Editor’s note: The Hong Kong Journal of Emergency Medicine has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase the awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine worldwide, as described in the WAME statement at http://www.wame.org/about/policy-statements#Promoting%20Global%20Health. Abstracts are reproduced as published in the respective participating journals and are not peer reviewed or edited by the Hong Kong Journal of Emergency Medicine.
African Journal of Emergency Medicine
The official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria and the Rwanda Emergency Care Association
(The print version of this article has been scheduled for May 2023)
Ten years of the community-based emergency first aid responder (EFAR) system in the Western Cape of South Africa: what has happened, what has changed, and what has been learned
Slingers M, De Vos S, Sun JH
Afr J Emerg Med 2022; 12(4): 299–306
https://doi.org/10.1016/j.afjem.2022.06.007
The emergency first aid responder (EFAR) system was designed as a low-cost and adaptable community-based prehospital emergency care system, and was first published after conducting a study in the township of Manenberg, South Africa, in 2010. EFARs are laypersons who are trained to respond to emergencies in their communities, and can provide support to the emergency medical services (EMS) by providing early clinical care, reporting back about the scene, and assisting with local scene management and logistics. Over the past 10 years in South Africa, the Western Cape Government Health (WCGH) EMS and the Western Cape Government (WCG) College of Emergency Care have implemented the EFAR system in multiple communities and have trained over 10,000 community members across the Western Cape. This report is a 10-year update on what has happened since the EFAR system started, and to candidly show how the system has evolved, what has been learned, and what challenges remain, so that others could look ahead and plan accordingly as they develop similar community-based first aid responder systems in resource-constrained areas. Core pillars to the EFAR system’s success have included community involvement and adaptation, collaboration with the WCGH EMS and WCG College of Emergency Care, opportunities for community and EMS development, and emphasis on the sustainability of local EFAR systems. Multiple challenges also remain that others may likely face.
Reproduced with permission
(The print version of this article has been scheduled for June 2023)
Assessing awareness and attitude of Egyptian medical students towards emergency medicine as a specialty and career choice: a single-institutional study
Hussein MA, AbdelMawgoud SE, Abd El Wahab MH, Nagy M, El-Shinawi M
Afr J Emerg Med 2023; 13(1): 20–24
https://doi.org/10.1016/j.afjem.2022.12.003
Introduction: Emergency medicine (EM) was formally recognized as a specialty in Egypt in 2002. Many institutions of higher education do not yet have an operational academic department of EM. This study attempts to quantify the awareness and attitude of Ain Shams University medical students toward emergency medicine as both a specialty and a career.
Methods: A paper-based survey was delivered to undergraduate medical students at the Faculty of Medicine, Ain Shams University in Cairo, Egypt between December 2021 and April 2022. The survey was designed to assess awareness toward the scope of practice of emergency physicians as well as general attitude toward EM as a specialty and career choice.
Results: A total of 391 students and interns/house officers participated in this study: 53.2% of participants were females and the mean age was 21.65 ± 2.25 years. Only 30 participants (7.7%) were classified as having “Excellent knowledge” of EM, 92 (23.5%) as “Good knowledge,” 158 “40.4%” as “Fair knowledge,” and 111 (28.4%) as “Poor knowledge.” The difference in scores between academic years was not statistically significant (p = 0.239); 91.8% of respondents favored the creation of student interest groups in EM and 40% of respondents found it difficult to reach information regarding EM.
Conclusion: Our study demonstrates a lack of awareness and knowledge toward EM as a specialty across all academic years at our institution. Formal recognition of EM as a specialty does not guarantee widespread knowledge among medical students, particularly at institutions without academic EM departments.
Reproduced with permission
Annals of Emergency Medicine
(The print version of this article has been scheduled for May 2023)
Comparison of YEARS and adjust-unlikely D-dimer testing for pulmonary embolism in the emergency department
Kerstin de Wit, Fayad Al-Haimus, Yang Hu, Rick Ikesaka, Noel Chan, Quazi Ibrahim, Joshua Klyn, Natasha Clayton, Federico Germini
Study objective: We prospectively assessed the diagnostic accuracy of YEARS and a modified age-adjusted clinical decision rule (“Adjust-Unlikely”) for pulmonary embolism (PE) testing in the emergency department.
Methods: This study was conducted in tertiary care Canadian emergency departments. When the D-dimer was 50 years old, it was applied in patients where PE was not the most likely diagnosis and 500 ng/ml threshold when PE was most likely.
Results: In all, 1703 patients were included, median age was 62 (50, 74), 58% was female, and PE prevalence 8.0%. YEARS sensitivity for PE diagnosis was 92.6% (87.0, 96.0%) and specificity was 45.0% (42.5, 47.5%). Adjust-Unlikely sensitivity was 100.0% (97.2, 100.0%) and specificity was 32.4% (30.1, 34.8%). Posttest probability of PE in the group of patients with PE excluded by D-dimer was between 500 ng/ml and the adjusted limit was 2.8% (1.6, 5.1%) for YEARS and 0.0% (0.0, 2.6%) for the “Adjust-Unlikely” rule.
Conclusion: The “Adjust-Unlikely” rule would modestly reduce imaging and identify all cases of PE. YEARS would substantially reduce imaging but miss 1 in 14 cases of PE.
How to cite this article:
De Wit K, Al-Haimus F, Hu Y, et al. Comparison of YEARS and adjust-unlikely D-dimer testing for pulmonary embolism in the emergency department. Ann Emerg Med 2022. DOI: 10.1016/j.annemergmed.2022.09.014.
(The print version of this article has been scheduled for June 2023)
Occupational accidents among search and rescue providers during mountain rescue operations and training events
Mario Milani, Giulia Roveri, Marika Falla, Tomas Dal Cappello, Giacomo Strapazzon
Study objective: We analyzed occupational accidents reported among Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS) providers during mountain search and rescue operations and training events in Italy (1999–2019).
Methods: We extracted anonymized data from the CNSAS accident database for all cases of injured mountain search and rescue providers that activated CNSAS insurance (1999–2019). We report epidemiological characteristics, mechanisms, type, and severity of injury or illness, clinical outcome, and recovery time.
Results: A total of 784 cases of injuries in CNSAS mountain search and rescue providers were recorded: 41% of the cases occurred during rescue operations and 59% during training events. Overall, trauma was the main cause of injury (96%), whereas only 4% of the cases were classified as medical or environmental illnesses. Moderate injury (National Advisory Committee for Aeronautics II to III) occurred in 80% of the reported accidents. Recovery time differed based on the degree of accident severity. Fatalities occurred in 2% of the cases reported and occurred during rescue operations only.
Conclusion: In this long-term retrospective analysis, we showed that accidents occurred among mountain search and rescue providers both during rescue operations and training events. Given the high prevalence and associated costs, it is of pivotal importance to understand the epidemiology and characteristics of occupational injury and illness among this out-of-hospital workforce to better inform future prevention strategies.
How to cite this article:
Milani M, Roveri G, Falla M, et al. Occupational accidents among search and rescue providers during mountain rescue operations and training events. Ann Emerg Med 2023. DOI: 10.1016/j.annemergmed.2022.12.015.
Emergencias
(The print version of this article has been scheduled for May 2023)
External validation of the Glasgow Coma Scale-pupils in patients with severe head injury
Jesús Abelardo Barea-Mendoza, Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Manuel Quintana-Díaz, Lluís Serviá-Goixart, Francisco Guerrero-López, Javier González-Robledo, Ismael Molina-Díaz, Juncal Sánchez Arguiano, Mario Chico-Fernández, en representación del grupo de Trabajo de Neurointensivismo y Trauma de la SEMICYUC
Cited: Barea Mendoza JA, Llompart-Pou JA, Pérez-Bárcena J, Quintana-Díaz M, Servià-Goixart L, Guerrero-López F, et al. Validación externa de la Escala de Coma de Glasgow con valoración pupilar en pacientes con traumatismo craneoencefálico grave. Emergencias 2023; 35: 39–43.
http://emergencias.portalsemes.org/descargar/validacin-externa-de-la-escala-de-coma-de-glasgow-con-valoracin-pupilar-en-pacientes-con-traumatismo-craneoenceflico-grave/
Objectives: To compare the ability of the Glasgow Coma Scale (GCS) score, the GCS Pupils (GCS-P) score, and the Pupil Reactivity Score (PRS) to predict mortality in patients with severe head injury.
Methods: Retrospective analysis of all patients with severe head injury and initial GCS scores of 8 or lower on initial evaluation for whom records included pupil dilation information and clinical course after admission to intensive care units of participating hospitals. We assessed the ability of each of the three scores (GCS, GCS-P, and PRS) to predict mortality using discrimination analysis. Discrimination was estimated by calculating the areas under the receiver operating characteristic curves (AUC) and 95% CIs.
Results: A total of 1551 patients with severe head injury and pupil dilation records were studied. The mean age was 50 years, 1190 (76.7%) were males, and 592 (38.2%) died. No pupil dilation was observed in 905 patients (58.3%), 362 (23.3%) had unilateral mydriasis, and 284 (18.3%) had bilateral mydriasis. The GCS-P score was significantly better at predicting mortality, with an AUC of 0.77 (95% CI, 0.74–0.79), versus 0.69 (95% CI, 0.67–0.72) for the GCS and 0.75 (95% CI, 0.72–0.77) for the PRS. As the GCS-P score decreased, mortality increased.
Conclusion: The GCS-P was more useful than the GCS for predicting death after severe head injury.
Keywords: Head injury, wounds and injuries, severe, intensive care unit, mortality, predictive scales
