Emergency Medicine Journal最新文献

{"title":"Prehospital resuscitative hysterotomy: a practice review.","authors":"Caroline Leech, Camella Main, Kim Hinshaw, Joe Fawke, Mark Beasley, Virginia Anne Beckett","doi":"10.1136/emermed-2025-215327","DOIUrl":"10.1136/emermed-2025-215327","url":null,"abstract":"<p><p>Management of out-of-hospital cardiac arrest (OHCA) in a pregnant patient is challenging, both logistically and emotionally. This review explores the adaptations to resuscitation in pregnancy; the indications and preparation for prehospital resuscitative hysterotomy (RH); the surgical procedure; and the post-procedure care. Prehospital clinicians should train for RH in their teams to maximise the chances of maternal and fetal survival. Further research is needed to understand the incidence of maternal OHCA, how we can improve the chain of survival and the duration of maternal cardiac arrest before RH becomes futile to inform future guidelines.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"180-185"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511707","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":"Response to: Correspondence on 'Reproducibility of the Manchester Triage System: a multicentre vignette study' by Zaboli <i>et al</i>.","authors":"Calvin Heal","doi":"10.1136/emermed-2025-215658","DOIUrl":"10.1136/emermed-2025-215658","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"198"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741508","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":"Applying a cost-effectiveness threshold to delay-related harm in emergency admissions: a novel approach.","authors":"Orla Kelly, Sidonie Chard, Gerard Markey","doi":"10.1136/emermed-2025-215315","DOIUrl":"10.1136/emermed-2025-215315","url":null,"abstract":"<p><p>We approach emergency department delay-related harm as though it were a distinct condition and explore use of an explicit cost-effectiveness threshold as a guide to management. Based on the reported association of delayed emergency admission with short-term mortality, to prevent loss of one quality-adjusted life year per patient harmed in Ireland, annual resources equivalent to 70 additional bed years, or infrastructure funding for 90 new beds, could be considered cost-effective. The additional commitment represents under 1% of annual public acute hospital sector expenditure in Ireland, an OECD member country.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"188-189"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767430","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":"Rash following a round of golf.","authors":"Karl Cook","doi":"10.1136/emermed-2025-215366","DOIUrl":"https://doi.org/10.1136/emermed-2025-215366","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 3","pages":"150-166"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282914","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":"Man with impaired consciousness and blue tongue.","authors":"Sota Zukeran, Hiroyuki Yano, Mitsuyo Kinjo","doi":"10.1136/emermed-2025-215597","DOIUrl":"https://doi.org/10.1136/emermed-2025-215597","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 3","pages":"179-187"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283006","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":"Should anticoagulants be initiated in patients with sepsis-induced new-onset atrial fibrillation? Best evidence topic report.","authors":"Khunassanan Nunthakunatip, Sofia Borhan","doi":"10.1136/emermed-2025-215820","DOIUrl":"https://doi.org/10.1136/emermed-2025-215820","url":null,"abstract":"<p><p>A focused literature review assessed whether starting therapeutic anticoagulation (AC) during or soon after hospitalisation for sepsis-induced new-onset atrial fibrillation (AF) affects stroke or bleeding risk. Four observational studies were identified. None demonstrated a significant reduction in stroke risk with AC, and one large study found a paradoxical increase in stroke among patients taking anticoagulants. Bleeding risk was not consistently increased, and one study reported reduced mortality with AC. Overall, current evidence does not support the routine use of AC for stroke prevention in patients with sepsis-induced new-onset AF. A randomised controlled trial is needed to clarify the role of AC in this population.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282927","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":"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":"174-179"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13018732/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pager explosions: lessons learnt from a hybrid-warfare mass casualty incident.","authors":"Eveline Hitti, Imad Bou Akl, Tharwat El Zahran, Amin Kazzi, Layal Hamdar, Rana Saleh, Gladys Honein- AbouHaidar","doi":"10.1136/emermed-2025-215108","DOIUrl":"10.1136/emermed-2025-215108","url":null,"abstract":"<p><strong>Background: </strong>Hospitals responding to mass casualty incidents (MCIs) must rapidly scale up operations to accommodate high casualty counts, with little lead time. On 17 September 2024, 4000 pager devices were detonated across Lebanon, injuring 2323 individuals. This paper reports on a single-centre MCI response to this unprecedented hybrid warfare tactic, describing success features and identifying areas for improvement.</p><p><strong>Methods: </strong>A qualitative analysis of 10 debrief meeting minutes held within 2 weeks of the incident, as part of the standard quality improvement process post-MCI response that included an after-action review conducted in accordance with the 2019 WHO guidelines. Group-based debriefs, facilitated by the emergency department (ED) chairperson, addressed different response elements and engaged relevant stakeholders. Conclusions were derived from the qualitative analysis of the meeting minutes.</p><p><strong>Results: </strong>Our hospital received 182 casualties, 66% of whom were triaged to urgent-level care (yellow), 21% to delayed-level care (green) and 13% to immediate-level care (red), with 35 requiring emergent surgery within the first 12 hours. The MCI response was activated 34 min postincident, initiating security lockdown protocols, expedited patient registration, MCI triage protocol implementation, opening of surge areas and command centre activation. Key success features included: shifting from ED-based response to a whole-hospital mobilisation to accommodate the influx; early secondary triage of urgent-level (yellow) patients for immediate transfer to inpatient wards, resulting in 22.5% being managed in the inpatient setting; and optimised information system workflows for admission and order entry. Recommended improvements include simplifying operating theatre transfer workflows, shifting to paper-based documentation of assessments/interventions, optimising surgical and diagnostic prioritisation processes and developing minimal diagnostic imaging standards of care.</p><p><strong>Conclusion: </strong>This study highlights key successes and challenges of a hospital response to a large hybrid-warfare MCI. Future research on reliability of key success features, specifically use of ED secondary triage protocols, is needed to support wider adoption. In addition, developing minimal imaging standards in MCIs is needed to reduce bottlenecks in this area.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"140-148"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13018838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145943178","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":"Emergency front of neck access in the setting of paediatric trauma.","authors":"Roisin McDonald, Michael Coffey, Fiona Lecky, Susan Mclellan, Peter Cameron, Stephen Mullen","doi":"10.1136/emermed-2025-215688","DOIUrl":"https://doi.org/10.1136/emermed-2025-215688","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275819","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":"Evaluating the TWIST score and point-of-care ultrasound for paediatric testicular torsion.","authors":"Toshiki Nakamura, Masakazu Kinoshita, Takateru Ihara, Yusuke Hagiwara, Hiroyuki Sato, Hiroshi Hataya, Yoshihiko Morikawa","doi":"10.1136/emermed-2025-215067","DOIUrl":"https://doi.org/10.1136/emermed-2025-215067","url":null,"abstract":"<p><strong>Background: </strong>An acute scrotum is an urological emergency. One of its most important causes is testicular torsion, which can result in testicular necrosis unless quickly diagnosed and treated. Along with point-of-care ultrasound (POCUS), the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score can be used to differentiate between testicular torsion and other causes of an acute scrotum. However, their diagnostic performance when undertaken by emergency physicians (EPs) and paediatricians in the emergency department (ED), as opposed to urologists/radiologists, is uncertain.</p><p><strong>Methods: </strong>This retrospective observational study investigated patients aged ≤15 years with an acute scrotum who visited a paediatric tertiary care hospital's ED between March 2018 and August 2022. The diagnostic accuracy of the TWIST score and POCUS when performed by EPs and paediatricians to diagnose testicular torsion was calculated. Each TWIST score served as a cut-off. For practical purposes, a cutoff ≥3 points was used for sensitivity and the negative predictive value (NPV), and a cutoff ≥5 points was used for specificity and the positive predictive value (PPV). The final diagnosis served as the reference standard.</p><p><strong>Results: </strong>Of 512 patients, 55 (11%) had testicular torsion. The TWIST score had 91% sensitivity (95% CI 80%-97%), 95% specificity (95% CI 93% to 97%), 63% PPV (95% CI 50% to 75%) and 99% NPV (95% CI 97% to 100%). When positivity was defined as either impaired testicular blood flow or the whirlpool sign, the sensitivity, specificity, PPV and NPV were 96% (95% CI 87% to 100%), 95% (95% CI 93% to 97%), 70% (95% CI 58% to 80%) and 100% (95% CI 98% to 100%) respectively.</p><p><strong>Conclusion: </strong>Although the TWIST score and POCUS had high diagnostic accuracy for paediatric testicular torsion when performed by EPs or paediatricians in the ED, the non-negligible, false-negative rate indicated that the TWIST score should be used for risk stratification rather than as an exclusionary method.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275794","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}