Frontiers in Emergency Medicine

FEM in 2024, A quick look

Saeed Aqavil-Jahromi — 2025-02-26

Over the past year, the journal Frontiers in Emergency Medicine (FEM) has reinforced its dedication to advancing emergency medicine by featuring research from five continents, including Iran, Turkey, India, Ethiopia, Spain, Canada, and the United States. The high volume of submissions reflects growing trust in FEM, though only 20.9% are accepted due to stringent scientific and ethical standards. A major milestone this year was FEM's inclusion in the EBSCO and Magiran databases, increasing visibility. FEM aims to expand publishing opportunities while maintaining quality through expert review. This article highlights key achievements and research contributions from the past year.

Causes and outcomes of hypotonia: a cross-sectional study of children admitted to a pediatric intensive care unit

Nahideh Khosroshahi — 2024-12-21

Objective: Hypotonia in children is an important and common clinical symptom that can manifest in various neurological disorders. It often poses a serious diagnostic challenge for physicians, frequently leading to inaccurate evaluations and unnecessary investigations. The purpose of this study was to investigate the causes of hypotonia, various diagnostic methods, and the final outcomes of these patients. Methods: Children with hypotonia who were hospitalized in the pediatric intensive care unit (PICU) of Bahrami Children's Hospital and Children's Medical Center during a two-year period (2017-2018) were enrolled. All relevant information, including key points from their medical history, clinical examinations, and paraclinical data that could lead to diagnosis, were recorded. The patients was followed up for two years after hospitalization through phone calls or visits to the neurology clinic. Results: Out of 65 children examined, 28 patients (43.07%) had peripheral nervous system involvement, 20 (30.76%) had central nervous system involvement, and 4 (6.17%) had both central and peripheral nervous system involvement. The most common causes for peripheral and central involvement were spinal muscular atrophy (SMA) and syndromic causes, respectively. In 20% of cases however an, specific underlying cause was found. The most common diagnoses were SMA (16.9%) and Guillain-Barre syndrome (13.8%). Finally, 15 children (23.1%) recovered, 31 (47.7%) had neurological sequelae, and 19 (29.2%) died. Conclusion: Understanding the underlying causes and outcomes of patients hospitalized with hypotonia in the PICU enhances physicians’ diagnostic skills. It is also useful for selecting effective treatment strategies and avoiding the complications associated with delayed diagnosis.

Elderly patients with emergency department return visit: descriptive analysis of adverse events

Elham Pishbin — 2025-01-14

Objective: An emergency department (ED) visit is a critical event for elderly patients, often associated with an increased likelihood of early return visits (RVs), functional decline, and adverse events (AEs). This study aimed to investigate the proportion of ED RVs within 72 hours that were due to AE among elderly patients. Methods: We conducted a retrospective review of hospital records for elderly patients aged 65 years and older who returned to the ED within 72 hours of discharge. The study focused on identifying AEs as a primary cause of RV and characterizing their type, severity, and preventability. Results: Over a 6-month period, 69,557 patients presented to the ED, of whom 9,439 patients (13.6%) were aged 65 years and older, with a median age of 75. Among these elderly patients, 373 (3.9%) returned within 72 hours. Of these, 201 patients underwent a secondary review to detect AEs which revealed that 49 RVs (24.4%) were attributed to AEs. Diagnostic errors were the most common type of AEs, accounting for 34.7% of cases. Severe AE occurred in 36.7% of patients, and more than half (63.4%) were deemed preventable. Conclusion: The results of our study indicate a concerning correlation between RV and AE in elderly patients. A substantial portion of these AEs is due to diagnostic and management errors, highlighting the necessity for strategies to enhance the quality of care for this vulnerable group. The study advocates for utilizing 72-hour ED RV as a trigger for identifying AEs.

Predictive factors of spontaneous circulation return following in-hospital cardiac arrest: a cross-sectional study

Saeed Safari — 2025-01-03

Objective: Existing predictive models for in-hospital cardiac arrest (IHCA) outcomes are mainly based on out-of-hospital cardiac arrest (OHCA) studies. This study aimed to identify factors that can independently predict the sustained return of spontaneous circulation (ROSC) following IHCA. Methods: This retrospective cross-sectional study included all patients aged 18 or older who underwent cardiopulmonary resuscitation (CPR) following IHCA in the emergency departments of two general hospitals in Tehran, Iran, from March 2021 to April 2024. The association of patient baseline characteristics, type of cardiac arrest, CPR characteristics, time-related parameters, and laboratory data with sustained ROSC were evaluated using multivariate logistic regression analysis trying to identify independent associated factors of sustained ROSC following IHCA. Results: 614 patients with a mean age of 68.23±17.65 (range: 18-115) years meeting the eligibility criteria were included (59.28% Male). 184 (29.96%) cases experienced sustained ROSC. Multivariate logistic regression analysis revealed a significant association between sustained ROSC and CPR duration less than 30 minutes (coefficient=4.38, 95% CI: 3.70,5.06, P<0.001), arrest due to cardiac etiologies (coefficient=1.05, 95% CI: 0.35,1.74, P=0.003), and administration of IV bicarbonate (coefficient=1.42, 95% CI: 0.72,2.13, P<0.001). Administration of amiodarone showed a borderline association with sustained ROSC (coefficient=1.07, 95% CI: -0.03,2.18, P=0.05). Conclusion: CPR duration of less than 30 minutes, arrest with cardiac etiologies, administration of bicarbonate and amiodarone were independent predictors of sustained ROSC.

Effectiveness of targeted multiple injuries nurses' training on emergency department nurses' knowledge and triage skills: a randomized control trial

Khalaf Awwad — 2025-02-05

Objective: The study's objective was to evaluate the effectiveness of a multiple injuries triage advanced trauma nursing course/ advanced trauma care for nurses programme on knowledge and skill among emergency nurses. Methods: One hundred and twelve emergency nurses from two government hospitals in the West Bank participated in a single-blinded randomised control trial, the data were gathered using a self-administered structured questionnaire. The advanced trauma nursing course was delivered to the experimental group using a practice-first approach followed by theory in two days (8 am- 4 pm), while advanced trauma care for nurses was delivered to the control group with with a theory-first approach followed by practice in two days (8 am- 4 pm). The material for both groups was PowerPoint, two videos, a low-fidelity simulation, two scenarios, and a group discussion. Results: There were significant mean score differences between the experimental and control groups in the pairwise comparisons of the groups in terms of knowledge and skill. There were significant mean score differences in knowledge between the baseline and post-intervention in the experimental group (mean difference=0.57; P-value<0.001), as well as between the baseline and the three-month follow-up (mean difference=0.26; P-value<0.001), and the post-intervention and three-month follow-up (mean difference= - 0.30; P-value<0.001). There was no significant mean difference in the knowledge and skill between the post-programme (mean difference=0.08; P-value=0.383) and three-month follow-up (mean difference=0.02; P-value=1.000) in the control group. Conclusion: Nurses attending the two-day training advanced trauma nursing course can improve their knowledge and skills in multiple injuries triage in the emergency department compared to advanced trauma care for nurses’ programme. Emergency nurses should regularly undergo retraining in the multiple injuries triage programme to evaluate and improve their skill level every two years.

Quality of YouTube Videos on Focused Assessment with Sonography in Trauma Protocol

Busra BILDIK — 2025-01-25

Objective: The Focused assessment with sonography in trauma (FAST) protocol is one of the most critical steps in trauma assessment in current emergency department practices. The contribution of video-based learning to medical education is increasingly recognized. This study aims to evaluate the quality of videos related to e-FAST ultrasonography as well as the factors influencing video quality. Methods: The study encompassed conducting searches on YouTube using the keywords "FAST," "E-FAST," and "Trauma USG," followed by a comprehensive analysis of the retrieved videos. The quality of these videos was evaluated using JAMA, GQS, and DISCERN scores. Results: The study included 93 videos. The mean mDISCERN score was 3.1 (0.9), the mean JAMA score was 2.1 (0.7), and the mean GQS score was 3.4 (1.0). Sixty-five (69.9%) of the videos were recorded by individuals, and 60 (64.5%) used only the US image in the video. The median video length was 639 seconds (s) (range: 250–1305 s), median number of comments was 0 (range 0–4), median upload date (days) was 1675 (range: 976-2750), number of views was 2250 (range: 467-14187), and number of likes was 28 (range: 8-162). The mean mDISCERN and JAMA scores of institutional videos were 3.2 (0.9) and 2.2 (0.7), respectively, and the mean mDISCERN and JAMA scores of individual videos were 2.7 (0.8) and 1.9 (0.7) (P values = 0.008 and 0.018, respectively). The mean GQS score of institutional videos was 3.5 (0.1), and the mean GQS score of individual videos was 3.3 (0.8) (P=0.325). The median number of comments in individual videos was 4.0 (range: 0.0–12.5), while the median number of comments in institutional videos was 0.0 (range: 0.0–2.0; P= 0.011). There is a significant difference in the number of likes (P=0.043). No significant difference was found in video length, date, and number of views between individual and institutional videos (P values = 0.236, 0.974, and 0.255, respectively). Conclusion: Upon reviewing e-FAST/FAST protocol videos on social networks, it becomes apparent that institutional videos exhibit better quality. Institutional videos are not only more target-oriented, but they also provide reliable information and are optimized for timeliness.

Serum IGF-1 level as a prognostic marker for acute ischemic stroke: a systematic review

Shayan Roshdi Dizaji — 2025-02-26

Objective: Assessing the risk levels of patients with acute ischemic stroke (AIS) can assist in making informed choices about their treatment and rehabilitation. To assess the prognostic value of serum insulin-like growth factor-1 (IGF-1) in neurological deficit (National Institutes of Health Stroke Scale [NIHSS]), functional independence (Modified Rankin Scale [mRS]), and mortality following AIS. Methods: The search encompassed Medline, Embase, Scopus, and Web of Science until June 2023. Two autonomous researchers incorporated articles by the established inclusion and exclusion criteria. The quality of the included studies were assessed using the quality assessment of prognostic accuracy studies (QUAPAS) tool. Results: Ten articles were included, with evidence suggesting that IGF-1 may have prognostic value in AIS outcomes. Several studies reported positive associations between IGF-1 levels, reduced neurological deficits, improved functional independence, and lower mortality. Additionally, intraindividual fluctuations in IGF-1 after AIS were identified as a potential predictor of recovery in functional independence, though significant inconsistencies exist in the findings. Conclusion: The available studies with a very low level of evidence are not sufficient to firmly endorse the applicability of IGF-1 as a prognostic factor for mortality, neurological disability, and functional independence.

Pediatric abdominal migraine as a recurrent emergency department presentation: a case report

Maria Leis — 2025-01-03

Pediatric functional abdominal disorders are some of the most commonly encountered disorders in childhood, and a recurrent presentation in the emergency department. Distinguishing functional disorders from organic causes is crucial to safe patient care and to identify optimal treatment strategies. We present a case of a 9-year-old boy with recurrent presentations of diffuse abdominal pain associated with nausea, recurrent vomiting and headache. He had no red flag symptoms, and his mother had a history of migraine headaches. Emergency department investigations demonstrated normal bloodwork, with ultrasound demonstrating only trace small volume deep pelvic ascites of unknown etiology. He was subsequently diagnosed with pediatric abdominal migraine, and counselled on the cornerstones of nonpharmacologic management. This case highlights the importance of assessing for red flags of abdominal pain and using strict diagnostic criteria when considering functional abdominal disorders in childhood.

Liver abscess due to appendicitis: a case report

Khazar Garjani — 2025-02-05

Pyogenic liver abscess (PLA) is a rare but serious condition that can be life-threatening. Recent developments in diagnostic techniques and treatment have resulted in earlier detection and intervention and hence reduction in mortality rates. Despite these improvements, PLA remains a clinical challenge due to its hidden symptoms and associated health risks. PLA may be caused by seeding from appendicitis. We present a 52-year-old woman presented with PLA due to appendicitis. Upon physical examination, laboratory study and imaging, an acute appendicitis with pyogenic liver abscess were found. The patient underwent percutaneous drainage of the abscesses with a catheter and an interval appendectomy.