Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 6 Articles
Background In Sweden with about 10 million inhabitants, there are about one million primary ambulance missions every year. Among them, around 10% are assessed by Emergency Medical Service (EMS) clinicians with the primary symptom of dyspnoea. The risk of death among these patients has been reported to be remarkably high, at 11,1% and 13,2%. The aim was to develop a Machine Learning (ML) model to provide support in assessing patients in prehospital settings and to compare them with established triage tools. Methods This was a retrospective observational study including 6,354 patients who called the Swedish emergency telephone number (112) between January and December 2017. Patients presenting with the main symptom of dyspnoea were included which were recruited from two EMS organisations in Göteborg and Södra Älvsborg. Serious Adverse Event (SAE) was used as outcome, defined as any of the following:1) death within 30 days after call for an ambulance, 2) a final diagnosis defined as time-sensitive, 3) admitted to intensive care unit, or 4) readmission within 72 h and admitted to hospital receiving a final time-sensitive diagnosis. Logistic regression, LASSO logistic regression and gradient boosting were compared to the Rapid Emergency Triage and Treatment System for Adults (RETTS-A) and National Early Warning Score2 (NEWS2) with respect to discrimination and calibration of predictions. Eighty percent (80%) of the data was used for model development and 20% for model validation. Results All ML models showed better performance than RETTS-A and NEWS2 with respect to all evaluated performance metrics. The gradient boosting algorithm had the overall best performance, with excellent calibration of the predictions, and consistently showed higher sensitivity to detect SAE than the other methods. The ROC AUC on test data increased from 0.73 (95% CI 0.70–0.76) with RETTS-A to 0.81 (95% CI 0.78–0.84) using gradient boosting. Conclusions Among 6,354 ambulance missions caused by patients suffering from dyspnoea, an ML method using gradient boosting demonstrated excellent performance for predicting SAE, with substantial improvement over the more established methods RETTS-A and NEWS2....
The authors aimed to prove that an increase in high-sensitivity Troponin (hsTnT) levels correlates with the corrected QT (QTc) interval measured during a standard 12-lead ECG. From the literature, we know that various drugs, stress, psychological states, and diseases prolong or lengthen the QT interval. The QTc interval, calculated according to the frequency, provides a more accurate result and is used in clinical practice and certain research studies. The QTc interval can be calculated using several formulas, among which the Bazett formula, the oldest mathematical model, shows the most distorted result. This publication demonstrates and proves that higher troponin levels correlate with, and therefore prolong, the QTc interval, which has relevance in clinical practice....
Shark attacks increased 23% globally within the past 20 years on a multifactorial scale through climate change and human impacts, yet healthcare lacks treatment guidelines for these victims. This systematic review proposed a shark attack treatment protocol that will potentially reduce the morbidity and mortality rates by assessing prehospital management with transfusions, hospital management with prophylactic antibiotics, and mental health evaluations to prevent and/or treat psychological impacts. This study screened 463 sources and eliminated 432 sources due to repetition or irrelevance to this study. The protocol initiates with prehospital management by implementing emergency medical service (EMS) to follow the SHARC protocol (systolic blood pressure (SBP) < 90, hemorrhage, appearance, radius of the bite over 15 cm, and coagulopathy) to administer whole blood transfusions in route to a hospital to prevent hypovolemic shock. The next step is the antibiotic protocol to administer ciprofloxacin or moxifloxacin, and a third-generation cephalosporin with doxycycline to prevent wound infections commonly caused by vibrio species. Assessing mental health before and three months after discharge can help prevent and/or treat anxiety, depression, and post-traumatic stress disorder (PTSD)....
Background The ongoing opioid epidemic in the United States has reinforced the need to provide multimodal and non-opioid pain management interventions. The PAMI-ED ALT program employed a multifaceted approach in the Emergency Department (ED) developing electronic health record (EHR) pain management order panels and discharge panels, as well as educating patients, clinicians, and ED staff on opioid alternatives, including nonpharmacologic interventions. The primary objective of this analysis was to compare changes in opioid and nonopioid analgesic administrations and prescribing in ED patients with select pain conditions (renal colic, headache, low back, and non-low back musculoskeletal pain) before and after implementation of PAMI ED-ALT. Secondary outcomes included characterizing changes in 30-day ED all-cause recidivism and hospital all-cause admissions within these pain populations. Methods Demographics, opioid and opioid alternative utilization, hospital admission, 30-day ED returns and change in pain intensity score were collected from January 2019-March 2020 (pre-program implementation) and January 2021-March 2023 (post-program implementation) for both the ED aggregate and program target pain populations. Results Pain management order panel utilization increased throughout the post-implementation period. When comparing pre to post program data, there was a reduction in opioid administrations and prescriptions for most of the target pain conditions, as well as within the ED aggregate population. Opioid alternative administrations and prescriptions increased for all pain conditions except renal colic. Hospital admissions decreased significantly amongst those with low back pain and headache/migraine and 30-day ED returns significantly declined in those with musculoskeletal pain. Conclusion Our findings demonstrate an opioid-alternatives program implemented within a safety-net hospital system serving a predominantly socially disadvantaged patient population can lead to changes in ED pain management and potentially reduce 30-day ED recidivism and hospitalizations....
Background: Approximately 25% of adolescents live with chronic pain, with many reporting symptoms of functional impairment and poor sleep quality. Both chronic pain and poor sleep quality can negatively impact brain functional connectivity and efficiency. Better sleep quality may improve pain outcomes through its relationship with brain functional connectivity. Methods: This pilot prospective cohort study used data from 24 adolescents with chronic pain (aged 10–18 years) participating in an Intensive Interdisciplinary Pain Treatment (IIPT) at the Alberta Children’s Hospital. Data were collected within the first couple of weeks prior to starting IIPT and on the last day of the 3-week IIPT program. Sleep quality was assessed using the modified Adolescent Sleep-Wake Scale. Resting-state functional MRI data were obtained, and graph-theory metrics were applied to assess small-world brain networks. Questionnaires were used to obtain self-reported functional disability data. Paired t-tests were applied to evaluate changes in outcomes from pre- to post-IIPT, and moderation analyses were used to examine the relationships between sleep, small-world brain network connectivity, and functional disability. Results: Total sleep quality (p = 0.005) increased, and functional disability (p = 0.020) decreased, between baseline and discharge from IIPT. Small-world brain networks did not change pre- to post-IIPT (p > 0.05). Unlike adolescents with high smallworldness (p = 0.665), adolescents with low to moderate small-world brain characteristics (1SD below or at the mean) who reported better sleep quality reported less functional disability (all p ≤ 0.001) over time. Conclusions: The IIPT program was associated with improvements in sleep quality and functional disability. Better sleep quality together with greater small-worldness was associated with less pain-related disability. This suggests that it is equally important for IIPTs to target sleep problems in adolescents with chronic pain, as this may have a key role in producing long-term improvements in pain outcomes....
Angioedema is a known side effect of angiotensin-converting enzyme inhibitors (ACE-I). However, trauma precipitating angioedema is a rare event. We detail a case of trauma-induced angioedema in a patient taking an ACE-I. Specifically, a patient presented to the emergency department (ED) having suffered a seizure from symptomatic hyponatremia; later, the patient precipitously developed angioedema requiring nasotracheal intubation. Herein, the mechanisms and treatments for angioedema are discussed. Acute angioedema is important to the emergency medicine physician because quick recognition, regardless of its precipitant can stave off untoward complications, possible respiratory failure and airway emergencies....
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