Frontiers in Emergency Medicine

The utilization of pain assessment tools in pediatric emergency for better pain management

2025-04-29T19:05:26+0430

Objective: Accurate assessment of acute pain in children is essential for effective emergency care but can be challenging due to varying pain expressions across ages. Our study aims to examine healthcare providers’ efforts to enhance assessment using age-appropriate tools. Methods: Patients were retrospectively selected from the King Abdulaziz University Hospital Emergency records which involved a cohort review of 157 children presented to the pediatric emergency department with acute pain from 2017 to 2018. Routine pain assessment tool grading acute pain as mild, moderate, severe by qualified pediatric emergency doctors, Canadian triage acuity scale (CTAS) and numerical rating scale (NRS) were used to describe pain intensity. Inter-statistical cohort analysis was used. Results: The mean age of patients were 8±3.3 years (range: 2.5-13.9 years) with 73 girls and 84 boys. About 80% (n=126) of the children presented to the emergency department with acute pain were scored as CTAS 2-3. All triaged patients passed to the emergency department were assessed as mild (n=66, 42%), moderate (n=27, 17%) and severe (n=35, 22%) pain. The NRS scoring was used in only 12 (7.6%) children as NRS only applies to older children. Paracetamol and nonsteroidal anti-inflammatory drug (NSAID) were the most frequent analgesia administered by the health care providers. There was a statistically insignificant relationship between the severity of the pain and the type of analgesia (P value>0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P<0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P<0.05) Conclusion: Pain assessment with scoring methods like CTAS or NRS in the emergency room (ER) is crucial despite challenges. Inconsistent use affects outcomes, emphasizing the need for research to encourage consistent application in pediatric emergency care.

Developing a model for predicting intra-abdominal injuries following blunt trauma; a cross-sectional study

2025-05-05T14:07:49+0430

Objective: Finding the associated factors of traumatic intra-abdominal injuries (IAIs) and designing a predictive model could minimize the unnecessary use of computed tomography (CT) scans. This study aimed to develop a risk stratification model in this regard. Methods: This prospective cross-sectional study was conducted at the emergency department (ED) of a level III trauma center. In this study, we thoroughly examined the association between demographic details, physical examinations, laboratory tests, and ultrasonography with abdominopelvic CT scan results regarding the presence of intra-abdominal injuries following blunt abdominal trauma, trying to develop a risk stratification model in this regard. Result: A total of 472 blunt trauma patients with a mean age of 39.06±18.49 (range: 15-96) were investigated (81.1% male). 47 intraabdominal damages in 45 (9.5%) patients were diagnosed. Based on logistic regression analysis, presence of abdominal pain (odds ratio [OR]: 39.60; 95% CI: 9.42,166.35), positive focused assessment sonography in trauma (FAST results (OR: 46.93; 95% CI: 14079,148.89), and injury severity index (ISS)≥25 (OR: 6.43; 95% CI: 2.07,19.90) were significantly correlated with the presence of intraabdominal injuries in blunt trauma patients. The area under the ROC curve of the model was 0,865 (95% Cl: 0.805,0.926) with 86.67% sensitivity and 86.41% specificity. Conclusion: Being accurate and user-friendly alongside broader criteria compared to similar studies makes our risk stratification model a reliable decision-making tool to optimize CT scan usage in the emergency department.

Evaluation of the severity and pattern of motorcycle-related injuries among riders and passengers in Iran: a retrospective study

2025-05-30T20:21:05+0430

Objective: Motorcycle-related traffic crashes remain a significant cause of severe injuries and fatalities, particularly in young populations. This study aimed to compare the injury severity and patterns sustained by motorcycle riders and passengers in crashes. Methods: A retrospective analysis was conducted on motorcycle crash victims, including both riders and passengers, evaluated at the forensic medical organization in Iran from 2020 to 2022. Variables such as injury type, helmet use, and demographic factors were compared. The chi-squared test was applied to categorical variables, with P-values of <0.05 considered significant. The injury severity score (ISS) and the abbreviated injury scale (AIS) were used to assess trauma severity. Results: Of 214 cases (81.8% male), helmet use was significantly higher among riders than passengers (39.6% vs. 14.8%, P<0.05). Passengers demonstrated a greater risk of severe injury (45.4%) than riders (27.4%, P=0.01). Head injuries were significantly more prevalent among passengers (13%) than riders (5.7%, P=0.019), correlating with lower helmet use among the passengers. Additionally, fractures and dislocations were more common in passengers, while external injuries predominated in riders. Conclusion: Strengthening helmet regulations for passengers is critical to reducing head trauma. Stricter enforcement of traffic safety measures could significantly mitigate fatalities, especially among novice riders.

Comparison of trauma severity in and out of the navigation ring around the metropolis: a case of Tabriz, Iran

2025-05-30T21:04:06+0430

Objective: One of the causes of severe injuries in urban accidents is the occurrence of accidents on urban highways and city outskirts. The present study will determine the severity of accidents in the complete urban ring of Tabriz, including Shahid Kasaei highway, Pasdaran, Dizel Abad, Sento road, and Airport road in Tabriz during the years 2016-2022. Methods: In a cross-sectional descriptive study, the injuries from traffic accidents that were registered in the pre-hospital emergency center of Tabriz city were included. The study variables included all the information recorded in the pre-hospital emergency file between 2016 and 2022 and included 44,712 injured patients. Timing of the missions, variables related to the injured (demographics, vital signs), the accident's location, the injury's severity, and the accident's outcome were evaluated at the scene. Data were analyzed by SPSS 24 software. Results: Among 44,712 patients, 32,299 (72.2%) were men and the rest were women. Regarding the location of the accident, 34321 (76.8%) of the injured were inside the city, and 10391 (23.2%) had an accident in the city traffic ring. The most common accident site was in the traffic ring on Pasdaran highway, with 3179 injured (30.6%). The rate of on-scene death was higher in traffic accidents inside the traffic ring (1.3% vs. 0.9%). The severity of trauma was higher inside the traffic ring (P-value ˂0.001). Reaction and response time were higher in missions outside the traffic ring, leading to death at the scene (P value˂0.001). Conclusion: Based on the study results and the role of arrival time on the outcome of missions, it seems necessary to establish new pre-hospital emergency stations inside the city. It is necessary to pay more attention to education through the media and improve the general culture of society to reduce the accidents and injuries caused by it.

Comparison of penthrox (methoxyflurane) inhalation and intravenous morphine for acute limb fracture pain management in the emergency department: a randomized controlled trial

2025-05-30T21:23:56+0430

Objective: Effective pain management is crucial in emergency settings, and both penthrox (methoxyflurane) inhalation and intravenous morphine are commonly used analgesics. This study aimed to compare the analgesic efficacy, adverse effects, and patient satisfaction associated with penthrox spray and morphine for acute limb fracture pain management in the emergency department. Methods: This prospective, double-blinded, randomized controlled trial included 50 patients aged 20-55 years with acute limb fracture pain, randomly assigned to receive either penthrox spray or intravenous morphine. The primary outcome was pain intensity assessed using the visual analog scale (VAS) over 60 minutes. Secondary outcomes included adverse effects, vital signs, and patient satisfaction. Results: Both groups experienced significant pain relief over time, with a similar reduction in VAS scores (P<0.001). However, the penthrox spray group showed a trend toward more rapid pain reduction, although not statistically significant. The frequency of vomiting and nausea tended to be lower in the penthrox spray group (24% vs. 40%, P=0.225). There were no significant differences in patient satisfaction scores between groups. While both groups experienced a decrease in blood pressure, the heart rate remained stable in the penthrox spray group but decreased significantly in the morphine group (P<0.001). Conclusion: Penthrox spray and intravenous morphine demonstrated comparable analgesic efficacy for acute limb fracture pain in the emergency department. Penthrox sprays trended toward faster pain relief and potentially lower risk of vomiting and nausea. The stable heart rate observed with penthrox may be advantageous in certain clinical scenarios. Consideration of factors such as onset of action, adverse effects, and patient preferences may guide the choice between these analgesics.

Trend topics in emergency medicine: a comprehensive bibliometric analysis of CPR research

2025-06-16T22:13:36+0430

Objective: This study aims to comprehensively evaluate the scientific contributions, research trends, and influential studies related to cardiopulmonary resuscitation (CPR), a critical life-saving intervention in cases of sudden cardiac arrest (SCA). By performing a bibliometric analysis of academic articles published between 1980 and 2023 in the Web of Science (WoS) database, the study seeks to identify key trends, thematic areas, and advancements in CPR research to provide valuable insights for guiding future studies and enhancing emergency medicine practices. Methods: This study conducted a bibliometric analysis of academic articles on CPR published between 1980 and 2023 in the WoS database. A total of 4393 articles were examined to identify trends and contributions to the scientific literature. Various metrics were analyzed, including publication counts, citation rates, leading countries and institutions, prominent researchers, and the most cited studies. Performance analysis, keyword analysis, co-citation analysis, and thematic analyses were performed. Results: The analysis revealed concentrated topics in CPR research and evolving trends over time. The findings showed significant contributions from leading countries, institutions, and researchers. The most cited studies highlighted key areas of focus and advancements in CPR practices. Thematic analysis indicated the major research themes and their development over the decades. Conclusion: This bibliometric analysis provides an in-depth examination of the place and importance of CPR in emergency medicine. It offers a comprehensive perspective on the current state and future directions of CPR research. The findings help us better understand CPR's position in the scientific literature and its contributions to emergency medicine practices. These insights will guide future research directions and enhance scientific contributions to CPR practices in emergency medicine.

Transvaginal evisceration after laparoscopic hysterectomy: case report

2025-05-18T12:42:36+0430

Transvaginal evisceration is a rare condition characterized by the externalization of abdominal viscera through the vagina. Menopause and hysterectomy are the primary risk factors. A postmenopausal woman presented to the emergency department with evisceration of the small intestine through the vagina three hours post-coitus. She had a history of laparoscopic hysterectomy performed three years prior. The patient underwent prompt laparotomic repair of the vaginal cuff. The diagnosis of transvaginal evisceration is primarily clinical, and immediate treatment aims to maintain intestinal viability and repair the vaginal cuff. The surgical approach is based on the surgeon’s experience, the patient's clinical condition, and resource availability.

COgnitive crisis: unveiling neurological consequences of carbon monoxide poisoning: a case report

2025-06-03T02:11:02+0430

Carbon Monoxide (CO) is commonly emitted by vehicles, industrial processes, and heating systems. It can lead to unintentional poisoning in enclosed spaces. Common findings include tachycardia, hypotension, hypoxemia, headache, dizziness, seizures, or coma. A thorough history is essential to suspect potential CO poisoning. Confirmatory tests include measuring carboxyhemoglobin levels in blood. The first step of management is to remove the patient from the source, followed by oxygen supplementation. In severe cases, hyperbaric oxygen therapy may be indicated. Prognosis depends on the level of exposure, as well as the promptness of treatment. Early intervention leads to better outcomes. Delayed neurological deficits are potential long-term outcomes. Prognosis for recovery improves significantly with the use of CO detectors in homes and education about the risks of CO exposure. We present a case of a 15-year-old male who presented with acute encephalopathy.

Massive hemorrhage update: what is known and what we should know?

2025-06-16T21:57:09+0430

Massive hemorrhage protocol (MHP) is an updated term for the formerly used massive transfusion protocol, highlighting crucial aspects of hemorrhage management other than the transfusion itself. This complex intervention includes acute hemorrhage control; administering tranexamic acid (TXA), preventing hypocalcemia, hypothermia, and acidosis; reversing anticoagulation or correcting coagulopathies; and planning for the next steps in definitive hemorrhage control. Here, we discuss exciting frontiers and challenges of MHP.

The emergence of a new category of disasters: manager-made disasters

2025-06-16T22:05:12+0430

The rise of manager-made disasters—crises stemming from incompetent leadership—demands urgent attention. Unlike natural or traditional human-made disasters, these failures are preventable yet increasingly destructive, with cascading impacts on organizations and societies.

To mitigate these risks, we propose four key measures:

First, appoint qualified leaders. Leadership selection must prioritize technical expertise and proven managerial competence, reducing reliance on political or regional favoritism.

Second, enhance training programs. Rigorous training in crisis management, risk assessment, and ethical decision-making should be implemented for current and aspiring leaders.

Third, strengthen accountability mechanisms. Transparent systems must be established to hold leaders responsible for failures, including independent audits, whistleblower protections, and performance-linked consequences.

Fourth, integrate safety-centric leadership practices. A culture of safety should be embedded in organizational governance, ensuring leaders prioritize risk mitigation, resource resilience, and employee well-being in all decisions.

Public awareness campaigns are equally critical to fostering accountability and demanding higher leadership standards. We urge academia and policymakers to address this gap by dedicating resources to studying and combating manager-made disasters.