Emergency Medicine Journal最新文献

{"title":"Pragmatic medicine, n=1.","authors":"Piotr Szawarski, David Hillebrandt","doi":"10.1136/emermed-2025-215840","DOIUrl":"10.1136/emermed-2025-215840","url":null,"abstract":"<p><p>Many practising clinicians have voiced concerns about limitations and imperfections associated with evidence-based medicine. Some of those concerns are aimed at the methodology and objectives of present-day medical research; others are a reflection of diverse environments and populations in which medical care is delivered. We argue in this paper that absence of evidence for any particular approach does not equate with evidence of absence of benefit of a considered intervention. Sufficient rather than perfect solutions may reflect patient preference or contextual constraints rather than ignorance on the part of the clinical practitioner. Relying on evidence without applying clinical judgement may sometimes be inappropriate. Medicine that acknowledges gaps in evidence needs to be pragmatic, seeking a solution for the patient in front of us.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"655-657"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766117","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":"Utilisation of an emergency medical services pathway into a virtual emergency department and the impact on non-transports and patient safety.","authors":"Emily Mahony, Nicole Magnuson, Amanda Thornton, Emily Nehme, Susanne Scott, Jason Talevski, Suzanne M Miller, Loren Sher, Ziad Nehme","doi":"10.1136/emermed-2025-214861","DOIUrl":"10.1136/emermed-2025-214861","url":null,"abstract":"<p><strong>Background: </strong>The establishment of an emergency medical services (EMS) pathway into a virtual emergency service-the Victorian Virtual Emergency Department (VVED)-introduced a video-enabled telehealth consultation service for patients assessed and treated by paramedics. This study examined the utilisation of the VVED by EMS in Victoria, Australia, including its impact on rates of non-transport to hospital and EMS reattendance.</p><p><strong>Methods: </strong>A retrospective study of all presentations (aged ≥12 years) to EMS between October 2021 and May 2023. EMS data were linked to VVED records. Surveys were distributed following VVED consultation to explore patient experience. Interrupted time-series analyses were used to evaluate the impact of VVED on non-transport rates and EMS reattendance within 24 hours. Multivariable logistic regression analyses were used to determine predictors of non-transport and EMS reattendance.</p><p><strong>Results: </strong>There were 914 747 EMS presentations within the study period, of which 30 433 (3.3%) were referred to VVED. Compared with those not referred, those referred to VVED were older with fewer vital sign derangements. Of VVED referrals, the median case time was 23 min shorter compared with cases not referred to VVED, and 74% were not transported. Compared with baseline, the VVED phase-in period was associated with a non-significant change in level (incident rate ratios (IRR): 1.03, 95% CI 0.99 to 1.06) and significant change in trend per 30 days (IRR: 1.01, 95% CI 1.01 to 1.02) for non-transports. Full implementation of VVED was associated with a step-reduction (IRR: 0.96, 95% CI 0.92 to 0.99) and downward trend per 30 days (IRR: 0.99, 95% CI 0.98 to 0.99). In both the VVED phase-in and full implementation periods, no associations were found for reattendance to EMS. After adjustment for clinical presentation and acuity, VVED referral was associated with a 16-fold (adjusted OR: 15.97 95% CI 15.53 to 16.43) increase in the odds of non-transport. Among the 8.9% of patients who responded to the survey, satisfaction of the VVED was high (91.1%).</p><p><strong>Conclusion: </strong>The EMS-VVED referral pathway contributed to significant improvements in ambulance non-transports and case-time savings.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"619-625"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586410","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":"Person-centred emergency care: translation and cross-cultural validation of the Australian Emergency Department Patient-Reported Experience Measure (ED PREM) in the Netherlands.","authors":"Renée A M Tuinte, Claudia Bull, Job M Hoonhorst, Reinier P Akkermans, Marie Louise Moors, Jaap Ten Oever, Marlies Ejl Hulscher, Jacobien J Hoogerwerf","doi":"10.1136/emermed-2024-214536","DOIUrl":"10.1136/emermed-2024-214536","url":null,"abstract":"<p><strong>Background: </strong>Measuring and evaluating patient experience in the emergency department (ED) is essential for improving the quality of emergency care. However, specific and validated tools to measure patient experience in the ED are lacking in many countries. The aim of this study was therefore to translate and cross-culturally validate the Australian ED Patient-Reported Experience Measure (ED PREM) for the Dutch setting.</p><p><strong>Methods: </strong>A single-centre validation study was conducted in a Dutch academic hospital. Step 1 involved forward and backward translation to produce a Dutch translation of the ED PREM (prototype). Step 2 involved establishing face and content validity of the Dutch prototype through cognitive patient interviews and researcher team consensus meetings. Step 3 involved administering the resultant Dutch pilot ED PREM to an ED population (n=527), to be able to perform psychometric analyses on this sample. Descriptive statistics and item reduction analyses were conducted prior to confirmatory factor analysis (CFA). CFA was used to confirm the structural validity of the Dutch ED PREM, and internal consistency was assessed.</p><p><strong>Results: </strong>The face and content validity of the prototype Dutch ED PREM was 'good' after 15 cognitive interviews and expert consultation. Over two-thirds of participants (357/527) completed the Dutch pilot ED PREM. Scores were high across all four domains. Several items were removed due to high ceiling effects and a large number of 'not applicable' responses. The final 18-item Dutch ED PREM showed acceptable model fit with CFA (χ²(df) 7519.55 (153), p<0.001, Root Mean Square Error of Approximation=0.090, Tucker-Lewis Index=0.942, Comparative Fit Index=0.951, Standardised Root Mean Square Residual=0.035). Internal consistency was high (Cronbach's alpha ranged 0.85-0.97 per domain).</p><p><strong>Conclusions: </strong>The final 18-item Dutch ED PREM showed good validity and reliability for measuring ED patient experience. It is suitable and feasible for use in clinical practice to assess and improve the person-centredness of emergency care.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"612-618"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741661","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":"Endovascular resuscitation: an expert practice review.","authors":"Thomas David Adams, Jon Barratt, James E Manning, Paul Rees, Ben Singer, Ed Benjamin Graham Barnard","doi":"10.1136/emermed-2025-215376","DOIUrl":"10.1136/emermed-2025-215376","url":null,"abstract":"<p><p>Endovascular resuscitation (EVR) describes a collection of novel therapies that aim to bridge patients in shock states or cardiac arrest to definitive treatment, through a combination of haemorrhage control and mechanical circulatory support. The last half-decade has seen landmark trials report on several techniques and adoption is growing despite controversies around risk, efficacy and implementation. As leaders in resuscitation, it is essential that emergency physicians understand the principles and practice of endovascular techniques to advocate for the critically unwell patients that may benefit from EVR and be engaged in future implementation.This practice review aims to provide emergency physicians with an overview of EVR, based around case scenarios of out-of-hospital cardiac arrest and non-compressible haemorrhage. We review the rationale for EVR in these conditions and describe the critical initial step of vascular access. We then describe the physiology, technique, efficacy and safety of three escalating interventions: resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion and extracorporeal cardiopulmonary resuscitation.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"626-633"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812439","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":"Association between catchment-area demographics and emergency department presentation rates and delays: a national cross-sectional study.","authors":"Ryan McHenry, Christopher E J Moultrie, Alasdair R Corfield, Daniel F MacKay, Jill P Pell","doi":"10.1136/emermed-2024-214837","DOIUrl":"10.1136/emermed-2024-214837","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) utilisation and delays are a major public health concern internationally, with increased mortality with ED delays and overcrowding. The study aimed to assess how the population characteristics of ED catchment areas are associated with ED use and delays to admission or discharge, and how catchment presentation rates are associated with ED delays.</p><p><strong>Methods: </strong>A cross-sectional study of presentations and delays to all 27 Scottish EDs for December 2023-February 2024. Catchment areas were defined for every ED in Scotland and population demographics for each, as Scottish Index of Multiple Deprivation (SIMD) and 8-fold Urban-Rural Classification (UR8). ED performance metrics for the study period were extracted from routinely reported data. Robust regression assessed the associations between catchment area demographics and ED delays, with negative binomial regression analysis of the association between catchment area demographics and presentation rates for the local population, reported as incidence rate ratio (IRR).</p><p><strong>Results: </strong>For each decile lower (more deprived) in median SIMD, monthly attendances increased by 10% (IRR 1.10, 95% CI 1.10 to 1.11). For each step more rural in the median UR8 of a catchment, the percentage of patients experiencing a delay to admission or discharge of over 4 hours reduced by 5.3% (95% CI 4.9% to 5.7%), and each step more deprived in median SIMD decile of a catchment area was associated with 4.8% more delays beyond 4 hours (95% CI 3.0 to 6.8%). There was no association between presentation rates and delay to admission or discharge.</p><p><strong>Conclusion: </strong>EDs with more deprived catchment areas have higher presentation rates and greater delays in care. More rural EDs have fewer delays, which may mitigate some of the effects of geographical isolation in the provision of more timely care. In isolation, ED presentation rates are not associated with delays to care, adding to evidence that overall attendances are less important than other factors contributing to ED delays. Policymakers should consider the allocation of resources to best promote health equity.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"600-605"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877731","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":"Quantifying the impact of prehospital arterial line insertion on scene time.","authors":"Jack Lyon, Sam Garner","doi":"10.1136/emermed-2026-215949","DOIUrl":"10.1136/emermed-2026-215949","url":null,"abstract":"<p><p>Enhanced prehospital care services, globally, have demonstrated the feasibility of establishing intra-arterial blood pressure monitoring prehospital to adapt their interventions to their patient's physiology. There is concern, however, that arterial line insertion may increase time on scene and subsequently delay transport to definitive care.A focused, systematic review was undertaken to investigate this. A structured keyword search of MEDLINE and EMBASE identified four studies meeting the inclusion criteria.All four studies noted an association between arterial line insertion and increased scene time (4-34.4 min). The strength and interpretability of this evidence is limited. The clinical significance of this delay is unclear and is likely to be context specific.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 10","pages":"658-660"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001446","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 in his 40s with a sudden onset of palpitations.","authors":"Raja Khan, Muhammad Shahid","doi":"10.1136/emermed-2025-215665","DOIUrl":"https://doi.org/10.1136/emermed-2025-215665","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"43 10","pages":"646-657"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001422","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":"My first surgical airway.","authors":"V A Ashwin Kumar","doi":"10.1136/emermed-2026-216070","DOIUrl":"10.1136/emermed-2026-216070","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"665"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715829","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":"Kayla Iuliucci, Lea Moujaes, Ghassan Bou Saba, Emma Louise Johnson, Gabrielle Prager","doi":"10.1136/emermed-2026-216286","DOIUrl":"10.1136/emermed-2026-216286","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"666-667"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711163","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":"Concordance between an artificial intelligence self-triage programme and physical triage.","authors":"Maaike Wempe, Frits Holleman, Michiel Schinkel, Michiel Gorzeman","doi":"10.1136/emermed-2024-214212","DOIUrl":"10.1136/emermed-2024-214212","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the concordance between the Dutch National Triage Standard (NTS) triage classification and the triage of an artificial intelligence (AI) self-triage programme.</p><p><strong>Methods: </strong>This observational comparative study was performed in the emergency departments (EDs) of two OLVG hospital locations in Amsterdam in October and November 2023. Adult patients who entered the ED without ambulance transport and were triaged using NTS (usual care), were asked to complete the digital AI triage programme. Cohen's kappa (ĸ), per cent agreement and the distribution across urgency categories were used to evaluate the concordance between the triage methods.</p><p><strong>Results: </strong>Of the 264 patients approached, 203 consented to participation and were included in analysis and follow-up. Agreement between the triage methods was none to slight, ĸ=0.092 (95% CI -0.196 to 0.380). The AI triage programme overtriaged in 12.8% of cases and undertriaged in 5.4% compared with the NTS. However, the AI triage programme classified more patients with serious clinical sequelae into S1 (ie, emergency care with ambulance) and S2 (ie, emergency care) compared with NTS U1 and U2. The AI triage programme predicted the final diagnosis at ED discharge in 27.1% of the cases. There were significantly more clinical sequelae (eg, death, ward admission or follow-up consultation) for general practitioner referred patients compared with self-referrals.</p><p><strong>Conclusion: </strong>The AI triage appeared more distinctive in urgency classification than classic triage when considering clinical sequelae for the patient. However, refinements and better validation of AI triage programmes are needed before these can be implemented in healthcare systems.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"606-611"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307546","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}