Emergency Medicine Journal最新文献

{"title":"Recognising and managing functional neurological disorder in the acute healthcare setting.","authors":"Andre Galenchik-Chan, Thomas Ren, David Cohen, Carine W Maurer","doi":"10.1136/emermed-2024-214459","DOIUrl":"https://doi.org/10.1136/emermed-2024-214459","url":null,"abstract":"<p><p>Functional neurological disorder (FND) is a complex and heterogenous condition characterised by abnormal neurological symptoms that are linked to structural and functional alterations in widely distributed brain networks. For many patients with FND, the emergency department (ED) is the first point of contact with the healthcare system. This review seeks to provide up-to-date FND diagnostic criteria to ED providers, with a focus on common FND subtypes. Furthermore, we summarise the appropriate management course for these patients. Proper recognition and management of FND at the time of initial presentation in the acute care setting has the potential to improve patient prognosis and reduce overall costs to the healthcare system.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180937","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":"Association between age and length of stay in the emergency department in a tertiary care hospital: a retrospective observational study.","authors":"Prachur Khandelwal, Yohei Okada, Yilin Ning, Zhongxun Hu, Andrew Fu Wah Ho, Kenneth Boon Kiat Tan, Marcus Eng Hock Ong","doi":"10.1136/emermed-2024-214299","DOIUrl":"https://doi.org/10.1136/emermed-2024-214299","url":null,"abstract":"<p><strong>Background: </strong>Older patients' attendances at EDs are rising. There are concerns that these individuals have prolonged stays, which have been shown to be associated with adverse clinical outcomes. We assessed the length of stay in older patients in a single ED in Singapore.</p><p><strong>Methods: </strong>This was an observational retrospective study of ED attendances between 2017 and 2019 at the Singapore General Hospital (SGH) using the SGH ED database. The primary outcome was ED length of stay, with prolonged stay defined as 4 hours or more. The association between age (categorised into 18-44, 45-64, 65-84 and 85+) and length of stay was analysed using a mixed-effects logistic regression adjusting for variables like gender, ethnicity and triage acuity. Associations are expressed as adjusted ORs (AOR) with 95% CI. A subgroup analysis was performed for all considered variables.</p><p><strong>Results: </strong>391 171 patients qualified for analysis; median age 57 years (IQR 37-70) and 51.5% male. The median length of stay increased across age categories (age 18-44, 3.53 hours; 45-64, 4.04 hours; 65-84, 4.32 hours; and 85+, 4.46 hours). Using patients aged 18-44 as a reference, the AORs for prolonged length of stay by age group were 45-64 AOR 1.17 (95% CI 1.13 to 1.21), 65-84 AOR 1.26 (95% CI 1.21 to 1.30) and 85+ AOR 1.25 (95% CI 1.18 to 1.31). In the subgroup analysis, there was no association between age and length of stay for patients admitted, having multiple comorbidities, having blood tests or having high acuity scores.</p><p><strong>Conclusion: </strong>In this Singaporean tertiary hospital, older patients had increased median stays and were more likely to stay in the ED for more than 4 hours. However, this did not apply in some subpopulations. This potentially suggests the need for systematic changes in discharge planning and triaging to reduce prolonged stays and their consequences for older patients.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179921","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":"In emergency settings, can a negative Prehn's sign be used to aid diagnosis of testicular torsion?","authors":"Lauren Grace Edwards, Joshua William Feldman, Craig Ferguson","doi":"10.1136/emermed-2025-214935","DOIUrl":"10.1136/emermed-2025-214935","url":null,"abstract":"<p><p>Prehn's sign describes the eradication of testicular pain on lifting the scrotum and has been proposed as a method to differentiate causes of acute testicular pain. A short systematic review was conducted to evaluate the question: in patients presenting with acute unilateral testicular pain, is a negative Prehn's sign an accurate sign for diagnosis of testicular torsion (TT)?Medline, Embase and Cochrane databases were searched using the OVID interface from inception to 26 February 2025. Following the removal of duplicates, the search strategy yielded a total of 11 papers. Study information, participant group, relevant outcomes and study weaknesses were extracted from each article.Four studies addressed the three-part question. The only study that had the full text available for review found that 33% of patients with TT had a positive Prehn's sign, which equated to an OR of 5.941 (95% CI 1.432 to 24.658). Of the three remaining retrospective cohort studies, Prehn's sign was reported to be positive in 10.5%, 37.5% and 100% of patients with TT, respectively. Therefore, the negativity of Prehn's sign ranged from 0% to 89.5% in patients with TT.The clinical bottom line is that Prehn's sign is insufficiently sensitive to rule out TT; however, its negativity increases the likelihood of a TT diagnosis.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"411-412"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810842","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":"Accuracy of the National Early Warning Score version 2 (NEWS2) in predicting need for time-critical treatment: retrospective observational cohort study.","authors":"Steve Goodacre, Laura Sutton, Gordon Fuller, Ashleigh Trimble, Richard Pilbery","doi":"10.1136/emermed-2024-214562","DOIUrl":"10.1136/emermed-2024-214562","url":null,"abstract":"<p><strong>Background: </strong>Initial ED assessment can use early warning scores to identify and prioritise patients who need time-critical treatment. We aimed to determine the accuracy of the National Early Warning Score version 2 (NEWS2) for predicting the need for time-critical treatment.</p><p><strong>Methods: </strong>We undertook a single-centre retrospective observational cohort study. We randomly selected 4000 adults who attended a tertiary hospital ED in England from 1 January 2022 to 31 December 2022 and had NEWS2 routinely recorded on electronic patient records. The first NEWS2 and vital signs were extracted from electronic records. Research nurses selected cases that received a potentially time-critical treatment. Two independent clinical experts then determined whether time-critical treatment was or should have been received using an expert consensus derived list of interventions. We used receiver operating characteristic analysis and calculated sensitivity and specificity at predefined thresholds to evaluate the accuracy of NEWS2 for predicting need for time-critical intervention and, as a secondary outcome, mortality at 7 days.</p><p><strong>Results: </strong>After excluding 10 patients who received their intervention before NEWS2 recording, 164/3990 (4.1%) needed time-critical treatment and 71/3990 (1.8%) died within 7 days. NEWS2 predicted need for time-critical treatment with a c-statistic of 0.807 (95% CI 0.765 to 0.849) and death within 7 days with a c-statistic of 0.865 (95% CI 0.813, 0.917). NEWS2>4 predicted need for time-critical treatment with sensitivity of 51.8% (95% CI 44.2%, 59.3%) and positive predictive value of 25.8% (95% CI 21.3%, 30.7%). 37 of the 45 patients needing emergency surgery, antibiotics for open fractures, insulin infusion or manipulation of limb-threatening injuries had NEWS2≤4. Patients with NEWS2>4 who did not need time-critical treatment frequently scored maximum points on NEWS2 for their respiratory rate, conscious level or receiving supplemental oxygen.</p><p><strong>Conclusion: </strong>NEWS2 has limited accuracy for predicting need for time-critical treatment. We have identified time-critical interventions that frequently have low NEWS2 scores and NEWS2 parameters than may overestimate need for time-critical intervention.</p><p><strong>Trial registration number: </strong>Research Registry 10450.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"396-402"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970143","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":"Comparison of the effects of vapocoolant spray and topical anaesthetic cream (lidocaine-prilocaine) on pain of intravenous cannulation: a randomised controlled trial.","authors":"Atousa Akhgar, Amirreza Mazidabadi Farahani, Hamideh Akbari, Mojtaba Sedaghat, Mohammad Jalili, Hadi Mirfazaelian","doi":"10.1136/emermed-2024-214479","DOIUrl":"10.1136/emermed-2024-214479","url":null,"abstract":"<p><strong>Objective: </strong>Intravenous cannulation is a routine procedure in the ED. Different methods are being used to reduce the pain of intravenous cannulation. Among them, there are studies which have shown the efficacy of vapocoolant spray and lidocaine-prilocaine combination topical cream. This study aimed to compare the efficacy of these methods in pain management.</p><p><strong>Method: </strong>This was a randomised clinical trial study including adult (18-65 year) patients admitted to the ED of an academic hospital in Iran between February 2024 and May 2024 and who required peripheral intravenous catheter. Patients were assigned randomly to vapocoolant spray or lidocaine-prilocaine cream. The spray was applied for 30 s immediately before intravenous cannulation and the cream 45 min before intravenous cannulation. Patients' pain scores were assessed by Numeric Rating Scale (NRS) immediately after cannulation along with adverse effects. Patients' willingness to use the same anaesthetic method was also recorded.</p><p><strong>Result: </strong>This study included 77 patients; median age was 39 (IQR: 29.75-55.39) and 48% were men. The median cannulation pain score was 2 (IQR: 2-3) in the vapocoolant group and 3 (IQR: 2-3) in the lidocaine-prilocaine cream group (p value=0.09). Overall, adverse events occurred in 24 (31%) patients; 21 patients in the lidocaine-prilocaine group experienced transient paleness (p value=0.03). 33 (43%) patients who received vapocoolant and 21 (27%) patients who used the cream selected to use their assigned method again (p value=0.02).</p><p><strong>Conclusion: </strong>This study demonstrated that the vapocoolant spray was not statistically more effective than lidocaine-prilocaine cream in pain reduction during intravenous cannulation. Although all these side effects were generally considered clinically insignificant, the spray group exhibited significantly fewer side effects compared with the cream group.</p><p><strong>Trial registration number: </strong>NCT04473820.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"373-377"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673648","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":"Elbow injury after a fall on outstretched hand.","authors":"Tun Hing Lui, Yiu Ho Sin, Yuk Chuen Siu, Jason Churk Yan Mok","doi":"10.1136/emermed-2024-214650","DOIUrl":"https://doi.org/10.1136/emermed-2024-214650","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 6","pages":"386-388"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127014","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":"Evaluation of nasogastric tube location using point-of-care ultrasonography in paediatric patients.","authors":"Ayla Akca Caglar, Oksan Derinoz Guleryuz, Songül Tomar Güneysu, Özlem Çolak","doi":"10.1136/emermed-2024-214126","DOIUrl":"10.1136/emermed-2024-214126","url":null,"abstract":"<p><strong>Background: </strong>Nasogastric tubes (NGTs) are used in children emergency departments (EDs) for gastric decompression, as well as for enteral nutrition and drug administration in hospitalised patients. Radiography is considered the gold standard for determining NGT location and may require repeat films until the tube is appropriately positioned. Point-of-care ultrasonography (POCUS) could potentially be useful in avoiding radiation in these children.</p><p><strong>Methods: </strong>Between September 2022 and February 2023, patients aged 0-18 years who presented to the Gazi University Faculty of Medicine Paediatric ED in Turkey and received NGTs were eligible for the study and included when our paediatric emergency physician certified in POCUS was present. The operation used a convex probe in B-mode to visualise the NGT tip as a hyperechoic line in the stomach. If not visualised, the air was injected through the tube to look for an air artefact on ultrasound. Radiographs were subsequently performed and interpreted by the treating ED physician, blinded to POCUS findings. The accuracy of POCUS was determined using radiography as a reference standard.</p><p><strong>Results: </strong>Twenty (13 boys) children were included in the study. The median age of the patients was 20 (IQR 9-108) months. 16 patients had underlying chronic neurological and metabolic diseases or congenital anomalies. Of the 20 NGTs, radiography detected 18 in the stomach. POCUS confirmed the NGT in the stomach for 15 of these patients by visualising the tip or air artefact. When radiography located the NGT in the oesophagus in two patients, POCUS was negative. The resulting test characteristics were as follows: sensitivity was 83% (95% CI 59% to 96%), specificity 100% (95% CI 16% to 100%), negative predictive value 40% (95% CI 19% to 65%), positive predictive value 100% (95% CI 78% to 100%) and accuracy 85% (95% CI 62% to 97%).</p><p><strong>Conclusion: </strong>POCUS may be an alternative method to radiography to confirm the location of the NGT in children. However, studies with a broader patient population are needed.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"367-372"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566308","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":"Allocation concealment using scratchcards in an emergency department drug trial.","authors":"Rachelle Sherman, Graham D Johnson, Andrew Tabner","doi":"10.1136/emermed-2024-214354","DOIUrl":"10.1136/emermed-2024-214354","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"387-388"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990650","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":"Bridging the divide: strengthening EMS decision-making for paediatric head injuries.","authors":"Fahd A Ahmad, J D Finney","doi":"10.1136/emermed-2025-214906","DOIUrl":"10.1136/emermed-2025-214906","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"350-351"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691584","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":"\"Hey doc, there is something within my skin\".","authors":"Leo Spora, Marie-Charlotte Brüggen, Matthias Möhrenschlager","doi":"10.1136/emermed-2024-214624","DOIUrl":"https://doi.org/10.1136/emermed-2024-214624","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 6","pages":"395-410"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127013","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}