Emergency Medicine Journal最新文献

{"title":"Allocation concealment using scratchcards in an emergency department drug trial.","authors":"Rachelle Sherman, Graham D Johnson, Andrew Tabner","doi":"10.1136/emermed-2024-214354","DOIUrl":"10.1136/emermed-2024-214354","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"387-388"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990650","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":"Bridging the divide: strengthening EMS decision-making for paediatric head injuries.","authors":"Fahd A Ahmad, J D Finney","doi":"10.1136/emermed-2025-214906","DOIUrl":"10.1136/emermed-2025-214906","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"350-351"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691584","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":"\"Hey doc, there is something within my skin\".","authors":"Leo Spora, Marie-Charlotte Brüggen, Matthias Möhrenschlager","doi":"10.1136/emermed-2024-214624","DOIUrl":"https://doi.org/10.1136/emermed-2024-214624","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 6","pages":"395-410"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127013","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":"Test characteristics of clinical findings and clinical decision rules for the diagnosis of septic arthritis in children with an acute limp presenting to the emergency department: a prospective observational study.","authors":"Jacky Tu, Stephanie Lam, Chiharu Yamano, Eldho Paul, Olivia Ghobrial, Peter Gowdie, Simon Craig","doi":"10.1136/emermed-2024-214607","DOIUrl":"10.1136/emermed-2024-214607","url":null,"abstract":"<p><strong>Background: </strong>Acute limb pain in young children presenting to the emergency department (ED) can be a sign of serious pathology, with septic arthritis being the most important condition to rule out. Two clinical decision rules (CDRs) have been developed to assist with the diagnosis: Kocher's rule (which allocates points for fever, weight-bearing status, white cell count and erythrocyte sedimentation rate) and Caird's rule (which also includes C-reactive protein). This study aimed to determine (1) the diagnostic accuracy of the two rules for the identification of septic arthritis and (2) other clinical features most strongly associated with septic arthritis.</p><p><strong>Methods: </strong>Prospective observational study of consecutive children aged <16 years with non-traumatic acute limp presenting to three EDs in Melbourne, Australia between July 2016 and September 2018. Data were prospectively collected on weight-bearing status, duration of symptoms, joint examination findings and signs of systemic disease. Structured chart reviews and telephone follow-up were used to adjudicate the presence/absence of septic arthritis. Area under the receiver operating characteristics curve (AUC) was calculated for each published CDR, and sensitivity, specificity and likelihood ratios were calculated for clinical findings.</p><p><strong>Results: </strong>Of 583 patients presenting with atraumatic limp, 535 (91.8%) eligible patients had sufficient follow-up data. 14 (2.6%) were diagnosed with septic arthritis. Kocher's rule had an AUC of 0.72 (95% CI 0.42 to 1.00), while Caird's rule had an AUC of 0.78 (95% CI 0.52 to 1.00) for septic arthritis. Univariable analysis demonstrated strong associations between range of joint motion (unadjusted OR 13.9, 95% CI 5.0 to 38.5), signs of systemic disease (OR 20.5, 95% CI 6.2 to 67.7), hip pain (OR 3.8, 95% CI 1.2 to 11.7) and presence of fever (OR 5.1, 95% CI 1.0 to 25.1) with septic arthritis. Markedly reduced range of motion compared with the unaffected side had the highest positive likelihood ratio (12.1, 95% CI: 7.5 to 19.5), while inability to weight bear had a positive likelihood ratio of 3.85 (95% CI 2.49 to 5.95). None of the tested clinical findings had a negative likelihood ratio less than 0.3, or a positive predictive value of more than 25%.</p><p><strong>Conclusion: </strong>Septic arthritis is a relatively uncommon diagnosis in children presenting to the ED with an acute limp. Markedly reduced range of motion and inability to weight bear appear to be the strongest predictors of septic arthritis; however, their absence is insufficient to rule out the diagnosis.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"360-366"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810843","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":"Patient with syncope.","authors":"Matthew Turner, Francis R Mencl","doi":"10.1136/emermed-2024-214511","DOIUrl":"https://doi.org/10.1136/emermed-2024-214511","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 6","pages":"366-372"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127015","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":"Reproducibility of the Manchester Triage System: a multicentre vignette study.","authors":"Arian Zaboli, Francesco Brigo, Gabriele Magnarelli, Hugh Gorick, Tiziano Garbin, Patrick Clauser, Serena Sibilio, Gloria Brigiari, Magdalena Massar, Michael Mian, Norbert Pfeifer, Gianni Turcato","doi":"10.1136/emermed-2024-214213","DOIUrl":"10.1136/emermed-2024-214213","url":null,"abstract":"<p><strong>Background: </strong>While several studies have evaluated the performance of the Manchester Triage System (MTS), none have specifically examined its accurate application by triage nurses and its association with clinical outcomes. This study focuses on the agreement between nurse-assigned MTS codes and those assigned by an expert group, as well as their ability to predict clinical outcomes.</p><p><strong>Methods: </strong>This multicentre simulation study was conducted from January to March 2024 across four EDs in Italy employing MTS in clinical practice. Two emergency physicians developed 30 vignettes derived from real clinical cases to encompass diverse triage scenarios and priority codes. An expert MTS group, composed of three experienced nurses, assigned MTS priority codes following the guidelines outlined in the official MTS textbook. Subsequently, the vignettes were presented to triage nurses, who independently assigned MTS codes. Error rate, agreement between nurse-assigned and expert MTS group codes, and the predictive ability for secondary clinical outcomes (mortality within 72 hours, hospitalisation, life-saving intervention, severe condition in the ED and time-dependent pathology) were compared between the MTS priority assigned by the expert MTS group codes and nurse-assigned triage codes.</p><p><strong>Results: </strong>77 nurses from four EDs participated. The triage code assignment error rate was 28.6% (660/2310). The overall agreement between the triage and expert nurses yielded a Cohen's kappa of 0.59 (95% CI 0.58 to 0.59). Expert MTS group applications performed better compared with nurse-assigned codes in predicting clinical outcomes. The mean error rate per nurse was 30% (9/30). Nurses with more ED experience and triage expertise had higher error rates.</p><p><strong>Conclusion: </strong>The application of MTS using case vignettes was suboptimal in our setting, with more senior nurses having higher error rates. Correct application of MTS better predicted clinical outcomes. It is important to conduct future studies to understand how to best support nursing clinical decision-making in triage.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"403-410"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572043","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":"Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study.","authors":"Alyesha Proctor, Jedd Billing, Mark Lyttle, Sarah Voss, Jonathan Benger","doi":"10.1136/emermed-2024-214467","DOIUrl":"10.1136/emermed-2024-214467","url":null,"abstract":"<p><strong>Introduction: </strong>Children with head injury are commonly transported to the ED by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Research is needed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED, and to establish whether a clinical decision tool designed to support them would be beneficial.</p><p><strong>Methods: </strong>A generic qualitative approach, comprising semistructured interviews with front-line ambulance paramedics working in the UK. Interviews were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. Interviews aimed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED.</p><p><strong>Results: </strong>A total of 20 paramedics from several ambulance services participated in interviews. Three overarching themes were identified: 'we just take them in'; 'there are too many hurdles'; 'creating the right tool'. These were further categorised into subthemes. Paramedics do not feel confident when assessing and managing children with head injury, and convey children to hospital due to fear of consequences, despite knowing there will be no intervention in the ED. Further education, a prehospital paediatric clinical decision tool and greater support from Ambulance Trusts would be welcomed by paramedics. Criteria such as: parental anxiety; time; wound closure; policy and non-accidental injury need to be considered in a clinical decision tool designed to support paramedics' management of children with head injury.</p><p><strong>Conclusion: </strong>Paramedics generally feel a lack of confidence in assessing and managing children with head injury. A decision tool, coupled with training and useful feedback from EDs following conveyance, would be useful to help improve decision-making.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"352-359"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188484","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":"Salbutamol for analgesia in renal colic: a prospective, randomised, placebo-controlled phase II trial.","authors":"Graham D Johnson, Andrew Tabner, Apostolos Fakis, Rachelle Sherman, Victoria Chester, Andrew Skeggs, Fran Game, Richard Jackson, Suzanne M Mason","doi":"10.1136/emermed-2024-214326","DOIUrl":"10.1136/emermed-2024-214326","url":null,"abstract":"<p><strong>Background: </strong>The pain of renal colic, mediated in part by ureteral spasm and inflammation, is often severe and difficult to control. Salbutamol has been shown to cause ureteral relaxation, but its effects on the pain of renal colic have never been studied. The objective of this trial was to investigate whether the use of intravenous salbutamol in addition to standard analgesia was associated with greater pain reduction compared with standard analgesia alone in patients presenting to emergency departments (EDs) with renal colic.</p><p><strong>Methods: </strong>This single-centre, double-blind, phase II, randomised, placebo-controlled trial recruited adult (≥18 years) ED patients with clinically suspected renal colic. Participants were randomised in a 1:1 ratio to receive either 250 µg of intravenous salbutamol or a placebo (0.9% sodium chloride). The primary outcome was the difference in the change in pain scores (measured on a 100 mm Visual Analogue Scale) from baseline to 30 min following trial treatment administration in participants with subsequently confirmed renal colic. A modified intention-to-treat analysis was undertaken for the primary population of participants with confirmed renal colic.</p><p><strong>Results: </strong>Consent was obtained from 151 patients; 108 participants with confirmed renal colic were included in the primary outcome analysis. There was no statistical difference between groups in median change in pain score at 30 min (salbutamol group -18 mm (IQR -25 to -3), placebo group -13 mm (IQR -33 to -1), difference 5 mm (95% CI -16 to 6, p=0.575)). No significant differences were found in the secondary outcomes related to pain, patient satisfaction or opiate requirement.More adverse events (AEs) were observed in the salbutamol group (65) compared with placebo (42, p=0.02); no unexpected AEs were identified.</p><p><strong>Conclusions: </strong>This trial has not identified a clinically or statistically significant benefit from the addition of intravenous salbutamol to standard care for patients presenting to an ED with pain caused by renal colic.</p><p><strong>Trial registration numbers: </strong>The trial was registered with the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), reference 2018-004305-11. It was also registered with the ISRCTN Registry, reference 14552440.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"378-386"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987319","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":"Cooling in context: consensus statement on the prehospital management of exertional heat illness for the UK Faculty of Pre-Hospital Care.","authors":"Ross Hemingway, Gareth Jones, Courtney Kipps, Michael J Stacey","doi":"10.1136/emermed-2025-214905","DOIUrl":"10.1136/emermed-2025-214905","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"389"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729224","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":"Faculty of Pre-Hospital Care: consensus statement on the prehospital management of exertional heat illness.","authors":"Ross Hemingway, Frederick Stourton, Todd Leckie, Daniel Fitzpatrick, Gareth Jones, Felix Wood, Amy Boalch, James McNulty-Ackroyd, Andrew Thurgood, Matthew Boulter, Andrew Hartle, Edward Walter, Harvey J Pynn, Courtney Kipps, Michael J Stacey","doi":"10.1136/emermed-2024-214795","DOIUrl":"10.1136/emermed-2024-214795","url":null,"abstract":"<p><p>Exertional heat illness (EHI) is an increasing cause of morbidity and mortality where physical activity is conducted, particularly in hot conditions. Prompt recognition and treatment of EHI have the potential to significantly alter the patient's outcome, and so adequate prehospital management is vital. This consensus statement provides evidence-based guidance and expert recommendations on the recognition, diagnosis and immediate management of EHI in the prehospital environment.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"390-395"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729232","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}