Emergency Medicine Journal最新文献

{"title":"Neuron-specific enolase as a Biomarker in Nerve Compression and Cauda Equina Syndrome (BioNCCES) Study.","authors":"Steven Crane, Emily Nicholson, Tom Jaconelli","doi":"10.1136/emermed-2024-214775","DOIUrl":"10.1136/emermed-2024-214775","url":null,"abstract":"<p><strong>Background: </strong>Cauda equina syndrome (CES) is a neurosurgical emergency, and suspected cases require urgent magnetic resonance imaging (MRI) scanning of the lumbosacral spine. This pilot study explores whether serum levels of neuron-specific enolase (NSE) can predict the degree of nerve compression seen on MRI scanning.</p><p><strong>Methods: </strong>This was a prospective, diagnostic cohort pilot study of adult patients presenting to the emergency department (ED) in York between February 2024 and July 2024 with symptoms suggestive of CES in the opinion of the treating clinician (eg, back pain, sciatica, perianal paraesthesia, bladder or bowel dysfunction, sexual dysfunction). Patients either self-presented to the ED or had been referred by local primary care doctors or physiotherapists. All patients underwent MRI scanning (or fine-slice computed tomography scan if MRI contraindicated) of the lumbosacral spine and measurement of serum NSE. Imaging was classified as positive if the radiological report described cauda equina compression, nerve root compression or impingement and negative if none of these were described. We compared the serum levels of NSE in patients with positive imaging with those in patients with negative scans.</p><p><strong>Results: </strong>98 patients were included. 97 patients had urgent MRI of the lumbosacral spine and 1 patient had fine-slice CT. 52 patients had imaging classified as positive, and 46 patients had scans classified as negative. Patients with positive scans had a mean serum NSE level of 7.16 µg/L (SD 2.54) and those with negative imaging had a mean serum NSE level of 6.82 µg/L (SD 2.91). NSE did not demonstrate any ability to discriminate between patients with positive and negative imaging with an area under the receiver operating characteristic curve of 0.542.</p><p><strong>Conclusion: </strong>The study shows that serum NSE is not a useful biomarker in the management of patients presenting to an ED with symptoms of CES.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882471","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 between pre-hospital critical care and functional outcomes in moderate-to-severe head injury: a retrospective cohort study.","authors":"Ryan McHenry, Sarah Norman, Richard D Hardern, Chris Smith","doi":"10.1136/emermed-2024-214500","DOIUrl":"10.1136/emermed-2024-214500","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"606-607"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616872","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":"Prehospital blood pressure in acute stroke.","authors":"Silje Holt Jahr, Else Charlotte Sandset, Maiken Nordahl Selseth, Kristin Tveitan Larsen, Vigdis Hillestad, Kashif Waqar Faiz, Ole Morten Rønning, Espen Saxhaug Kristoffersen","doi":"10.1136/emermed-2024-214462","DOIUrl":"10.1136/emermed-2024-214462","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure (BP) is a potential target for early stroke treatment and triage, yet our knowledge about prehospital BP is limited. We aimed to investigate whether prehospital BP differs by stroke type and severity in patients with suspected acute stroke and explore associations between prehospital BP and outcomes.</p><p><strong>Methods: </strong>This single-centre retrospective study analysed consecutive patients with suspected stroke admitted to a primary hospital within 4.5 hours of symptom onset, comparing prehospital BP by discharge diagnosis, ischaemic stroke subtypes and stroke severity. Associations between prehospital BP and 90-day modified Rankin Scale and National Institutes of Health Stroke Scale (NIHSS) score changes within 24 hours of admission were analysed using logistic and ordinal regression.</p><p><strong>Results: </strong>Of the 1165 patients included, 64% (742) had acute stroke and 36% (423) were stroke mimics. Patients who had an acute stroke had higher mean prehospital systolic BP (SBP) than mimics (162±31 mm Hg vs 152±29 mm Hg, p<0.001). Patients with intracerebral haemorrhage (ICH) had the highest SBP (173±34 mm Hg). Among ischaemic strokes, lacunar stroke had higher SBP than non-lacunar stroke (169±33 vs 158±29 mm Hg, p=0.002), and large vessel occlusion (LVO) had lower SBP than non-LVO (150±28 vs 164±30 mm Hg, p<0.001). Patients with NIHSS score >15 had lower SBP than patients with NIHSS score ≤5 (155±34 vs 165±29 mm Hg, p=0.009). In ischaemic stroke, higher SBP was associated with less chance of early neurological improvement (adjusted OR 0.95, (95% CI, 0.91 to 0.98)).</p><p><strong>Conclusion: </strong>Prehospital BP varies by stroke subtype and severity and is associated with outcome. Blood pressure was higher in ICH than in ischaemic stroke, with lacunar infarcts showing the highest BP among ischaemic subtypes. The association between prehospital BP and poor outcomes in observational studies highlights the need for further research on early BP management across different stroke subtypes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"593-598"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590707","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":"Toddler with elbow pain following falling down.","authors":"I-An Chen, Po-Chih Shen","doi":"10.1136/emermed-2024-214516","DOIUrl":"10.1136/emermed-2024-214516","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 9","pages":"571-618"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882473","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":"Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice.","authors":"","doi":"10.1136/emermed-2024-214616","DOIUrl":"10.1136/emermed-2024-214616","url":null,"abstract":"<p><strong>Background: </strong>Numerous strategies have been developed to rapidly rule-out acute coronary syndrome (ACS) using high-sensitivity troponin. We aimed to establish their performance in terms of emergency care length of stay (LOS) in real-world practice.</p><p><strong>Methods: </strong>A multicentre observational cohort study in 94 UK sites between March and April 2023. Recruitment was preferably prospective, with retrospective recruitment also allowed. Adults presenting to the ED with chest pain triggering assessment for possible ACS were eligible. Primary outcome was emergency care LOS. Secondary outcomes were index rate of acute myocardial infarction (MI), time to be seen (TTBS), disposition and discharge diagnosis. Details of ACS rule-out strategies in use were collected from local guidelines. Mixed effects linear regression models tested the association between rule-out strategy and LOS.</p><p><strong>Results: </strong>8563 eligible patients were recruited, representing 5.3% of all ED attendances. Median LOS for all patients was 333 min (IQR 225, 510.5), for admitted patients was 460 min (IQR 239.75, 776.25) and for discharged patients was 313 min (IQR 221, 451). Heterogeneity was seen in the rule-out strategies with regard to recommended troponin timing. There was no significant difference in LOS in discharged patients between rule-out strategies defined by single and serial troponin timing (p=0.23 and p=0.41). The index rate of acute MI was 15.2% (1301/8563). Median TTBS was 120 min (IQR 57, 212). 24.4% (2087/8563) of patients were partly managed in a same day emergency care unit and 70% (5934/8563) of patients were discharged from emergency care.</p><p><strong>Conclusion: </strong>Despite heterogeneity in the ACS rule-out strategies in use and widespread adoption of rapid rule-out approaches, this study saw little effect on LOS in real-world practice. Suspected cardiac chest pain still accounts for a significant proportion of UK ED attendances. ED system pressures are likely to be explanatory, but further research is needed to understand the reasons for the unrealised potential of these strategies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"585-592"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324790","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":"More ACP, less CPR?","authors":"Sam Love","doi":"10.1136/emermed-2025-215245","DOIUrl":"https://doi.org/10.1136/emermed-2025-215245","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820927","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":"Potential impact of a point-of-care high-sensitivity cardiac troponin assay on emergency department length of stay and patient disposition: findings from a cardiac emergency department.","authors":"Robert Meek, Zhong Xian Lu, Udara Dilrukshi Senarathne, Sean Tan, Louise Cullen, John W Pickering, Martin Paul Than, Georgina Hayden, Adam Damianopoulos, Claire Charteris, Alex Duong, Diana Egerton-Warburton","doi":"10.1136/emermed-2025-214985","DOIUrl":"https://doi.org/10.1136/emermed-2025-214985","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783825","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":"Strengthening emergency care in Pakistan: priorities for reform.","authors":"Zeeshan Ahsan","doi":"10.1136/emermed-2025-215287","DOIUrl":"https://doi.org/10.1136/emermed-2025-215287","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741662","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 STANDING algorithm in patients with isolated vertigo: a multicentre prospective study (STANDING-M).","authors":"Mattia Ronchetti, Paola Bartalucci, Giuseppe Pepe, Giulia Canaroli, Simone Magazzini, Ersilia De Curtis, Federico Di Sacco, Maurizio Bartolucci, Rudi Pecci, Claudia Casula, Lorenzo Pelagatti, Ginevra Fabiani, Andrea Pavellini, Cosimo Caviglioli, Peiman Nazerian, Paolo Vannucchi, Simone Vanni","doi":"10.1136/emermed-2025-214902","DOIUrl":"https://doi.org/10.1136/emermed-2025-214902","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the diagnostic accuracy of the STANDING algorithm for central vertigo across different emergency departments (EDs). Secondary outcomes compared STANDING with usual care in terms of diagnostic accuracy, resource utilisation and length of stay (LOS).</p><p><strong>Methods: </strong>We prospectively enrolled adult patients presenting with vertigo at one 'hub' and three 'spoke' EDs in Tuscany. Patients were assessed using either STANDING or 'usual care', depending on the availability of a trained emergency physician. Imaging tests, consultations and dispositions were made independently of the study. The final diagnosis of central vertigo was determined by an expert panel, based on clinical data, along with a 30-day follow-up.</p><p><strong>Results: </strong>A total of 456 patients were included, with 242 (53%) assessed by STANDING. There were no statistically significant differences in age, gender or cardiovascular risk factors between the STANDING and usual care groups. The prevalence of central vertigo was 8.6%, with ischaemic stroke (4.2%) as the leading cause, with no differences between groups. The STANDING algorithm had a sensitivity of 88.2%, specificity of 91.6%, positive predictive value of 44.1%, and negative predictive value of 99%. Usual care showed lower specificity and positive predictive value (36.5% and 14.7%, respectively, p<0.05). Additionally, the STANDING group had both fewer non-contrast head CT (NCCT) requests (48.3% vs 66.8%) and a shorter LOS (median 271 vs 339 min) (p<0.05).</p><p><strong>Conclusions: </strong>The STANDING algorithm demonstrated high diagnostic accuracy and a very high negative predictive value for central vertigo across EDs and appears to be associated with improved specificity, reduced use of NCCT and shorter LOS compared with 'usual care'.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741660","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":"https://doi.org/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":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}