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

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

Effectiveness of digital consultation in reducing emergency department length of stay

Objective: Emergency department length of stay (EDLOS) is a critical measure of healthcare efficiency and quality, and prolonged stays are associated with worse outcomes, particularly for patients requiring intensive care unit (ICU) admission. This study evaluates the impact of a digital consultation management system implemented at Hiwot Fana Comprehensive University Hospital in Ethiopia between May 2020 and May 2024. Methods:  A pre–post quasi-experimental design was utilized to compare EDLOS for ICU patients before and after the implementation of the new consultation system. The traditional consultation process was characterized by multi-step verbal communication among healthcare providers. The new system employed a secure Telegram channel to facilitate real-time communication, whereby all physicians in the consulting service were simultaneously notified of the patient requiring ICU care. We determined the proportion of patients admitted to the ICU staying more than 24 hours in the emergency department (ED) between pre- and post-implementation of the Telegram system using chi-squared tests and mean difference in LOS using Mann Whitney U. Results: This study included 415 patients with 202 patients in the pre-implementation period (May 01, 2020, to May 31, 2022) and 213 in the post-implementation period (June 01, 2022, to May 31, 2024). The mean age was 43.3 years (SD: 18.75 years), and no significant demographic or clinical differences were observed between the pre- and post-intervention groups, except for payment method. Before implementation, 32.6% of patients stayed in the ED> 24 hours while after the implementation 28.8% stayed > 24 hours (P=0.03) The mean EDLOS decreased from 2.83 (SD: 2.5) days to 2.27(SD: 1.64) days following implementation (P=0.04), with a reduction of approximately 13.2 hours in EDLOS. Overall ICU mortality decreased from 31.4% to 25.8%, though this was not statistically significant. Conclusion: A digital consultation system can reduce EDLOS in a limited-income country, consistent with findings from similar studies. Further research is needed to explore long-term impacts and scalability, especially in low-resource settings

Diltiazem vs metoprolol for atrial fibrillation with rapid ventricular response in heart failure with reduced ejection fraction in emergency departments

Objective: As emergency department (ED) visits for atrial fibrillation (AF) grow, comorbidities lead to challenging treatment scenarios. There are limited data evaluating the safety of diltiazem in the acute management of AF with rapid ventricular rate (RVR) in patients with heart failure with reduced ejection fraction (HFrEF). The objective of this study was to evaluate the safety of diltiazem vs metoprolol in patients presenting to the ED with AF with RVR with HFrEF. Methods: This multicenter, retrospective, cohort study evaluated patients with AF with RVR with HFrEF who received either intravenous (IV) diltiazem or metoprolol in the ED. The primary endpoint was worsening heart failure, defined as an increase in supplemental oxygen requirement, acute kidney injury (AKI), or inotrope administration. Secondary endpoints included bradycardia, systolic blood pressure (SBP) <90 mmHg, or atropine administration. Results: Of the 5,465 patients screened, 62 (1.1%) patients were included for analysis. Forty-nine (79%) patients received IV diltiazem and 13 (21%) received IV metoprolol. The primary endpoint of worsening heart failure occurred in 26.5% in the diltiazem cohort and 15.4% in the metoprolol cohort (P=0.493). There were no differences in increased need for supplemental oxygen, incidence of AKI, or inotropic support. There were no differences in the secondary safety endpoints. Conclusion: For ED management of patients with AF with RVR with HFrEF, treatment with IV diltiazem did not lead to an increase in worsening heart failure compared to IV metoprolol. Future prospective trials are needed to evaluate this treatment approach in this population

Beyond the obvious: spontaneous esophageal perforation mimicking flank pain

Spontaneous esophageal perforation, also known as Boerhaave syndrome, is a rare but potentially fatal condition that classically presents with chest pain, vomiting, and subcutaneous emphysema. Atypical presentations can lead to diagnostic delays and increased morbidity and mortality rates. A 51-year-old male presented to the emergency department with isolated left flank pain. The CT scan unexpectedly revealed bilateral diffuse subcutaneous emphysema and left pleural effusion. Following chest tube insertion, food particles were recovered from the pleural drainage, which established the diagnosis of esophageal perforation. Emergency surgical repair was performed successfully with a good clinical outcome. This case highlights the importance of maintaining high clinical suspicion for esophageal perforation even in patients presenting with atypical symptoms. The absence of classic triad symptoms should not exclude this diagnosis from consideration. CT imaging can provide crucial diagnostic information when the clinical presentation is unclear or atypical

Transvaginal evisceration after laparoscopic hysterectomy: case report

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

Spontaneous coronary artery dissection (SCAD) as a rare but life-threatening emergency department presentation: a case report

Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening cause of acute coronary syndrome, particularly in young women with few traditional risk factors for atherosclerosis. SCAD is often underrecognized due to its atypical presentation which can lead to misdiagnosis or delayed diagnosis in emergency settings. We present a case of a 40-year-old female who presented to the emergency department with acute chest pain and was found to have ST-elevation myocardial infarction (STEMI) due to SCAD. This case highlights the importance of considering SCAD in the differential diagnosis of acute coronary syndrome in young patients, especially females, and the need for increased awareness among emergency physicians to optimize patient outcomes and reduce recurrence risks. This case also emphasizes the importance of recognizing SCAD as a distinct entity from atherosclerotic ACS, as it requires a different management approach, particularly in the initial steps of care

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

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

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

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

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

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

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

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