Emergency Medicine Journal最新文献

{"title":"Decision rules in the diagnostic work-up of aortic dissection.","authors":"Tom Jaconelli, Steven Crane","doi":"10.1136/emermed-2024-214567","DOIUrl":"10.1136/emermed-2024-214567","url":null,"abstract":"<p><p>A short cut review of the literature was carried out to examine whether a decision rule in conjunction with a D-dimer can be used to rule out aortic dissection. 117 unique papers were found of which three systematic reviews included data on patients relevant to the clinical question; these are discussed in the paper. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The clinical bottom line is that in low-risk patients (aortic dissection detection risk score 0 or 1) who present to the Emergency Department with chest pain, a negative D-dimer level makes aortic dissection unlikely. However, further prospective validation studies are needed to optimally define the patient group that warrants investigation, the threshold for investigation and the clinical effectiveness of such a diagnostic strategy before it can be widely adopted.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"279-280"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002199","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":"Conservative management of traumatic haemothoraces: a UK single-centre trauma unit retrospective audit.","authors":"Tom Roberts, Kirk Ramharack, Avinash Aujayeb","doi":"10.1136/emermed-2024-214305","DOIUrl":"10.1136/emermed-2024-214305","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"229-230"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695391","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":"Experiences and perceptions of acute testicular pain, with a focus on reasons for delayed presentation to hospital: a qualitative evidence synthesis.","authors":"Elizabeth Anderson, Wendy J Chaplin, Chloe Turner, Graham D Johnson, Holly Blake, Andrew Tabner","doi":"10.1136/emermed-2024-214125","DOIUrl":"10.1136/emermed-2024-214125","url":null,"abstract":"<p><strong>Background: </strong>The annual incidence of testicular torsion is approximately 1 in 4000 males under the age of 25. Despite the 97% testicular salvage rate when surgical intervention is within 6 hours of onset, orchidectomy is required in 40% of cases. These comparatively poor outcomes are driven by delays to intervention, the majority of which take place prior to presentation to healthcare. This study synthesises existing evidence to understand factors leading to delayed presentation to hospital in individuals with acute scrotal pain.</p><p><strong>Methods: </strong>A comprehensive literature search was performed with support from an information scientist. Two authors performed article screening, data extraction and inductive thematic synthesis independently, with disagreements resolved by discussion at each stage. An assessment of confidence in the review findings was performed using the ConQual approach.</p><p><strong>Results: </strong>The search identified 1251 unique articles for screening, with five eligible for inclusion; all included publications were drawn from two PhD projects. Synthesis of these articles revealed five descriptive themes with five subthemes. A lack of knowledge and education about testicular health, embarrassment and reliance on others for access to healthcare are major factors leading to delays in presentation. Societal and cultural impacts on health-seeking behaviour and denial were also causes of delayed presentation to healthcare.</p><p><strong>Discussion: </strong>A lack of knowledge about testicular anatomy and health among both adults and children is amenable to improvement through education, and would likely impact many of the factors identified as contributory to delays. Communication was an overarching factor connecting the descriptive themes.</p><p><strong>Prospero registration number: </strong>CRD42023469435.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"264-270"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616980","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":"The path to precision trauma care.","authors":"Karim Brohi","doi":"10.1136/emermed-2025-214862","DOIUrl":"10.1136/emermed-2025-214862","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"220-221"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467369","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 vital sign abnormalities and in-hospital outcomes in children.","authors":"Sriram Ramgopal, Remle P Crowe, Christopher M Horvat, Michelle L Macy, Rebecca E Cash, Robert J Sepanski, Christian Martin-Gill","doi":"10.1136/emermed-2024-214402","DOIUrl":"10.1136/emermed-2024-214402","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"239-240"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028133","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":"Man with intermittent low back pain.","authors":"Tai-Yuan Chen, Wan-Ching Lien","doi":"10.1136/emermed-2024-214532","DOIUrl":"https://doi.org/10.1136/emermed-2024-214532","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 4","pages":"283-286"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708217","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":"Identifying the walk-in wounded: paediatric major trauma patients self-presenting to a paediatric major trauma centre.","authors":"Robert Hirst, Ashwini Sridhar, Anne Frampton","doi":"10.1136/emermed-2024-214718","DOIUrl":"10.1136/emermed-2024-214718","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"237-238"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364082","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":"Oral tranexamic acid for immediate use in major trauma: implications for mass casualty events.","authors":"Matthew Warner, Jonathon Lowe, Ed Benjamin Graham Barnard","doi":"10.1136/emermed-2024-214661","DOIUrl":"10.1136/emermed-2024-214661","url":null,"abstract":"<p><p>The early administration of tranexamic acid is recognised as significantly reducing mortality in traumatically injured patients with major haemorrhage, typically given via intravenous or intramuscular routes. In the context of mass casualty events, there may exist multiple traumatically injured casualties that would benefit from tranexamic acid, however, it's administration may be delayed through the need to establish intravenous access. Additionally, if the initial assessment of the traumatically injured casualty is undertaken by an individual who cannot administer intravenous or intramuscular medications, time to administration will be further delayed. This concepts paper seeks to discuss the potential for utilising oral tranexamic acid, in the context of mass casualty events, as an alternative administration route.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"271-272"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064533","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":"Comparison between point-of-care international normalised ratio, COAST, TICCS and truncated FibAT scores to rule in clinically significant hypofibrinogenaemia in the prehospital setting.","authors":"Daniel Bodnar, Glenn Ryan, Andrew Colen, Gary Berkowitz, Sue Williams, Martin Wullschleger, Alfred K Lam, Emma Bosley","doi":"10.1136/emermed-2023-213844","DOIUrl":"10.1136/emermed-2023-213844","url":null,"abstract":"<p><strong>Background: </strong>Hypofibrinogenaemia on ED arrival and in the prehospital setting has been associated with both increased mortality and increased blood transfusions. The timely administration of fibrinogen-rich products on arrival to hospital is difficult to achieve and there is no clinical benefit with early, in-hospital empirical fibrinogen supplementation.</p><p><strong>Methods: </strong>This was a prospective study of a convenience sample of adult trauma patients who had blood drawn in the prehospital setting prior to the administration of tranexamic acid. A point-of-care international normalised ratio (PoCINR) was performed at the time of blood draw, and Coagulopathy of Severe Trauma (COAST) score, Trauma Induced Coagulopathy Clinical Score (TICCS) and truncated Fibrinogen on Admission in Trauma (FibAT) score were calculated. Hypofibrinogenaemia was defined as a FibTEM A5<10 or a fibrinogen level ≤1.5 g/L with a clinically important specificity defined as 85%.</p><p><strong>Results: </strong>A total of 152 patients were included in the primary analysis. The cohort was predominately male (82.9%) with a median age of 35 years (IQR 26-51). The median Injury Severity Score was 17 (IQR 10-25.5) with 18.4% sustaining penetrating trauma and 24.3% receiving prehospital blood transfusions. The area under the receiver operating characteristic curve for hypofibrinogenaemia was PoCINR: 0.63 (95% CI 0.53 to 0.73), FibAT: 0.57 (95% CI 0.47 to 0.67), COAST: 0.47 (95% CI 0.37 to 0.58) and TICCS: 0.50 (95% CI 0.40 to 0.61). A cut-off PoCINR value of ≥1.2, FibAT score ≥4, COAST≥4 and TICCS≥12 all yielded ≥85% specificity in detecting hypofibrinogenaemia.</p><p><strong>Conclusions: </strong>PoCINR and a truncated FibAT are potential tools for the prehospital detection of hypofibrinogenaemia. Future work should examine the feasibility of PoC devices to test for hypofibrinogenaemia in the prehospital setting and if the use of PoC devices and/or clinical risk stratification tools would result in more rapid fibrinogen replacement.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"222-228"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467368","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":"Young man with right hip pain.","authors":"Bo-Hwi Kang, Jia-Shan Chen, Chih-Jung Chang","doi":"10.1136/emermed-2024-214461","DOIUrl":"https://doi.org/10.1136/emermed-2024-214461","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 4","pages":"221-230"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708171","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}