Clinical and Experimental Emergency Medicine最新文献

{"title":"Computed tomography images of acute iodinate contrast medium reaction.","authors":"Annapaola Truono, Nicola Romano, Lorenzo Bacigalupo, Antonio Castaldi","doi":"10.15441/ceem.24.295","DOIUrl":"10.15441/ceem.24.295","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"175-176"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459482","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":"Young woman with recurrent paroxysmal stridor after extubation.","authors":"Dong Eun Lee, Jong Kun Kim, Sin-Youl Park","doi":"10.15441/ceem.24.311","DOIUrl":"10.15441/ceem.24.311","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"177-179"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001117","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":"Enhancing community awareness and survival rates through a systemic approach to cardiac arrest.","authors":"Guglielmo Imbriaco, Donatella Del Giudice, Federico Semeraro, Lorenzo Gamberini","doi":"10.15441/ceem.25.014","DOIUrl":"10.15441/ceem.25.014","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 2","pages":"180-182"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607695","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":"Tricuspid annular plane systolic excursion (TAPSE) in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis.","authors":"Maria Groussis, Quincy K Tran, Megan Hoffer, Jalil Ahari, Ali Pourmand","doi":"10.15441/ceem.24.228","DOIUrl":"10.15441/ceem.24.228","url":null,"abstract":"<p><strong>Objective: </strong>Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter that serves as a prognostic indicator for the severity of chronic obstructive pulmonary disease (COPD) clinical course. This study, consisting of a systematic review and meta-analysis, evaluates the current literature to elucidate the relationship between TAPSE measurement in COPD patients versus control subjects to discern baseline evidence of right heart strain.</p><p><strong>Methods: </strong>PubMed, Scopus, CINAHL, Web of Science, and Cochrane Library databases were searched from their beginnings through November 1, 2023, for eligible studies. Outcomes included the difference of TAPSE measurement and right ventricular (RV) wall thickness between COPD patients and control patients. The Newcastle-Ottawa Scale was applied to assess risk of bias, Q-statistics and I2 values were used to assess for heterogeneity, and Egger and Begg tests were used to assess publication bias.</p><p><strong>Results: </strong>The search yielded 11 studies reporting TAPSE values involving 1,671 patients, 800 (47.9%) of which had COPD. The unadjusted mean TAPSE value for COPD patients was 18.9±4.0 mm, while the mean TAPSE value for control patients was 22.2±0.8 mm. The presence of COPD was significantly associated with decreased TAPSE values, with the meta-analysis reporting the mean difference in TAPSE value at -3.0 (95% confidence interval, -4.3 to -1.7; P=0.001) between COPD and control patients. Six studies reported the RV free wall thickness. The unadjusted mean RV free wall thickness for COPD patients was 4.9±1.2 mm, and for control patients was 3.4±0.7 mm.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrated statistically significant lower TAPSE values and thicker RV free wall among COPD patients as compared with control patients.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"121-131"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139481","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":"Characteristics of pediatric patients with heat-related illness transferred to emergency departments: Descriptive analysis.","authors":"Yohei Okada, Marcus Eng Hock Ong, Tadashi Ishihara, Shoji Yokobori, Jun Kanda","doi":"10.15441/ceem.24.343","DOIUrl":"https://doi.org/10.15441/ceem.24.343","url":null,"abstract":"<p><strong>Background: </strong>Children are particularly vulnerable to heat-related illnesses due to their unique physiological and behavioral characteristics. Understanding the epidemiology and clinical features of heat-related illnesses in children is crucial for guiding targeted preventive measures and management strategies. This descriptive study aims to investigate the characteristics of pediatric patients with heat-related illness transferred to emergency department (ED) s in Japan.</p><p><strong>Method: </strong>This study was a secondary analysis of the Heatstroke study, led by the Heatstroke and Hypothermia surveillance committee of the Japanese Association for Acute Medicine. This study included pediatric patients (<18 years old) with heat-related illness transferred to EDs in the summer from 2017 to 2021. We summarized the circumstances of onset, clinical characteristics, and outcomes.</p><p><strong>Results: </strong>Of the 3,154 registered patients, 146 children were included. Of them, 60% were male, with a median age of 15 years (interquartile range [IQR]: 13-16). Most cases occurred in August (47%) and most cases (80%) were associated with sports activities and with outdoor setting (70%). Cases with a body temperature above 40°C were rare (3%). Most cases were admitted to hospitals (75% to a general ward, and 16% to the ICU), and patients admitted to ICU had altered consciousness status with increased serum creatinine. There were two cases of mortality, both of which were out-of-hospital cardiac arrest.</p><p><strong>Conclusion: </strong>Most pediatric cases with heat-related illness were middle or high school-aged, occurred in August and were related to outdoor sports activity. Patients admitted to hospitals suffered from altered consciousness status, dehydration and acute kidney injury.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiologic Trends in Pediatric Urinary Tract Infections Among United States Emergency Departments from 2016-2023.","authors":"Michael Gottlieb, Tamara Amponsah, Nhat Nguyen, Ohm Shukla, Kyle Bernard, Eric Moyer","doi":"10.15441/ceem.25.055","DOIUrl":"https://doi.org/10.15441/ceem.25.055","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary tract infections are a common consideration among pediatric patients with fever. With rising resistance rates and increased focus on antibiotic stewardship, there is a need to better understand the current management. This study reports the incidence and antibiotic distribution among a nationwide cohort of Emergency Department (ED) patients with cystitis and pyelonephritis over an eight-year period.</p><p><strong>Methods: </strong>We performed a cohort study from 1/1/2016-12/31/2023 using Epic Cosmos. Pediatric (<18 years) ED patients with an ICD-10 code corresponding to cystitis or pyelonephritis were included. Outcomes included total number of ED presentations, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients with cystitis or pyelonephritis. Binary logistic regression models were used to measure the relationship between year and dependent variables.</p><p><strong>Results: </strong>Among 46,774,814 total pediatric ED visits, 730,863 (1.5%) were for cystitis and 82,717 (0.18%) were for pyelonephritis. Among those admitted, the most common antibiotics were third-generation cephalosporins (cystitis:55.6%, pyelonephritis:62.3%), first-generation cephalosporins (cystitis:13.8%, pyelonephritis:13.7%), and ampicillin (cystitis:10.8%, pyelonephritis:6.6%). First-generation cephalosporin use rose over time, while ampicillin and ciprofloxacin use declined. Among discharged patients, the most common antibiotics were first-generation cephalosporins (cystitis:43.1%, pyelonephritis:33.7%), third-generation cephalosporins (cystitis:20.8%, pyelonephritis:25.8%), and trimethoprim-sulfamethoxazole (cystitis:13.5%, pyelonephritis:11.8%). First-generation cephalosporin use rose over time, while trimethoprim-sulfamethoxazole and ciprofloxacin use declined. Among those with cystitis specifically, third-generation cephalosporins declined over time.</p><p><strong>Conclusion: </strong>Cystitis and pyelonephritis remain common ED presentations, representing nearly 2% of all pediatric ED visits, and there have been notable shifts in the antibiotic selection over time. Understanding the current epidemiology can inform public health planning and antibiotic stewardship in the ED.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interethnic Validation of an ECG Image Analysis Software for Detecting Left Ventricular Dysfunction in Emergency Department Population.","authors":"Haemin Lee, Woon Yong Kwon, Kyoung Jun Song, You Hwan Jo, Joonghee Kim, Youngjin Cho, Ji Eun Hwang, Yeongho Choi","doi":"10.15441/ceem.24.342","DOIUrl":"https://doi.org/10.15441/ceem.24.342","url":null,"abstract":"<p><strong>Objective: </strong>We previously developed and validated an AI-based ECG analysis tool (ECG Buddy) in a Korean population. This study aims to validate its performance in a U.S. population, specifically assessing its left ventricular (LV) Dysfunction Score and left ventricular ejection fraction (LVEF)-ECG feature for predicting LVEF <40%, using N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP) as a comparator.</p><p><strong>Methods: </strong>We identified emergency department (ED) visits from the MIMIC-IV dataset with information on LVEF <40% or ≥40%, along with matched 12-lead ECG data recorded within 48 hours of the ED visit. The performance of ECG Buddy's LV Dysfunction Score and LVEF-ECG feature was compared with NT-ProBNP using Receiver Operating Characteristic - Area Under the Curve (ROCAUC) analysis.</p><p><strong>Results: </strong>A total of 22,599 ED visits were analyzed. The LV Dysfunction Score had an AUC of 0.905 (95% CI: 0.899 - 0.910), with a sensitivity of 85.4% and specificity of 80.8%. The LVEF-ECG feature had an AUC of 0.908 (95% CI: 0.902 - 0.913), sensitivity 83.5%, and specificity 83.0%. NT-ProBNP had an AUC of 0.740 (95% CI: 0.727 - 0.752), with a sensitivity of 74.8% and specificity of 62.0%. The ECG-based predictors demonstrated superior diagnostic performance compared to NT-ProBNP (all p<0.001). In the Sinus Rhythm subgroup, the LV Dysfunction Score achieved an AUC of 0.913, and LVEF-ECG had an AUC of 0.917, both outperforming NT-ProBNP (0.748, 95% CI: 0.732 - 0.763, all p<0.001).</p><p><strong>Conclusion: </strong>ECG Buddy demonstrated superior accuracy compared to NT-ProBNP in predicting LV systolic dysfunction, validating its utility in a U.S. ED population.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound as a Tool in Prehospital Settings: Scoping review.","authors":"Jose Luis Piñeros-Alvarez, Jose Daniel Yusty Prada, Esteban Portuguez","doi":"10.15441/ceem.24.374","DOIUrl":"https://doi.org/10.15441/ceem.24.374","url":null,"abstract":"<p><p>Prehospital ultrasound (POCUS) is emerging as a valuable tool in the management of critically ill patients, particularly in trauma, dyspnea, and shock. This review aims to evaluate the diagnostic and therapeutic applications, limitations, and implementation challenges of POCUS in prehospital care. Key findings demonstrate that ultrasound, particularly the eFAST protocol, offers high specificity in identifying severe hemorrhage in trauma cases, although its sensitivity varies depending on the clinical context and operator experience. In dyspnea, pulmonary ultrasound significantly enhances diagnostic accuracy, aiding early detection of heart failure and other respiratory conditions. For shock, focused echocardiography facilitates rapid diagnosis and timely therapeutic decisions, improving patient outcomes. However, the effectiveness of POCUS is highly dependent on the operator's expertise, and challenges such as time, space, and resource limitations in prehospital settings may impact its use. Furthermore, there is a lack of local studies in Latin America assessing the impact of prehospital ultrasound on morbidity and mortality reduction, highlighting a gap in research. The review recommends standardized training programs, increased availability of portable ultrasound devices, and prospective studies on cost-benefit analysis to optimize POCUS implementation in prehospital systems, particularly in resource-limited regions. Prehospital ultrasound has the potential to revolutionize patient care by improving diagnostic precision and reducing time to definitive treatment, but its successful implementation requires strategic integration of technology, education, and research.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Anticoagulant Use by Emergency Medical Services Patients in the United States.","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":"https://doi.org/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 EMS care characteristics associated with patients on OACs.</p><p><strong>Methods: </strong>We analyzed prehospital data (2018-2020) from the ESO Data Collaborative, focusing on adult (≥18) 911 EMS calls. OAC use included 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 (56/1,000 calls). OAC users were older (73.6 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>Conclusions: </strong>OAC users accounted for 1 in 18 adult EMS encounters. Specific patient and call characteristics were associated with OAC use. These findings are essential for EMS training to efficiently recognize and manage OAC-related emergencies.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring burnout and professional fulfillment among emergency medicine residency program leaders in the United States: a cross-sectional survey study.","authors":"Carl Preiksaitis, Kalen N Wright, Al'ai Alvarez, Teresa M Chan, Michael Gottlieb, Andrew G Little, Adaira Landry","doi":"10.15441/ceem.24.255","DOIUrl":"10.15441/ceem.24.255","url":null,"abstract":"<p><strong>Objective: </strong>Emergency medicine (EM) physicians face high burnout rates, even in academic settings. Research on burnout among EM residency program leaders is limited, despite their role in shaping the training environment and influencing resident well-being. This study aims to measure burnout and professional fulfillment among EM residency program leaders and identify contributing factors.</p><p><strong>Methods: </strong>A cross-sectional survey using the adapted Stanford Professional Fulfillment Index was conducted in 2023 to assess burnout and professional fulfillment among EM residency program leaders at US programs. The survey, tailored to EM leaders, was distributed to all current EM program directors (PDs) and assistant/associate PDs (APDs) from accredited US programs. Descriptive statistics and odds ratios were used to compare burnout and professional fulfillment across various groups.</p><p><strong>Results: </strong>A total of 112 of 281 PDs (response rate, 39.9%) and 130 of 577 APDs (response rate, 22.5%) participated. Professional fulfillment was reported by 59.8% of PDs and 58.5% of APDs. Burnout was experienced by 42.0% of PDs and 26.9% of APDs. Higher professional fulfillment correlated with alignment with expectations, positive work environments, and perceived appreciation, while burnout was strongly associated with negative impacts on personal health and relationships. Approximately 27.7% of PDs and 23.8% of APDs expressed an intention to leave their current position within 18 months.</p><p><strong>Conclusion: </strong>A significant proportion of US EM residency program leaders experience burnout and low professional fulfillment. Addressing well-being in this population has important implications for education and mentorship provided to future physicians in the field.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"76-85"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139478","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}