Emergency Medicine Journal最新文献

{"title":"Sex and gender reporting in scientific papers now strongly recommended by the Emergency Medicine Journal.","authors":"Ellen J Weber, Richard Body","doi":"10.1136/emermed-2024-214743","DOIUrl":"10.1136/emermed-2024-214743","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"80-81"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946437","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":"Nebulised high-dose corticosteroids as add-on therapy for adults with asthma exacerbation: a randomised controlled trial.","authors":"Kumpol Kornthatchapong, Nat Chatchairatanavej, Nattaya Chormai, Winchana Srivilaithon, Chitlada Limjindaporn, Narongkorn Saiphoklang, Jiraporn Sri-On","doi":"10.1136/emermed-2024-213893","DOIUrl":"10.1136/emermed-2024-213893","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding high-dose inhaled corticosteroids (HDICS) in asthma exacerbations in adults is insufficient. This study compares the treatment outcomes of HDICS as add-on therapy to the outcomes of standard treatment in adult patients with acute asthma exacerbation in the ED.</p><p><strong>Methods: </strong>This was a single-centre, triple-blind, randomised controlled trial conducted in the ED in Thailand between March 2022 and April 2023. Adult patients with asthma exacerbation were randomly assigned to receive either a placebo (normal saline) or HDICS (budesonide 9000 µg) nebulisation combined with beta agonist and ipratropium within the first hour. The primary endpoints were length of ED stay, hospital admission and ED revisit. The secondary endpoints were dyspnoea scale, pulmonary functions, length of hospital stay and home exacerbation after ED discharge.</p><p><strong>Results: </strong>A total of 88 patients were randomly assigned to one of two groups: 44 patients received a HDICS and 44 patients were placed in the control group. The HDICS group had a significantly shorter ED length of stay (adjusted mean difference -133.6 min; 95% CI -242.4 to -24.8 min; p=0.016), and a higher proportion of ED discharged home within 8 and 16 hours compared with the control group. However, there were no significant differences between the two groups in hospital admission rates, ED revisit, dyspnoea scale, pulmonary functions, length of hospital stay or home exacerbation after ED discharge.</p><p><strong>Conclusions: </strong>HDICS may be useful as an add-on therapy to standard treatment for asthma exacerbation in adults to reduce ED stay.</p><p><strong>Trial registration number: </strong>TCTR20201214001.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"91-97"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853375","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 SARS-CoV-2 and influenza antigen test in Omicron age in hospital emergency department: real-life analysis during 2023.","authors":"Celia García-Rivera, Isabel Escribano, Maria Paz Ventero, Iryna Tyshkovska, Sandra López-Hurtado, Alicia Doña, Pere Llorens, Esperanza Merino, José Manuel Ramos, José Sánchez-Payá, Pilar Gallardo, Raissa Silva-Afonso, Juan Carlos Rodríguez","doi":"10.1136/emermed-2024-214160","DOIUrl":"10.1136/emermed-2024-214160","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"105-107"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715672","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":"Is it time to reframe resuscitation in trauma?","authors":"Rich Carden, Daniel Horner","doi":"10.1136/emermed-2024-214422","DOIUrl":"10.1136/emermed-2024-214422","url":null,"abstract":"<p><p>Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. The evidence for permissive hypotension lacks the robustness as other treatments, such as tranexamic acid. Despite this clinicians still target arbitrary systolic blood pressure cutoffs as both goals and ceilings of therapy. In this paper, we suggest that perhaps more consideration should be given to the diastolic blood pressure in bleeding trauma patients. The diastolic blood pressure is critical for coronary perfusion, and in turn the cardiac output responsible for cerebral blood flow. We suggest that a move to reframing resuscitation in terms of physiology may change the way that we resuscitate these patients and allow for more nuanced treatment strategies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"132-133"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675461","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":"Sex differences in the intention and decision to use emergency medical services for acute coronary syndrome in Australia: a retrospective study.","authors":"Kathryn J Eastwood, Annie Shi, Stuart Howell, Amanda Buttery, Janet E Bray","doi":"10.1136/emermed-2023-213800","DOIUrl":"10.1136/emermed-2023-213800","url":null,"abstract":"<p><strong>Background: </strong>Sex-based disparities in acute coronary syndrome (ACS) presentations exist and women often have worse outcomes after an ACS event. Calling the emergency medical services (EMS) initiates prehospital diagnosis and treatment and reduces in-hospital time to treatment. This study aims to identify factors affecting the intention to call EMS and EMS usage in Australian women and men.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis was conducted to identify sex differences and associated characteristics in the (1) intention to call EMS and (2) EMS use in the setting of ACS. Data sources included national survey data (2018-2020) and the Victorian Emergency Minimum Dataset (2016-2021). Multivariable analysis identified factors associated with intention and EMS use by sex.</p><p><strong>Results: </strong>Of 34 328 survey participants, fewer men expressed an intention to call EMS if experiencing ACS symptoms than women (62.7% vs 70.4%, p<0.001). Associated factors in men included being of Aboriginal or Torres Strait Islander origin, living in Western Australia, having diabetes or having a lower education level. In both sexes, preferring a non-English language, having cardiovascular risk factors, poor symptom knowledge, living in the Northern territory or no/unclear EMS insurance status were associated with lower intentions to call EMS. Finally, women were less comfortable with calling EMS and more likely to hesitate (69.1 vs 76.7%, p<0.001).Among 51 165 ACS presentations (33.6% women) to Victorian public hospitals, fewer men presented by EMS (62.5% vs 67.7%, p<0.001), however, no associated male-specific characteristics were identified. Women preferring a non-English language or living in outer regional/remote Victoria were less likely to use EMS. Being born overseas or being referral by a healthcare provider was associated with lower EMS use in both sexes.</p><p><strong>Conclusion: </strong>Sex differences were identified in the intention and use of EMS during an ACS event based on cultural background, preferred language and residential regionality. These subgroups' characteristics can be targeted with education to improve EMS use.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"108-116"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806368","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":"Accuracy of the National Early Warning Score version 2 (NEWS2) in predicting need for time-critical treatment: retrospective observational cohort study.","authors":"Steve Goodacre, Laura Sutton, Gordon Fuller, Ashleigh Trimble, Richard Pilbery","doi":"10.1136/emermed-2024-214562","DOIUrl":"https://doi.org/10.1136/emermed-2024-214562","url":null,"abstract":"<p><strong>Background: </strong>Initial ED assessment can use early warning scores to identify and prioritise patients who need time-critical treatment. We aimed to determine the accuracy of the National Early Warning Score version 2 (NEWS2) for predicting the need for time-critical treatment.</p><p><strong>Methods: </strong>We undertook a single-centre retrospective observational cohort study. We randomly selected 4000 adults who attended a tertiary hospital ED in England from 1 January 2022 to 31 December 2022 and had NEWS2 routinely recorded on electronic patient records. The first NEWS2 and vital signs were extracted from electronic records. Research nurses selected cases that received a potentially time-critical treatment. Two independent clinical experts then determined whether time-critical treatment was or should have been received using an expert consensus derived list of interventions. We used receiver operating characteristic analysis and calculated sensitivity and specificity at predefined thresholds to evaluate the accuracy of NEWS2 for predicting need for time-critical intervention and, as a secondary outcome, mortality at 7 days.</p><p><strong>Results: </strong>After excluding 10 patients who received their intervention before NEWS2 recording, 164/3990 (4.1%) needed time-critical treatment and 71/3990 (1.8%) died within 7 days. NEWS2 predicted need for time-critical treatment with a c-statistic of 0.807 (95% CI 0.765 to 0.849) and death within 7 days with a c-statistic of 0.865 (95% CI 0.813, 0.917). NEWS2>4 predicted need for time-critical treatment with sensitivity of 51.8% (95% CI 44.2%, 59.3%) and positive predictive value of 25.8% (95% CI 21.3%, 30.7%). 37 of the 45 patients needing emergency surgery, antibiotics for open fractures, insulin infusion or manipulation of limb-threatening injuries had NEWS2≤4. Patients with NEWS2>4 who did not need time-critical treatment frequently scored maximum points on NEWS2 for their respiratory rate, conscious level or receiving supplemental oxygen.</p><p><strong>Conclusion: </strong>NEWS2 has limited accuracy for predicting need for time-critical treatment. We have identified time-critical interventions that frequently have low NEWS2 scores and NEWS2 parameters than may overestimate need for time-critical intervention.</p><p><strong>Trial registration number: </strong>Research Registry 10450.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970143","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":"Survey of major incident preparedness in English type 1 emergency departments.","authors":"Robert Hywel James, Rhiannon Jones, Anthony Kelly, Simon Horne","doi":"10.1136/emermed-2024-214317","DOIUrl":"https://doi.org/10.1136/emermed-2024-214317","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946445","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":"Variation in ambulance pre-alert process and practice: cross-sectional survey of ambulance clinicians.","authors":"Joanne E Coster, Fiona C Sampson, Rachel O'Hara, Jaqui Long, Fiona Bell, Steve Goodacre","doi":"10.1136/emermed-2023-213851","DOIUrl":"10.1136/emermed-2023-213851","url":null,"abstract":"<p><strong>Background: </strong>Ambulance clinicians use pre-alert calls to inform emergency departments (EDs) about the arrival of critically ill patients. However, there is variation in guidance between local ambulance service policies in terms of what should be pre-alerted and how pre-alerts should happen. We conducted a national online survey to understand the use of ambulance pre-alerts and to inform recommendations for practice and guidance.</p><p><strong>Methods: </strong>Ambulance clinicians in England involved in pre-alert decision-making were recruited via ambulance trusts and social media to complete an anonymous online survey conducted during May-July 2023. Quantitative data was analysed descriptively using SPSS (version 28) and free-text responses are reported to illustrate the quantitative findings.</p><p><strong>Results: </strong>We included 1298 valid responses from 10 English ambulance services. There was variation in practice at all stages of the pre-alert process, including the reported frequency of pre-alert (7.1% several times a shift, 14.9% once/two times per month). Most respondents reported that pre-alerts were delivered directly to the ED, but 32.8% reported pre-alerting via an ambulance control room. A third of respondents always used mnemonics to guide a pre-alert (eg, ATMIST (Age, Time of Incident, Mechanism of injury, Injuries, Signs, Treatments)), but 10.2% reported not using any fixed format.The type of guidance used to identify patients for pre-alert varied between clinicians and ambulance services, with local ambulance service guidance being most commonly used, and 20% stating they never use national guidelines. Respondents reported variable understanding of appropriate conditions for pre-alert, with paramedic students particularly wanted further guidance on trauma in older patients and medical pre-alerts. 29% of respondents reported receiving specific pre-alert training, while 50% reported never receiving feedback.</p><p><strong>Conclusion: </strong>We identified variation in pre-alert processes and practices that may result in uncertainty and challenges for ambulance clinicians providing time-critical care. Guidance and training on the use of pre-alerts may promote more consistent processes and practices.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"14-20"},"PeriodicalIF":2.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784527","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":"Mass casualty decontamination following a chemical incident: evaluating improvised and interim decontamination protocols in a controlled cross-over volunteer study.","authors":"Louise Davidson, Felicity Southworth, Natalie Williams, Thomas James, Emily Orchard, Tim Marczylo, Samuel Collins, Richard Amlôt","doi":"10.1136/emermed-2024-214221","DOIUrl":"10.1136/emermed-2024-214221","url":null,"abstract":"<p><strong>Background: </strong>On-scene improvised and interim decontamination protocols in the Initial Operational Response to chemical incidents aim for rapid intervention to minimise injury before specialist capabilities arrive. This study examines the effectiveness of UK improvised and interim protocols conducted in sequence.</p><p><strong>Method: </strong>A simulant with methyl salicylate (MeS) in vegetable oil and a fluorophore was applied to participants' shoulders, arms and legs. Participants either received no decontamination or used one of four decontamination protocols: improvised dry, improvised wet, improvised dry followed by interim or improvised wet followed by interim. Remaining simulant on the skin was quantified using gas chromatography tandem mass spectrometry for MeS analysis and UV imaging for fluorophore detection. Additionally, urine samples were collected for 8 hours post application to analyse MeS levels.</p><p><strong>Results: </strong>Significantly less simulant was recovered from the skin post decontamination compared with no decontamination. There were no differences in the total simulant recovered across all decontamination conditions. However, significantly more simulant was recovered from the shoulder compared with the arm and leg. Variation in simulant recovery from different application areas was significantly higher in improvised-only conditions than in combined conditions. Decontamination did not affect the amount of MeS excreted in urine over 8 hours.</p><p><strong>Conclusion: </strong>This research supports current practice of starting decontamination as soon as possible after chemical exposure and highlights the importance of implementing interim decontamination following improvised decontamination.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"55-61"},"PeriodicalIF":2.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779576","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":"Dying matters in the emergency department.","authors":"Sarah Edwards","doi":"10.1136/emermed-2024-214747","DOIUrl":"10.1136/emermed-2024-214747","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885060","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}