Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 05 06 e1 e1 Reza Ghasemi Department of Emergency Medicine, Imam-Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Science, Tehran, Iran. Mohammad Eftekhari Department of Emergency Medicine, Imam-Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Science, Tehran, Iran. 2026 04 25 2026 05 01 In this editorial, we provide an overview of the performance of Frontiers in Emergency Medicine (FEM) in 2025 compared with the preceding year and summarize the 37 articles published during this period. The included manuscripts are described with respect to the authors’ countries of origin, article type, and major domains of emergency medicine (EM). FEM appears to have successfully fostered international collaboration among EM specialists. In addition, through strengthened oversight of the submission‑to‑publication process, the journal has sought to publish high‑quality, clinically relevant research while maintaining a high level of author satisfaction. https://fem.tums.ac.ir/index.php/fem/article/view/1743 https://fem.tums.ac.ir/index.php/fem/article/download/1743/546

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 05 06 e2 e2 Mohammad Reza Kardan Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. Mehdi Torabi Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. Amin Saberinia Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. Moghaddameh Mirzaee Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. 2025 03 12 2025 11 24 Objective: In traditional triage, there is often a challenge in accurately assessing the severity of a patient's condition, which can result in under-triage or over-triage. The purpose of this study is to compare traditional and innovative vital signs in predicting possible mortality in critically ill patients. Methods: This is a cross-sectional study conducted over a three-month period. Patients presenting emergency severity index (ESI) level 1 and 2 triage were divided into two groups: those with and without mortality. Subsequently, the role of traditional triage vital signs [blood pressure, heart rate, oxygen saturation (SpO2), mean arterial pressure (MAP), pulse pressure (PP)] was compared with that of innovative vital signs [shock index (SI), reverse shock index (RSI), modified shock index (MSI), age-shock index (ASI)] in predicting mortality in two groups. Results: A total of 360 patients were included in the study. A statistically significant association was observed between all innovative and traditional vital signs (with the exception of heart rate) and mortality. In logistic regression, the univariate model revealed a significant association between age, triage level, innovative and traditional vital signs with the occurrence of mortality. In the multivariate model, only MAP, PP, SI, RSI×SpO2, and ASI were found to have a significant association with mortality. Conclusion: The combination of innovative and traditional vital signs, including MAP, PP, SI, MSI, RSI×SpO2, and ASI in triage may be capable of predicting critically ill patients with a higher probability of mortality. https://fem.tums.ac.ir/index.php/fem/article/view/1570 https://fem.tums.ac.ir/index.php/fem/article/download/1570/543

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 05 06 e3 e3 Latife Jabbari Department of Emergency Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Zahra Alipour Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Reza Yazdani Department of Emergency Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Seyed Ashkan Tabibzadeh Dzfuli Department of Emergency Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Saeed Hayati Department of Emergency Medicine, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 2025 05 24 2025 12 10 Objective: Chest pain is a prevalent and potentially life-threatening presentation in emergency departments, necessitating prompt and precise risk stratification to identify patients at high risk, particularly those with acute coronary syndrome (ACS). This study evaluates the predictive accuracy of the HEART score in stratifying short-term major adverse cardiac events (MACE) risk among chest pain patients in Bandar Abbas, aiming to enhance clinical decision-making and resource utilization in emergency departments. Method: This prospective observational study was conducted on patients presenting with chest pain at Shahid Mohammadi Hospital’s emergency department. Patients aged ≥18 years with chest pain were included, while those with STEMI or incomplete records were excluded. The HEART score was used for risk stratification, and patients were classified into low, moderate, or high-risk groups. The primary outcome was MACE within six weeks, confirmed via follow-up calls. Data analysis included logistic regression and ROC curve analysis. Result: A total of 1,501 individuals participated in the study, with a mean age of 48.99±14.71 years. Among the participants, 28.6% were diagnosed with MACE. The most common risk factors for MACE included a history of coronary artery disease (79.1%) and hypertension (77.2%). Based on the HEART score, patients were categorized into low-risk (≤ 3), moderate-risk (4-6), and high-risk (≥ 7) groups. The majority of non-MACE patients were classified as low-risk (78.3%), while 65.6% of MACE patients fell into the moderate-risk category. The mean HEART score was significantly higher in the MACE group (5.73±1.68) compared to the non-MACE group (2.31± 1.54). The optimal HEART score cutoff for predicting MACE was determined to be 3.5, with the ROC curve demonstrating strong predictive performance (AUC=0.932). Conclusion: The HEART score is a reliable tool for risk stratification in chest pain patients in the emergency department. Our study shows that a score of ≤ 3.5 indicates low risk, while higher scores predict a greater likelihood of MACE. The HEART score effectively guides clinical decisions, highlighting its high sensitivity and specificity for identifying low- and high-risk patients, making it an essential tool for patient management in emergency settings. https://fem.tums.ac.ir/index.php/fem/article/view/1607 https://fem.tums.ac.ir/index.php/fem/article/download/1607/544

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 06 25 e4 e4 Adenova Gulzhan Kazakhstan Medical University “KSPH”, Almaty, Kazakhstan. Kausova Galina Kazakhstan Medical University “KSPH”, Almaty, Kazakhstan. Brukhanov Alexander Diagnostic Center of the Altai Territory, Kazakhstan Juvashev Almaz Almaty City Emergency First Aid Hospital, Almaty, Kazakhstan. Utaganov Bakyt Almaty City Emergency First Aid Hospital, Almaty, Kazakhstan. Lyazzat Ayaganova Almaty City Emergency First Aid Hospital, Almaty, Kazakhstan. Zhanna Dyusembayeva Stroke Unit at City Clinical Hospital No. 7, Almaty, Kazakhstan. Sabina Medukhanova Republican Coordination Center for Stroke in the Republic of Kazakhstan, Kazakhstan. Konstantin Bulygin Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan. Tazhiyeva Aigul Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan. 2025 09 23 2026 05 01 Objective: The study aimed to evaluate the accessibility and performance of emergency medical service (EMS) in Kazakhstan, with a focus on regional disparities and implications for health system development. Methods: A retrospective study on ambulance services in Kazakhstan for 2024 used data from the medical information system. The study found that the ambulance service has 100% automated call management in cities like Astana, Almaty, Shymkent, and 17 regions. The dispatcher processes calls within 5 minutes, categorizing challenges into four types: direct threats to life, potential threats, potential health threats, and acute conditions without danger. The time of arrival for ambulances varies between 10 minutes and 60 minutes. Results: The ambulance service has 20 stations, 96 urban substations, and 195 district offices. 1,499 mobile EMS teams operate in one shift, with a ratio of 18/82. In 2024, 914 city and 585 district brigades operate consultations without team departure, accounting for 10.27% of calls. Kazakhstan has a high proportion of urgent category one calls, accounting for 86% of the total number. This raises concerns about the accuracy of the assessment of urgency, as it may indicate system errors in triage or overloading ambulances with tasks not within their competence.  The Ulytau region, North Kazakhstan, East Kazakhstan, Mangystau, Kyzylorda, and Karaganda regions have the highest percentages of urgent calls (94-96%). The study recorded 8,531,652 calls, with 70.8% coming from urban areas and 29.2% of rural regions. The highest urbanization rates were found in republican significance towns like Almaty, Shymkent, and Astana. In all regions, the distribution of calls between urban and rural areas differs significantly from the overall structure for the country (χ² = 3,210,171.3, P< 0.001). Conclusion: The study shows that Kazakhstan's EMS system has fully automated call management, but regional disparities persist. Urgent category one calls are predominant, with urban areas like Almaty, Astana, and Shymkent generating the majority. This highlights structural imbalances in EMS utilization and calls need improvement in triage protocols, resource allocation, and health system capacity. https://fem.tums.ac.ir/index.php/fem/article/view/1659 https://fem.tums.ac.ir/index.php/fem/article/download/1659/550

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 07 11 e5 e5 Shakiba Mohammadi Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Mohammadi Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Afzalimoghaddam Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran Mohammad Mahdi Pirmoradi Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. Sara Parviz Radiology Department, Tehran University of Medical Sciences, Tehran, Iran. Hadi Mirfazaelian Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 12 2026 06 19 Objective: This study aimed to quantitatively evaluate the diagnostic performance of inverted grayscale radiography for detecting tibial plateau fractures. Methods: In this retrospective diagnostic accuracy study, two emergency physicians independently assessed one-view (anteroposterior) knee radiographs in both conventional and inverted grayscale modes in separate, blinded sessions. Spiral knee computed tomography (CT) scans served as the reference standard for fracture confirmation. Sensitivity, specificity, and area under the receiver operating characteristic curve values were calculated. Inter-observer agreement was also assessed using Cohen's kappa. Results: Of 112 included cases, 31 (27.67%) had tibial plateau fractures confirmed on CT. For the first physician, sensitivity and specificity were 54.84% (36.00%-72.70%, CI 95%) and 85.19% (75.60%-92.10%, CI 95%) with conventional images, compared with 35.48% (19.20%-54.60%, CI 95%) and 83.95% (74.10%-91.20%, CI 95%) with inverted grayscale images. For the second physician, sensitivity was identical for both modalities (38.71% (21.90%-57.80%, CI 95%)) while specificity was higher with conventional radiography (100.00% (95.60%-100.00%, CI 95%)) than inverted grayscale radiography (90.12% (81.50%-95.60%, CI 95%)). The area under the operating characteristic curve values were consistently higher for conventional imaging: 0.70 (0.60–0.78, CI 95%) versus 0.59 (0.50–0.68, CI 95%) for the first physician (P-value=0.03) and 0.69 (0.57–0.81, CI 95%) versus 0.64 (0.52–0.76, CI 95%) for the second physician (P-value=0.18). Inter-observer agreement was moderate for conventional radiographs (κ = 0.51) and lower for inverted grayscale images (κ = 0.38). Conclusion: Inverted grayscale radiography did not improve the detection of tibial plateau fractures and was associated with reduced inter‑observer reliability. https://fem.tums.ac.ir/index.php/fem/article/view/1667 https://fem.tums.ac.ir/index.php/fem/article/download/1667/552

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 06 28 e6 e6 Shiva Bahrehmand Department of General Surgery, Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran. Omid Mehrazin Bashkir State Medical University, Ufa, Russia. Nafiseh Mehri Khotbehsara Bashkir State Medical University, Ufa, Russia. Firooze Abolhasani zade Cancer & Breast Surgery fellowship, Kerman University of Medical Sciences, Kerman, Iran. Mohammadreza Lashkarizad Department of Thoracic Surgery, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran. 2025 12 05 2026 05 02 Objective: Chronic pain after blunt thoracic trauma remains a frequent and debilitating problem driven by complex neuropathic mechanisms and insufficient acute pain control. Pregabalin has emerged as a potential non‑opioid option, though evidence remains inconsistent. Given these gaps, the present study aims to evaluate the therapeutic efficacy of oral pregabalin in managing chronic post‑traumatic thoracic pain. Methods: This randomized, double‑blind clinical trial was conducted from early 2024 to the end of September 2025 at Shahid Bahonar Hospital in Kerman. A total of 50 patients (25 in each group) were enrolled through convenience sampling. Participants received pregabalin or a placebo alongside naproxen for 12 weeks. The primary outcome was chronic pain intensity, while secondary outcomes included changes in pain scores, additional naproxen use, the 30% treatment‑response rate, adverse events, and quality of life. Results: Across the 12‑week follow‑up, additional naproxen use remained consistently lower in the pregabalin group, with significant between‑group differences from week 2 onward (P=0.042 to P=0.001). Pain intensity similarly declined more steeply with pregabalin (repeated measures P=0.001) compared with the control group (P=0.236). Persistent chronic pain was markedly less frequent with pregabalin (8 vs. 19 patients; P=0.001). SF‑36 scores improved significantly across all subscales in the pregabalin group (P<0.05) and remained higher than in controls post‑treatment (P=0.018–0.025). Conclusion: Adjunctive pregabalin significantly reduced the severity and persistence of chronic post‑traumatic chest pain when added to naproxen therapy. Its effects are likely mediated through modulation of neuropathic pathways and central sensitization, resulting in decreased analgesic requirements. While no major safety concerns emerged, conclusions regarding tolerability are limited by sample size and warrant confirmation in larger trials. https://fem.tums.ac.ir/index.php/fem/article/view/1703 https://fem.tums.ac.ir/index.php/fem/article/download/1703/551

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 06 08 e7 e7 Moojan Shabani Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Samrand Fattah Ghazi Department of Anesthesiology and Intensive Care, Tehran University of Medical Sciences, Tehran, Iran. Morteza Daraie Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hamed Kazemi Khaledi Department of Endocrine Surgery, Tehran University of Medical Sciences, Tehran, Iran. Shahram Bagheri-Hariri Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 15 2025 12 05 Rare tumors that release catecholamines and originate in the adrenal medulla are called pheochromocytomas. They usually manifest as headaches, diaphoresis, palpitations, and hypertension, but occasionally they can resemble panic disorder. We report the case of a 51-year-old man who had dyspnea, chest pain, and a hypertensive crisis. Despite treatment with antihypertensives and anxiolytics, his symptoms persisted. Imaging revealed a large hemorrhagic adrenal mass consistent with a ruptured pheochromocytoma. Following laparoscopic adrenalectomy, histopathological analysis confirmed pheochromocytoma with a Zellballen pattern and vascular invasion but no capsular invasion. This case highlights the importance of considering secondary causes of hypertension, particularly pheochromocytoma, in patients with refractory symptoms and overlapping psychiatric features. https://fem.tums.ac.ir/index.php/fem/article/view/1671 https://fem.tums.ac.ir/index.php/fem/article/download/1671/547

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 06 08 e8 e8 Ahmad Abbasian Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hadi Mirfazaelian Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. AmirAli Soltani School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2026 02 06 2026 05 02 A 34-year-old man presented to the emergency department with a chief complaint of shortness of breath and sore throat. On examination, the patient exhibited stridor and noisy breathing with the rest of the physical examination being within normal range, ultimately leading to a diagnosis of acute uvulitis. We present a case of acute uvulitis in this report. https://fem.tums.ac.ir/index.php/fem/article/view/1722 https://fem.tums.ac.ir/index.php/fem/article/download/1722/549

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 06 08 1705 1705 Ali Labaf Department of Emergency Medicine, Tehran University of Medical Sciences, Hakim Children’s Hospital, Tehran, Iran. Parisa Sharifian Department of Emergency Medicine, Tehran University of Medical Sciences, Hakim Children’s Hospital, Tehran, Iran. 2025 12 11 2026 05 18 Pediatric Emergency Medicine (PEM) has emerged globally as a subspecialty dedicated to the acute care of infants, children, and adolescents, addressing their unique physiological and psychosocial needs. Following international developments in North America, Europe, and Asia, PEM was formally recognized in Iran between 2022 and 2023, with curriculum approval and the establishment of training programs at four major universities. A landmark achievement occurred in October 2025 with the graduation of the first cohort of eight subspecialists, creating a dedicated national workforce. Epidemiological studies in Iran highlight respiratory illnesses, trauma, and poisoning as leading pediatric emergencies, underscoring the relevance of PEM expertise. Institutional support is expanding, with additional centers accredited for training. Despite these advances, challenges remain, including limited pediatric-specific resources, gaps in emergency medical services preparedness, and lack of standardized protocols. Future priorities include establishing a national PEM journal, research center, and academic society to strengthen education, research, and collaboration. These milestones mark a historic turning point in Iranian pediatric emergency care, laying the foundation for sustainable growth and improved outcomes for children nationwide. https://fem.tums.ac.ir/index.php/fem/article/view/1705 https://fem.tums.ac.ir/index.php/fem/article/download/1705/548

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 0 0 2026 05 06 e9 e9 Hesam Seyedin Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Shandiz Moslehi Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran. Asghar Tavan Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. sajjad narimani Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. 2025 09 05 2025 12 26 Emergency Medical Services (EMS) providers are routinely exposed to mass casualty incidents, with post-crisis care traditionally focusing on mitigating psychological pathologies like PTSD through protocols such as Critical Incident Stress Debriefing (CISD). This commentary argues that while this clinical, deficit-based model is necessary, it is insufficient for addressing the profound existential crisis of meaning that many providers experience. Such crises are characterized by a fracturing of professional purpose and unanswered questions about the value of their work in the face of devastating outcomes. The article proposes a pivotal shift from mere psychological recovery to a framework of meaning reconstruction. This involves reframing success from measurable outcomes to the unwavering act of providing care itself, enabling agency by channeling experience into tangible roles like mentoring and protocol development, and legitimizing the search for meaning as a core component of occupational health. Ultimately, the goal is to help providers integrate traumatic events into their professional narrative, transforming them from passive victims into active architects of a more resilient future, thereby ensuring their sense of purpose is not extinguished by trauma. https://fem.tums.ac.ir/index.php/fem/article/view/1655 https://fem.tums.ac.ir/index.php/fem/article/download/1655/545