Archives of Academic Emergency Medicine <p><strong>Welcome to "Archives of Academic Emergency Medicine (AAEM)"</strong></p> <p>This journal was published under the title <strong>"Emergency"</strong> from 2013 to 2018. From the beginning of 2019, the journal is published on this website. Archives of Academic Emergency Medicine (AAEM) is an international, peer-reviewed, and open access journal. The journal publishes articles on critical care, disaster and trauma management, environmental diseases, toxicology, pediatric emergencies, emergency medical services, emergency nursing, and other related topics.</p> SBMU Journals en-US Archives of Academic Emergency Medicine 2645-4904 <p>Based on the obtained author agreement upon submission, "Archives of Academic Emergency Medicine" is the copyright owner of the published material. However, according to Bethesda Statement, all works published in this journal are open access and freely available to anyone on the journal web site without cost under creative common license BY-NC. Based on this license, under the condition of proper citation, "Archives of Academic Emergency Medicine" grants to all users the following rights:</p> <p>1. Free, irrevocable, worldwide, perpetual access to all published materials.</p> <p>2. To copy, use, distribute, transmit and display the work on third party repositories and social media.</p> <p>3. To make and distribute derivative works in any digital medium for any non-commercial purpose.</p> Proposing an Emergency Medicine Ethical Guideline; a Qualitative Study <p><strong>Introduction:</strong> Emergency medicine physicians face major ethical challenges in their practices. Furthermore, they need to be aware of the principles of ethical analysis and clinical decision-making in order to provide quality care. This study aimed to propose professional ethics codes in the emergency medicine department.</p> <p><strong>Method:</strong> This is a qualitative study, which was performed using narrative review and expert panel, and was conducted in three steps, including: literature review and preparation of the initial draft of the ethical concepts, obtaining expert opinions on this initial draft and its validation, and finalizing main ethical components in emergency medicine. In this study, we received the opinions of an expert panel including 10 medical ethicists and 12 emergency medicine specialists using a survey form.</p> <p><strong>Results:</strong> The ethical guide to emergency medicine can be formulated in 34 key ethical concepts, 6 sub-components, and 5 main components including emergency physician-patient relationship, and emergency physicians’ relationships with other professionals, students, researchers, and community.</p> <p><strong>Conclusion:</strong> Emergency care providers need to be familiar with ethical guidelines in order to improve quality of care in emergency departments. The findings of this study suggest that a guideline on patient-physician relationship as well as the emergency physicians’ ethical obligations for other professionals, students, researchers, and community should be developed in line with ethical norms.</p> Leili Asadabadi Kamran Soltani Nejad Atefeh Zolfagharnasab Mina Mobasher Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e1 e1 10.22037/aaem.v10i1.1391 Remote Analysis and Transmission System of Electrocardiogram in Prehospital Setting; a Diagnostic Accuracy Study <p><strong>Introduction:</strong> One of the trends in the development of medical technologies is considered to be telemedicine. This study aimed to evaluate the accuracy of a remote electrocardiogram (ECG) analysis and transmission system in prehospital setting.</p> <p><strong>Methods:</strong> In this cross-sectional study, the data of 19,265 ECGs was gathered from emergency medical service (EMS) database of Almaty city, Kazakhstan, from 2015 to 2019. All ECGs were recorded in the prehospital setting by a paramedic, using "Poly-Spectrum" ECG recording device. Subsequently, all ECGs were sent to the cardiologist for interpretation and the findings were compared between software and cardiologist.</p> <p><strong>Results: </strong>19,265 ECGs were registered. The average time from taking ECGs to receiving an expert’s conclusion was 9.2 ± 2.5 minutes.&nbsp;The medical teams were called in 17.9% of cases after paramedic ECG recording; however, in the rest of the cases there was no need to call those teams. Using the device reduced the number of visits of specialist teams.</p> <p>The overall sensitivity, specificity, and accuracy of ECG analysis device in diagnosis of ECG abnormalities were 83.8% (95%CI: 82.6 – 84.9), 95.5% (95%CI: 95.1 – 95.8), and 93.3% (95%CI: 92.9 – 93.7), respectively.</p> <p><strong>Conclusion:</strong> The findings of this study showed the 93.3% accuracy of automatic ECG analysis device in interpretation of ECG abnormalities in prehospital setting compared with the cardiologist interpretations. Using the device causes a decrease in the number of cardiologist visits needed as well as reduction in cost and elapsed time.</p> Elmira Almukhambetova Murat Almukhambetov Abdugani Musayev Ainur Yeshmanova Vildan Indershiyev Zhadira Kalhodzhaeva Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e5 e5 10.22037/aaem.v10i1.1399 Nifekalant versus Amiodarone for Out-Of-Hospital Cardiac Arrest with Refractory Shockable Rhythms; a Post Hoc Analysis <p><strong>Introduction: </strong>It is still unclear that which anti-arrhythmics are adequate for treating refractory dysrhythmia. This study aimed to compare amiodarone and nifekalant in management of out-of-hospital cardiac arrest cases with refractory shockable rhythm.</p> <p><strong>Methods: </strong>This was a post hoc analysis of cases registered in a nationwide, multicentre, prospective registry that includes 288 critical care medical centres in Japan. From June 2014 to December 2017, we included all out-of-hospital cardiac arrest patients aged ≥18 years who presented with refractory arrhythmia (sustained ventricular fibrillation or ventricular tachycardia following delivery of at least two defibrillator shocks) and treated with nifekalant or amiodarone after arrival to hospital. Overlap weight was performed to address potential confounding factors.</p> <p><strong>Results: </strong>1,317 out-of-hospital cardiac arrest patients with refractory arrhythmia were enrolled and categorized into amiodarone (n = 1,275) and nifekalant (n = 42) groups. After overlap weight was performed, there were no significant intergroup differences in increased the rate of admission after return of spontaneous circulation [–5.9% (95%CI: –7.1 to 22.4); p = 0.57], 30-day favourable neurological outcome [0.1% (95%CI: –14 to 13.9); p = 0.99], and 30-day survival [–3.9% (95% CI: –19.8 to 12.0); p = 0.63].</p> <p><strong>Conclusion: </strong>This nationwide study showed that nifekalant was not associated with improved outcomes regarding admission after return of spontaneous circulation, 30-day survival, and 30-day favourable neurological outcome compared with amiodarone.</p> Hiraku Funakoshi Shotaro Aso Yosuke Homma Ryuta Onodera Yoshio Tahara Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e6 e6 10.22037/aaem.v10i1.1425 Association of CT Scan Parameters with the Risk of Renal Angiomyolipoma Rupture; a Brief Report <p><strong>Introduction: </strong>Rupture of renal angiomyolipoma (AML) is an emergency and life-threatening complication. This study aimed to evaluate the association of computed tomography (CT) scan parameters with the risk of rupture in renal AMLs.</p> <p><strong>Methods: </strong>In this retrospective cross-sectional study, patients who were referred to a referral university hospital with diagnosis of AML, between 2007 and 2019, were included. Patients were divided into ruptured and non-ruptured cases based on surgery and CT scan findings and the baseline characteristics as well as CT scan parameters were compared between the two groups.</p> <p><strong>Results:</strong> 20 AML patients with the mean age of 39.6 ± 12.5 years were included (75% female). The lesion was ruptured in 8 (40%) patients. The mean size of the lesion was ‎97.0 ± 15.9 mm‎‏ in the ruptured and ‏‎72.0 ± 29.4‎‏ in the non‎-‎ruptured AML ‏‎(‎p ‎= ‎‏0.045). The ‎mean fat density based on non-contrast enhanced CT (NCCT) scan (-‎56.1 ± 16.3 ‎vs ‎-‎‎74.9±24.1; ‏p = ‏‎0.018) and contrast enhanced CT (CECT) scan (-‎20.8 ± 16.9 ‎vs ‎-‎‎50.5 ± 31.7; ‏p ‏= ‏‎0.‎016) was significantly higher in the ruptured cases. Total tumor density based on NCCT scan was significantly greater in the ruptured ‎AMLs ‏(‏‎19.6 ± 25.9 ‎‏ vs‎ ‎-22.7±41.6, p=0.033).</p> <p><strong>Conclusion:</strong> It seems that some CT scan parameters such as mean fat density and ‎total tumor density ‏could be used for differentiation between ruptured and non-ruptured AMLs.</p> Razieh Heidari Mostafa Ghadamzadeh Mansour Bahardoust Forugh Khezrian Afrooz Moradkhani Parmida Ghadimi Seyed Morteza Bagheri Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e7 e7 10.22037/aaem.v10i1.1472 Risk Stratification of Pulmonary Thromboembolism using Brain Natriuretic Peptide and Troponin I; a Brief Report <p><strong>Introduction:</strong> Pulmonary thromboembolism (PTE) is one of the most prevalent medical disorders, with a notable annual fatality rate. This study aimed to evaluated the accuracy of serum pro-BNP and troponin I levels in PTE diagnosis.</p> <p><strong>Methods:</strong> This cross-sectional study was implemented on 267 patients with suspected PTE (sudden chest pain or sudden dyspnea) in Imam Reza Hospital in Mashhad, Iran. All patients underwent pulmonary computed tomography (CT) angiography (as the gold standard test) and their serum levels of troponin I and pro-BNP were measured. The screening performance characteristics of pro-BNP in detection of PTE cases were measured and reported using receiver operating characteristic (ROC) curve analysis.</p> <p><strong>Results:</strong> Two-hundred-sixty-seven patients with a mean age of 67.7 ±11.5 years were evaluated (60.1% male). PTE was confirmed via CT angiography in 121 patients. The area under the ROC curve of troponin I and pro-BNP in detection of PTE was 0.501 ng/mL and 0.972 pg/mL, respectively. The sensitivity and specificity of proBNP at the best cut-off point (100 pg/ml) were 85.4% and 80.2%, respectively. The sensitivity and specificity of troponin I at the best cut-off point (0.005 ng/ml) were 65.5% and 42%, respectively.</p> <p><strong>Conclusion:</strong> Due to the comparatively good sensitivity and specificity of proBNP in diagnosis of pulmonary thromboembolism, it can be employed as a diagnostic determinant in patients with suspected pulmonary thromboembolism along with other laboratory tests.</p> Mohsen Ebrahimi Mohammad Mohsen Arab Hamid Zamani Moghadam Majid Jalal Yazdi Esmail Rayat doost Mahdi Foroughian Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-01-08 2022-01-08 10 1 e8 e8 10.22037/aaem.v10i1.1453 Clinical Predictors of Testicular Torsion in Patients with Acute Scrotum; a Cross-Sectional Study <p><strong>Introduction: </strong>Testicular torsion is an important and critical issue in patients with acute scrotum referring to emergency department (ED). Early detection is very important to save the testicles. This study aimed to determine the diagnostic accuracy of clinical variables in predicting the presence of testicular torsion.</p> <p><strong>Methods:</strong> This prospective cross-sectional study was done using the information of patients hospitalized from September 2015 to September 2020, with complaint of acute scrotum (ICD 10 code: N50.8), referring to ED for evaluation of the clinical predictors of testicular torsions, which were confirmed by surgery.</p> <p><strong>Results: </strong>81 patients with the mean age of 20.07 ± 9.64 (3- 45) years were studied. After surgical exploration, 70 patients (86.4%) had testicular torsion. Patients with torsion had lower age (p &lt; 0.0001), lower time from symptom to ED visit (p &lt; 0.0001), sudden onset pain (p = 0.003), left side pain (p &lt; 0.0001), and lower white blood cell (WBC) count (p = 0.001). The frequency of dysuria (p = 0.032), diarrhea/vomiting (p = 0.005), and fever (p = 0.002) was significantly lower in patients with torsion. The cremasteric reflex was absent in 57 (81.4%) cases who suffered from testicular torsion (p = 0.001). Based on the results of binary logistic regression analysis, age (B = -0.175, SE = 0.45; p &lt; 0.0001) was the sole independent predictor of testicular torsion. The highest area under the receiver operating characteristics (ROC) curve in predicting the presence of torsion belonged to lower age [91.0 (95%CI: 83.2 – 98.7)], pain in left testis [0.931 (95%CI: 0.828-0.987)], and lower WBC count [0.805 (95%CI: 0.684-0.926)], respectively.</p> <p><strong>Conclusion: </strong>It seems that clinical variables are not accurate enough to be considered as the sole predictor of testicular torsion and they should be used with caution and in combination with other available screening tools like Doppler ultrasonography in this regard.&nbsp;&nbsp;</p> Mohammad Sazgar Seyed Hossein Montazer Seyed Mohammad Hosseininejad Fatemeh Jahanian Behkam Rezaimehr Mohammad Behbohaninia Hamed Aminiahidashti Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-01-11 2022-01-11 10 1 e9 e9 10.22037/aaem.v10i1.1484 Clinical, Laboratory and Imaging Characteristics of Hospitalized COVID-19 Patients with Neurologic Involvement; a Cross-Sectional Study <p><strong>Introduction:</strong> Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics.</p> <p><strong>Methods: </strong>This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay.</p> <p><strong>Results: </strong>Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p &lt; 0.001).</p> <p><strong>Conclusion: </strong>Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.</p> Ali Zare Dehnavi Mohammadreza Salehi Mehran Arab Ahmadi Mohammad Hossein Asgardoon Farzad Ashrafi Nasrin Ahmadinejad Atefeh Behkar Ramin Hamidi Farahani Hassan Hashemi Abbas Tafakhori Hamze Shahali Mohammad Rahmani Alireza Ranjbar Naeini Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-01-30 2022-01-30 10 1 e10 e10 10.22037/aaem.v10i1.1507 Clinical Features and Outcomes of Acute Chlorine Gas Inhalation; a Brief Report <p><strong>Introduction:</strong> On March 6<sup>th</sup>,2020, chlorine gas leak was reported at Engro Polymer &amp; Chemicals Plant in Karachi City, Pakistan. This study aimed to evaluate the clinical features and outcomes of patients who presented to emergency department (ED) following this event.</p> <p><strong>Methods: </strong>This retrospective cross-sectional study, evaluated the clinical features and outcomes (length of hospital stay, complications, and mechanical ventilation requirement) of patients presenting to ED of Aga Khan University Hospital, Karachi, Pakistan, with history of chlorine gas exposure at the Engro Plant from 6<sup>th</sup> March to 14<sup>th</sup> March 2020.</p> <p><strong>Results: </strong>38 patients with mean age of 33.1 ± 8.1 years presented to ED with history of chlorine gas exposure (100% male). &nbsp;4 (10.5%) cases&nbsp;had comorbid diseases. Most common presenting symptom was dyspnea, observed in 33 (86.8%) cases, followed by cough, seen in 27 (71.1%) subjects. 13.2% (5/38) patients had infiltration on chest x-ray and 33 (86.8 %) required hospitalization. 6 (15.8%) patients had repeat presentation requiring hospitalization or ED visit. 18 (47.4%) were managed with high flow oxygen therapy, 9 (23.7%) required non-invasive ventilation and one patient was intubated due to development of pneumo-mediastinum. Mean length of stay was 1.55 ± 1.58 days and no patients died. Presence of tachycardia was the only finding significantly associated with need for oxygen (p = 0.033) and non-invasive ventilation (p = 0.012).</p> <p><strong>Conclusion: </strong>The majority of patients presenting with acute chlorine gas exposure showed good clinical outcomes and rapid recovery, however, a high index of suspicion and vigilance should be maintained for complications such as pneumomediastinum and acute respiratory distress syndrome in these patients.</p> Taymmia Ejaz Sheema Saadia Safia Akhlaq Adil Aziz Muhammad Arslan Ahmed Aisha Fareed Siddiqui Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-02-14 2022-02-14 10 1 e15 e15 10.22037/aaem.v10i1.1448 Correlation Between TIMI Risk Score and the Number of Vessels Involved in the Angiographic Study; a Cross-sectional Study <p><strong>Introduction: </strong>TIMI (Thrombolysis in Myocardial Infarction) score is a model for predicting the severity of vascular diseases. This study aimed to evaluate the correlation between this score and the number of vessels involved in patients with Unstable Angina (UA) or Non-ST Elevation Myocardial Infarction (NSTEMI).</p> <p><strong>Methods: </strong>This prospective cross-sectional study was designed to evaluate the correlation between TIMI score, and the number of vessels involved in the angiographic study of NSTEMI and UA patients presenting to emergency department.</p> <p><strong>Results: </strong>297 patients with the mean age of 62.16±36.59 years were entered (58.2% male; 193 (65%) UA and 104 (35%) NSTEMI). The Mean TIMI score among patients was 3.21±1.55. Based on the TIMI score, patients were categorized into 3 groups. 105 (35.35%) patients had a TIMI score of 0 to 2, 120 (40.40%) had a score of 3 to 4, and 72 (24.24%) had a score of 5 to 7. Patients with a TIMI score of 5 to 7 had a greater likelihood of three-vessel coronary artery disease compared to patients with a TIMI score of 3 to 4 (OR: 5.34, 95% CI: 2.64 to 10.80; p &lt; 0.0001) or those with a TIMI score of 0 to 2. (OR: 29.45, 95% CI: 12.87 to 67.37; p &lt; 0.0001). Two-vessel coronary artery disease was more likely to be found in patients with a TIMI score of 3 to 4 or those with a score of 5 to 7 compared to patients with a TIMI score of 0 to 2 (OR: 3.69, 95% CI: 1.60 to 8.51; p &lt;0.0001 and OR: 2.67, 95% CI: 1.04 to 6.82; p = 0.04, respectively).</p> <p><strong>Conclusion:</strong> There is a direct and significant correlation between TIMI score and the number of coronary vessels involved in patients presenting to emergency department following UA or NSTEMI.</p> Mohammad Hasan Namazi Seyedeh Slimeh Mazloomi Mohammad Kalate Aghamohammadi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-02-14 2022-02-14 10 1 e16 e16 10.22037/aaem.v10i1.1466 Propofol + Granisetron vs. Propofol + Metoclopramide in Symptom Management of Acute Migraine Headache; a Double-Blind Randomized Clinical Trial <p><strong>Introduction:</strong> Acute headache is one of the most common reasons for emergency department (ED) visits. This study aimed to compare the combination of propofol and granisetron with propofol and metoclopramide in symptom management of acute migraine headache.</p> <p><strong>Methods:</strong> In this double-blind randomized clinical trial, 60 adult patients with acute migraine headache who referred to ED were randomly divided into two groups of propofol + metoclopramide and propofol + granisetron. Pain and nausea/vomiting severity as well as blood pressure were compared between groups 30, 45, and 60 minutes after treatment.</p> <p><strong>Results:</strong> The two groups had similar situation regarding mean age (p = 0.606), sex distribution (p = 0.793), baseline severity of pain (p = 0.642), frequency of nausea/vomiting (p = 0.488), and vital signs (p &gt; 0.05). The severity of pain was similar in the two groups 30 (p = 0.731), 45 (p = 0.460), and 60 (p = 0.712) minutes after treatment. The number of patients with resistant nausea and vomiting 60 minutes after treatment was significantly higher in metoclopramide group (30.0% versus 10.0%; p = 0.033). Diastolic pressure 60 minutes after treatment (81.43 ±8.94 vs. 74.97 ± 4.8; p = 0.001) and heart rate 30 minutes after treatment (68.87 ±6.52 vs. 73.57± 7.62; p = 0.013) had statistically significant differences between the groups.</p> <p><strong>Conclusion:</strong> The combination of propofol and granisetron was superior to propofol and metoclopramide in case of controlling nausea and vomiting of cases with acute migraine headache; meanwhile, no differences were observed in case of pain relief and hemodynamic status between the two groups.</p> Samaneh Abiri Mehdi Chegin Reza Soleimani Naser Hatami Navid Kalani Esmail Rayatdoost Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-03-05 2022-03-05 10 1 e19 e19 10.22037/aaem.v10i1.1561 Skin Cooling to Reduce the Pain Associated with Local Anesthetic Injection; a Randomized Controlled Trial <p><strong>Introduction: </strong>Different methods have been proposed for the reduction of the pain caused by the injection of local anesthetics. This study aimed to evaluate the effect of skin cooling on reduction of pain associated with local injection of lidocaine buffered with sodium bicarbonate.</p> <p><strong>Methods: </strong>This randomized controlled trial included 108 adult patients with arm/forearm wounds who referred to the emergency departments. Participants were randomly allocated to two equal groups. Patients in both groups received subcutaneous injection of buffered lidocaine. In the intervention group, an ice cube measuring 2 × 2 × 2 cm (at 0 ° C) in sterile gloves were placed on the wound for 2 minutes before the injection of buffered lidocaine. The primary outcome was severity of pain during lidocaine injection using a visual analog scale (VAS).</p> <p><strong>Results: </strong>One hundred and eight patients were enrolled in the study, 54 in each group. There was no statistically significant difference in age (p = 0.777), sex (p = 0.466), and length of laceration (p = 0.410) between the two groups. The pain scores during lidocaine injection were significantly lower in the intervention group compared to control group (2.39 ± 1.14 vs 4.26 ± 0.94, p &lt; 0.001).</p> <p><strong>Conclusions: </strong>Skin cooling prior to the injection of local anesthetics can significantly reduce the pain caused by local anesthetic infiltration</p> Saeed Majidinejad Farhad Heidari Amir Chitgarian Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-03-10 2022-03-10 10 1 e20 e20 10.22037/aaem.v10i1.1562 Relationship Between Income Level and Hospitalization Rate in COVID-19 Cases; an Example of Social Factors Affecting Health <p><strong>Introduction:</strong> Considering the population's socioeconomic status and clinical features is essential in planning and performing interventions related to disease control. The main purpose of this study was to investigate the relationship between income level and hospitalization rate of COVID-19 patients‌.</p> <p><strong>Methods: </strong>A cross-sectional study was performed on 198,944 hospitalized COVID-19 patients in Tehran province between March 2020 and March 2021. Data of hospitalized COVID-19 patients was obtained from the Hospital Intelligent Management System (HIM). The income data of patients were obtained from the Iranian Database on Targeted Subsidies belonging to the Ministry of Cooperatives, Labor, and Social Welfare. Data analyses were performed using SPSS software.</p> <p><strong>Results: </strong>About 2.5% of the inpatients were from the first decile, while 20.6% were from the tenth. The share of the lower three deciles of total hospitalization was about 11%, while the share of the upper three deciles was 50%. There was a big difference between the upper- and lower-income deciles regarding death rates. In the first decile, 30% of inpatients died, while the proportion was 10% in the tenth decile. There was a significant and positive relationship between income decline and hospitalization (r = 0.75; p = 0.02). Also, there was a significant and negative relationship between income decline and death rate (r = -0.90; p = 0.01).</p> <p><strong>Conclusion: </strong>Low-income groups use fewer inpatient services, are more prone to severe illness and death from COVID-19‌, and treatment in this group has a lower chance of success. Using a systemic approach to address socioeconomic factors in healthcare planning is crucial.</p> Ali Maher Hamed Dehnavi Elham Salehian Mona Omidi Khatereh Hannani Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-09 2022-04-09 10 1 e23 e23 10.22037/aaem.v10i1.1600 Glasgow Coma Scale Versus Physiologic Scoring Systems in Predicting the Outcome of ICU admitted Trauma Patients; a Diagnostic Accuracy Study <p><strong>Introduction: </strong>There is no consensus on the performance of decision rules in predicting the prognosis of trauma patients. Therefore, the present study aimed to compare the value of Glasgow coma scale (GCS) and physiologic scoring systems in predicting mortality and poor outcome of trauma patients.</p> <p><strong>Methods:</strong> This diagnostic accuracy study was conducted on multiple trauma patients admitted to the intensive care units of two hospitals in Tehran, Iran, from 21 November 2020 to 22 May 2021. The patients' demographic characteristics, length of stay in the intensive care unit (ICU), the vital signs, and the GCS on admission were recorded. Finally, the mortality, disability, and complete recovery of patients at the time of discharge were evaluated and receiver operating characteristics (ROC) curve analysis was used to compare the performance of physiologic scoring systems with GCS.</p> <p><strong>Results:</strong> 200 trauma patients with the mean age of 43.53±19.84 years were evaluated (74% male). The area under the ROC curve for New Trauma Score (NTS), Revised Trauma Score (RTS), Worthing Physiological Scoring System (WPSS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), National Early Warning&nbsp; Score (NEWS), Glasgow Coma Scale (GCS), Age, and Systolic Blood Pressure (GAPS) in prediction of mortality were 0.95, 0.95, 0.83, 0.89, 0.91, 0.84, 0.77, 0.98, and 0.97 respectively. The performance of GCS was statistically superior to RTS (P=0.005), WPSS (P=0.0001), RAPS (P=0.0002), REMS (P=0.002), MEWS (P&lt;0.0001), and NEWS (P&lt;0.0001). However, the performance of GCS, NTS (P=0.146), and GAPS (P=0.513) were not significantly different. Also, in prediction of poor outcomes, the AUC of GCS (0.98) was significantly higher than RTS (0.95), RAPS (0.85), REMS (0.85), MEWS (0.84), NEWS (0.77), and WPSS (0.75).</p> <p><strong>Conclusion:</strong> The GCS score seems to be a better instrument to predict mortality and poor outcome in trauma patients compared to other tools due to its high accuracy, wide application, and easy calculation.</p> Sorour Khari Mitra Zandi Mahmoud Yousefifard Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-09 2022-04-09 10 1 e25 e25 10.22037/aaem.v10i1.1483 Potential Impact of 3% Hypertonic Saline Infusion on Tramadol Poisoning-Induced Electrocardiogram Changes; a Randomized Clinical Trial <p><strong>Introduction: </strong>Tramadol is a synthetic analgesic with weak mu-opioid receptor agonist activity. Tramadol overdose is associated with adverse cardiac effects due to inhibiting cardiac Na+ and K+ channels. This study aimed to investigate the potential ameliorative role of 3% hypertonic saline on the electrocardiogram (ECG) changes in patients presenting with tramadol poisoning.</p> <p><strong>Methods: </strong>This was a single-center, controlled, randomized, single-blind clinical trial. Patients were randomized into the case (received hypertonic saline) and control (received placebo) groups. ECG was obtained twice in each group (upon arrival and following the intervention). Response to therapeutic interventions was evaluated using Wilcoxon Signed Ranks Test.</p> <p><strong>Results: </strong>A total of 76 patients were included. The mean age of patients was 24.88 ± 4.29 years, and 62 (81.6%) were male. The mean ingested dose of tramadol was 1673.68 ± 608.85 (range: 550-2750) mg. The number needed to treat and the absolute risk reduction of 3% hypertonic saline in the treatment of wide QRS were 1 (95% CI: 1.00 – 1.00) and 100%, respectively. In the treatment of long QTc, these measures were 1.9 (95%CI: 1.2 – 4.5) and 53.85% (95%CI: 22.00 – 85.69), respectively.</p> <p><strong>Conclusion: </strong>Given that hypertonic saline infusion can significantly ameliorate tramadol-mediated ECG changes, including QRS prolongation and QT lengthening, it can be regarded as a potential therapeutic strategy to prevent the development of life-threatening ventricular arrhythmias caused by tramadol toxicity.</p> Ali Omraninava Ahmad Mehdizade Ebrahim Karimi Amir Ghabousian Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-13 2022-04-13 10 1 e26 e26 10.22037/aaem.v10i1.1567 Efficacy of Sumatriptan/Placebo versus Sumatriptan/Propofol Combination in Acute Migraine; a Randomized Clinical Trial <p><strong>Introduction:</strong> Migraine headaches can cause severe pain for patients and lead them to multiple visits to the emergency department (ED). This study aimed to evaluate the efficacy of propofol + sumatriptan combination in comparison with sumatriptan alone in the management of acute migraine headaches.</p> <p><strong>Methods:</strong> This triple-blind clinical trial involved patients who referred to two emergency departments with acute migraine headaches. Patients were randomly assigned to control (sumatriptan and placebo) or intervention (propofol and sumatriptan) groups for comparison of the efficacy and side effects of treatment.</p> <p><strong>Results: </strong>In this study, 60 patients were included whose mean age was 31±8.8 years, and headaches were more common among women. After 30 and 60 minutes from the beginning of treatment, the mean pain score reduction in the intervention group was significantly greater than that in the control group (p=0.012, p=0.024). In addition, the rate of chest tightness in the control group was significantly higher than the intervention group. The&nbsp;absolute risk reduction of adverse events (Chest tightness, Bradycardia, hypotension, and etc.), in patients with acute migraine headache taking propofol and sumatriptan treatment, was 32.18% (95% CI: 8.02 – 56.35).</p> <p><strong>Conclusions:</strong> This study supports the use of propofol for treatment of acute migraine headaches and shows that combining sumatriptan with propofol is more effective in relieving migraine headaches and the associated symptoms than using sumatriptan alone. However, more studies with longer follow-ups are still needed.</p> Reza Farahmand Rad Akram Zolfaghari Sadrabad Mohammadali Jafari Marzieh Ghilian Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-14 2022-04-14 10 1 e27 e27 10.22037/aaem.v10i1.1510 Alveolar Arterial Gradient and Respiratory Index in Predicting the Outcome of COVID-19 Patients; a Retrospective Cross-Sectional Study <p><strong>Introduction: </strong>Alveolar arterial (A-a) oxygen gradient and respiratory index can be of immense help for the critical care physician in clinical decision making. This study aimed to evaluate the potential application of A-a oxygen gradient and respiratory index in predicting the survival of COVID-19 patients in intensive care unit (ICU).</p> <p><strong>Method: </strong>This is a retrospective cross-sectional study involving 215 adult patients with COVID-19 disease, admitted to the ICU between 1<sup>st</sup> April 2020 and 30 June 2021. Details regarding demographic variables, comorbidities, laboratory and arterial blood gas (ABG) findings were recorded. Alveolar-arterial gradient and respiratory index were calculated and tested as predictors of survival.</p> <p><strong>Result: </strong>The mean age of the patients was 51.92 years (65.6 % male). Hypertension was the most common comorbidity and oxygen via non-rebreathing mask was the most common modality used at the time of ICU admission. Mortality was 28.37% and average length of stay was 12.84 days. Patients who died were older (p=0.02), mostly male (p=0.017), had at least one comorbidity (p&lt;0.001), and higher heart rate and respiratory rate (&lt;0.001 and p=0.03, respectively), lower pH on arterial blood gas (ABG) (p=0.002), higher FiO2 requirement (p&lt;0.001), and increased A-a oxygen gradient on admission compared to survivors. According to receiver operating characteristic (ROC) curve analysis, A-a oxygen gradient and respiratory index were not sensitive or specific in predicting mortality in the studied patient subset.</p> <p><strong>Conclusion: </strong>A-a oxygen gradient and respiratory index calculated at time of admission to ICU in patients with COVID-19 were poor predictors of survival.</p> Abhishek Singh Kapil Dev Soni Yudhyavir Singh Richa Aggarwal Vineeta Venkateswaran Mohd Suhail Ashar Anjan Trikha Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-14 2022-04-14 10 1 e28 e28 10.22037/aaem.v10i1.1543 Factors Associated with 24-Hour Clinical Outcome of Emergency Patients; a Cohort Study <p><strong>Introduction:</strong> Pre-hospital and in-hospital emergency management play an important role in quality of care for emergency patients. This prospective cohort study aimed to determine factors associated with the 24-hour clinical outcome of emergency patients.</p> <p><strong>Methods:</strong> The sample included 1,630 patients, randomly selected through multi-stage stratified sampling from 13 hospitals in 13 provinces of Thailand. Data were collected during January-November 2018. Clinical outcome was determined using pre-arrest sign score. Data were analyzed via ordinal multivariate regression analysis.</p> <p><strong>Results:</strong> Factors influencing 24-hour clinical outcome of emergency patients were age (OR: 0.965; 95% CI: 0.96-0.97), having coronary vascular disease (CAD) (OR: 1.41; 95% CI: 1.05-1.88), and severity of illness based on Rapid Emergency Medical Score (REMS) (OR:1.09; 95% CI: 1.05-1.15). Self-transportation and being transported by emergency medical service ambulance with non-advanced life support (EMS-Non-ALS) did not influence clinical outcome when compared to EMS-ALS transport. Being transported from a community hospital increased pre-arrest sign score 1.78 times when compared to EMS-ALS (OR: 1.78; 95% CI: 1.17-2.72). Increased transportation distance increased the risk of poor clinical outcome (OR: 1.01; 95% CI: 1.002-1.011). Length of stay in emergency department (ED-LOS) more than 4 hours (OR: 0.21; 95% CI: 0.15-0.29) and between 2-4 hours (OR: 0.60; 95% CI: 0.47-0.75) decreased the risk of poor clinical outcome when compared to ED-LOS less than 2 hours.</p> <p><strong>Conclusion:</strong> Having CAD, severity of illness, increased transport distance, and ED-LOS less than 2 hours were found to negatively influence 24-hour clinical outcome of emergency patients.</p> Kannika Katsomboon Siriorn Sindhu Ketsarin Utriyaprasit Chukiat Viwatwongkasem Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-24 2022-04-24 10 1 e30 e30 10.22037/aaem.v10i1.1590 Mortality and Years of Life Lost due to Burn Injury Among Older Iranian People; a Cross-Sectional study <p><strong>Introduction</strong>: The mortality of burn injury is a serious health problem among older people. The present study aimed to determine the epidemiological characteristics of burn mortality and Years of Life Lost (YLLs) among people aged ≥ 60.</p> <p><strong>Methods</strong>: The National and Subnational Burden of Disease (NASBOD) study includes population-based cross-sectional data from the death registration system of Iran and those recorded by the cemeteries of Tehran and Esfahan were used in this study. Spatio-temporal and Gaussian process regression models were applied to estimate rates and trends of mortality and cause-specific mortality fractions. YLLs were calculated using Iranian life expectancy and the number of deaths.</p> <p><strong>Results</strong>: The mortality rate for 1990 and 2015 was 17.4 and 4.5 per 100,000, respectively. From 1990 through 2015, the annual percentage of change in burn mortality rate was -6.1% in females and -4.4% in males. During 2015, there were 326 deaths following burns in people aged 60+ with 4586 person YLLs, and in 1990 there were 523 deaths with 4862 person-YLLs. The male-female ratio for 1990 and 2015 were 0.80 and 0.88, respectively. The age-standardized mortality rate was higher than 8.5 per 100,000 in border provinces in 2015. The provinces with better socioeconomic situations, such as Tehran, had a lower mortality rate than poor provinces, such as Sistan va Baluchistan.</p> <p><strong>Conclusion</strong>: Although burn mortality in old people decreased in those 26 years, it is still high compared to high-income countries. Continued efforts to increase preventive measures and adequate access to quality care, especially in border provinces, is suggested.</p> Farideh Sadeghian Sahar Saeedi Moghaddam Zahra Ghodsi Parinaz Mehdipour Ali Ghanbari Gerard O'Reilly Nazila Rezaei Sahar Mohammadi Fateh Ali H. Mokdad Vafa Rahimi-Movaghar Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-27 2022-04-27 10 1 e31 e31 10.22037/aaem.v10i1.1547 Resident Productivity in the Emergency Department After Implementation of an Automated Patient Assignment System; a Brief Report <p><strong>Introduction:</strong> The clinical diversity of patients presenting to the emergency department (ED) allows emergency medicine (EM) and non-EM residents to sharpen their clinical skills. In most EDs, residents self-assign patients at their discretion. Our institution transitioned from a self-assignment-system to an automated-system, after which we sought to determine the productivity of our non-EM residents compared to the previous system.</p> <p><strong>Methods:</strong> In this retrospective cross-sectional study, resident productivity was measured as number of patient visits per hour and per 8.5-hour shift before and after the implementation of an automated patient assignment system in emergency department. The automated-system assigns one patient at the start of the shift, another 30 minutes later, and one patient every hour thereafter, throughout the shift.</p> <p><strong>Results:</strong> 28 residents performed 406 total shifts prior to implementation and 14 residents performed 252 total shifts post-implementation. The average number of patient visits per hour significantly increased from 0.52 ± 0.18 (95% CI 0.45-0.59, IQR 0.43-0.60) to 0.82 ± 0.11 (95% CI 0.75-0.88, IQR 0.74-0.89) after implementation of our assignment system (p&lt;0.00001; figure 1). Additionally, the average number of patient visits per 8.5-hour shift significantly increased from 4.46 ± 1.53 (CI 3.86-5.05, IQR 3.66-5.08) to 6.52 ± 0.86 (CI 6.02-7.02, IQR 5.90-7.09) after the implementation of our system (p&lt;0.00001; figure 1).</p> <p><strong>Conclusion: </strong>These findings warrant further evaluation of the impact of patient assignment systems on trainee education.</p> Christian Rosenow Sophia Aguirre Thomas Polveroni Zachary Ginsberg Jordan Pollock Stephen Traub Douglas Rappaport Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-30 2022-04-30 10 1 e33 e33 10.22037/aaem.v10i1.1516 Demographic and Clinical Characteristics of 907 Cases with Naltrexone Intoxication; a 14-Year Cross-Sectional Study <p><strong>Introduction:</strong> Opioids have been the leading cause of death from poisoning in Iran for several years. This study aimed to evaluate the clinical and para-clinical presentations of naltrexone intoxication, its toxic dose, and its epidemiological properties.</p> <p><strong>Methods</strong><strong>:</strong> This retrospective cross-sectional study was conducted on medical records of patients presenting to Toxicology Department of Loghman Hakim Hospital, Tehran, Iran, following naltrexone intoxication, from 2002 to 2016. Patients’ demographic and laboratory data, clinical signs, supposed ingested dose, and intent of naltrexone consumption were collected, analyzed, and then interpreted.</p> <p><strong>Results:</strong> 907 patients with the mean age of 36.6 ±11.7 years were evaluated (94.3% male).&nbsp; The mean amount of naltrexone consumed by the intoxicated patients reported in the medical records was 105.8 ± 267.8 mg. One hundred thirty patients (14.3%) used naltrexone to treat substance use disorder. Two hundred eighty-seven poisoned patients (31.6%) were current opium users who intentionally or unintentionally used naltrexone concomitantly. The most common symptoms observed in these patients were agitation (41.8%), vomiting (16.4%), and nausea (14.8%). Among patients with naltrexone poisoning, 25 patients were intubated (2.8%), and three passed away. Aspartate aminotransferase (AST) levels were significantly higher in patients intoxicated with naltrexone who needed intubation (p = 0.02).</p> <p><strong>Conclusion</strong>: The probability of intubation of cases with naltrexone intoxication was associated with AST elevation. It seems that, the number of intensive care unit (ICU) admissions and mortality rates are not high among these patients.</p> Mitra Rahimi Alireza Kargar Delara Hazegh Fetratjoo Sayed Masoud Hosseini Arezou Mahdavinejad Shahin Shadnia Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-01 2022-05-01 10 1 e34 e34 10.22037/aaem.v10i1.1554 The Challenges of Emergency Medical Services Response to Arasbaran Twin Earthquakes; a Content Analysis <p><strong>Introduction:</strong> One of the most important concerns in responding to disasters is providing Basic Life Support (BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose of this study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earthquakes and its challenges in Iran.</p> <p><strong>Methods:</strong> This study was conducted using a qualitative approach and the conventional content analysis method. Data were collected through Focused Group Discussions (FGD) and semi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East Azerbaijan Province, Iran. To form the main categories, the interviews were encoded in three stages and the similar codes were placed under the same subcategories and merged.</p> <p><strong>Results:</strong> A total of 26 EMS paramedics participated in the study. The codes extracted from the interviews, after three stages of reduction, were placed in the top ten categories, including the lack of preparedness and coordination, dead bodies' management challenges, responders’ psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteer management, non-documentation of the experiences, communication challenges, recalling, and deploying of EMS responders.&nbsp;</p> <p><strong>Conclusion:</strong> Timely response of the EMS and paramedics’ sense of responsibility for providing services were positive and successful points about the emergency response operations. The weaknesses of EMS should, therefore, be addressed through transferring of experiences and by planning and arranging training courses.</p> Mahboub Pouraghaei Javad Babaie Laleh Rad Saeed Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-01 2022-05-01 10 1 e35 e35 10.22037/aaem.v10i1.1571 CURB-65, qSOFA, and SIRS Criteria in Predicting In-Hospital Mortality of Critically Ill COVID-19 Patients; a Prognostic Accuracy Study <p><strong>Introduction: </strong>Outcome prediction of intensive care unit (ICU)-admitted patients is one of the important issues for physicians. This study aimed to compare the accuracy of Quick Sequential Organ Failure Assessment (qSOFA), Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), and Systemic Inflammatory Response Syndrome (SIRS) scores in predicting the in-hospital mortality of COVID-19 patients.</p> <p><strong>Methods: </strong>This prognostic accuracy study was performed on 225 ICU-admitted patients with a definitive diagnosis of COVID-19 from July to December 2021 in Tehran, Iran. The patients' clinical characteristics were evaluated at the time of ICU admission, and they were followed up until discharge from ICU. The screening performance characteristics of CURB-65, qSOFA, and SIRS in predicting their mortality was compared.</p> <p><strong>Results:</strong> 225 patients with the mean age of 63.27±14.89 years were studied (56.89% male). The in-hospital mortality rate of this series of patients was 39.10%. The area under the curve (AUC) of SIRS, CURB-65, and qSOFA were 0.62 (95% CI: 0.55 - 0.69), 0.66 (95% CI: 0.59 - 0.73), and 0.61(95% CI: 0.54 - 0.67), respectively (p = 0.508). In cut-off ≥1, the estimated sensitivity values of SIRS, CURB-65, and qSOFA were 85.23%, 96.59%, and 78.41%, respectively. The estimated specificity of scores were 34.31%, 6.57%, and 38.69%, respectively. In cut-off ≥2, the sensitivity values of SIRS, CURB-65, and qSOFA were evaluated as 39.77%, 87.50%, and 15.91%, respectively. Meanwhile, the specificity of scores were 72.99%, 34.31%, and 92.70%.</p> <p><strong>Conclusions: </strong>It seems that the performance of SIRS, CURB-65, and qSOFA is similar in predicting the ICU mortality of COVID-19 patients. However, the sensitivity of CURB-65 is higher than qSOFA and SIRS.</p> Sorour Khari Atefe Salimi Akin Abadi Marzieh Pazokian Mahmoud Yousefifard Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-10 2022-05-10 10 1 e36 e36 10.22037/aaem.v10i1.1565 Impact of COVID-19 Pandemic on Emergency Department Referrals with Urologic Complaints; a Retrospective Cross-Sectional Study <p><strong>Introduction: </strong>Medical and surgical priorities were dramatically changed during the COVID-19 pandemic. This study aimed to evaluate the impact of this pandemic on presentation to emergency department (ED) with urologic complaint.</p> <p><strong>Method: </strong>This cross-sectional study was conducted at a tertiary urology referral center in Tehran, Iran. The data of all ED admissions were collected and the frequency of admissions with urologic complain and their outcomes were compared between two 90-day periods (before and during COVID-19 era).</p> <p><strong>Results: </strong>480 ED admissions were studied. The number of patients visiting the ED with urologic complaint during COVID-19 era was significantly lower than the same period in the pre-COVID-19 period (125 vs. 355 admissions; p = 0.01). The mean hospitalization days for patients in the pre-COVID-19 period were significantly higher (5.6 ± 4.4 vs. 3.2 ± 4.2 days; p &lt;0.001). The most common patient complaints before and during COVID-19 period were flank pain (32.7%) and gross hematuria (32.8%), respectively. The number of patients discharged against medical advice in the COVID-19 period was significantly higher than before (22 (17.6%) vs. 10(2.8%); p &lt; 0.001). The number of patients who developed severe complications was significantly higher in the COVID-19 period than in the pre-COVID-19 period (p = 0.001).</p> <p><strong>Conclusion: </strong>During the COVID-19 pandemic we were faced with decreasing frequency of admission with urologic complaint, change in the pattern of referrals, decrease in the duration of hospitalization, increase in the number of patients discharged against medical advice, and increase in the number of cases with irreversible urologic complications or complications requiring surgery due to deferred treatment.</p> Anahita Ansari Djafari Babak Javanmard Amirhossein Rahavian Ahmad Reza Rafiezadeh Rafiezadeh Nasrin Borumandnia Seyyed Ali Hojjati Seyyed Mohammad Hosseininia Hormoz Karami Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-17 2022-05-17 10 1 e37 e37 10.22037/aaem.v10i1.1563 Nurses' Knowledge Regarding Oxygen Therapy; a Cross-Sectional Study <p><strong>Introduction:</strong> Oxygen therapy, if done correctly, can save patients' life promptly. However, improper use will be just as dangerous. The present study aimed to investigate the level of nurses’ knowledge on properly using oxygen.</p> <p><strong>Method: </strong>This was a cross-sectional study with a minimum sample size of 72 nurses who were randomly selected from various wards of Masih Daneshvari Hospital, Tehran, Iran. To determine the level of knowledge about oxygen therapy, a questionnaire was used to collect data. This questionnaire consists of seven items, each of which is designed to determine the level of the individual’s knowledge about the various details of oxygen therapy.</p> <p><strong>Results:</strong> Seventy-eight nurses with the mean age of 35.80±7.42 years participated in the study (87% female). The mean knowledge score of nurses regarding oxygen therapy was 8.89 ± 2.79 out of 16 points. 84.6% of the nurses were able to differentiate various types of oxygen masks. Accordingly, 94.9% of nurses had good knowledge on oxygen humidification. Also, 50% of the nurses had sufficient knowledge about the amount of oxygen flow produced by different masks. 10.3% of the nurses could choose the most appropriate mask for different clinical conditions. 6.4% of the nurses had knowledge of working with flowmeters, and 15.4% of the nurses had sufficient information about the maximum level of oxygen required for the patient. 17.9% of the nurses were familiar with measuring the appropriate amount of oxygen for patients. There was no statistically significant relationship between age (p = 0.57), gender (p = 0.09), employment status (p = 0.38), workplace (p = 0.86), current position (p = 0.11), degree (p = 0.27), and graduation time (p = 0.58) of nurses with good knowledge of using oxygen. However, a statistically significant relationship was reported between nurses' related work experience and their knowledge of the proper use of oxygen (p = 0.03).</p> <p><strong>Conclusion:</strong> In general, the nurses’ knowledge at Masih Daneshvari Hospital on how to properly use oxygen is at a moderate level. Nurses' knowledge in some areas, such as working with the flowmeter, choosing the suitable mask for specific clinical conditions, and the maximum oxygen required for patients, is meager and requires training intervention.</p> Maryam Hassanzad Hosseinali Ghaffaripour Mahsa Rekabi Mahsa Mirzendehdel Elham Sadati Nasrin Elahimehr Hojjat Derakhshanfar Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-18 2022-05-18 10 1 e38 e38 10.22037/aaem.v10i1.1553 An 18-Month Epidemiologic Survey of 3364 Deceased COVID-19 Cases; a Retrospective Cross-sectional Study <p><strong>Introduction:</strong> The COVID-19 pandemic has been considered an international problem. This study aimed to survey the demographic and clinical characteristics of the deceased COVID-19 patients.</p> <p><strong>Methods: </strong>The present cross-sectional study was performed on all deceased COVID-19 patients who died in Imam Reza Hospital, Mashhad, Iran, from March 20, 2020, to September 23, 2021. Their data, including age, gender, complaints, and clinical symptoms at the time of admission, as well as information at the time of death (hour, shift, holiday/non-holiday) were analyzed and reported.</p> <p><strong>Results:</strong> 3364 deaths due to COVID-19 have been registered during the study period (60.46% male). The patients' mean age was 66.99±16.97 (range: 1-101) years (92.7% of them were Iranian). The mortality at night shifts was less than day shifts (1643 vs. 1721). The average amount of deaths/day on holidays and workdays was (5.63 vs. 6.24). The number of deaths varied during the various hours of the day and night. Diabetes and cardiovascular diseases were the most common confounding factors, which were observed in 22.44% and 15.36% of the cases, respectively.</p> <p><strong>Conclusion: </strong>Based on the findings of this series, COVID-19 mortality was frequently observed in male patients, those with the mean age of 66.99 years, morning shifts, and workdays.</p> Ayoub Tavakolian Seyed Hassan Ashrafi Shahri Mohammad Ali Jafari Elham Pishbin Hamid Zamani Moghaddam Mahdi Foroughian Hamidreza Reihani Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-31 2022-05-31 10 1 e42 e42 10.22037/aaem.v10i1.1568 Optimization of Service Process in Emergency Department Using Discrete Event Simulation and Machine Learning Algorithm <p><strong>Background</strong><strong> - </strong>Emergency Department(ED) are operating with limited resources and high levels of unexpected requests. As a result, it is really precious to try for improving the productivity level of EDs. The aims of this study was minimizing the patients waiting time at ED as well as maximizing the percentage of units’ engagement in order to improve the ED efficiency in a public hospital in Iran.</p> <p><strong>Methods - </strong>Optimization method used in this research is a comprehensive combination method. After simulating the case and making sure about the validity of the model, experiments were designed to study the effects of change in individuals – equipment on the average time that patients wait, as well as units’ engagement in ED. In order to determine objective functions, Artificial Neural Network (ANN) algorithm was used and MATLAB software was used to train it. Finally, after estimating objective functions and adding related constraints to the problem, fractional Genetic Algorith (GA) was used to solve the model.</p> <p><strong>Results </strong><strong>–</strong> The results show that the average waiting time in triage section reached near to zero and the average waiting time in screening section reduced to 158/97 min and also coefficient of units’ engagement in both sections has been 69% and 84%.</p> <p><strong>Conclusions- </strong>The optimization of patient stream at ED is possible through appropriate allocation of the human and material resources.</p> <p>&nbsp;</p> Sayyed_Morteza Hosseini_Shokouh Kasra Mohammadi Maryam Yaghoubi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-08 2022-06-08 10 1 e44 e44 10.22037/aaem.v10i1.1545 The Effect of Exercise-Based Pulmonary Rehabilitation on Quality of Life in Recovered COVID-19 Patients; a Quasi-Experimental Study <p><strong>Introduction:</strong> The coronavirus disease 2019 (COVID-19) is associated with a variety of physical and emotional disorders, and subsequently lower Quality of Life (QOL). This study aimed to investigate the effect of a 2-week exercise-based pulmonary rehabilitation on clinical characteristics and QOL of severe COVID-19 patients after discharge from intensive care unit (ICU).</p> <p><strong>Methods:</strong> In this quasi-experimental study, eligible severe COVID-19 cases, who had survived and were discharged from ICU were selected using convenience sampling method. O<sub>2</sub> saturation (SpO2), pulse rate, dyspnea, and QOL were evaluated and compared before and after two weeks of exercise-based pulmonary rehabilitation (PR).</p> <p><strong>Results:</strong> 35 cases with the mean age of 57.86 ± 11.73 (18-75) years were studied (51.4% female). The mean SpO2 increased from 90.41 ± 3.97 to 95.11 ± 1.96% after two weeks of pulmonary rehabilitation (p&lt;0.0001). In addition, the mean pulse rate (98.97±16.23 to 88.91±14.03 pulse/minute; p&lt;0.001) and the mean dyspnea severity (5.6±1.97 to 3.45±1.97; p&lt;0.0001) decreased after two weeks of intervention. Besides, the mean total QOL and its dimensions, including general health (p&lt;0.0001), physical status (p&lt;0.0001), emotional status (p = 0.036), and social function (p&lt;0.0001) of patients, had significantly increased after intervention.</p> <p><strong>Conclusion:</strong> Based on the findings of this study, it seems that two-week exercise-based pulmonary rehabilitation could be effective in increasing the SpO2, decreasing dyspnea and pulse rate, and improving the QOL of patients with severe COVID-19 after discharge from ICU.</p> Seyed Mansoor Rayegani Rama Bozorgmehr Leila Angooti Oshnari Amir Hossein Mahdi Kaghazi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-08 2022-06-08 10 1 e45 e45 10.22037/aaem.v10i1.1569 Effect of Sofosbuvir on Length of Hospital Stay in Moderate COVID-19 Cases; a Randomized Controlled Trial <p><strong>Introduction:</strong> Efforts to control the COVID-19 pandemic are still on. This study aimed to evaluate the effect of sofosbuvir on length of hospital stay and complications in COVID-19 cases with moderate severity.</p> <p><strong>Methods:</strong> This randomized clinical trial was done on moderate COVID-19 cases, who were admitted to Shohadaye Tajrish Hospital, Tehran, Iran, from 4/2021 to 9/2021. Eligible patients were randomly allocated into two groups of intervention (sofosbuvir) and control, and their outcomes were compared regarding the length of hospital stay and complications.</p> <p><strong>Results: </strong>100 COVID-19 cases were randomly divided into two groups of 50 patients, as the intervention and control groups. The mean age of patients was 50.56 ± 12.23 and 57.1±14.1 years in the intervention and control groups, respectively (p = 0.02). The two groups were similar regarding distribution of gender (p = 0.15), underlying diseases (p = 0.08), the severity of COVID-19 (p = 0.80) at the time of admission, signs and symptoms (p &gt; 0.05), and essential laboratory profile (p &gt; 0.05). The length of hospital stay in the control and intervention groups was 7.7 ± 4.09 days and 4.7±1.6 days, respectively (p = 0.02). None of our patients needed ICU or mechanical ventilation.</p> <p><strong>Conclusion: </strong>Sofosbuvir may decrease the length of hospital stay of COVID-19 cases with moderate severity, without a significant effect on the rate of intensive care unit (ICU) need and mortality.</p> Rama Bozorgmehr Farbod Amiri Mohammad Hosein Zade Fariba Ghorbani Arash Khameneh Bagheri Esmat Yazdi Sayyed Mojtaba Nekooghadam Guitti Pourdowlat Alireza Fatemi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-09 2022-06-09 10 1 e46 e46 10.22037/aaem.v10i1.1621 Point-Of-Care Ultrasonography for Diagnosis of Medial Collateral Ligament Tears in Acute Knee Trauma; a Diagnostic Accuracy Study <p><strong>Introduction:</strong> The use of point-of-care ultrasonography (POCUS) for identifying medial collateral ligament (MCL) tears has increased in recent years. This study aimed to evaluate the diagnostic accuracy of POCUS in the diagnosis of acute MCL tears of the knee.</p> <p><strong>Methods:</strong> This prospective cross-sectional study was performed on patients with suspected MCL tear of the knee in the emergency department (ED). After history taking and primary physical examination, radiographic imaging of the knee was done. If there was no fracture in the knee X-ray, the POCUS examination was done. All of the patients were asked to refer to an orthopedic clinic, 7-10 days after discharge from ED, for Magnetic Resonance Imaging (MRI) evaluation. The second POCUS was done in the orthopedic clinic. Finally, the findings of POCUS and MRI were compared in diagnosing MCL injury.</p> <p><strong>Results:</strong> Two hundred and fifty patients with a mean age of 25.05 ± 9.12 years were analyzed (86.8% male). According to the MRI findings, as the gold standard, 55(22.0%) patients had MCL injury. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of ultrasound in detection of MCL injury, in comparison with MRI were 83.64 (95% CI, 71.20 to 92.23), 94.36% (95% CI, 90.13 to 97.15), 80.70% (95% CI, 69.95 to 88.25), 95.34% (95% CI, 91.83 to 97.38), and 92.00% (95% CI, 87.92 to 95.05), respectively. The area under the receiver operating characteristic (ROC) curve of POCUS was 0.890 (95% CI, 0.844 to 0.926).</p> <p><strong>Conclusion:</strong> It seems that POCUS can be applied in screening patients with MCL tears following blunt knee trauma.</p> Farhad Heydari Omid Ahmadi Keihan Golshani Sirous Derakhshan Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-09 2022-06-09 10 1 e47 e47 10.22037/aaem.v10i1.1480 Risk Factors of Readmission in COVID-19 Patients; a Retrospective 6-Month Cohort Study <p><strong>Introduction:</strong> The available literature regarding the rate of readmission of COVID-19 patients after discharge is rather scarce. Thus, the aim in the current study was to evaluate the readmission rate of COVID-19 patients and the components affecting it, including clinical symptoms and relevant laboratory findings.</p> <p><strong>Methods: </strong>In this retrospective cohort study, COVID-19 patients who were discharged from Imam Hossein hospital, Tehran, Iran, were followed for six months. Data regarding their readmission status were collected through phone calls with COVID-19 patients or their relatives, as well as hospital registry systems. Eventually, the relationship between demographic and clinical characteristics and readmission rate was assessed.</p> <p><strong>Results: </strong>614 patients were entered to the present study (mean age 58.7±27.2 years; 51.5% male). 53 patients were readmitted (8.6%), of which 47 patients (7.6%) had a readmission during the first 30 days after discharge. The reasons for readmission were relapse of COVID-19 symptoms and its pulmonary complications in 40 patients (6.5%), COVID-19 related cardiovascular complications in eight patients (1.3%), and non-COVID-19 related causes in five patients (0.8%). Older age (OR=1.04; 95% CI: 1.01, 1.06; p=0.002) and increased mean arterial pressure during the first admission (OR=1.04; 95% CI: 1.01, 1.08; p=0.022) were found to be independent prognostic factors for the readmission of COVID-19 patients.</p> <p><strong>Conclusion: </strong>Readmission is relatively frequent in COVID-19 patients. Lack of adequate hospital space may be the reason behind the early discharge of COVID-19 patients. Hence, to reduce readmission rate, extra care should be directed towards the discharge of older or hypertensive patients.</p> Mohammad Haji Aghajani Reza Miri Mohammad Sistanizad Amirmohammad Toloui Arian Madani Neishaboori Asma Pourhoseingholi Ziba Asadpoordezaki Roxana Sadeghi Mahmoud Yousefifard Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-20 2022-06-20 10 1 e48 e48 10.22037/aaem.v10i1.1514 Clinical and Laboratory Predictors of COVID-19-Related In-hospital Mortality; a Cross-sectional Study of 1000 Cases <p><strong>Introduction: </strong>Identifying patients at risk for mortality and using appropriate treatment for each patient based on their situation could be an effective strategy in improving their outcome. This study aimed to evaluated the predictors of COVID-19 in-hospital mortality.</p> <p><strong>Methods</strong>: This descriptive cross-sectional study was conducted on all adult COVID-19 patients who were managed in Imam-Reza and Sina Hospitals, Tabriz, Iran, from November 2020 until December 2021. The demographic, clinical, and laboratory characteristics of patients were evaluated and predictors of in-hospital mortality were identified using logistic regression model.</p> <p><strong>Results: </strong>1000 patients with the mean age of 56.34 ± 18.00 years were studied (65.7% male). There were significant associations between COVID-19 in-hospital mortality and hospitalization above five days (p = 0.001), white blood cell count (WBC) &gt; 4000 Cells*103/mL (p &lt; 0.01), aspartate aminotransferase (AST) above 40 IU/L (p = 0.001), alanine transaminase (ALT) above 40 IU/L (p = 0.001), creatinine above 1.4 mg/dL (p = 0.007), urea above 100 mg/dL (p = 0.024), and SaO2 below 80% (p = 0.001). Hospital stay above five days (OR: 3.473; 95%CI: 1.272 - 9.479; p = 0.15), AST above 40 IU/L (OR: 0.269, 95%CI: 0.179 - 0.402; p = 0.001), creatinine above 1.4 mg/dL (OR: 0.529; 95%CI: 0.344 - 0.813; p = 0.004), urea above 100 mg/dL (OR: 0.327, 95%CI: 0.189 - 0.567; p = 0.001), and SaO2 below 80% (OR: 8.754, 95%CI: 5.413 - 14.156; p = 0.001) were among the independent predictors of COVID-19 in-hospital mortality.</p> <p><strong>Conclusion: </strong>The mortality rate of patients with COVID-19 in our study was 29.9%. Hospitalization of more than five days, AST above 40 IU/L, creatinine above 1.4 mg/dL, urea above 100 mg/dL and SaO2 &lt; 80% were independent risk factors of in-hospital mortality among patients with COVID-19.</p> Zohreh Mohammadi Masood Faghih Dinevari Nafiseh Vahed Haniyeh Ebrahimi Bakhtavar Farzad Rahmani Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-23 2022-06-23 10 1 e49 e49 10.22037/aaem.v10i1.1574 Diagnostic Accuracy of Ultrasonography by Emergency Medicine Resident in Detecting Intestinal Obstruction; a Pilot Study <p><strong>Introduction</strong>: There are many ambiguities regarding the application of ultrasound in detection of intestinal obstruction. This study aimed to evaluate the diagnostic accuracy of ultrasound in diagnosis of intestinal obstruction.</p> <p><strong>Methods</strong>: This cross-sectional study was performed on patients with symptoms and signs of bowel obstruction between November19 and July 2020 in Shohadaye-Tajrish and Imam Hossein General Hospitals, Tehran, Iran. After a brief explanation and getting verbal consent, the patients underwent ultrasound examination in the emergency department by the emergency medicine resident. The results of ultrasound were compared with the surgical findings as the gold standard.</p> <p><strong>Results</strong>: 24 patients with the mean age of 57.50±18.26 (range: 28 – 81) years were studied (58.3% male). Ultrasonography findings revealed the lumen diameter ≥ 2.5 cm in 21 (87.5%) cases, wall thickness ≥ 3 mm in 3 (12.5%) cases and inter-loop free fluid in 3 (12.5%) cases. Sensitivity, positive predictive value, and accuracy of ultrasound in detection of intestinal obstruction were found to be 85.00% (95%CI: 61.13 – 96.03), 80.95% (95%CI: 57.42 – 93.71), and 70.83% (95%CI: 48.91 – 87.38), respectively.</p> <p><strong>Conclusion</strong>: It seems that point-of-care ultrasound has good sensitivity and accuracy in detection of intestinal obstruction when performed in the emergency department by a trained emergency medicine resident.</p> Anita Sabzghabaei Majid Shojaei Miromid Chavoshzadeh Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-26 2022-06-26 10 1 e50 e50 10.22037/aaem.v10i1.1628 Predicting the 28-Day Mortality of Non-Trauma Patients using REMS and RAPS; a Prognostic Accuracy Study <p><strong>Introduction</strong>: Various scoring systems have been designed for calculating the mortality risk of patients. This study evaluated the accuracy of Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) in predicting the 28-day mortality of non-trauma patients.</p> <p><strong>Methods</strong>: This prospective cross-sectional study was conducted on 1003 adult non-trauma patients, who referred to the emergency department of Imam Khomeini Hospital, Urmia, Iran, in the second half of 2018, using the census sampling. We determined the screening performance characteristics of REMS and RAPS in predicting the 28-day mortality of patients. &nbsp;&nbsp;</p> <p><strong>Results</strong>: This study examined 1003 non-trauma patients with a mean age of 61.5±18.05 years (60.6% male). The mean REMS (8.7 ± 3.2 vs. 6.0 ± 3.6; p &lt; 0.001) and RAPS (3.7 ± 2.8 vs. 2.7 ± 2.0; p &lt; 0.001) scores were significantly higher in deceased cases.</p> <p>Sensitivity and specificity of REMS in predicting the risk of non-trauma patients’ mortality were 85.19% (95%CI: 78.05% - 90.71%) and 78.34% (95%CI: 75.45% - 81.04%), respectively. While, the Sensitivity and specificity of RAPS in this regard were 61.39% (95%CI: 53.33% - 69.02%) and 71.12% (95%CI: 67.94% - 74.16%), respectively. The area under the receiver operating characteristic (ROC) curve of REMS and RAPS were 0.72 (95% CI: 0.68 -0.75) and 0.62 (95% CI: 0.56 - 0.65) in predicting the patients’ 28-day mortality, respectively (p = 0.001).</p> <p><strong>Conclusion</strong>: The total accuracies of REMS and RAPS in predicting the 28-day mortality of non-trauma patients were in good and poor range, respectively. The screening performance characteristics of REMS were a little better in this regard.</p> Omid Garkaz Farzin Rezazadeh Saeed Golfiroozi Sahar Paryab Sadaf Nasiri Hamidreza Mehryar Mousa Ghelichi-Ghojogh Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-04 2022-07-04 10 1 e52 e52 10.22037/aaem.v10i1.1601 Ethanol Sclerotherapy versus Laparoscopic Surgery in Management of Ovarian Endometrioma; a Randomized Clinical Trial <p><strong>Introduction:</strong> A variety of therapeutic modalities are available in management of ovarian endometrioma. This study aimed to compare the effects of ethanol sclerotherapy and laparoscopic surgery on disease recurrence and ovarian factors of these patients.</p> <p><strong>Methods:</strong> 70 women with ovarian endometrioma and chronic pelvic pain were randomly divided into two groups. The first group underwent sclerotherapy with a puncture needle (cook) and the second group underwent laparoscopic surgery. Both groups were followed up every three months to investigate the recurrence rate. In this regard, ultrasonography was performed 3 months and 12 months after treatment, and serum anti-Müllerian hormone (AMH) levels were also reassessed 12 weeks after the intervention.</p> <p><strong>Results:</strong> 70 women with the mean age of 31.46 ± 4.71 years, and the mean body mass index (BMI) of 23.12 ± 1.01 were studied. The two groups were similar regarding age (p = 0.770), BMI (p = 0.371), history of gastrointestinal signs (p = 0.794), history of urinary diseases (p = 0.324), dysmenorrhea (p = 0.403), pelvic pain (p = 0.454), dyspareunia (p = 0.448), location of cyst (p = 0.448), and diameter of cyst (p = 0.250). In the laparoscopic group, a significant decrease in anti-Müllerian hormone (AMH) levels was observed after 12 weeks (p &lt; 0.0001), while in the sclerotherapy group, no significant changes were found between pre-and post-operative AMH levels (p = 0.120). Cyst size decreased significantly in both groups three months (p &lt; 0.001) and twelve months (p &lt; 0.0001) after treatment. In the third month, 8 patients in the sclerotherapy group and 13 patients in the laparoscopic group had recurrences, and in the twelfth month, 17 patients in the sclerotherapy group and 15 patients in the laparoscopic group had recurrence of symptoms (p &gt; 0.05).</p> <p><strong>Conclusions:</strong> Although AMH level and mean cyst diameter were significantly lower one year after laparoscopy, recurrence rate of ovarian endometrioma was similar between ethanol sclerotherapy and laparoscopy methods.</p> Hatav Ghasemi Tehrani Raheleh Tavakoli Maryam Hashemi Somayeh Haghighat Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-07 2022-07-07 10 1 e55 e55 10.22037/aaem.v10i1.1636 Comparing the Characteristics of Mucormycosis Between Cases with and without COVID-19; a Cross-sectional Study <p><strong>Introduction:</strong> Mucormycosis as a rare but life-threatening disease with 46-96% mortality, which challenged the healthcare system during the COVID-19 pandemic. This study aimed to compare the characteristics of mucormycosis between cases with and without COVID-19.</p> <p><strong>Methods:</strong> This cross-sectional study was done in two referral hospitals, Imam Hossein and Labbafinezhad Hospitals, Tehran, Iran, between 21 March to 21 December 2021. Data related to all hospitalized adults subject with the diagnosis of mucormycosis during the study period was collected from patients’ profiles and they were divided into two groups of with and without COVID-19 based on the results of real time PCR. Then demographic, clinical, and laboratory findings as well as outcomes were compared between the two groups.</p> <p><strong>Results:</strong> 64 patients with the mean age of 53.40±10.32 (range: 33-74) years were studied (53.1% male). Forty-three (67.2%) out of the 64 subjects had a positive COVID-19 PCR test. The two groups had significant differences regarding some symptoms (cough (p &lt; 0.001), shortness of breath (p = 0.006)), acute presentation (p = 0.027), using immunosuppressive (p = 0.013), using corticosteroid (p &lt; 0.001), and outcomes (mortality (p = 0.018), need for intubation (p &lt; 0.001)). 22 (34.3%) patients expired during hospital admission. Univariate analysis showed the association of in-hospital mortality with need for ventilation (p &lt; 0.001), sinus involvement (p = 0.040), recent use of dexamethasone (p = 0.011), confirmed COVID-19 disease (p = 0.025), mean body mass index (BMI) (p =0.035), hemoglobin A1c (HbA1c) (p = 0.022), and median of blood urea nitrogen (BUN) (p =0.034). Based on the multivariate model, confirmed COVID-19 disease (OR = 5.01; 95% CI: 1.14-22.00; p = 0.033) and recent use of dexamethasone (OR= 4.08, 95% CI: 1.05-15.84, p = 0.042) were independent predictors of mortality in this series.</p> <p><strong>Conclusion:</strong> The mucormycosis cases with concomitant COVID-19 disease had higher frequency of cough and shortness of breath, higher frequency of acute presentation, higher need for immunosuppressive, corticosteroid, and ventilator support, and higher mortality rate. The two groups were the same regarding age, gender, BMI, risk factors, underlying diseases, symptoms, and sites of involvement.</p> Mohammad Sistanizad Mohammad Haji Aghajani Mehrdad Haghighi Hossein Amini Asma Pourhoseingholi Niloufar Taherpour Shadi Ziaie Sara Salarian Omid Moradi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-12 2022-07-12 10 1 e56 e56 10.22037/aaem.v10i1.1608 Effect of Interposed Abdominal Compression on Cardiopulmonary Resuscitation Outcomes; a Randomized Clinical Trial <p><strong>Introduction:</strong> Standard cardiopulmonary resuscitation (STD-CPR) is successful in only 10-15% of cases in emergency department (ED). This study aimed to determine the effect of interposed abdominal compression (IAC) during resuscitation on outcomes of ED cardiac arrests.</p> <p><strong>Methods:</strong> In this randomized clinical trial study, non-trauma patients aged 18-85 years, patients with in-hospital cardiac arrest hospitalized in the ED were randomly assigned into two either STD-CPR or IAC-CPR group on a 1:1 basis and using computer-generated random numbers. Participants in the intervention group, received abdominal compression during the diastole phase of STD-CPR. The rate of return of spontaneous circulation (ROSC), heart rate (HR), respiratory rate (RR), arterial blood gas (ABG) indicators, and survival rate were compared between the two groups.</p> <p><strong>Results:</strong> Ninety patients were enrolled (45 in each group). There were no differences between the two groups regarding age (p = 0.76), sex (p = 0.39), employment status (p = 0.62) and Charlson comorbidity scale (p = 0.46). Abdominal compression had a positive effect on heart rate (p &lt; 0.001), mean arterial pressure (p = 0.003), arterial blood oxygen pressure (p = 0.001), and arterial blood carbon dioxide pressure (p = 0.001) as well as a negative effect on arterial blood oxygen saturation (p = 0.029) 30 minutes after resuscitation. Out of the 90 CPR cases, 8 (17.7%) cases in intervention group and 8 (17.7%) cases in control group were successful, among which all of the 8 patients in the intervention group and 5 of the patients in the control group had been discharged from hospital without any complications.</p> <p><strong>Conclusion:</strong> The results showed that abdominal compression during CPR can improve resuscitation outcomes in patients with cardiac arrest. Therefore, in order to use this technique, further research is recommended.</p> Atefeh Ghanbari Khanghah Mohammad Taghi Moghadamnia Latif Panahi Somaye Pouy Marjan Aghajani Nargesi Ehsan Kazemnezhad Leyli Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-16 2022-07-16 10 1 e57 e57 10.22037/aaem.v10i1.1678 Evaluating the Ability of PRISM4 and PIM3 to Predict Mortality in Patients Admitted to Pediatric Intensive Care Unit; a Diagnostic Accuracy Study <p><strong>Introduction :</strong> Limited resources and the large number of children in need of services in the pediatric intensive care unit (PICU) emphasize the need for effective allocation of resources for improving the outcome of at-risk patients. This study aimed to evaluate and compare the accuracy of PRISM4 and PIM3 systems in prediction of in-hospital mortality of patients admitted to PICU.</p> <p><strong>Methods:</strong> The present retrospective cross-sectional study was a diagnostic accuracy study performed on patients admitted to PICU of Qods Hospital, Qazvin, Iran, during one year. Scores of PRISM4 and PIM3 scales were calculated for each patient using the available calculators, and the outcome of patients regarding in-hospital mortality was recorded. Finally, screening performance characteristics of the mentioned scales in prediction of patients’ mortality were calculated and reported.</p> <p><strong>Results:</strong> 218 patients with the mean age of 40.68 ± 37.92 (2-160) months were studied (57.8% female). There was a significant direct correlation between PIM3 score and duration of stay in PICU (p &lt; 0.0001; r = 0.259), need for inotropic drug administration (p = 0.001), and mortality rate (p = 0.001). In addition, area under the receiver operating characteristic (ROC) curve of PIM3 and PRISM4 in prediction of mortality among patients admitted to the PICU was 0.939 (95%CI: 0.880 – 0.998) and 0.660 (95%CI: 0.371 – 0.950), respectively (p = 0.001). Based on the findings, the best cut-off point for PIM3 scale in prediction of mortality was the score of 4 and it was estimated to be the core of 8 for PRISM4 scale. Sensitivity and specificity of PIM3 scale in prediction of mortality in the cut-off of 4 points were 100.00 (95% CI: 56.09- 100.00) and 81.51 (95% CI: 75.47- 86.38), respectively. These measures were 42.85 (95%CI: 11.80- 79.76) and 98.10 (95%CI: 94.89- 99.39) for PRISM4 model, which indicates the higher sensitivity of PIM3 system in this regard.</p> <p><strong>Conclusion:</strong> based on the results of the present study, the accuracy of PIM3 is significantly higher than PRISM4 in prediction of in-hospital mortality among patients admitted to the PICU. It seems that considering the 100% sensitivity of PIM3 in prediction of outcome, this model is a better tool for screening patients who are at risk for in-hospital mortality in order to pay more attention and allocate more resources to improve their outcome.</p> Victoria Chegini Hamidreza Hatamabadi Sima Jedari Attaran Abolfazl Mahyar Monirsadat Mirzadeh Venus Chegini Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-21 2022-07-21 10 1 e58 e58 10.22037/aaem.v10i1.1738 An Epidemiologic Overview of Traumatic Vascular Injures in Emergency Department; a Retrospective Cross-Sectional Study <p><strong>Introduction: </strong>Vascular system injuries (VSIs) are one of the main causes of preventable mortality and morbidity of trauma patients. This study aimed to evaluate baseline characteristics, presenting signs, managements, and outcomes of patients presenting to emergency department (ED) with traumatic VSIs.&nbsp;</p> <p><strong>Methods: </strong>This retrospective cross-sectional study was conducted on patients with traumatic VSIs admitted to the ED of a referral tertiary trauma center, during one year. Using a pre-prepared checklist, demographics, pre-hospital care, type of VSIs, injury severity score (ISS), anatomical location of trauma, associated injuries, method of surgery, complications, and outcome were collected from patients’ profiles and reported.</p> <p><strong>Results: </strong>One hundred and twelve patients with the mean age of 33.5 ± 14.7 (range = 8 - 80) years were studied (90.2% male). Most of the patients were categorized as mild or moderate in terms of their ISS. 90 (80.4%) patients had at least one soft sign and 99 (88.4%) patients had at least one hard sign. Isolated arterial injury was diagnosed in 90 (80.4%) patients, isolated venous injuries in 12 (10.7%) cases, and combined arteriovenous injuries in 10 (8.7%) patients. The most common associated injury was tendon rupture (63.4%) and nerve injuries were present in 60.7% of patients. 1 (0.9%) patient died, 6 (5.4%) patients went through amputation, and 3 (2.7%) patients were discharged against medical advice. The rest of the patients were discharged in perfect health. There was a significant correlation between trauma type (p = 0.001), upper and lower extremity trauma (p &lt; 0.001), presence of distal ischemia and lack of pulse (p = 0.041), penetrating injury close to a major vessel (p = 0.006), type of injured vessels and arteries (p&lt;0.001), injury to nerve (p = 0.011) and tendon (p = 0.007), presence of open fracture (p = 0.005), multiple trauma (p &lt; 0.001), method of surgery (p &lt; 0.001), and number of postoperative complications (p&lt; 0.001) with poor outcome.</p> <p><strong>Conclusion: </strong>The findings showed that the majority of the studied patients were young males, most of whom were discharged in perfect situation. Those who presented with higher ISS, or were affected by blunt trauma or injury to lower limb arteries had worse outcome than the others.</p> Niloofar Mirdamadi Maryam Bakhtiari Alireza Baratloo Mohammad Reza Fattahi Pezhman Farshidmehr Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-21 2022-07-21 10 1 e59 e59 10.22037/aaem.v10i1.1663 Comparing the Outcomes of Surgical and Non-Surgical Approaches in Management of Older Patients with Distal Radius Fracture; a Retrospective Cohort Study <p><strong>Introduction</strong>: Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency department. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population.</p> <p><strong>Methods</strong>: In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complications were compared between the two groups at 3 and 6-month follow-ups.</p> <p><strong>Results</strong>: A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain intensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-union (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group.</p> <p><strong>Conclusion</strong>: The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.</p> Mehdi Teimouri Milad Ghaderi Saeed Hatami Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-02 2022-08-02 10 1 e62 e62 10.22037/aaem.v10i1.1606 Lactate Dehydrogenase to Albumin ratio as a Predictive Factor of COVID-19 Patients’ Outcome; a Cross-sectional Study <p><strong>Introduction:&nbsp;</strong>Despite the increasing vaccination coverage, COVID-19 is still a concern. With the limited health care capacity, early risk stratification is crucial to identify patients who should be prioritized for optimal management. The present study investigates whether on-admission lactate dehydrogenase to albumin ratio (LAR) can be used to predict COVID-19 outcomes.</p> <p><strong>Methods:&nbsp;</strong>This retrospective cross-sectional study evaluated hospitalized COVID-19 patients in an academic referral center in Iran from May 2020 to October 2020. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the value of LAR in the prediction of mortality. The Yuden index was used to find the optimal cut-off of LAR to distinguish severity. Patients were classified into three groups (LAR tertiles), first: LAR&lt;101.46, second: 101.46≤LAR&lt; 148.78, and third group: LAR≥148.78. Logistic regression analysis was used to identify the association between tertiles of LAR, as well as the relationship between each one-unit increase in LAR with mortality and ICU admission in three models, based on potential confounding variables</p> <p><strong>Results:</strong> A total of 477 patients were included. Among all patients, 100 patients (21%) died, and 121 patients (25.4%) were admitted to intensive care unit (ICU). In the third group, the risk of mortality and ICU admission increased 7.78 times (OR=7.78, CI: 3.95-15.26; p &lt;0.0001) and 4.49 times (OR=4.49, CI: 2.01-9.04; p &lt;0.0001), respectively, compared to the first group. The AUC of LAR for prediction of mortality was 0.768 (95% CI 0.69- 0.81). LAR ≥ 136, with the sensitivity and specificity of 72% (95%CI: 62.1-80.5) and 70% (95%CI: 64.9-74.4), respectively, was the optimal cut-off value for predicting mortality.</p> <p><strong>Conclusion</strong>: High LAR was associated with higher odds of COVID-19 mortality, ICU admission, and length of hospitalization. On-admission LAR levels might help health care workers identify critical patients early on.</p> Nafiseh Alizadeh Fatemeh-sadat Tabatabaei Amirali Azimi Neda Faraji Samaneh Akbarpour Mehrnoush Dianatkhah Azadeh Moghaddas Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-15 2022-08-15 10 1 e63 e63 10.22037/aaem.v10i1.1646 Predictive Factors of Outcome in Cases of Out-of-hospital Cardiac Arrest Due to Traffic Accident Injuries in Thailand; a National Database Study <p><strong>Introduction</strong><strong>:</strong> Traffic accident injury is one of the global leading causes of death and an important public health problem. This study aimed to evaluate the predictive factors of return of spontaneous circulation (ROSC) at the scene in out-of-hospital cardiac arrest (OHCA) due to traffic accidents.</p> <p><strong>Methods : </strong>This retrospective cross-sectional study was conducted on cases of OHCA due to traffic accident, who were resuscitated at the scene by emergency medical services (EMS) in Bankok, Thiland, from January 1, 2020, to December 31, 2020 (1 year). Patients were divided into two groups of with and without ROSC and independent predictive factors of outcome were evaluated.</p> <p><strong>Results&nbsp;: </strong>2400 OHCA cases met the inclusion criteria, among them, 1728 (72.0%) achieved ROSC at the scene. Facial injury (adjusted OR = 2.17, 95%CI: 1.37–3.44, p = 0.001); prehospital airway management using bag valve mask (adjusted OR = 1.69, 95%CI: 1.21–2.34, p = 0.002), and endotracheal tube (adjusted OR = 3.88, 95%CI: 1.84–8.18, p &lt;0.001); and prehospital fluid therapy using normal saline (adjusted OR = 4.24, 95%CI: 3.12–5.77, p &lt;0.001), ringer lactate (adjusted OR = 5.13, 95%CI: 3.47–7.61, p &lt;0.001), and other solutions (adjusted OR = 5.25, 95%CI: 2.16–12.8, p &lt;0.001) were independent predictive factors of ROSC at the scene in OHCA due to traffic accidents.</p> <p><strong>Conclusion : </strong>Based on the findings, the rate of ROSC at the scene for cases with OHCA due to traffic accidents, serviced by EMS was high, i.e., 72%, and three independent predictive factors of ROSC at the scene were facial injury, prehospital airway management, and prehospital fluid management.</p> Thongpitak Huabbangyang Chunlanee Sangketchon Sakditat Ittiphisit Kanittha Uoun Chomkamol Saumok Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-16 2022-08-16 10 1 e64 e64 10.22037/aaem.v10i1.1700 Comparing Emergency Medical Services Processing Times for Stroke Patients Before and During COVID-19 Pandemic; A Cross-sectional Study <p><strong>Introduction: </strong>Coronavirus disease 2019 (COVID-19) has directly affected global healthcare, especially the front-line of healthcare provision, including emergency medical services (EMS). The present study aimed to compare EMS processing times and the number of acute stroke patients serviced by EMS before and during COVID-19 pandemic.</p> <p><strong>Methods: </strong>This is a retrospective observational review of Bangkok Surgico Medical Ambulance and Rescue Team (S.M.A.R.T.) EMS data from 2018 to 2021. The EMS processing times and the number of acute strokes were compared between pre-COVID-19 era (January 1st, 2018, and December 31st, 2019) and during COVID-19 pandemic (January 1st, 2020, and December 31st, 2021).</p> <p><strong>Results: </strong>The number of stroke patients transported by EMS in one year, before and during COVID-19 pandemic was 128 and 150 cases, respectively (Change difference = 17.2%, 95% CI: 11.1–24.9). However, the average number of acute stroke patients per week was not significantly different (p = 0.386). The mean total EMS processing times before and during COVID-19 era were 25.59 ± 11.12 and 45.47 ± 14.61 minutes, respectively (mean difference of 19.88 (95% CI: 16.77–22.99) minutes; p &lt; 0.001).&nbsp; The mean time from symptom onset to EMS arrival (p &lt; 0.001), the mean call time (p &lt; 0.001), the mean response time (p &lt; 0.001), and the mean scene time (p &lt; 0.001) were significantly higher during COVID-19 period. The mean transportation times for stroke patients was similar before and during COVID-19 pandemic (10.14 ± 6.28 and 9.41 ± 6.31 minutes, respectively; p = 0.338).</p> <p><strong>Conclusions: </strong>During COVID-19 pandemic, the number of acute stroke patients serviced by EMS increased substantially, but there was no difference in the average number of patients per week. During the pandemic, EMS processing times markedly increased.</p> Thongpitak Huabbangyang Rossakorn Klaiangthong Krit Prasittichok Sutida Koikhunthod Jakkapan Wanna Nutthapong Sudajun Parichat Khaisri Anucha Kamsom Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-16 2022-08-16 10 1 e65 e65 10.22037/aaem.v10i1.1710 Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series <p><strong>Introduction: </strong>Since the emergence of COVID-19 pandemic, several articles have reported the co-existence of mucormycosis and COVID-19. This study aimed to distinguish the characteristics of COVID-19-associated rhinocerebral mucormycosis.</p> <p><strong>Methods: </strong>In this case series, 18 patients with COVID-19-associated rhinocerebral mucormycosis and unique clinical manifestations and outcomes, who were referred to Amiralam Hospital, a tertiary otorhinolaryngology center, Tehran, Iran, during the COVID-19 era, were reported.</p> <p><strong>Results: </strong>Eighteen patients with the mean age of 62.0 ± 11.6 (range: 42 – 83) years were studied (50% males). The mean time interval between diagnosis of COVID-19 and first manifestation of mucormycosis was 15.5 ± 9.7 days. The most common presenting symptom was facial paresthesia (72.2%). Fifty percent of patients developed frozen eye. Palatal necrosis was seen in 7 cases (38.8%). Remarkably, facial paralysis was observed in 5 (27.7%) patients. Another notable clinical picture was cavernous sinus thrombosis, seen in 7 patients. We also had two cases of carotid artery occlusion. Three patients, unfortunately, passed away.</p> <p><strong>Conclusion: </strong>Rhinocerebral mucormycosis is one of the most important complications of COVID-19 patients, especially those with underlying diseases. It seems that the key to proper management of mucormycosis is early diagnosis and timely intervention, which could give a patient a chance to live more.</p> Seyedhadi Samimiardestani Shirin Irani Mehrdad Hasibi Maral Seyedahadi Shahin Bastaninejad Mohammadreza Firouzifar Mojataba Mohammadi Ardehali Sina Berijani Reza Erfanian Mohammad Ali Kazemi Afshar Etemadi-Aleagha Abolfazl Rahimi Kourosh Karimi Yarandi Samira Ahadi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-18 2022-08-18 10 1 e66 e66 10.22037/aaem.v10i1.1644 Risk Factors of Recurrent Anal Abscess in Patients with Type 2 Diabetes Mellitus; a 4-Year Retrospective study <p><strong>Introduction: </strong>Anal abscess is considered as a relatively common compilation in type 2 diabetes mellitus (T2DM) patients. This study aimed to determine the risk factors of recurrent anal abscess in T2DM patients. &nbsp;</p> <p><strong>Methods:</strong> In this 4-year retrospective cross-sectional study, T2DM patients hospitalized due to anal abscess in Shahid Modarres Hospital, Tehran, Iran from December 2016 to December 2020 were studied. The independent risk factors of disease recurrence were determined among demographic factors, underlying diseases, diabetes-related factors, clinical factors, laboratory parameters, abscess type, and culture using multivariate stepwise logistic regression analysis.&nbsp;</p> <p><strong>Results:</strong> 203 patients were enrolled in the study. 58 (28.6%) patients had at least one re-occurrence of anal abscess during four years. The recurrent episodes had occurred more frequently in the first year after the initial treatment (55.2%). The prevalence of comorbidities such as metabolic syndrome, coronary artery disease, chronic kidney disease, end stage renal disease, and peripheral vascular disease was significantly higher amongst patients with abscess recurrence. The patients with recurrent anal abscess had statically significant poor glycemic control (HbA1C &gt; 7.5), decreased levels of Estimated Glomerular Filtration Rate (e-GFR), and higher C-reactive Protein (CRP) upon the first admission. Presence of metabolic syndrome, HbA1c &gt; 7.5%, WBC &gt; 11.0 ×10<sup>9</sup>/L, and CRP &gt; 5 mg/l were amongst the independent risk factors of recurrence. HbA1c &gt; 7.5% was the greatest independent risk factor of anal abscess recurrence (OR=2.68, 95% CI: 1.37-5.25; p &lt; 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of HbA1C, CRP, and WBC in predicting the risk of abscess recurrence was 0.81, 0.71, and 0.64, respectively.</p> <p><strong>Conclusion:</strong> Th recurrence rate of anal abscess in this series was 28.6 %. It seems that in T2DM patients with uncontrolled diabetes who have metabolic syndrome and increased CRP and WBC in their routine tests, the probability of anal abscess reoccurrence is high.</p> Nasser Malekpour Alamdari Siamak Afaghi Farzad Esmaeili Tarki Mohammad Fathi Sara Besharat Fatamehsadat Rahimi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-24 2022-08-24 10 1 e69 e69 10.22037/aaem.v10i1.1692 The Effect of Gracilaria Corticata and Scenedesmus Acuminates Extract Mixture on the Healing of Wounds Contaminated with Staphylococcus in the Rat Model <p><strong>Introduction</strong>: Wound healing processes are dependent on the severity of the trauma, invasion of opportunistic microorganisms, and inflammatory, immunological, and metabolic responses. We tried to show the ability of algae to inhibit wound infection, which can lead to proper wound healing.</p> <p><strong>Methods</strong>: Eighty rats were housed according to laboratory animal care protocols and divided into four groups at each operating time. Group I consisted of the non-treated animals. Group II was treated with 25% zinc oxide as a choice treatment. In the treated groups 3 and 4, an equal ratio of Gracilaria Corticata and Scenedesmus acuminate marine algae (mixed algae) was applied as 3% and 7% ointment pomade. Percentage of wound closure, number of bacteria in the wound surface, angiogenesis (Vascular endothelial growth factor; VEGF), the number of macrophages, collagen production level and transforming growth factor-beta (TGFβ), epithelialization, and fibrosis were evaluated.</p> <p><strong>Results</strong>: Applying mixed algae extract 7% and zinc oxide 25% could result in a mild improvement in wound closure (df: 9, 48; F=5.97; p&lt;0.0001). In addition, mixed algae 3%, mixed algae 7% and zinc oxide could reduce the rate of bacterial growth compared to non-treated animals (df: 3, 16; F=5.74; p=0.0007). However, these improvements do not seem to be clinically significant. Induction of angiogenesis, increase in macrophage infiltration rate, and expression of TGFβ are possible underlying mechanisms of mixed algae in accelerating wound healing process.</p> <p><strong>Conclusion</strong>: The result showed that the administration of 3% and 7% mixed algae could mildly accelerate the wound healing process in a rat model of pelleted skin wound. However, it seems that its effect is not clinically significant compared to non-treated and zinc oxide treated animals.</p> Hooman Akashe Alireza Jahandideh Amireghbal Khajehrahimi Shapour Kakoolaki Saeed Hesaraki Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-29 2022-08-29 10 1 e70 e70 10.22037/aaem.v10i1.1686 Usability of Emergency Department Information System Based on Users' Viewpoint; a Cross-Sectional Study <p>Introduction: The emergency department is of special importance due to its emergency and vital services, the high volume of referrals, and the patients' physical condition. Thus, it requires a well-designed information system with no usability problems. This study aimed to evaluate the usability of the emergency department information system from users' perspectives.</p> <p><strong>Methods:</strong> This was a cross-sectional study. The research setting was the emergency department of 3 hospitals. The research instrument was a 37-item questionnaire adapted from the USE and ISO Metrics questionnaires, consisting of five dimensions measuring the usefulness of the system, ease of use, ease of learning, user satisfaction, and suitability for the task. The content validity of the questionnaire was examined using the content validity ratio and content validity index, and its reliability was assessed using Cronbach's alpha (α = 0.88).</p> <p><strong>Results:</strong> Fifty questionnaires were administered in the three hospitals, and the response rate was 80%. According to the findings, 55% of the respondents were female. The highest mean scores belonged to usefulness in emergency department information system (EDIS) A, ease of use in EDIS B, ease of learning in EDIS A, user satisfaction in EDIS C, and suitability for the task in EDIS A. According to the usability evaluation criteria, ease of learning (3.66 ± 0.74), usefulness (3.53 ± 0.87), and suitability for the task (3.47 ± 0.96) received the highest scores, and the lowest scores belonged to user satisfaction (3.29 ± 1.01) and ease of use (3.12 ± 1.00).</p> <p><strong>Conclusion:</strong> In terms of usability criteria, the emergency department information system is at a relatively good level. The usability of these systems can be further enhanced by considering the users' working needs, improving software flexibility, customizing the software, using data visualization tools, observing consistency of features and standards, and increasing the quality of information and system services.</p> Sohrab Almasi Nahid Mehrabi Farkhondeh Asadi Mahboobeh Afzali Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-01 2022-09-01 10 1 e71 e71 10.22037/aaem.v10i1.1635 Factors Associated with Return of Spontaneous Circulation following Pre-Hospital Cardiac Arrest in Daegu Metropolitan City, South Korea; a Cross-Sectional Study <p><strong>Introduction:</strong> The probability of Return of Spontaneous Circulation (ROSC) in cardiac arrest cases in pre-hospital setting is still low. This study aimed to identify the factors that may improve the rate of ROSC in patients with pre-hospital cardiac arrest.</p> <p><strong>Methods:</strong> This retrospective cross-sectional study is a secondary data analysis of cardiac arrest patients, who were managed by paramedics in the pre-hospital setting, from January 1, 2019,&nbsp;to December 31, 2019,&nbsp;in Daegu, South Korea.&nbsp;The association of ROSC with place of arrest occurrence, cardiac arrest being witnessed, performing cardiopulmonary resuscitation (CPR), using compression device and defibrillator, administration of epinephrine, and intubation&nbsp;was analyzed and independent predictive factors of ROSC were reported.</p> <p><strong>Results:</strong> 2750&nbsp;out-of-hospital cardiac arrest cases, which were managed by paramedics in the pre-hospital setting were studied. 2034 (86.9%) cases of arrest had occurred at home, 2028 (73.7%) were not witnessed,&nbsp;and CPR was not performed&nbsp;for 1721 (64.1%) cases.&nbsp;ROSC before arriving to emergency department (ED) was more probable if the cardiac arrest was witnessed&nbsp;(p&nbsp;&lt;&nbsp;0.001), if CPR was performed&nbsp;(p&nbsp;=&nbsp;0.044),&nbsp;if a mechanical compression device was used&nbsp;(p&nbsp;&lt;&nbsp;0.001),&nbsp;if a first-aid defibrillator was used&nbsp;(p&nbsp;&lt;&nbsp;0.001), and if intravenous access was secured&nbsp;(p&nbsp;&lt;&nbsp;0.001). Multivariate regression analysis revealed that using mechanical compression device (OR: 0.18; 95% CI&nbsp;=&nbsp;0.08&nbsp;-&nbsp;0.40; p = 0.001), using first-aid defibrillator (OR: 3.13; 95% CI&nbsp;=&nbsp;1.40&nbsp;-&nbsp;6.99; p = 0.005), administration of epinephrine (OR: 6.57; 95% CI&nbsp;=&nbsp;2.16&nbsp;-&nbsp;19.53; p = 0.001), and intubation (OR: 1.82;&nbsp;95% CI&nbsp;=&nbsp;1.04-3.19; p = 0.001) were independent predictive factors of ROSC&nbsp;before arrival to ED.</p> <p><strong>Conclusion: </strong>It seems that chest compression by hand instead of using chest compression device, using defibrillator, epinephrine administration, and intubation my increase the probability of ROSC in pre-hospital arrest cases.</p> Hyun-Ok Jung Seung-Woo Han Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-01 2022-09-01 10 1 e72 e72 10.22037/aaem.v10i1.1589 Attitudes of Emergency Nurses and Patients’ Family Members Towards the Presence of Family Members During Cardiopulmonary Resuscitation; a Cross-sectional Study <p><strong>Introduction</strong><strong>:</strong> Family presence during cardiopulmonary resuscitation (CPR) is one of the elements where family-centered care is practiced. This study aimed to investigate the attitudes of Iranian emergency nurses and patients’ family members regarding the presence of family during CPR.</p> <p><strong>Methods:</strong> In a cross-sectional study, 350 emergency nurses and 254 family members of patients admitted to the emergency department of an educational hospital in Iran were enrolled. Data were collected from May to November 2020 using convenience sampling and using a 27-item questionnaire of participants' attitudes towards family presence during CPR.</p> <p><strong>Results: </strong>The mean attitude scores of nurses and family members of patients regarding family presence during CPR were 86.79 ± 7.50 and 92.48 ± 6.77, respectively (p &lt; 0.001). The highest and lowest mean scores of nurses' attitude towards family presence during CPR were related to "CPR performance will be negatively influenced" and "Family members have the right to be present during CPR of their relatives/ Allows relatives to stay with the patient until the end/ Makes the patient less worried ", respectively. The highest and lowest mean scores of family members’ attitude towards family presence during CPR were related to "Family members may interfere with CPR" and " May be beneficial to the relatives’ grieving process ", respectively.</p> <p><strong>Conclusion</strong><strong>:</strong> Overall, the results of this study showed that the attitude of emergency nurses and patients’ family members towards family presence during CPR was positive. Of course, the mean attitude score of nurses in this regard was significantly lower.</p> Zohreh Hosseini Marznaki Samad Karkhah Mehdi Mohammadian Amiri Håkan Källmen Azadeh Moradi Maede Najjarboura Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-06 2022-09-06 10 1 e73 e73 10.22037/aaem.v10i1.1679 Game-based vs. Case-based Training for Increasing Knowledge and Behavioral Fluency of Nurse Students Regarding Crisis and Disaster Management; a Quasi-Experimental Study <p><strong>Introduction: </strong>Nurses play an active role in disaster response, and the ability of nurses to appropriately apply management principles during large-scale disasters or mass casualty incidents is of critical importance. This study aimed to compare the effect of game-based Training (GBT) and case-based training (CBT) on nursing students' knowledge and behavioral fluency regarding Crisis and Disaster Management.</p> <p><strong>Methods:</strong> This is a quasi-experimental study with a pretest-posttest design. Convenience sampling was used to select third-year nursing students who had completed their clinical clerkship at the time of the study (n=60). In the intervention group, disaster-themed games were used, while in the control group, CBT was used. The emergency and crisis management course consisted of this study's theoretical and clinical training phases. After completion of the theoretical phase (five weeks), the practical part (four weeks) is completed as an internship. The data was collected from the disaster Nurses' Knowledge Questionnaire, demographic survey, and measurement checklists for disasters and crises at five stations.</p> <p><strong>Results:</strong> GBT students achieved significantly higher knowledge scores than CBT students after training (p&lt; 0.001). CBT and GBT groups had no significant differences in Objective Structured Clinical Examination (OSCE)1 pretest scores. Posttest1-OSCE2 and posttest2-OSCE3 scores showed significant differences after one week (P &lt; 0.001) and one month (P &lt; 0.001). The mean pretest and posttest1 scores were statistically significant in both groups. A comparison of posttest scores between one month after GBT training (69.03 ± 6.09) and one week after it (69.23 ± 6.14) revealed no statistical significance (p = 0.056).</p> <p><strong>Conclusion:</strong> Nursing students' knowledge and behavioral fluency regarding crisis management were more effectively improved by using the disaster and crisis game than by using a case-based method.</p> Mohsen Masoumian Hosseini Toktam Masoumian Hosseini karim Qayumi Najibullah Baeradeh Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-24 2022-09-24 10 1 e77 e77 10.22037/aaem.v10i1.1739 Incidence of Pediatric Perforated Appendicitis during the COVID-19 Pandemic; a Systematic Review and Meta-Analysis <p><strong>Introduction</strong>: COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooled event rate of pediatric perforated appendicitis before and during the COVID-19 pandemic.</p> <p><strong>Methods</strong>: This was a systematic review and meta-analysis study based on the PRISMA guidelines.&nbsp; Scopus, Web of Sciences, and PubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect and depict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3.</p> <p><strong>Results:&nbsp; </strong>Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforated appendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%.&nbsp; In the COVID era, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a significant difference in the subgroup analysis within the pre-COVID and COVID era (P&lt;0.001), showing a higher perforation rate in the COVID era.</p> <p><strong>Conclusion: </strong>Our study showed that during the COVID-19 pandemic, the rate of perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.</p> Gholamreza Motazedian Poorya Aryanpoor Ehsan Rahmanian Samaneh Abiri Navid Kalani Naser Hatami Farhad Bagherian Mohammad Etezadpour Roohie Farzaneh Fatemeh Maleki Mahdi Foroughian Mojtaba Ghaedi Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e3 e3 10.22037/aaem.v10i1.1421 Ultra-early Spinal Decompression Surgery Can Improve Neurological Outcome of Complete Cervical Spinal Cord Injury; a Systematic Review and Meta-analysis <p><strong>Introduction: </strong>Early decompression within the first 24 hours after spinal cord injury (SCI) is proposed in current guidelines. However, the possible benefits of earlier decompression are unclear. Thus, the present meta-analysis aims to investigate the existing evidence regarding the efficacy of ultra-early decompression surgery (within 12 hours after SCI) in improving patients’ neurological status.</p> <p><strong>Methods: </strong>A search was performed in Medline, Embase, Scopus and Web of Science electronic databases, until the end of August 2021. Cohort studies and clinical trials were included in the present study. Exclusion criteria were absence of an early or late surgery group, failure to report neurological status based on the American spinal injury association impairment scale (AIS) grade, failure to perform the surgery within the first 12 hours after SCI, and duplicate reports and review articles. Two independent reviewers performed data collection, and risk of bias and certainty of evidence assessments. The outcome was reported as odds ratio (OR) and 95% confidence interval (CI).</p> <p><strong>Results: </strong>Data from 16 articles, which studied 868 patients, were included. Compared to early or late decompression surgery, ultra-early decompression surgery significantly improves patients’ neurological status (OR = 2.25; 95% CI: 1.41 to 3.58). However, ultra-early surgery in thoracolumbar injuries is not significantly more effective than early to late surgery. Moreover, ultra-early surgery in patients with a baseline AIS A increases the chance of neurologic resolvent up to 3.86 folds (OR=3.86; 95% CI: 1.50 to 9.91). Contrastingly, ultra-early surgery does not result in significant improvement compared to early to late surgery in patients with AIS B (OR = 1.32; 95% CI: 0.51 to 3.45), AIS C (OR = 1.83; 95% CI: 0.72 to 4.64), and AIS D (OR = 0.99; 95% CI: 0.31 to 3.17).</p> <p><strong>Conclusion: </strong>Current guidelines emphasize that spinal decompression should be performed within 24 hours after SCI, regardless of injury severity and location. However, results of the present study demonstrated that certain considerations may be taken into account when performing decompression surgery: 1) in patients with AIS A injury, decompression surgery should be performed as soon as possible, since its efficacy in neurological improvement is 3.86 folds higher in the first 12 hours after injury. 2) ultra-early decompression surgery in patients with cervical injury is more effective than in patients with thoracic or lumbar injuries. 3) postponing decompression surgery to 24 hours in SCI patients with AIS B to D does not significantly affect the neurological outcome.</p> Mahmoud Yousefifard Behrooz Hashemi Mohammad Mehdi Forouzanfar Rozita Khatamian Oskooi Arian Madani Neishaboori Reza Jalili Khoshnoud Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-01-31 2022-01-31 10 1 e11 e11 10.22037/aaem.v10i1.1471 Accuracy of Triage Systems in Disasters and Mass Casualty Incidents; a Systematic Review <p><strong>Introduction</strong>: To prioritize patients to provide them with proper services and also manage the scarce resources in emergencies, the use of triage systems seems to be essential. The aim of this study was to evaluate the accuracy of the existing triage systems in disasters and mass casualty incidents.</p> <p><strong>Methods</strong>: The present study is a systematic review of the accuracy of all triage systems worldwide. The results of this study were based on the articles published in English language journals. In this research, all papers published from the beginning of 2000 to the end of 2021 were sought through different databases. Finally, a total of 13 articles was ultimately selected from 89 articles.</p> <p><strong>Results</strong>: 13 studies on the accuracy of triage systems were reviewed. The START, mSTART, SALT, Smart, Care Flight, ASAV, MPTT, Sieve and ESI triage systems, had an accuracy, sensitivity, and specificity of less than 90%. Only the Smart triage system had an overall accuracy of more than 90%.</p> <p><strong>Conclusion</strong>: According to the findings of the current systematic review, the performance of the existing triage systems in terms of accuracy of prioritizing the injured people and other performance indexes is not desirable. Therefore, to improve the performance and increase the precision of triage systems, the world nations are recommended to change or revise the indexes used in triage models and also identify other influential factors affecting the accuracy of triage systems.</p> Jafar Bazyar Mehrdad Farrokhi Amir Salari Hamid Safarpour Hamid Reza Khankeh Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-30 2022-04-30 10 1 e32 e32 10.22037/aaem.v10i1.1526 Orthopedic Trauma During Pregnancy; a Narrative Review <p><strong>Introduction:</strong> Blunt traumas, like road accidents and falls, are common causes of injuries to pregnant women, and the major risk factors are young age and low socioeconomic level. Due to physiological and anatomical changes specific to pregnancy, such as changes in blood pressure and hemoglobin drop, trauma management involves certain complexities. Physical trauma is estimated to cause at least 1 complication in every 12 pregnancies. This study aims to evaluate orthopedic trauma during pregnancy and appreciate the different approaches to circumvent the resultant challenges.</p> <p><strong>Methods: </strong>&nbsp;We reviewed 55 articles, published on orthopedic trauma during pregnancy between 2011 and 2021. The articles were identified by searching PubMed, google-scholar, Scopus, and Science-Direct. We utilized the search terms: fall in pregnancy, traumas in pregnancy, motor vehicle accident/crash in pregnancy, blunt trauma in pregnancy, pregnant trauma patient, penetrating injury during pregnancy, assault, interpersonal violence in pregnancy, and mortality and pregnancy.</p> <p><strong>Results: </strong>According to available reports, after stabilizing the pregnant patient, diagnostic procedures, including radiography, and even gadolinium-based techniques when needed, can be performed to examine extensive trauma. In contrast to elective orthopedic surgery, emergency orthopedic surgeries, including reduction of open fractures, should be performed promptly.</p> <p><strong>Conclusion:</strong> Based on our investigation, pregnant women with orthopedic injuries that are severe, or even seemingly less severe, experience significantly increased adverse pregnancy outcomes, which include preterm birth, placental abruption, poor infant condition at birth, infant death, and even maternal death.</p> Meisam Jafari Kafiabadi Amir Sabaghzadeh Seyyed Saeed Khabiri Mehrdad Sadighi Amir Mehrvar Farsad Biglari Adel Ebrahimpour Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-18 2022-05-18 10 1 e39 e39 10.22037/aaem.v10i1.1573 Safety and Adverse Events Related to COVID-19 mRNA Vaccines; a Systematic Review <p><strong>Introduction:</strong> Knowledge of vaccine-related adverse events is crucial as they are among the most ‎important factors ‎that cause hesitation in receiving vaccines. Therefore, we aimed to systematically ‎review the adverse events ‎related to the mRNA vaccines reported in the literature.‎</p> <p><strong>Method: </strong>A systematic literature search was carried out in the databases of Scopus, PubMed, ‎Cochrane, and Web ‎of Science. We selected original studies that explored the side effects of ‎mRNA ‎COVID-19 vaccines using a two-phase (title/abstract and full-text) screening process.‎</p> <p><strong>Results: </strong>Cardiac ‎complications were the most commonly reported severe adverse events. It appeared that ‎systemic adverse reactions are more ‎common after the second dose of vaccines. The number of ‎adverse effects reported after the Pfizer vaccine was ‎higher than other vaccines, mostly due to its ‎earlier approval and more widespread use throughout the world. Cardiac adverse events had a ‎‎higher prevalence but no significant association has been found between COVID-19 mRNA vaccines ‎and cardiac ‎adverse events except for myopericarditis. ‎</p> <p><strong>Conclusion: </strong>Vaccines ‎play a crucial role in controlling the COVID-19 pandemic and decreasing ‎mortalities and the results of the present ‎review acknowledge the fact that the benefits outweigh the ‎adverse events of these vaccines.‎</p> SeyedAhmad SeyedAlinaghi Amirali Karimi Zahra Pashaei Arian Afzalian Pegah Mirzapour Kobra Ghorbanzadeh Afsaneh Ghasemzadeh Mohsen Dashti Newsha Nazarian Farzin Vahedi Marcarious Tantuoyir Ahmadreza Shamsabadi Omid Dadras Esmaeil Mehraeen Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-28 2022-05-28 10 1 e41 e41 10.22037/aaem.v10i1.1597 Adherence to Referral Criteria for Burn Patients; a Systematic Review <p><strong>Introduction:</strong> Burn injuries are under-appreciated trauma, associated with substantial morbidity and mortality. It is necessary to refer patients in need of specialized care to more specialized centers for treatment and rehabilitation of burn injuries. This systematic review aimed to assess the adherence to referral criteria for burn patients.</p> <p><strong>Methods: </strong>An extensive search was conducted on Scopus, PubMed, and Web of Science online databases using the relevant keywords from the earliest to October 7, 2021. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool).</p> <p><strong>Results:</strong> Among a total of 7,455 burn patients included in the nine studies, 60.95% were male. The most frequently burned areas were the hands (n=3) and the face (n=2). The most and least common burn mechanisms were scalds (62.76%) and electrical or chemical (2.88%), respectively. 51.88% of burn patients had met ≥ 1 referral criteria. The overall adherence to the referral criteria for burn patients was 58.28% (17.37 to 93.39%). The highest and lowest adherence rates were related to Western Cape Provincial (WCP) (26.70%) and National Burn Care Review (NBCR) (4.97%) criteria, respectively.</p> <p><strong>Conclusion:</strong> The overall adherence to the referral criteria for burn patients was relatively desirable. Therefore, well-designed future studies are suggested in order to uncover approaches to improve adherence to referral criteria for burn patients.</p> Ali Bazzi Mohammad Javad Ghazanfari Masoumeh Norouzi Mohammadreza Mobayen Fateme Jafaraghaee Amir Emami Zeydi Joseph Osuji Samad Karkhah Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-02 2022-06-02 10 1 e43 e43 10.22037/aaem.v10i1.1534 Premature Coronary Artery Disease and Plasma Levels of Interleukins; a Systematic Scoping Review and Meta-Analysis <p><strong>Introduction:</strong> Interleukins (ILs) can act as a predictive indicator of Premature Coronary Artery Disease (pCAD) and may be useful in screening of high-risk patients. However, there is no consensus on the relationship of serum levels of ILs and pCAD, yet. As a result, this study has been conducted in order to review the literature on the relationship between serum levels of different ILs and pCAD.</p> <p><strong>Methods: </strong>Medline, Scopus, Embase, and Web of Science databases were searched until December 7<sup>th</sup> 2020. Two reviewers independently screened and summarized eligible articles. A meta-analysis was performed to assess the relationship of ILs and pCAD.</p> <p><strong>Results: </strong>12 case-control articles were included. IL-6 plasma changes do happen in pCAD patients with a standardized mean difference (SMD) of 0.51 (95% CI: 0.12-0.90; p=0.010) compared with the control group. This difference was also observed when evaluating the plasma levels of IL-1 and IL-17, with an SMD of 1.42 (95% CI: 1.11-1.73; p&lt;0.001) and 0.59 (95% CI: 0.14-1.04; p=0.011), respectively. Meanwhile, no significant difference existed in plasma levels of IL-10 (SMD=0.26; 95% CI: -0.17-0.70; p=0.236), and IL-18 (SMD=1.44; 95% CI: -0.19-3.07; p=0.083) between pCAD patients and those in the control group.</p> <p><strong>Conclusion:</strong> Low level of evidence showed that there may be a significant relationship between increased plasma levels of ILs and the occurrence of pCAD. As a result, prospective cohort studies with serial assessments of serum ILs during follow up period, focusing on controlling classical risk factors of pCAD and increase in level of ILs, should be conducted.</p> Mohammad Haji Aghajani Amirmohammad Toloui Koohyar Ahmadzadeh Arian Madani Neishaboori Mahmoud Yousefifard Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-06-27 2022-06-27 10 1 e51 e51 10.22037/aaem.v10i1.1605 COVID-19 Vaccines’ Protection Over Time and the Need for Booster Doses; a Systematic Review <p><strong>Introduction: </strong>Controversies existed regarding the duration of COVID-19 vaccines’ protection and whether receiving the usual vaccine doses would be sufficient for long-term immunity. Therefore, we aimed to systematically review the studies regarding the COVID-19 vaccines’ protection three months after getting fully vaccinated and assess the need for vaccine booster doses.</p> <p><strong>Methods: </strong>The relevant literature was searched using a combination of keywords on the online databases of PubMed, Scopus, Web of Science, and Cochrane on September 17th, 2021. The records were downloaded and the duplicates were removed. Then, the records were evaluated in a two-step process, consisting of title/abstract and full-text screening processes, and the eligible records were selected for the qualitative synthesis. We only included original studies that evaluated the efficacy and immunity of COVID-19 vaccines three months after full vaccination. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement to ensure the reliability of results.</p> <p><strong>Results: </strong>Out of the 797 retrieved records, 12 studies were included, 10 on mRNA-based vaccines and two on inactivated vaccines. The majority of included studies observed acceptable antibody titers in most of the participants even after 6 months; however,it appeared that the titers could also decrease in a considerable portion of people. Due to the reduction in antibody titers and vaccine protection, several studies suggested administering the booster dose, especially for older patients and those with underlying conditions, such as patients with immunodeficiencies.</p> <p><strong>Conclusion: </strong>Studies indicated that vaccine immunity decreases over time, making people more susceptible to contracting the disease. Besides, new variants are emerging, and the omicron variant is continuing to spread and escape from the immune system, indicating the importance of a booster dose.</p> Omid Dadras SeyedAhmad SeyedAlinaghi Amirali Karimi Alireza Shojaei Ava Amiri Sara Mahdiabadi Amirata Fakhfouri Armin Razi Hengameh Mojdeganlou Paniz Mojdeganlou Alireza Barzegary Zahra Pashaei Amir Masoud Afsahi Parnian Shobeiri Esmaeil Mehraeen Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-04 2022-07-04 10 1 e53 e53 10.22037/aaem.v10i1.1582 Safety and Adverse Events Related to Inactivated COVID-19 Vaccines and Novavax; a Systematic Review <p><strong>Introduction:</strong> Knowledge of the safety of vaccines is crucial, both to prevent and cure them and to decrease the public hesitation in receiving vaccines. Therefore, this study aimed to systematically review the adverse events reported for inactivated vaccines and Novavax.</p> <p><strong>Methods:</strong> In this systematic review, the databases of PubMed, Scopus, Cochrane, and Web of Science were searched on September 15, 2021. Then we identified the eligible studies using a two-step title/abstract and full-text screening process. Data on the subjects, studies, and types of adverse events were extracted and entered in a word table, including serious, mild, local, and systemic adverse events as well as the timing of side effects’ appearance.</p> <p><strong>Results:</strong> Adverse effects of inactivated coronavirus vaccines side effects were reported from phases 1, 2, and 3 of the vaccine trials. The most common local side effects included injection site pain and swelling, redness, and pruritus. Meanwhile, fatigue, headache, muscle pain, fever, and gastrointestinal symptoms including abdominal pain and diarrhea were among the most common systemic adverse effects.</p> <p><strong>Conclusion:</strong> This systematic review indicates that inactivated COVID-19 vaccines, including Sinovac, Sinopharm, and Bharat Biotech, as well as the protein subunit vaccines (Novavax) can be considered as safe choices due to having milder side effects and fewer severe life-threatening adverse events.</p> Omid Dadras Esmaeil Mehraeen Amirali Karimi Marcarious M. Tantuoyir Arian Afzalian Newsha Nazarian Hengameh Mojdeganlou Pegah Mirzapour Ahmadreza Shamsabadi Mohsen Dashti Afsaneh Ghasemzadeh Farzin Vahedi Parnian Shobeiri Zahra Pashaei SeyedAhmad SeyedAlinaghi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-07 2022-07-07 10 1 e54 e54 10.22037/aaem.v10i1.1585 Complications of COVID-19 Vaccines during Pregnancy; a Systematic Review <p><strong>Introduction: </strong>Rare serious complications have been documented after COVID-19 vaccination as clinical research proceeded and new target populations, such as children and ‎pregnant women, were included. In this study, we attempted to review the literature relevant to ‎pregnancy complications and maternal outcomes of COVID-19 immunization in pregnant women. ‎</p> <p><strong>Methods: </strong>We searched the databases of PubMed, Scopus, Cochrane, and Web of Science on 31 August 2022. The records were downloaded and underwent a two-step screening; 1) title/abstract and then 2) full-text screening to identify the eligible studies. We included English original studies that evaluated the adverse effects of COVID-19 vaccines during pregnancy. Information such as the type of ‎study, geographical location, type of vaccine injected, gestational age, maternal underlying diseases, and ‎complications following the vaccination were extracted into pre-designed tables.</p> <p><strong>Results:</strong> According to the findings of included studies, in most of them vaccination had a positive impact and no negative effects were observed. Also, no medical history was reported in 11 articles, and pregnant women had no underlying diseases. Some serious adverse events were reported after ‎vaccination, including miscarriage, paresthesia, uterine contraction, vaginal bleeding, preterm birth, major ‎congenital anomalies, intrauterine growth restriction, and seizure. ‎</p> <p><strong>Conclusion:</strong> Because of limited data availability and the cross-sectional design of most studies, we could neither infer ‎causation between vaccines and incidence of adverse effects nor comment with certainty about any ‎possible adverse outcome of COVID-19 vaccines in vaccinated pregnant women. Consequently, more longitudinal and experimental studies are needed to define the exact adverse effects of COVID-19 vaccines in pregnant women.</p> SeyedAhmad SeyedAlinaghi Mehrzad MohsseniPour Solmaz Saeidi Pedram Habibi Mohsen Dashti Newsha Nazarian Tayebeh Noori Zahra Pashaei AmirBehzad Bagheri Afsaneh Ghasemzadeh Amir Masoud Afsahi Narjes Aghaie Paniz Mojdeganlou Ghazal Arjmand Ghazal Zargari Roshanak Modiri Hengameh Mojdeganlou Armin Razi Esmaeil Mehraeen Omid Dadras Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-24 2022-09-24 10 1 e76 e76 10.22037/aaem.v10i1.1622 From Q/Non-Q Myocardial Infarction to STEMI/NSTEMI: Why It’s Time to Consider Another Simplified Dichotomy; a Narrative Literature Review <p>Acute coronary syndromes (ACSs) are classified as ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) based on the presence of guideline-recommended ST-segment elevation (STE) criteria on the electrocardiogram (ECG). STEMI is associated with acute total coronary occlusion (ATO) and transmural myocardial necrosis and is managed with emergent reperfusion therapy, and NSTEMI is supposedly synonymous with subendocardial myocardial infarction without ATO. However, coronary angiograms reveal that a significant proportion of patients with NSTEMI have ATO. Here, we review articles that studied the frequency and cardiovascular outcomes of ATO in NSTEMI patients compared with those without ATO. We discuss ECG patterns of patients with suspected acute myocardial infarction that do not fulfill STEMI criteria but are associated with ATO. Under-recognition of these atypical patterns results in delays to reperfusion therapy.&nbsp; We also advocate revision of the current STEMI/NSTEMI paradigm because consideration of STE, by itself, out of context of other clinical and ECG features, leads to the ECG diagnosis of STEMI when the ECG actually represents a mimic [“Pseudo-STEMI”],<strong>&nbsp;and suggest renaming the ACSs classification as the Occlusion Myocardial Infarction (OMI)/Non-Occlusion Myocardial Infarction (NOMI) paradigm.</strong></p> Grigorios Avdikos George Michas Stephen W. Smith Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-10-01 2022-10-01 10 1 e78 e78 10.22037/aaem.v10i1.1783 Removal of Coin Cell Lithium Battery Lodged in the Pediatric Pharyngoesophageal Junction by Rigid Esophagoscopy; a Case Report <p>A coin cell lithium battery is a common foreign body that can become lodged in the pediatric pharyngoesophageal junction. Because the voltage of such batteries is relatively high, their rapid removal is necessary to avoid mucosal necrosis. Despite being the initial choice for removal, flexible endoscopy cannot remove such foreign bodies from the esophagus. Various removal methods, including rigid esophagoscopy, should be considered for removing lithium coin cell batteries. The transcervical approach is feasible for removing esophageal foreign bodies, but it carries the risk of complications such as esophageal stenosis. Here we report a case of lithium coin battery ingestion that was successfully removed using a rigid esophagoscope. A 2-year-old girl was referred to a local doctor with cough and general fatigue. Chest X-ray and flexible endoscopy revealed a coin cell lithium battery stuck in the pharyngoesophageal junction, but it could not be removed. The foreign body was removed using Nishihata forceps through a rigid esophagoscope under general anesthesia.</p> Hisataka Ominato Takumi Kumai Yasuaki Harabuchi Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e4 e4 10.22037/aaem.v10i1.1430 A 25-Year-Old Chronic Ketamine User with Urinary Symptoms; a Case Report <p>Ketamine is mainly used for short-acting general anesthesia, chronic pain, sedation, depression, and bipolar disorder. Long-term ketamine use may cause lower urinary tract symptoms and voiding dysfunction. Small capacity and fibrotic bladder can be associated with chronic ketamine use. Here, we present a 25-year-old male with a history of chronic ketamine use complicated with contracted heart-shape bladder.&nbsp;&nbsp;</p> Chin-Chu Wu Aming Chor-Ming Lin Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-01-31 2022-01-31 10 1 e12 e12 10.22037/aaem.v10i1.1449 Dorsal Approach in the Surgical Treatment of Complex Dorsal Dislocation of Index Metacarpophalangeal Joint; a Case Report <p>Complex metacarpophalangeal (MCP) joint dislocation is an uncommon entity, which occurs following a hyperextension injury. Closed reduction is not feasible due to entrapped volar plate and/or coexisting fractures. Various approaches and techniques have been proposed for treatment of complex MCP dislocation; however, controversies exist over which one is superior. This study describes a right-handed 14-year-old boy who fell on the outstretched hand and sustained a dorsal dislocation of the left index MCP joint. The dislocation was complicated by an epiphyseal metacarpal head fracture with dorsal-ulnar displacement of the osteochondral fragment. The patient underwent open reduction through the dorsal approach, and the metacarpal head was fixed via the two-screw technique. The patient resumed left-hand function after six weeks. At the two-year follow-up, the range of motion and grip strength were normal, the patient was pain-free, and no sign of growth disturbance or joint stiffness was detected. Dorsal surgical approach with screw fixation is a feasible technique for the treatment of complex MCP dislocation, especially when it is complicated by a large epiphyseal head fracture.</p> Shahab Aldin Sattari Ali Reza Sattari Kamran Heydari Seyed Matin Sadat Kiaei Farshad Zandrahimi Mehdi Mohammadpour Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-02-09 2022-02-09 10 1 e13 e13 10.22037/aaem.v10i1.1479 Inferior Hip Dislocation in a 60-Year-Old Man; a Case Report <p>Inferior hip dislocation or luxatio erecta femoris is among the rarest hip dislocations, which has been described in limited studies. The patients usually present with their hip in flexion, abduction, and external rotation. Hip dislocation is an orthopedic emergency, and a reduction needs to be performed promptly to avoid devastating complications such as avascular necrosis. Here, we present a rare case of inferior hip dislocation in a 60-year-old man following a car-motorcycle collision. The patient presented to the emergency department with left hip flexion, abduction, external rotation, and inability to move his leg due to pain. Closed reduction under procedural sedation was attempted in the emergency department once, which was unsuccessful. The patient was then taken to the operating room for another attempt of closed reduction under general anesthesia. The patient was discharged after two days with pin traction and double crutches. After two weeks, the pin was removed, and full weight-bearing was permitted. After 12 weeks, the patient had mild pain with unusual activity and slight limping; however, imaging revealed no signs of any complications.</p> Ali Yeganeh Nader Tavakoli Mohammad Soleimani Seyed Nima Taheri Sahand Cheraghiloohesara Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-02-27 2022-02-27 10 1 e17 e17 10.22037/aaem.v10i1.1498 Right Upper Quadrant Pain Following Endoscopic Retrograde Cholangiopancreatography; a Case Report <p>Endoscopic retrograde cholangiopancreatography (ERCP) is a standard for diagnosing and treating hepato-pancreatico-biliary (HPB) diseases in clinical settings. ERCP-related complications are relatively common, ranging from 4 to 30%. The most common one is acute pancreatitis. ERCP-related necrotizing pancreatitis accounts for 7.7% of ERCP-related pancreatitis cases. This complication may still be misdiagnosed, which might lead to inappropriate treatment with a worse prognosis. Here, we report a 34-year-old case with ERCP-related necrotizing pancreatitis who was successfully managed, but initially misdiagnosed with biliary peritonitis.</p> Lan Thi Nguyen Dang Hai Do An Duc Thai Hoa Thi Nguyen Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-03-16 2022-03-16 10 1 e21 e21 10.22037/aaem.v10i1.1535 Prolonged Resuscitation with Multiple Defibrillations; a Case Report <p>Although American Heart Association Guidelines (AHA) are practical and standardized in many aspects of cardiopulmonary resuscitation (CPR) performance, recommendations on when to terminate resuscitation are not fully understood and clear. There is not enough evidence about how long we can continue CPR in shockable rhythms and how many shocks can be delivered to patients, and if there is an end point for it or not. This issue is more challenging when we read papers published on survival rates and good functional and neurological outcomes after prolonged CPRs. Here, we demonstrate a case of cardiac arrest receiving CPR in the emergency room, for whom it was hard and challenging to make a decision on when to terminate the resuscitation attempts.</p> Shaghayegh Rahmani Elham Mokhtari Amirmajdi Rana Kolahi Ahari Roohie Farzaneh Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-05-26 2022-05-26 10 1 e40 e40 10.22037/aaem.v10i1.1583 Jejunal Dieulafoy’s Lesion as a Rare Cause of Massive Gastrointestinal Bleeding; a Case Report and Literature Review <p>Jejunal Dieulafoy's lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy’s lesion.</p> <p>It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy’s lesion should be included in the differential diagnoses.</p> Mohammad Ebrahim Kalantari Newsha Sardarzadeh Ali Mirsadeghi Ali Akbar Bagherzadeh Tooraj Zandbaf Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-27 2022-07-27 10 1 e61 e61 10.22037/aaem.v10i1.1623 Hamman’s Syndrome Accompanied by Diabetic Ketoacidosis; a Case Report <p>Hamman’s syndrome is an uncommon clinical entity characterized by an idiopathic spontaneous pneumomediastinum as a result of a sudden increase in intra-alveolar pressure. It can be triggered by repeated vomiting or Kussmaul breathing associated with diabetic ketoacidosis (DKA). Substantially, careful attention to this particular condition is needed to avoid underdiagnosis and to provide optimal management. Herein, we report a case of an 18-year-old man complaining of chest discomfort and progressive weight loss, ultimately diagnosed with Hamman’s syndrome secondary to DKA. The patient’s symptoms disappeared after intravenous fluid and insulin administration, while his pneumomediastinum resolved following conservative treatment. Our report highlights the importance of recognition of the links between pneumomediastinum and DKA.</p> Koya Yamashita Takashi Hongo Tsuyoshi Nojima Tetsuya Yumoto Atsunori Nakao Hiromichi Naito Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-21 2022-08-21 10 1 e68 e68 10.22037/aaem.v10i1.1709 Acute Intermittent Porphyria as a Rare Challenging Neuro-Metabolic Disease; a Case Report <p>Porphyria is a challenging metabolic disease due to its heterogeneous presentation symptoms and its difficult diagnosis. Many affected individuals can complain of recurrent neuro-visceral attacks per year, some of which may be persistent and life-threatening, which is confusing if there is no established diagnosis. Although the motor manifestations, autonomic changes and seizure are highly suggestive, the diagnosis is often overlooked and needs confirmatory genetic testing. To the best of our knowledge, the acute intermittent porphyria (AIP) reported in this case, involving severe electrolyte disturbances and rapid severe weakness is a challenging neuro-metabolic case and is extremely rare worldwide. Here, we reported a case of AIP in a young girl who presented to the emergency department of Al-Araby international Hospital, Monufia, Egypt with severe abdominal pain, constipation, and headache which had started 10 days ago. It seems that the diagnosis of porphyria should be considered particularly in those patients with abdominal complaints associated with electrolyte disturbances, seizures, and severe progressive neuropathy.</p> Elsayed Abed Omer Saeed Basem Abd El-Hamid Mohamed Elsayed Heba Dawoud Nahla Heikal Ahmed Elshafie Aya Hagar Hossam Emam Ahmed Farag El-adawey Abdel-Ghaffar Fayed Ahmed Hassan Elsheshiny Mahmoud Galal Ahmed Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-13 2022-09-13 10 1 e74 e74 10.22037/aaem.v10i1.1780 Cocaine and Volatile Nitrite–Induced Methemoglobinemia; a Case Report and Treatment Approach Review <p>Cyanosis is typically a sign of a potentially life-threatening condition in the emergency department and requires immediate workup and treatment. This case report highlights the diagnostic reasoning and clinical approach to cocaine- and volatile nitrite–induced methemoglobinemia (MHG). MHG is a rare, life-threatening cause of cyanosis. The diagnosis must be suspected in the emergency department in the presence of hypoxia and cyanosis disproportionate to cardiopulmonary repercussions and refractory to oxygen supplementation. Acquired causes are more prevalent than genetics, and recreational drugs should be highly suspected. Despite the rarity of this situation, cyanosis precipitants and the specificities of each hemoglobinopathy are reviewed in this article.</p> Milena Ribeiro Paixão Tarso Augusto Duenhas Accorsi Luis Felipe Lopes Prada Lucas Zoboli Pocebon Karine De Amicis Lima Karen Francine Köhler Leandro Santini Echenique José Leão de Souza Júnior Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-09-21 2022-09-21 10 1 e75 e75 10.22037/aaem.v10i1.1753 21-Year-Old Female with Pneumothorax and Massive Air Leak Following Blunt Trauma; a Photo Quiz <p>A 21-year-old female presented to the emergency department, about 20 minutes after a motorcycle accident. She was agitated and complaining of shortness of breath. Her vital signs were: heart rate 110 bpm, respiratory rate 32/minute, blood pressure 89/67 mmHg, oxygen saturations 79% on room air, temperature 36.5°C and GCS 15. Chest auscultation revealed decreased breath sounds on the left side. The diagnosis of pneumothorax was made for the patient and a left thoracostomy tube was inserted; however, massive air leak was noted and the clinical symptoms did not improve. Computed tomography scan of the chest in the mediastinal window showeda doubtful pathology, crumpled laminated membrane.</p> Ahmad Shirinzadeh-Dastgiri Ali Saberi Mohammad Vakili Sayed Mahdi Marashi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-09 2022-04-09 10 1 e24 e24 10.22037/aaem.v10i1.1513 A 27-year-old Female Patient with Acute nausea/vomiting and Pelvic pain; a Photo Quiz <p>A 27-year-old female patient, G2P1, presented to the emergency department (ED) with acute onset nausea, vomiting, and mild chronic abdominopelvic pain. Physical examination revealed bilateral lower quadrant tenderness without rebound, guarding, or rigidity, and vital signs were within normal limits. Electrolytes, complete blood count, and liver and kidney function tests were normal. A pregnancy test was negative, and urinalysis did not reveal any abnormalities. No free fluid was observed in the abdominal ultrasound, and the ovaries and other intra-abdominal structures were found to be normal. The patient underwent intravenous contrast-enhanced abdomiopelvic computed tomography (CT) scan.</p> Murat Ozsarac Yusuf Yurumez Onur Karakayalı Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-04-24 2022-04-24 10 1 e29 e29 10.22037/aaem.v10i1.1508 An Overview of Published Articles in Archives of Academic Emergency Medicine in 2021 <p><strong><em>Archives of Academic Emergency Medicine</em></strong> has published 70 articles in 2021, which have been authored by more than three hundred researchers from various countries, including but not limited to the United States, Australia, India, Japan, Thailand, Iraq, Pakistan, France, Greece, and Iran. In this editorial, we intend to&nbsp;provide an overview of our publications in 2021, so that we can identify our strengths and weaknesses and provide a brief report on our performance to readers and authors, which they might find useful in becoming more familiar with the journal.</p> Mehrnoosh Yazdanbakhsh Somayeh Saghaei Dehkordi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-02-27 2022-02-27 10 1 e18 e18 10.22037/aaem.v10i1.1555 Advance Without Cut and Retrograde Removal of Embedded Fishhook; Introducing a Novel Technique <p>Removing embedded fishhook without causing further tissue damage from the barbed nature of the hook is a challenge in emergency department (ED). The four most commonly used techniques include advance and cut, string-yank, needle cover, and retrograde removal. This study aims to describe a modified push- through technique without cutting the barb, namely advance without cut and retrograde removal, as an effective technique of successful removal of fishhooks. There is no risk of additional injury to patients and healthcare staff, and the technique does not need tools that are not generally readily available in EDs.</p> Abdolghader Pakniyat Kourosh Akhbari Fatemeh Radfar Copyright (c) 2021 Archives of Academic Emergency Medicine 2022-01-01 2022-01-01 10 1 e2 e2 10.22037/aaem.v10i1.1403 Intravenous Lipid Emulsion for treating Tramadol-Induced Seizures: Surprising but Worth Considering for Future Studies; a Letter to Editor <p>None</p> Bruno Megarbane Ahmed S. Gouda Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-02-09 2022-02-09 10 1 e14 e14 10.22037/aaem.v10i1.1541 Video Laryngoscopy in Emergency Airway Management - a Paradigm Shift from ‘I’ to ‘We’; a Letter to Editor <p>Emergency medicine has evolved as a speciality but airway management is still a challenge. Traditionally, direct laryngoscopy (DL) is used for intubation with maneuvers to directly visualize the vocal cords. Most tracheal intubations in the emergency department (ED) are done on an emergent basis and enhancing the technicalities of intubation can be life-saving. Video laryngoscopy (VL) is available in the emrgenyc department and can help reduce the intubation failure rate; hence, it has been recommended for maintaining airways in obese patients.</p> Sadaf Sheikh Faisal Shamim Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-03-20 2022-03-20 10 1 e22 e22 10.22037/aaem.v10i1.1474 Monkeypox Outbreak in Non-Endemic Areas: Will it Cause a New Pandemic? a Letter to Editor <p>Monkeypox (MP) is a rare endemic infection found in tropical rainforest areas of west or central Africa. The recent world health organization (WHO) reports of confirmed MP cases from non-endemic areas have raised global concern over the risk of a new pandemic. Monkeypox is a misnomer, as the first confirmed case of MP was diagnosed in a monkey in 1958; however, MP virus is a viral zoonosis that belongs to Orthopoxvirus genus of the Poxviridea family and in addition to old and new world monkeys and apes, it can infect rats, mice, squirrels, prairie dogs, and rabbits (1). MP virus can be transmitted through touching blood, body fluids, spots, blisters or scabs of infected animals or infected persons. MP virus is also spread through touching the clothing, bedding, or towels of infected persons. Face to face exposure to infected persons and eating raw or under-cooked meat from infected animals are other sources of infection (2).</p> Mostafa Alavi-Moghaddam Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-07-25 2022-07-25 10 1 e60 e60 10.22037/aaem.v10i1.1706 Is Monkeypox a Concern in Multiple Sclerosis Patients? A Letter to Editor <p>Individuals with autoimmune conditions have been characterized as the population very much prone to illness. This is because of the way various diseases impact their immune system, and because immunosuppressant medications were&nbsp;employed to cure the majority of these ailments (1). By weakening the immune system, these drugs allow the control of&nbsp;many autoimmune disorders such as multiple sclerosis. Patients with multiple sclerosis who use&nbsp;these drugs are in danger of developing a weak&nbsp;immune system and a wide range of infectious diseases such as herpesvirus infections (2). Viral, bacterial, and fungal infections can cause MS exacerbations (3).</p> Elnaz Asadollahzadeh Fereshteh Ghadiri Zahra Ebadi Abdorreza Naser Moghadasi Copyright (c) 2022 Archives of Academic Emergency Medicine 2022-08-18 2022-08-18 10 1 e67 e67 10.22037/aaem.v10i1.1729