Emergency Medicine Journal最新文献

{"title":"BET: methoxyflurane to facilitate reduction of anterior shoulder dislocation.","authors":"Gregory Yates, Ame Kumba Saidy","doi":"10.1136/emermed-2025-215390","DOIUrl":"https://doi.org/10.1136/emermed-2025-215390","url":null,"abstract":"<p><p>A short systematic review was undertaken to assess whether use of inhaled methoxyflurane in reduction of anterior shoulder dislocation is associated with an acceptable procedural success rate and decreased time spent in the emergency department. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. Eight relevant papers were found. The author, date, country of publication, study type, patient characteristics, relevant results and study weaknesses were tabulated. Our results suggest favourable outcomes with methoxyflurane, but a multicentre randomised trial is needed to fully address this clinical question.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Step-by-Step and Paediatric Emergency Care Applied Research Network (PECARN) Clinical Decision Aids in the management of young febrile infants in a UK cohort.","authors":"Etimbuk Umana, Hannah Norman-Bruce, Clare Mills, Oenone Rodgers, Hannah Mitchell, Lisa McFetridge, Gareth McKeeman, Steve Foster, Michael Barrett, Damian Roland, Mark D Lyttle, Chris Watson, Thomas Waterfield","doi":"10.1136/emermed-2025-214876","DOIUrl":"https://doi.org/10.1136/emermed-2025-214876","url":null,"abstract":"<p><strong>Background: </strong>Young febrile infants are at high risk of invasive bacterial infections (IBIs). Clinical Decision Aids (CDA) such as the Step-by-Step and Paediatric Emergency Care Applied Research Network (PECARN) use Procalcitonin (PCT), limiting their application in settings without PCT access. This study aimed to test the performance of these CDAs in a UK cohort.</p><p><strong>Methods: </strong>This was a planned analysis of the Febrile Infant Diagnostic Assessment and Outcome Study, a large, prospective multicentre observational study conducted across over 30 sites in the UK. Febrile infants (0-90 days of age) with complete biomarker data, who also underwent PCT testing, were included. Two CDAs, PECARN and Step-by-Step, were applied to the cohort, using their recommended low-risk criteria. The diagnostic performance of the CDAs was analysed.</p><p><strong>Results: </strong>Of the 1527 infants who completed biomarker testing in the main study, 442 had PCT testing and were included, 22 (5%) were diagnosed with an IBI. PECARN and Step-by-Step CDAs demonstrated sensitivities of 1.00 (95% CI: 0.85 to 1.00) and 0.96 (95% CI: 0.77 to 1.00) respectively. The PECARN CDA performed with a specificity of 0.14 (95% CI: 0.11 to 0.18) identifying 14% of the participants as low-risk and did not misclassify any infants. The Step-by-Step CDA performed with a specificity of 0.15 (95% CI: 0.12 to 0.19) identifying 14% of the participants as low-risk and misclassifying one participant with IBI as low-risk.</p><p><strong>Conclusion: </strong>Both PECARN and Step-by-Step CDAs demonstrated high sensitivity for detecting IBI in our cohort. While specificity was relatively low, these tools could potentially identify a subset of low-risk infants suitable for less intensive management.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of adult emergency ward patients with sepsis who received corticosteroids at the Mbarara Regional Referral Hospital in Uganda.","authors":"Reagan Kakande, Victor Adejayan, Muhammad Zulfiqar, Michael Ndyomugabe, Phoebe Gruccio, Philemon Ojuman, William S Girard, Rinah Arinaitwe, Mark Conaway, Eva Otoupalova, Christopher C Moore, Edwin Nuwagira","doi":"10.1136/emermed-2025-214957","DOIUrl":"https://doi.org/10.1136/emermed-2025-214957","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids are recommended for the treatment of septic shock but are understudied in Africa. We aimed to determine (1) characteristics of patients with sepsis in Uganda who received corticosteroids, and (2) the association between receiving corticosteroids and outcomes.</p><p><strong>Methods: </strong>We conducted a single centre retrospective observational cohort study of patients with sepsis at the Mbarara Regional Referral Hospital in Uganda. We included patients admitted from the emergency ward with suspected infection and ≥2 quick sequential organ failure assessment criteria. We determined predictors of receiving corticosteroids with logistic regression and predictors of 28-day mortality using Cox proportional hazards regression. We adjusted models for severity of illness using the Universal Vital Assessment (UVA) mortality risk score.</p><p><strong>Results: </strong>Of the 300 patients analysed, 141 (47%) were female, and the median (IQR) age was 55 (43-66) years. Corticosteroids were received by 71 (23%) patients at a median (IQR) of 1 (0-2) day from admission. The UVA score (adjusted OR (aOR) 1.16, 95% CI 1.03 to 1.30) and meningitis (aOR 4.31, 95% CI 2.04 to 9.12) were predictors of receiving corticosteroids. The UVA score (adjusted HR (aHR) 1.14, 95% CI 1.02 to 1.26) and receiving corticosteroids (aHR 0.43, 95% CI 0.21 to 0.91) were predictors of increased and decreased 28-day mortality, respectively. Receiving corticosteroids remained an independent predictor of decreased 28-day mortality when entered into the model as a time dependent variable (aHR 0.33, 95% CI 0.13 to 0.83, p=0.02). In a sensitivity analysis adjusted for age, sex and severity of illness, receiving vasopressors (aHR 3.48, 95% CI 1.88 to 6.43, p<0.001) and receiving corticosteroids (aHR 0.40, 95% CI 0.19 to 0.85, p=0.02) were independent predictors of increased and decreased 28-day mortality, respectively.</p><p><strong>Conclusions: </strong>In patients with sepsis in Uganda, receiving corticosteroids was associated with severity of illness and meningitis, and receiving corticosteroids was associated with improved outcomes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'Contact with emergency departments and hospitals in England before suicide death: a retrospective cohort study' by Healey <i>et al</i>.","authors":"Zijie Zhou, Lifeng Xiao","doi":"10.1136/emermed-2025-215336","DOIUrl":"https://doi.org/10.1136/emermed-2025-215336","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of strategies to improve flow and lower hospital admissions for low back pain in the emergency department: an interrupted time-series analysis.","authors":"Simon R E Davidson, Steven Kamper, Robin Haskins, Dragan Petkovic, Nicole Feenan, Damien Smith, Michael O'Flynn, Jeremy D Pallas, Bruce Donald, John Paul Smiles, Gustavo Machado, Christopher Oldmeadow, Christopher M Williams","doi":"10.1136/emermed-2024-214082","DOIUrl":"https://doi.org/10.1136/emermed-2024-214082","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a common, disabling condition that often results in presentation to the emergency department (ED). There is currently a paucity of research examining how to optimise care for this patient group and concurrently improve service efficiency. We assessed the impact of a suite of co-designed strategies to improve the flow and reduce admission rate of people with LBP presenting to the ED.</p><p><strong>Methods: </strong>A quasi-experimental implementation science study in a 30-bed ED at an Australian tertiary referral hospital. We implemented four improvement strategies: (1) co-design and development of a local ED guideline, (2) patient handout, (3) clinician education programme and (4) rapid-access physiotherapy follow-up clinic. We included all ED presentations from patients ≥16 years old, with a final diagnosis of LBP. Using an interrupted time series analysis, we compared a pre-implementation phase (July 2014-December 2019), a transition phase (July 2020-February 2021) and a post implementation phase (March 2021-November 2021). Our primary outcome was the proportion of patients admitted to hospital, in each phase. Secondary outcomes included ED length of stay (LOS), ED presentation cost, re-presentations within five days, admission LOS and outcome measures for those patients who attended the rapid-access physiotherapy clinic.</p><p><strong>Results: </strong>There were 5301 LBP presentations pre-implementation, 752 during transition and 732 post implementation. The mean age of patients was 50.3 (20.1) years, 53% were female and 6.5% identified as Aboriginal and/or Torres Strait Islander. We observed a small reduction (2%) in the proportion of admissions per month (post implementation vs pre-implementation slope difference 0.98 ((95% CI 0.928 to 1.035), p=0.467) and a monthly decrease of 1.5 min in the average ED LOS for these patients (post implementation vs pre-implementation slope difference -1.5 ((95% CI -8.1 to 5.1), p=0.653) which was not statistically significant. 121 patients were referred to the follow-up physiotherapy clinic, and 41% attended an appointment.</p><p><strong>Conclusion: </strong>The improvement strategies did not significantly reduce admissions or LOS for people with LBP presenting to the ED, and based on the CIs, we cannot exclude that these increased.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 3-year experience of an Australian short-stay Psychiatric, Alcohol and Non-prescription Drug Assessment Unit: unit activity and the patient experience.","authors":"Jane Ellen Carland, Yvonne Nguyen, Hannah Paul, Nadine Ezard, Matthew Bode, Bash Jagarlamudi, Mayura Sandrasegaran, Bridin Murnion, Richard Osborne Day, Paul Thomas Preisz, Jacqueline Huber, Jonathan Brett","doi":"10.1136/emermed-2024-214653","DOIUrl":"https://doi.org/10.1136/emermed-2024-214653","url":null,"abstract":"<p><strong>Background: </strong>The Psychiatric, Alcohol and Non-Prescription Drug Assessment (PANDA) Unit was opened at St Vincent's Hospital Sydney in 2020 to provide short-stay medical monitoring and care for people presenting to the emergency department with alcohol or other drug intoxication or behavioural disturbance with co-existing general medical, drug and alcohol and/or mental health issues. The aim of this study was to describe the activity of the PANDA Unit across the first 3 years of operation and explore patient experience.</p><p><strong>Methods: </strong>A mixed methods design was used. A retrospective record review (2020-2023) captured patient demographics, admission characteristics and discharge disposition. Brief, structured interviews were conducted with PANDA patients to explore their admission experience, including the care provided. Interviews were analysed using an inductive approach to develop themes.</p><p><strong>Results: </strong>2473 patients had 4108 admissions to PANDA, median 333 (range, 296-396) admissions per quarter. Median patient age was 40 (range, 16-93) years, most (64.5%) were male and 11.2% had 'no-fixed abode' documented. Most admissions were associated with alcohol and stimulant intoxication and/or suicidality. Median PANDA length of stay was 21.2 hours (range, 0.5-883.1); 20% of admissions were >48 hours. Most patients (83.8%) were discharged from PANDA to their usual place of residence, 4.9% self-discharged and 15% were readmitted to PANDA within 28 days of discharge, 56 people were readmitted three or more times. The experiences of interview participants (n=14) regarding the PANDA Unit was described by three key themes: (1) patients receive non-judgemental, whole-person care from a large multidisciplinary team, (2) PANDA provides a transition point to further care and (3) PANDA is a comfortable and busy space.</p><p><strong>Conclusions: </strong>PANDA provided tailored care in a short-stay context for people presenting to emergency department with complex comorbidities. Its unique model of care addressed barriers to healthcare access, such as stigma and siloed care.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We need to talk about Annie.","authors":"Ellen J Weber","doi":"10.1136/emermed-2025-215559","DOIUrl":"https://doi.org/10.1136/emermed-2025-215559","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency physicians' perspectives on integrating physiotherapists into emergency departments: a national survey from France.","authors":"Justine Malcuit, Emilie Lesieur, Daniel Aiham Ghazali, François-Régis Sarhan","doi":"10.1136/emermed-2024-214746","DOIUrl":"https://doi.org/10.1136/emermed-2024-214746","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) worldwide are facing increasing patient volumes and thus crowding, prolonged waiting times and rising healthcare costs. In France, ED visits rose from 8.5 to 16 million between 2014 and 2024. To address these challenges, several countries (including Australia, the UK and Canada) have integrated physiotherapists into EDs in advanced practice roles-primarily for musculoskeletal (MSK) conditions. In contrast, this type of integration is rare in the French healthcare system. The objective of the present study was to assess the attitudes of French emergency physicians to the incorporation of physiotherapists into ED teams.</p><p><strong>Methods: </strong>A nationwide, cross-sectional survey of emergency physicians practising in France was conducted between 22 November 2023 and 15 February 2024. The study questionnaire assessed the physicians' willingness to collaborate with physiotherapists, the perceived benefits of collaboration and views on task delegation. Descriptive statistics and χ² tests were used to analyse the data.</p><p><strong>Results: </strong>Of the 420 respondents, 333 (79.3%) expressed willingness to collaborate with physiotherapists in EDs. The most commonly cited benefits were improved quality of care n=321 (76.4%), greater patient satisfaction n=318 (75.7%), a lower physician workload n=276 (67.5%) and enhanced ED efficiency n=211 (50.2%). The conditions most frequently considered for delegation included suspected ankle sprains n=313 (74.5%), knee sprains n=277 (66.0%) and lower back pain n=271 (64.5%). Compared with junior colleagues, senior physicians with five or more years of experience were significantly more supportive of delegating cases of neck pain (n=110, 41.7%, p=0.017).</p><p><strong>Conclusions: </strong>French emergency physicians are generally supportive of integrating physiotherapists into EDs, especially for the management of non-urgent MSK conditions. The physicians see physiotherapists as capable of providing on-site care and patient education, potentially improving patient flow and alleviating pressures in overcrowded EDs. These findings offer valuable insights for countries in which the integration of physiotherapy into emergency care is still emerging.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observational service evaluation of voice recognition technology in the emergency department: association with electronic note-writing efficiency.","authors":"Taylor J Langmead, Francis A W Mimmack, Obioha C Ukoumunne, Andrew Appelboam","doi":"10.1136/emermed-2024-214589","DOIUrl":"https://doi.org/10.1136/emermed-2024-214589","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early clinical evaluation of a machine-learning system for risk prediction of trauma-induced coagulopathy in the prehospital setting.","authors":"Max E R Marsden, Zane B Perkins, Erhan Pisirir, William Marsh, Evangelia Kyrimi, Andrea Rossetto, Richard L Lyon, Anne Weaver, Ross Davenport, Nigel Rm Tai","doi":"10.1136/emermed-2024-214396","DOIUrl":"10.1136/emermed-2024-214396","url":null,"abstract":"<p><strong>Background: </strong>Early intervention in patients with major traumatic injuries is critical. Decision support can improve clinicians' ability to identify high-risk patients. The aim of this study was to compare the performance of a machine-learning (ML) decision support system to that of expert clinicians and to assess the ML system's impact on augmenting human risk prediction after injury in the prehospital phase of care.</p><p><strong>Methods: </strong>This early clinical evaluation study compared a ML risk prediction system to expert clinicians in assessing a patient's risk of trauma-induced coagulopathy (TIC). The study was conducted between 1 January 2019 and 31 June 2019 at two air ambulance sites in the south of England. The ML system used a Bayesian Network algorithm to predict TIC. Comparisons in predictive performance were made first between expert clinicians and the ML system and second, between expert clinicians and expert clinicians exposed to the ML system's outputs.</p><p><strong>Results: </strong>Overall, 51 expert clinicians were enrolled in the study and 184 patient assessments from 135 patients were analysed. The median age of included patients was 31 years old (IQR 23, 47), 75% were male and median Injury Severity Score 17 (IQR 9, 34). 62 patients (46%) received blood within 4 hours of injury and 26 patients (19%) developed TIC. The ML system did not outperform expert clinicians in discriminating between patients with and without TIC (area under the curve (AUC) ML: 0.87 (95% CI 0.79, 0.95) vs AUC clinician: 0.83 (95% CI 0.74, 0.92), p=0.330)). Calibration and overall accuracy of the ML system were superior. Expert clinicians' risk prediction, when augmented by the ML system, showed potential for improvement compared with unassisted human performance.</p><p><strong>Conclusions: </strong>Early after injury, an ML system performs well compared with expert prehospital clinicians in the prediction of TIC and blood transfusion. The study suggests that ML systems may augment clinical risk prediction in trauma.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"654-661"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}