Emergency Medicine Journal最新文献

{"title":"Correspondence on \"Factors associated with late hospital arrival in acute stroke patients of Bangladesh\" by Iktidar <i>et al</i>.","authors":"Wenjianbin Zhou, Shenghao Xu","doi":"10.1136/emermed-2025-214938","DOIUrl":"10.1136/emermed-2025-214938","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"558"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969069","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":"Exploring the refusal of first-aid instructions during emergency calls: an exploratory analysis of dispatchers' feedback.","authors":"Guglielmo Imbriaco, Donatella Del Giudice, Nicola Ramacciati","doi":"10.1136/emermed-2024-214436","DOIUrl":"10.1136/emermed-2024-214436","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"534-535"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566310","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":"Patients discharged to police custody after paramedic evaluation: an observational cohort study.","authors":"Kari Heinonen, Markku Kuisma, Tuukka Puolakka","doi":"10.1136/emermed-2024-214555","DOIUrl":"10.1136/emermed-2024-214555","url":null,"abstract":"<p><strong>Background: </strong>In Finland, more than a third of the patients attended by the emergency medical services (EMS) are discharged on scene without ambulance transport, with reported recontact of <10% and 24-hour to 48-hour mortality of 0.3%-3.5%. In cases of disturbing or violent behaviour or suspected criminal activity, patients can also be discharged directly to police custody, with or without consultation with a prehospital physician. This study reports the incidence of patient deterioration in these situations.</p><p><strong>Methods: </strong>All EMS calls between 2013 and 2021 with patient discharge to police custody were collected from electronic prehospital patient records and combined with data from the national causes of death registry. Patient and EMS call-related factors were studied to identify associations with EMS recontact, ambulance transport or death within 48 hours after discharge to police custody.</p><p><strong>Results: </strong>A total of 2184 patients were discharged directly to police custody by EMS, of whom 6% (132) involved a prehospital physician's consultation. The most common reasons for ambulance dispatch were intoxications (n=497, 22.8%), falls (n=439, 20.1%) and assaults (n=188, 8.6%). The mean (SD) age was 44.1 (16.2) years, 78.2% were male, and 1736 patients (79.5%) were reported to be under the influence of alcohol. A new EMS contact within 48 hours occurred in 192 (8.8%) cases; 26 patients were still in police custody at the time. Ambulance transport was required in 126 (5.8%) cases; 19 of these were for patients still in custody. Consultation with a prehospital physician was associated with EMS recontact (OR 2.79, 95% CI 1.76 to 4.40) and ambulance transport (OR 3.51, 95% CI 2.12 to 5.82). Three (0.14%) patients died in custody; none had a prehospital physician consultation. Alcohol use was not associated with a new EMS contact after discharge or patient death.</p><p><strong>Conclusion: </strong>Violent behaviour and the use of alcohol and drugs were common in patients who were discharged to police custody. Despite this, discharge to police custody was not found to have a higher EMS recontact or mortality rate than non-conveyance in general.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"542-547"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983754","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":"Manual pressure augmentation to enhance defibrillation in cardiac arrest.","authors":"Emma Carley, Simon Carley","doi":"10.1136/emermed-2025-215019","DOIUrl":"10.1136/emermed-2025-215019","url":null,"abstract":"<p><p>A shortcut review of the literature was conducted to determine whether manual pressure augmentation improves the outcome from cardiac arrest. A total of nine publications were screened by title and abstract and one study (a case report and literature review) underwent full-text review. A further review of bibliographies of relevant papers found one further relevant study protocol. Details about the author, date of publication, country of publication, patient group studied, study type, relevant outcomes (survival and return of spontaneous circulation rate), results and study limitations were tabulated. The clinical bottom line is that, in adult patients in ventricular fibrillation or ventricular tachycardia, manual pressure augmentation during defibrillation may reduce impedance. This might improve defibrillation success, but there is insufficient evidence to recommend this without further research.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"553"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989868","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":"Adjust-Unlikely pulmonary embolism testing using telephone recruitment: a pilot study to assess the feasibility of evaluating its safety and efficiency.","authors":"Nicole F Morris, Rasha Georgie, Christine L D'Arsigny, Paula James, Sameer Parpia, Federico Germini, Natasha Clayton, David Good, Kerstin de Wit","doi":"10.1136/emermed-2024-214465","DOIUrl":"10.1136/emermed-2024-214465","url":null,"abstract":"<p><strong>Background: </strong>Studies on pulmonary embolism (PE) rule-out strategies traditionally recruited patients in the ED. This method is increasingly impractical given excessive pressures experienced in EDs. Attempting to reach patients after leaving the ED may be more feasible. The aim of this study was to assess the feasibility of recruiting and following patients for an ED PE testing study by telephone.</p><p><strong>Methods: </strong>This was a prospective pilot study conducted in one ED and one urgent care centre in Ontario, Canada. Adult patients tested for PE using Adjust-Unlikely (a simple decision rule combining Gestalt with age-adjusted D-dimer) were called for consent after leaving the ED. Patients were followed for 90 days by medical record review plus telephone, text or email to identify subsequent venous thromboembolism testing. Venous thromboembolism events were independently adjudicated. Feasibility outcomes were recruitment rate, missed eligible rate and follow-up rate. Progression criteria were a recruitment rate of at least five participants per site, per week, a missed eligible rate of no more than two patients per site, per week, and a follow-up rate of at least 90% of enrolled patients.</p><p><strong>Results: </strong>684 patients were tested for PE between 24 March and 10 June 2023. A total of 210 patients were excluded. From 474 eligible patients, 200 were recruited. Median age was 58 years, 72.2% were female, and 3.5% were diagnosed with PE on index visit. Median recruitment rate was 7 participants per site, per week (first-third quartile (Q1-Q3), 4-14) and median missed eligible rate was 6 patients per site, per week (Q1-Q3, 3-8). After 90 days, 2 participants withdrew and 191/198 (96.5%, 95% CI 92.9, 98.3%) were contacted in follow-up. 143/198 (72.2%, 95% CI 65.6, 78.0%) participants did not require pulmonary imaging because PE was excluded by Adjust-Unlikely. 1/143 (0.7%, 95% CI 0.1, 3.9%) of these participants was diagnosed with PE in the segmental pulmonary arteries during follow-up.</p><p><strong>Conclusions: </strong>Telephone recruitment did not meet predefined feasibility thresholds as the missed eligible rate was high. However, the recruitment rate was higher than in previous studies, and there was minimal loss to follow-up.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"496-502"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964479","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":"Puzzling young lady with breathlessness.","authors":"Joel Davis, Salma Atef, Diana Hulbert","doi":"10.1136/emermed-2024-214813","DOIUrl":"https://doi.org/10.1136/emermed-2024-214813","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 8","pages":"502-510"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689583","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":"Journal update monthly top five.","authors":"Felix Wood, Matthew Ellington, Jonathon Lowe, Leo Potter, Owen Williams, Robert Hywel James, Ed Benjamin Graham Barnard, Laura Cottey","doi":"10.1136/emermed-2025-215305","DOIUrl":"https://doi.org/10.1136/emermed-2025-215305","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 8","pages":"554-555"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689582","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":"How do we avoid being accused of 'playing God'? Approaches to information provision for relatives in the era of emergency waiver of consent.","authors":"Ellen J Weber, Edward Carlton","doi":"10.1136/emermed-2025-215097","DOIUrl":"10.1136/emermed-2025-215097","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"486-487"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324791","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 affecting diagnostic imaging decision-making in the emergency department during day and night shifts.","authors":"Robert Peter Klein, Gary Velan, Husna Razee, Andrew Coggins, Kevin Lai, Amith Shetty, Noel Young, Michelle Moscova","doi":"10.1136/emermed-2024-214416","DOIUrl":"10.1136/emermed-2024-214416","url":null,"abstract":"<p><strong>Background: </strong>Medical imaging use has increased progressively, prompting discussions about its clinical impact. Interventions to reduce low-value imaging have had varying success, as they generally do not consider the influence of the clinical environment on decision-making. Factors affecting imaging ordering decisions by Emergency Department (ED) medical officers (MOs) and how these factors differ between day and night shifts are poorly understood.</p><p><strong>Methodology: </strong>This mixed methods study was conducted in 2021 at a major tertiary hospital in Western Sydney. Observations and interviews with ED MOs for 20 day-shift and 26 night-shift clinical encounters were analysed to understand how and why imaging decisions were made, along with usage of imaging guidelines. Demographic and clinical patient data (including patient disposition) were obtained retrospectively from medical records to assess the impact of imaging.</p><p><strong>Results: </strong>During night shifts, 18 of the 26 observed clinical encounters used diagnostic imaging, compared with 12 of the 20 observed clinical encounters during day shifts. Factors affecting decision-making during night shifts included limited resources, fatigue, reduced support for junior ED MOs and higher patient load. Interviews suggested CT was more likely to be used during night shifts as a screening tool to expedite decisions and as a substitute for unavailable imaging modalities. In contrast, imaging decisions by day shift junior MOs were influenced by the need to justify their decisions to senior MOs, prompting them to research presenting complaints and imaging indications. Generally, there was minimal reference to imaging decision-making guidelines across both shifts.</p><p><strong>Conclusion: </strong>Differing factors impact imaging decisions by ED MOs during day and night shifts. This needs consideration when designing and implementing targeted physician support strategies and interventions to reduce low-value imaging. Limited resources and MO fatigue should be considered when modifying guidelines/strategies aiming to support MOs during ED night shifts.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"511-518"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224753","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":"Nitazene detections and clinical characteristics: data from a prospective observational study in a Glasgow emergency department.","authors":"Rufus Turner, Lisa Christine Dunlop, David John Lowe, Fraser Norman, Vicki Craik, Nicole Jarvie, Simon Hudson, Matthew Walters, James Dear, Ryan McHenry","doi":"10.1136/emermed-2024-214787","DOIUrl":"10.1136/emermed-2024-214787","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"548-549"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224754","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}