Clinical and Experimental Emergency Medicine最新文献

{"title":"Oral anticoagulant use by emergency medical services patients: an observational study.","authors":"Henry E Wang, Mengda Yu, Ching Min Chu, Travis P Sharkey-Toppen, J Madison Hyer, Michelle Nassal, Alix Delamare, Jonathan Powell, Lai Wei, Robert Lowe, Kim Moeller, Alexander Keister, Ashish Panchal","doi":"10.15441/ceem.24.369","DOIUrl":"10.15441/ceem.24.369","url":null,"abstract":"<p><strong>Objective: </strong>Oral anticoagulant (OAC) use increases the risk of death in conditions like hemorrhagic stroke, trauma, and traumatic brain injury. Early identification of OAC use is critical for timely interventions to mitigate hemorrhage risk and improve survival. We aimed to identify emergency medical services (EMS) care characteristics associated with patients using an OAC.</p><p><strong>Methods: </strong>We analyzed prehospital data (2018-2020) from the ESO Data Collaborative, focusing on adult (≥18 years) 911 EMS calls. The administered OACs were warfarin, dabigatran, rivaroxaban, and apixaban. We compared EMS call characteristics, patient demographics, response times, and interventions between OAC and non-OAC users. We used univariate logistic regression to identify independent predictors of OAC use.</p><p><strong>Results: </strong>Of 16,244,550 adult 911 EMS events, 906,575 involved OAC users (56 of 1,000 calls). Those using OAC were older (73.6 years vs. 56.9 years) and more often from nursing homes or long-term care facilities (17.0% vs. 9.2%) but less likely to have trauma (14.7% vs. 18.1%) or cardiac arrest (1.2% vs. 1.4%). The most common EMS primary clinical impressions for OAC users were chest pain (7.4%), altered mental status (7.3%), injury (6.5%), abdominal pain (4.3%), and brain injury (2.8%).</p><p><strong>Conclusion: </strong>OAC users accounted for 1 in 18 adult EMS encounters. Specific patient and call characteristics were associated with OAC use. These findings should be incorporated into EMS training to facilitate recognition and appropriate management of OAC-related emergencies.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"350-357"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-induced sialadenitis.","authors":"Manas Deolankar, Katarzyna Gore, Michael Gottlieb","doi":"10.15441/ceem.25.150","DOIUrl":"10.15441/ceem.25.150","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"416-417"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated Sequential Organ Failure Assessment (SOFA)-2 score: major changes and emergency department perspectives.","authors":"Seung Mok Ryoo","doi":"10.15441/ceem.25.285","DOIUrl":"10.15441/ceem.25.285","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"303-305"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trends in emergency department visits by age group: a report from the National Emergency Department Information System (NEDIS) of Korea, 2020-2024.","authors":"Hang A Park, Taehui Kim, Hyo Jin Kim, So-Hyun Han","doi":"10.15441/ceem.25.291","DOIUrl":"10.15441/ceem.25.291","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"405-413"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical considerations of artificial intelligence in emergency medicine for triage and resource allocation: a scoping review.","authors":"Hyunjae Cha, Junhewk Kim","doi":"10.15441/ceem.25.199","DOIUrl":"10.15441/ceem.25.199","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to systematically review the ethical and legal discussions regarding the utilization of artificial intelligence (AI) for patient triage and resource allocation in emergency medicine, and to identify the current state of discussions, their limitations, and future research directions.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted following scoping review methodology. Relevant literature published after January 2020 was searched in the Web of Science, Scopus, CINAHL, PubMed, and Cochrane Library databases. Based on a PCC (population, concept, and context) framework (emergency patients/medical staff; triage, resource allocation; and emergency medicine with AI application), a final selection of 27 articles was analyzed.</p><p><strong>Results: </strong>The selected literature raised various ethical and legal issues related to the introduction of AI triage systems and AI utilization in emergency medicine, including data privacy, algorithmic bias, automation dependency, accountability, and explainability. In response to these issues, human-centered design, implementation of explainable AI, establishment of regulatory frameworks, continuous verification and evaluation, and ensuring human-in-the-loop were discussed as major solutions. However, discussions on the risks of \"persuasive AI\" that could mislead users, ethical issues of generative AI, and social validation and patient and public involvement were found to be insufficient.</p><p><strong>Conclusion: </strong>Ethical and legal discussions regarding AI in emergency medicine are evolving toward seeking concrete solutions at technical, institutional, and relational dimensions. However, in-depth research on ethical challenges, such as reflecting the specificity of rapidly developing AI and the values of emergency medicine, is urgently required.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"306-319"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A harmless fang with harmful consequences: Kounis syndrome after a nonvenomous snakebite.","authors":"Mohammed Arif Abdul Salam, Joshua Birru, Sarbari Swaika","doi":"10.15441/ceem.25.137","DOIUrl":"10.15441/ceem.25.137","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"418-421"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated traumatic brain injury.","authors":"Kyung Won Park, Sung Wook Song, Woo Jeong Kim, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee, Seo Young Ko, Soo Hoon Lee, Chang Bae Park, Jin Gu Lee, Jong Yeon Kang, Jaeyoon Ha, Jiwon Kim","doi":"10.15441/ceem.24.331","DOIUrl":"10.15441/ceem.24.331","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) often occurs alongside injuries to other body regions, worsening patient outcomes. This study evaluates the impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated TBI.</p><p><strong>Methods: </strong>This retrospective cross-sectional analysis was conducted using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) for 180,058 TBI patients admitted to 23 tertiary hospitals from January 1, 2020, to December 31, 2022. Patients were categorized into isolated TBI group (iTBI; n=127,673) and non-isolated TBI group (niTBI; n=52,385) based on injury diagnostic codes. Clinical outcomes-24-hour and 30-day mortality, hospital admission, and interhospital transfer-were compared. Multivariate logistic regression analyses adjusted for potential confounders were performed.</p><p><strong>Results: </strong>The niTBI patients exhibited significantly higher 24-hour mortality (1.5% vs. 0.4%), 30-day mortality (2.6% vs. 1.0%), hospital admissions (24.5% vs. 8.4%), and interhospital transfers (3.6% vs. 1.1%) than iTBI patients (all P<0.001). Concomitant injuries increased the adjusted odds of 24-hour mortality (adjusted odds ratio [aOR], 1.456; 95% confidence interval [CI], 1.286-1.648) and 30-day mortality (aOR, 1.111; 95% CI, 1.022-1.208). Thoracic injuries were the most significant predictor of adverse outcomes in niTBI patients, increasing the odds of 24-hour mortality by nearly sixfold (aOR, 5.958; 95% CI 5.057-7.019).</p><p><strong>Conclusion: </strong>s: Concomitant injuries significantly worsen clinical outcomes in TBI patients, with thoracic injuries being the most critical predictor of mortality. These findings highlight the importance of comprehensive trauma assessments and targeted prevention strategies to improve survival rates and optimize resource allocation for patients with multiple injuries.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"358-368"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of ubiquitin C-terminal hydrolase-L1, glial fibrillary acidic protein, and interleukin-6 levels in an experimental head trauma model in rabbits.","authors":"İlknur Şahin, Hasan Kara, Ali Ünlü, Ceyhan Uğurluoğlu, Beyza Saraçlıgil","doi":"10.15441/ceem.24.383","DOIUrl":"10.15441/ceem.24.383","url":null,"abstract":"<p><strong>Objective: </strong>The study investigates experimental brain trauma in rabbits, assessing levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and interleukin 6 (IL-6) in serum and cerebrospinal fluid (CSF) and compares these biomarkers among trauma groups.</p><p><strong>Methods: </strong>Thirty rabbits were randomized to a control group (n=6) or to mild-, moderate-, and severe-trauma groups (n=8 each) created by dropping 200, 350, or 500 g weights, respectively, onto their skulls using a modified Marmarou impact acceleration model. CSF and venous blood samples were collected at 0, 12, and 24 hours after injury; UCH-1 L, GFAP, and IL-6 concentrations in CSF and serum were quantified by enzyme-linked immunosorbent assays, and group differences were analyzed with a Friedman test followed by Dunn-Bonferroni correction.</p><p><strong>Results: </strong>Neither CSF nor serum concentration of GFAP, IL-6, or UCH-L1 differed from those of controls after mild trauma. Severe head trauma produced markedly higher GFAP and IL-6 concentrations in CSF compared with the control group (P<0.05), with both biomarkers peaking at 12 hours after injury. Serum UCH-L1 increased significantly in both moderate-trauma (peak at 12 hours) and severe-trauma groups (peak at 24 hours) compared with the control group (P<0.05), whereas no intergroup difference in CSF UCH-L1 levels was evident.</p><p><strong>Conclusion: </strong>Serum UCH-L1 differentiated moderate and severe trauma from controls in a rabbit model, whereas CSF GFAP and IL-6 levels reflected severe injury. Validation in larger preclinical and clinical studies is warranted.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"380-390"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric trauma management in Switzerland: insights from a nationwide survey.","authors":"Leopold Simma","doi":"10.15441/ceem.24.251","DOIUrl":"10.15441/ceem.24.251","url":null,"abstract":"<p><strong>Objective: </strong>To explore and analyze pediatric trauma care practices across designated pediatric trauma centers (PTCs) in Switzerland. The focus was on reception, trauma team activation (TTA), trauma team composition, patient volumes, and infrastructure.</p><p><strong>Methods: </strong>A national online survey was conducted among all eight PTCs in Switzerland using an 18-item questionnaire. The survey investigated organizational aspects, criteria for TTA, patient volume, and communication modalities in pediatric emergency departments (PEDs).</p><p><strong>Results: </strong>All PTCs responded, revealing varying methods of TTA, with reception of major trauma patients occurring at either PEDs or adjacent adult trauma facilities. Trauma team composition and activation criteria also differ among centers, with nonsurgeons often leading the teams and anesthesiologists being the default facilitators of airway management. TTA criteria vary widely, with the most common being the request of prehospitalization staff (62.5%) and physician discretion (50%). Trauma resuscitation is predominantly led by PED attendants (75%).</p><p><strong>Conclusion: </strong>This survey provides insights into the state of pediatric trauma care in Switzerland. The findings underscore the importance of multidisciplinary teams and variability in trauma management practices, which are often tailored to local circumstances. Despite the study limitations of using self-reported data and the small sample size owing to the country's size, the result suggest that a national trauma registry would be helpful to the evaluation and optimization of pediatric trauma care protocols.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"280-286"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy of bolus low-dose ketamine versus bolus plus infusion low-dose ketamine on pain management in emergency departments: a randomized clinical trial.","authors":"Reza Azizikhani, Ali Sanaei, Farhad Heydari, Saeed Majidinejad, Keihan Golshani, Fateme Sadeghi, Pardis Rafiei","doi":"10.15441/ceem.24.244","DOIUrl":"10.15441/ceem.24.244","url":null,"abstract":"<p><strong>Objective: </strong>Ketamine is a promising drug for analgesia in emergency medicine, but the high rate of side effects is a barrier to widespread usage. We hypothesized that ketamine bolus followed by ketamine infusion would provide a more even and longer duration of analgesia and lower rates of side effects in comparison to bolus-only administration.</p><p><strong>Methods: </strong>This was a double-blinded clinical trial. Eligible trauma patients were randomly allocated with the numeric rating scale ≥6 in two study groups. The first group received a dose of 0.3 mg/kg of ketamine over 1 minute, followed by an infusion of saline 0.9% over the next 30 minutes (bolus-only group). The second group was given 0.15 mg/kg of ketamine over 1 minute, followed by an infusion of 0.15 mg/kg over the next 30 minutes (bolus-and-infusion group). The primary outcome was to measure the average reduction in pain scores.</p><p><strong>Results: </strong>In total, 80 patients were recruited. Of these, 77 patients were analyzed. Both groups achieved a statistically significant decrease in pain scores (all P<0.001). After 30 minutes, patients in the bolus-and-infusion group reported lower pain scores in all intervals with lower rates of need for rescue analgesia, but this difference was not statistically significant. Vital signs remained stable during the study in both groups. No statistically significant difference was observed between study groups for any side effect (P<0.05).</p><p><strong>Conclusion: </strong>Both administration protocols resulted in significant pain control. No statistically significant difference was observed between study groups in terms of analgesic efficacy and side effects.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"259-266"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}