FEM in 2024, A quick look

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

Detecting COVID-19-infected regions in Lung CT scan through a novel dual-path Swin Transformer-based network

Background: Deep learning-based automatic segmentation provides significant advantages over traditional manual segmentation methods in medical imaging. Current approaches for segmenting regions of Coronavirus disease 2019  (COVID-19) infections mainly utilize convolutional neural networks (CNNs), which are limited by their restricted receptive fields (RFs) and consequently struggle to establish global context connections. This limitation negatively impacts their performance in accurately detecting complex details and boundary patterns within medical images. Methods: This study introduces a novel dual-path Swin Transformer-based network to address these limitations and enhance segmentation accuracy. Our proposed model extracts more informative 3D input patches to capture long-range dependencies and represents both large and small-scale features through a dual-branch encoder. Furthermore, it integrates features from the two paths via the new Transformer Interactive Fusion (TIF) module. The architecture also incorporates an inductive bias by including a residual convolution (Res-conv) block within the encoder. Results: The proposed network has been evaluated using a 5-fold cross-validation technique, alongside data augmentation, on the publicly available COVID-19-CT-Seg and MosMed datasets. The model achieved Dice coefficients of 0.872 and 0.713 for the COVID-19-CT-Seg and MosMed datasets, respectively, demonstrating its effectiveness relative to prior methodologies. Conclusion: The significant improvements in segmentation accuracy, demonstrated by the achieved Dice coefficients on the COVID-19-CT-Seg and MosMed datasets, highlight the potential of our approach to enhance automated segmentation in medical imaging

Analyzing thoracic trauma trends at Dr. Mohammad Hoesin Hospital, Indonesia: findings from 2020

Objective: Thoracic trauma is frequently encountered in Indonesia, contributing to significant rates of mortality and morbidity. A considerable number of patients with thoracic injuries succumb before reaching medical facilities, as the prevalence of such trauma continues to escalate. Nevertheless, the risk of fatal outcomes can be mitigated through timely emergency intervention, precise diagnosis, and appropriate treatment. This study aimed to present an overview of the demographic characteristics, treatment outcomes, and duration of hospitalization for thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang during the years 2020 and 2021. Methods: This descriptive observational study utilized secondary data derived from the medical records of thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang from January 1, 2020, to December 31, 2021, who satisfied the established inclusion and exclusion criteria. Results: A total of 78 thoracic trauma patients were treated at Dr. Mohammad Hoesin Palembang Hospital during 2020–2021, with a sociodemographic profile predominantly consisting of males (91.3%) and individuals aged 45 years and older (66.3%). Penetrating injuries caused by sharp objects accounted for 45% of cases. The most prevalent diagnosis among these patients was hemopneumothorax (23.1%), followed by thoracic trauma without associated injuries (62.5%). The majority of patients (97.5%) were discharged from the hospital. Notably, 58.8% of patients arrived at the hospital more than six hours post-trauma, and nearly half (48%) had a hospital stay ranging from one to five days. Conclusion: The cohort of thoracic trauma patients admitted to Dr. Mohammad Hoesin Palembang hospital in 2020–2021 was primarily male, aged 45 years or older, sustained injuries from sharp objects, diagnosed with hemopneumothorax without associated thoracic injuries, arrived at the hospital after more than six hours, and were discharged within one to five days

Massive hemorrhage update: what is known and what we should know?

Massive hemorrhage protocol (MHP) is an updated term for the formerly used massive transfusion protocol, highlighting crucial aspects of hemorrhage management other than the transfusion itself. This complex intervention includes acute hemorrhage control; administering tranexamic acid (TXA), preventing hypocalcemia, hypothermia, and acidosis; reversing anticoagulation or correcting coagulopathies; and planning for the next steps in definitive hemorrhage control. Here, we discuss exciting frontiers and challenges of MHP

Comparison of penthrox (methoxyflurane) inhalation and intravenous morphine for acute limb fracture pain management in the emergency department: a randomized controlled trial

Objective: Effective pain management is crucial in emergency settings, and both penthrox (methoxyflurane) inhalation and intravenous morphine are commonly used analgesics. This study aimed to compare the analgesic efficacy, adverse effects, and patient satisfaction associated with penthrox spray and morphine for acute limb fracture pain management in the emergency department. Methods: This prospective, double-blinded, randomized controlled trial included 50 patients aged 20-55 years with acute limb fracture pain, randomly assigned to receive either penthrox spray or intravenous morphine. The primary outcome was pain intensity assessed using the visual analog scale (VAS) over 60 minutes. Secondary outcomes included adverse effects, vital signs, and patient satisfaction. Results: Both groups experienced significant pain relief over time, with a similar reduction in VAS scores (P<0.001). However, the penthrox spray group showed a trend toward more rapid pain reduction, although not statistically significant. The frequency of vomiting and nausea tended to be lower in the penthrox spray group (24% vs. 40%, P=0.225). There were no significant differences in patient satisfaction scores between groups. While both groups experienced a decrease in blood pressure, the heart rate remained stable in the penthrox spray group but decreased significantly in the morphine group (P<0.001). Conclusion:  Penthrox spray and intravenous morphine demonstrated comparable analgesic efficacy for acute limb fracture pain in the emergency department. Penthrox sprays trended toward faster pain relief and potentially lower risk of vomiting and nausea. The stable heart rate observed with penthrox may be advantageous in certain clinical scenarios. Consideration of factors such as onset of action, adverse effects, and patient preferences may guide the choice between these analgesics

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

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

Comparison of trauma severity in and out of the navigation ring around the metropolis: a case of Tabriz, Iran

Objective: One of the causes of severe injuries in urban accidents is the occurrence of accidents on urban highways and city outskirts. The present study will determine the severity of accidents in the complete urban ring of Tabriz, including Shahid Kasaei highway, Pasdaran, Dizel Abad, Sento road, and Airport road in Tabriz during the years 2016-2022. Methods: In a cross-sectional descriptive study, the injuries from traffic accidents that were registered in the pre-hospital emergency center of Tabriz city were included. The study variables included all the information recorded in the pre-hospital emergency file between 2016 and 2022 and included 44,712 injured patients. Timing of the missions, variables related to the injured (demographics, vital signs), the accident's location, the injury's severity, and the accident's outcome were evaluated at the scene. Data were analyzed by SPSS 24 software. Results: Among 44,712 patients, 32,299 (72.2%) were men and the rest were women. Regarding the location of the accident, 34321 (76.8%) of the injured were inside the city, and 10391 (23.2%) had an accident in the city traffic ring. The most common accident site was in the traffic ring on Pasdaran highway, with 3179 injured (30.6%). The rate of on-scene death was higher in traffic accidents inside the traffic ring (1.3% vs. 0.9%). The severity of trauma was higher inside the traffic ring (P-value ˂0.001). Reaction and response time were higher in missions outside the traffic ring, leading to death at the scene (P value˂0.001). Conclusion: Based on the study results and the role of arrival time on the outcome of missions, it seems necessary to establish new pre-hospital emergency stations inside the city.  It is necessary to pay more attention to education through the media and improve the general culture of society to reduce the accidents and injuries caused by it

Clinical and radiographic findings in children with foreign body aspiration: a 10-year cross-sectional study in a tertiary hospital

Objective: Aspiration of a foreign body in the airways of children is one of the important emergencies in children, which is associated with high mortality and morbidity if not diagnosed promptly or managed effectively. The aim of this study was to investigate the clinical and radiographic findings in children with foreign body aspiration.  Methods: In a large cross-sectional retrospective study at a tertiary hospital from 2009 to 2019, children with foreign body aspiration were evaluated. The required information (demographics, clinical examination findings, and results of radiological and bronchoscopy reports) was extracted from the medical records of the patients in the hospital archive.  Results: In this study, 330 patients were enrolled, 61.2% of whom were male. The mean age of the patients was 2.65±2.68 years. The average time interval from the onset of symptoms to the final diagnosis was 11.54 days. The most common location and type of aspirated foreign body were the right main bronchus (60%) and seeds (39.1%), respectively. Cough and decreased unilateral lung sounds were the most common clinical symptoms (91.5%) and physical findings (50.6%), respectively. The most common finding on chest X-ray was local emphysema (43%).  Conclusion: Foreign body aspiration can lead to irreparable injuries if it is not recognized and managed promptly. Aspiration of a foreign body can result in serious harm if not quickly diagnosed and properly managed. Clinical suspicion of aspiration and the management of these children are critical

The utilization of pain assessment tools in pediatric emer- gency for better pain management

Objective: Accurate assessment of acute pain in children is essential for effective emergency care but can be challenging due to varying pain expressions across ages. Our study aims to examine healthcare providers’ efforts to enhance assessment using age-appropriate tools. Methods: Patients were retrospectively selected from the King Abdulaziz University Hospital Emergency records which involved a cohort review of 157 children presented to the pediatric emergency department with acute pain from 2017 to 2018. Routine pain assessment tool grading acute pain as mild, moderate, severe by qualified pediatric emergency doctors, Canadian triage acuity scale (CTAS) and numerical rating scale (NRS) were used to describe pain intensity. Inter-statistical cohort analysis was used. Results: The mean age of patients were 8±3.3 years (range: 2.5-13.9 years) with 73 girls and 84 boys. About 80% (n=126) of the children presented to the emergency department with acute pain were scored as CTAS 2-3. All triaged patients passed to the emergency department were assessed as mild (n=66, 42%), moderate (n=27, 17%) and severe (n=35, 22%) pain. The NRS scoring was used in only 12 (7.6%) children as NRS only applies to older children. Paracetamol and nonsteroidal anti-inflammatory drug (NSAID) were the most frequent analgesia administered by the health care providers. There was a statistically insignificant relationship between the severity of the pain and the type of analgesia (P value>0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P<0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P<0.05) Conclusion: Pain assessment with scoring methods like CTAS or NRS in the emergency room (ER) is crucial despite challenges. Inconsistent use affects outcomes, emphasizing the need for research to encourage consistent application in pediatric emergency care

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

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