Emergency Medicine Journal最新文献

{"title":"Experience and needs of emergency nurses in palliative care: a qualitative meta-synthesis.","authors":"Na Liu, Lina Chen, Xinrui Mao, Shuqin Xia, Qi Wang, Dandan Hu, Runv Zhou, Weiying Zhang","doi":"10.1136/emermed-2025-215369","DOIUrl":"10.1136/emermed-2025-215369","url":null,"abstract":"<p><strong>Objective: </strong>This study seeks to explore the experiences of emergency nurses in providing care to patients nearing the end of life and to identify the needs of emergency nurses in the palliative care (PC) process.</p><p><strong>Methods: </strong>A qualitative meta-synthesis approach (following Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines) was implemented to systematically review relevant qualitative studies. A comprehensive search was conducted across multiple databases, encompassing PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature; (CINAHL), PsycINFO, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang database and Scopus. The search duration was from database inception to March 2025.</p><p><strong>Results: </strong>In total, 22 studies complied with the inclusion criteria and were included in the meta-synthesis. Three main themes were identified: (i) needs for emergency palliative care (EPC) and current practice in emergency departments (EDs); (ii) emotional, ethical and communication experiences of nurses in providing PC in EDs; (iii) nurses' perceived needs for training, support and system coordination. Across studies, EPC in the ED was described as occurring alongside acute life-saving care. Nurses' experiences and attitudes towards EPC varied significantly, ranging from positive engagement to perceived incompatibility with their roles in emergency care.</p><p><strong>Conclusion: </strong>This meta-synthesis highlights the complexity of providing PC in EDs and the urgency of implementing systematic interventions. To enhance the effectiveness and quality of EPC, it is necessary to provide systematic support and targeted strategies, thereby helping emergency nurses better meet the needs of patients at the end of life.</p><p><strong>Prospero registration number: </strong>CRD420251008755.</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":"147590749","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 of acute neurological symptoms with mortality in patients with heat-related illness: a nationwide study in Japan.","authors":"Kasumi Satoh, Yohei Okada, Yuya Suzuki, Jun Kanda, Shoji Yokobori, Manabu Okuyama, Hajime Nakae","doi":"10.1136/emermed-2025-215492","DOIUrl":"https://doi.org/10.1136/emermed-2025-215492","url":null,"abstract":"<p><strong>Background and objective: </strong>Heat-related illnesses can range from mild to severe, potentially causing death or disability. Central nervous system abnormalities are crucial clinical indicators, yet their relationships with outcomes remain unclear. We aimed to investigate this association using a Japanese nationwide database.</p><p><strong>Methods: </strong>This study analysed data from the Heatstroke Study database (2017-2021) which included adult Japanese patients with heat-related illnesses. Acute neurological symptoms (Glasgow Coma Scale (GCS) <14 and/or seizures) were the primary exposure. Outcomes included in-hospital mortality and unfavourable functional outcomes (modified Rankin Scale (mRS) ≥3). Adjusted ORs with 95% CIs were estimated using multivariable logistic regression, adjusting for age, sex, preadmission mRS, Charlson Comorbidity Index, occurrence situation, body temperature and systolic blood pressure.</p><p><strong>Results: </strong>Among 2961 patients (median age 73.0 years, 69.4% were male), the in-hospital mortality was 5.4% (160/2961). The observed mortality was 10.9% (142/1303) in patients with acute neurological symptoms and 1.1% (18/1658) in patients without symptoms. Unfavourable functional outcomes occurred in 42.2% (455/1078) of patients with acute neurological symptoms and 10.4% (155/1492) of patients without symptoms. After adjustment, acute neurological symptoms were found to be significantly associated with in-hospital mortality (adjusted OR 7.33, 95% CI 4.50 to 12.64) and unfavourable functional outcomes (adjusted OR 5.15, 95% CI 4.14 to 6.44). A dose-dependent relationship was observed between GCS severity and mortality, with GCS 3-8 showing the highest risk compared with GCS 14-15 (adjusted OR 12.23, 95% CI 7.42 to 21.17).</p><p><strong>Conclusion: </strong>Acute neurological symptoms, particularly impaired consciousness, were independently associated with mortality and unfavourable outcomes in heat-related illnesses. These findings emphasise the importance of neurological symptoms in severity classification for heat-related illnesses.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688854","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":"Diagnostic accuracy of the G-FAST score for detecting large vessel occlusion in suspected stroke patients: a systematic review and network meta-analysis.","authors":"Jyun-Jhe Wang, Hui-An Lin, Ho-Chang Huang, Yu-Chen Lin, Sheng-Feng Lin","doi":"10.1136/emermed-2025-215449","DOIUrl":"https://doi.org/10.1136/emermed-2025-215449","url":null,"abstract":"<p><strong>Background: </strong>Early and accurate detection of large vessel occlusion (LVO) is essential for timely endovascular thrombectomy in acute ischaemic stroke. The Gaze-Face-Arm-Speech-Time (G-FAST) scale has been proposed as a potential prehospital screening tool for LVO than the Cincinnati Prehospital Stroke Scale (CPSS). This study systematically evaluates the diagnostic performance of G-FAST and compares it with CPSS.</p><p><strong>Methods: </strong>A systematic review and network meta-analysis were conducted. A comprehensive literature search in PubMed, Embase and Scopus was performed up to 31 December 2024. Pooled sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were estimated. Network meta-analysis was used to compare diagnostic performance across G-FAST≥3, CPSS≥2 and CPSS≥3.</p><p><strong>Results: </strong>13 studies involving 12 414 patients were eligible for inclusion in the meta-analysis of G-FAST. G-FAST ≥3 demonstrated pooled sensitivity and specificity of 73.3% (95% CI 66.2% to 79.4%) and 74.3% (95% CI 65.3% to 81.6%), respectively, with an AUC of 0.80. In the network meta-analysis (six studies, 7012 participants), CPSS ≥2 showed the highest pooled sensitivity (79.0%, 95% CI 60.4% to 90.3%) and pooled specificity (66.1%, 95% CI 40.6% to 84.7%), whereas CPSS ≥3 demonstrated higher specificity (83.8%, 95% CI 63.6% to 93.9%) but reduced sensitivity (63.4%, 95% CI 40.1% to 81.7%). G-FAST ≥3 showed a more balanced performance between sensitivity (71.6%, 95% CI 51.4% to 85.7%) and specificity (76.4%, 95% CI 53.8% to 90.0%), with a numerically higher specificity than CPSS ≥2. Overall, there were no statistically significant differences in diagnostic performance among the scales.</p><p><strong>Conclusions: </strong>G-FAST demonstrates moderate diagnostic accuracy for prehospital LVO detection, with performance comparable to traditional scales. Its use provides a feasible alternative for pre-hospital stroke triage, though further large-scale validation is warranted.</p><p><strong>Prospero registration number: </strong>CRD42023477601.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688970","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":"From health literacy to emergency room: understanding the factors behind adult emergency visits.","authors":"Hatice Dilek Doğan, Seda Tuğba Baykara Mat","doi":"10.1136/emermed-2025-215114","DOIUrl":"https://doi.org/10.1136/emermed-2025-215114","url":null,"abstract":"<p><strong>Background: </strong>It is believed that low health literacy (HL) is associated with inappropriate use of emergency departments (ED). The volume of ED visits in Turkey continues to increase. This study aimed to evaluate the effects of adults' HL level, reasons for attending the ED, frequency of visits and trust in health news on social media on HL level and ED visits.</p><p><strong>Methods: </strong>This prospective cross-sectional study was conducted at a university hospital ED in Istanbul from December 2021 to January 2023. Participants were adults (>18 years) admitted to the green or yellow triage areas, representing non-urgent or moderately urgent conditions. Data were collected through a Personal Information Form and the Turkish Health Literacy Scale-32 (THLS-32), administered either face to face or online.</p><p><strong>Results: </strong>A total of 466 participants (mean age 30.3±12.9 years, 71.7% female) were included. Most participants were university graduates. The mean THLS-32 score was 30.35±10.11 (range 0-50), with only 13.9% (42-50 points) classified as having 'excellent' HL. Participants who reported relying on social media for health news and those who visited the ED due to 'long waits for a hospital outpatient clinic' had lower THLS-32 scores. There was no statistically significant association between HL and frequent ED attendance, age, gender or educational level.</p><p><strong>Conclusion: </strong>Lower HL is associated with greater reliance on unverified information in social media for health news and ED attendance due to long outpatient waits. Our findings highlight the need for targeted HL and digital HL initiatives to reduce avoidable ED visits and strengthen healthcare navigation skills.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688995","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":"Emergency medicine as risk management: a cognitive scaffold for safe decisions under uncertainty.","authors":"Arihant Jain, Sanjeev Bhoi, Amrithanand V T","doi":"10.1136/emermed-2026-215940","DOIUrl":"https://doi.org/10.1136/emermed-2026-215940","url":null,"abstract":"<p><p>Emergency medicine (EM) is often mischaracterised as symptom-based care, yet, in practice, it is the discipline of making time-critical decisions with incomplete information, under conditions where delay can cause irreversible harm. The emergency physician's central cognitive task is therefore less the pursuit of perfect diagnostic labels and more the management of risk: identifying immediate threats, stabilising physiology, excluding dangerous alternatives and formulating a safe disposition plan. This concepts paper introduces a simple cognitive scaffold-<i>Stabilise, Exclude, Decide (S-E-D)</i>-to make EM reasoning explicit, teachable and transferable across settings. We describe how S-E-D maps onto the realities of undifferentiated presentations, crowding and diagnostic uncertainty, and how neglecting this mindset contributes to predictable errors such as premature closure, anchoring and underestimation of disposition risk. We then outline practical strategies for teaching S-E-D at the bedside using structured questions, deliberate reassessment and probability-based interpretation of tests. By reframing EM as the cognitive craft of safe decision-making under uncertainty, this framework aims to clarify the specialty's contribution for clinicians and residents and to support safer practice and more purposeful education internationally.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688997","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":"Unlocking clinical narratives: how natural language processing and artificial intelligence can address data deficits and mitigate health inequities in urgent and emergency care.","authors":"Chris Humphries, Lisa Schölin, Gearóid Brennan, Jonathan Brett, Michael Eddleston, Adam Lloyd, Anna Miell, Matthew J Reed, Arlene Casey","doi":"10.1136/emermed-2025-215530","DOIUrl":"https://doi.org/10.1136/emermed-2025-215530","url":null,"abstract":"<p><p>The Urgent and Emergency Care system generates a wealth of clinical information, but our ability to harness this for public health planning and to address health inequalities is constrained by systemic data quality issues. Modern natural language processing (NLP), driven by the context-aware capabilities of transformer-based architectures and large language models, offers a transformative opportunity to bridge this gap. By training machines to interpret and structure context-rich clinical notes at scale, we can translate complex patient stories into data ready for research and systems intelligence that reflects the realities of real-world care.This technology offers a potential route to addressing health inequities in vulnerable populations, such as those presenting with crises related to mental ill-health, alcohol and drug use. Current reliance on structured but oversimplistic data often fails to capture the complex intersectionalities of clinical and social contexts. This is due to factors like diagnostic overshadowing and unrecorded multimorbidity, leaving these patients statistically obscured within routine datasets, which fail to accurately represent volume or complexity. This data invisibility perpetuates a cycle of inaccurate disease burden estimates, under-resourced services and flawed policy. By unlocking the detailed narrative data within unstructured notes, NLP could allow us to identify the acute social stressors and psychiatric contexts that are currently invisible, making these inequities visible and actionable.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688982","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":"Telesimulation as a digital strategy for scaling trauma skills training for reach: a global partnership case study from India.","authors":"Shweta Gidwani, Susan Owens, Vanita Mittal, Johnson Varghese, Narendra Nath Jena, Tania Ahluwalia, Katherine Douglass","doi":"10.1136/emermed-2025-215074","DOIUrl":"https://doi.org/10.1136/emermed-2025-215074","url":null,"abstract":"<p><p>Injuries account for 8.5% of global deaths, with 83% occurring in low and middle-income countries (LMICs). India faces a significant trauma burden, with 153 972 road traffic fatalities in 2021, alongside a pronounced shortage of trained emergency care providers. Existing trauma training models, such as WHO-ICRC Basic Emergency Care and the Advanced Trauma Life Support course, while valuable, are resource-intensive. The COVID-19 pandemic has accelerated the adoption of virtual education, presenting an opportunity to scale trauma training in LMICs.This paper describes a novel, gamified trauma telesimulation activity designed to address these challenges. Using the each, Effectiveness, Adoption, Implementation and Maintenance framework, we assessed its reach, effectiveness, adoption, implementation and potential for maintenance. The activity involved 20 emergency medicine residents across four hospitals in India who participated in a competitive, single-elimination trauma simulation via Zoom. Scenarios focused on managing paediatric head trauma and adult polytrauma. A further 159 residents from 13 remote sites observed and contributed to scoring and debrief discussions. The initiative reached 179 trainees across 17 hospitals in 12 cities, spanning distances of over 2000 km. Adoption was facilitated by familiarity with online platforms, English as a shared language and stable connectivity. The model demonstrated feasibility for scaling trauma skills training in resource-limited settings. Future work should include mixed-methods evaluation, tracking clinical outcomes and establishing frameworks for local faculty to sustain delivery. Integrating telesimulation into national programmes and trauma registries may support broader health system strengthening. This model offers a promising, low-cost strategy to help address critical gaps in trauma training and workforce capacity in LMICs.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688961","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":"Harm reduction in nightlife settings: from data to implementation.","authors":"Chris Humphries","doi":"10.1136/emermed-2026-216081","DOIUrl":"https://doi.org/10.1136/emermed-2026-216081","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637986","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":"Emergency medicine in Ethiopia: key updated statistics and insights.","authors":"Mikiyas G Teferi","doi":"10.1136/emermed-2025-215574","DOIUrl":"https://doi.org/10.1136/emermed-2025-215574","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638024","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":"Some nights stay with you.","authors":"Arihant Jain","doi":"10.1136/emermed-2026-215982","DOIUrl":"10.1136/emermed-2026-215982","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510516","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}