg 2020; 7:e452. [PMID: 31988764 PMCID: PMC6971468 DOI: 10.1002/ams2.452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/22/2019] [Indexed: 12/05/2022] Open
Abstract
AIM Little is known about the detailed characteristics of patients using gas substances for self-inflicted injury in prehospital settings. The aim of this study was to investigate the characteristics, incidence trends, and outcomes of patients who used gas substances for self-inflicted injury in Osaka City, Japan, using ambulance records. METHODS This was a retrospective observational study that used data from 2009 to 2015. We extracted details from ambulance records of self-inflicted injury patients who used gas substances. The annual incidence of self-inflicted injury by gas substance and age group and Poisson regression models were applied for calculating the annual incidence trend by type of gas substance. The main outcome was confirmed death at the scene, and we also calculated the crude odds ratios and 95% confidence intervals for each gas substance. RESULTS During the study period, there were 324 self-inflicted injury patients who used gas substances. The most commonly used gases were carbon monoxide (CO) (54.9%), followed by hydrogen sulfide (12.7%), helium (6.5%). The incidence of CO and hydrogen sulfide have subsequently decreased (P for trend = 0.023 and <0.001, respectively); however, the incidence of helium did not change during the study period (P for trend = 0.586). The mortality rate was highest in patients who used helium (66.7% [14/21]) and the crude odds ratio of helium was 3.857 (95% confidence interval, 1.267-11.745; P = 0.017) compared with hydrogen sulfide. CONCLUSION This study revealed that the incidence of self-inflicted injury with helium did not change and its proportion of death at the scene was high in Osaka City.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tasuku Matsuyama
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population SciencesDepartment of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
- Emergency and Critical Care CenterOsaka Police HospitalOsakaJapan
| | | | - Junya Sado
- Department of Health and Sport SciencesMedicine for Sports and Performing ArtsOsaka University Graduate School of MedicineSuitaJapan
| | - Kosuke Kiyohara
- Department of Food ScienceFaculty of Home EconomicsOtsuma Women's UniversityTokyoJapan
| | - Hiroki Takahashi
- Department of Emergency and Critical MedicineKansai Medical UniversityHirakataJapan
| | - Shingo Adachi
- Rinku General Medical CenterSenshu Trauma and Critical Care CenterIzumisanoJapan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Junichi Izawa
- Intensive Care UnitDepartment of AnesthesiologyThe Jikei University School of MedicineTokyoJapan
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
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Yumoto T, Naito H, Yorifuji T, Aokage T, Fujisaki N, Nakao A. Association of Japan Coma Scale score on hospital arrival with in-hospital mortality among trauma patients. BMC Emerg Med 2019; 19:65. [PMID: 31694575 PMCID: PMC6836363 DOI: 10.1186/s12873-019-0282-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/24/2019] [Indexed: 01/06/2023] Open
Abstract
Background The Japan Coma Scale (JCS) score has been widely used to assess patients’ consciousness level in Japan. JCS scores are divided into four main categories: alert (0) and one-, two-, and three-digit codes based on an eye response test, each of which has three subcategories. The purpose of this study was to investigate the utility of the JCS score on hospital arrival in predicting outcomes among adult trauma patients. Methods Using the Japan Trauma Data Bank, we conducted a nationwide registry-based retrospective cohort study. Patients 16 years old or older directly transported from the trauma scene between January 2004 and December 2017 were included. Our primary outcome was in-hospital mortality. We examined outcome prediction accuracy based on area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis with multiple imputation. Results A total of 222,540 subjects were included; their in-hospital mortality rate was 7.1% (n = 15,860). The 10-point scale JCS and the total sum of Glasgow Coma Scale (GCS) scores demonstrated similar performance, in which the AUROC (95% CIs) showed 0.874 (0.871–0.878) and 0.878 (0.874–0.881), respectively. Multiple logistic regression analysis revealed that the higher the JCS score, the higher the predictability of in-hospital death. When we focused on the simple four-point scale JCS score, the adjusted odds ratio (95% confidence intervals [CIs]) were 2.31 (2.12–2.45), 4.81 (4.42–5.24), and 27.88 (25.74–30.20) in the groups with one-digit, two-digit, and three-digit scores, respectively, with JCS of 0 as a reference category. Conclusions JCS score on hospital arrival after trauma would be useful for predicting in-hospital mortality, similar to the GCS score.
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Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyuki Aokage
- Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noritomo Fujisaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Okamoto J, Katayama Y, Kitamura T, Sado J, Nakamura R, Kimura N, Misaki H, Yamao S, Nakao S, Nitta M, Iwami T, Fujimi S, Kuwagata Y, Shimazu T, Matsuoka T. Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population-based registry of emergency patients with both ambulance and in-hospital records. Acute Med Surg 2018; 6:12-24. [PMID: 30651993 PMCID: PMC6328924 DOI: 10.1002/ams2.371] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
Abstract
Aim To describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in‐hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan. Methods The Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on‐scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data. Results From January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system. Conclusion Using the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.
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Affiliation(s)
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine Division of Environmental Medicine and Population Sciences Osaka University Graduate School of Medicine Suita Japan
| | - Junya Sado
- Department of Health and Sports Sciences Medicine for Sports and Performing Arts Osaka University Graduate School of Medicine Suita Japan
| | | | | | | | | | - Shota Nakao
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
| | - Masahiko Nitta
- Department of Emergency Medicine Osaka Medical College Takatsuki Japan
| | - Taku Iwami
- Kyoto University Health Service Kyoto Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuya Matsuoka
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
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van Gaal S, Demchuk A. Clinical and Technological Approaches to the Prehospital Diagnosis of Large Vessel Occlusion. Stroke 2018. [PMID: 29540610 DOI: 10.1161/strokeaha.117.017947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen van Gaal
- From the Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada (S.v.G.); and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada (A.D.).
| | - Andrew Demchuk
- From the Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada (S.v.G.); and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada (A.D.)
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Cai P, Peng Y, Li L, Chu W, Wang X. Fibroblast growth factor 23 (FGF23) gene polymorphisms are associated with essential hypertension risk and blood pressure levels in Chinese Han population. Clin Exp Hypertens 2018; 40:680-685. [PMID: 29336609 DOI: 10.1080/10641963.2018.1425417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this case-control study, 246 EH patients and 157 healthy controls were selected from Chinese Han population to explore the associations between the fibroblast growth factor 23 (FGF23) gene polymorphisms and essential hypertension (EH).The SequenomMassarray system was used for the genotyping of three FGF23 gene Tag single-nucleotide polymorphisms, namely rs7955866, rs13312756, and rs3812822. The primers were designed by Assay Designer 3.1 software, and then the samples were added to a 384-well plate for the polymerase chain reaction amplification, shrimp alkaline phosphatase reaction, and desalting after extension. The distributions of the alleles, genotypes, and haplotypes were compared between the two groups. Confounding factors (sex, age, BMI, smoking, and drinking) were adjusted in the non-logistic regression, and the results showed that rs7955866 and rs3812822 polymorphisms were independently associated with the risk of developing EH (P < 0.05). The statistical analysis of the haplotype of rs7955866-rs13312756-rs3812822 showed that haplotype ACC could increase the risk of developing EH (P = 0.046; OR = 1.513, 95%CI: 1.005-2.278). The analysis of the control group showed that carrying rs7955866 A allele (P = 0.031) and rs3812822 C allele (P = 0.025) was associated with the increase of systolic blood pressure (SBP). The insulin (INS) level in the peripheral blood was significantly different between the case and control groups (P = 0.014). After confounding factors were excluded, the results showed that the serum INS level was also an independent risk factor of developing EH (P = 0.044; OR = 1.604, 95%CI: 1.014-2.539). In summary, our results suggest that FGF23 gene polymorphisms are associated with the risk of developing EH in Chinese Han population.
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Affiliation(s)
- Peng Cai
- a Deparment of Cardiology , Institute of Field Surgery, Daping Hospital, Third Military Medical University , Chongqing , China
| | - Yan Peng
- a Deparment of Cardiology , Institute of Field Surgery, Daping Hospital, Third Military Medical University , Chongqing , China
| | - Li Li
- a Deparment of Cardiology , Institute of Field Surgery, Daping Hospital, Third Military Medical University , Chongqing , China
| | - Wei Chu
- a Deparment of Cardiology , Institute of Field Surgery, Daping Hospital, Third Military Medical University , Chongqing , China
| | - Xukai Wang
- a Deparment of Cardiology , Institute of Field Surgery, Daping Hospital, Third Military Medical University , Chongqing , China
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Katayama Y, Kitamura T, Kiyohara K, Iwami T, Kawamura T, Izawa J, Gibo K, Komukai S, Hayashida S, Kiguchi T, Ohnishi M, Ogura H, Shimazu T. Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based Before-and-After Observational Study in Osaka City, Japan. JMIR Mhealth Uhealth 2017; 5:e134. [PMID: 28893725 PMCID: PMC5616023 DOI: 10.2196/mhealth.8296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Recently, the number of ambulance dispatches has been increasing in Japan, and it is therefore difficult for hospitals to accept emergency patients smoothly and appropriately because of the limited hospital capacity. To facilitate the process of requesting patient transport and hospital acceptance, an emergency information system using information technology (IT) has been built and introduced in various communities. However, its effectiveness has not been thoroughly revealed. We introduced a smartphone app system in 2013 that enables emergency medical service (EMS) personnel to share information among themselves regarding on-scene ambulances and the hospital situation. Objective The aim of this study was to assess the effects of introducing this smartphone app on the EMS system in Osaka City, Japan. Methods This retrospective study analyzed the population-based ambulance records of Osaka Municipal Fire Department. The study period was 6 years, from January 1, 2010 to December 31, 2015. We enrolled emergency patients for whom on-scene EMS personnel conducted hospital selection. The main endpoint was the difficulty experienced in gaining hospital acceptance at the scene. The definition of difficulty was making ≥5 phone calls by EMS personnel at the scene to hospitals until a decision to transport was determined. The smartphone app was introduced in January 2013, and we compared the patients treated from 2010 to 2012 (control group) with those treated from 2013 to 2015 (smartphone app group) using an interrupted time-series analysis to assess the effects of introducing this smartphone app. Results A total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 emergency patients in the control group (50.00%, 300,313/600,526) from 2010 to 2012 and 300,395 emergency patients in the smartphone app group (50.00%, 300,395/600,526) from 2013 to 2015. The rate of difficulty in hospital acceptance was 14.19% (42,585/300,131) in the control group and 10.93% (32,819/300,395) in the smartphone app group. No change over time in the number of difficulties in hospital acceptance was found before the introduction of the smartphone app (regression coefficient: −2.43, 95% CI −5.49 to 0.64), but after its introduction, the number of difficulties in hospital acceptance gradually decreased by month (regression coefficient: −11.61, 95% CI −14.57 to −8.65). Conclusions Sharing information between an ambulance and a hospital by using the smartphone app at the scene was associated with decreased difficulty in obtaining hospital acceptance. Our app and findings may be worth considering in other areas of the world where emergency medical information systems with IT are needed.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Iwami
- Kyoto University Health Sevices, Kyoto, Japan
| | | | - Junichi Izawa
- Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Sho Komukai
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | | | | | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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11
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Gabayan GZ, Gould MK, Weiss RE, Derose SF, Chiu VY, Sarkisian CA. Emergency Department Vital Signs and Outcomes After Discharge. Acad Emerg Med 2017; 24:846-854. [PMID: 28375565 DOI: 10.1111/acem.13194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vital signs are critical markers of illness severity in the emergency department (ED). Providers need to understand the abnormal vital signs in older adults that are problematic. We hypothesized that in patients age > 65 years discharged from the ED, there are abnormal vital signs that are associated with an admission to an inpatient bed within 7 days of discharge. METHODS We conducted a retrospective cohort study using data from a regional integrated health system of members age > 65 years during the years 2009 to 2010. We used univariate contingency tables to assess the relationship between hospital admission within 7 days of discharge and vital sign (including systolic blood pressure [sBP], heart rate [HR], body temperature, and pulse oximetry [SpO2 ] values measured closest to discharge) using standard thresholds for abnormal and thresholds derived from the study data. RESULTS Of 104,025 ED discharges, 4,638 (4.5%) were followed by inpatient admission within 7 days. Vital signs had a greater odds of admission beyond a single cutoff. The vital signs with at least twice the odds of admission were sBP < 97 mm Hg (odds ratio [OR] = 2.02, 95% CI = 1.57-2.60), HR > 101 beats/min (OR = 2.00 95% CI = 1.75-2.29), body temperature > 37.3°C (OR = 2.14, 95% CI = 1.90-2.41), and pulse oximetry < 92 SpO2 (OR = 2.04, 95% CI = 1.55-2.68). Patients with two vital sign abnormalities per the analysis had the highest odds of admission. A majority of patients discharged with abnormal vital signs per the analysis were not admitted within 7 days of ED discharge. CONCLUSION While we found a majority of patients discharged with abnormal vital signs as defined by the analysis, not to be admitted after discharge, we identified vital signs associated with at least twice the odds of admission.
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Affiliation(s)
- Gelareh Z. Gabayan
- Department of Medicine; University of California; Los Angeles CA
- Department of Medicine; Greater Los Angeles Veterans Affairs Healthcare System; Los Angeles CA
| | - Michael K. Gould
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA
| | - Robert E. Weiss
- Department of Biostatistics; UCLA Fielding School of Public Health; Los Angeles CA
| | - Stephen F. Derose
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA
| | - Vicki Y. Chiu
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA
| | - Catherine A. Sarkisian
- Department of Medicine; University of California; Los Angeles CA
- Department of Medicine; Greater Los Angeles Veterans Affairs Healthcare System; Los Angeles CA
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12
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Katayama Y, Kitamura T, Kiyohara K, Iwami T, Kawamura T, Hayashida S, Yoshiya K, Ogura H, Shimazu T. Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan. BMJ Open 2016; 6:e013849. [PMID: 27798040 PMCID: PMC5093624 DOI: 10.1136/bmjopen-2016-013849] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls. DESIGN A retrospective, observational study. SETTING Osaka City, Japan. PARTICIPANTS A total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013. PRIMARY OUTCOME MEASUREMENTS The definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls. RESULTS Multivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene. CONCLUSIONS Ambulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kosuke Kiyohara
- Division Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | | | | | - Kazuhisa Yoshiya
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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13
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Gioia LC, Zewude RT, Kate MP, Liss K, Rowe BH, Buck B, Jeerakathil T, Butcher K. Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics. Neurology 2016; 86:2146-53. [PMID: 27194383 DOI: 10.1212/wnl.0000000000002747] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/11/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic). METHODS A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted. Hospital charts and neuroimaging were utilized to determine the final diagnosis (ischemic stroke, TIA, ICH, or stroke mimic). RESULTS A total of 960 patients were transported by EMS to ED with suspected stroke. Stroke was diagnosed in 544 patients (56.7%) (38.2% ischemic stroke, 12.2% TIA, 5.3% ICH) and 416 (43.2%) were considered mimics. Age-adjusted mean prehospital systolic BP (SBP) was higher in acute stroke patients (155.6 mm Hg; 95% confidence interval [CI]: 153.4-157.9 mm Hg) compared to mimics (146.1 mm Hg; 95% CI: 142.5-148.6 mm Hg; p < 0.001). Age-adjusted mean prehospital SBP was higher in ICH (172.3 mm Hg; 95% CI: 165.1-179.7 mm Hg) than in either ischemic stroke or TIA (154.7 mm Hg; 95% CI: 152.3-157.0 mm Hg; p < 0.001). Median (interquartile range) SBP drop from initial prehospital SBP to ED SBP was 4 mm Hg (-6 to 17 mm Hg). Mean prehospital SBP was strongly correlated with ED SBP (r = 0.82, p < 0.001). CONCLUSIONS Prehospital SBP is higher in acute stroke relative to stroke mimics and highest in ICH. Given the stability of BP between initial EMS and ED measurements, it may be reasonable to test the feasibility and safety of prehospital antihypertensive therapy in patients with suspected acute stroke.
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Affiliation(s)
- Laura C Gioia
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Rahel T Zewude
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Mahesh P Kate
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Kim Liss
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Brian H Rowe
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Brian Buck
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Thomas Jeerakathil
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada
| | - Ken Butcher
- From the Division of Neurology (L.C.G.), University of Montreal; Division of Neurology (R.T.Z., M.P.K., B.B., T.J., K.B.), University of Alberta; Department of Emergency Medical Services (K.L.), Alberta Health Services; and Department of Emergency Medicine (B.H.R.), University of Alberta, Canada.
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14
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Sharma M, Helzner E, Sinert R, Levine SR, Brandler ES. Patient characteristics affecting stroke identification by emergency medical service providers in Brooklyn, New York. Intern Emerg Med 2016; 11:229-36. [PMID: 26553585 DOI: 10.1007/s11739-015-1347-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
Early identification of stroke should begin in the prehospital phase because the benefits of thrombolysis and clot extraction are time dependent. This study aims to identify patient characteristics that affect prehospital identification of stroke by Long Island college hospital (LICH) emergency medical services (EMS). All suspected strokes brought to LICH by LICH ambulances from January 1, 2010 to December 31, 2011 were included in the study. We compared prehospital care report-based diagnosis against the get with the guidelines (GWTG) database. Age-adjusted logistic regression models were used to study that the effect of individual patient characteristics have on EMS providers' diagnosis. Included in the study were 10,384 patients with mean age 43.9 years. Of whom, 75 had a GWTG cerebrovascular diagnosis: 53 were ischemic strokes, 7 transient ischemic attacks, 3 subarachnoid hemorrhage, and 12 intercerebral bleeds. LICH EMS correctly identified 44 of 75 GWTG strokes. Fifty-one patients were overcalled as stroke by the EMS. Overall EMS sensitivity was 58.7 % and specificity was 99.5 %. Dispatcher call type of altered mental status, stroke, unconsciousness, and increasing prehospital blood pressure quartile were found to be significantly predictive of a true stroke diagnosis. Patients with a past medical history and EMS providers' impression of seizures were more likely to be overcalled as a stroke in the field. More than a third of actual stroke patients were missed in the field in our study. Our results show that the patients' past medical history, dispatcher collected information and prehospital vital sign measurements are associated with a true diagnosis of stroke.
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Affiliation(s)
- Mohit Sharma
- Department of Community Medicine, Government Medical College and Guru Nanak Dev Hospital, Amritsar, 143001, India.
| | - Elizabeth Helzner
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Richard Sinert
- Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA.
| | - Steven Richard Levine
- Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA.
- Department of Neurology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA.
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15
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Kiyohara K, Nishiyama C, Hayashida S, Matsuyama T, Hatakeyama T, Shimamoto T, Izawa J, Fujii T, Katayama Y, Iwami T, Kitamura T. Characteristics and Outcomes of Bath-Related Out-of-Hospital Cardiac Arrest in Japan. Circ J 2016; 80:1564-70. [DOI: 10.1253/circj.cj-16-0241] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kosuke Kiyohara
- Department of Public Health, Tokyo Women’s Medical University
| | - Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Medicine and School of Health Sciences, Kyoto University
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | | | | | | | | | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | | | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
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16
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Sakai T, Kitamura T, Iwami T, Nishiyama C, Tanigawa-Sugihara K, Hayashida S, Nishiuchi T, Kajino K, Irisawa T, Shiozaki T, Ogura H, Tasaki O, Kuwagata Y, Hiraide A, Shimazu T. Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City. Scand J Trauma Resusc Emerg Med 2014; 22:53. [PMID: 25182381 PMCID: PMC4156961 DOI: 10.1186/s13049-014-0053-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO. METHODS We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx. RESULTS A total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21-13.00], p = 0.023). CONCLUSIONS From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO.
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Affiliation(s)
- Tomohiko Sakai
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan.
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