PurposeSepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.MethodsThe study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38 °C or lower than 36 °C, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.ResultsAmong the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788–0.963) as compared with 0.75 (0.634–0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.ConclusionSPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore...

Background Biological markers of acute nerve cell damage can assist in the outcome of acute ischemic stroke, such as neuron-specific enolase (NSE) that have been tested for association with initial severity of stroke, extent of infarction, and functional outcome. Objective To determine short-term prognostic value of the biochemical marker neuron-specific enolase (NSE) in acute ischemic stroke. Methods A cohort study carried out on 37 patients with acute ischemic stroke. Data were gathered in a prepared data sheet. Initial serum NSE level was measured to the patients in the Emergency department within 6 h of the onset of stroke and another measurement after 48 h. National Institute of Health Stroke Scale (NIHSS) was held to the patients at presentation and after 28 days of stroke to determine short-term morbidity and mortality. Results Out of the 37 patients, 31 patients survived (no-death group) and 6 patients died (death group). The mean serum level of neuron-specific enolase at presentation and after 48 h was significantly higher in the death group than in the no-death group. There was a statistically significant positive correlation between neuron-specific enolase (NSE) serum level and clinical severity of stroke (NIHSS) among the patients at presentation (r = 0.737, p = 0.000). Conclusion Neuron-specific enolase (NSE) can be applied as single independent marker for prediction of mortality and short-term morbidity in ischemic stroke patients.

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Background: In-hospital cardiac arrest (IHCA) is defined as cessation of cardiac activity, confirmed by the absence of signs of circulation, in a hospitalized patient who had a pulse at the time of admission. The purpose of the present study was to record the definitive predictors of IHCA, focusing on the relation between cause and outcome as well as the influence of location on survival. Subjects and Methods: This prospective observational study (cross sectional) was carried out in Emergency Department at Suez Canal University Hospital and included 223 patients experiencing IHCA at the Emergency Department (ED). Results: Our study showed return of spontanous circulation (ROSC) rate of 27.4%, which is lower than those reported in other studies from the region. In our study, we found that the overall mean duration for comprehensive cardiopulmonary resuscitation (CPR) was 21 min (SD ± 10).We found that Pulse, RR, BP, Witnessed and advanced life support (ALS) interventions at time of event were significant positive predictors to ROSC with patients while age, modified early warning score (MEWS), Interval between collapse to start CPR and CPR duration were negative predictors to cognitive impairment with diabetic patients. Conclusions: IHCA can be predicted using different variable related to patients vital data, laboratories, radiological investigations and patient demographic data which helps in predicting and modifying the outcome in limited situations.

Background: Among kids older than a year old, trauma is the primary cause of illness and death. Injuries to two or more organ systems that could prove fatal or disabling are unfortunately not out of the ordinary in pediatric patients who have sustained multiple severe injuries. Objective: To improve the circulatory management in pediatric polytrauma by detection of pitfalls according to international guidelines in Suez Canal University Hospital. Patients and Methods: All children with polytrauma who were brought to the Emergency Department (ED) at Suez Canal University Hospital were included in a cross-sectional study. Patients were evaluated and cared for with an emphasis on circulatory management in accordance with Advanced Trauma Life Support (ATLS) standards. Next, the patient's outcome was documented. Results: Obstruction of the airway, breathing difficulties, bradycardia, and extended capillary refill were substantially linked with the 9.5% death rate among pediatric polytrauma patients who presented to ED at Suez Canal University Hospital. Survival of the studied patients was statistically significant associated with higher frequency of performing chest X-ray (p < 0.001), pelvis X-ray (p < 0.012) and Focused Assessment with Sonography for Trauma (FAST) study (p=0.024). Conclusion: Adherence to the international guidelines in evaluation and management of pediatric polytrauma patients is a cornerstone in improving outcomes and decreasing mortality.