ICD-10 Classification in the Practice of Emergency Medical Teams: New Insights.

The role of the emergency medical system is to provide assistance to every person in a state in the event of a sudden threat to health and life. Emergency medical teams (EMTs) are an important element of this system, making diagnoses based on the International Classification of Diseases (ICD-10). The study was aimed at analysing the causes of EMT intervention based on groups of diagnoses codified according to the ICD-10. The analysis was based on data from 116,278 EMT interventions in central-eastern Poland in 2017-2019. The research showed that EMT most often made diagnoses based on groups of ICD-10 codes: R00-R99-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (39.11%); S00-T98-Injury, poisoning, and certain other consequences of external causes (18.23%); and I00-I99-Diseases of the circulatory system (15.57%). The analysis of the obtained results showed statistically significant differences (p < 0.0001) regarding the area of intervention (urban, rural), sex, age of the patient, and the method of completion of the activities by EMTs in relation to the group of ICD-10 diagnoses for the diagnosis. The conducted study showed the actual reasons for EMT calls. The use of the ICD-10 classification has practical application in EMTs, as it enables the identification of a disease or health problem.

Maladaptive perfectionism and authentic leadership skills in emergency medicine students

Introduction: Leadership skills can be critical in emergency medicine. However, there are no works that analyze this issue in much more details. The aim: To analyze the level of leadership skills in emergency medicine students, and also checking if despondency perfectionism is a variable that reduce the correlation between self-efficacy and leadership skills. Material and methods: The analyzed group consisted of 75.76% of all emergency medicine students taking up education at the Medical University of Warsaw in 2018 (n = 150, W = 74, M = 71). The average age was 23 years (SD = 1.7). All students were divided into two groups: Group 0 - without maladaptive perfectionism (n = 64), and group 1- with maladaptive perfectionism (n = 79). In the cross-sectional study, three standardized research tools were used: Authentic Leadership Questionnaire, Almost Perfect Scale-Revised (APS-R), and General Self-Efficacy Scale (GSES). ANCOVA analysis was used. Results: The linear regression coefficients for both comparison groups were significantly different (interaction of variables: "maladaptive perfectionism * self-efficacy": F = 4.841, p = .029). Comparing adjusted mean values for both groups (0 vs 1), it can be stated that students from group 0 had a significantly higher level of authentic leadership skills compared to group 1 (F = 4.432, p = .037). Conclusions: Studies to determine the mechanisms of a positive relationship between the self-efficacy and leadership skills in emergency medicine students with high maladaptive perfectionism are required. This will allow the development of effective programs to strengthen the leadership skills of these students.

Soluble tumour necrosis factor receptor I is a promising early indicator of complicated clinical outcome in patients following severe trauma.

Post-traumatic mortality rates are still very high and show an increasing tendency. Early identification of patients at high risk of severe complications has a significant impact on treatment outcomes. The aim of the study was to better understand the early pathological inflammatory response to injury and infection, and to determine the usefulness of the assessment of TNF-α and sTNFR1 concentrations in the peripheral blood as early indicators of severe post-traumatic complications. The study was carried out in a group of 51 patients after trauma, treated in the ED, including 32 patients who met the inclusion criteria for immunological analysis. Patients were divided into two groups using the ISS scale (A ISS ≥ 20, B ISS < 20). The highest TNF-α and sTNFR1 concentrations in both groups were recorded at admission and were significantly higher in group A compared to group B (A vs. B TNF-α 2.46 pg/ml vs. 1.78 pg/ml; sTNFR1 1667.5 pg/ml vs. 875.2 p < 0.005). The concentration of sTNFR1 in patients with severe complications was significantly higher compared to patients without complications and preceded clinical symptoms of complications (C+ vs. C- 1561.5 pg/ml vs. 930.6 pg/ml, p < 0,005). The high diagnostic sensitivity calculated from the ROC curves was found for the concentrations of both cytokines: TNF-α (AUC = 0.91, p = 0.004) and sTNFR1 (AUC = 0.86, p = 0.011). Elevated levels of sTNFR1, determined in the peripheral blood shortly after injury, are significantly associated with the occurrence of later complications, which in some patients lead to death. In contrast, high levels of TNF-α shortly after injury are associated with mortality.

The diagnostic value of early cytokine response in patients after major trauma - preliminary report.

This study was aimed to give a better understanding of the mechanisms of early immune response to trauma by assessing the concentration of cytokines in peripheral blood. The study group comprised 32 patients admitted to the Emergency Department due to injury. Depending on the magnitude of the Injury Severity Score (ISS) trauma patients were divided into two groups. In group A (ISS ≥ 20), 13 patients had complications, and five died, while in group B (ISS < 20) only three patients had complications (e.g. respiratory failure and infections). Depending on the extent of the injury, significant differences were observed in the concentrations of cytokines in the treatment groups. The highest levels of IL-6 and IL-1Ra in both groups were recorded in the third hour of hospitalisation and were considerably higher in group A compared to the concentration of these cytokines in group B (p = 0.001). In patients with complications, IL-6 and IL-1Ra concentrations were significantly higher compared to those without complications. Spearman's rho-correlation showed a statistically significant positive correlation between baseline concentrations of IL-6 (r = 0.64, p < 0.001) and IL-1Ra (r = 0.37, p = 0.042) and the values of the ISS. A high diagnostic sensitivity calculated from ROC curves was found for IL-6 concentrations. In summary, our findings suggest that elevated levels of the cytokines tested, determined in the peripheral blood shortly after injury, may be significantly associated with the occurrence of severe complications, which in some patients can lead to death. Monitoring the levels of these cytokines in patients with a high risk of serious complications should be used routinely.

Occupational injury rates in personnel of emergency medical services.

INTRODUCTION AND OBJECTIVES: The system of emergency medical services (EMS) in Poland was established in 2006. The risk of occupational injuries to EMS personnel is very high, irrespective of the country where they operate, as they face many hazards in their everyday work. The aim of this study is to describe the type, incidence and consequences of occupational accidents among the personnel of the National Emergency Medical Services in Poland (NEMS - land and air ambulance crews) in 2008-2012. MATERIAL AND METHODS: The study reviewed all occupational accidents among the EMS personnel reported to the National Labour Inspectorate in 2008-2012. RESULTS: In the period reported, the number of accidents decreased from 32 in 2008 to just 6 in 2012. Traffic accidents predominated and most of the victims were male paramedics under 30 years of age. The most common injuries included multiple organ injuries and injuries of the cervical spine, chest and trunk. CONCLUSIONS: The growing professional experience of the EMS personnel has a beneficial effect on occupational injury rates as they tend to decrease with longer employment. Occupational accidents are definitely more common among ambulance crews than in the personnel of other organizational units of the National Emergency Medical Services.

Current views on the mechanisms of immune responses to trauma and infection.

According to the World Health Organization, post-traumatic mortality rates are still very high and show an increasing tendency. Disorders of innate immune response that may increase the risk of serious complications play a key role in the immunological system response to trauma and infection. The mechanism of these disorders is multifactorial and is still poorly understood. The changing concepts of systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS) early inflammatory response, presented in this work, have been extended to genetic studies. Overexpression of genes and increased production of immune response mediators are among the main causes of multiple organ dysfunction syndrome (MODS). Changes in gene expression detected early after injury precede the occurrence of subsequent complications with a typical clinical picture. Rapid depletion of energy resources leads to immunosuppression and persistent inflammation and immune suppression catabolism syndrome (PICS). Early diagnosis of immune disorders and appropriate nutritional therapy can significantly reduce the incidence of complications, length of hospital stay, and mortality. The study presents the development of knowledge and current views explaining the mechanisms of the immune response to trauma and infection.

Results of arthroscopic treatment of rotator cuff tear with the resection of symptomatic acromioclavicular joint with degenerative changes.

BACKGROUND: Rotator cuff (RC) tear is one of the most common disorders affecting the shoulder. Acromioclavicular (AC) joint arthritis is an equally common pathology of the shoulder. The coexistence of both disorders is common, although RC tear is more frequently the cause of shoulder pain than AC joint arthritis. The purpose of this study was to compare the results of arthroscopic treatment of RC tear and simultaneous resection of symptomatic AC joint with arthritis. MATERIAL/METHODS: We retrospectively evaluated 40 patients who underwent arthroscopic RC repair between January 2008 and December 2009. Patients were divided into two groups. The first group consisted of 20 patients with symptomatic arthritis of AC joint, specifically painful joint palpation test and painful cross-body adduction test. The control group included 20 patients with asymptomatic degenerative changes of AC joint. The first group of patients underwent RC resection and AC joint repair; the second group had an isolated RC repair. Follow-up period lasted from 44 to 68 months, an average of 54.4 months. RESULTS: Analysis using chi-squared test for independence has shown no statistically significant difference in terms of subjects' gender or age in both groups. No significant difference in terms of pain intensity (VAS) was observed before and after surgery in either group. Significant reduction in pain intensity after surgery was observed in both groups, the AC joint resection group (p<0.001) and the without joint resection group (p<0.001). An increase in Constant's scale score was recorded in both groups after the surgery. Analysis has shown that patients who had undergone AC joint resection, had lower scores on a Constant's scale (p<0.022) before the surgery than those who were not resected. There were no statistically significant differences between the two groups after the surgery. CONCLUSIONS: Supplementary resection of a painful AC joint with arthritis during RC tear repair provides good, long-term outcomes. In contrast to patients with asymptomatic AC joint arthritis, the coexistence of a torn RC and symptomatic AC joint with arthritis, can worsen shoulder function in the preoperative period.