Journal of Emergency Practice and Trauma

Abstract Objective: 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: Approximately 38% of children under the age of 5 years, 24% adolescents in India are underweight, indicating chronic malnutrition. Undernutrition has been associated with immunosuppression and increased susceptibility to infection and poor prognosis. Prognostic Nutrition Index (PNI) is an objective indicator calculated using serum albumin level and lymphocyte count . Lu y et al conducted a retrospective study on relationship between Prognostic Nutritional Index and All-Cause Mortality in 5800 Critically Ill patients and concluded that PNI was an independent, inverse predictor of both short and long term all cause mortality in ICU patients, highlighting its value as a simple, objective nutritional-immune indicator in critical care
OBJECTIVES :To assess the role of prognostic nutritional index as a severity marker in mechanically ventilated children.
MATERIALS AND METHODS: A cross sectional study was conducted in Paediatric intensive care unit (PICU) of M S Ramaiah hospital, Bangalore. All the children who met the inclusion criteria were taken . PNI was calculated using the formula 10 x serum albumin (g/dl) +0.005 x total lymphocyte count (mm3). All critically ill children admitted to PICU during study period were included. Total of 186 subjects were included , out of which 93 were mechanically ventilated and 91 were non mechanically ventilated critically ill children. Data record analysis was done and PNI was calculated. Out of 93 mechanically ventilated children 34 died. PNI was used to assess the outcome and severity.
RESULTS :The mean PNI was low among non survivors when compared to survivors (48 vs 52) however there was no statistical significance (p= 0.2). The mean PNI for ventilated patients (47.02) is significantly lower than that for non-ventilated patients (56.85), with a p-value of 0.002, indicating statistical significance . PNI also had a weak positive co relation with length of hospital stay(r=0.032,p=0.75) and Paediatric risk of mortality III (PRISM 3) score( r=0.105)
CONCLUSION: PNI has a role in assessing severity of illness in critically ill children especially among mechanically ventilated.

Abstract Abstract:
Objective: 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 CAD patients.
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; comparisons used t-test for means and χ² test for proportions. Significance was set at 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 to aspirin sensitive patients, those resistant 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:


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 Abstract :
Background:
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 attending 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 entailed 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
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 response to disasters and emergencies.
Methods
This study used a mixed-method design. In the first stage, a domain review was conducted. 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 and CVR were calculated.
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: Traumatic hemothorax (HT) or intrapleural bleeding is not so rare complication of thoracic trauma, so the aim was to present 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 Thoracic Surgery Department or Intensive Care Unit of University Clinical Centre of Kosovo, Prishtina, in period of 3 years. The patients with HT were assessed on the nature and mechanism of thoracic trauma, complexity of thoracic trauma, joint intra and extra-thoracic injuries, surgical therapy, complications, and mortality.
Results: There were 136 (20.0%) out of 681 patients with HT, out of these 22 (16.2%) were children. 70 (51.5%) had suffered from HT after blunt thoracic trauma; 66 (48.5%) had HT with penetrating thoracic trauma. Majority were male 129 (95.0%), and only few were female patients (n=7; 5.0%). The main etiologic factors were traffic accidents, falls and attacks by firearm or stab wounds. Surgical therapy consisted of observation, thoracentesis, thoracostomy tube drainage, rarely there was a need for applying urgent thoracotomy (8.1%). Elective thoracotomy happened in 2.2% and decortications in 6.6% of cases.
Conclusion: Thoracic trauma required careful surveillance to take actions in time for patients who needed surgery correction. Presence of any of associated HT injuries triggered a suspicion of possible complications and contributed to the longer length of stay in the intensive care unit.

Abstract 【Objective】
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), and we review 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 CPR with intubation and mechanical ventilation were initiated. Veno-arterial ECMO was established 56 min after 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). 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 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 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 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 Background: 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 Objective: 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 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 included. According to the sample size of 20 per group, 40 patients were included and allocated per 4-block randomization to the control group (n=20), receiving only local anesthesia and the intervention group (n=20), receiving local anesthesia with addition of a modified intercostal block with lidocaine in the posterior axillary line in supine position. Pain intensity was assessed via Visual Analogue Scale for pain during and one hour after the procedure. One-way analysis of variance was used for normally distributed continuous variables, while Mann-Whitney-U test was used for non-normally distributed continuous variables. Comparisons of categorical variables were performed using χ2 test or Fisher test as appropriate. P < .05 was considered statistically significant. Clinical significance was defined as a decrease of ≥ 1 point in VAS for pain.
Results: Forty patients completed the study with a mean age of 41.1±16.06 years, including 30 males (75%). Visual Analogue Scale Score for pain during the procedure was 8.26 in the intervention group in comparison to 9.05 in the control group, showing a non-significant reduction of 0.79 in pain intensity (p-value=0.17). Visual Analogue Scale Score for pain one hour after the procedure was 5.57 in the intervention group in comparison to 6.63 in the control group, showing 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 of pain after chest tube insertion. Higher efficacy might be achievable with adding ultrasound guidance or simultaneous block of the collateral branch of the intercostal nerve in the superior border of the ribs.