Abstract: Background: Sarcopenia is a progressive muscle disorder commonly associated with aging and chronic diseases. It has been linked to worse clinical outcomes and increased vulnerability during acute illness. However, its prevalence in emergency department (ED) populations remains underexplored. This study aimed to evaluate the presence of sarcopenia among ED patients using ultrasound, determine its relationship with underlying comorbidities, and assess its association with in-hospital complications. Methods: We conducted a prospective, observational, cross-sectional study at the Infanta Cristina University Hospital (Madrid, Spain) from January to May 2023. A total of 150 patients ≥18 years old presenting to the ED were assessed for sarcopenia using rectus femoris ultrasound. Sociodemographic, clinical, and laboratory variables were collected. Patients were followed for 30 days to evaluate in-hospital outcomes and complications. Comparisons were made between diagnostic groups and sarcopenia indices. Results: The mean age of the cohort was 70.7 years (SD 18.15), and 52% were male. Neurological diseases were associated with the highest degree of sarcopenia (mean Y-axis: 0.9343 cm), followed by digestive (1.046 cm), hematological (1.048 cm), and cardiovascular diseases (1.079 cm). Patients who developed in-hospital complications had lower mean muscle thickness values compared to those without complications (1.0786 cm vs. 1.2414 cm; p < 0.05). Sarcopenia was significantly correlated with the presence of comorbidities and poor clinical outcomes. Conclusions: Sarcopenia is highly prevalent among ED patients, especially those with neurological and digestive diseases. Muscle ultrasound is a feasible screening tool in acute care settings and may aid in early identification of patients at higher risk of adverse outcomes. These findings support the integration of sarcopenia screening protocols into emergency care and highlight the need for further studies to develop targeted interventions

Abstract: Background/Objectives: Sepsis is a life-threatening organ dysfunction and a leading cause of mortality due to infection worldwide. Early recognition and rapid intervention in Emergency Department (ED) are critical, therefore diagnostic/prognostic tools are used to guide and prioritize interventions. This study compared the prognostic accuracy of four sepsis scoring systems; Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), National Early Warning Score 2 (NEWS2), and quick Sequential Organ Failure Assessment (qSOFA). Methods: A prospective observational study was conducted at a general hospital in Athens, Greece. The study population included adult patients (≥18 years) presenting to the ED with suspected infection. To support data collection, a custom-designed patient registration form was developed. The study was conducted in the ED triage from December 1, 2023, to December 1, 2024. The outcomes assessed included 28-day in-hospital mortality and Intensive Care Unit (ICU) stay of ≥ 3 days. Results: For 28-day in-hospital mortality, qSOFA showed the highest overall accuracy (84.91%) and Area Under the Receiver Operating Characteristic curve (AUROC; 0.7895), followed by NEWS2 (AUROC; 0.7712) both significantly outperformed SIRS and MEWS. For ICU stay ≥3 days, qSOFA showed the highest overall accuracy (81.04%) and NEWS2 the best AUROC (0.7248) while SIRS had significantly lower discriminatory ability of the four scales. Conclusions: This study evaluated qSOFA, NEWS2, SIRS, and MEWS scales for predicting 28-day in-hospital mortality and prolonged ICU stays in ED patients with suspected sepsis. qSOFA and NEWS2 showed superior predictive accuracy, significantly outperforming SIRS and MEWS. qSOFA’s simplicity makes it ideal for rapid triage, while NEWS2 suits continuous monitoring.

Abstract: Cardiopulmonary resuscitation (CPR) is a vital skill for healthcare professionals, crucial in life-saving situations. More than 80% of cardiac arrest cases occur out of hospital. As the demand for competent CPR practitioners grows, the effectiveness of training methods becomes increasingly important, especially for undergraduate students preparing to enter the healthcare field. The primary objective of our study is to investigate the effectiveness of simulation-based teaching methods and by integrating innovative technologies, such as the OMNI2 stimulator, to improve the precision and objectivity of CPR instruction. A cohort of 144 undergraduate students from the Nursing School Department of the National Kapodistrian University of Athens participated in an 8-hour Basic Life Support Seminar. It consisted of 5 hours theoretical instruction followed by 3 hours of practical training using the OMNI2 simulator. Each student was tasked with identifying cardiac arrest and performing two cycles of CPR according to the 2021 guidelines. Metrics, including total session time, cycles performed, compression-to-ventilation ratio, compression depth, compressions and ventilations per minute, full recoil, peak inspiratory pressure, and ventilation duration, were measured and compared against the stimulator's specified targets. Statistically significant differences (p < 0.05) were observed across all parameters, except for peak inspiratory pressure. Concluding, while simulation-based teaching has conventionally been proven effective for CPR proficiency, real-time data collected in this study reveal a disparity between anticipated and actual performance. Our research underscores the necessity of refining instructional methods to enhance accuracy, potentially leading to improved patient outcomes in the future.

Abstract: Background: Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening condition, often triggered by infections or undiagnosed diabetes. Spontaneous pneu-momediastinum (SPM) and pneumothorax are rare but recognized complications of DKA, possibly due to alveolar rupture from increased respiratory effort or vomiting. Sometimes, acute pancreatitis (AP) may further complicate DKA, but the co-occurrence of these three conditions remains exceptionally rare. Case Presentation: We describe the case of a 60-year-old woman without a known history of diabetes who arrived at the emergency department with abdominal pain, fatigue, vomiting, and altered mental status. Initial laboratory findings showed metabolic acidosis, hyperglycemia, and ele-vated anion gap, consistent with DKA. Imaging revealed spontaneous pneumomedi-astinum and subsequently a left-sided pneumothorax, without evidence of trauma or esophageal rupture. Epigastric pain, along with elevated serum lipase and CT findings also confirmed an acute pancreatitis. Despite the complexity of her condition, the pa-tient responded well to supportive treatment, including oxygen therapy, fluid resusci-tation, insulin infusion, and antibiotics. She was discharged in good condition after 28 days, with a confirmed diagnosis of type 2 diabetes, without further complications. Conclusion: This case highlights an unusual combination of DKA complicated by spontaneous pneumomediastinum, pneumothorax and acute pancreatitis in a previ-ously undiagnosed diabetic patient. Because prompt intervention can lead to favorable outcomes even in complex, multisystem cases, early recognition of atypical DKA com-plications is critical in order to avoid misdiagnosis.

Abstract: Background: Philadelphia has experienced a surge in illicit fentanyl adulterated with alpha-2 agonist sedatives. Initially, xylazine (“tranq”) was the predominant adulterant, and a multimodal withdrawal protocol was effective at mitigating symptoms. However, since mid-2024, medetomidine—a more potent sedative—has largely supplanted xylazine. Clinicians have reported more severe, treatment-resistant opioid withdrawal during this transition. Objectives: To assess whether the previously effective withdrawal management protocol retained efficacy after the emergence of medetomidine. Methods: We conducted a retrospective cohort study of patients receiving protocol-based opioid withdrawal treatment at two emergency departments in Philadelphia between September 2022 and March 2025. Patients were divided into the xylazine era (Sept 2022–July 2024) and medetomidine era (Aug 2024–Mar 2025). The primary outcome was change in Clinical Opioid Withdrawal Scale (COWS) score from pre- to post-treatment. Secondary outcomes included rates of discharge against medical advice (AMA) and ICU admission. Results: Among 1269 encounters, 616 occurred during the xylazine era and 653 during the medetomidine era. Median COWS reduction was greater in the xylazine group (−9.0 vs −5.0 points, p < 0.0001), with more patients achieving symptom relief (COWS ≤ 4: 65.6% vs 14.2%, p < 0.0001). ICU admission occurred in 10.6% of xylazine-era patients and 25.7% of medetomidine-era patients. AMA rates were higher during the medetomidine era (6.5% vs 3.6%). Conclusions: The protocol was significantly less effective during the medetomidine era. Findings highlight the need to adapt withdrawal treatment protocols in response to changes in the illicit drug supply.

Abstract: Rapid, safe, and field-deployable molecular diagnostics are crucial for effective man-agement of infectious disease outbreaks, particularly those involving highly infectious pathogens, which can produce clinical symptoms similar to less infectious pathogens, thus raising potential biosafety concerns. In this study, we evaluated DNA/RNA De-fend Pro (DRDP) buffer, a novel viral-inactivating transport medium designed to stabilize nucleic acids and allow direct PCR without nucleic acid extraction. To ensure critical qPCR parameters were not compromised by using DRDP, we conducted serial dilution tests using herpes simplex viruses 1 and 2 (HSV-1, HSV-2) and varicel-la-zoster virus (VZV), comparing DRDP to standard universal transport medium (UTM). Detection sensitivity, determined by cycle quantification (Cq) values, slightly favored DRDP, as UTM samples required a 2–3-fold dilution to mitigate PCR inhibition. DRDP maintained reliable PCR compatibility at reaction volumes containing up to 25% buffer. At higher DRDP concentrations (30–35%), PCR inhibition occurred due to EDTA content but was fully reversible by adding supplemental magnesium. Fur-thermore, DRDP samples did not require an initial 95 °C thermal lysis step, thus simplifying the procedure without reducing PCR sensitivity or efficiency.

Abstract: Background Patients following falls from great height with suicidal intent present unique challenges including delayed medical attention, different often masked injury patterns, severe hypothermia and difficulties obtaining informed consent due to the patient's mental state. Legal and logistical hurdles, such as coordinating with legal guardians or family members, can further delay treatment. These co-factors contribute to reported overall high complication rates in these cases, reaching up to 50%. The aim of this study is to analyze injury patterns, inflammatory responses and complication rates in suicidal jumpers compared to unintentional falls. The purpose of this study is also to investigate correlations between jump height and injury severity. Methods In this retrospective monocentric study patient data such as age, gender, injuries, treatments, and the duration of hospitalization were analysed. Over the last decade it was possible to include 68 suicidal falls. Subsequently, 68 work related falls from >3m were included as a control group to analyse against the suicidal ones. Statistical analysis was performed with SPSS 28 (SPSS Inc.) on the included patients (total n=136; male=86, female=48) with parametric analysis using t-tests, chi-squared tests and correlation analyses. The classification of injury outcomes was based on German polytrauma guidelines. The significance level was set at 5% and an exploratory data analysis with one-sided testing was carried out. Results In the analysis of the subgroup of unintentional falls, a predominance of male patients was observed (76.5%, p = 0.002). In contrast, the group of suicidal jumps exhibited a balanced gender distribution, with 50% male (n=34) and 50% female (n=34) patients. Overall, suicidal falls presented with a significantly more severe injury pattern. The average reported fall height was 9.61 m (± 6.42 m) in the suicidal group compared to 6.14 m (± 4.08 m) in the unintentional group. Regarding the assessment of injury severity based on the Injury Severity Score (ISS), higher values were observed in the suicide group, with an ISS of 32.04 (± 23.43) compared to 17.37 (± 14.01). In accordance with this we observed higher complication rates for the suicidal cases (52.5% vs. 29.9%, p = 0.011), and a greater number of total surgeries required in the suicidal group (3.21 (± 4.27) vs. 1.69 (± 2.81), p = 0.016). The measurable coagulation status (prothrombin time) of patients upon admission was significantly worse in the suicidal group (74.95 (± 21.89) vs. 89.09 (± 21.66), p < 0.001), which resulted in a significantly higher transfusion requirement for erythrocyte concentrates (4.07 (± 9.39) vs. 0.97 (± 2.29), p < 0.001). Conclusion Patients with suicidal jumps suffered from more severe injury patterns with an ISS of 32.04 (± 23.43) compared to 17.37 (± 14.01) in the unintentional group (p< 0.001). The suicidal patients exhibited a higher complication rate (p=0.011), an increased overall transfusion requirement, and a greater number of (re-)operations compared to the cohort of unintentional falls. Our data suggests that these patients require more resources and are more challenging to treat. In these patients, particular attention should be given to the frequent occurrence of complications (e.g., wound healing disorders and infections), the elevated transfusion demand, and the significantly impaired coagulation status upon hospital admission.

Abstract: Emergency Department (ED) Triage is the cornerstone of ED operations. Many different triage systems have been proposed and implemented globally. To date an ideal triage system has not been identified. As the burden on ED’s rises with overcrowding being recognized as a universal problem ED triage needs to restructure to address this reality. Extensive and critical of the literature has identified the strengths and weaknesses of current ED triage implementations. A novel multi-layer triage system was introduced and implemented in Greek ED's combining the strengths of various triage and Early Warning Systems and scores, in an effort to minimize under-triage and the adverse downstream effects that in creates on patient outcomes. In its years of implementation, it has proven to be fast, accurate, objective, and reproducible. Acknowledging that no triage system can be universally adapted in different settings, that the structural concepts of this triage system address most of the triage problems currently reported in the literature.

Abstract: Background: Organophosphate (OP) pesticides are widely used in agriculture and can cause acute cholinergic toxicity by inhibiting the enzyme acetylcholinesterase, leading to an accumulation of acetylcholine.Case presentation: A 45-year-old male plumber was admitted to the emergency department four hours after ingesting an unknown quantity of a 50% emulsifiable concentration of diazinon. He presented with sialorrhea, excessive tearing, emesis, and constricted pupils. Laboratory tests revealed a significant reduction in serum cholinesterase activity. A chest X-ray showed no signs of pulmonary edema or lung abnormalities.Treatment Strategy: The patient was found to be moderately dehydrated and was managed with intravenous normal saline (20 mL/kg) during the first four hours of treatment. He received 1,770 mg of pralidoxime over the first 12 hours, along with 9.44 mg of atropine in the first eight hours, followed by 84.96 mg of atropine over the next three days.Clinical Outcome: The patient's condition significantly improved after 48 hours of intensive treatment, with symptom resolution and normalization of cholinesterase levels. His neurological function progressively returned to normal, and he was discharged on day seven without any lasting complications, having made a full recovery.Conclusion: This case highlights the critical importance of prompt diagnosis and immediate treatment of organophosphate poisoning to prevent life-threatening outcomes. Continuous monitoring and appropriate supportive care are essential for ensuring a successful recovery.

Abstract: Background: Emergency Departments (ED) are vital within the health system, often representing the first hospital contact for patients who are undifferentiated and may be critically ill. Although advancements in digital technology and increasing use of electronic medical records in health systems have led to the dramatic growth of large data sets, the presence of ED clinical registries in the literature is currently unknown. Objectives: Our scoping review aims to investigate the extent of emergency department clinical registries reported in peer-reviewed literature. Methods: We conducted a scoping review of ED registries in accordance with the PRISMA-ScR checklist. Searches were undertaken in PUBMED, EMBASE and SCOPUS. Studies were included if they described a clinical registry with a focus on the ED. Results: We identified 60 manuscripts with 27 identified as primary registries (6 had a general scope, 21 were condition or population specific). The remaining 33 papers were investigational reports sourced from the iden-tified primary registries. Funding sources were identified for some registries: 3 by re-search grants, 2 by medical colleges, 5 by government organizations or initiatives, 2 by pharmaceutical companies and 3 by research institutes. No funding information was provided in 12 studies. The reported registry periods ranged from 31 days to 4018 days (median 365 days, IQR 181-1309 days). A grey literature search revealed that 6 registries were ongoing. Conclusions: Internationally there appears to be a wide degree of het-erogeneity with primary ED registry publications and secondary publications. Inte-grating ED registries with a learning health system model will enable clinicians to serve their community proactively and with a focus on quality, rather than the current safe-ty-focused approach.

Abstract:

Background and Objectives: Elderly trauma patients face unique physiological challenges that often lead to undertriage under the current guidelines. The present study aimed to develop machine-learning (ML)-based, age-specific triage guidelines to improve predic-tions for intensive care unit (ICU) admissions and in-hospital mortality. Materials and Methods: A total of 274,347 trauma cases transported via Emergency Medical System (EMS)-119 in Seoul (2020–2022) were analyzed. Physiological indicators (e.g., systolic blood pressure; saturation of partial pressure oxygen; and alert, verbal, pain, unrespon-siveness scale) were incorporated. Bayesian optimization fine-tuned models for sensitivity and specificity, emphasizing the F2 score to minimize undertriage. Results: Compared with the current guidelines, the alternative guidelines achieved superior sensitivity for ICU admissions (0.728 vs. 0.541) and in-hospital mortality (0.815 vs. 0.599). Subgroup analyses across injury severities, including traumatic brain and chest injuries, confirmed the enhanced performance of the alternative guidelines. Conclusions: ML-based, age-specific triage guidelines improve sensitivity of triage decisions, reduce undertriage, and optimize elderly trauma care. Implementing these guidelines can significantly en-hance patient outcomes and resource allocation in emergency settings.

Abstract:

Background:The aim of this study is to analyze cancer patients who were admitted to the emergency department with cardiac symptoms and hospitalized in the cardiology service or cardiology intensive care unit. Methods:One hundred thirty-one patients cancer patients who were hospitalized in the period of 5 years were included in the study. Age, sex, type of cancer, treatment, emergency department diagnosis, laboratory parameters, and in-hospital outcomes were evaluated. Results: The most common hospitalization diagnosis was acute coronary syndromes (69.5%, n=91). The mortality rate was 14.5%(n=19). NTproBNP levels were found to be higher in all patients, and especially high in patients with LVEF < 40%. Conclusion: Cancer patients with low LVEF and elevated NTproBNP levels and increased HEART and TIMI scores have increased risk for cardiac toxicity and mortality. This patient group should be treated and followed up with great care.

Abstract:

Ischemic stroke represents one of the most significant causes of morbidity and mortality worldwide, with early recognition and timely prehospital intervention playing a crucial role in improving overall patient outcomes. In Italy, stroke continues to be the second leading cause of death, with an annual incidence estimated to range between 95 and 290 cases per 100,000 inhabitants. Given the substantial burden of this condition, optimizing prehospital management is of paramount importance. Methods: A retrospective observational study was conducted analyzing 1,051 emergency cards from the calendar year 2023 with a final diagnosis of ischemic stroke. After applying exclusion criteria, 944 cases were evaluated, managed by different emergency medical services: nurse-staffed ambulances (MSI, n=762), helicopter emergency medical services (HEMS, n=20), physician-staffed ambulances (MSAn=33), and medical -car services (n=129). Primary outcomes measured were time on target for each service type and the impact of advanced airway management on these times. Comparative analysis was performed between different service types and between intubated vs. non-intubated patients. Results: Both nurse-staffed (average: 22 min) and physician-staffed ambulances (average: 18 min) demonstrated significantly shorter time on target compared to medical car (average: 41 min for intubated patients, 29 min for non-intubated patients). HEMS maintained comparable times to nurse-staffed ambulances (average: 21 min for non-intubated patients, 25 min for intubated patients). The overall intubation rate for ischemic stroke patients was 1.23% (13/1,051), with similar rates between HEMS (10%) and road-based physician services (9%). Orotracheal intubation increased time on target by an average of 4 minutes for HEMS teams and 12 minutes for road-based physician teams. Conclusions: In conclusion, when responding to patients with a suspected ischemic stroke who are not expected to require advanced airway management, the most efficient and time-sensitive emergency medical response options are ambulances that are staffed either by nurses (MSI) or by physicians (MSA). These types of vehicles enable prompt on-scene assessment, stabilization, and transportation to an appropriate medical facility without unnecessary delays. However, in situations where a patient is experiencing a suspected stroke and is located at a considerable geographical distance from the nearest hospital equipped with a specialized stroke unit, the deployment of a Helicopter Emergency Medical Service (HEMS) should be prioritized. Due to its ability to cover long distances in a significantly shorter time frame, HEMS represents the most effective pre-hospital transport solution for these patients, ensuring that they reach definitive stroke care as quickly as possible. On the other hand, the use of self-medication services or the dispatch of a medical car (automedica) for this patient population has been associated with an average delay of approximately 10 minutes in initiating critical pre-hospital care, without offering any significant additional treatment advantages compared to nurse-staffed ambulances. These findings offer essential insights and practical guidance for emergency medical dispatchers, enabling them to make more strategic and informed decisions regarding the optimal allocation of emergency resources. By improving pre-hospital response efficiency, these optimized dispatch strategies could contribute to reducing treatment delays, ultimately enhancing the overall quality of time-sensitive stroke care and improving patient outcomes.

Abstract: Objectives: To investigate the usefulness of emergency electroencephalogram(emEEG) in the differential diagnosis of transient neurological deficits(TND) and acute confusional state(ACS). Methods: An analysis was performed on a subset of patients included in EMINENCE, a retrospective study of subjects admitted to the Emergency Department(ED) of our tertiary hospital during a 1-year period. The analysis was limited to patients with neurological symptoms/signs compatible with cerebral hemispheric origin or with ACS of < 24h duration. We evaluated the usefulness of emEEG in the diagnostic workup of TND and ACS. Results: Speech disorder(75.3%), hyposthenia(68.1%) and ACS(62.9%) were the signs/symptoms with the highest percentage of abnormal emEEG, especially concerning epileptic discharges. Seizures(85.7%) and encephalopathy(74.3%) were the final diagnoses with the highest percentage of abnormal emEEG, particularly, epileptic discharges and focal slow waves in patients discharged as seizures and bilateral slow waves and triphasic waves in patients discharged as encephalopathy. The presence/absence of epileptic discharges associated with focal slow waves discriminated between seizures and vascular disease, especially in hyposthenia (100% seizures when epileptic discharges were present vs 50% when absent). Migraine with aura(66%) and unknown diagnosis(56%) were the final diagnoses with the most normal emEEG. The rapid timing of the emEEG recording compared to the patient's admission allowed us to perform the test in 29.5% of patients who were still symptomatic, of whom 79% had an abnormal emEEG. Discussion: EmEEG contributed to the diagnosis mainly when speech disorder, hyposthenia and ACS were the admission signs/symptoms and especially for the final diagnosis of seizures and encephalopathy.

Abstract: The battle against coronary artery disease has been in the spotlight for decades. Ongoing research focuses on refined biomarker strategies for the early identification and disposition of patients with symptoms suggestive of acute myocardial infarction (AMI). Copeptin, a surrogate of the hormone arginine vasopressin, has emerged as a novel biomarker that could potentially aid in the diagnos-tic approach of patients with chest pain presenting to the emergency department. Observational studies have demonstrated that copeptin is upregulated in patients with AMI, although the exact pathophysiological mechanisms implicated in its release during myocardial ischemia remain un-clear. Following these observations, copeptin was proposed as an adjunct to troponin in an effort to augment diagnostic accuracy of conventional troponin assays. However, after the introduction of high-sensitivity troponin assays, the diagnostic utility of copeptin has been debated. This narra-tive review aims to elucidate plausible pathophysiological mechanisms involved in copeptin re-lease during myocardial ischemia and to summarize most recent evidence regarding its diagnostic potential in combination with high-sensitivity troponin assays.

Abstract: Background: Despite advances in treatment over the past 20 years that have significantly improved patient survival in shock conditions, septic shock continues to present numerous questions regarding long-term outcomes, primarily due to its associated metabolic changes.Objective: To evaluate hypoalbuminemia as a predictor of mortality in patients admitted with septic shock to the emergency department, through a review of clinical records from January to September 2023 at Hospital General Regional No. 1 (HGR1) in Michoacán, Mexico.Methods: A retrospective study analyzed patients diagnosed with septic shock between January and September 2023. The study examined admission albumin parameters and mortality, along with sociodemographic variables, comorbidities, mean arterial pressure, lactate levels, and vasopressor use.Results: The study included 130 patients meeting inclusion criteria, with equal gender distribution (50% male, n=65; 50% female, n=65). The predominant age group was over 68 years (35.3%, n=46), followed by 59-68 years (27.6%, n=36). Common comorbidities included systemic arterial hypertension (50.7%, n=66), diabetes mellitus (48.4%, n=63), chronic kidney disease (21.5%, n=28), and neoplasms (19.2%, n=25). Serum albumin levels were distributed as follows: ≥3.5 g/dL (13.8%, n=18), 3.4-3.0 g/dL (20%, n=26), 2.9-2.5 g/dL (24.6%, n=32), and <2.5 g/dL (41.5%, n=54). Among patients with albumin <2.5 g/dL, mortality was 92.5% (n=50), with only 7.4% (n=4) surviving to discharge. Statistical analysis using Pearson's Chi-square showed an asymptotic significance of 0.003 with a likelihood ratio of 0.346.Conclusions: This descriptive study demonstrates that hypoalbuminemia (<2.5 g/dL) is significantly associated with mortality in septic shock patients, with a mortality rate of 92.5%. The findings validate the initial hypothesis that hypoalbuminemia serves as a predictor of mortality in more than 50% of patients with septic shock.

Abstract: Background and Objectives: Sepsis, a life-threatening condition caused by a dysregulated immune response to infection, is associated with high mortality. Endotoxin and cytokine overload play a crucial role in sepsis-induced organ dysfunction. The Oxiris® membrane, traditionally used as a hemofilter for renal replacement therapy, has demonstrated the capacity to adsorb endotoxins and cytokines. This study investigates the clinical effect during hemoperfusion with the Oxiris® membrane in patients with septic shock and preserved renal function. Materials and Methods: We present three adult patients with septic shock who were admitted to the intensive care unit with high vasopressor requirements and elevated inflammatory markers. As they were refractory to standard therapy and renal function was preserved, a 12-hour hemoperfusion session with Oxiris® membrane was initiated. Hemodynamic parameters, inflammatory biomarkers, and endotoxin concentrations were evaluated before, during and after hemoperfusion treatment. Results: All patients demonstrated hemodynamic stabilization, with norepinephrine support reduced by 10.3% to 70.0%. Key inflammatory markers decreased significantly, including interleukin-6 (-41.6% to -94.0%), procalcitonin (-29.3% to -49.5%), C-reactive protein (4.7% to -37.2%). Endotoxin concentrations decreased by 62.0% and 13.6% in two of the three patients. No adverse effects related to hemoperfusion were observed. Conclusions: Hemoperfusion with the Oxiris® membrane effectively reduced vasopressor support, inflammatory markers, and endotoxin concentrations in patients with refractory septic shock. This approach may offer a novel strategy for early immune modulation in sepsis before renal dysfunction occurs. Further studies with larger cohorts are required to validate these findings and determine optimal treatment protocols.

Abstract: Background: Some authors advocate that ECGs with conventional computer algorithm (CCA) interpretations of “normal” need not be immediately reviewed. However, such ECGs may actually manifest findings of acute coronary occlusion myocardial infarction (OMI). We sought to determine if such cases can be detected by artificial intelligence (AI). Methods: Retrospective series (2014 - 2024) of cases with ≥ 1 pre-angiography ECGs with proven OMI outcome with a CCA ECG interpretation of “normal.” OMI outcome was defined as 1) diagnosis of acute type I MI, 2) angiographic culprit with intervention, 3) one of the following: a) TIMI 0-2 flow, or b) TIMI-3 or unknown flow, with high peak troponin or new wall abnormality. Each ECG was retrospectively interpreted by the PMcardio OMI AI ECG model. The primary analysis was the diagnostic performance of AI for the interpretation of CCA “normal” ECGs for OMI. Results: 42 patients with OMI met inclusion criteria. The first ECG was interpreted as “normal” by the CCA in 88% of cases; AI interpreted 81% as OMI and 86% as abnormal. Of 78 total ECGs interpreted by the CCA, 73% were diagnosed as “normal.” Of this 73%, AI identified 81% as abnormal and 72% as OMI. Conclusion: The CCA may interpret an ECG manifesting OMI as “normal.” AI not only recognized these as abnormal, but, in 81% of patients, correctly recognized OMI on the first ECG, and recognized 72% of all CCA “normal” ECGs as OMI. It was rare for AI to diagnose a normal ECG in any OMI patient.

Abstract: Background: Mild traumatic brain injury (mTBI) in children is a public health concern resulting in one of the main causes of pediatric emergency department (PED) visits. However, the acute care of mTBI patients remains challenging due to the limited use of specific and safe diagnostic tools. Objectives: To evaluate the performances of combined blood biomarkers to safely rule out intracranial injuries in children with mTBI in the PED. Methods: This was a prospective multicenter cohort study of children aged 0-16 years who presented to the PED within 24 hours of sustaining mTBI. Blood was drawn at admission and levels of IL6, NfL, NTproBNP, GFAP, IL10, S100b, and HFABP were analyzed. Patients were dichotomized in two groups: 1) with intracranial injuries (ICI) on computed tomography scan (CT) (= CT+) and 2) without ICI on CT or kept in observation without CT (= CT- &amp; Obs.). Biomarker age correlation was assessed in a healthy group of children aged 0-16 years. Results: 419 children with mTBI and 99 healthy children were enrolled. All the single and duplex combinations of blood-biomarkers were tested for their capacity to safely rule out intracranial injuries. IL6 was present in the three best combinations reaching 100% sensitivity (SE) and with the highest associated specificity (SP). IL6 + NfL yielded 61% SP, followed by IL6 + NTproBNP with 60% SP, and IL6 + GFAP with 57% SP. Neither IL6 nor NTproBNP were found to be age correlated. Conclusions: IL6 in combination with either NfL, NTproBNP, or GFAP could safely rule out 61% of children without ICI (corresponding to 33/79 unnecessary CT scans and 212/322 observation stays at PED). Blood panels incorporating IL6 show promise as decision-making tools for the acute management of children with mTBI. However, further external studies are required to validate these findings.

Abstract:

Background and Objectives: Data on the prognosis of hypercapnic respiratory failure (HRF) are limited, despite existing studies focusing on its causes and association with mortality. This study aimed to evaluate prognostic factors influencing long-term survival in patients with HRF due to chronic obstructive pulmonary disease (COPD) and to assess the effectiveness of the Age-adjusted Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (A-DECAF) score. Materials and Methods: This retrospective study included patients admitted to the intensive care unit from the emergency department with HRF between April 2022-November 2023. Demographic data, comorbidities, laboratory results, and treatment protocols were recorded. A-DECAF scores were calculated, and survival was analyzed using Kaplan-Meier and ROC analysis. Results: Among 357 patients, 24.4% died within one year of discharge. Deceased patients had significantly higher mean ages (p<0.001) and higher APACHE-II, DECAF and A-DECAF scores (p<0.001). ROC analysis showed that A-DECAF had the highest sensitivity (93.1%) and accuracy (AUC=0.813) for predicting survival. Kaplan-Meier analysis indicated that higher A-DECAF scores were associated with reduced survival rates. Conclusion: The A-DECAF score is an effective tool for predicting long-term survival in COPD patients with HRF, particularly aiding clinical decisions in elderly populations. Further research is needed to validate its use in diverse patient groups.