Journal of Emergency Practice and Trauma

Abstract Background: Trauma-related injuries are a leading cause of hospitalization and mortality worldwide. In response to trauma, pathological and anti-inflammatory processes occur, characterized by an increase in neutrophils and a decrease in lymphocytes. This study aimed to assess the prognostic value of the Neutrophil-to-Lymphocyte Ratio (NLR) in predicting outcomes in multiple trauma patients, focusing on hospital stay length and mortality.
Methods: The study included 474 adult trauma patients (ages 14 to 80) who presented to the Trauma Center of Qazvin Province in the first half of 2024. The Injury Severity Score (ISS) was used to classify patients, and data from Complete Blood Count (CBC) and Differential Count (Diff) tests were collected. Statistical analysis was conducted using the Kolmogorov-Smirnov test for data normality, the Chi-square test for qualitative variables, and Pearson’s correlation coefficient for quantitative variables. Data analysis was done using SPSS version 16.
Results: The 67.7% of patients were male, and the mortality rate was 9.72%. The average NLR was 3.9, with a cutoff point identified by maximizing the Youden Index. Cox regression analysis showed that NLR > 3.9 was significantly associated with prolonged hospital stays and ICU admissions (P < 0.001, P < 0.004). Additionally, 69% of the patients who died had an NLR greater than 3.9 (P < 0.001).
Conclusion: In conclusion, NLR > 3.9 serves as a reliable prognostic marker for adverse outcomes, including prolonged hospitalization and increased mortality. The NLR is a simple, cost-effective tool that could be implemented in clinical settings to predict patient prognosis and guide more effective interventions. Further research is needed to confirm these findings and investigate the mechanisms by which NLR influences trauma outcomes.

Abstract Abstract:
Background: Anaphylaxis is a life-threatening systemic hypersensitivity reaction of increasing global incidence. Regional epidemiological data on triggers and management are essential for improving outcomes. No previous study has investigated this condition in Iran's Sistan and Baluchestan province. This study aimed to characterize the clinical manifestations, causes, and management of anaphylaxis in emergency departments in Zahedan, Iran.
Methods: This cross-sectional study enrolled 78 patients diagnosed with anaphylaxis using standard criteria who presented to Zahedan University of Medical Sciences emergency departments in 2023. Data on demographics, triggers, clinical features, and treatment were collected via checklist and analyzed using SPSS version 26, with p<0.05 considered significant.
Results: Patients' mean age was 26.6±17.6 years, with 52.6% female. Most reactions occurred at home (62.8%). Medications and insect stings were the most common triggers (32.9% each), followed by food (27.3%). Cutaneous (83.3%) and respiratory (78.2%) symptoms predominated. Intravenous fluids (88.5%), antihistamines (85.9%), and steroids (76.9%) were most frequently administered. Epinephrine was used in 65.4% of cases, with recipients being significantly younger than non-recipients (24.6±16.6 vs 31.2±19.1 years, p=0.048). Most patients (42.3%) recovered completely in the emergency department with no fatalities.
Conclusion: Insect stings and medications are the predominant anaphylaxis triggers in this region. The high prevalence of cutaneous and respiratory symptoms requires heightened clinical suspicion. Suboptimal epinephrine use indicates a critical management gap, necessitating improved guideline adherence and enhanced education for healthcare professionals and the public.

Abstract Objective: The central Pyrenees form the natural border between France and Spain and attract many outdoor enthusiasts. Cross-border mountain rescues are frequent, yet their medical and logistical consequences remain poorly described. We aimed to quantify the incidence of cross-border rescue victims and assess their hospital pathways, satisfaction, and practical difficulties during care abroad.
Methods: We conducted a retrospective bicentric study (RESCAPYR study) including all consecutive cross-border mountain rescue patients in 2018–2019 (n = 150). Data were obtained from rescue and hospital records. Patients referred to a healthcare facility were contacted for follow-up interviews assessing satisfaction and reported difficulties. Categorical variables were compared using the Chi-square or Fisher’s exact test, continuous variables using the Mann–Whitney U test, and paired satisfaction scores using the Wilcoxon signed-rank test.
Results: In France, 54 Spanish nationals were rescued over two years (5.1–5.6% of annual rescues), while in Spain, 96 French nationals were rescued (12.0–17.2%). Approximately two-thirds required hospitalization in the neighboring country. Median hospital stay was 2 days [1–4] for Spanish patients and 1 day [1–2] for French patients. Satisfaction significantly decreased between the prehospital and hospital phases (p = 0.01 and p < 0.01), without differences between groups. Patients from both countries reported similar difficulties, mainly language barriers, financial concerns, and repatriation challenges.
Conclusion: Cross-border mountain rescues frequently result in hospitalization outside patients’ national healthcare systems and expose them to administrative and communication barriers. Improved cross-border coordination and structured emergency transfer agreements are needed in border regions.