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Open Access Publications from the University of California

Original Research

Use National Early Warning Score In The Prognosis Of Stroke Patients In The Emergency Department

Introduction: Few scoring systems are used in the emergency department to identify critically ill patients and anticipate patients' deterioration such as National Early Warning Score (NEWS). This study aimed to evaluate NEWS in patients with acute stroke and its relationship with treatment and type of stroke and patient outcome.

Methods: In this prospective cross-sectional descriptive-analytical study, all patients over 18 years of age with a diagnosis of ischemic stroke, who presented through the emergency department, were involved. The variables of interest were collected; the NEWs score was calculated for each patient.

Results: In assessing NEWS and its relationship with outcome based on the ROC curve, the area under the curve was equal to 0.417. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 16.67%, 98.77%, 83.33%, 74.45%, 13.5, 0.84 respectively. In assessing NEWS and its relationship with stroke type on the ROC curve, the (AUC) was equal to 0.526. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 8.33%, 94.95%, 16.67%, 88.53%, 1.65, and 0.97 respectively.

Conclusion: In terms of outcome, NEWS seems to have acceptable specificity and positive and negative predictive values. Regarding the type of stroke, NEWS has an acceptable specificity but it only has a negative predictive value about the non-hemorrhagic type of stroke. This means that if the NEWS number is LOW, the probability is that the type of stroke is ischemic and the patient outcome is good.


Case Report

A Case Report of Toxicity from Ingestion of a Hospital Antiseptic Solution Containing 1-Propanol and 2-Propanol

In the midst of the COVID-19 pandemic, the increased risk of exposure to 1-propanol has led the United States Food and Drug Administration to issue a warning about toxicity of 1-propanol-contaminated brands of hand sanitizers. We report a mixed intoxication with 1-propanol and 2-propanol in a patient who unintentionally ingested approximately 300 mL of hospital topical antiseptic solution and who presented to the emergency department with nausea, vomiting, and decreased level of consciousness. The patient developed an anion gap metabolic acidosis without an osmolar gap, elevated serum lactate, and undetectable serum beta-hydroxybutyrate. One hour later, he developed chest pain and was found to have an ST-segment elevation myocardial infarction. The patient underwent urgent coronary  angiography and stenting of the totally occluded mid-segment of the Left Anterior Descending coronary artery. The patient recovered and was discharged home after 7 days.

Special Contribution

An Overview of the State of Emergency Medicine in Syria

Introduction: Emergency medicine is a developing specialty in low-to-middle income countries. The specialty was in its infancy in Syria when the war started a decade ago. Syria has since experienced civil war, unrest, famine, and financial collapse that has strained its healthcare system. There is limited research and information regarding Emergency Medicine residencies and training in Syria. Therefore, this article describes the growing and current state of Emergency Medicine and its training in Syria.

Methods: A mixed methods approach using a systematic review and semi-structure interviews was utilized. MEDLINE, EMBASE and PsychINFO were searched from inception until March 9, 2022. Eligible studies were specific to emergency medicine and discussed the training of emergency medicine physicians in Syria. Semi-structured key informant interviews and a review of the Ministry of Health website were utilized to supplement information regarding the structure of emergency medicine residency in Syria.

Results: Out of 252 unique citations identified, none described emergency medicine training in Syria. The most common articles identified were case reports (40), studies of mental health (34) and nicotine use (33). Public information from the Ministry of Health website was used to gather further information regarding the current state of healthcare in Syria; however, it provided little data specific to emergency medicine. Semi-structured interviews provided additional information regarding emergency medicine training in Syria. This revealed that prior to the 2011 onset of war, Syrian EM had begun to develop and included residency training, Arab Board certification and the establishment of a national specialist society. However, it also revealed, that in Syria, emergency medicine deteriorated much faster than other sectors of health care.

Conclusion: As of now, Emergency Medicine remains in a very early phase of development as a field and medical specialty. It requires renewed commitment, funding, and development. We recommend expanding virtual emergency medicine education, partnering with established emergency medicine training programs across the region and the world, and increasing collaboration across borders to further develop emergency medicine within Syria.