Emergency Medicine Journal最新文献

{"title":"Deprivation is associated with hospital conveyance among patients who are terminally ill.","authors":"Maddy French, Michelle Waddington, Pete Dixon, Kieran Potts, Sandra Igbodo, Jane Simpson, Nancy Preston","doi":"10.1136/emermed-2023-213742","DOIUrl":"10.1136/emermed-2023-213742","url":null,"abstract":"<p><strong>Background: </strong>Hospital admissions of patients who are terminally ill can be associated with poor experiences and unwanted outcomes, such as dying away from home. While area deprivation is associated with emergency hospital admissions in the last year of life, few studies have explored the relationship between deprivation and ambulance clinicians' decisions to convey a patient to the hospital. The aim of this study is to understand the overall proportion of terminally ill patients conveyed to hospitals by paramedics in North West England, and to explore the associations between hospital conveyance and area deprivation.</p><p><strong>Methods: </strong>This is an observational study using routinely collected ambulance data held by the North West Ambulance Service NHS Trust in England, UK. Data on adult patients (aged 18+ years) who were coded by ambulance personnel as having a terminal illness were extracted for the period from March 2021 to February 2022. Logistic regression mixed models were used to examine the associations between hospital conveyance and area deprivation. To control for confounding variables, additional data were collected on age, gender, ethnicity, location, clinical assessment codes and place of residence.</p><p><strong>Results: </strong>The number of calls attended by ambulance clinicians for terminally ill patients included in the analysis was 1737. Ten per cent of these calls resulted in the patient being taken to the hospital. The odds of being taken to hospital were 1.51 (95% CI 1.06 to 2.16) times greater for patients living in the 20% most deprived areas compared with those in less deprived areas, in the final model adjusted for age, gender, place of residence and the initial coded reason for the call.</p><p><strong>Conclusion: </strong>This study suggests that patients with terminal illnesses living in the most deprived areas are more likely to be taken to hospital by ambulance clinicians, compared with those in less deprived areas. Overall, however, a small proportion of patients classed as terminally ill in all areas were taken to hospital. This implies that most end-of-life care provided by ambulance clinicians in this region will be in a patient's place of residence, with implications for time, resources and training.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"565-571"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984439","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":"Reducing time delays and enhancing reperfusion eligibility related to stroke suspicion by the Emergency Medical Dispatch Centre: a registry-based observational study.","authors":"Nedim Leto, Elisabeth Farbu, Paul Barach, Michael Busch, Helene Lund, Conrad Arnfinn Bjørshol, Martin Kurz, Annette Fromm, Øyvind Østerås, Linn Therese Hagen, Thomas Werner Lindner","doi":"10.1136/emermed-2024-214294","DOIUrl":"10.1136/emermed-2024-214294","url":null,"abstract":"<p><strong>Background and aims: </strong>Research on the importance of the Emergency Medical Dispatch Centre (EMDC) role in reducing the time delays for patients with acute ischaemic stroke (AIS) is limited. This study aimed to analyse how Norwegian EMDCs' accurate suspicions can impact the clinical care times in this patient group.</p><p><strong>Methods: </strong>We collected clinical care time metrics and acute reperfusion treatment data from the Norwegian Stroke Registry on patients with AIS in Western Norway who were evaluated by the EMDC and had an ambulance dispatched in 2021. In case a stroke was suspected by the EMDC, the dispatcher communicated their diagnosis suspicions to the ambulance personnel. Outcomes of interest were reperfusion treatment for AIS, prehospital and in-hospital time-to-treatment delays, and patient outcomes.</p><p><strong>Results: </strong>Of the 1106 patients with AIS in our region, 771 (70 %) fulfilled the inclusion criteria. The EMDC suspected a stroke in 481 cases (62 %). Patients with suspected stroke experienced lower ambulance on-scene times (11 min vs 15 min; p=0.001), Emergency Medical Service prehospital times (40 min vs 49 min; p=0.021) and door-to-needle times (23 min vs 31 min; p=0.023). The EMDC stroke suspicion was associated with increased thrombolysis rates (OR 2.42 (95% CI 1.72 to 3.40)) after adjusting for age, sex, risk factors and functional status prior to the stroke event. The door-to-groin puncture times were lower for patients with a stroke suspicion who received endovascular treatment (65 min vs 85 min; p=0.004). No differences in the National Institutes of Health Stroke Scale score at the initial hospital arrival (4 vs 4; p=0.42) or in 90-day functional independence outcomes (rate of modified Rankin Scale score 0-2; 240 (61%) vs 160 (66%); p=0.24) were observed.</p><p><strong>Conclusions: </strong>Accurate EMDC recognition of stroke suspicion alerts to ambulances were associated with a reduction in time until treatment and increased intravenous thrombolysis rates. A significant proportion of patients who had a stroke were not identified by the dispatcher. Improving dispatcher stroke assessment training, tools and knowledge may reduce time delays, thus improving patient outcomes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"599-605"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572036","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":"Choice at the end of life is a privilege.","authors":"Cliona Ni Cheallaigh, Rosa McNamara","doi":"10.1136/emermed-2025-215030","DOIUrl":"10.1136/emermed-2025-215030","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"564"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224752","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":"Improving Care with the First measurement of high-sensitivity troponin T (ICare-FirsT) to enable early rule out and reduce length of stay: a diagnostic and observational study.","authors":"John W Pickering, Laura Joyce, Gerard Devlin, Chris Pemberton, Richard Troughton, A Mark Richards, Martin P Than","doi":"10.1136/emermed-2024-214754","DOIUrl":"10.1136/emermed-2024-214754","url":null,"abstract":"<p><strong>Background: </strong>Pathways incorporating clinical risk assessment, ECG and serial troponin measurements for the assessment of patients with possible myocardial infarction (MI) in the ED are standard practice. Incorporating a single troponin test to stratify to low risk of MI using a baseline measurement of cardiac troponin (cTn) with a high-sensitivity T assay (hs-cTnT) is recommended. We aimed to implement a pathway incorporating a single-test component and measure the impact on length of stay (LOS).</p><p><strong>Methods: </strong>There were two study phases: (1) Development and performance assessment of a novel pathway incorporating a single-test hs-cTnT stratification using high-fidelity research data, (2) An audit of the implementation of a single-test Roche hs-cTnT strategy within multiple EDs. The low-risk threshold used for hs-cTnT was 5 ng/L. The safety metric was MI or death not known to be non-cardiac within 30 days (MACE30).</p><p><strong>Results: </strong>Phase I: The derived pathway had 16.3% low risk after one blood draw ≥3 hours from symptom onset with hs-cTnT <5 ng/L, non-ischaemic ECG and ED Assessment of Chest pain Score <21.</p><p><strong>Phase ii: </strong>In six hospitals, there were 10 912 patients in the control arm and 13 997 after implementation of single-test hs-cTnT. The unadjusted estimated mean reduction in LOS after intervention was 1.6% (95% CI 0.4% to 2.9%). After adjustment accounting for increased presentations, this was 8.5% (95% CI 7.7% to 9.3%).</p><p><strong>Conclusions: </strong>Within clinical pathways, a single test with a result from an hs-cTnT of <5 ng/L as a component resulted in a small, but meaningful, reduction in mean ED LOS.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"579-584"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274432","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":"Correspondence on \"Effectiveness of double Tubigrip in grade 1 and 2 ankle sprains\" by Watts and Armstrong.","authors":"Paul Atkinson, David Lewis","doi":"10.1136/emermed-2025-215265","DOIUrl":"10.1136/emermed-2025-215265","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"626"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583380","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 acute asthma presentations to the emergency department an opportunity for optimising long-term management? A qualitative study on beliefs and behaviours of healthcare professionals.","authors":"Imogen Skene, Chris Griffiths, Katherine Pike, Benjamin Michael Bloom, Paul Pfeffer, Liz Steed","doi":"10.1136/emermed-2024-214407","DOIUrl":"10.1136/emermed-2024-214407","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend Emergency Department (ED) healthcare professionals (HCPs) ensure patients have a supply of inhaled corticosteroid on discharge after an acute asthma presentation. By optimising medication, acute asthma presentations to EDs are a potentially reachable moment to improve long-term asthma management as well as treating the acute exacerbation. Optimising medication for long-term asthma management requires behavioural changes from HCPs, which may be considered unacceptable or unfeasible. Understanding health beliefs and attitudes of HCPs who provide asthma treatment in emergency care is a critical step in determining whether interventions could be developed to address this.</p><p><strong>Aims: </strong>To explore the health beliefs, attitudes and behaviours of HCPs involved in the care of adult patients presenting to the ED with asthma.</p><p><strong>Methods: </strong>UK HCPs, purposively sampled for profession, experience and work setting, were invited to participate in a semi-structured face-to-face or online interview. These were conducted between November 2021 and June 2022. Eligible participants had experience of caring for patients with asthma in either the ED or primary care setting. Interviews were analysed with reflective thematic analysis.</p><p><strong>Results: </strong>19 HCPs were interviewed. Four themes were identified, constructed around the beliefs and behaviours of HCPs: (1) Compassionate understanding, that is, recognising the accessibility of ED, patients' self-management and the emotional aspects of exacerbations, (2) Doing what is right for the patient, that is, maximising a reachable moment, (3) Tensions of capacity in the system, that is, acknowledging workload within ED and (4) ED as providers of preventative care.</p><p><strong>Conclusion: </strong>This study found HCPs recognise both the accessibility of the ED as a place for patients to seek help and that there are potential opportunities to optimise asthma control, but there are barriers to overcome. ED professionals may be willing to make changes in the best interests of the patients if they can follow guidelines and receive training.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"608-614"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987630","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":"Journal update monthly top five.","authors":"Gregory Yates, Rhea Saldanha, Daniel Darbyshire, Madeline Dann, Emma Wilson, Simon Carley, Thomas Alexander Gerrard Shanahan","doi":"10.1136/emermed-2025-215384","DOIUrl":"10.1136/emermed-2025-215384","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 9","pages":"622-623"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882472","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":"Comparing approaches to code status conversations between Thai and American emergency clinicians: a survey study.","authors":"Thidathit Prachanukool, Pongsakorn Atiksawedparit, Suthasinee Senasu, Thapanawong Mitsungnern, Thavinee Trinarongsakul, Suwarat Wongjittraporn, Hannah Oelschlager, Sarayut Kahapana, Kei Ouchi","doi":"10.1136/emermed-2024-213883","DOIUrl":"10.1136/emermed-2024-213883","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency clinicians conduct code status conversations as part of shared decision-making regarding the management of patients with serious life-limiting illnesses. Given that varying sociocultural norms and healthcare systems affect communication, we hypothesised that American and Thai emergency clinicians report different approaches to code status conversations.</p><p><strong>Methods: </strong>A cross-sectional survey study was conducted in one US hospital and four Thai hospitals from December 2021 to November 2022. Using a 5-point Likert Scale, the survey questions focused on clinical practice for procedure-based and value-based components of code status conversations. We developed the survey from a medical communication expert team and then reviewed, refined and validated the questions. Multiple logistic regression analysis was used to compare the asking in code status conversation among American and Thai emergency clinicians and controlled for potential confounding variables.</p><p><strong>Results: </strong>We received responses from 84 American and 81 Thai emergency clinicians (74% and 70%, respectively). Most of the participants had 6-10 years of clinical experience (n=71, 43%), had code status conversations more than twice each month (n=63, 38%), and had prior palliative care training (n=141, 86%). Over 50% of all emergency clinicians responded 'very likely' or 'somewhat likely' to incorporate all six procedure-based components but only one of the six value-based components. Compared with Thai emergency clinicians, American emergency clinicians were significantly more likely to ask one procedure-based component (restarting the patient's heart, adjusted OR (aOR) =9.3 (95% CI 3.2 to 26.8)), while less likely to ask another procedure-based component (the patient's preference for vasopressors, aOR=0.3 (95% CI 0.1 to 0.7)), and two value-based components (providing a recommendation, aOR=0.2 (95% CI 0.1 to 0.5), assessing the patient's baseline activity, aOR=0.2 (95% CI 0.1 to 0.4)).</p><p><strong>Conclusion: </strong>In the approaches to code status conversations, American and Thai emergency clinicians collectively report asking about procedures rather than personal values, while specific distinctions exist and potentially reflect different cultural approaches.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"572-578"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301376","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":"Inhaled or nebulised salbutamol for exacerbations of asthma and chronic obstructive pulmonary disease?","authors":"Ame Kumba Saidy, Bethany Foo","doi":"10.1136/emermed-2024-214699","DOIUrl":"10.1136/emermed-2024-214699","url":null,"abstract":"<p><p>A short review of the literature was conducted to compare the length of emergency department (ED) stay and hospital admission rates in patients with exacerbations of asthma or chronic obstructive pulmonary disease (COPD) treated with salbutamol via a metered dose inhaler with a spacer (MDIS) versus nebulisation. Database searches were conducted using Cochrane, EMBASE, MEDLINE and Google Scholar. Six papers met our inclusion criteria and underwent analysis. Our results suggest that delivery of salbutamol via MDIS may reduce hospital admissions and ED length of stay in this patient cohort.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"619-621"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763436","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":"Point-of-care ultrasound for intussusception.","authors":"Maytal Firnberg, Ashkon Shaahinfar, Margaret Lin-Martore","doi":"10.1136/emermed-2025-215084","DOIUrl":"10.1136/emermed-2025-215084","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"615-618"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526861","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}