Journal of Emergency Medicine, Trauma and Acute Care - Volume 2022, Issue 5

Objectives: Lactic acid is a metabolite that is physiologically produced and metabolized in a balanced state in the body from glucose. Critically ill patients with sepsis are found to have higher serum lactate levels. In this study, the established Intensive Care Unit (ICU) scores that are Sequential Organ Failure Assessment (SOFA) and Acute physiology and chronic health evaluation (APACHE IV) were compared to serial serum lactate measurements as a superior predictor of mortality in critically ill patients with sepsis admitted under Intensive Care Unit. Methods: In this cross-sectional study, 280 patients who were admitted to ICU care and were diagnosed to have sepsis were enrolled from August 2019 to September 2021. The presentation of the categorical variables was done in the form of numbers and percentages (%). On the other hand, the quantitative data were presented as the means ± SD and as median with 25th and 75th percentiles (interquartile range). The data normality was checked by using the Kolmogorov-Smirnov test. In the cases in which the data was not normal, nonparametric tests were used. Results: An ICU mortality rate of 43.21% was observed among the 280 adult patients diagnosed with sepsis admitted to ICU involved in this study. The interpretation of the area under the Receiver operating curve (ROC) showed that the performance of serum Lactate (mmol/L) on day 3 (Area under the curve [AUC] 0.909; 95% CI: 0.867 to 0.941) was very much comparable to APACHE IV score on day 3(AUC 0.931; 95% CI: 0.893 to 0.960). Serum lactate on day 3 was even better than the SOFA score on day 3(AUC 0.936; 95% CI: 0.898 to 0.963). Among all the parameters, the APACHE IV score on day 3 was the best predictor of mortality at the cut-off point of >132 with a 91.0% chance of correctly predicting mortality. Conclusion: When compared with SOFA and APACHE IV scores, serial serum lactate was reliable and comparable as far as an outcome in terms of mortality is concerned in patients with sepsis admitted to the intensive care unit. Thus, serum lactate can be considered a surrogate marker for predicting mortality in sepsis patients in low-resource rural setups.

Background: Exploratory laparotomy has been the standard intervention for surgical evaluation or treatment of abdominal trauma. Laparoscopic surgery with its proposed favorable surgical outcome may provide a reliable and accurate diagnosis of the injury. In this study, we aim to define the diagnostic role of laparoscopy in abdominal trauma and define the proposed advantages of reducing nontherapeutic laparotomies. Methodology: The study is a cohort retrospective study conducted at a level I trauma center – Rashid Hospital, United Arab Emirates. All patients from January 2016 to May 2019 with a history of abdominal trauma requiring surgical intervention fulfilling the inclusion criteria were included. The outcome of this study was to look at the rate of reduction of nontherapeutic laparotomies and the rate of missed injury. Results: The rate of reduction of nontherapeutic laparotomy in patients with abdominal trauma using diagnostic laparoscopy was 19.4%. Post-operative complications were higher in the open exploration group (p-value = 0.04). No missed injury was reported among the laparoscopy group. The mean hospital stay was higher in the laparotomy group compared to the laparoscopy group (13.6 vs 17.1). Laparoscopy was successful in 68.4% of the patients and the conversion rate was 31.6%. Conclusions: Laparoscopy has a role in the diagnosis of intra-abdominal injuries of hemodynamically stable patients with suspected abdominal injury to reduce unnecessary laparotomies, thereby decreasing postoperative complications.

Background: The consequences and potential complications of encrusted double J (DJ) stents can be devastating. This work retrospectively reviews a series of Yemeni patients with encrusted DJ stents and shares the experience of handling such a challenging subject. Materials and Methods: A retrospective study was carried out from January 2016 to February 2021 at the Urology center, 48 Model Hospital, and Al-Khamseen Hospital, Sana’a, Yemen. About 30 patients with encrusted DJ stents for more than six months treated with various urological procedures were included in this study. The demographic characteristics, duration and indication of DJ stent placement, and surgical intervention were gathered and analyzed. Univariate analysis was performed to determine risk factors of long-standing encrusted DJ stent. Result: The mean age of patients was 31± 12.4 years (range 5–69), including 20 (66.7%) males and 10 (33.3%) females. The mean duration of DJ stents was 31.8± 20.8 months (12–120 months). The most common cause of long-standing encrusted DJ stent was poor compliance in 15 (50%) patients, followed by ignorance of DJ stent in 11 (36.7%) patients, and inability to access the hospital in 4 (13.3%) patients. Extracorporeal shock wave lithotripsy (ESWL) was the most common intervention performed in 11 (36.7%) patients as a single procedure. Multiple sessions of ESWL with another endourological procedure were required in 10 (33.3%) patients. A nephrectomy was performed on one (3.3%) patient due to a nonfunctional kidney. In univariate analysis, a longer duration of DJ stenting was associated with the need for multiple treatment modalities (p= 0.001). Factors such as poor compliance and farming community were associated with encrusted DJ stents in the female gender (p <0.05). In the male gender, ignorance of DJ stents was associated with encrusted DJ stents (p <0.05). Conclusion: A longer duration of DJ stenting is associated with worse outcomes, including DJ encrustation and the need for invasive and multiple treatment modalities. Poor compliance, residing in farming communities, and ignorance of the DJ stents are associated with long-standing encrusted risks and should be considered by the treating physicians.

Objectives: This study aims to understand how decision fatigue affects emergency department (ED) operations which is of paramount importance to improve patient flow through the ED and to minimize cognitive errors. It assessed admission rates and throughput metrics in relation to time into 12-hour ED shifts. It was hypothesized that there would be increased throughput and increased likelihood of admission toward the end of the shift as a result of accumulated fatigue. Methods: The retrospective cohort study assessed 9,848 patient visits to Blue Diamond (BD) and Green Valley Ranch (GVR) - two freestanding EDs - from January 1, 2020 to May 31, 2020. A chi-square analysis was performed to determine whether patients were more likely to be admitted in the first 8 hours versus the last 4 hours of the shift at the two EDs. Student’s t-tests were also performed to evaluate differences in decision-to-admit time, door-to-doctor time, throughput time, and average patients per hour. Results: More patients were seen per hour at both BD (p < 0.0001) and GVR (p < 0.0001) during the first 8 hours. From the first 8 hours to the last 4 hours, GVR had decreased admission rates from 6.18% to 3.91% (p < 0.0001) and increased throughput time from 109.9 minutes to 114.1 minutes (p = 0.02). BD had increased door-to-doctor time from 4.86 minutes during the first 8 hours to 6.2 minutes during the last 4 hours (p < 0.0001). There was no significant difference in decision-to-admit time at BD (p = 0.6774) or GVR (p = 0.2276). Conclusions: Decision fatigue has a significant effect on physician decision-making in the ED. Later in a physician’s shift, as decision fatigue accumulates, decision-making is altered in such a way as to lead to less efficient patient flow. The accumulation of decision fatigue, and its subsequent effect on patient flow and patient admissions, may be more related to the patient volume than shift length.

Background: Research strengthening and capacity development in academic health systems are important for advancing medicine, delivering best practices, improving patient outcomes, and reducing healthcare costs. The Research Forum is a biomedicine and health research strengthening program facilitated by the lead organization of the Academic Health System in Qatar. The event brought together researchers and health professionals together so they could present their research work on a particular health or research topic and network with a targeted local audience. Methods: This retrospective study evaluated the Research Forum program from August 2015 to July 2016. The Research Forum was designed as a pan-institutional multi-disciplinary program that would convene quarterly and bring health professionals and researchers together to present their work on a particular health and research topic. The primary outcome was peer-reviewed journal publications of the Research Forum events’ research presentations. The secondary outcomes were the number of attendees and speakers at the successive Research Forum events during the study period. Results: There were five Research Forum events in the first year: Neuroscience (August, 2015), Heart (October 2015), Infections (January 2016), Cancer (March 2016), and Diabetes, Obesity, and Metabolism (May 2016). A total of 722 health professionals and researchers attended the Research Forum events with 68 studies presented: 5 in Neuroscience, 10 in Heart, 12 in Infections, 18 in Cancer, and 23 in Diabetes/Metabolism. There were 13(19%) research presentations that were successfully published in peer-reviewed journals. The mean time between the study presentation and publication was 2.85 + 1.9 months (median 2; IQR 1.5, 4). None of the presenter and study characteristics variables considered for publication of presented studies was statistically significant. Conclusions: The Research Forum was a capacity building and research-strengthening program at an individual, institutional, and national level. The Research Forum was a unique program that brought together health professionals and researchers from various health institutions, universities, and organizations on a unifying health and research topic.

Background: Fasting for extended periods of time increases gastric acid and pepsin levels and consequently the risk of peptic ulcer perforation (PUP). The effects of Ramadan fasting on PUP have not been thoroughly studied, and a few existing studies report contradictory findings. The present study compares patients with PUP operated during the Islamic Ramadan fasting to those operated outside this period and determines whether an association between Ramadan fasting and PUP exists. Patients and methods: A retrospective cross-sectional study between June 2019 and December 2020 was conducted at the Al-Nasr Hospital in the city of Ibb in Yemen. All adult patients operated for a PUP were included. Patient demographic characteristics, risk factors for peptic ulcer, ultrasound and radiological findings on admission, operative findings, postoperative complications, and outcomes were collected from the Hospital Medical Records. Patients were divided into two groups for comparison. Group A included the patients operated on during Ramadan, while Group B included patients operated on outside Ramadan. Results: A total of 40 adult patients with PUP were included. The overall mean age of the participants was 41.6 ± 8.21 years (range: 23–58 years). Most patients were men (30, 75%), and most (19, 47.5%) were admitted to the Al-Nasr Hospital between 24 and 48 hours from the start of the symptoms. History of chewing khat, consumption of nonsteroidal anti-inflammatory drugs, dyspepsia, alcohol use, and smoking were presented in 39 (97.5%), 30 (75%), 36 (90%), 6 (15%), and 35 (87.5%) patients, respectively. The most presented blood group (57.5% of patients) was O type. Most of the patients (72.5%) presented with multiple gastrointestinal symptoms such as abdominal pain, anorexia, vomiting, and constipation. An x-ray found air under the diaphragm in 85% of the patients. Ultrasonography found free fluid in 20 (50%) patients. The size of the perforated ulcer (diameter) was less than 10 mm in 65% of the patients. Postoperative complications were surgical site infection, fluid collection, need for reoperation, and intra-abdominal sepsis in 6 (15%), 4 (10%), 3 (7.5%), and 3 (7.5%) patients, respectively. Most patients (37, 92.5%) recovered well and were discharged from the hospital, and three (7.5%) patients died. The comparative analysis demonstrated a significantly younger age in those operated during Ramadan fasting (Group A) compared to those operated at other times of the year (Group B; 38.8 ± 7.42 years vs. 44.4 ± 8.17; p = 0.029). We observed a statistically significant increase in the number of patients with PUP operated on during Ramadan (p = 0.006), compared to those operated at other times of the year. There was no statistically significant difference between groups in demographic factors, radiologic findings, operative findings, or outcomes (p ≥ 0.05). During the ultrasound, ascites were more frequently diagnosed in group A patients, while acute appendicitis was generally misdiagnosed in Group B patients, a statistically significant difference (p = 0.013). Conclusions: The findings of the present study report an increase in the number of PUP operations during Ramadan fasting in Yemen, but not in postoperative complications, suggesting an association between Ramadan fasting and PUP.

Sudden cardiac arrest (SCA) in long-distance running races has an incidence rate of 2.18 per 100,000 participants and a high mortality rate. Strategic planning for the medical response in a marathon event is therefore an uphill task for the organizer. Our medical operational model for the Penang Bridge International Marathon (PBIM) has not just improved the survival for marathon-related SCA, but also has been cost-effective for a middle-income country. Two runners from PBIM in 2019 had episodes of cardiac arrest at almost the same time at different locations towards the end of the run route, which were both responded by different teams of Basic Life Support trained volunteers, and then were sent to the Main Medical Base for further Advanced Life Support care before receiving ICU care in the tertiary hospital. Both patients achieved good neurological outcomes and survived hospital discharge.

Background: Mortality associated with COVID-19 varies in various reports, with minimal data on the factors associated with in-hospital mortality.

Objective: To identify the risk factors for in-hospital death of patients with COVID-19 in an intensive care unit (ICU) in Qatar.

Methods: A retrospective observational study of patients confirmed with COVID-19 and admitted to the medical-surgical ICU at The Cuban Hospital was carried out from April 12, 2020, to September 12, 2020. From patients’ electronic medical records, demographic, clinical, laboratory, and radiology data was collected.

Results: 275 patients with COVID-19 were admitted to the ICU, and 32 (11.6%) died. 56.1% were men, and the mean age was 52.2 years. According to the univariate analysis, patients with diabetes mellitus with end-organ damage (37.5%), cardiovascular disease (31.3%), dementia (9.4%), kidney disease (28.1%), chronic obstructive pulmonary disease (31.3%), and higher Charlson index had higher mortality. According to the multivariate analysis, an increase of mortality risk by 9% was observed for each additional year of age (Odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04–1.14), patients on mechanical ventilation (OR 27.33; 95% CI 3.21–232.46), and those with adult respiratory distress (OR 15.85; 95% CI 1.45–172.82) and elevated procalcitonin (OR 7.30; 95% CI 1.25–42.58), and the PiO2/FiO2 ratio between 100 and 299 decreased the risk of death by 92% (OR 0.08; 95% CI 0.02–0.39), in comparison to a PiO2/FiO2 ratio less than 100 or greater than 300.

Conclusion: The study provides evidence about the risk of mortality among COVID-19 patients with a significant contribution of age, respiratory failure, and co-infections.

Background: Pre-hospital emergency medical services (EMS) staff are at a high risk of occupational injuries. Therefore, this analysis aimed to calculate the 12-month prevalence of injuries due to occupational accidents and identify the associated factors in German pre-hospital EMS staff.

Methods: We analyzed data from a cross-sectional survey to calculate the 12-month prevalence and the 95% confidence interval (95% CI) of an injury due to an occupational accident. In addition, the variables associated with these injuries were identified by multivariable logistics regression analysis and by calculating adjusted odds ratios (AORs) with 95% CI using JASP software.

Results: A total of 2,307 study participants were included in the analysis. The 12-month prevalence of an injury due to an occupational accident was 15.61% (95% CI: 14.15%; 17.15%). The presence of lower back pain or chronic back pain (AOR: 1.65 [95% CI: 1.24; 2,20]; p ≤ 0.001), allergies other than allergic asthma (AOR: 1.42 [95% CI: 1.09; 1.86]; p = 0.009), and osteoarthritis (AOR: 1.85 [95% CI: 1.03; 3.32]; p = 0.039) in the previous 12 months, which are associated with an injury due to an occupational accident, were statistically significant. In addition, participants who were working in rural areas indicated lower odds compared to those working in metropolitan areas (AOR: 0.62 [95% CI: 0.43; 0.90]; p ≤ 0.001).

Conclusion: This analysis indicates a high 12-month prevalence and mainly health-related factors associated with injuries due to occupational accidents being statistically significant in the participating German pre-hospital EMS staff.