Journal of Emergency Practice and Trauma

Abstract Neglect, the ongoing failure to meet a child’s basic needs, is one of the most common forms of maltreatment and typically appears in four main forms: physical neglect, which involves not providing basic necessities such as supervision, food, clothing, shelter, or hygiene; educational neglect, which is the denial of a child’s legal right to education; emotional neglect, which includes withholding emotional support or subjecting a child to humiliation, isolation, or intimidation; and medical neglect, where caregivers fail to provide appropriate health and dental care, including ignoring medical advice or refusing vaccinations
Safeguarding children with chronic illnesses and disabilities requires a collaborative, multidisciplinary effort involving healthcare professionals, educators, caregivers, and the wider community. These children's unique vulnerabilities necessitate close observation, culturally sensitive communication, and timely, ethical interventions when abuse or neglect is suspected. Regular screenings, detailed documentation, and teamwork across sectors are critical for early detection and response. Furthermore, addressing underlying social determinants and promoting preventive education both within healthcare settings and in the broader community are key strategies to reduce risk and build resilience.

Abstract Addressing violence in emergency centers, also known as Emergency Departments or EDs, is essential for ensuring the safety of staff, improving patient care, and maintaining efficient operations. Violence can take many forms, including physical, verbal, or psychological, and it can occur from patients, visitors, or even between patients. Violence against healthcare workers (HCWs) in emergency departments (EDs) is at epidemic levels, resulting in serious physical, psychological, and operational repercussions. A comprehensive strategy that integrates prevention, mitigation, and support methods is necessary for successful protection.
The integration of environmental safeguards, proactive risk assessment, staff empowerment, and systemic cultural transformation is necessary in order to reduce violence in the emergency department.
Combining these features into programs results in fewer incidents and a better sense of safety. Furthermore, ongoing success depends on institutional commitment, ongoing training, and community involvement to make sure HCWs can practice their profession anxiety. .
This article contains a well-structured approach to reduce the risk of violence, organized around prevention, response, and organizational culture.

Abstract Introduction: Parkinson’s disease (PD) is one of the most common movement disorders. Some
studies have reported cerebral hemodynamic abnormalities in patients with Parkinson’s disease.
This study aimed to measure cerebrovascular reactivity in patients with Parkinson’s disease and
to examine its relationship with the Unified Parkinson’s Disease Rating Scale scores.
Methods: In this case-control study was conducted on 36 patients with Parkinson’s disease
and 36 age- and gender-matched healthy individuals as the control group in 2022. Sampling
was performed with the convenience method. Transcranial Doppler was performed to measure
the mean flow velocity of the middle cerebral artery at rest and after the apnea test. The
Unified Parkinson’s Disease Rating Scale was administered to patients, and the results were
statistically analyzed.
Results: The Breath-Holding Index (BHI) was 1.02 ± 0.19 and 0.714 ± 0.14 in the control
and patient groups, respectively, indicating a statistically significant difference (P < 0.001) .
Also, BHI showed a statistically significant relationship with all questionnaire items and the
questionnaire’s total score.
Conclusion: Cerebrovascular reactivity decreased in patients with PD, and this decrease was
correlated with clinical findings.

Abstract Introduction: Low back pain ranks among the most prevalent musculoskeletal disorders worldwide. It greatly affects the quality of life and contributes to higher rates of work absenteeism. Traditional treatment usually involves nonsteroidal anti-inflammatory drugs (NSAIDs), but there is a growing interest in complementary therapies like acupressure and reflexology as additional options.
Objective: This study aimed to assess the effectiveness of merging acupressure and reflexology with conventional NSAID treatment in alleviating pain intensity in nonspecific low back pain in patients presenting to the emergency department (ED).
Methods: This prospective cohort study, conducted at a tertiary center from May 2021 to May 2023, involved 81 patients with nonspecific spasmodic low back pain, who were sequentially assigned to either a control group (NSAID therapy alone, n = 41) or a combined therapy group (NSAIDs plus a 30-minute session of acupressure and reflexology, n = 40). All individuals were administered 30 mg of intramuscular ketorolac tromethamine. The acupressure and reflexology intervention included the stimulation of Nei Guan (P6), He Gu (LI4), Zu San Li (ST36), and the lower medial arch of the foot. Pain intensity was assessed with the Short-Form McGill Pain Questionnaire (SF-MPQ) at baseline and 24 hours following the intervention. Statistical analysis utilized the Mann-Whitney U and Wilcoxon signed-rank tests, with a significance threshold at P < 0.05.
Results: Baseline pain scores did not differ significantly between groups. However, the combined therapy group exhibited a significantly greater reduction in pain (mean difference: 3.85 ± 2.14) compared to the control group (mean difference: 1.27 ± 1.78, P < 0.001).
Conclusion: The integration of acupressure and reflexology with standard NSAID therapy may provide enhanced pain relief for patients with nonspecific low back pain in the ED. Further multicenter studies with larger sample sizes and longer follow-up periods are recommended to confirm these findings and assess long-term benefits.

Abstract Introduction: Critically ill patients encounter significant health problems, which are reflected in the morbidity and mortality rates in intensive care units (ICUs). The prognostic nutritional index (PNI), which gauges immunological and nutritional health, is increasingly recognized as a significant predictor of outcomes in critical care units. The present study aimed to assess the prognostic nutritional index as a marker of severity in mechanically ventilated children.
Methods: This retrospective cross-sectional study was conducted from January 2023 to October 2024 in the Paediatric Intensive Care Unit (PICU) of M S Ramaiah Medical College Hospital, Bangalore. All critically ill children admitted to the PICU during the study period were included. Purposive sampling was used; 184 consecutive critically ill children (93 were mechanically ventilated and 91 were non-mechanically ventilated) were included. Retrospective case record data collection was performed using a demographic questionnaire, including Paediatric Risk of Mortality III (PRISM-3) scoring and complete blood counts. The data were analysed using SPSS 22 software. Statistical analysis, including Pearson correlation, was used to evaluate the association between the prognostic nutritional index and the severity of illness. P-values < 0.05 were considered significant.
Results: The mean PNI for ventilated patients was 47.01, which was significantly lower than that for non-ventilated patients (56.84; P = 0.002). PNI also showed a weak positive correlation with length of hospital stay (r = 0.03282, P = 0.7548) and PRISM-3 score (r = 0.105). The mean PNI was lower among non-survivors than among survivors (48.35 vs. 52.73), but the difference was not statistically significant (P = 0.298).
Conclusion: Our findings highlight that, at admission, PNI is a weak severity indicator among mechanically ventilated children.

Abstract Introduction: Traumatic hemothorax (TH) is not a rare complication of thoracic trauma. This study aimed to assess the incidence of this complication among injured patients and assess it as an indicator of severity.
Methods: A retrospective study comprised 681 injured patients with thoracic trauma admitted to the Thoracic Surgery Department or Intensive Care Unit of the University Clinical Centre of Kosovo, Prishtina, during a period of three years (from July 2019 to June 2022). Trauma severity was assessed using indirect clinical indicators, including length of hospital and ICU stay, need for surgical intervention (thoracic drainage and urgent or elective thoracotomy), presence of associated intra- and extra-thoracic injuries, occurrence of complications, and in-hospital mortality.
Results: Traumatic hemothorax was identified in 136 of 681 patients with thoracic trauma (20.0%). Hemothorax occurred more frequently in penetrating than blunt thoracic trauma (37.7% vs. 13.8%; P < 0.01). Definitive surgical treatment was required in 16.9% of patients with TH, including urgent thoracotomy in 8.1%. Patients with intrapleural bleeding had a significantly longer hospitalization stay compared to patients without hemothorax (20.6 ± 17.4 vs. 9.4 ± 10.4 days; P < 0.001), indicating increased trauma severity.
Conclusion: Careful surveillance was necessary for thoracic trauma patients to ensure timely action would be taken for patients who required surgical intervention. Presence of any of the associated TH injuries triggered a suspicion of possible complications and contributed to the longer length of stay in the intensive care unit.

Abstract Introduction: Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide. Aspirin is a cornerstone in CAD management due to its antiplatelet effects; however, aspirin resistance can lead to suboptimal outcomes. In Iran, limited data exist regarding the prevalence of aspirin resistance among patients presenting with chest pain. This study aimed to determine the prevalence of aspirin resistance and its clinical implications in a cohort of Iranian patients with CAD.
Methods: This prospective cross-sectional study was conducted in 2021 at the Emergency Department of Imam Hossein Hospital, Tehran, Iran. A total of 155 patients aged ≥ 18 years on daily aspirin therapy ( ≥ 75 mg for ≥ 7 days) were recruited using convenience sampling. Bleeding time was measured by the standard SimPlate method (resistance defined as BT < 5 minutes). Normality of variables was tested with the Shapiro–Wilk test; between-group comparisons were performed using the t-test for continuous variables and the χ² test for categorical variables. Statistical significance was defined as P < 0.05.
Results: Among 155 participants (mean age 57.49 ± 13.13 years; 59.4% male), 133 (85.8%) exhibited aspirin resistance. Resistant patients were significantly older than sensitive ones (59.64 ± 12.47 vs. 44.50 ± 9.05 years; P < 0.001). No gender difference was observed (P = 0.363). Compared with aspirin-sensitive patients, resistant patients had higher rates of hypertension (42.1% vs. 18.2%; P = 0.033), diabetes mellitus (42.9% vs. 9.1%; P = 0.003), and hyperlipidemia (32.3% vs. 0%; P = 0.002). Finally, hospitalization was more frequent in resistant patients (81.2% vs. 22.7%; P < 0.001).
Conclusion: These findings indicate that aspirin resistance is prevalent among Iranian CAD patients and is strongly associated with older age and increased cardiovascular risk factors, underscoring its clinical significance. Routine screening for aspirin resistance should be integrated into CAD management protocols, enabling personalized antiplatelet strategies and ultimately improving patient outcomes.

Abstract Introduction: Tube thoracostomy is one of the most painful procedures for trauma patients. Therefore, we aimed to evaluate the effectiveness of a variation of intercostal nerve block in the posterior axillary line in the supine position for trauma patients who are candidates for urgent chest tube insertion.
Methods: For this randomized controlled study, normotensive and conscious trauma patients needing urgent chest tube insertion, admitted to Shahid Beheshti Hospital of Kashan from May 2023 until September 2024, were enrolled. Based on the sample size of 20 per group, 40 patients were included and allocated using 4-block randomization to the control group (n = 20), receiving only local anesthesia, and the intervention group (n = 20), receiving local anesthesia with the addition of a modified intercostal block with lidocaine in the posterior axillary line in the supine position. Pain intensity was assessed using the Visual Analogue Scale during and 1 hour after the procedure. One-way analysis of variance was used for normally distributed continuous variables, while the Mann-Whitney U test was used for non-normally distributed continuous variables. Comparisons of categorical variables were performed using the χ2 test or the Fisher test, as appropriate. P < 0.05 was considered statistically significant. Clinical significance was defined as a decrease of ≥ 1 point on the VAS for pain.
Results: Forty patients with a mean age of 41.1 ± 1 6.06 years , including 30 males (75%), completed the study. The Visual Analogue Scale Score for pain during the procedure was 8.26 in the intervention group, compared with 9.05 in the control group, indicating a non-significant reduction of 0.79 in pain intensity (P-value = 0.17). The Visual Analogue Scale Score for pain one hour after the procedure was 5.57 in the intervention group, compared with 6.63 in the control group, indicating a small but clinically relevant reduction of 1.06 (P-value = 0.07).
Conclusion: A modified intercostal block in the posterior axillary line is feasible in the emergency room, technically simple, and can provide a modest decrease in pain after chest tube insertion. Higher efficacy might be achievable through ultrasound guidance or by simultaneously blocking the collateral branch of the intercostal nerve at the superior border of the ribs.

Abstract Introduction: Hospitals are among the critical infrastructures of society that must continue to provide services under all circumstances. Hospital safety is one of the essential components of disaster and emergency management, and its observance enhances hospital preparedness and maintains its structure and function during crises. To assess the level of readiness and performance of hospitals in dealing with disasters and emergencies, it is necessary to identify and extract the key indicators of hospital preparedness. Therefore, this study aimed to develop and validate a checklist for assessing the preparedness of hospital emergency departments in responding to disasters and emergencies.
Methods: This qualitative study was conducted using a mixed-method approach at Tabriz University of Medical Sciences in 2024–2025. In the first stage, articles related to hospital emergency preparedness in disasters were identified through searches in databases, including Science Direct, Google Scholar, Medline, Web of Science, EMBASE, PubMed, SID, and Magiran. Dimensions and criteria of the preparedness checklist were extracted from these studies. In the second stage, based on the findings from the literature review and expert opinions, a preparedness assessment checklist was developed. To verify content validity, the opinions of 22 experts in the field of disaster and emergency management were obtained and CVI (Content Validity Index) and CVR (Content Validity Ratio) were calculated. To determine reliability, the intraclass correlation coefficient (ICC) was used, and to determine internal consistency reliability, the Cronbach coefficient alpha (Cronbach’s alpha) was calculated for each factor and the entire instrument.
Results: Through qualitative content analysis, a total of 85 items were initially extracted. After reviewing overlaps and evaluating content validity, the number of items was reduced to 79. The results indicated that all items had acceptable CVR values, confirming their appropriateness. Moreover, the CVI values for all items were above 0.79, indicating satisfactory content validity. Reliability testing yielded a Cronbach’s alpha coefficient of 0.83 and an intra-class correlation coefficient (ICC) of 0.82 in the test–retest analysis, confirming the instrument’s internal consistency and stability.
Conclusion: The developed checklist is a valid and reliable tool for assessing the preparedness of hospital emergency departments in dealing with disasters and emergencies. Utilizing this instrument enables managers and policymakers to identify strengths and weaknesses within their emergency departments and take corrective measures to enhance preparedness. Furthermore, it provides a standardized tool for benchmarking and harmonizing hospital emergency preparedness at the national level.

Abstract Introduction: Spinal epidural abscess (SEA) is an uncommon but serious infection that may lead to significant neurological deficits if not promptly diagnosed and treated. This study conducts a systematic review of the current literature to evaluate treatment strategies, including both surgical and nonsurgical approaches. It introduces a novel minimally invasive technique to reduce morbidity compared with traditional open surgery.
Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and evaluated both surgical and nonsurgical treatment strategies for spinal epidural abscess (SEA). We included English-language studies published up to April 2025 that reported original data on SEA management outcomes in human patients. PubMed, Embase, Scopus, and Web of Science were searched using a combination of MeSH and free-text terms. A manual search in Google and Google Scholar was conducted as well. Two reviewers independently screened titles, abstracts, and full texts, extracted data on treatment modalities (surgical vs. nonsurgical), outcomes, and patient characteristics, and assessed study quality and bias using NHLBI tools for observational studies and case series. Any conflicts in opinion were settled through discussion among the reviewers or, when necessary, by consulting a third independent reviewer.
Results: This literature review encompassed 106 eligible studies, spanning from 1957 to 2025. Across the studies, 3143 patients underwent surgical management, and 712 received nonsurgical treatment. Treatment outcomes indicated an average failure rate of 11.7% for surgically treated patients and 34% for those managed non-surgically. Time to symptom resolution, documented in 67 studies, averaged 3.7 months, ranging from several days to over a year.
Conclusion: This systematic review, encompassing 106 studies, reveals that the surgical approach to treating spinal epidural abscess is associated with a markedly lower average failure rate (11.7%) compared to nonsurgical approaches (34%)—even though nonsurgical treatment is typically reserved for milder cases—highlighting the critical importance of timely surgical intervention in reducing mortality, persistent neurological deficits, and relapse.

Abstract Introduction: Traumatic basal ganglia hemorrhage is a rare phenomenon compared with spontaneous hypertensive intracerebral hemorrhage. We aimed to present a rare case of traumatic basal ganglia hemorrhage following a motor vehicle accident and discuss its clinical and radiological features.
Case Presentation: A 59-year-old woman was admitted to the emergency department after a motor vehicle accident with confusion and left-sided weakness. Her Glasgow Coma Scale score was 12. Cranial computed tomography revealed a right basal ganglia hematoma measuring approximately 26 × 20 mm without midline shift or intraventricular hemorrhage. The patient was managed conservatively with antiedema treatment and close neurological follow-up. Follow-up imaging demonstrated gradual hematoma resolution, and the patient recovered without neurological deficit.
Conclusion: Traumatic basal ganglia hemorrhage is an uncommon form of traumatic intracerebral hemorrhage. Careful differentiation from spontaneous hypertensive hemorrhage is essential. Conservative management may provide favorable outcomes in patients without significant mass effect or neurological deterioration.

Abstract Introduction: We report a rare survival case of accidental hypothermia (core temperature 20 °C) with cardiac arrest and an initial rhythm of asystole, in which neurological recovery to the point of verbal communication was achieved after extracorporeal cardiopulmonary resuscitation (ECPR) despite prolonged no-perfusion ( ≥ 30 min) and hypoperfusion times ( ≥ 117 min), reviewing the relevant literature.
Case Presentation: A 78-year-old woman developed hypothermia while descending a snowy mountain and called emergency services at 13:53. Rescue was delayed and she was found around 18:00; she was handed over in asystole at 18:30. During ambulance transport, the rhythm changed to ventricular fibrillation (VF) and eight defibrillations were delivered. She arrived at the emergency department at 19:01 in cardiac arrest with VF; bladder temperature was 20 °C, with no evidence of trauma. Arterial blood gas analysis revealed mixed acidosis. Active surface rewarming and high-quality cardiopulmonary resuscitation (CPR) with intubation and mechanical ventilation were initiated. Veno-arterial extracorporeal membrane oxygenation (ECMO) was established 56 min after emergency department (ED) arrival. After rewarming to 35 °C, she was defibrillated to sinus rhythm. Targeted temperature management was continued for 48 h. ECMO was weaned on day 5 (62 h after initiation). Computed tomography (CT) on day 5 showed acute pancreatitis without hypoxic–ischemic brain injury. She was extubated on day 11, discontinued oxygen on day 16, and resumed oral intake on day 17. Brain magnetic resonance imaging (MRI) on day 36 demonstrated hypoxic encephalopathy with residual higher brain dysfunction. She was discharged on day 151 with a Cerebral Performance Category of 3.
Conclusion: ECPR may be considered for cardiac arrest due to severe accidental hypothermia, even in patients presenting with asystole and prolonged no-perfusion or hypoperfusion times.

Abstract Introduction: This study aimed to report a case of covert carbon monoxide (CO) poisoning presenting with seizure as the sole initial symptom. It also aimed to emphasize the diagnostic difficulty caused by the nonspecific clinical manifestations of CO poisoning. Delayed diagnosis in such cases may lead to serious morbidity or mortality. Therefore, CO poisoning should be considered in patients presenting with unexplained seizures.
Case Presentation: A 32-year-old man with no contributory medical history presented to the hospital with decreased consciousness, seizures, blurred vision, impaired balance, and hearing loss after spending the night alone at home. When he arrived at the hospital, he had hearing loss and balance disturbance. Nasal oxygen therapy (4–6 L/min) was administered. Initial lab results and brain imaging were unremarkable, and a diagnosis of “seizure of unknown origin” was made. A toxicology consultation and fire department inspection revealed CO levels over 150 ppm due to a leak from the central heating system.
Conclusion: This case demonstrates that CO poisoning may present solely with acute neurological symptoms like seizures, without the classic signs of exposure. In patients with unexplained neurological findings, especially those who have spent time in enclosed spaces with central heating, CO poisoning should be considered. Training healthcare staff, increasing public awareness, and using CO detectors are crucial for prevention and timely diagnosis.

Abstract Introduction: The management of anticoagulation in patients with gastrointestinal cancer is complicated by the elevated risk of bleeding, which is amplified by concomitant renal failure affecting the pharmacokinetics of anticoagulant drugs. This case report illustrates the complexities of selecting a safe and effective anticoagulant regimen in this high-risk scenario.
Case Presentation: A 77-year-old male patient with a history of colorectal cancer and chronic kidney disease (creatinine level 2.3 mg/dL) presented with acute dyspnea. Doppler ultrasound confirmed deep vein thrombosis in the left femoral vein. Due to renal impairment, computed tomography pulmonary angiography was contraindicated; a ventilation-perfusion (V/Q) lung scan was performed instead, which diagnosed pulmonary embolism. The primary dilemma was selecting an appropriate anticoagulant that could balance the high risk of recurrent thromboembolism against the heightened risks of drug accumulation and catastrophic gastrointestinal bleeding.
The selection of the therapeutic regimen required a multidisciplinary evaluation involving cardiology, nephrology, and clinical pharmacy experts. To mitigate the risk of drug accumulation while ensuring efficacy, subcutaneous enoxaparin was initiated at a renal-adjusted dose of 60 mg subcutaneously once daily. This approach aimed to provide effective treatment for cancer-associated thrombosis while carefully monitoring the patient’s clinical status in the setting of severe renal impairment.
The patient was discharged on this regimen and completed a full 6-month course of enoxaparin without any thromboembolic or bleeding complications. At the 9-month follow-up, the patient remains asymptomatic and off anticoagulants. Based on recent colonoscopy findings showing no active disease or residual mass, the patient requires no further surgical intervention or anticoagulant therapy, demonstrating an excellent clinical outcome.
Conclusion: This case underscores the need for a tailored, multidisciplinary approach to anticoagulation in patients with gastrointestinal cancer, thromboembolic disease, and renal insufficiency. Low-molecular-weight heparin (LMWH), alongside careful dose adjustment and continuous monitoring, represents a viable therapeutic option in this complex patient population.