Emergency Care Unit Research Articles

TECNOLOGIAS PARA ESTRATIFICAÇÃO DE RISCO PEDIÁTRICO: UMA REVISÃO DE LITERATURA NARRATIVA

Objective: Search for bibliographic reviews on mobile applications for pediatric risk stratification screening. Method: This is a bibliographic review. The investigation was carried out at an Emergency Care Unit (UPA) with the objective of developing a soft-hard technology for nurses in pediatric risk stratification. Results: It was observed that 80 articles were identified, including scientific articles and dissertations, however, a careful reading of the articles was carried out from which, as a result of a careful reading, a selection of 23 articles was obtained, including review articles, repeated articles the articles. which escaped the focus, 4 articles were excluded. In the end, 8 articles were selected. Conclusion: It is concluded that mobile applications are necessary in nursing care, including in the stratification of pediatric care during the nursery, helping to provide better care and clarifying doubts.

Viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và một số yếu tố liên quan tại Trung tâm Thần kinh, Bệnh viện Bạch Mai

Introduction: Peripheral venous catheter-related phlebitis is a common complication in healthcare facilities, causing pain, disrupting treatment, and potentially leading to severe complications.Objective: This study investigates the incidence and risk factors associated with peripheral intravenous catheter-related phlebitis. Method: A prospective cross-sectional descriptive study was conducted using a self-designed questionnaire and the Visual Infusion Phlebitis (VIP) Scale to assess the degree of phlebitis. The study included 347 inpatients treated in the Emergency and Intensive Care Unit, Neurology Center, at Bach Mai Hospital. Data were collected from medical records and clinical observation. Results: Among the studied patients, the incidence of phlebitis was 17.6%, and 4.3% of catheter insertion sites exhibited signs of inflammation. Grade 1 and 2 were the most common phlebitis (43.1% and 54.2%), with a small number of grade 3 cases (2.8%) and no cases of grade 4 or 5. Factors such as catheter insertion sites in the forearm, elbow, or ankle; underlying conditions like hypertension, cerebral hemorrhage, pneumonia; paralysis; continuous fluid infusion; and certain intravenous medications were identified as being associated with an increased risk of phlebitis. Conclusion: Phlebitis at the PVC site is a significant concern during treatment in ICU and Neurology centers. Proper catheter site selection and effective management of underlying conditions can help reduce the risk of phlebitis. These findings may assist in developing clinical guidelines to improve patient care quality.

CUIDADOS DE ENFERMAGEM EM SITUAÇÕES TRAUMÁTICAS

In Brazil, nursing care in traumatic situations was based on the North American models adopted by the Fire Departments and the Mobile Emergency Care Service (SAMU). Due to issues related to legal aspects, in our country, one of the greatest challenges encountered in emergency care units, and one of the reasons that contributed to the support of several structures. METHODOLOGY: This is a descriptive epidemiological narrative review with a qualitative approach. It is a narrative review of the literature, a method that consists of a syntactic analysis of publications, enabling a synthesis of published studies and eliminating gaps that need to be filled by knowledge, through new bibliographic research. RESULTS AND DISCUSSIONS: Nursing professionals, equipped with solid scientific knowledge, play a crucial role in improving the quality of health services, especially in the care of patients in critical situations. This expertise contributes significantly to a better prognosis for patients, demonstrating that evidence-based practice is essential for positive results. CONCLUSION: With the development of this work, it was possible to evaluate the evidence found from literature on nursing care in traumatic situations and their complications. In addition, during this study, we saw the awareness of the nursing team about the importance of medical record notes, which, when well prepared, present valuable elements for the diagnosis of the patient’s needs and for the planning and evaluation of the assistance provided within the scope of nursing care.

Hemodynamic monitoring- (NOT) anursing task?!

Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.

MULTIDISCIPLINARY APPROACH IN THE CARE OF PSYCHIATRIC OUTBREAKS IN URGENCY AND EMERGENCY SETTINGS: A LITERATURE REVIEW

Introduction: patients diagnosed with psychiatric disorders, before the psychiatric reform, were isolated from society and admitted to asylums, in a coercive manner, without ethical and human support from the multidisciplinary treatment team. Objective: to contribute to reflection on care practices and improvement of care for individuals experiencing a psychiatric outbreak directed to the urgent and emergency care network. Method: a theoretical, descriptive, exploratory literature review was carried out in the Virtual Health Library (BVS). The inclusion criteria were articles published between 2019 and 2023, complete, available online, free of charge in national or international journals, in the Portuguese language. Results: seven articles responded to the proposed methodological compliances and criteria and encouraged discussion on the research topic. Conclusion: patients in a psychiatric outbreak were directed to the Emergency Care Units (UPA), but the reception according to law 10.216/2011 is not done with mastery, given that there is a lack of professional qualifications in the multidisciplinary team and difficulties related to the physical structure from the emergency room to specific reception.

Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea

IntroductionChronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome (OVS) is associated with higher mortality compared with COPD alone in stable outpatients. However, the prognosis of patients hospitalised with...

A-192 Effectiveness in Communicating Critical Results: impact of technology and consultive actions on improving performance indicators in a laboratory in Northeast Brazil

Abstract Background Critical results consist of laboratory test results that require immediate intervention or decision-making by the responsible medical team, as they pose a risk to the patient's life. To manage the process of communicating critical results, it is also necessary to define the indicators, goals and systematic comparability through benchmarking. Methods The performance of the indicators measuring the critical results process for the year 2023 was analyzed. Performance indicators such as resolution time, success and failure rate in communication, delay rate in communication and the rate of open incidents related to the communication of critical results were monitored using a Business Intelligence tool. Results In the first two months of 2023 the results reflected the absence of parameters in the LIS for effective communication of critical results. September and October there was a high turnover rate in the laboratory in addition to the change in the hospital care profile in which the laboratory medicine service was inserted. These causes culminated in a number of 122 (1.48%) communication failures, representing an increase of 1,120% compared to the first two months of the year. On the other hand, there was a significant improvement in the average communication time for critical results, decreasing from approximately 736 hours to 184 hours(reduction of around 75%). There was also a reduction in communication delay of approximately 67%. These numbers corroborate the parameterization actions in the system aimed at speeding up the process. As a continuation of the improvement actions, the laboratory implemented goal setting for the resolution time indicator and also the periodic meeting for critical analysis of the results.In addition to these actions, the laboratory approached the hospital's clinical staff, making it possible to provide clarity on the difference between compulsory notification and critical results. This clarification allowed for the establishment of a list of exams considered critical, in order to meet the hospital profile, as well as to define the communication flow. For the success indicator in communicating critical results, there was a 22% improvement when comparing the last two months of 2023 with the first two months of the same year. In the last two months of the year, this indicator performed at 99.4%, corroborating the study published by Noronha et al., (2016), where the effectiveness rate in critical results communication was 96.1%. Comparing with the study by Noronha et al., (2016), where the biochemistry sector had the highest rate of critical results communication failures (73.8%), followed by the Emergency Room (78.6% ) and ICU (16.7%), the findings of this study highlighted the top 3 detracting sectors: Biochemistry (68%), “UPA” - Emergency Care Unit (42.1%) and ICU (21.4%), making data superimposable. Conclusions The communication of critical results has challenges related to its effectiveness, especially in hospital contexts. As a critical and high-impact activity, constant actions are necessary to continuously improve the process. Actions should take into account: interactions with attending physicians, the development and training of the internal team, and constant checks of the LIS, as technology can support the process management.

Nurses’ Experiences with the Use of Electronic Nursing Record: A Qualitative Study

Background: The electronic nursing record has contributed to improving nursing practice and ensuring nursing quality, but it is still incomplete in supporting nursing workflow. The purpose of this study is to explore the experience of using the electronic nursing record by nurses working in frontline care for trauma, emergency, and infectious disease-exposed patients.Methods: The study employed a qualitative descriptive design and qualitative content analysis. In-depth interviews were conducted with 10 nurses working in emergency, trauma, and critical care units in the tertiary hospital.Results: The nurses’ experiences with the use of the electronic nursing record emerged into three subjects (improvements to electronic nursing record implementation, benefits of electronic nursing record implementation, electronic nursing record user factors), five categories (information finding and sharing function, information input function, facilitating efficient communication, ensuring record quality, need for education), and eight subcategories.Conclusions: Electronic nursing record supports the visualization of special information such as emergency and infection, and has the advantage of facilitating communication between medical staff. Both support better clinical decision-making. However, system instability and low nursing friendliness delay nursing work in the process of inputting, confirming, and sharing information. Copy-andpaste practices, poor quality of records, and insufficient electronic nursing record education were identified as factors to be changed on the user side. Improvement of nursing-friendly interfaces, optimization of nursing workflows, and participation of nurses in the improvement process are necessary. We should also focus on developing electronic nursing record education programs.

Does the Use of Prehospital Emergency Care Units in Inter-Hospital Transfers Affect Regional Prehospital Emergency Care Readiness?—A Finnish Pilot Study

Does the Use of Prehospital Emergency Care Units in Inter-Hospital Transfers Affect Regional Prehospital Emergency Care Readiness?—A Finnish Pilot Study

Can clinical presentation predict radiologically confirmed cauda equina syndrome: retrospective case review of 530 cases at a tertiary emergency department

PurposeCauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC)..MethodsThis was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed.Results530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001].ConclusionThis study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan..

Prevalence of inappropriate antibiotic doses among pediatric patients of inpatient, outpatient, and emergency care units in Bangladesh: A cross-sectional study.

The heterogeneous pediatric populations, their physiological differences, along with the necessity of performing additional dose calculation, make the pediatric population more vulnerable to the incidences of inappropriate antibiotic doses. This study was conducted to examine and evaluate the appropriateness of antibiotic doses. A cross-sectional study with a quantitative approach was conducted in three hospitals located in Savar from January 06, 2021 to October 17, 2022. This study had used a convenient sampling method to collect 405 filled prescription orders from heterogeneous pediatric patients prescribed by physicians from emergency, inpatient, and outpatient care units of various clinical settings. The Harriet Lane Handbook was used as reference to investigate inappropriate doses of antibiotics. Subsequently, all analyses were conducted using the RStudio 1.3.959 software. Binary logistic regression was used to assess the risk of inappropriate antibiotic prescription in pediatrics. The overall prevalence of inappropriate antibiotic dosing in pediatrics was 335 out of 545 (61.5%). Overdosing (36.3%) and oral antibiotic prescriptions (64%) were more common than underdosing (20.4%) and parenteral antibiotics (36%). The majority (230 out of 405, 56.8%) of pediatric patients had prescriptions with inappropriate antibiotic doses, with prevalence rates of 33.8% for inpatients, 86.7% for outpatients, and 50% for emergency pediatrics. The results also indicated that pediatric patients in outdoor and emergency care units, infants, toddlers, and early childhood, those prescribed two antibiotics simultaneously, and those receiving parenteral antibiotics, were less likely to have inappropriate antibiotic dosages in their prescriptions. This study demonstrated that about one out of every two prescriptions had inappropriate antibiotic doses; in particular, prescriptions containing only one antibiotic exhibited a substantial proportion of inappropriate antibiotic doses. Inappropriate antibiotic doses may result in therapeutic failure, patient harm, and antibiotic resistance. Good clinical pharmacy practice and careful adherence to pediatric dosing standards may minimize inappropriate antibiotic doses.

Preventing Trauma and Grief in Emergency and Critical Care Units: A Mixed Methods Study on a Psycho-Educational Defusing Intervention.

Emergency and critical care services inevitably expose their staff to potential work stressors and traumatic events, which can cause emotional, behavioral, and physical reactions. The literature presents a wide range of evidence-based knowledge on the effectiveness of interventions to promote mental health after traumatic events. However, little is known about the effectiveness of prevention programs. In this study, we sought to improve the empirical understanding of the potential of a combination of psycho-educational-defusing training for trauma prevention. We employed a mixed methods approach using statistical modeling and content/focus group analysis to describe the sample of investigation and the effectiveness of the prevention training. A retrospective quantitative chart measured and evaluated the psychological state of physicians, nurses, and registered nurses (N = 222). A retrospective qualitative chart examined staff accounts of traumas and their coping strategies via autobiographies (n = 26). Prospective focus groups examined participants of the psycho-educational defusing intervention administered (n = 61). Findings revealed different forms of experiencing grief and trauma. Prospective analysis of the training effectiveness revealed favorable perceptions by participants. Results support the formal implementation of continuous prevention, building relational support, and coping strategies as keys to recovery and preventing traumas.

Profile of adult care classified as non-urgent in emergency care unit

Objective: To identify the profile of care classified as non-urgent in the Emergency Care Unit (ECU). Methods: This is a descriptive, retrospective, documentary study with a quantitative approach, carried out in an ECU located in the city of Curitiba, PR, with users from 18 years of age and blue priority in the risk classification. Data were tabulated in Excel® and analyzed in SPSS® to obtain descriptive statistics, inferences and perform the chi-square test. Results: 213 medical records were analyzed, predominantly looking for young adults, with a mean age of 39 years, female. The main clinical complaints/demands reported (p&lt;0.001) by users were: respiratory and flu problems (36%), followed by medication administration (14%) and unprotected sexual exposure (8%). Morning calls (39%) were more frequent (p&lt;0.001), with Monday and Wednesday being the days with the highest demand (p=0.026). The most common outcome of the consultations was discharge from the unit (61%; p&lt;0.001). Conclusion: The care of adults up to 39 years old predominated, with greater demand during the day. The clinical complaints and demands presented were not compatible with the profile and complexity intended for an urgent and emergency service.

Standardized emergency protocols to improve the management of patients with suspected or confirmed inherited metabolic disorders (IMDs): An initiative of the French IMDs Healthcare Network for Rare Diseases

ObjectivesPatients with inherited metabolic disorders (IMDs) may require emergency hospital care to prevent life-threatening situations such as metabolic decompensation. To date, over one thousand different rare IMDs have been identified, which means that healthcare professionals (HCPs) initiating emergency treatment may not be familiar with these conditions. The objective of this initiative was to provide HCPs with practical guidance for the acute management of children and adults with IMDs who need emergency care, regardless of the underlying reason. MethodsWe outline how a multidisciplinary working group from the French IMDs Healthcare Network for Rare Diseases, known as G2M, has created concise and standardized protocols _each consisting of a single double-sided A4 sheet _ focused on a specific disease, a group of diseases, or a particular symptom. Prior to validation, these protocols were reviewed by all French reference and competence centres for IMDs, as well as by medical experts from other specialities when necessary, physicians from emergency and intensive care units, and representatives from patient associations. Results and conclusionIn total, 51 emergency protocols containing essential information have been developed and provided to affected patients. All the emergency protocols are freely available in both French and English at https://www.filiere-g2m.fr/urgences. These standardized protocols aim to enhance the emergency care of patients without delay, while also assisting HCPs by increasing their confidence and efficiency, minimizing the risk of dosage errors when administering specialized treatments, saving time, and reducing the number of phone calls to metabolic medicine specialists on night duty. The protocols are scheduled for annual review to facilitate further improvements based on feedback from HCPs and patients, as well as to accommodate any changes in management practices as they evolve.

Complications of Tenecteplase in pre-hospital care for treatment of acute myocardial infarction

The main objective of STEMI treatment is myocardial reperfusion, although FT is a viable and efficient option, it has possible complications like any other medication. The objective of this article to analyze the complications of the pre-hospital use of Tenecteplase for the treatment of Acute Myocardial Infarction. Was performed a study cross-sectional study, carried out in the Mobile Emergency Care Services and Emergency Care Units, with data analyzed by descriptive and inferential statistics. Fifty-three (53) medical records of patients with acute myocardial infarction who used Tenecteplase were analyzed. The use of the medication within 3 hours after the onset of symptoms decreased mortality and provided clinical improvement. Outcomes without clinical improvement were associated with time to onset of use greater than 3 hours. Tenecteplase was an effective therapy when administered within the first 3 hours from the onset of symptoms. However, it was evidenced that hemorrhagic risks are possible, but depended on the dose of fibrinolytic administered, the pharmacological therapy used and the clinical condition of the population studied.

Emergency care in Brazil: factors leading to clinically inappropriate use of emergency care among young adult users in the Brazilian context

BackgroundThis study aims to investigate the prevalence and associated risk factors of inappropriate use of emergency services among young adults in Vitória, Brazil.MethodsA cross-sectional study was conducted over 30 consecutive days in November and December 2019, involving systematic random sampling of young adults (aged 18–39) visiting the municipal emergency care unit. Data were collected through structured interviews, utilizing the Hospital Urgency Appropriateness Protocol (HUAP) to identify inappropriate use. Demographic characteristics, healthcare utilization patterns, and medical diagnoses were assessed. Poisson regression models were employed to explore associations between variables.ResultsAmong the 631 young adults surveyed, 30.6% exhibited inappropriate use of the emergency care unit. Factors associated with higher rates of inappropriate use included not seeking previous care in other healthcare services; having specific medical diagnoses like diseases of the respiratory system (PR: 2.03), diseases of the skin (PR: 4.13), and diseases of the ear and mastoid (PR: 3.74).ConclusionThe study underscores the significance of addressing inappropriate use of emergency services among young adults. Though the prevalence of inappropriate use was not significantly different from other age groups, the demographic characteristics and healthcare utilization patterns of young adults contribute to their unique challenges. To mitigate inappropriate use, efforts should focus on improving access to primary healthcare services, enhancing continuity of care, and raising awareness about appropriate healthcare-seeking behaviors among young adults. Ultimately, these interventions can foster a more effective and sustainable healthcare system that better serves the needs of the community.

Knowledge, practice, and factors associated with electrocardiography interpretation among nurses working in adult emergency and critical care units at selected governmental hospitals in Addis Ababa, Ethiopia, 2023: a cross-sectional study

BackgroundElectrocardiography (ECG) is a noninvasive diagnostic method used to examine electrical and muscular cardiac activity. It is usually the first-line diagnostic tool for patients with chest pain. Late recognition of electrocardiography abnormalities can cause in-hospital cardiac arrest, further complicate care, increase the cost of health care, and prolong admission. Hence, the objective of this study was to determine the knowledge, practice, and associated factors of nurses regarding the interpretation of electrocardiography.MethodsA cross-sectional study was carried out on 334 nurses working at randomly selected public hospitals from March 06, 2023, to April 05, 2023. Since our study populations were less than the calculated sample size, all nurses who fulfilled the inclusion criteria were included. The collected data were coded and cleaned using EpiData version 4.2 and analysed using Statistical Package for the Social Sciences (SPSS) version 25. Both bivariate and multivariate logistic regression was run to find an association between dependent and independent variables. Odds ratios (ORs) with 95% confidence levels were used to measure the strength of associations.ResultsA total of 334 nurses responded to the survey, yielding a 93% response rate. Only 15.4% and 9% of them had satisfactory knowledge and good practice, respectively. Nurses who had 2–4 years of experience in the current unit were 3.13 times more likely (AOR = 3.13 (1.23, 7.92) to have sufficient knowledge. Nurses working in cardiac care units were 3.45 times more likely to have good practices than those working in intensive care units (AOR = 3.45 (1.02, 13.73)).ConclusionThe study revealed that educational qualifications, in-service training, and current working units were significantly associated with nurses’ knowledge and practice of electrocardiography interpretation. The concerned body must provide continuous on-the-job training related to ECG interpretation to all nurses working in adult emergency and critical care unit.

765 Enhancing the Quality of Referrals to Vascular Surgery at a District General Hospital: A Closed-Loop Quality Improvement Project

Abstract This quality improvement project aimed to improve the completeness of referrals to vascular surgery from in-patient wards and the Sameday Emergency Care unit at a UK district general hospital. We implemented a comprehensive vascular surgery proforma to enhance the quality of referrals to the department. Referrals made between 01/01/23 and 01/03/23 were assessed according to Professional Record Standards Body (PRSB) guidelines, which outlines the necessary information to be included in clinical referrals. The new proforma was introduced to all hospital clinicians, enabling them to email completed referrals to a dedicated vascular surgery inbox. To evaluate the impact of the new system, referrals were re-audited between 12/05/23 and 13/07/2023 using the same PRSB criteria. Significant improvements were observed in the completeness of referrals, as indicated by the percentage of fulfilled PRSB criteria: patient demographics (60% vs. 100%), referrer details (51% vs. 100%), reason for referral (93% vs. 100%), relevant clinical risk factors (60% vs. 95%), medication history (60% vs. 100%), family history (40% vs. 84%), social history (47% vs. 93%), patient ideas concerns and expectations (40% vs. 81%), examination findings (60% vs. 93%), and investigation findings (63% vs. 91%). The median number of fulfilled criteria per referral increased from 2.5 to 9 (out of 10), demonstrating a substantial improvement (p &amp;lt; 0.0001). Our dedicated vascular surgery referrals proforma had a significant positive impact on the completeness of referrals to the department. This change has the potential to enhance continuity of care, improve clinical prioritisation, promote patient safety, and enhance the overall efficiency of our service.

Distribution Patterns and Antibiotic Resistance Profiles of Bacterial Pathogens Among Patients with Wound Infections in the Jiaxing Region from 2021 to 2023.

To systematically assess the distribution and antimicrobial susceptibility of pathogens in wound infections, and analyze risk factors associated with multidrug resistance (MDR). Retrospectively analyzing Jiaxing-region medical records between January 2021 and December 2023, we identified a cohort of 461 wound infection patients. Cultures were grown on various agars, with bacteria identified via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. The antimicrobial susceptibility of the organisms were conducted by VITEK 2 system, Kirby-Bauer disk diffusion method and Epsilometer test. Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical analysis. Multivariable logistic regression models were developed to pinpoint risk factors for multidrug-resistant organism (MDRO) infections and predict occurrences. From 461 patients, 549 bacterial pathogens were isolated, predominantly consisting of Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Enterobacter cloacae, and Enterococcus faecalis. Vancomycin, linezolid, and tigecycline maintained their efficacy against Staphylococcus aureus and Enterococcus species, while Pseudomonas aeruginosa demonstrated sensitivity to aminoglycosides. Conversely, Escherichia coli exhibited high amoxicillin resistance (85.4%). More than half of the isolates were resistant to levofloxacin, ceftriaxone, cotrimoxazole, and gentamicin, with Acinetobacter baumannii strains showing considerable resistance (65.8-68.4%) to advanced cephalosporins and carbapenems. Within this group, 58 MDROs were detected, primarily originating from Burn Plastic Surgery, Emergency, and Intensive Care Unit (ICU) departments. Multivariate logistic regression identified hyperglycemia, hypoalbuminemia, surgery, extended hospitalization, and exposure to multiple antibiotic classes as independent risk factors for MDRO wound infections. Based on these findings, a predictive model for MDRO occurrence in wounds was constructed, which had a sensitivity of 0.627, specificity of 0.933, and an Area Under the Curve (AUC) of 0.838. Staphylococcus aureus and Pseudomonas aeruginosa dominated in wound infections with differential antibiotic resistance. Independent risk factors included hyperglycemia, hypoalbuminemia, surgery, extended hospitalization, and polyantibiotic use. We urge prioritizing culture, susceptibility tests, and personalized antibiotic strategies to address MDRO risks and improve wound infection management specificity and efficacy.

Proposition of indicators for evaluation of Emergency Care Units

Proposition of indicators for evaluation of Emergency Care Units