Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol.

BACKGROUND: Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS: PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION: PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION: The study is registered at ClinicalTrials.gov (NCT05172479).

Prevalence of Computed Tomography Overuse for Mild Head Injury in Adults.

INTRODUCTION: The Canadian CT Head Rule (CCHR) is one of many established guidelines for assessing the need for computed tomography (CT) imaging in patients with minor head injuries. Adhering to such criteria would promote the appropriate use of CT imaging, lower healthcare expenses, and prevent harmful radiation exposure. There is no current literature assessing the overuse of CT imaging for minor head injuries in the Kingdom of Bahrain. This study aims to evaluate CT overuse in adult patients with minor head trauma.  Methods: The study was conducted at the Bahrain Defense Force Hospital over 12 months from January to December 2021. All adult patients (>14 years) who sustained a minor head injury and were referred to the emergency department for CT brain imaging were included in the study. Patients presenting for other reasons or suffering from moderate to severe head injuries were excluded. CT reports were retrieved for analysis. The CCHR was used as a reference.  Results: A total of 486 CT scans were performed. Loss of consciousness was the most common symptom on presentation (n = 74 cases). Only 12.1% of CT scans reported positive findings. The prevalence of CT overuse was highest in patients aged 21-30 years. Patients presenting with loss of consciousness showed a high overuse of CT imaging, accounting for 20.3% of all cases. Only 77.4% of cases met the CCHR criteria and 22.6% were defined as overuse, with 95% confidence interval (0.189, 0.266).  Conclusion: When referring to the CCHR, CT imaging for a minor head injury in adults was overused in 22.6% of cases. Further research will be required to reveal the underlying reasons for these findings along with interventions to reduce future overuse.

Bird's-Eye View of COVID-19 Knowledge, Attitude and Practice Among Emergency Physicians in the Kingdom of Bahrain: A Cross-Sectional Study.

BACKGROUND: Coronavirus 2019 (COVID-19) has exemplified the crucial role played by emergency physicians on the frontlines, by triaging, quarantining and treating myriad patients in time. Despite this, there exists a dearth of literature comprehensively assessing the knowledge and awareness of these health-care workers on the disease in the Kingdom of Bahrain. This study was designed to evaluate the knowledge, attitude, and practice (KAP) of emergency physicians in the Kingdom of Bahrain towards COVID-19. METHODS: This cross-sectional descriptive study included 142 emergency physicians from three major hospitals in Bahrain. A self-designed questionnaire divided into 4 parts, which consists of demographics, knowledge, attitude and practices towards COVID-19, was completed by the emergency physicians working in these hospitals. Analysis of variance (ANOVA), t-test, chi-square test, and multiple linear regression were employed to evaluate KAP scores. RESULTS: The mean COVID-19 knowledge and practice score was 26.29 for a maximum score of 32 suggesting an overall 82.15% correct rate on the knowledge and practice test. Multiple linear regression analysis highlighted age (p=0.038), genders (p=0.033), marital status (p=0.021), organization (p=0.032), having children (p=0.008), and continuing professional development (CPD) activity (p=0.0001) as significant predictors for knowledge and practice scores. The attitude towards the final success in controlling COVID-19 significantly differed across marital status (p=0.021), organization of participants (p=0.020) and position of participants (p=0.012), respectively. CONCLUSION: Adequate knowledge, positive attitude and sufficient safe practice towards COVID-19 were observed in majority of the participants. These findings can foster development of nuanced and salient health management strategies that augment KAP so that proper control and elimination of the disease can be achieved, while prioritizing patient health and satisfaction.

Epidemiology of pediatric trauma in the Kingdom of Bahrain: a national pediatric trauma registry pilot study.

BACKGROUND: A pediatric trauma registry for the Kingdom of Bahrain would be a novel public health tool for the Bahraini health system. The aim of this study was to explore the epidemiology of pediatric trauma at the national level by describing the distribution of pediatric injury in the Kingdom, and quantifying the burden of injury shouldered by the study population. METHODS: This multicenter observational cross-sectional study was conducted in Bahrain using data from the Pediatric Trauma Registry (PTR), which was a short-term paper-based prospective trauma registry that collected data over a three-month period in 2018. PTR was based in the pediatric emergency departments (ED) of the three national referral hospitals in the Kingdom. By simultaneously collecting data from all three trauma hospitals in the country, it was assumed that during the data collection period all major pediatric trauma patients in the country would be captured by the study, and that the data collected would provide national estimates of trauma. Inclusion criteria for the study was any individual under the age of 14, that arrived at the ED seeking care for intentional and unintentional injuries. RESULTS: A total of 1328 patients were included in the study. Sixty-nine percent of patients were treated and discharged from the ED, 30.5% were admitted to the hospital, admitted for surgery, or seen by a specialist, and 0.5% were declared deceased. The percentage of patients documented as unrestrained during Motor Vehicle Collisions (MVC) was 92.3%, and amongst those involved in MVC, 12% were ejected from the cabin of the vehicle. CONCLUSIONS: There are significant implications that this study holds for policy implementation and practice surrounding injury prevention in the Kingdom of Bahrain. Low seatbelt utilization and the high proportion of ejection amongst MVC victims warrant immediate public health policy implementation, including enforcement of seat belt laws, strengthening of the traffic court system, and awareness campaigns for MVC prevention. Additionally, pediatric drowning prevention programs centered on constant adult supervision, pool isolation fencing, personal flotation devices, and swimming education should be created to address the mortality attributable to drowning in this study.

Correction to: Emergency Medicine in the Kingdom of Bahrain.

Following the publication of the original article [1], it was brought to our attention that author Leena Alqasem was erroneously included as Leena Alqusem.

Emergency Medicine in the Kingdom of Bahrain.

It has been more than a decade since emergency medicine became recognized as a specialty in the Kingdom of Bahrain. In the last fifteen years emergency medicine has widely established itself and developed rapidly in the Kingdom. The three main emergency departments are: Salmanyia Medical Complex (SMC), Royal Medical Services of Bahrain Defence Force (RMS-BDF) and King Hamad University Hospital (KHUH) are now fully equipped and operated by a majority of board certified emergency physicians.Standardized protocols, and the Central National Ambulance will be established in the near future, and the ambulances will offer both basic and advanced life support by trained nurses and paramedics.Emergency Medicine residency training programs were established in the main three hospitals in Bahrain for the Arab Board Certification initially, while currently only two hospitals, BDF hospital and KHUH are recognized as training centers for the Saudi Board Residency Program.This article will focus on many aspects related to emergency medicine in the Kingdom of Bahrain including: history of health care systems in Bahrain, hospitals and primary care, disaster management, Emergency medical services (EMS), hospital-based emergency care, training in emergency medicine and universities. We aim to present Bahrain's past and existing emergency medicine experience, our perspective about the existing challenges faced by the specialty, and the future plans for the advancement of emergency medicine in the Kingdom.