Clinical and Experimental Emergency Medicine最新文献

{"title":"Process-first relief of emergency department overcrowding: a before-after analysis of time-to-decision and boarding in a regional center.","authors":"Wookjin Choi, Sungsil Lee, Eun Ji Park","doi":"10.15441/ceem.25.322","DOIUrl":"https://doi.org/10.15441/ceem.25.322","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the extent to which time-based and operational factors drive emergency department (ED) overcrowding and evaluate the impact of targeted process improvements without constructing a new composite index.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective before-after study of 6,881 adults with high triage acuity (Korean Triage and Acuity Scale levels 1-3) who were admitted from the ED across two consecutive 12-month periods: period 1 (2021-07-01 to 2022-06-30) and period 2 (2022-07-01 to 2023-06-30). Interventions were launched hospital-wide, targeting consultation responsiveness, earlier admission decision-making, faster ward bed assignment, and post-assignment transport and handover, which were implemented concurrently. The primary outcome was the change in ED length of stay (LOS; arrival-to-ED exit), and the secondary outcomes were changes in five key interval times along the care pathway.</p><p><strong>Results: </strong>The Mean ED LOS decreased significantly from 424.8±471.3 minutes to 283.2±306.9 minutes (-141.6 minutes, approximately 33% reduction; p<0.05). All interval means improved significantly (all p<0.05); notably, the 'admission decision-to-ED exit' interval shortened from 173.3±295.2 to 84.7±118.4 min. Improvements were consistent across all the high-acuity strata.</p><p><strong>Conclusion: </strong>Targeted pathway-level process improvements, especially those that shorten boarding, substantially reduced ED LOS and relieved overcrowding among admitted highacuity patients. A boarding-focused, hospital-wide approach is an operationally transferable framework for institutions that cannot implement composite crowding indices owing to data limitations although attribution to specific components requires more granular study designs.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638161","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":"Declining Ambulance Offload Delays and Stabilised Emergency Department Length of Stay Post-COVID: An Interrupted Time Series Analysis.","authors":"Edward Stacey, Liam Hemingway, Gabriel E Blecher, Cameron M Gosling, Clifford Connell, Nadine Andrew, Brendan Shannon","doi":"10.15441/ceem.25.240","DOIUrl":"https://doi.org/10.15441/ceem.25.240","url":null,"abstract":"<p><strong>Objective: </strong>Ambulance offload delays and emergency department [ED] crowding worsened during COVID-19 and remain critical in Victoria, where <62 % of ambulances offload on time. Evidence on post-pandemic trends is limited. We analysed offload delays and ED length of stay [LOS] at a major Melbourne health service [Jan 2018-Aug 2024] across three periods: pre-COVID, during COVID and post-COVID, stratified by admission status.</p><p><strong>Methods: </strong>Monthly median offload times and ED LOS were examined using interrupted time-series models to detect level and slope changes.</p><p><strong>Results: </strong>Among 529 261 presentations, median offload times for non-admitted patients increased 12.7 min at the post-COVID transition then fell 0.62 min per month, ending below pre-COVID projections. Admitted patients showed a median 14.2 min increase and a 0.73 min per month decline. ED LOS median time rose post-COVID by 53.6 min for non-admitted and 124.8 min for admitted patients. Thereafter, non-admitted patient LOS declined, whereas admitted patient LOS remained persistently elevated and stabilised at a high level.</p><p><strong>Conclusions: </strong>Although ambulance offload delays have improved, now below pre-COVID counterfactual levels, emergency department length of stay remains elevated particularly for admitted patients. Targeted interventions such as dedicated offload staff, real-time bed management, and streamlined discharge pathways are needed to address persistent emergency department crowding.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608175","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":"Prognostic Significance of Admission Blood Glucose for 30-Day Survival and Neurological Outcomes in Non-Diabetic Out-of-Hospital Cardiac Arrest Patients: A Retrospective Cohort Study.","authors":"Mei Li, Qinghui Hu, Lifeng Du","doi":"10.15441/ceem.25.193","DOIUrl":"https://doi.org/10.15441/ceem.25.193","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between admission blood glucose (BG) and 30-day survival and neurological outcomes in adult, non-diabetic out-of-hospital cardiac arrest (OHCA) patients with return of spontaneous circulation (ROSC).</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study (2014-2023) including 1,128 non-diabetic adults with OHCA who achieved ROSC. Patients were stratified by admission BG into four categories: <80 mg/dL, 80-179 mg/dL, 180-299 mg/dL, and ≥300 mg/dL. Primary outcomes were 30-day survival and favorable neurological status (Cerebral Performance Category [CPC] 1-2). Multivariable logistic regression models adjusted for major confounders (age, sex, initial rhythm, bystander CPR, call-to-arrival time, and extracorporeal CPR) using the 80-179 mg/dL group as the reference. Restricted cubic spline analyses explored potential nonlinear relationships between BG and outcomes.</p><p><strong>Results: </strong>Patients with mild-to-moderate hyperglycemia (180-299 mg/dL) demonstrated the highest 30-day survival (14.7%) and favorable neurological outcome (10.8%) rates, compared with hypoglycemia (6.6% and 4.7%; both p < 0.05). In adjusted analyses, hypoglycemia (<80 mg/dL) and severe hyperglycemia (≥300 mg/dL) were associated with significantly lower odds of survival (adjusted odds ratio [aOR] = 0.41, 95% CI 0.21-0.79; and aOR = 0.69, 95% CI 0.52-0.91, respectively). Spline analysis revealed a U-shaped association, with optimal survival observed at 140-195 mg/dL.</p><p><strong>Conclusion: </strong>Admission BG is an easily measurable prognostic biomarker in non-diabetic OHCA. Mild-to-moderate hyperglycemia was associated with the most favorable short-term outcomes, whereas both hypoglycemia and severe hyperglycemia predicted worse survival and neurological recovery.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608227","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":"Initial diagnosis and management of acute ischemic stroke: updates and future directions.","authors":"Sang Hee Ha, Sujin Koo, Seung Min Kim, Jae Young Park, Seung Eun Lee, Bum Joon Kim","doi":"10.15441/ceem.25.241","DOIUrl":"10.15441/ceem.25.241","url":null,"abstract":"<p><p>Outcomes in acute ischemic stroke (AIS) depend critically on rapid and accurate early diagnosis in the emergency department. Traditional prehospital tools and large vessel occlusion-focused scales facilitate triage but have limited capacity to distinguish ischemic from hemorrhagic stroke, a distinction essential for acute-phase treatment decisions. Recent advances include mobile stroke units equipped with computed tomography (CT), point-of-care laboratories, and telemedicine systems, as well as the emergence of biomarkers that enable field-based diagnosis and faster initiation of therapy. In-hospital imaging strategies incorporating CT, CT perfusion, and magnetic resonance imaging (MRI)-based tissue clocks have expanded eligibility for endovascular thrombectomy to include patients with large-core infarction or unclear-onset wake-up strokes. Prolonged cardiac monitoring and high-resolution vessel wall MRI have improved the detection of embolic sources and high-risk atherosclerotic plaques. Artificial intelligence now supports rapid imaging interpretation, workflow optimization, and treatment selection. Tenecteplase, a novel thrombolytic, provides a practical alternative to alteplase with comparable safety and efficacy, while post-thrombectomy management emphasizes individualized blood pressure control. In patients with minor stroke or high-risk transient ischemic attack, short-term dual antiplatelet therapy reduces early recurrence, and early initiation of lipid-lowering agents after AIS may stabilize vulnerable plaques and enhance vascular outcomes. Collectively, these innovations represent a shift toward integrated, time-sensitive, and precision-based AIS care spanning prehospital assessment, emergency department management, and post-reperfusion management.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"5-12"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003244","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 four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study.","authors":"Matteo Guarino, Giacomo Maroncelli, Benedetta Perna, Paolo Baldin, Caterina Ghirardi, Alex Zanotto, Silvia Eichner, Matteo Bolognesi, Chiara Pesci, Martina Maritati, Carlo Contini, Roberto De Giorgio, Michele Domenico Spampinato","doi":"10.15441/ceem.25.075","DOIUrl":"10.15441/ceem.25.075","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis, a life-threatening organ dysfunction, is a major global health concern. Early detection remains challenging due to nonspecific symptoms. Noninvasive tools such as the shock index, diastolic shock index, capillary refill time (CRT), and mottling score (MS) could help clinicians assess hemodynamic status and predict mortality, but a comprehensive comparison of their prognostic value is lacking. This study compares the performance of those four tools in predicting mortality in septic patients at 24 hours, 7 days, and 28 days.</p><p><strong>Methods: </strong>A single-center, prospective observational study was conducted from January to September 2024. Adult patients (≥18 years) with suspected infection and a National Early Warning Score-2 of ≥5 were enrolled. Demographic data, vital signs, and CRT and MS results were collected at presentation, and mortality outcomes were recorded at 24 hours, 7 days, and 28 days.</p><p><strong>Results: </strong>In total, 135 patients were included (median age, 85 years [interquartile range, 79-90 years]; 44.4% female). The mortality rates were 15.6% at 24 hours, 25.2% at 7 days, and 35.6% at 28 days. CRT showed the highest predictive value for 24-hour mortality (area under the curve [AUC], 0.829; 95% confidence interval [CI], 0.755-0.889), and MS had the best performance at 7 days (AUC, 0.732; 95% CI, 0.646-0.806) and at 28 days (AUC, 0.749; 95% CI, 0.662-0.823). No significant differences emerged in pairwise comparisons.</p><p><strong>Conclusion: </strong>Although no one tool significantly outperformed the others, all four tools may provide useful, noninvasive mortality prediction in sepsis. CRT may be most effective for early risk stratification and MS correlates with mid-term outcomes, supporting their integration into clinical assessments.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"44-52"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653850","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":"Epidemiologic trends in pediatric urinary tract infections in United States emergency departments from 2016 to 2023.","authors":"Michael Gottlieb, Tamara Amponsah, Nhat Nguyen, Ohm Shukla, Kyle Bernard, Eric Moyer","doi":"10.15441/ceem.25.055","DOIUrl":"10.15441/ceem.25.055","url":null,"abstract":"<p><strong>Objective: </strong>Urinary tract infections are a common consideration when assessing pediatric patients with fever. With rising resistance rates and increased focus on antibiotic stewardship, current management needs to be better understood. This study reports the incidence and antibiotic distribution in a nationwide cohort of pediatric emergency department (ED) patients with cystitis and pyelonephritis during an 8-year period.</p><p><strong>Methods: </strong>We performed a cohort study from January 1, 2016, to December 31, 2023, using Epic Cosmos data. Pediatric ED patients (<18 years) with an ICD-10 code corresponding to cystitis or pyelonephritis were included. The outcomes were the total number of ED presentations, outpatient antibiotic prescriptions, and antibiotics administered in the ED for patients admitted with cystitis or pyelonephritis. Binary logistic regression models were used to measure the relationship between the year and the dependent variables.</p><p><strong>Results: </strong>Among 46,774,814 total pediatric ED visits, 720,863 (1.5%) were for cystitis, and 82,717 (0.2%) 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, 11.7%). First-generation cephalosporin use rose over time, while trimethoprim-sulfamethoxazole and ciprofloxacin use declined. Among those with cystitis specifically, the use of 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 antibiotic selection has shifted notably 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":"37-43"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966813","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":"Performance of a transesophageal echocardiography probe at temperature monitoring during simulated hypothermia and rewarming.","authors":"Madeline Larochelle, Margarita Popova, David Mackenzie, Andrew Fried, Peter Croft, Joshua Rehberg, Christina Wilson","doi":"10.15441/ceem.24.321","DOIUrl":"10.15441/ceem.24.321","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether a transesophageal echocardiography (TEE) probe can accurately measure temperature and be used to monitor temperature changes over time without overheating in an experimental model of hypothermia and rewarming.</p><p><strong>Methods: </strong>A 6-L water bath was heated with a sous vide immersion circulator to 24, 28, 32, and 36 °C to simulate severe hypothermia, moderate hypothermia, mild hypothermia, and normothermia, respectively. A TEE probe, esophageal temperature probe, and bladder temperature probe were used to measure temperature every 60 seconds for 15 minutes.</p><p><strong>Results: </strong>The TEE probe reported temperatures with a mean difference of 0.60 °C (95% confidence interval [CI], 0.51 to 0.69 °C) compared to the sous vide immersion circulator. The esophageal probe and bladder probe reported temperatures with a mean difference of -0.19 °C (95% CI, -0.23 to -0.14 °C) and -0.20 °C (95% CI, -0.26 to -0.14 °C), respectively.</p><p><strong>Conclusion: </strong>During this simulation, the TEE tip temperature did not increase beyond the expected changes produced by water temperature. The probe temperature was less accurate than the esophageal and bladder temperature probes but demonstrated precision in monitoring temperature changes and stable hypothermia. Based on this study, TEE probes should not be relied upon for an accurate initial temperature but can likely be used to monitor changes in temperature over time.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"81-85"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001104","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":"Automated chain-of-thought evaluation framework for large language model-generated emergency department documentation: a simulation-based study.","authors":"Dasol Choi, Junhyuk Seo, Won Cul Cha, Minha Kim, Sejin Heo, Hansol Chang, Taerim Kim","doi":"10.15441/ceem.25.153","DOIUrl":"10.15441/ceem.25.153","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate MEDIVAL (Medical Documentation Validation), a progressive chain-of-thought (CoT) evaluation framework for automated assessment of large language model (LLM)-generated emergency department documentation, designed to align with expert clinical judgment in acute care settings.</p><p><strong>Methods: </strong>We designed a three-tier evaluation framework incorporating persona-based, error-enhanced, and insight-integrated strategies. The framework was tested across four LLMs (GPT-4o, GPT-4.1, Claude-3.5, Claude-3.7) on 33 emergency department records reviewed by four expert emergency physicians. Each model applied the three CoT strategies across five criteria: appropriateness, accuracy, structure/format, conciseness, and clinical validity. Model outputs were compared with expert ratings using Spearman correlation coefficients. Differences were analyzed with the Friedman test and Wilcoxon signed rank test with Bonferroni correction. Reproducibility was assessed through intraclass correlation coefficient (ICC) analysis.</p><p><strong>Results: </strong>All models demonstrated stronger alignment with expert ratings as CoT complexity increased, with Claude-3.7 (r=0.712, P<0.001) and GPT-4o (r=0.702, P<0.001) showing the highest correlations under the insight-integrated strategy. GPT-4.1 showed the greatest relative improvement (43.3% increase, r=0.457 to r=0.655, P<0.001). Significant overall differences were observed across strategies (χ2 (2)=48.39, P<0.001), though the error-enhanced and insight-integrated approaches differed only modestly yet significantly (P=0.002). High reproducibility was confirmed (ICC >0.919), with Claude-3.5 achieving the most consistent results (ICC, 0.997-0.998).</p><p><strong>Conclusion: </strong>MEDIVAL demonstrates that progressive CoT strategies systematically improve automated evaluation of emergency department documentation while maintaining excellent reproducibility. This framework offers a viable prescreening tool to reduce expert workload and support reliable artificial intelligence integration into emergency medicine workflows.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"53-64"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653692","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 pilot study of recurrent abdominal pain in the emergency department: low-risk disease associated with high pain severity and frequent opioid administration.","authors":"Soroush Shahamatdar, Felice Yang, Meylakh Barshay, Ryan Heidish, Aditya Loganathan, Taylor Bolden, William Huang, Andrew C Meltzer","doi":"10.15441/ceem.25.036","DOIUrl":"10.15441/ceem.25.036","url":null,"abstract":"<p><strong>Objective: </strong>Abdominal pain is the most common emergency department (ED) chief complaint, with many patients experiencing recurrent episodes due to non-life-threatening etiologies such as disorders of gut-brain interaction. This pilot study aimed to characterize patients with recurrent low-risk abdominal pain, focusing on pain severity, management, biopsychosocial factors, opioid use, and 30-day return visits.</p><p><strong>Methods: </strong>This prospective, observational pilot study enrolled adult ED patients with recurrent abdominal pain at a single academic center between July 2022 and June 2023. Inclusion required at least one similar episode in the prior year with symptom resolution between episodes. Exclusions included unstable clinical status or high-risk conditions. Patient-reported outcomes, social determinants of health, and clinical data were collected. Primary outcomes included pain severity, opioid use, and 30-day return visit rates.</p><p><strong>Results: </strong>A total of 101 participants were enrolled (mean age, 43.7 years; 65.3% female; 69.3% Black). Pain severity was high (triage pain score, 7.1±2.6). Frequent prior computed tomography imaging was noted in 56.4% of participants. Opioids were administered in 50 participants (49.5%), while Patient-Reported Outcomes Measurement Information System (PROMIS)-29 scores highlighted risks of anxiety (T-score, 56.0±11.1) and pain interference (T-score, 60.8±8.2). Return visits occurred in 11 participants (10.9%) within 30 days.</p><p><strong>Conclusion: </strong>In this pilot study, patients with recurrent low-risk abdominal pain showed high symptom burden and healthcare utilization. Targeted interventions addressing biopsychosocial factors and improving pain management are needed to reduce ED revisits and improve outcomes.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"74-80"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653809","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":"The role of fomepizole in acetaminophen-related poisoning: a narrative review.","authors":"Frank Chen, Shelly Zq Lu, Harleen Chohan, Anthony Lau","doi":"10.15441/ceem.25.059","DOIUrl":"10.15441/ceem.25.059","url":null,"abstract":"<p><p>N-acetylcysteine (NAC) as the gold standard antidote in cases of acetaminophen (APAP)-related poisoning might not be sufficient with delayed presentation or massive ingestion. Human reports published up to July 2021 suggest that fomepizole could play a role in APAP overdoses by inhibiting cytochrome P450 2E1 (CYP2E1)-mediated N-acetyl-p-benzoquinone imine (NAPQI) production and JNK-mediated oxidative damage. This narrative review builds on previous systematic and scoping reviews by adding the latest evidence about the use of fomepizole in APAP poisoning to better understand the hepatoprotective role and safety profile of this medication, as well as its practical place in therapy. A systematic search of MEDLINE and Embase was completed through November 2024. Studies involving human patients with APAP toxicity who received fomepizole treatment were included. Each case was summarized in tables to identify clinical trends, particularly the risk of hepatotoxicity, quantity of ingestion, time of presentation since ingestion, therapeutic and dosing regimens, and clinical outcomes. This review covers 28 studies and 45 patients across 18 case reports and 6 case series. When used with NAC, fomepizole seemed to result in favorable laboratory and clinical outcomes in most patients at high risk of hepatotoxicity because of late presentation or massive APAP ingestion. The available data suggest that fomepizole might complement NAC in treating severe APAP toxicity. Though they lack detailed clinical outcome analyses, case studies suggest that fomepizole could improve hepatotoxicity, survival, and transplant-free days.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"13-27"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844789","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}