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Objective: To compare the effect of isotonic crystalloid solutions between lactated Ringer's solution (LRS) and normal saline solution (NSS) on lactate clearance in septic patients at the emergency department (ED). Materials and Methods:This study is a single-center retrospective chart review. The study enrolled patients older than 18 years with sepsis and initial serum lactate level >2 mg/dL in the ED. The primary outcome was to determine which isotonic solution was better for serum lactate clearance in septic patients. The secondary outcomes were serum creatinine change within 24 h and the 48-h survival rate after admission. Results: A total of 120 patients were enrolled with a median crystalloid volume administered in the ED of 1000 mL. Within 2 h of resuscitation, there was no difference in lactate clearance between the LRS and NSS groups with median values of 29.2% and 25%, respectively (P=0.839). The 48-h survival rate after admission did not differ between the LRS and NSS groups with median values of 90% and 86%, respectively. Both isotonic solutions increased serum creatinine levels within 24 h of treatment with median values of 0.3 for each group (P=0.647). Conclusion: Among septic patients in the ED treated with NSS or LRS, there was no difference in lactate clearance, serum creatinine change within 24 h, or 48-h survival. However, several factors were associated with increased lactate levels, such as older age and use of vasopressors and immunosuppressive agents.

Background. In most community-acquired pneumonia (CAP) treatment guidelines, the Pneumonia Severity Index (PSI) and CURB-65 are used as prognostic tools. Recently, simpler and more effective predictive tools for CAP treatment, such as the A-DROP scoring system, have been developed. However, no study has performed a comparative evaluation to identify the superior tool for predicting when patients can be discharged safely. Objectives. To compare the performances of A-DROP and CURB-65, simple predictive tools for CAP, based on 30-day death rates and 72-hour revisit rates for CAP following discharge from the emergency department (ED). Method. This single-center retrospective observational study enrolled patients who were at least 18 years old and diagnosed with CAP at the Songklanagarind Hospital ED from January 2015 to April 2021. Following a severity assessment using the A-DROP and CURB-65 scoring systems, the 30-day mortality rates and 72-hour revisit rates after discharge from the ED were compared. Results. A total of 408 patients were enrolled in this study. Six (1.47%) died within 30 days after presentation, whereas 29 (7.1%) returned to the ED within 72 hours after discharge. Most patients (72%) who revisited the ED were over the age of 65 years. The areas under the receiver operating characteristic curves for the prediction of 30-day mortality were 0.756 (95% confidence interval [CI]: 0.526–0.987) and 0.808 (95% CI: 0.647–0.970) for A-DROP and CURB-65, respectively. The areas under the receiver operating characteristic curves for the prediction of 72-hour revisit were 0.617 (95% confidence interval [CI]: 0.507–0.728) and 0.639 (95% CI: 0.536–0.743) for A-DROP and CURB-65, respectively. Conclusion. A-DROP and CURB-65 yield similar results and can be used to assess low-risk patients with CAP for discharge from the ED. Older patients, even those with low-risk scores, should be particularly considered for admission to a short-term observation unit or ward.

Objective To study the association between prolonged emergency department length of stay (EDLOS) and in-hospital adverse events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods In this retrospective cohort study, the medical records of 738 patients diagnosed with NSTE-ACS and admitted to the emergency department (ED) from 1 January 2013 to 31 December 2019 were reviewed. The patients were categorized into groups with EDLOS < 4 hours and EDLOS ≥ 4 hours, and baseline characteristics, clinical presentation, Killip classification, Global Registry of Acute Coronary Events score, investigations, use of the European Society of Cardiology (ESC) 0/1-hour and 0/3-hour algorithms, and treatments in the ED were compared between the groups. The associations of in-hospital adverse events with EDLOS were examined using univariate logistic regression. Results Four hundred and twenty-three (57.3%) patients had an EDLOS of ≥ 4 hours, and the median (IQR) EDLOS was 4.48 hours (3.03, 6.20 hours). EDLOS ≥ 4 h was associated with a prolonged time to receive P2Y 12 inhibitors and anticoagulants (P < 0.001). However, the two groups showed no significant differences in in-hospital adverse events (congestive heart failure [CHF], shock, stroke or transient ischemic attack [TIA], major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events). Nevertheless, a non-significant trend for a higher rate of adverse events (CHF, shock, major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events) with longer EDLOS was observed in the subgroup of patients who received diuretic or antiarrhythmic drugs, ventilator or bilevel positive airway pressure support, oxygen support, or inotropic/vasopressor drugs in the ED. Conclusion Prolonged EDLOS showed a significant association with longer times to receive P2Y 12 inhibitors and anticoagulants. However, the EDLOS < 4 hour and EDLOS ≥ 4 hour groups of patients with NSTE-ACS showed no significant differences in the rates of in-hospital adverse events. Patients who receive cardiovascular medications in the ED or are on respiratory support should be hospitalized as soon as practically possible. Proper use of the 0/1-hour algorithm over the 0/3-hour algorithm without unnecessary repeated cardiac troponin tests in the ED could reduce the EDLOS in patients with NSTE-ACS.