Emergency Medicine Journal最新文献

{"title":"3-foot world in emergency medicine: attentional narrowing as adaptive paradox.","authors":"Kenneth V Iserson","doi":"10.1136/emermed-2026-216019","DOIUrl":"https://doi.org/10.1136/emermed-2026-216019","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766067","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":"External validation of the emergency CT head score to reduce non-trauma imaging: a multicentre retrospective study.","authors":"Romain Seingier, Jeremy Pasco, Jean-Luc Hanouz, Richard Macrez, Mathieu Goetz, Félix Amiot","doi":"10.1136/emermed-2025-215110","DOIUrl":"https://doi.org/10.1136/emermed-2025-215110","url":null,"abstract":"<p><strong>Background: </strong>Cerebral CT (CCT) is used in emergency departments (EDs) to assess suspected central nervous system disorders, particularly neurovascular issues. However, the increasing use of CCT raises concerns regarding cost, radiation exposure and efficiency, prompting the development of clinical scoring systems to guide informed decisions and reduce unnecessary imaging. The Emergency CT Head Score (ECHS) is a recent tool designed to streamline CCT prescriptions using four criteria: neurological deficit, acute headache, seizures with altered consciousness and transient neurological disorders. This study aimed to validate the ECHS in a different population and healthcare system in France while also providing a detailed cost analysis.</p><p><strong>Methods: </strong>This multicentre retrospective study, conducted in two EDs in Normandy, included adults (≥18 years) presenting with non-rotatory vertigo, acute headache, altered consciousness, seizures, confusion, dizziness, syncope or presyncope without recent trauma who underwent CCT. Exclusion criteria were suspected stroke/transient ischemic attack (TIA) according to French guidelines, head trauma, brain cancer, hydrocephalus, recent stroke or minors. No follow-up was performed. The ECHS was calculated retrospectively and compared with CT findings.</p><p><strong>Results: </strong>Of the 600 included patients, the mean age was 62.4±18.7 years and 86 (14.3%) showed abnormalities on CT. The ECHS score demonstrated strong performance, with an area under the curve of 0.894 (95% CI 0.849 to 0.940). Using a threshold of ECHS≥1, we observed no false negatives, resulting in a sensitivity of 100% (95% CI 95.8% to 100%) and negative predictive value of 100% (95 % CI 98.2% to 100%). At this threshold, 48% of CCT scans could have been avoided without adverse outcomes.</p><p><strong>Conclusion: </strong>The ECHS demonstrated high sensitivity for detecting CT abnormalities in this cohort, suggesting potential to reduce unnecessary scans in patients with a score of 0. However, prospective implementation studies are needed.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766086","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":"Pragmatic medicine, n=1.","authors":"Piotr Szawarski, David Hillebrandt","doi":"10.1136/emermed-2025-215840","DOIUrl":"https://doi.org/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":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","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":"Haematoma block versus sedation for manipulating distal radius fractures in the emergency department.","authors":"Amy Fox, Marrigje Nell","doi":"10.1136/emermed-2026-215904","DOIUrl":"https://doi.org/10.1136/emermed-2026-215904","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures commonly require manipulation in the emergency department. Procedural sedation is frequently used but is resource-intensive and associated with potential adverse events. Haematoma block may offer a practical alternative, particularly in busy emergency departments, but its comparative efficacy and safety are uncertain.</p><p><strong>Objective: </strong>To evaluate whether haematoma block provides a comparable procedural success rate to procedural sedation, and whether there is a difference in the likelihood of adverse events, in adult patients undergoing manipulation of distal radius fractures in the emergency department.</p><p><strong>Methods: </strong>A structured search of MEDLINE and Embase databases was conducted using the Ovid interface. Studies comparing haematoma block with procedural sedation for manipulation of distal radius fractures in adults were included. Outcomes assessed included procedural success rate and adverse events. Seven studies met inclusion criteria, comprising four randomised controlled trials and three observational studies. Two studies were derived from the same dataset and were combined in the Best Evidence Topic (BET) table as one.</p><p><strong>Results: </strong>Across the included studies, there was no consistent evidence of a difference in procedural success between haematoma block and procedural sedation. The highest-quality evidence from two randomised controlled trials found no difference in radiographic outcome. Regarding the likelihood of adverse events when comparing haematoma block versus sedation, one study found less pain in the haematoma block group. None of the other studies detected a statistically significant difference.</p><p><strong>Conclusion: </strong>In adult patients presenting to the emergency department with distal radius fractures requiring manipulation, the use of haematoma blocks appears to be associated with comparable procedural success rate to procedural sedation, without strong evidence of a difference in likelihood of adverse events.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766070","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":"Management and outcomes of critically ill patients admitted to a critical care resuscitation unit: a retrospective cohort study.","authors":"Matthias Noitz, Dominik Jenny, Florian Steininger, Thomas Tschoellitsch, Romana Erblich, Marius Knöll, Jens Meier, Martin W Dünser","doi":"10.1136/emermed-2025-215099","DOIUrl":"https://doi.org/10.1136/emermed-2025-215099","url":null,"abstract":"<p><strong>Background: </strong>Providing early support to critically ill patients before intensive care unit (ICU) admission improves morbidity and mortality. We aimed to evaluate the management and outcomes of critically ill patients admitted to a critical care resuscitation unit (CCRU).</p><p><strong>Methods: </strong>This retrospective study was conducted in the CCRU of a tertiary hospital and included adults (≥18 years) admitted from November 2015 until March 2020 and from July 2021 until December 2023. The primary outcome was the disposition category at CCRU discharge. Comparisons with a historical control group of critically ill emergency department (ED) patients prior to CCRU implementation were made.</p><p><strong>Results: </strong>2059 CCRU patients (median age 70 years; 57.4% male) were analysed. Patients were admitted to the CCRU from the ED (72.2%), wards (18%), emergency medical services (6.7%) or other sources (3.2%). Following a median CCRU length of stay of 2.7 (IQR 1.7-4.2) hours, during which 2 (IQR 1-4) critical care interventions per patient were delivered, 911 patients (44.2%) required ICU admission, while 978 (47.5%) and 74 (3.6%) patients were admitted to general wards or discharged home. 84 patients (4.1%) died in the CCRU. Compared with a historical control group, the ICU admission rate of ED patients (0.73 vs 0.56%, p<0.001) and the delay between ED presentation and ICU or CCRU admission decreased after CCRU implementation (1.87 (0.48-6.53) vs 0.85 (0.48-2.79) hours, p<0.001).</p><p><strong>Conclusion: </strong>The CCRU at a large tertiary centre admitted critically ill patients with a wide range of emergencies. Following a short treatment period, during which several critical care interventions were delivered, less than half of CCRU patients required subsequent ICU admission. Comparisons with a historical control group suggest that CCRU implementation reduced the ICU admission rate and time to initiation of critical care for ED patients.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766057","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":"Are rapid diagnostic tests reliable for the detection of malaria in the emergency department?","authors":"Chloé Moran, Saoirse Coyne","doi":"10.1136/emermed-2026-215905","DOIUrl":"https://doi.org/10.1136/emermed-2026-215905","url":null,"abstract":"<p><p>A short systematic review assessed the diagnostic accuracy of malaria rapid diagnostic tests in febrile adults from malaria-endemic regions. A database search of MEDLINE, EMBASE, Cochrane and Google Scholar returned 138 papers. Six papers met the inclusion criteria and were included in our analysis.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766074","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":"Clinician interaction with a machine learning algorithm for the assessment of patients with possible acute heart failure: a qualitative study.","authors":"Amy V Ferry, Kuan Ken Lee, Dimitrios Doudesis, Chris Tuck, Alasdair J Gray, Nicholas L Mills","doi":"10.1136/emermed-2025-215220","DOIUrl":"https://doi.org/10.1136/emermed-2025-215220","url":null,"abstract":"<p><strong>Background: </strong>Machine learning (ML) could improve clinical decisions in patients with possible acute heart failure, but few studies have evaluated acceptance, and barriers or facilitators that lead to clinician engagement with these tools. In a qualitative study, we used anonymised clinical cases of breathless patients to explore barriers and facilitators to engagement with a clinical decision-support tool-'CoDE-HF'-that applies ML to estimate the probability of acute heart failure from natriuretic peptide concentrations and clinical variables.</p><p><strong>Methods: </strong>Emergency department clinicians across three acute care hospitals were invited to participate in 1:1 semi-structured interviews either face-to-face or by video call. Clinicians were asked to review five anonymised clinical cases and 'think aloud' about patient assessment strategies and interpretation of the Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF) model outputs. Interviews were recorded, transcribed and coded. Codes were mapped onto the four domains of the unified theory of acceptance and use of technology model (performance expectancy, effort expectancy, social influences, facilitating conditions) which was used to identify barriers and facilitators to acceptance.</p><p><strong>Results: </strong>Facilitators to use were CoDE-HF's ability to promote objective communication between colleagues and its role in reprioritising acute heart failure in cases where a diagnosis may have been missed. The method of presentation of model output (statements relating to the positive or negative predictive value of the CoDE-HF output score and visual traffic light system for the low-probability, intermediate-probability or high-probability categories) was viewed as facilitators, though the absolute numerical score was more difficult to interpret. Access to a computer and clinical sample processing time were the only potential organisational issues identified as barriers.</p><p><strong>Conclusion: </strong>Clinicians reported that CoDE-HF could be a useful adjunct to clinical assessment of patients with breathlessness in the emergency department. Ease of model output interpretation is key to acceptance with interviews identifying a need to refine presentation of score information.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766152","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":"Absorbable sutures appear clinically effective and may be more cost-effective than non-absorbable sutures for definitive closure of adult facial lacerations.","authors":"Mairead Kelly, Daniel Edward Horner","doi":"10.1136/emermed-2026-216075","DOIUrl":"https://doi.org/10.1136/emermed-2026-216075","url":null,"abstract":"<p><p>A short cut review of the literature was carried out to examine the evidence supporting the use of absorbable suture for definitive closure of facial lacerations. Two papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The current evidence suggests that use of absorbable sutures for definitive wound closure in facial lacerations delivers comparable cosmetic outcomes, with no difference in reported complications. Use of absorbable sutures may be more cost effective, through avoidance of further downstream healthcare resource use.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766083","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":"https://doi.org/10.1136/emermed-2026-216070","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-17","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":"Epidemiology and outcomes in patients with out-of-hospital cardiac arrest without coma after return of spontaneous circulation: a multicentre cohort study.","authors":"Takuya Taira, Akihiko Inoue, Yasuhiro Kuroda, Takeshi Nishimura, Masafumi Suga, Yuki Yamafuji, Yukihide Nakatani, Shinichi Ijuin, Kentaro Nakamura, Satoshi Ishihara","doi":"10.1136/emermed-2024-214835","DOIUrl":"https://doi.org/10.1136/emermed-2024-214835","url":null,"abstract":"<p><strong>Background: </strong>In clinical practice, we encounter patients with out-of-hospital cardiac arrest (OHCA) without coma after return of spontaneous circulation (ROSC). However, the epidemiology, characteristics and outcomes in this population remain unclear. The primary aim was to describe the epidemiology, characteristics and outcomes of patients with OHCA who did not experience coma after ROSC. The secondary aim was to identify factors associated with survival and good functional outcomes in this patient population.</p><p><strong>Methods: </strong>This was a secondary analysis of the data from the Japan Association for Acute Medicine (JAAM)-OHCA Registry. Adult patients with OHCA without coma (Glasgow Coma Scale (GCS) Score ≥8) after ROSC between June 2014 and December 2019 were included. The primary endpoint was 30-day survival with good functional outcomes (Cerebral Performance Category Score of 1-2). Multivariable logistic regression analysis with a generalised estimating equation was performed to examine the factors associated with 30-day survival with good functional outcomes.</p><p><strong>Results: </strong>During the study period, 57 754 patients with OHCA were enrolled in the JAAM-OHCA Registry, of which 874 (1.5%) adult patients without coma after ROSC were analysed. Among them, the proportion of patients with 30-day survival with good functional outcomes was 76.0% (n=664), and the 30-day survival rate was 86.4% (n=755). Multivariable analysis revealed that younger age, witnessed cardiac arrest, shockable rhythms at the scene, GCS Motor Response (GCS-M) Score of 5 or 6 after ROSC, lower lactate levels and higher pH levels (pH≥7.10) were associated with 30-day survival with good functional outcomes.</p><p><strong>Conclusions: </strong>Even among the patients with OHCA who achieved ROSC without coma, approximately a quarter of patients had poor functional outcomes. Older age, non-witnessed cardiac arrest, non-shockable rhythms at the scene, lower GCS-M Score after ROSC, higher lactate levels and lower pH levels predicted poorer outcomes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697722","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}