The following is a summary of “Effective use of the hybrid emergency Department system in the treatment of non-traumatic critical care diseases,” published in the December 2023 issue of Emergency Medicine by Matsumoto, et al.

Despite its effectiveness in trauma cases, evidence of the hybrid emergency room (ER) system’s utility for non-traumatic critical illnesses remains limited. For a study, researchers sought to identify endogenous diseases that may benefit from treatment in the hybrid ER.

They conducted a retrospective review of patients with non-traumatic conditions treated in a hybrid ER between August 2017 and July 2022. Patients undergoing surgery, endoscopy, or interventional radiology (IR) in the hybrid ER were selected and categorized pathophysiologically into bleeding and non-bleeding groups. The incidence of shock or cardiac arrest, blood transfusion, and mortality within 24 hours of admission or in-hospital death were compared using Fisher’s exact test. Multivariable logistic regression analysis was performed to explore the relationships among in-hospital mortality, transfusion, and hemorrhagic conditions in patients undergoing endoscopy and IR.

Among 726 patients with non-traumatic conditions treated in the hybrid ER, 50 (6.9%) experienced cardiac arrest, 301 (41.5%) were in shock, 126 (17.4%) received blood transfusions, 42 (5.8%) died within 24 hours of admission, and 141 (19.4%) died in the hospital. Emergency surgery was performed in 39 patients, with significantly more blood transfusions administered in the bleeding group (71.4% vs. 18.8%, P = 0.01). Endoscopy and IR were performed in 122 and 100 patients, respectively, with the bleeding group exhibiting higher rates of shock or cardiac arrest (87.5% vs. 66.7%, P = 0.008) and blood transfusion (62.5% vs. 4.8%, P < 0.0001). Multivariable analysis suggested a trend toward higher in-hospital mortality in non-hemorrhagic conditions (odds ratio = 3.8, 95% CI: 0.88–17, P = 0.073), although significance was not reached.

In the hybrid ER, there may be an association between in-hospital mortality and hemorrhagic conditions among patients with endogenous diseases. Future research should focus on demonstrating the effectiveness of the hybrid ER in managing specific diseases.

Reference: sciencedirect.com/science/article/pii/S073567572300551X