BBackground: Head trauma is an urgent medical condition that is prevalent in pediatric patients. The association between white blood cell (WBC) counts and their prognostic value in pediatric traumatic brain injury has been proposed in multiple studies. Hence, WBC count can be used to determine the presence of traumatic brain injury. Thus, we aimed to address this gap by assessing the value of WBC count in predicting pathological CT findings in pediatric patients with traumatic head injuries. Methods: This retrospective cohort study included 108 patients with isolated head trauma aged 0–14 years who underwent brain CT examination and had available data on WBC count upon presentation to the emergency room. Chi-square and Fisher's exact tests were used to determine the statistical significance. Logistic regression analysis was performed to further explore the relationships between the variables. Results: Falls were the most common cause of head trauma (88 [81.48%] patients). Leukocytosis was... Continue Reading

Objective: This study aimed to identify the rate of discharge of hospitalized patients against medical advice (DAMA) and its risk factors, including length of stay as well as to assess patients' outcome after signing DAMA. Methods: This retrospective study included Saudi patients aged 14 years and above who were presented to the Emergency Department (ED) at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia and left against medical advice from January 2021 to March 2022. Included patients were interviewed via phone calls to investigate the reasons of DAMA. Results: The study included 186 DAMA patients with 52.7% females and majority (21%) falling in the 30-39 years category. The most common complaint was shortness of breath (13.4%). The prevalence of DAMA was 0.89%. The length of stay in the ED was the common reason for DAMA (60.7%). The length of stay varied, and the highest percentage of patients... Continue Reading

Background: Maintaining effective clinical handover between prehospital services and emergency departments is crucial to recognize critical cases, guiding proper management, and determining final outcomes. Methods: This is a single-center cross-sectional study that was conducted between October 15, 2021, and July 30, 2022, in a tertiary care center in Riyadh, Saudi Arabia. A novel handover tool (SRCA checklist) was developed, and eight emergency medicine consultants checked its content validity. It contains 4 domains and 12 items and is based on previously validated tools after an extensive literature review and experts' opinions. The primary outcome of this study was to validate the newly developed tool aimed at assessing the quality of handover skills between prehospital medical care providers and emergency departments. The tool's reliability was examined using Cronbach's alpha method, while factor analysis with varimax rotation was used to examine the construct validity. Results: 147 handovers were captured in this study. Almost... Continue Reading

Background: Viral croup is an upper respiratory tract inflammation that commonly affects children. This paper reports the prevalence, clinical characteristics, outcomes, and management of patients with croup who presented to the emergency department of a tertiary care center in Jeddah, Saudi Arabia. Methods: A retrospective study was conducted using the hospital's electronic medical records of pediatric patients with croup aged 0–14 who presented to the emergency department between July 1, 2016, and December 30, 2022. A data collection sheet containing four sections–demographics, clinical manifestations, assessment, and management–was used. Statistical analysis was conducted using JMP statistical software version 15.2.0. Results: A total of 146 patients were included; 74 (50.68%) were under 2 years of age, and approximately half presented to the ER during autumn. Cough was the most common clinical manifestation, reported in 134 patients (91.78%). Regarding the Westley score, a mild grade was reported in 25 (58.14%) patients. Abnormal chest... Continue Reading

Background: High quality and immediate initiation of cardiopulmonary resuscitation (CPR) can contribute to improve the survival rates and outcomes of cardiac arrests. As for medical students, it is of great importance that they are fully qualified to appropriately apply Basic Life Support (BLS). This study aimed to assess the level of theoretical knowledge and self-perceived comfort of medical students in Saudi Arabia in performing lifesaving CPR. Methodology: cross-sectional study which included medical students from 3rd to 6th academic years from the five main regions of Saudi Arabia. The selection of participants was through the non-probability convenience sampling. Data was collected using a questionnaire that consisted of sections of BLS knowledge and self-perceived confidence/comfort. Results: A total of 1372 participants were included in the study, of which 745 (54.3%) were female. The majority were not BLS license holders n=771 (56.2%). Male students reported a higher self-perceived comfort 2.99(CI 2.89 to 3.10).... Continue Reading

Background: Midline catheters (MCs) are effective and safe devices that provide patients with intravenous access within hospitals and healthcare facilities. This study aimed to investigate emergency medicine physicians' and nurses' clinical skills and confidence in performing midline catheter insertion after a directed simulation course. Methods: This single-center study was conducted in King Faisal Specialist Hospital, Riyadh, Saudi Arabia, among physicians and nurses in the emergency department (ED). The study participants were recruited into a simulation course. The participants' practical skills were assessed for quality improvement, and retrospectively, the difference in pre-post measurement was analyzed, and a cross-sectional part that included a survey of self-rated comfort levels. Results: A total of 51 participants were included in the study. Two-thirds of the participants were physicians (66.7%), worked more than 15 shifts (66.7%), and were Saudi (66.7%). Most worked in governmental hospitals (90.2%), and about half were residents (43.1%). There was a significantly... Continue Reading

Background: Considering the rapid and emergent spread of coronavirus disease (COVID-19) or severe acute respiratory syndrome (SARS), hospitals were obligated to follow their emergency disaster plan [1]. This paper evaluates the effectiveness of the disaster plan based on the incidence of COVID-19 in emergency department (ED) staff of King Abdulaziz Medical City – Western Region (KAMC-WR) for one year. Methods: After reviewing the multidisciplinary management guidelines of COVID- 19, a cohort retrospective study was applied from March 2020 to March 2021 to measure the incidence of COVID-19 [2]. All emergency department health care workers (HCWs) were included in the study. Results: During the study period, results showed that 9 (4.24%) HCWs were infected by COVID-19 whereas 203 (95.75%) HCWs were not infected. The prevalence of COVID-19 among ED staff in KAMC-WR was low as compared to previous studies [3,4,5,6,7,8]. This indicates the effectiveness of KAMC-WR disaster plan. KAMC-WR disaster plan... Continue Reading

For a healthcare system to be successful, doctors must be competent and leaders must be effective. The healthcare industry is often characterized by the presence of teams. In order to be a good team leader, one must possess certain attributes, which are often found in emergency physicians. Three leadership models are discussed in this report: the transactional, the transformational, and the situational leadership models. The situational leadership appears to be the most appropriate leadership approach for an emergency medicine scenario. Within the concept of situational leadership, there is not a single approach that is applicable to every situation and every circumstance. Therefore, it is extremely important for team leaders to explore the capabilities of the team members, determine the intrinsic motivators of each individual, and work towards ensuring that the team members are fully engaged Continue Reading

Background: Emergency medicine is instrumental in addressing undifferentiated patient concerns, particularly those related to non-traumatic back pain. While a significant portion of these presentations are benign, it is essential to maintain a systematic approach to identifying individuals with serious underlying conditions. Case Presentation: A 47-year-old man presented with six months of escalating upper back pain. He had been slated for a magnetic resonance imaging (MRI) scan through an outpatient neurosurgery clinic, but this was delayed. A thoracic spine computed tomography scan in the emergency department revealed notable abnormalities at the T9 vertebral level. A subsequent MRI detected a major bone lesion with tumor intrusion into the spinal canal. Diagnosis revealed metastatic thyroid papillary carcinoma, leading to surgical interventions and subsequent treatments. Conclusion: Given the frequency with which back pain concerns are addressed across medical specialties, it is vital to recognize potential red flags and adhere to a structured assessment approach.... Continue Reading

Background: Early diagnosis of Acute Aortic Dissection (AAD) can be a challenge for emergency physicians given its unspecific and variable presentation. For this reason, it is frequently referred to as "the great imitator," as it can mimic so many other conditions, including acute coronary syndrome and stroke. Case Presentation: We report a middle-aged male who presented to the Emergency Department (ED) with complaints of dizziness. His vitals showed differences in blood pressure (BP) between both arms and an absent pulse in the right arm. a computerized tomographic (CT) angiography of the aorta, which showed a Stanford type A aortic dissection. The patient was in stable condition until he was transferred to another health care facility for further care and intervention. AAD is a challenging diagnosis to make in the ED and has a high mortality rate, especially if there is a delay in diagnosis and definitive management. Conclusion: So far,... Continue Reading