The largest non-nuclear blast in modern history took place on August 4, 2020, at 6:07 PM in Beirut, Lebanon, after an estimated 2750 tons of unsafely stored ammonium nitrate exploded. The physical ...and social impacts of this catastrophic event coinciding with the coronavirus disease (COVID-19) pandemic were massive. This article describes the national and international emergency responses to this event and highlights the impact of the explosion on the health care sector in Lebanon. Challenges noted during this response with recommendations for improving response to future disasters are also described.
There is paucity of information regarding electronic medical record (EMR) implementation in emergency departments in countries outside the United States especially in low-resource settings. The ...objective of this study is to describe strategies for a successful implementation of an EMR in the emergency department and to examine the impact of this implementation on the department's operations and patient-related metrics.
We performed an observational retrospective study at the emergency department of a tertiary care center in Beirut, Lebanon. We assessed the effect of EMR implementation by tracking emergency departments' quality metrics during a one-year baseline period and one year after implementation. End-user satisfaction and patient satisfaction were also assessed.
Our evaluation of the implementation of EMR in a low resource setting showed a transient increase in LOS and visit-to-admission decision, however this returned to baseline after around 6 months. The bounce-back rate also increased. End-users were satisfied with the new EMR and patient satisfaction did not show a significant change.
Lessons learned from this successful EMR implementation include a mix of strategies recommended by the EMR vendor as well as specific strategies used at our institution. These can be used in future implementation projects in low-resource settings to avoid disruption of workflows.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Injury severity score (ISS) is commonly used in trauma registries to describe injury severity and to predict outcomes in trauma patients regardless of injury mechanism. This study examined the ...correlation between ISS and mortality in adult trauma patients presenting to emergency departments in the United States with different mechanisms of injury. A retrospective observational study was conducted using the 2014 Nationwide Emergency Department Sample. Patients' characteristics were stratified by mortality. Receiver operating characteristic (ROC) curves were generated for death against ISS for each mechanism of injury. A logistic regression model was conducted for each mechanism of injury to determine whether ISS (≥16 vs <16) is a predictor of mortality. The study sample consisted of 16,147,058 weighted adult trauma patients. Median age was 46 years. Slightly over half were females (51.9%). Falls, motor vehicle accidents and being struck by or against, were the most commonly reported mechanisms of injury (44.6%, 18.1%, and 15.3%, respectively). The overall mortality in the study population was 0.4%. The area under the ROC curve was highest in injuries sustained in accidents involving machinery (0.947; 95% confidence intervals CI, 0.896-0.998), followed by motor vehicle traffic (MVA) (0.788; 95% CI, 0.775-0.801) and cutting or piercing (0.746; 95% CI, 0.701-0.791). Deceased patients were accurately identified by ISS 65.2% in injury by machinery, 47.7% in injury involving MVA, 39.7% in injury by firearm and 31.4% in injury by assault. After adjusting for confounders, the multivariate models in which ISS was the main independent factor performed best in predicting mortality from firearm and machinery mechanism of injuries. Although the ROC curve analysis demonstrated a moderate or high discriminatory ability to identify deceased patients in 6 out of twelve mechanisms, and the multivariate analysis revealed that ISS was a significant predictor of mortality in 9 out of 12 injury mechanisms, the sensitivities of all logistic regression models were poor. The ISS ≥ 16 threshold alone therefore should not be used to identify patients with high-mortality risk. The mortality risk assessment should be done individually and be based on clinical evaluation.
Introduction: Lebanon lacks a national database of gunshot injuries (GSIs), which limits injury prevention initiatives. Objectives: This study examines patient characteristics, injury patterns, and ...clinical outcomes in GSI victims and evaluates the impact of intent on clinical outcomes with the aim of improving awareness among emergency department (ED) physicians about the importance of inquiring about intent to predict prognosis. Materials and Methods: We conducted a retrospective cohort study of GSI victims presenting to the ED of a tertiary care center in Beirut, Lebanon. Descriptive and bivariate analyses were done to identify differences based on intent. Results: A total of 83 patients were included, 59% with intentional GSI, 22% with unintentional GSI, and 19% with unspecified intent. They were mostly males (89.2%), with a mean age of 31.7 years, and mostly presenting during summer seasons. Females were more commonly victims of unintentional GSI. All victims sustaining multiple GSIs were in the intentional group. When compared to unintentional GSI, intentional and unspecified GSIs were found to result in more ICU admissions (46.9%, 31.3%, and 16.7%,P = 0.096), significantly longer hospital stays (18.2, 26.3, and 5.6 days;P = 0.001) and higher mortality (11.6%, 18.2%, and 6.7%;P = 0.747). The rates of surgical procedures were similar between the three groups although more victims of intentional and unspecified GSI underwent multiple surgeries. Conclusion: GSIs have different features, resource utilization, and clinical outcomes depending on the intentionality of injuries. All GSI victims suffer from substantial morbidity and mortality, but intentionally harmed victims sustain more severe injuries with worse outcomes.
Ultrasound (US) is an essential tool for evaluating trauma patients in the hospital setting. Many previous in-hospital studies have been extrapolated to out of hospital setting to improve diagnostic ...accuracy in prehospital and austere environments. This review article presents the role of prehospital US in blunt and penetrating trauma management with emphasis on its current clinical applications, challenges, and future implications of such use.
•Males report most injuries and youth sustain more unintentional, violent, and self-assault injuries.•Older age is linked to at-home fall injuries, severe disabilities, and high hospital ...admissions.•Falls, struck-by, and transport injuries are common in all ages.•Self-funding decreases the odds of seeking hospital care.•Legalizing and enforcing targeted safety policies and designing awareness campaigns are crucial to control injuries.
Injury accounts for nearly 4 million deaths and 63 million disabilities annually. The injury burden is disproportionally large in low- and middle-income countries (LMICs), including Lebanon. This study aims to examine the characteristics and patterns of adult injuries presenting at multiple emergency departments (ED) in Lebanon and further identifies factors associated with hospital admission.
A retrospective cross-sectional study was conducted on adult patients (aged≥16) who presented with an injury to one of the five participating EDs from June 2017 to May 2018. Pan-Asia Trauma Outcomes Study (PATOS) variables were adopted for data collection. A descriptive analysis was performed, followed by bivariate and multivariate logistic regression to identify injury risk factors for hospital admission.
A total of 3,716 patients’ records were included. Most injuries were sustained by males (62.7%), patients aged between 16 and 35 years (16–25: 28%; 26–35: 22.7%), and above 65 years (15.6%). Most injuries were unintentional (94.9%). Falls were highly prevalent across all age groups (38.8%), more proclaimed among the older adults’ population (56–65:52.8%; ≥66:73.7%), followed by struck-by object (23.6%) and transport injuries (10.1%). Upper and lower extremity injuries were common across all ages. Most patients (80.9%) were treated and discharged at the ED, 11.4% were admitted to the hospital, 4.3% were transferred to other trauma care facilities, and 2 patients died in the ED. Factors positively associated with hospital admission included: older age (≥ 56 years); private insurance; spine and lower extremity injuries; fractures, cuts/open wounds, concussion, and organ injuries (p-value≤0.05; OR>1).
Injury is a neglected public health problem in many LMICs, including Lebanon. While youth and the elderly are most affected, injuries occur across all age groups. This study lays the foundation for establishing a population-based injury surveillance system, crucial for designing tailored injury prevention programs to reduce injury-related deaths and disabilities.
Out of hospital cardiac arrest (OHCA) remains a leading cause of mortality among adults in the United States. Environmental impact on incidence and outcomes of OHCA has not been fully investigated in ...recent years. Previous studies showed a possible increase in incidence and mortality in winter season and during seasons with temperature extremes. This study examines seasonal variation in incidence and outcomes of OHCA in the United States.Retrospective study of adult OHCA using the Nationwide Emergency Department Sample was carried out. Monthly incidence rate per 100,000 ED presentations was calculated. Survival rates for each month of admission were examined by hospital region. Multivariate analyses were conducted to determine the effect of the season and month of admission on survival.A total of 122,870 adult OHCA cases presented to emergency departments (EDs) in 2014 and were included. Average incidence of OHCA cases was 147 per 100,000 ED presentations. Overall survival rate in the study population was 5.6% (95% confidence intervals CI = 5.4%-5.9%). Patients had an average age of 65.5 (95% CI: 65.3-65.7) years and were mainly men (61.8%). Rates of OHCA presentations were highest during December and January (9.9% and 10.0%) while survival rates were lowest during December (4.6%) and highest in June (6.9%). Regional variation in OHCA outcomes was also noted with highest average survival rate in West (7.8%) and lowest in South (4.3%). After adjusting for confounders including region of hospital, Summer season (Ref: all other seasons), and more specifically month of June (Ref: all other months) were found to be positively associated with survival (OR 1.27, 95% CI 1.07-1.52, P-value = .008) and (OR 1.43, 95% CI 1.08-1.89, P-value = .012 respectively).Incidence and outcomes of out of hospital cardiac arrest presentations to the emergency departments in the United States have seasonal variation. Both incidence and mortality of OHCA increase during colder months, and survival is significantly higher in summer season or in June. Exploring how to use this variation to improve outcomes through refresher training of medical providers or through other mitigation plans is needed.
Helicopter Emergency Medical Services (HEMS) dispatch currently depends on predefined protocols, on first responders’ initial assessment, or on medical direction decision in some states. National ...guidelines do not provide recommendations concerning prehospital time criteria.
Our aim was to investigate the association between the mode of transportation (HEMS vs. ground EMS GEMS) and survival of adult patients with blunt trauma across different prehospital time intervals.
This retrospective matched cohort study was carried out using the 2015 National Trauma Data Bank (NTDB) dataset. Adult patients with blunt injuries transported via HEMS were selected and matched (1 to 1) for 13 variables to those who were transported by GEMS. Survival rates were calculated for the two groups across different prehospital time intervals.
Patients transported by HEMS (n = 16,269) were compared with those transported by GEMS (n = 16,269). Most patients were aged 16 to 64 years (84.0%), male (69.4%), and white (88.0%). Overall survival rate to hospital discharge was significantly higher in the HEMS group (96.8% vs. 96.2%; p = 0.002). Patients transported by HEMS had higher survival rates in the ≤ 30-min interval (97.7% vs. 93.2%; p = 0.004); GEMS patients had higher survival rates in the 61- to 90-min interval (97.4% vs. 96.5%; p = 0.038). No difference in survival rates between the two groups was observed in intervals > 90 min.
In adult patients with blunt trauma, HEMS transport was associated with overall improved survival rates mainly in the first 30 min after injury. GEMS transport, however, had a survival advantage in the 61- to 90-min total prehospital time interval.
Motorcycle crash–related injury mechanism is a criterion in the Centers for Disease Control and Prevention field triage guidelines of injured patients, with a recommendation to transport affected ...patients to a trauma center need not be the highest level.
This study examines the evidence behind this recommendation because severe injuries can result from motorcycle crashes and patients can benefit from treatment at higher-level trauma centers.
This retrospective cohort study used the National Trauma Data Bank 2015 dataset. We conducted descriptive analyses (univariate and bivariate) followed by adjusted multivariate analysis to examine the association between trauma center designation levels and survival to hospital discharge.
A total of 28,821 patients with motorcycle injuries were included. Most patients were men (n = 25,361; 88%) and aged between 16 and 64 years (n = 26,989; 93.6%). Survival rates were higher in level II (n = 10,658; 95.3%) and III (n = 2,129; 95.5%) trauma centers compared to level I centers (n = 14,498; 94.6%). After adjusting for confounders, decreased survival to hospital discharge was noted for patients treated at level III trauma centers compared to those at level I centers (odds ratio 0.543; 95% confidence interval 0.390–0.729). No difference in survival was noted between level I and II centers.
Patients with motorcycle crash–related injuries treated at higher-level trauma center (I or II) had increased survival. This warrants a re-evaluation and adjustment of the field triage criterion for such patients. Examining the evidence behind field triage guidelines in trauma systems is needed for improved patient outcomes.
Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Developing countries including Lebanon report low survival rates and poor neurologic outcomes in affected victims. ...Community involvement through early recognition and bystander cardiopulmonary resuscitation (CPR) can improve OHCA survival.This study assesses knowledge and attitude of university students in Lebanon and identifies potential barriers and facilitators to learning and performing CPR.A cross-sectional survey was administered to university students. The questionnaire included questions regarding the following data elements: demographics, knowledge, and awareness about sudden cardiac arrest, CPR, automated external defibrillator (AED) use, prior CPR and AED training, ability to perform CPR or use AED, barriers to performing/learning CPR/AED, and preferred location for attending CPR/AED courses. Descriptive analysis followed by multivariate analysis was carried out to identify predictors and barriers to learning and performing CPR.A total of 948 students completed the survey. Participants' mean age was 20.1 (±2.1) years with 53.1% women. Less than half of participants (42.9%) were able to identify all the presenting signs of cardiac arrest. Only 33.7% of participants felt able to perform CPR when witnessing a cardiac arrest. Fewer participants (20.3%) reported receiving previous CPR training. Several perceived barriers to learning and performing CPR were also reported. Significant predictors of willingness to perform CPR when faced with a cardiac arrest were: earning higher income, previous CPR training and feeling confident in one's ability to apply an AED, or perform CPR. Lacking enough expertise in performing CPR was a significant barrier to willingness to perform CPR.University students in Lebanon are familiar with the symptoms of cardiac arrest, however, they are not well trained in CPR and lack confidence to perform it. The attitude towards the importance of bystander CPR and the need to learn CPR is very positive. Interventions should focus on public awareness campaigns regarding the importance of initiating bystander CPR while activating emergency medical services (EMS) and on making CPR training more available.
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