Emergency Medicine Journal最新文献

{"title":"Assessing urgent care centres as alternatives to emergency departments for paramedic transported non-emergent patients: implications for length of stay.","authors":"Ryan Peter Strum, Brent McLeod, Andrew Costa, Shawn E Mondoux","doi":"10.1136/emermed-2024-214592","DOIUrl":"10.1136/emermed-2024-214592","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"652-653"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224751","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":"High whole blood to total transfusion volume ratio and survival outcomes in patients with trauma requiring massive transfusions.","authors":"Chi Peng, Ronghui Zhu, Fan Yang, Yibin Guo, Lei Li, Zhichao Jin, Cheng Wu, Shuogui Xu","doi":"10.1136/emermed-2025-215051","DOIUrl":"10.1136/emermed-2025-215051","url":null,"abstract":"<p><strong>Objective: </strong>Whole blood (WB) resuscitation has been reported to improve haemostasis and reduce mortality in trauma patients with severe haemorrhage. However, the ideal ratio of WB to total transfusion volume (TTV) and whether a high WB to TTV ratio is associated with favourable clinical outcomes for patients with trauma requiring massive transfusion remains unclear. We aimed to investigate the effectiveness of a high WB to TTV ratio in the treatment of patients with trauma requiring massive transfusion and explore the nonlinear relationship between the ratio of WB to TTV and patient's outcomes.</p><p><strong>Methodology: </strong>We performed a retrospective cohort study using the National Trauma Data Bank from the USA in 2020. The study included patients aged ≥16 years who received WB transfusion within 4 hours of hospital arrival. Patients were categorised into two groups based on the optimal cut-off value (0.5) of the WB to TTV ratio. The primary outcomes were in-hospital mortality at 24 hours and 30 days. Secondary outcomes included transfusion-related adverse events.</p><p><strong>Results: </strong>Among the 902 patients (median (IQR) age, 34 (24-51) years; 783 male (86.9%)), the optimal cut-off value for the WB to TTV ratio was 0.5. Based on this cut-off value, 143 patients (15.85%) were classified into the high WB group and 759 (84.15%) into the low WB group. Inverse probability of treatment weighting-adjusted logistic regression demonstrated that the high WB group had lower odds of 24-hour mortality (OR, 0.29; 95% CI 0.22 to 0.38; p<0.001) and 30-day mortality (OR, 0.40; 95% CI 0.32 to 0.49; p<0.001) compared with the low WB group.</p><p><strong>Conclusion: </strong>A high WB to TTV ratio was associated with reduced mortality in patients with trauma requiring massive transfusion. These findings suggested that incorporating a high WB to TTV ratio into resuscitation protocols may improve outcomes for patients with trauma, warranting further research to optimise transfusion strategies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"669-675"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820926","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":"Blood product use in paediatric trauma: lessons from the TARN data.","authors":"Kathryn Mullan, Peter McAlister, Shane Michael Mc Veigh, Sophie Jones, Omar Bouamra, Fiona Lecky, Stephen Mullen","doi":"10.1136/emermed-2024-214397","DOIUrl":"10.1136/emermed-2024-214397","url":null,"abstract":"<p><strong>Background: </strong>Trauma contributes significantly to childhood morbidity and mortality. Uncontrolled haemorrhage leading to cardiovascular collapse remains the leading cause of preventable death in paediatric trauma. Evidence to support the early and accurate identification of paediatric trauma patients requiring blood products is growing. Consensus guidelines advocating for more liberal blood product use based on the concept of damage control resuscitation and the introduction of risk predictor tools to identify children requiring resuscitation with blood products may have altered use in recent years. We aimed to identify trends in blood product prescribing practice in paediatric trauma resuscitation over the last decade.</p><p><strong>Methods: </strong>In this retrospective, observational study, data were abstracted from Trauma Audit Research Network (TARN) from sites in England, Wales and Northern Ireland over a 10-year period (2012-2021). Eligible cases were defined as injured children or young people aged less than 16 years who received blood products, including in the prehospital environment.</p><p><strong>Results: </strong>During the study period, 2.5% (n=678) of injured children received blood products within 24 hours of hospital arrival, including the prehospital environment. Blood product administration over the study period remained largely unchanged (p=0.190). Over the 10-year period, we saw a significant increase in blood product use among paediatric trauma patients of increasing age and those with penetrating injuries (p<0.03). By contrast, there was a decrease in blood product use across the same 10-year period among paediatric trauma related to road traffic collisions (p=0.01). On analysing the paediatric trauma population that received blood products, the distribution across locations can be seen as follows: 60.5% received blood products at the scene of the incident, 25% in the ED and 12.8% in critical care settings. The most common blood product given was packed red blood cells (84%), with fresh frozen plasma, platelets and cryoprecipitate administered in 9.7%, 2.4% and 1.6% of cases, respectively.</p><p><strong>Conclusion: </strong>UK trauma centres have not significantly changed blood product use in paediatric trauma over the last decade. Monitoring and understanding national blood product use in paediatric trauma is integral to understanding trends and current practice.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"662-668"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957224","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":"Whose turn is it?","authors":"Jeffrey P Louie, Mary Ryan","doi":"10.1136/emermed-2025-214879","DOIUrl":"10.1136/emermed-2025-214879","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"692"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247005","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":"Malreduction of a dislocated elbow joint.","authors":"Tun Hing Lui, Yiu Ho Sin, Yuk Chuen Siu","doi":"10.1136/emermed-2025-214949","DOIUrl":"https://doi.org/10.1136/emermed-2025-214949","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 10","pages":"653-661"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136996","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":"Vapocoolant spray for intravenous cannulation.","authors":"Caglar Kuas, Mustafa Emin Canakci","doi":"10.1136/emermed-2025-215060","DOIUrl":"10.1136/emermed-2025-215060","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"690"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247004","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 child with elbow pain after fall injury.","authors":"Tun Hing Lui, Kar Hei Lam, Ching Kiu Phoebe Law, Hon Chun Chong","doi":"10.1136/emermed-2024-214601","DOIUrl":"https://doi.org/10.1136/emermed-2024-214601","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 10","pages":"635-651"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136912","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":"Journal update monthly top five.","authors":"Jared Charlton-Webb, Thomas Hosfield, Cayla Marshall, Muhammad Yaseen, Liam Gardner, Trijit Guha, Kiera Welman, Gabrielle Prager","doi":"10.1136/emermed-2025-215495","DOIUrl":"https://doi.org/10.1136/emermed-2025-215495","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 10","pages":"686-687"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136980","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 same day emergency care services on urgent and emergency care delivery outcomes: a systematic review.","authors":"Katherine Jones, Christopher Carroll, Steve Goodacre, Carl Marincowitz, Anthea Sutton, Anastasios Bastounis, Andrew Booth","doi":"10.1136/emermed-2024-214821","DOIUrl":"10.1136/emermed-2024-214821","url":null,"abstract":"<p><strong>Introduction: </strong>Same day emergency care (SDEC) describes an ambulatory service designed to provide an alternative to ED management, reduce admission rates and improve emergency care system performance. This systematic review aimed to identify and synthesise the evidence base for SDEC and its impact on urgent and emergency healthcare delivery.</p><p><strong>Methods: </strong>Eight bibliographic databases were searched, including: MEDLINE, EMBASE, PsycInfo, CINAHL, the Science and Social Science Citation Indices in the Web of Science Core Collection, Health Management Information Consortium, the Cochrane Library and Epistemonikos. Study selection, extraction and quality assessment were conducted independently by two reviewers. Given the clinical heterogeneity and weakness of the evidence base to determine intervention effect, a narrative synthesis was performed. Formal assessment of implementation was undertaken using the Quality Improvement Minimum Quality Criteria Set.</p><p><strong>Results: </strong>We identified 1283 citations, with 21 publications reporting 20 evaluations (18 UK and 2 Australia). SDEC services were heterogeneous in terms of referral sources, patient selection and specialties provided. Studies were mostly single centre and compared SDEC care with alternative services (such as ED) or compared outcomes before and during SDEC implementation. Patients receiving SDEC demonstrated same-day discharge ranging from 38.3% to >92%. 30-day mortality varied between <1% and 6% (four studies). Change in 30-day ED or SDEC reattendance was not examined. A learning curve was indicated in two studies, with inappropriate or 'rejected' referrals reducing from 31% to 18% in one SDEC service. Where reported, triage was led by senior clinical decision-makers, however, the appropriateness of SDEC referrals was also complicated by contextual factors. Comparative evaluation, including inpatient admissions, generally favoured SDEC care, but study designs carried a high risk of bias and confounding.</p><p><strong>Conclusions: </strong>Limited evidence suggests that implementing SDEC services is feasible and may increase same-day discharge but with variable 30-day mortality (very-low or low confidence) and unexamined change in 30-day ED or SDEC reattendance. Clinical heterogeneity and limited reporting make it difficult to characterise SDEC services. Implementation, although with varied referral criteria, proved feasible given the involvement of senior clinical decision-makers.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"643-651"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583381","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 adult patients presenting to ED with severe acute pain, is intranasal ketamine as effective as intravenous opiates for pain reduction?","authors":"Khilan Santilal, Rhea Saldanha","doi":"10.1136/emermed-2025-215080","DOIUrl":"10.1136/emermed-2025-215080","url":null,"abstract":"<p><p>This systematic review assessed whether intranasal (IN) ketamine is as effective as intravenous (IV) opiates for adults presenting to the ED with acute severe pain. EMBASE and Medline were searched, using relevant search terms, identifying four studies relevant to our three-part question. Key findings, as well as study weaknesses, were presented in a table. In summary, our results indicate that IN ketamine provides pain relief comparable to IV morphine in this patient cohort, with a similar side effect profile. However, the generalisability of these findings is limited owing to the lack of uniformity in study methodologies, short-term follow-up, broad exclusion criteria, sampling techniques and small sample sizes. Further studies regarding the role of IN ketamine in this setting would be worthwhile.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"683-685"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186772","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}