Clinical and Experimental Emergency Medicine最新文献

{"title":"A review of hypoglycemia and dextrose treatment in patients with cardiac arrest.","authors":"Glenn Goodwin, Michael Hinton, Moshe Bengio, Akash Patel, Nicholas Gaeto, Huy Tran, Sanaz Kashan, Tony Zitek","doi":"10.15441/ceem.24.305","DOIUrl":"10.15441/ceem.24.305","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"90-93"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977884","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 physician-nurse team adjacent to triage shortens length of stay and left-without-being-seen rates.","authors":"Samita M Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alision Rowe, Henry Thode, Adam J Singer","doi":"10.15441/ceem.24.248","DOIUrl":"10.15441/ceem.24.248","url":null,"abstract":"<p><strong>Objective: </strong>Staffing significantly influences emergency department (ED) throughput; however, there is a shortage of registered nurses (RNs), impacting ED flow and crowding. Non-RN providers, like licensed practical nurses (LPNs), could potentially assist with tasks traditionally assigned to RNs. To improve the front-end ED process, we implemented an attending physician-LPN team (PNT) positioned next to triage and utilized existing ED hallway space.</p><p><strong>Methods: </strong>This study took place at a tertiary care ED with over 110,000 annual visits. We compared postintervention (post-PNT) data (November 1, 2022-February 28, 2023) to preintervention (pre-PNT) data (July 31, 2022-October 31, 2022). The PNT, positioned adjacent to triage, expedited care for ED patients awaiting open rooms. The PNT selected patients from the waiting room to bypass the main ED, evaluated them in a private room, and then moved them to the hallway pending further care. Multivariable regression analysis was utilized to measure the impact of different factors on ED length of stay (LOS).</p><p><strong>Results: </strong>We analyzed 23,516 patient visits, 10,288 in the pre-PNT period and 13,288 in the postPNT period. Post-PNT consisted of 2,454 PNT visits and 10,834 non-PNT visits. The intervention led to significant improvements, including a decrease in mean ED LOS from 492 to 425 minutes, a decrease in 72-hour revisits from 5.1% to 4.0%, a decrease in left-without-being-seen rate from 6.7% to 3.3%, and a decrease in the mean arrival-to-provider time from 74 to 60 minutes. Multivariable regression analysis showed that ED LOS was significantly lower for post-PNT patients than pre-PNT.</p><p><strong>Conclusion: </strong>By leveraging the scope of LPNs and utilizing existing ED space, the PNT model successfully reduced front-end bottlenecks, leading to improved throughput and reduced revisitation and left-without-being-seen rates.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"26-34"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139439","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":"Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study.","authors":"Jaleh Aghaie, Marianne Lisby, Marie Kristine Jessen","doi":"10.15441/ceem.24.219","DOIUrl":"10.15441/ceem.24.219","url":null,"abstract":"<p><strong>Objective: </strong>Fluids administered as drug diluents with intravenous (IV) medicine constitute a substantial fraction of fluids in inpatients. Whether physicians are aware of fluid volumes administered with IV antibiotics for patients with suspected infections is unclear. Moreover, whether this leads to adjustments in 24-hour fluid administration/antibiotics is unknown.</p><p><strong>Methods: </strong>This cross-sectional interview-based study was conducted in three emergency departments. Physicians were interviewed after prescribing around-the-clock IV antibiotics for ≥24 hours to patients with suspected infection. A structured interview guide assessed the physicians' awareness, considerations, and practices when prescribing IV antibiotics. The 24-hour antibiotic fluid volume was calculated.</p><p><strong>Results: </strong>We interviewed 100 physicians. The 24-hour fluid volume administered with IV antibiotics was 400 mL (interquartile range, 300-400 mL). Overall, 53 physicians (53%) were unaware of the fluid volume administered with IV antibiotics. Moreover, 76 (76%) did not account for the antibiotic fluid volume in the 24-hour fluid administration, and 96 (96%) indicated that they would not adjust prescribed fluids after receiving information about 24-hour antibiotic fluid volume administered for their patient. No comorbidities associated with fluid intolerance were the primary reason for not adjusting prescribed fluids/ antibiotics. Approximately 79 (79%) opted for visibility of fluid volumes administered with IV antibiotics in the medical record.</p><p><strong>Conclusion: </strong>The majority of physicians were unaware of fluid volumes administered as a drug diluent with IV antibiotics. The majority chose not to make post-prescribing adjustments to their planned fluid administration; they regarded their patient as fluid tolerant. The physicians opted for visibility of fluid volumes administered as diluents during the prescribing process.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"66-75"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080705","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 and trends of pediatric trauma on Jeju Island, Korea: a community-level serial cross-sectional study.","authors":"Chaemoon Lim, Jung-Hwan Oh, Jeong Rae Yoo, Seo Young Ko, Jeong Ho Kang, Sung Kgun Lee, Wooseong Jeong, Gil Myeong Seong, Hyun Jung Lee, Chul-Hoo Kang, Ji Hyun Moon, In-Seok Son, Hyun Ju Yang, Min-Su Oh, Sung Wook Song","doi":"10.15441/ceem.24.203","DOIUrl":"10.15441/ceem.24.203","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments on Jeju Island, Korea.</p><p><strong>Methods: </strong>Using a community-level serial cross-sectional analysis, we targeted pediatric patients 18 years or younger who visited emergency departments for injuries over a 10-year period. A comprehensive examination of injury characteristics and epidemiological trends was performed using the data sourced from the Jeju Injury Surveillance System. This included an evaluation of the annual incidence and overall trends in pediatric injury cases.</p><p><strong>Results: </strong>The study found toddlers (42.5% of cases) to be the most frequently injured age group. Male patients were more prone to injuries, with a male to female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in summer, evenings, and weekends. Most incidents occurred at home, were predominantly accidental in nature, with adolescents more likely to require emergency medical system services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized; however, self-harm/suicide and assault/ violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents.</p><p><strong>Conclusion: </strong>The result of the present study underscore the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and time of injury, to effectively mitigate pediatric trauma on Jeju Island.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"56-65"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080659","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":"Floating thrombus involving the aortic arch in a woman.","authors":"Gabriele Pagliariccio, Massimo Mattioli, Ilenia Di Sario","doi":"10.15441/ceem.24.292","DOIUrl":"10.15441/ceem.24.292","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"97-98"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459486","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":"Simulation intervention related to family presence during resuscitation for physicians and medical students: a scoping review.","authors":"Kyung Hye Park, Jannet J Lee-Jayaram, Melissa K Kahili-Heede, Benjamin W Berg","doi":"10.15441/ceem.24.224","DOIUrl":"10.15441/ceem.24.224","url":null,"abstract":"<p><strong>Objective: </strong>Family presence during resuscitation (FPDR) is an established part of family-centered care. However, how physicians are educated about FPDR is relatively unclear. We aim to review the current status of FPDR simulation for physicians and medical students.</p><p><strong>Methods: </strong>A scoping review of literature published from 1999 to May 5, 2023, and written in English was undertaken. Articles were searched for using combinations of various family-, resuscitation-, and simulation-related words as keywords, respectively.</p><p><strong>Results: </strong>Eight articles were included in the final review. This review of FPDR simulation for physicians and medical students revealed findings in three categories: measuring cardiopulmonary resuscitation quality, investigating participant responses after FPDR simulation, and extracting exemplar good-communication elements. First, in four studies measuring resuscitation quality, physicians participated in adult resuscitation, and resuscitation quality was reduced with a family witness showing an overt reaction. Second, in three studies investigating the response to simulation training, interprofessional teams participating in pediatric resuscitation had negative responses to FPDR simulation. Third, in one study, good-communication elements during FPDR were observed during infant simulation, in which interprofessional teams participated. To the best of our knowledge, FPDR simulation training for medical students has not been reported.</p><p><strong>Conclusion: </strong>Our literature review highlights a gap in FPDR simulation involving physicians and/ or medical students. Physicians were more concerned with resuscitation quality than supporting families during resuscitation simulations. Medical students should be considered as participants for FPDR simulation. More high-evidence studies with interprofessional teams that include physicians and/or medical students are needed to evaluate curriculum design and participant-response changes following FPDR simulation.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"16-25"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723220","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":"Single-lumen displacement of a hemodialysis catheter into the azygous vein on a chest radiograph.","authors":"Robert Hlavin, Michael Gottlieb","doi":"10.15441/ceem.24.298","DOIUrl":"10.15441/ceem.24.298","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"99-100"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459489","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":"Factors that predict emergency department length of stay in analysis of national data.","authors":"Minha Kim, Sujeong Lee, Minyoung Choi, Doyeop Kim, Junsang Yoo, Tae Gun Shin, Jin-Hee Lee, Seongjung Kim, Hansol Chang, Eunsil Ko","doi":"10.15441/ceem.24.309","DOIUrl":"10.15441/ceem.24.309","url":null,"abstract":"<p><strong>Objective: </strong>This study used a nationwide database to identify and analyze factors that influence emergency department (ED) length of stay (LOS) and improve the efficiency of emergency care.</p><p><strong>Methods: </strong>This retrospective study analyzed data from the National Emergency Department Information System (NEDIS) database in Korea: 25,578,263 ED visits from 2018 to 2022. Patient demographics, clinical characteristics, and ED operational variables were examined. Univariate and multivariate logistic regression analyses were used to assess the associations between the variables and prolonged ED LOS, defined as 6 hours or more.</p><p><strong>Results: </strong>Among the 25,578,263 patients, the median ED LOS was 2.1 hours (interquartile range, 1.050-3.830 hours), with 12.6% experiencing a prolonged ED LOS. Elderly patients (aged ≥65 years) were significantly more likely than younger patients to experience prolonged ED LOS (adjusted odds ratio [aOR], 1.415; 95% confidence interval [CI]: 1.411-1.419). Patients transferred from other hospitals (aOR, 1.469; 95% CI, 1.463-1.474) and those arriving by emergency medical services (aOR, 1.093; 95% CI, 1.077-1.108) also had high odds of prolonged LOS. Conversely, pediatric patients had a low likelihood of extended stay (aOR, 0.682; 95% CI, 0.678-0.686). Severe illness, including sepsis (aOR, 1.324; 95% CI, 1.311-1.340) and COVID-19 infection (aOR, 1.413; 95% CI, 1.399-1.427), was strongly associated with prolonged LOS.</p><p><strong>Conclusion: </strong>Prolonged ED LOS is influenced by a combination of patient demographics, clinical severity, and systemic factors. Targeted interventions for older adults, severe illness, and operational inefficiencies such as hospital transfers are essential for reducing ED LOS and improving overall emergency care delivery.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"35-46"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459488","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":"Novel biomarkers for acute phase reactants.","authors":"Sun Young Cho","doi":"10.15441/ceem.24.336","DOIUrl":"10.15441/ceem.24.336","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"1-3"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977803","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":"Sex and age differences in atypical chief complaints for acute decompensated heart failure in the emergency department.","authors":"Matthew L Regan, Jason J Bischof, Montika Bush, Anna E Waller, Timothy F Platts-Mills, Martin F Casey, Michelle L Meyer","doi":"10.15441/ceem.24.226","DOIUrl":"10.15441/ceem.24.226","url":null,"abstract":"<p><strong>Objective: </strong>About one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing the presentation of ED symptoms among ADHF patients may improve clinical care; however, sex and age differences in ED chief complaints have not been thoroughly investigated. In this paper, we describe differences in chief complaints and comorbid conditions for ED patients with ADHF diagnoses, stratified by sex and age.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of adults presenting to North Carolina EDs using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a statewide syndromic surveillance system, between 2010 and 2016, screening for patients with a diagnosis of ADHF. We evaluated frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, and computed standardized differences.</p><p><strong>Results: </strong>The most common chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 years age group, women were more likely than men to report nausea/vomiting (6.7% vs. 4.1%) and headache (4.2% vs. 2.0%). In those 45-64 and ≥65 years, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 years age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the ≥65 years age group.</p><p><strong>Conclusion: </strong>Differences in atypical ADHF symptoms were seen in in ED patients based on sex and age. Understanding the variation in ADHF symptoms among ED patients can facilitate the identification of ED patients with ADHF and improve management of ADHF-related symptoms.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"47-55"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080666","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}