Emergency Medicine Journal最新文献

{"title":"Management of patients with suspected but unidentified poisoning in the emergency department: a joint Royal College of Emergency Medicine and National Poisons Information Service best practice guideline.","authors":"Peter Welby-Everard, Mark Pucci, Sally Bradberry, Paul Dargan, Aravindan Veiraiah, Ruben Thanacoody, Muhammad E M O Elamin","doi":"10.1136/emermed-2025-215194","DOIUrl":"https://doi.org/10.1136/emermed-2025-215194","url":null,"abstract":"<p><p>The management of patients suspected, but not confirmed, as being poisoned is challenging. The Royal College of Emergency Medicine and National Poisons Information Service have produced this guidance to provide a generalised clinical approach to any poisoned patient in the emergency department. This guideline provides a clinical approach to support the initial assessment of a patient, identification of potential toxic agents and emergency management. A toxidromic approach is used, with emphasis on consideration of the toxicokinetics of potential poisons and how the patient's clinical condition may change. It does not replace poison-specific guidance available from TOXBASE and the NPIS or a locally appropriate poisons centre.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856116","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":"On the optimal sodium correction rate in hyponatraemia and clinical outcome: a meta-analysis.","authors":"Ludwig Matrisch, Yannick Rau, Lars Graßhoff, Martin Nitschke","doi":"10.1136/emermed-2025-215189","DOIUrl":"https://doi.org/10.1136/emermed-2025-215189","url":null,"abstract":"<p><strong>Background: </strong>Hyponatraemia is associated with greater mortality in emergency patients. Therefore, the correction of low serum sodium levels remains an important field in clinical practice.</p><p><strong>Methods: </strong>Eligible studies were searched through a literature query in PubMed and Web of Science in August 2024. Sodium correction rates and mortality data were extracted. The articles were grouped based on the threshold used to distinguish between slow and rapid correction. For each group, a random effects model was used for meta-analysis. The sodium correction rate thresholds were 8, 10 and 12 mmol/L/24 hours. Additionally, a random effects model was used to estimate the difference in osmotic demyelination syndrome (ODS) incidence.</p><p><strong>Results: </strong>11 retrospective studies with a total of 27 672 cases were included in the meta-analysis, each scoring at least 8* on the Newcastle-Ottawa quality assessment score. Mortality was significantly lower in the rapid correction group compared with the slow correction group for the 8 mmol/L/day threshold (OR: 0.398, p<0.001), for 10 mmol/L/day (OR: 0.489, p<0.001) and for 12 mmol/L/day (OR: 0.57, p<0.001). Overall incidence of ODS was low (0.085%), but it was higher in the rapid correction group (OR: 3.959, p=0.002).</p><p><strong>Conclusion: </strong>Within all three thresholds of sodium correction, rapid correction was associated with improved survival. Although no causal relation can be concluded, a more liberal approach to sodium correction rate in hyponatraemia may be beneficial. However, osmotic demyelination remains a serious, although very rare, issue.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835237","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":"Preinjury, injury and post-injury factors leading to death in children and young people who were victims of knife crime in England between 2019 and 2024: a review of the National Child Mortality Database.","authors":"Tom Roberts, David Odd, John Coveney, Stacey Webster, Jade Levell, Sylvia Stoianova, Vicky Sleap, Tom Williams, Robin Marlow, Karen Luyt, Edward Carlton","doi":"10.1136/emermed-2025-215154","DOIUrl":"10.1136/emermed-2025-215154","url":null,"abstract":"<p><strong>Background: </strong>Knife-related deaths in children present a serious public health challenge. This study reports the demographics and preinjury, injury and postinjury factors associated with death in children and young people (CYP), under the age of 18 years, who died of knife wounds in England between 2019 and 2024.</p><p><strong>Methods: </strong>A retrospective cohort review of the English National Child Mortality Database between April 2019 and March 2024. Rates of death were corrected for population size using the 2021 census. Preinjury, injury and postinjury factors associated with death are reported descriptively.</p><p><strong>Results: </strong>145 CYP died of knife wounds. The mean age was 14.4 years (SD 4.2) and 90.3% (n=131) were male. The rates of death per 100 000 CYP, per year were highest in children of 'Black/Black British' ethnicity (1.40 (95% CI 1.03 to 1.86)), with an incidence rate ratio (IRR) of 13.29 (95% CI 8.23 to 20.00), compared with CYP of 'White' ethnicity. Children living in the most deprived areas, had a greater than seven times higher risk of death (IRR 7.48 (95% CI 3.22 to 17.29), compared to CYP living in the least deprived areas. Of the 57 cases available for detailed analysis, injuries to the chest and neck were responsible for the fatal injuries in 75.9% of cases (n=44) and 60.3% (n=35) died before reaching hospital. A thoracotomy was performed in 56.9% (n=33) of cases. Prior to death, 75.4% (n=43) had been known to social services and 57.9% (n=33) had experienced domestic violence and abuse. Neurodiversity or mental health concerns were reported in 50.9% (n=29) of CYP.</p><p><strong>Conclusions: </strong>Death of CYP secondary to knife wounds occurred in all regions of England. Many children are exposed to adverse childhood experiences before death and known to statutory services. The identification of interventions to decrease the risk to children from knife violence remains a priority.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728481","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":"Prehospital prediction of clinical course in patients with suspected sepsis: a prospective cohort study.","authors":"Lars-Jøran Andersson, Gunnar Skov Simonsen, Erik Solligård, Knut Fredriksen","doi":"10.1136/emermed-2025-215135","DOIUrl":"https://doi.org/10.1136/emermed-2025-215135","url":null,"abstract":"<p><strong>Background: </strong>Early prediction of the clinical course may aid clinical decisions for patients with suspected sepsis. We examined how variables observed by ambulance personnel predicted the clinical course in patients with suspected sepsis.</p><p><strong>Methods: </strong>We prospectively collected prehospital data from patients with suspected sepsis in the ambulance service and supplemented the data with in-hospital findings. Prehospital data were used to calculate outputs of quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score-2 (NEWS2). Outcomes were (1) sepsis severity after hospital admission, measured by Sequential Organ Failure Assessment (SOFA) score; (2) development of septic shock, defined by need for intravenous fluid resuscitation and pressors; and (3) 30-day all-cause mortality. Factors that predicted the three outcomes were identified with regression analysis. We performed receiver operating characteristic curve analysis to find the discriminatory abilities of prehospital scores.</p><p><strong>Results: </strong>We included 398 patients with a median age of 76 years and a 30-day all-cause mortality of 10.1%. Oxygen saturation, systolic blood pressure and qSOFA were associated with sepsis severity and septic shock; Glasgow Coma Score and male sex with sepsis severity and mortality; age with sepsis severity; ashen or marbled skin and focus of infection with septic shock; cyanosis, nursing home resident and comorbidity with mortality. No variable predicted all three outcomes. Area under the curve (AUC) for septic shock was higher for qSOFA than for NEWS2 (p=0.033). AUC for septic shock was higher for males than for females if NEWS2 score was used (p=0.049), indicating that NEWS2 is better at predicting shock among males compared with females.</p><p><strong>Conclusions: </strong>While there may be a role for the use of prehospital scoring systems in patients who are critically ill on presentation, established clinical decision aids must be used with caution and predictive information is lost if the tools are applied alone.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835222","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":"Clinical decision rules for obtaining chest radiography in adult patients presenting to the emergency department with non-traumatic chest pain: a systematic review and meta-analysis.","authors":"Yahya Al Fathil, Joe Anthony Rotella","doi":"10.1136/emermed-2025-215673","DOIUrl":"https://doi.org/10.1136/emermed-2025-215673","url":null,"abstract":"<p><strong>Introduction: </strong>Chest pain is the second leading emergency department (ED) presentation, with its associated diagnostics requiring ED resource utilisation. Radiography is used in 70% of cases but identifies clinically significant findings in only 1.5%-2.1%. The predominance of non-actionable imaging results, combined with paucity of decision rules, prompted this systematic review to inform the development of a new clinical decision rule (CDR).</p><p><strong>Methods: </strong>Four bibliographical databases were searched, including: PubMed, MEDLINE, EMBASE and COCHRANE. Study selection, extraction and quality assessment were conducted independently by two reviewers via Covidence. Studies using a shared clinical decision tool were pooled to calculate sensitivity, specificity, likelihood ratios and false-positive rates using Meta-DiSc V.2.0. Univariate and, where possible, bivariate analyses generated forest plots and summary receiver operating characteristics curves. Heterogeneity was quantified by I², and methodological bias assessed via the Prediction model study Risk of Bias Assessment Tool (PROBAST).</p><p><strong>Results: </strong>From 626 records, 7 studies (6654 ED patients, Canada, Australia, USA) met inclusion. Of these, further analysis was undertaken of four validation studies. Two studies examined the Hess CDR reporting 98.3% sensitivity (95% CI 17% to 100%) and 47.6% specificity (95% CI 43.8% to 51.3%). Two studies examined the Rothrock CDR and reported 88.6% sensitivity (95% CI 80.1% to 93.7%) and 73% specificity (95% CI 17.7% to 97.2%). Hess had a negative likelihood ratio of 0.04 (95% CI 0 to 9.17) compared with Rothrock (0.156, 95% CI 0.06 to 0.38) and Rothrock had a positive likelihood ratio of 3.3 (95% CI 0.52 to 20.95) compared with Hess (1.9, 95% CI 1.67 to 2.11). Meta-analysis showed high heterogeneity with low bias as per PROBAST criteria.</p><p><strong>Conclusions: </strong>A systematic review and meta-analysis of two chest X-ray decision rules for non-traumatic chest pain found the Hess <i>et al</i> rule more sensitive but unlikely to reduce imaging. Evidence is limited by few studies, high heterogeneity and retrospective cohorts. Neither rule is recommendable, highlighting the need for prospective derivation using established methodological standards.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835208","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":"Strengthening emergency care in Pakistan: priorities for reform.","authors":"Zeeshan Ahsan","doi":"10.1136/emermed-2025-215287","DOIUrl":"10.1136/emermed-2025-215287","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"324"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741662","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":"Sequence of advanced airway management and epinephrine administration for paediatric patients with non-shockable out-of-hospital cardiac arrest.","authors":"Shu Utsumi, Shunsuke Amagasa, Masashi Okubo, Nanami Taketomi, Yasushi Orihashi, Shinichiro Ohshimo, Nobuaki Shime","doi":"10.1136/emermed-2025-215292","DOIUrl":"10.1136/emermed-2025-215292","url":null,"abstract":"<p><strong>Background: </strong>Despite the frequent use of both advanced airway management (AAM) and epinephrine during resuscitation, no studies have evaluated the optimal sequencing of these interventions in paediatric out-of-hospital cardiac arrest (OHCA). We therefore aimed to investigate the association between the sequence of AAM and epinephrine administration and outcomes in paediatric patients with OHCA with non-shockable rhythms.</p><p><strong>Methods: </strong>This retrospective observational study analysed data from a multicentre OHCA registry in Japan from 2014 to 2022. We included paediatric patients (aged <18 years) with non-shockable OHCA who received AAM (endotracheal intubation or supraglottic airway device placement) and/or epinephrine administration. The primary outcome was 1-month survival, and the secondary outcomes were 1-month favourable neurological outcome (defined as a paediatric cerebral performance category of 1-3) and the return of spontaneous circulation (ROSC). Inverse probability of treatment weighting (IPTW) was applied based on propensity scores to address imbalances in patient characteristics.</p><p><strong>Results: </strong>Of the 952 paediatric patients with non-shockable OHCA (median age (IQR) 2 (0-14) years), 577 (61%) were male. Of these, 455 and 497 belonged to the AAM-first and epinephrine-first groups, respectively. After IPTW, all covariates were well balanced between the AAM-first and epinephrine-first groups (standardised mean difference ≤0.10). Compared with the epinephrine-first group, the AAM-first group showed similar 1-month survival (adjusted OR (aOR), 1.09; 95% CI 0.61 to 1.86), favourable neurological outcome at 1 month (aOR, 0.79; 95% CI 0.12 to 5.07) and ROSC (aOR, 0.98; 95% CI 0.72 to 1.35).</p><p><strong>Conclusions: </strong>The sequence of AAM and epinephrine administration was not associated with 1-month survival, favourable neurological outcome at 1 month or ROSC in paediatric patients with non-shockable OHCA.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"298-304"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303647","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":"Helicopter Emergency Medical Services attendance is associated with favourable survival outcomes in major trauma: derivation and internal validation of prediction models in a regional trauma system.","authors":"Joanne Griggs, Jenny Harris, Jack Barrett, Scott Clarke, John O'Neill, Leigh Curtis, Malcolm Tunnicliff, Claire Baker, Duncan Bootland, Emma Ream, Richard Lyon","doi":"10.1136/emermed-2025-215451","DOIUrl":"10.1136/emermed-2025-215451","url":null,"abstract":"<p><strong>Background: </strong>Survival benefit of Helicopter Emergency Medical Services (HEMS) attended major trauma remains inadequately quantified across injury severity. We evaluated HEMS performance and identified predictors of survival.</p><p><strong>Methods: </strong>Retrospective observational analysis of 3225 trauma patients attended by a regional HEMS in South-East England (2013-2022). Survival was assessed using W-statistic (<i>W_s</i> ) methodology stratified by probability of survival (<i>P_s</i> ) bands. Multivariable logistic regression identified predictors of 30-day mortality in major trauma (injury severity score (ISS) ≥15). Sub-analysis examined unexpected survival predictors and return of spontaneous circulation (ROSC) rates in traumatic cardiac arrest (TCA).</p><p><strong>Results: </strong>Among 2125 patients meeting <i>W_s</i> analysis criteria, observed (O) 30-day survival exceeded expected (E) survival (84.7% vs 81.3%; O/E ratio 1.04), yielding adjusted <i>W_s</i> of 5.23 (95% CI 3.27 to 7.19), representing 5.23 excess survivors per 100 patients. Survival benefit was greatest in severely injured patients with moderate survival probability (<i>P_s</i> 25-45%: 3.33 excess survivors per 100, 95% CI 1.37 to 5.29). Among patients with low probability of survival (<i>P_s</i> <50), 38.7% survived unexpectedly; younger ages and higher presenting Glasgow Coma Scale scores were key predictors of unexpected survival. Pre-hospital emergency anaesthesia (PHEA) was independently associated with unexpected survival in this group (adjusted OR 2.01, 95% CI 1.12 to 3.72, p=0.023). TCA ROSC rates demonstrated an annual improvement (6.3% increased odds per year, 95% CI 1.02 to 1.10, p=0.002).</p><p><strong>Conclusion: </strong>HEMS attendance to major trauma in this regional service was associated with survival exceeding case-mix adjusted predictions, and was most pronounced in severely injured patients. PHEA was associated with survival benefit in low probability patients, supporting the value of advanced pre-hospital interventions.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"279-290"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The intruder within: a puzzling case of right upper quadrant pain.","authors":"Arun A M, Vasudha Dinesh, Kavya O K","doi":"10.1136/emermed-2025-215206","DOIUrl":"https://doi.org/10.1136/emermed-2025-215206","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 5","pages":"313-320"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835218","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":"Imposter participants and artificial intelligence: growing concerns in online surveys.","authors":"Eva Maria Krockow, Deborah Bamber, Carolyn Tarrant, Tim Coats","doi":"10.1136/emermed-2025-215321","DOIUrl":"10.1136/emermed-2025-215321","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"319-320"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917175","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}