Hospital Arrival Time Research Articles

Could fasciotomy prevent amputation in patients with electrical burn injuries? Insights from a cross-sectional study in Indonesia.

The amputation rate resulting from electrical burn injuries remains high, yet no study has investigated whether early fasciotomy may reduce the amputation rate. The aim of this study was to analyze the success rate of fasciotomy in preventing amputation and determine the optimal timing for fasciotomy in electrical burn injuries. This study was conducted at Dr. Soetomo Hospital from January 2020 to July 2023. Total sampling was employed to recruit the patients. Clinical data, voltage characteristics, burn location, affected total body surface area, burn depth, hospital arrival time, and time interval from incident to fasciotomy were assessed. Chi-squared test was used to assess factors associated with the fasciotomy incidence and factors associated with amputation after fasciotomy. A total of 45 patients were included, of which 97.8% were male, with a mean age of 37.60 years old. Approximately 73% of patients had full-thickness burn injuries, with the left upper extremity being the most affected (80%). There are seven patients (15.6%) had fasciotomy and five (11.1%) patients had an amputation. Our data indicated a significant association between voltage characteristics and fasciotomy incidence (p=0.034). Additionally, our data indicated that earlier arrival to the hospital (p=0.002) and timely fasciotomy conducted upon arrival (p<0.001) were associated with a reduced rate of amputation. This study highlights that prompt arrival to the hospital and early fasciotomy may prevent amputation in patients with electrical burn injuries.

Retrospective Evaluation of Falls From Height Cases Admitted to the Pre-Hospital Emergency Healthcare System

Aim: The aim of this study is to analyze the demographic characteristics, timing aspects (time of occurrence, emergency response time, ambulance arrival time), and hospital arrival times in pre-hospital cases of falls in Ankara. Material and Methods: This cross-sectional observational epidemiological study examined data from patients who received pre-hospital emergency care due to fall-related trauma in Ankara between January 1, 2019, and December 31, 2023. Patients were identified through calls made to the central 112 Call Center and documented in the Emergency Health Automation System. Demographic details, injury epidemiology (ICD-10 codes, injury mechanism, incident timing), and emergency response times (command response time, time from ambulance dispatch to scene arrival, transport time) were collected. Results: This study includes 16,136 patients, of whom 6,346 are female and 9,790 are male, with an average age of 38.3 ± 24.3 years. The predominant ICD-10 diagnosis codes are W03, W10, W12, W13, W14, W17, Y30, and X80. The year 2019 saw the highest number of incidents (n=4,014), with a decrease observed in 2020 (n=2,790). The highest number of falls occurred in July, while the lowest was in February, with the fewest falls reported in winter and the most in summer throughout the five years. Most incidents occurred between 08:00 and 15:59 (n=8,366), followed by 16:00 to 23:59 (n=6,456); 1,314 incidents occurred between 00:00 and 07:59. Falls occurred most frequently during working hours (61.9%, n=9,983). The average command center response time was 216.4 ± 203.6 seconds, station response time was 39.6 ± 47.8 seconds, and transport time was 371.6 ± 249.9 seconds. Most patients were transported to Training and Research Hospital (n=7,827), followed by State Hospital (n=3,422), University Hospital (n=2,210), and Private Hospital (n=249). Secondary transfers were mostly related to Training and Research Hospital (n=1,387), primarily for specialist needs (n=1,165). There were 32 patients who received on-scene intervention and 231 patients who died. Significantly increased response times were observed from 2019 to 2023 (p

Development of an Acute Stroke Care Seeking Framework.

BACKGROUND: A multitude of variables influence an individual's decision to seek care in emergency situations. By recognizing these variables and their impact on the timeline of an individual seeking care for a stroke, nurses have an opportunity to positively affect the outcomes of stroke within the community. The purpose of this narrative review was to develop a research framework describing the variables involved in care seeking during an acute stroke. METHODS: Using a theory synthesis methodology that included variable identification and the establishment of relationships between variables based on existing literature, a framework describing variables relevant to acute stroke care seeking behavior was developed. RESULTS: Fourteen recently published studies reported significant variables related to seeking emergency medical care during the hyperacute phase of a stroke. Eight variables were identified and characterized as either promoters or distractors. Promoters led an individual to seek acute stroke care earlier, such as perceived symptom severity, stroke knowledge, and the presence of others. Distractors led an individual to delay seeking acute stroke care and resulted in later hospital arrival times, such as a lack of social network or resources, comorbid conditions, and incongruity with the local health system. CONCLUSION: Although individual decision making is exceedingly complex and varies by individual and situation, the developed acute stroke care seeking framework may provide a basis on which to develop stroke awareness programs and interventions targeted at individuals at risk for delayed acute stroke care.

Characteristics of traumatic major haemorrhage in a tertiary trauma center

BackgroundMajor traumatic haemorrhage is potentially preventable with rapid haemorrhage control and improved resuscitation techniques. Although advances in prehospital trauma management, haemorrhage is still associated with high mortality. The aim of this study was to use a recent pragmatic transfusion-based definition of major bleeding to characterize patients at risk of major bleeding and associated outcomes in this cohort after trauma.MethodsThis was a retrospective cohort study including all trauma patients (n = 7020) admitted to a tertiary trauma center from January 2015 to June 2020. The major bleeding cohort (n = 145) was defined as transfusion of 4 units of any blood components (red blood cells, plasma, or platelets) within 2 h of injury. Univariate and multivariable logistic regression analyses were performed to identify risk factors for 24-hour and 30-day mortality post trauma admission.ResultsIn the major bleeding cohort (n = 145; 145/7020, 2.1% of the trauma population), there were 77% men (n = 112) and 23% women (n = 33), median age 39 years [IQR 26–53] and median Injury Severity Score (ISS) was 22 [IQR 13–34]. Blunt trauma dominated over penetrating trauma (58% vs. 42%) where high-energy fall was the most common blunt mechanism and knife injury was the most common penetrating mechanism. The major bleeding cohort was younger (OR 0.99; 95% CI 0.98 to 0.998, P = 0.012), less female gender (OR 0.66; 95% CI 0.45 to 0.98, P = 0.04), and had more penetrating trauma (OR 4.54; 95% CI 3.24 to 6.36, P = 0.001) than the rest of the trauma cohort. A prehospital (OR 2.39; 95% CI 1.34 to 4.28; P = 0.003) and emergency department (ED) (OR 6.91; 95% CI 4.49 to 10.66, P = 0.001) systolic blood pressure < 90 mmHg was associated with the major bleeding cohort as well as ED blood gas base excess < -3 (OR 7.72; 95% CI 5.37 to 11.11; P < 0.001) and INR > 1.2 (OR 3.09; 95% CI 2.16 to 4.43; P = 0.001). Emergency damage control laparotomy was performed more frequently in the major bleeding cohort (21.4% [n = 31] vs. 1.5% [n = 106]; OR 3.90; 95% CI 2.50 to 6.08; P < 0.001). There was no difference in transportation time from alarm to hospital arrival between the major bleeding cohort and the rest of the trauma cohort (47 [IQR 38;59] vs. 49 [IQR 40;62] minutes; P = 0.17). However, the major bleeding cohort had a shorter time from ED to first emergency procedure (71.5 [IQR 10.0;129.0] vs. 109.00 [IQR 54.0; 259.0] minutes, P < 0.001). In the major bleeding cohort, patients with penetrating trauma, compared to blunt trauma, had a shorter alarm to hospital arrival time (44.0 [IQR 35.5;54.0] vs. 50.0 [IQR 41.5;61.0], P = 0.013). The 24-hour mortality in the major bleeding cohort was 6.9% (10/145). All fatalities were due to blunt trauma; 40% (4/10) high energy fall, 20% (2/10) motor vehicle accident, 10% (1/10) motorcycle accident, 10% (1/10) traffic pedestrian, 10% (1/10) traffic other, and 10% (1/10) struck/hit by blunt object. In the logistic regression model, prehospital cardiac arrest (OR 83.4; 95% CI 3.37 to 2063; P = 0.007) and transportation time (OR 0.95, 95% CI 0.91 to 0.99, P = 0.02) were associated with 24-hour mortality.ResultsEarly identification of patients at high risk of major bleeding is challenging but essential for rapid definitive haemorrhage control. The major bleeding trauma cohort is a small part of the entire trauma population, and is characterized of being younger, male gender, higher ISS, and exposed to more penetrating trauma. Early identification of patients at high risk of major bleeding is challenging but essential for rapid definitive haemorrhage control.

Early prediction for massive fresh frozen plasma transfusion based on fibrinogen/fibrin degradation products and D-dimer in patients with blunt trauma: a single-center, retrospective cohort study.

This study aimed to examine the association of fibrinogen/fibrin degradation product (FDP) values in comparison with D-dimer and fibrinogen (Fib) values and the need for massive fresh frozen plasma (FFP) transfusion in patients with blunt trauma. This retrospective study included patients with blunt trauma aged ≥ 18years who were transported directly to the tertiary care hospital between April, 2012, and March, 2021. Massive FFP transfusion was defined as a composite outcome of at least 10 units of FFP or death for any cause except for cerebral herniation, within 24h after hospital arrival. We evaluated the diagnostic accuracy of predicting the need for massive FFP transfusions using FDP, D-dimer, and Fib levels at the time of hospital arrival. A total of 2160 patients were eligible for the analysis, of which 167 fulfilled the criteria for the composite outcome. The area under the curve and 95% confidence interval for FDP, D-dimer, and Fib levels were 0.886 (0.865-0.906), 0.885 (0.865-0.906), and 0.771 (0.731-0.810), respectively. When the cutoff values of FDP and D-dimer were set at 90μg/mL and 45μg/mL, the sensitivity values were 77% and 78%, the positive predictive values were 28% and 27%, and the negative predictive values were both 98%, respectively. In contrast, the sensitivity of Fib was low regardless of the cutoff value. FDP and D-dimer levels at the time of hospital arrival showed a higher predictive accuracy for the need for massive FFP transfusion than Fib.

Abstract NS9: Nurse-Led Quality Improvement Initiative: Advancing Stroke Awareness in Communities Experiencing Racial and Ethnic Disparities

Background and Purpose: As a Joint Commission Comprehensive Stroke Center, the provision of community education is a priority goal of our program. The majority of our existing community education program takes place in locations where we receive requests to provide these sessions. Analysis of our Get With the Guidelines (GWTG) data reveals gaps in early arrival to the hospital and Emergency Medical Service (EMS) utilization among African American and Hispanic populations. Providing educational resources within these populations may help to close these gaps and foster trust in the healthcare system. The aim of this proposed nurse-led quality improvement project is to improve hospital arrival times of African American and Hispanic stroke patients living in zip codes where GWTG data have identified gaps, through provision of targeted community education. Methods: The top zip codes associated with our target outcomes for improvement will be identified using GWTG pre-data from 2022 and 2023. We will partner with our Community Outreach department. We will identify educational venues and stakeholders among African American and Hispanic populations in these zip codes. We will provide education tailored to our identified populations including early recognition of stroke signs and symptoms, activation of EMS, stroke risk factors, and opportunities for treatment. Post implementation, GWTG data will be reviewed for any changes. Results: Using GWTG data, arrival mode, last known well time, and symptom discovery time to Emergency Department arrival as it pertains to zip codes, race and ethnicity will be reviewed and analyzed. The target zip codes’ data will be compared pre- versus post-implementation of community education efforts. Discussion: Through community education and partnership with the Community Outreach department we hope to improve timeliness of arrival to hospital among disproportionately affected racial minorities in our community for early stroke evaluation and treatment consideration.

Abstract WP64: Assessment of a Smartphone App-Sensor to Assist Patients in Identification of Neurologic and Cardiac Emergencies: The Emergency Call for Heart Attack and Stroke (ECHAS) Study

Introduction: While timely therapy of neurologic and cardiac emergencies can improve outcomes, patients often fail to identify acute events resulting in delays in seeking emergency care. ECHAS is a smartphone application and sensor system aimed to reduce patient-related delay. We performed a retrospective study to test ECHAS in identifying patients who required emergency assessment for possible myocardial infarction (MI) or stroke. Methods: We enrolled 202 patients (57 with stroke-like, 145 MI-like symptoms) who presented to the ED at a single center in Canada. Participants answered yes-no questions about their prior history, acute symptoms, and performed a finger-tapping test on an Apple iPhone with ECHAS. Answers resulted in a risk score that guided one of the three triage decisions: 1) call 911, 2) call hotline, or 3) call your primary care physician. The ground truth for the triage decision assessment was the appropriateness of the patient’s visit to the ED. Specificity could not be calculated due to low numbers of patients who did not need emergency evaluation. Results: The mean time to complete the acute assessment was 60 seconds for MI and 111 seconds for stroke. ECHAS output recommended 66% of patients call 911, 30% hotline, and 4% primary care follow-up. The sensitivity to identify the need for emergency evaluation was 0.98. The sensitivity to identify patients who were admitted for possible MI or stroke was 1.0. A negative correlation was found between low ECHAS score and prolonged symptom onset to hospital arrival time for MI-like symptoms (r = -0.21, p &lt; 0.05). Patients found ECHAS to be very useable (Fig 1). Conclusion: The ECHAS application was highly sensitive and easily usable in guiding patients to identify medical emergencies without input by healthcare personnel. These pilot results will drive a planned 4,000-patient prospective randomized trial to evaluate whether ECHAS will reduce times from symptom onset to first medical contact for MI and stroke.

Effect of Hospital Arrival Time on Functional Prognosis of Stroke Patients: Japan Stroke Data Bank Over 20 Years.

The impact of weekend/holiday and nighttime hospitalization on functional outcomes and long-term trends in stroke patients is unclear. We examined functional and life outcomes and changes over time. We analyzed the clinical data of 203,176patients for hospital arrival day of week and 76,442patients for arrival times using Japan Stroke Data Bank. The endpoints were favorable outcome (Modified Rankin Scale[mRS]0-2), unfavorable outcome(mRS 5-6), and in-hospital mortality. We calculated odds ratios(OR) and 95% confidence interval(CI) of weekends/holidays and off-hours versus weekdays and on-hours for 2000-2009 and 2010-2020 using a mixed-effect multivariate model adjusted for confounding factors and evaluated interactions. Thereafter, we performed to check for year trends. All endpoints were worse in weekend/holiday admissions for all stroke and in off-hours hospitalization for total stroke(TS), ischemic stroke(IS), and intracerebral hemorrhage(ICH). The adjusted ORs for favorable outcomes of weekend/holiday admissions were TS, 0.90(0.87-0.93); IS, 0.89(0.86-0.93); ICH, 0.91(0.84-0.98) and unfavorable outcome TS, 1.04(1.002-1.08) IS, 1.06(1.01-1.11). Off-hour hospitalization had adjusted ORs for favorable outcome(TS, 0.86 [95% CI: 0.82-0.91]; IS, 0.90 [0.84-0.95]; ICH, 0.85 [0.75-0.96]), unfavorable outcome(TS, 1.14 [1.07-1.22]; IS, 1.13 [1.04-1.23]; ICH, 1.15 [1.01-1.31]), and mortality (TS, 1.15 [1.05-1.26]; IS, 1.17 [1.04-1.32]). For IS, the incidence of unfavorable outcomes during off-hours was significantly lower in 2010-2020 than in 2000-2009; after adjusting for reperfusion therapy, it was no longer significant. Stroke patients admitted on weekends/holidays and off-hours had worse functional and life outcomes. Functional outcomes for off-hour admission for IS improved at 10-year intervals, possibly due to improvements in stroke care systems.

Safety of early discharge after primary percutaneous coronary intervention in low risk ST-segment elevation myocardial infarction presented in a tertiary center without an established STEMI network

Abstract Introduction The application of ST-segment elevation myocardial infarction (STEMI) networks, is a key factor for improvements in outcomes of STEMI patients, leading to earlier treatment, better outcomes and shorter hospital stay. Current guidelines support an early discharge (48-72 h) in selected low risk patients. Yet, this strategy is not routinely applied, especially in centers without an established STEMI network. Purpose To evaluate safety of early discharge in low risk STEMI patients treated with primary PCI by analyzing 30 days outcomes, in a unique tertiary center without an established STEMI network and serving a large area of population. Methods We prospectively collected data from 220 consecutive patients admitted to our center with diagnosis of STEMI, in two different time periods, categorized as low risk according to Zwolle risk score.175 patients were discharged within 72 hours and 45 patients after 72 hours. Follow-up was done by phone call at 30 days. Primary endpoint was occurrence of a major adverse event - a composite of death from cardiac cause, nonfatal myocardial re-infarction, and repeat intervention. Secondary endpoints were death from any cause, residual angina and re-hospitalization. Results The mean age was 58.12 +/-10.32 years. 193 (87%) of patients were male. 118 (53.6%) of them had inferior MI. Mean ejection fraction was 50% +/- 6.04%. Median symptom to hospital arrival time was 5.17 +/- 0.2 hours. Median length of hospital stay was 69.8 +/-17.09 hours. Primary endpoint occurred in 6 (3.4%) patients, all of them in the &amp;lt;72 hours discharge group. 3 patients had cardiac death, 3 had nonfatal MI and eventually 2 of them had repeat intervention. Secondary endpoint occurred in 8 (4.6%) patients in the &amp;lt;72 hours discharge group and 1 (2.2%) patient in the &amp;gt;72 hours discharge group, all of them having residual angina. Conclusion In low risk STEMI patients treated with successful primary PCI, data from our study suggest that an early discharge strategy within 72 hours is associated with comparable outcomes regarding major adverse events compared to late discharge strategy.

Abstract 237: Effect of Hospital Arrival Time on Mortality Rate in Pediatric Patients With Severe Trauma: A Nationwide Database Study in Japan

Introduction: Previous studies have reported that hospital arrival during nighttime was associated with worse outcomes in critically ill pediatric patients. However, this “nighttime effect” in pediatric patients with severe trauma has not yet been well-investigated. Hypothesis: We hypothesized that hospital arrival during nighttime is associated with higher mortality rates in pediatric patients with severe trauma. Methods: We conducted a nationwide retrospective cohort study in Japan from 2004 to 2019 using the Japan Trauma Data Bank, a nationwide trauma registry. Patients who were aged &lt;18 years and had an Injury Severity Score (ISS) &gt;15 were included. Patients with cardiac arrest on hospital arrival were excluded. Hospital arrival was categorized into daytime (from 8:00 am to 4:59 pm) arrival and nighttime (from 5:00 pm to 7:59 am) arrival. The main outcome was the in-hospital mortality rate, and the secondary outcome was the emergency department (ED) mortality rate. As a main analysis, an inverse probability of treatment weighting (IPTW) analysis was performed using propensity scores to adjust for confounders such as age, sex, type of injury, transport time, vital signs, and ISS. In addition, we conducted 1) a subgroup analysis in patients who underwent operation (OP) or interventional radiology (IR) during hospitalization and 2) sensitivity analysis using a multilevel mixed-effects logistic regression model. Results: In total, 6,574 pediatric patients with severe trauma were included, and the overall in-hospital mortality rate was 6.5%. The IPTW analysis showed that compared with daytime arrivals, nighttime arrivals were associated with significantly higher in-hospital mortality (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.09-1.83; P = 0.010) and ED mortality rates (OR, 2.42; 95% CI, 1.07-5.45; P = 0.034) in the entire cohort but not in the subgroup who underwent OP or IR during hospitalization. The sensitivity analysis consistently supported the results of the main analysis. Conclusions: Hospital arrival during nighttime was associated with a higher in-hospital mortality rate in pediatric patients with severe trauma. Further investigations are needed to elucidate the reasons for this “nighttime effect.”

Association Between Hospital Arrival Time and Avoidable Transfer in Pediatric Trauma

BackgroundAvoidable transfers (AT) in pediatric trauma can increase strain on healthcare resources and families. We sought to identify characteristics of patients and their injuries that are associated with AT. MethodsA multicenter retrospective cross-sectional study of the regional Trauma Registry was conducted from 1/1/10–12/31/21 of children <18 years-old who experienced an interfacility transfer. AT was defined as receiving hospital length of stay (LOS) < 48 hrs without procedure or intervention performed. Patient demographics, mechanism of injury, and arrival time were analyzed with descriptive statistics. A multivariable logistic regression was performed to analyze demographic and clinical factors associated with AT. ResultsWe included 5438 trauma transfers, of which 2187 (40.2%) were AT. Patients experiencing AT had a median [IQR] age of 5 years [1–12] and most were male (67%) and Hispanic/Latino (46.3%). The odds of experiencing AT decreased as age increased and were less likely in females and Non-Hispanic Black children. Injuries from falls (ground level (OR = 2.48; 95%CI = 1.89–3.28) and >10 ft (OR = 3.20; 95%CI = 2.35–4.39)), sports/recreational activities (OR = 2.36; 95%CI = 1.78–3.16), MVCs (OR = 1.44; 95%CI = 1.05–1.98), and firearms (OR = 1.74; 95%CI = 1.15–2.62) were associated with an increased odds of AT. Time of arrival at the receiving facility in early hours (00:00–07:59) (OR = 1.48; 95%CI = 1.24–1.76) and evening hours (17:00–23:59) (OR = 1.75; 95%CI = 1.47–2.07) were associated with an increased odds of AT. ConclusionYounger patients, injuries from falls, sports/recreational activities, MVCs, and firearms as well as arrival time outside of standard work hours are more likely to result in AT. Knowing these results, we can begin working with our referral centers to improve communication and strengthen institutional transfer criteria for pediatric trauma patients. Further investigation will then be needed to determine if the changes implemented have influenced care and lowered rates of avoidable transfer. Level of evidenceLevel III.

313 Audit of adherence to the National Standards of acute stroke metrics in a tertiary hospital in Dublin, Ireland

Abstract Background Acute stroke is a medical emergency defined as a sudden neurological event of vascular origin caused by decreased cerebral perfusion, preventing oxygen and nutrient supply to parts of the brain, leading to neuronal cell death. The annual cost for the management of stroke patients in Ireland is approximately €489–€805 million. Treatment of ischaemic stroke is very time-dependent and the two main therapies currently available, are intravenous thrombolysis with tissue plasminogen activator (tPA), and endovascular thrombectomy. The aim of this study is to assess the adherence to key performance parameters, but not limited to, such as the onset of symptoms to hospital arrival, time of hospital arrival to imaging, time of hospital arrival to tPA, and time of symptoms onset to recanalization in a tertiary stroke unit as compared to the 2021 Irish National Audit of Stroke report. Methods We carried out a retrospective chart review of 100 stroke patients admitted from 1st January 2022 until 31 December 2022 who were identified using The Hospital In-Patient Enquiry (HIPE). We accessed various hospital sources including PIPE, thrombectomy software, McKesson Radiology and medical charts to retrieve data of interest. This audit was registered with the Hospital Audit Office (CA 2023/112). Results We report here a thrombolysis rate of 18% with 75% receiving tPa within 1 hour of hospital arrival compared to 10% and 56% reported by INAS, respectively. The median door-to-image and door-to-needle for Beaumont Hospital were 24 mins and 42 mins compared to 63 mins and 43 mins reported by INAS, respectively. Conclusion Beaumont Hospital is compliant and performs higher compared to the national average. Inclusion of more study participants is needed to confirm the findings of this report.

Attitude of Emergency Medical Technicians Toward Electrocardiogram - Needs of Electrocardiogram Training Courses and Other Learning Opportunities.

Early intervention in prehospital settings is important for treating patients with acute coronary syndrome (ACS). Emergency medical technicians (EMTs) are the essential first responders who treat these patients, and their current attitudes towards electrocardiograms (ECGs) have not been identified. This study investigated the awareness of EMTs of ECGs to shorten hospital arrival time, improving patient prognosis. An anonymous questionnaire survey, with 27 statements about ECG and ACS response, was administered to 395 EMTs. The statements were related to interest, motivation, learning status, confidence, and norms pertaining to ECGs, a sense of perceived behavioral control, and training courses. The primary outcome was the perception of EMTs that their interpretation of an ECG affected patient prognosis (Statement [S] 1). Participants assigned scores for each statement using a scale ranging from 1 (strongly disagree) to 10 (strongly agree). The mean score for S1 was 7.09. Mean scores for statements regarding confidence and learning status were 3.96 and 3.53, respectively. The participants had a positive impression of training courses (score >5.5). The EMTs experience was that their interpretation of an ECG could affect the prognosis of patients with ACS. Conversely, they lacked confidence reading ECGs, but were willing to attend ECG training courses. Therefore, efficient training programs need to be established to achieve a better prognosis for ACS patients.

The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes.

This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. The study incorporated cases that included the OHCA's building floor information. The primary outcome assessed was survival to discharge, analyzed using multivariate logistic regression, and the secondary outcome was favorable neurological outcome. Among 36,977 patients, a total of 29,729 patients were included, and 1680 patients were survivors. A weak yet significant correlation between floor level and hospital arrival time was observed. Interestingly, elevated survival rates were noted among patients from higher floors despite extended emergency medical service response times. Multivariate analysis identified age, witnessed OHCA, shockable rhythm, and prehospital return of spontaneous circulation (ROSC) as primary determinants of survival to discharge. The floor level's impact on survival was less substantial than anticipated, suggesting residential emergency response enhancements should prioritize witness interventions, shockable rhythm management, and prehospital ROSC rates. The study underscores the importance of bespoke emergency response strategies in high-rise buildings, particularly in urban areas, and the potential of digital technologies to optimize response times and survival outcomes.

Intravenous Thrombolysis Increases the First Pass Effect for Large Vessel Occlusion Treated With Mechanical Thrombectomy

Background It remains unclear whether intravenous thrombolysis (IVT) influences the incidence of the first pass effect (FPE) in patients with acute large vessel occlusion treated with mechanical thrombectomy (MT). Therefore, this study investigated the effects of IVT on FPE in patients treated with MT. Methods This is a post hoc analysis of the SKIP (Direct Mechanical Thrombectomy in Acute LVO Stroke) study, which was an investigator‐initiated, multicenter, randomized, open‐label clinical trial performed in 23 hospital networks in Japan from January 1, 2017, to July 31, 2019. Among 204 patients, 24 were excluded because they did not undergo MT. Patients treated with MT alone were compared with those treated with MT+IVT for the incidence of FPE (achieving a modified treatment in cerebral ischemia score of 2c or 3 after the first MT pass). Additional subgroup analyses were performed to investigate factors more closely related to the association between IVT and FPE. Results Among the 180 patients, 91 were treated with MT alone and 89 were treated with MT+IVT. FPE was achieved in 56 patients (31.1%). The incidence of FPE was significantly higher in patients treated with MT+IVT than in those treated with MT alone (39.3% versus 23.0%, respectively; P =0.02). In the subgroup analyses, IVT markedly increased FPE in female patients and tended to increase FPE in patients with first‐segment middle cerebral artery distal occlusion and onset to hospital arrival time &gt;100 minutes. Conclusion IVT using alteplase increased the incidence of FPE in Japanese patients with acute ischemic stroke treated with MT. Trial Registration : Trial registration umin.ac.jp/ctr identifier: UMIN000021488

Pre-Hospital Delaying Factors in Patients of Acute Ischemic Stroke who are Candidates for Thrombolytic Therapy

Objective: To identify and statistically evaluate pre-hospital delaying factors for thrombolysis in Acute Ischemic Stroke (AIS).&#x0D; Study Design: Cross-sectional study.&#x0D; Place And Duration OF Study: Emergency/Neurology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2020 to Mar 2021.&#x0D; Methodology: Patients older than 18 years and who reported to the emergency/Neurology clinic with stroke symptoms were included in the study. The patients or their relatives were interviewed with a detailed questionnaire that recorded patients' National Institute of Health Stroke Scale and other socio-demographic variables. In addition, the patients were grouped based on time of arrival to the hospital: Early (&lt;4.5 hours) and Late (&gt;4.5 hours), and the variables recorded were compared with each other.&#x0D; Results: Of 98 patients, 71(72.5%) arrived early, and 27(27.5%) arrived late. Seventy patients (72%) were male, and 28(28%) were female. Only 18 patients availed of the ambulance service, whereas the rest of the study participants reached the hospital using private transportation.&#x0D; Conclusion: Female gender, NIHSS score of 10 or below and using transport other than ambulance adversely affect the hospital arrival time of acute ischemic stroke patients.

Relationship Between Time of Hospital Arrival and Clinical and Fluid Biomarker Outcomes in Traumatic Brain Injury (P14-7.003)

<h3>Objective:</h3> Identify variables related to delayed emergency department (ED) presentation after traumatic brain injury (TBI). <h3>Background:</h3> Delayed presentation to ED after TBI may differ based on demographic and clinical variables and may confound interpretation of clinical assessments and blood biomarker testing. <h3>Design/Methods:</h3> Patients with non-penetrating TBI were enrolled after admission to an urban trauma center. Time between injury and ED arrival was categorized as &lt;1 hour, 1–6 hours, and &gt;6 hours. Blood was drawn on Day 1, Day 3, 2 weeks, and 6 months post-injury and analyzed using Simoa HD-X Neuro4plex assay for NfL, GFAP, and UCH-L1 levels. Demographic variables and clinical outcomes by arrival time category were assessed with Chi-Square or Kruskal-Wallis tests. For fluid blood-biomarkers, log2 levels were compared between arrival time categories using one-way ANOVA. <h3>Results:</h3> 187 individuals with TBI (mean age 47.7 years, 71% male, 50% white, and median Glasgow Coma Score (GCS) of 15) were included in this analysis. 60% arrived in &lt;1 hour, 24% 1–6 hours, and 11% &gt;6 hours (only 3% presented &gt;24 hours after injury). There were significant differences by arrival time categories by injury mechanism, with 84% motor vehicle incidents presenting within an hour (χ²=27.6, <i>p</i>&lt;0.001). Additionally, younger patients (H=13.6, <i>p</i>=0.001), and Black individuals (χ²=17.2, <i>p</i>=0.002), also were most likely to arrive within an hour. There were no differences in arrival time category by sex, head CT findings, or GCS. For blood-biomarkers, there were no differences between arrival time categories for NfL, UCH-L1, and GFAP. <h3>Conclusions:</h3> Mechanism of injury, age, and race are identifiable factors that may influence both arrival time at ED and clinical outcomes and interpretation of biomarker results after TBI. Since our cohort mostly presented within 12 hours, and CT and biomarker results were not influenced, future research should focus on a small cohort of patients with ED presentation beyond 12 hours. <b>Disclosure:</b> Mr. Anandarajah has nothing to disclose. Alexa Walter has nothing to disclose. Dr. Gugger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceribell. The institution of Dr. Gugger has received research support from American Epilepsy Society. Cillian Lynch has nothing to disclose. Dr. Schneider has nothing to disclose. The institution of Dr. Sandsmark has received research support from NINDS. Dr. Diaz-Arrastia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ischemix, Inc. Dr. Diaz-Arrastia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pinteon Therapeutics. Dr. Diaz-Arrastia has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BrainBox, LLC. Dr. Diaz-Arrastia has received stock or an ownership interest from BrainBox, LLC. Dr. Diaz-Arrastia has received stock or an ownership interest from NovaSignal . Dr. Diaz-Arrastia has received stock or an ownership interest from Nia Therpeutics. The institution of Dr. Diaz-Arrastia has received research support from National Institutes of Health. The institution of Dr. Diaz-Arrastia has received research support from Department of Defense.

Epidemiology and clinical features of venomous snake bites in the Northern Amazon of Ecuador (2017-2021)

Introduction: In Ecuador, poisonous snakebites are a public health problem. However, there is no recent hospital information from the Amazon. Objective: To retrospectively analyse the clinical-epidemiological characteristics of snakebites in patients admitted to a hospital in the Ecuadorian Amazon. Materials and methods: This is a cross-sectional study conducted at the Nueva Loja-Sucumbíos Provincial Hospital, bordering Colombia (2017-2021). Demographic, epidemiological and clinical variables, and condition at hospital discharge, were obtained from the epidemiological file of the Ministerio de Salud Pública. Results: In 5 years, 147 patients (29.4 per year) were hospitalized with no mortality. They corresponded to 26, 34, 32, 29 and 26 cases, in 2017, 2018, 2019, 2020 and 2021, respectively. Men with 99 (67.3%), aged 21-30 years with 28, mixed race with 94 cases, students, and farmers, were the most affected. The most affected (99; 67.3%) were men, people 21 to 30 years-old (28; 19.0%), mestizos (94; 63.9%), students, and farmers. The median age was 28 (range: 4-81) years. Prevalence was higher in April, June, and September. All accidents were caused by Viperidae snakes. Twenty (13.6%) cases were mild, (61.2%) were moderate and 37 (25.2%) were severe. The feet with 45 were the most bitten. Pre-hospitalization anti-venom serum was received by 53.1% and tourniquet by 19.8% patients. Median hospital arrival time was 5 (range 1-192) hours, mostly between 2-3 hours with 41 cases. No statistically significant differences were found considering the severity. Conclusions: A high prevalence of snakebites was evidenced in the north of the Amazon in Ecuador, with a higher incidence in the rainy season and all by Viperidae species. It is important to highlight the null mortality. Information campaigns on prevention and first aid, such as discouraging the use of tourniquets, especially among vulnerable groups.

The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand.MethodsThis retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018–December 31, 2019, and January 1, 2020–December 31, 2021, respectively.ResultsA total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =− 6.0, 95% confidence interval [CI] − 4.1, − 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36–8.27; p value < 0.001), and 6.88 min (95% CI 4.55–9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50–3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58–1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic.ConclusionsIn the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.

Evaluation of the demographic, etiological &amp; the costs of drug intoxication

Cases of intoxication are among the common medical emergencies. Cases of suicidal drug intoxication are more common among young people. Based on this information, our study aimed to identify the demographic and etiological characteristics of cases of drug intoxication and their costs to the social security institution. The files of patients diagnosed with drug intoxication in the adult emergency department of Kahramanmaraş Sutcu Imam University Medical Faculty Hospital between 01.01.2022 and 31.12.2022 were reviewed retrospectively from the automation system. In our study, the data of 110 patients admitted to the emergency department with a clinical picture of drug-related intoxication were evaluated. 75.5% of the patients were female and 40% of them were in the 18-24 age group. It was determined that 92.7% of the patients took the drug that caused intoxication for suicidal purposes and that psychiatric agents constituted a significant part of the drugs taken. Treatment costs increased significantly in cases of suicidal drug intake and multiple drug intake. The length of hospital stay and the cost of treatment increased as the time between the time of drug intake and the hospital arrival time increased. Most of the drug-related intoxications occurred due to suicidal intake. Most of the drugs used for this purpose were analgesics and psychiatric drugs. Emergency departments are the first places where patients with drug intoxication are evaluated, and all physicians working in the emergency department should know the approach to intoxication very well.