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1.
Saee Byel Kang Kyung Su Kim Gil Joon Suh Woon Yong Kwon Kyoung Min You Min Ji Park Jung-In Ko Taegyun Kim 《The American journal of emergency medicine》2017,35(10):1457-1461
Background
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy.Methods
All adult OHCA patients were retrospectively analyzed in a single institution for 6 years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy.Results
Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P = 0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n = 341; P = 0.028), patients with survival to admission (n = 172, P = 0.002), patients with discharge CPC 1 or 2 (n = 18, P = 0.010) and patients with discharge CPC 3 or 4 (n = 57, P = 0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge.Conclusions
Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy. 相似文献2.
Lindley E. Folkerson Duncan Sloan Elizabeth Davis Ryan S. Kitagawa Bryan A. Cotton John B. Holcomb Jeffrey S. Tomasek Charles E. Wade 《The American journal of emergency medicine》2018,36(1):38-42
Study hypothesis
Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality.Methods
We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009–May 2013, excluding those with polytrauma and anticoagulant use. Rapid thrombelastography (rTEG) was obtained after emergency department (ED) arrival and coagulopathy was defined as follows: ACT ≥ 128 s, KT ≥ 2.5 s, angle ≤ 56°, MA ≤ 55 mm, LY-30 ≥ 3.0% or platelet count ≤ 150,000/μL. Regression modeling was used to assess the association of coagulopathy on mortality.Results
1086 patients with head CT scans performed and ICU admission orders were reviewed. After exclusion criteria were met, 347 patients with isolated TBI were analyzed-99 (29%) with p-TBI and 248 (71%) with b-TBI. Patients with p-TBI had a higher mortality (41% vs. 10%, p < 0.0001) and a greater incidence of coagulopathy (64% vs. 51%, p < 0.003). After dichotomizing p-TBI patients by mortality, patients who died were younger and were more coagulopathic. When adjusting for factors available on ED arrival, coagulopathy was found to be an early predictor of mortality (OR 3.99, 95% CI 1.37, 11.72, p-value = 0.012).Conclusions
This study demonstrates that p-TBI patients with significant coagulopathy have a poor prognosis. Coagulopathy, in conjunction with other factors, can be used to earlier identify p-TBI patients with worse outcomes and represents a possible area for intervention. 相似文献3.
Ebru Biyikli Afsin Emre Kayipmaz Cemil Kavalci 《The American journal of emergency medicine》2018,36(4):647-650
Background
Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance.Objective
Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department.Methods
This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department.Results
131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n = 59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001).Conclusion
Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p = 0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. 相似文献4.
Ye Ma Lili Huang Lu Zhang Hai Yu Bin Liu 《The American journal of emergency medicine》2018,36(7):1270-1279
Background
Obesity as one of the risk factors for cardiovascular diseases increases mortality in general population. Several clinical studies investigated clinical outcomes in patients with different body mass index (BMI) after cardiac arrest (CA). Controversial data regarding BMI on clinical outcomes in those patients exist in those studies. Therefore, we conducted a meta-analysis to evaluate the effect of BMI on survival condition and neurological prognosis in those patients.Methods
We searched Pubmed, Embase, Ovid/Medline and EBM reviews databases for relational studies investigating the association between BMI and clinical outcomes of patients after CA. Seven studies involving 25,035 patients were included in this meta-analysis. Primary outcome was survival condition and secondary outcome was neurological prognosis. Three comparisons were conducted: underweight (BMI < 18.5) versus normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) versus normal weight and obese (BMI ≥ 30) versus normal weight.Results
Using normal weight patients as reference, underweight patients had a higher mortality (odds ratio [OR] 1.35; 95% confidence interval [CI] 1.10 to 1.66; P = 0.004; I2 = 17%). Overweight was associated with increased hospital survival (OR 0.80; 95% CI 0.65 to 0.98; P = 0.03; I2 = 62%) and better neurological recovery (OR 0.72; 95% CI 0.61 to 0.85; P < 0.001; I2 = 0%). No significant difference was found in clinical outcomes between obese and normal weight patients.Conclusions
Low BMI was associated with lower survival rate in CA patients. Overweight was associated with a higher survival rate and better neurological recovery. Clinical outcomes did not differ between obese and normal weight patients. Further studies are needed to explore the underlying mechanisms. 相似文献5.
Chenxi Dai Zhi Wang Liang Wei Gang Chen Bihua Chen Feng Zuo Yongqin Li 《The American journal of emergency medicine》2018,36(12):2242-2248
Objective
Early and reliable prediction of neurological outcome remains a challenge for comatose survivors of cardiac arrest (CA). The purpose of this study was to evaluate the predictive ability of EEG, heart rate variability (HRV) features and the combination of them for outcome prognostication in CA model of rats.Methods
Forty-eight male Sprague-Dawley rats were randomized into 6 groups (n = 8 each) with different cause and duration of untreated arrest. Cardiopulmonary resuscitation was initiated after 5, 6 and 7 min of ventricular fibrillation or 4, 6 and 8 min of asphyxia. EEG and ECG were continuously recorded for 4 h under normothermia after resuscitation. The relationships between features of early post-resuscitation EEG, HRV and 96-hour outcome were investigated. Prognostic performances were evaluated using the area under receiver operating characteristic curve (AUC).Results
All of the animals were successfully resuscitated and 27 of them survived to 96 h. Weighted-permutation entropy (WPE) and normalized high frequency (nHF) outperformed other EEG and HRV features for the prediction of survival. The AUC of WPE was markedly higher than that of nHF (0.892 vs. 0.759, p < 0.001). The AUC was 0.954 when WPE and nHF were combined using a logistic regression model, which was significantly higher than the individual EEG (p = 0.018) and HRV (p < 0.001) features.Conclusions
Earlier post-resuscitation HRV provided prognostic information complementary to quantitative EEG in the CA model of rats. The combination of EEG and HRV features leads to improving performance of outcome prognostication compared to either EEG or HRV based features alone. 相似文献6.
Taeyoung Kong Jong Eun Park Yoo Seok Park Hye Sun Lee Je Sung You Hyun Soo Chung Incheol Park Sung Phil Chung 《The American journal of emergency medicine》2017,35(12):1819-1827
Background
This is the first study to evaluate the association between the serially measured RDW values and clinical severity in patients surviving > 24 h after sustaining trauma. We evaluated the serial measurement and cut-off values of RDW to determine its significance as a prognostic marker of early mortality in patients with suspected severe trauma.Methods
This study retrospectively analyzed prospective data of eligible adult patients who were admitted to the ED with suspected severe trauma. The RDW was determined on each day of hospitalization. The primary outcome was all-cause mortality within 28-days of ED admission.Results
We included 305 patients who met our inclusion criteria. The multivariate Cox regression model demonstrated that higher RDW values on day 1 (hazard ratio [HR], 1.558; 95% confidence interval [CI], 1.09–2.227; p = 0.015) and day 2 (HR, 1.549; 95% CI, 1.046–2.294; p = 0.029) were strong independent predictors of short-term mortality among patients with suspected severe trauma. Considering the clinical course of severe trauma patients, the RDW is an important ancillary test for determining severity. Specifically, we found that RDW values > 14.4% on day 1 (HR, 4.227; 95% CI: 1.672–10.942; p < 0.001) and > 14.7% on day 2 (HR, 6.041; 95% CI: 2.361–15.458; p < 0.001) increased the hazard 28-day all-cause mortality.Conclusion
An increased RDW value is an independent predictor of 28-day mortality in patients with suspected severe trauma. The RDW, routinely obtained as part of the complete blood count without added cost or time, can be serially measured as indicator of severity after trauma. 相似文献7.
George Lim Katrina Harper-Kirksey Ram Parekh Alex F. Manini 《The American journal of emergency medicine》2018,36(7):1178-1181
Objectives
New paradigm shifts in trauma resuscitation recommend that early reconstitution of whole blood ratios with massive transfusion protocols (MTP) may be associated with improved survival. We performed a preliminary study on the efficacy of MTP at an urban, Level 1 trauma center and its impact on resuscitation goals.Methods
A case-control study was performed on consecutive critically-ill trauma patients over the course of 1 year. The trauma captain designated patients as either MTP activation (cases) or routine care without MTP (controls) in matched, non-randomized fashion. Primary outcomes were: time to initial transfusion; number of total units of packed red blood cells (pRBC) and fresh frozen plasma (FFP) transfused; and ratio of pRBC to fresh frozen plasma (pRBC:FFP). Secondary outcomes were in-hospital mortality, and length of stay.Results
Out of 226 patients screened, we analyzed 58 patients meeting study criteria (32 MTP, 26 non-MTP). Study characteristics for the MTP and non-MTP groups were similar except age (34.0 vs. 45.85 years, p = 0.015). MTP patients received blood products more expeditiously (41.7 minutes vs. 62.1 minutes, p = 0.10), with more pRBC (5.19 vs 3.08 units, p = 0.05), more FFP (0.19 vs 0.08 units, p < 0.01), and had larger pRBC:FFP ratios (1.90 vs 0.52, p < 0.01). Secondary outcomes did not differ significantly but the MTP group was associated with a trend for decreased hospital length of stay (p = 0.08).Conclusions
MTP resulted in clinically significant improvements in transfusion times and volumes. Further larger and randomized studies are warranted to validate these findings to optimize MTP protocols. 相似文献8.
Hiroyuki Yamazaki Tadakazu Kondo Kazunai Aoki Kouhei Yamashita Akifumi Takaori-Kondo 《Diagnostic microbiology and infectious disease》2018,90(2):123-131
Liposomal amphotericin B (L-AMB) has the potential to cause two major adverse events, renal dysfunction and serum potassium abnormality; however, appropriate clinical management of these events remains unclear. We retrospectively analyzed data regarding 128 hematology patients who received L-AMB in our institute and examined the association between clinical characteristics and renal dysfunction or serum potassium abnormality. We found that the median weight-normalized dose of L-AMB was 2.69 mg/kg and the median administration period was 16 days. The overall occurrence rates of renal dysfunction and hypokalemia were 55.7% and 76.6%, respectively. Multivariate analysis revealed that pre-existing renal dysfunction (P = 0.017) and concomitant use of nephrotoxic (P < 0.0001) or antifungal drugs (P = 0.012) were independent risk factors for renal dysfunction. A higher infusion volume did not mitigate the risk of renal dysfunction. Hypokalemia occurred significantly less often in men (P = 0.028) and in patients who concomitantly used nephrotoxic drugs (P = 0.013). Approximately 40% of the adverse events were improved at 30 days after L-AMB termination and there was no significant association between these adverse events improvement and L-AMB dosage or infusion volume. Of note, hyperkalemia was observed in more patients who received allogeneic hematopoietic stem cell transplantation (P = 0.0303) and concomitant treatment with nephrotoxic drugs (P = 0.0281). These results suggest that imprudent reduction of L-AMB dose or redundant intravenous infusion may have minimal benefit for critical patients with suspected invasive fungal infection. 相似文献
9.
Bonny J. Baron Andrew Nguyen Dimitre Stefanov Amit Shetty Shahriar Zehtabchi 《The American journal of emergency medicine》2018,36(5):784-788
Emergency physicians face the challenge of rapidly identifying high-risk trauma patients. Lactate (LAC) is widely used as a surrogate of tissue hypoperfusion. However, clinically important values for LAC as a predictor of mortality are not well defined. Objectives: 1. To assess the value of triage LAC in predicting mortality after trauma. 2. To compute interval likelihood ratios (LR) for LAC.
Methods
Retrospective chart review of trauma patients with a significant injury mechanism that warranted labs at an urban trauma center. Outcome: In-hospital mortality. Data are presented as median and quartiles or percentages with 95% confidence intervals. Groups (lived vs. died) were compared with Man-Whitney-U or Fisher's-exact test. Multivariate analysis was used to measure the association of the independent variables and mortality. The interval likelihood ratios were calculated for all LAC observed values.Results
10,575 patients; median age: 38 [25–57]; 69% male; 76% blunt; 1.1% [n = 119] mortality. LAC was statistically different between groups in univariate (2.3 [1.6,3.0] vs 2.8 [1.6,4.8], p = 0.008) and multivariate analyses (odds ratio: 1.14 [1.08–1.21], p = 0.0001). Interval ratios for LR- ranged from 0.6–1.0. Increasing LAC increased LR +. However, LR + for LAC reached 5 with LAC > 9 mmol/L and passed 10 (moderate and conclusive increase in disease probability, respectively) with LAC > 18 mmol/L.Conclusions
In a cohort of trauma patients with a wide spectrum of characteristics triage LAC was statistically able to identify patients at high risk of mortality. However, clinically meaningful contribution to decision-making occurred only at LAC > 9. LAC was not useful at excluding those with a low risk of mortality. 相似文献10.
Chih-Chia Hsieh Ching-Chi Lee Hsiang-Chin Hsu Hsin-I Shih Chien-Hsin Lu Chih-Hao Lin 《The American journal of emergency medicine》2017,35(1):39-44
Background/Purpose
To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED).Methods
This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively.Results
For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05).Conclusions
For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation. 相似文献11.
Hesham R. Omar Mehdi Mirsaeidi Michael B. Weinstock Garett Enten Devanand Mangar Enrico M. Camporesi 《The American journal of emergency medicine》2018,36(2):297-300
Introduction
There are conflicting data regarding the prognostic value of syncope in patients with acute pulmonary embolism (APE).Methods
We retrospectively reviewed data of 552 consecutive adults with computed tomography pulmonary angiogram-confirmed APE to determine the correlates and outcome of the occurrence of syncope at the time of presentation.Results
Among 552 subjects with APE (mean age 54 years, 47% men), syncope occurred in 12.3% (68/552). Compared with subjects without syncope, those with syncope were more likely to have admission systolic blood pressure < 90 mm Hg (odds ratio (OR) 5.788, P < 0.001), and an oxygen saturation < 88% on room air (OR 5.560, P < 0.001), right ventricular dilation (OR 2.480, P = 0.006), right ventricular hypokinesis (OR 2.288, P = 0.018), require mechanical ventilation for respiratory failure (OR 3.152, P = 0.014), and more likely to receive systemic thrombolysis (OR 4.722, P = 0.008). On multivariate analysis, syncope on presentation was an independent predictor of a massive APE (OR 2.454, 95% CI 1.109–5.525, P = 0.03) after adjusting for patients' age, sex, requirement of antibiotics throughout hospitalization, peak serum creatinine, admission oxygen saturation < 88% and admission heart rate > 100 bpm. There was no difference in mortality in cases with APE with or without syncope (P = 0.412).Conclusion
Syncope at the onset of pulmonary embolization is a surrogate for submassive and massive APE but is not associated with higher in-hospital mortality. 相似文献12.
Matthieu Marchetti Antoine Benedetti Olivier Mimoz Jean-Yves Lardeur Jérémy Guenezan Nicolas Marjanovic 《The American journal of emergency medicine》2017,35(3):444-447
Objectives
Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality.Methods
We conducted a single site, retrospective review of adult patients (≥ 18 years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period.Results
There were a total of 322 patients. Mean age was 83.9 ± 9.1 years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30 days of admission to the ED. The following three characteristics were associated with increased mortality: age > 85 years (OR = 1.5[95%CI:0.8–2.7], p = 0.01), creatinine clearance < 30 mL/min (OR = 2.6[95%CI:1.4–5], p < 0.001) and Nt-proBNP > 5000 pg/mL (OR = 2.2[95%CI:1.2–4], p < 0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000 pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634–0.935], p < 0.001). For 7-day mortality, it was 7900 pg/mL (0.698 [0.578–0.819], p < 0.001) and for 30-day mortality, 5000 pg/mL (0.667 [0.576–0.758], p < 0.001).Conclusions
Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF. 相似文献13.
Hyeongkyu Kwak Gil Joon Suh Taegyun Kim Woon Yong Kwon Kyung Su Kim Yoon Sun Jung Jung-In Ko So Mi Shin 《The American journal of emergency medicine》2018,36(10):1784-1788
Objective
We conducted this study to investigate whether ESI combined with qSOFA score (ESI + qSOFA) predicts hospital outcome better than ESI alone in the emergency department (ED).Methods
This was a retrospective study for patients aged over 15 years who visited an ED of a tertiary referral hospital from January 1st, 2015 to December 31st, 2015. We calculated and compared predictive performances of ESI alone and ESI + qSOFA for prespecified outcomes. The primary outcome was hospital mortality, and the secondary outcome was composite outcome of in-hospital mortality and ICU admission. We calculated in-hospital mortality rates by positive qSOFA in each subgroup divided according to ESI levels (1, 2, 3, 4 + 5).Results
43,748 patients were enrolled. The area under receiver-operating characteristics curves were higher in ESI + qSOFA than in ESI alone for both mortality and composite outcome (0.786 vs. 0.777, P < .001 for mortality; 0.778 vs. 0.774, P < .001 for composite outcome). In each subgroup divided by ESI levels, patients with positive qSOFA had significantly higher in-hospital mortality rate compared to those with negative qSOFA (20.4% vs. 14.7%, P = .117 in ESI level 1 subgroup; 11.3% vs. 2.7%, P = .001 in ESI level 2 subgroup; 2.3% vs. 0.4%, P < .001 in ESI level 3 subgroup; 0.0% vs. 0.0% in ESI level 4 or 5 subgroup).Conclusion
The prognostic performance of ESI + qSOFA for in-hospital mortality was significantly higher than that of ESI alone. Within each subgroup, patients with positive qSOFA had higher in-hospital mortality compared to those with negative qSOFA. 相似文献14.
Byunghyun Kim Kyuseok Kim Jieun Lee Joonghee Kim Yoo Hwan Jo Jae Hyuk Lee Ji Eun Hwang 《The American journal of emergency medicine》2018,36(5):758-762
Objective
In cases of community acquired pneumonia (CAP), it has been known that blood cultures have low yields and rarely affect clinical outcomes. Despite many studies predicting the likelihood of bacteremia in CAP patients, those results have been rarely implemented in clinical practice, and use of blood culture in CAP is still increasing. This study evaluated impact of implementing a previously derived and validated bacteremia prediction rule.Methods
In this registry-based before and after study, we used piecewise regression analysis to compare the blood culture rate before and after implementation of the prediction rule. We also compared 30-day mortality, emergency department (ED) length of stay, time-interval to initial antibiotics after ED arrival, and any changes to the antibiotics regimen as results of the blood cultures. In subgroup analysis, we compared two groups (with or without the use of the prediction rule) after implementation period, using propensity score matching.Results
Following the implementation, the blood culture rate declined from 85.5% to 78.1% (P = 0.003) without significant changes in 30-day mortality and antibiotics regimen. The interval to initial antibiotics (231 min vs. 221 min, P = 0.362) and length of stay (1019 min vs. 954 min, P = 0.354) were not significantly changed. In subgroup analysis, the group that use the prediction rule showed 25 min faster antibiotics initiation (P = 0.002) and 48 min shorter length of stay (P = 0.007) than the group that did not use the rule.Conclusion
Implementation of the bacteremia prediction rule in CAP patients reduced the blood culture rate without affecting the 30-day mortality and antibiotics regimen. 相似文献15.
Yun Zhang Chun-Sheng Li Xiao-Li Yuan Ji-Yang Ling Qiang Zhang Yong Liang Bo Liu Lian-Xing Zhao 《The American journal of emergency medicine》2018,36(11):2020-2028
Background
Recently, a series of studies have been conducted to investigate the association of the common biochemical biomarkers, such as serum lactate and creatinine, with clinical outcomes in cardiac arrest patients treated with extracorporeal membrane oxygenation (ECMO), however, the results were not consistent and the sample size of primary studies is limited. In the present study, we performed a systematic review and meta-analysis to summarize the associations.Methods
Relevant studies in English databases (PubMed, ISI web of science, and Embase) and Chinese databases (Wanfang and CNKI) up to January 2018 were systematically searched. Crude ORs or HRs from the included studies were extracted and pooled to summarize the associations of lactate and creatinine with clinical outcomes including survival and neurological outcomes in ECMO treated cardiac arrest patients.Results
17 papers containing 903 cases were included in the present meta-analysis study. After pooling all the eligible studies, we identified the significant associations of high lactate level with poor survival (N = 13, OR = 1.335, 95%CI = 1.167–1.527, P < 0.001) and poor neurological outcome (N = 2, HR = 1.058, 95%CI = 1.020–1.098, P = 0.002) in CA patients treated with ECMO and a slight significant association of high creatinine with poor survival was also found (N = 7, OR = 1.010, 95%CI = 1.002–1.018, P = 0.015).Conclusions
High serum lactate level was associated with poor survival and poor neurological outcome in CA patients treated with ECMO. Further well-designed studies with larger sample size should be conducted to confirm the results. 相似文献16.
Yan-ling Li Jun-rong Mo Nga-man Cheng Stewart S.W. Chan Pei-yi Lin Xiao-hui Chen Colin A. Graham Timothy H. Rainer 《The American journal of emergency medicine》2018,36(6):988-992
Objective
The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard.Method
In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18 years or older admitted to the resuscitation room or high dependency unit were recruited. Eligible patients had a standard ED workup for shock. The emergency physician treating the patient was asked whether he or she considered shock to be probable, and this was compared with LiPS. The proxy ‘gold’ or reference standard was 30-day mortality. The area under the receiver operating curve (AUROC) was used to predict prognosis. The primary outcome measure was 30-day mortality.Results
A total of 220 patients fulfilled the inclusion criteria and were included in the analysis. The AUROC for LiPS (0.722; sensitivity = 0.733, specificity = 0.711, P < 0.0001) was greater than emergency physician gestalt (0.620, sensitivity = 0.467, specificity = 0.774, P = 0.0137) for diagnosing shock using 30-day mortality as a proxy (difference P = 0.0229). LiPS shock patients were 6.750 times (95%CI = 2.834–16.076, P < 0.0001) more likely to die within 30-days compared with non-shock patients. Patients diagnosed by emergency physicians were 2.991 times (95%CI = 1.353–6.615, P = 0.007) more likely to die compared with the same reference.Conclusions
LiPS has a higher diagnostic accuracy than emergency physician gestalt for shock when compared against an outcome of 30-day mortality. 相似文献17.
Martin Hulldin Jonas Kängström Magnus Andersson Hagiwara Andreas Claesson 《The American journal of emergency medicine》2018,36(6):1040-1044
Background
Emergency medical services (EMS) facilitate out of hospital care in a wide variety of settings on a daily basis. Stretcher-related adverse events and long term musculoskeletal injuries are commonly reported. Novel stretcher mechanisms may facilitate enhanced movement of patients and reduce workload for EMS personnel.Aim
To describe EMS personnel's perceived exertion using two different stretcher systems.Methods
The methodology of this explorative simulation study included enrolling twenty (n = 20) registered nurses and paramedics who worked in ten pairs (n = 10) to transport a conscious, 165 lb. (75 kg) patient using two different EMS stretcher systems: the Pensi stretcher labeled A and the ALLFA stretcher labeled B. The ten pairs (n = 10) were randomized to use either an A stretcher or a B stretcher with subsequent crossover. The pairs performed six identical tasks with each stretcher, including conveying stretchers from an ambulance up to the first floor of a building via a staircase, loading a patient on to the stretcher, and using the stretcher to transport the patient back to the ambulance. The subjective Rating of Perceived Exertion (RPE) survey (Borg scale) was used to measure perceived exertion at predefined intervals during transport.Results
No significant differences in workload were seen between stretcher groups A and B regarding unloading the stretcher (7.4 vs 8.2 p = 0.3), transporting up a stairway (13.7 vs 12.5 p = 0.06), lateral lift (12.1 vs 11.2 p = 0.5), or flat ground transportation (10.4 vs 11.1 p = 0.13). Pairs using stretcher A showed significantly less workload with regards to transporting down a stairway (11.0 vs 14.5 p < 0.001) and loading into ambulance (11.1 vs 13.0 p < 0.001).Conclusion
A structured methodology may be used for testing the exertion levels experienced while using different stretcher systems. The use of supporting stretcher system mechanisms may reduce perceived exertion in EMS personnel mainly during transports down stairs and during loading into ambulance vehicles. 相似文献18.
Yu Koon Chiu Chun Tat Lui Kwok Leung Tsui 《The American journal of emergency medicine》2018,36(1):79-83
Objective
To investigate the relationship between hypotension in the first 3 h after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest.Method
This retrospective cohort study occurred at two regional hospitals and included adult OHCA patients who experienced ROSC from July 1, 2014 to December 31, 2015. Hemodynamic and inotrope administration data were retrieved for 3 h after ROSC. We calculated the hypotensive exposure index (HEI) as the surrogate marker of the exposure of hypotension. The area under the ROC curve and multivariate logistic regression models were performed to analyze the effect of HEI on survival. Mean arterial pressure (MAP) was explored in the surviving and non-surviving patient groups using repeated measures MANCOVA, adjusted for the use of inotropes and down time.Results
A total of 289 patients were included in the study, and 29 survived. The median 1-hour HEI and 3-hour HEI were significantly lower in the survival group (p < 0.001). The area under the ROC curve for 3-hour HEI was 0.861. The repeated measures MANCOVA indicated that an interaction existed between post-ROSC time and downtime [F(5,197) = 2.31, p = 0.046]. No significant change in the MAP was observed in the 3 h after ROSC, except in the group with a prolonged down time. According to the tests examining the effects of the use of inotropes on the survival outcomes of the different subjects, the MAP was significantly higher in the surviving group [F(1,201) = 4.11; p = 0.044; ηp2 = 0.020].Conclusion
Among the patients who experienced ROSC after OHCA, post-ROSC hypotension was an independent predictor of survival. 相似文献19.
Objective
The aim of this study was to identify the perception of students, lecturers and staffs on smoke-free campus policy.Method
Samples, including 880 students, 102 lecturers and 209 staff, were taken from all faculties in Universitas Riau using convenience sampling technique. A survey was conducted for these respondents through the distribution of questionnaires. Information pertaining to demographics, smoking and non-smoking behaviors and experiences, and perceptions regarding smoke-free campus policy was obtained.Results
It was discovered that 58% of survey groups and respondents were females, 84.3% were non-smokers, and 66.1% reported exposure to cigarette smoke in university campus every day or several days in a week. All groups reported that they were affected by cigarette smoking with no significant difference in the proportion (p = .540). The rate of students and lecturers were similar in terms of their agreements on smoking prohibition in campus environment (81.7% and 84.3% respectively), while it was different with staff (p = .004). Further ANOVA analysis revealed that there was a significant difference between groups regarding agreements on smoking prohibition (p = .007) such that staff differed from lecturers and students (p = .014 and p = .028), while lecturers and students showed no significant difference (p = .502). All groups strongly agreed on establishing a smoke-free campus (81.9% of students, 85.3% of lecturers, 77.7% of staffs) with no significant difference in their proportion (p = .079).Conclusions
Interventions can be introduced to enhance support gotten from the staff group, however, majority of the students, lecturers and staffs were very supportive of creating a smoke-free campus. Therefore, there is a call to action for university leaders and decision makers to implement the policy. 相似文献20.
Farid Sadaka Amar Jadhav Melinda Miller Ammar Saifo Jacklyn O&#x;Brien Steven Trottier 《The American journal of emergency medicine》2018,36(9):1624-1626