Journal of Emergency Medicine, Trauma and Acute Care - Volume 2024, Issue 3

Background and Aims: Several methods have been used in plastic and reconstructive surgery to reduce post-surgical complications, such as partial or complete flap loss due to ischemia and necrosis. Nitroglycerine application has been introduced as a viable alternative to papaverine to act as a local vasodilator to improve perfusion and reduce vasospasm. However, the literature has not thoroughly studied its efficacy and administration dose. This systematic review and meta-analysis study has been designed to assess the efficacy of topical nitroglycerine applications in reducing post-surgical flap necrosis and complications.

Methods and Materials: A systematic literature search was performed on PubMed, Scopus, and Web of Science from inception to January 2023 with relevant keywords and terms. Case reports, review articles, letters, articles in any language other than English, and animal studies were excluded. The Newcastle-Ottawa and Jadad scales were used to assess the quality of the included studies. The pooled effect sizes were calculated using the random effect model with the Mantel-Haenszel method.

Results: Overall, 2031 studies were obtained, among which 454 articles were duplicated and removed. Of the remaining 1577 articles, based on the eligibility and exclusion criteria, 20 articles were retrieved for full-text review. Finally, eight articles were included in our study. Three thousand nine hundred six patients had undergone reconstructive microsurgery and received topical nitroglycerin for the prevention of possible complications. The pooled rate of flap complication was 15% (95% CI: 8% to 25%, I² = 96%, p-value < 0.01), and the pooled odds ratio of flap complication was 0.35 (95% CI: 0.15 to 0.83, I² = 91%, p-value = 0.02). The heterogeneity of the included studies was significantly high. The dose and regimen of application significantly differed between each study.

Conclusion: Topical administration of nitroglycerin compounds post reconstructive microsurgery can reduce the risk of flap necrosis. However, the precise dosage, duration of application, and possible underlying factors affecting drug efficacy are yet to be discovered.

Introduction: Various early warning score tools have been developed to identify clinical deterioration in patients. This study assessed the predictive capacity of the National Early Warning Score 2 (NEWS-2) in the prehospital setting to predict death within 24 hours and 30-day intensive care unit admission.

Methods: A single-center observational retrospective study was conducted in the emergency medical services (EMS) of King Abdulaziz Medical City, Riyadh, Saudi Arabia. We included adult patients (> 18 years) who attended the emergency medical service. The primary outcome was 24-hour death and 30-day intensive care unit admission. Sensitivity, specificity, and negative/positive predictive values (NPV/PPV) were determined.

Results: The study comprised 1,343 eligible patients. NEWS-2 exhibited a sensitivity of 20% and a specificity of 80% for predicting 24-hour death and a sensitivity of 10% and a specificity of 80% for predicting 30-day intensive care unit admission. The area under the curve for predicting death was 0.529, and for intensive care unit admission was 0.456.

Conclusion: Our study underscores the limited utility of NEWS-2 as a predictor of 24-hour death and 30-day intensive care unit admission in adult patients utilizing the emergency medical service. Further extensive studies are warranted to corroborate this study’s findings.

Tracheobronchial injury (TBI) is an uncommon, life-threatening chest injury, particularly in children, that can occur as a result of iatrogenic or unintentional trauma. It can induce airway obstruction and precipitate life-threatening respiratory failure. However, clinical manifestations can vary, posing challenges in establishing a diagnosis. We report an 11-year-old male presented with respiratory difficulty and neck swelling immediately after falling from a height of 15 meters. Chest examination revealed absent air entry in the right lung and decreased air entry in the left lung. A chest computed tomography (CT) scan revealed a right-sided pneumothorax and a complete transection of the right main bronchus 7mm from the carina. Bilateral thoracostomy and chest tube insertion were performed. The patient was further evaluated by fibreoptic bronchoscope, which showed a complete transection of the right main bronchus. However, due to the progression of subcutaneous emphysema and persistent pneumothorax, the patient subsequently underwent surgical repair of the bronchial damage with a successful outcome.

In conclusion, this case report presents a rare clinical entity of TBI in children. Heightened clinical suspicion, prompt stabilization, and multidisciplinary care involving healthcare specialists are essential for the survival of TBI patients. Often, a tailored surgical approach is necessary for definitive repair.

Spontaneous pneumomediastinum (SPM) associated with subcutaneous emphysema and tracheal injury following persistent vomiting is rare. Here, we report a case of a young adult who presented to the emergency and trauma department with severe vomiting and abdominal pain, persisting for four days, and denied any symptoms of respiratory distress. Physical examination revealed mild dehydration and abdominal tenderness. A chest X-ray indicated subcutaneous emphysema and pneumomediastinum. A subsequent computed tomography (CT) scan confirmed a tracheal tear, pneumomediastinum, and emphysema. The patient received conservative management, including fluids, adequate analgesia, and antibiotics. Spontaneous cases are often linked to forceful coughing. Diagnosis primarily relies on imaging, mainly CT scans, while bronchoscopy aids in assessing tracheal tears. Treatment typically involves conservative measures like observation, pain management, and antibiotics. The patient was managed conservatively with antibiotics and supportive care in this case. SPM with stable conditions typically respond favorably to conservative treatment, and complete resolution can be anticipated within two days to one week.

Background: Globally, road traffic accidents cause around 50 million injuries and disabilities and close to 1.35 million deaths every year. In Ethiopia, approximately five thousand deaths are estimated to occur annually due to road traffic accidents. However, there is limited data on the precise burden of the problem in Ethiopia. This study aimed to assess the magnitude of road traffic accidents and associated factors among traumatized patients who visited the emergency units of selected public hospitals in Addis Ababa, Ethiopia.

Methods: A facility-based cross-sectional study design was conducted on 381 trauma patients who visited the emergency department of three public hospitals in Addis Ababa between June 1 and July 12, 2022. The data were collected using a structured questionnaire, entered into Epi-data, and exported to SPSS for statistical analysis. A logistic regression model was used to identify factors contributing to road traffic accidents at a significant level of P < 0.05.

Results: The majority of participants were males (73.5%), between 20 and 39 years old (65.1%), and married (45.7%). The prevalence of road traffic accidents among traumatized patients was 37.3% (95% CI: 32.5, 42.3) in public hospitals in Addis Ababa. After adjusting for potential confounders, being male [AOR (95% CI) = 2.77 (1.6, 4.8)], traveling in the afternoon [AOR (95% CI) = 0.6 (0.3, 0.9)], and alcohol-drinking before travel [AOR (95% CI) = 2.50 (1.6, 4.0)] were factors contributing to road traffic accidents.

Conclusion: The prevalence of road traffic accidents was very high in Addis Ababa public hospitals. Being male, traveling in the afternoon, and drinking alcohol before travel were significantly associated with an increased risk of road traffic accidents. Community awareness creation, strict traffic flow control in the morning, and alcohol breath tests will ultimately decrease road traffic accidents. In the meantime, expansion and strengthening of pre-hospital care and post-crash trauma care services.

Diaphragmatic hernias following severe thoracoabdominal injuries are infrequent clinical occurrences, and right-sided post-traumatic hernias are particularly rare due to the protective barrier provided by the liver. The overall incidence of diaphragmatic rupture following trauma is approximately 1.3%, with only 20% of these cases identified on the right side. This report aims to present the case of a patient diagnosed with a substantial intrathoracic liver hernia 4 years after a traumatic incident. Surgical intervention successfully corrected the diaphragmatic defect, and the patient’s postoperative course was uneventful. A 2-month follow-up revealed no signs of recurrence, underscoring the effectiveness of the surgical approach in managing this unusual presentation of diaphragmatic hernia.

Purpose: No study to date has investigated the prognostic ability of the recently introduced “systemic immune-inflammation index” (SII) in thoracic empyema. Therefore, we aimed to evaluate the association between SII and outcome in such patients.

Methods: The single-center retrospective study involved 84 patients with thoracic empyema admitted to the Clinic of Thoracic Surgery at a University Hospital Stara Zagora between January 2021 and October 2023. Clinical and laboratory parameters were recorded at admission. We analyzed the area under receiver operating characteristics (AUROC) curves of SII, qSOFA, and SIRS and compared their prognostic value.

Results: The observed in-hospital mortality was 10.7%. As a predictor of death, SII showed the best prognostic ability compared to SIRS (AUROC = 0.782 vs. 0.676) and qSOFA (AUROC = 0.782 vs. 0.747). At the optimal cut-off value of > 3269 x 10⁹/L, we identified a sensitivity of 71.4% and a specificity of 78.7%.

Conclusion: In thoracic empyema, SII could be routinely used as a simple, low-cost, and easily assessable indicator for patients at higher risk of poor outcome.

This paper presents a case of Enterococcus cecorum (E. cecorum) meningitis with bacteremia in a middle-aged woman who had previously undergone a splenectomy. Within 24 hours, the bacterium was identified from a blood culture. The patient was clinically diagnosed with meningitis, which was radiologically verified by an MRI brain scan. Fortunately, she had a favorable outcome. To the best of our knowledge, this is the first reported case of E. cecorum-induced meningitis in humans and the second documented incidence of E. cecorum infection in humans in Australia. The purpose of this case report is to emphasize the potential for serious human infections caused by an extremely rare pathogen.

Background and Aim: Distal radius fractures are the most frequent upper extremity fractures in the whole population. The incidence of distal radius fractures is 195.2/100,000, and the rate is increasing. It can occur with low-energy trauma in the elderly associated with osteoporosis. The purpose of this study is to compare the two different treatment groups (1. Sedation analgesia, 2. Supracondylar radial nerve block) in terms of reduction in Visual Analogue Scale (VAS) score, the length of hospital stay, complications, side effects, patient-physician satisfaction, and the ease of application.

Materials and Methods: Patients diagnosed with distal radius fracture were enrolled prospectively, to whom the study’s exclusion criteria do not apply. The patients included in the study were randomly separated into two groups. Ketofol was administered to the sedation and analgesia group’s patients at a dose of 0.5 mg/kg (ketamine 0.5 mg/kg, propofol 0.5 mg/kg) intravenously, and supracondylar radial nerve block was performed on the other group’s patients under ultrasound guidance.

Results: There were 20 patients (6 male, 14 female) in the sedation and analgesia group and 21 patients (11 male, 10 female) in the supracondylar radial nerve block group. There was no significant difference between the groups regarding patient-physician satisfaction and complications. The length of hospital stay was significantly shorter in the supracondylar radial nerve block group (49.25 ± 4.05) compared with the sedation and analgesia group (125 ± 5.85) (p < 0.01). The mean reduction VAS score in the block group was observed to be lower than the admission VAS score (p < 0.01).

Conclusion: Consequently, ultrasound-guided supracondylar radial nerve block would be a valuable alternative to procedural sedation analgesia and could become routine clinical practice in treating distal radius fractures.

Background and Importance: Emergency department (ED) care is complex, involving multifaceted factors such as patient volume, provider experience, throughput metrics, and patient-provider interactions. While some studies have explored relationships between these parameters, there is still much to understand about the nuances in ED care.

Objective: Our study aimed to analyze the statistical relationships between admission rates, Press Ganey (PG) scores, and various throughput/resource utilization variables in the ED. These variables include imaging and lab ordering rates, door-to-doctor (D2D) success rate, disposition times for specific patient acuities, and elopement or discharge against medical advice (AMA) rates.

Design: A retrospective cohort study was conducted using data from eight emergency facilities within the Valley Health System.

Settings and Participants: Data from six community hospital EDs and two freestanding emergency departments (FEDs) in the Valley Health System, spanning August 1, 2020, to July 31, 2021, were examined. The analysis involved 99 physicians and approximately 200,000 adult patients.

Outcome Measures and Analysis: Correlations between admission rates, PG scores, and various ED metrics were examined using the Jamovi software. Separate analyses were conducted based on facility type using ANOVAs.

Main Results: Our findings revealed several significant correlations. There was a positive correlation between lab ordering and admission rates, while D2D success rates showed a negative correlation with admission rates. Additionally, there was a positive association between D2D success rates and quick dispositioning of lower acuity patients. Patient satisfaction (PG score) was negatively correlated with admission, AMA, and D2D success rates, whereas it positively correlated with lab ordering rates.

Conclusion: This study identifies significant relationships among ED throughput, resource utilization, and patient satisfaction metrics. These findings can guide further research to understand the patient experience better, optimize resource utilization, and improve overall ED efficiency.