Emergency Medicine Journal最新文献

{"title":"Cadaveric Dissection Study of the Pericapsular Nerve Group Block: Role of the Iliopectineal Bursa.","authors":"Anirudh Ramachandran, Vinay Saggar, Sherry A Downie, William Murk, Jonathan Maik, John Mascia, Priti Mishall, Adi Pinkas, Michael Halperin","doi":"10.1136/emermed-2024-214240","DOIUrl":"10.1136/emermed-2024-214240","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"324-325"},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963977","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":"Use of nasal clips as first aid for anterior epistaxis.","authors":"Bethany Foo, Ame Kumba Saidy","doi":"10.1136/emermed-2024-214829","DOIUrl":"10.1136/emermed-2024-214829","url":null,"abstract":"<p><p>A short systematic review was undertaken to establish whether the use of a nasal clip is superior to manual compression as first aid in patients presenting to the ED with epistaxis. A systematic keyword search of EMBASE, MEDLINE, Cochrane and Google Scholar databases returned two relevant papers. The author, year, country of publication, patient group studied, study type, key findings and weaknesses are tabulated. Our results suggest that nasal clips are an effective intervention for first aid in epistaxis, although larger prospective studies are required to fully address this clinical question.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"343-344"},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623990","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":"Are acute asthma presentations to the emergency department an opportunity for optimising long-term management? A qualitative study on beliefs and behaviours of healthcare professionals.","authors":"Imogen Skene, Chris Griffiths, Katherine Pike, Benjamin Michael Bloom, Paul Pfeffer, Liz Steed","doi":"10.1136/emermed-2024-214407","DOIUrl":"https://doi.org/10.1136/emermed-2024-214407","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend Emergency Department (ED) healthcare professionals (HCPs) ensure patients have a supply of inhaled corticosteroid on discharge after an acute asthma presentation. By optimising medication, acute asthma presentations to EDs are a potentially reachable moment to improve long-term asthma management as well as treating the acute exacerbation. Optimising medication for long-term asthma management requires behavioural changes from HCPs, which may be considered unacceptable or unfeasible. Understanding health beliefs and attitudes of HCPs who provide asthma treatment in emergency care is a critical step in determining whether interventions could be developed to address this.</p><p><strong>Aims: </strong>To explore the health beliefs, attitudes and behaviours of HCPs involved in the care of adult patients presenting to the ED with asthma.</p><p><strong>Methods: </strong>UK HCPs, purposively sampled for profession, experience and work setting, were invited to participate in a semi-structured face-to-face or online interview. These were conducted between November 2021 and June 2022. Eligible participants had experience of caring for patients with asthma in either the ED or primary care setting. Interviews were analysed with reflective thematic analysis.</p><p><strong>Results: </strong>19 HCPs were interviewed. Four themes were identified, constructed around the beliefs and behaviours of HCPs: (1) Compassionate understanding, that is, recognising the accessibility of ED, patients' self-management and the emotional aspects of exacerbations, (2) Doing what is right for the patient, that is, maximising a reachable moment, (3) Tensions of capacity in the system, that is, acknowledging workload within ED and (4) ED as providers of preventative care.</p><p><strong>Conclusion: </strong>This study found HCPs recognise both the accessibility of the ED as a place for patients to seek help and that there are potential opportunities to optimise asthma control, but there are barriers to overcome. ED professionals may be willing to make changes in the best interests of the patients if they can follow guidelines and receive training.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987630","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":"Early clinical evaluation of a machine-learning system for risk prediction of trauma-induced coagulopathy in the prehospital setting.","authors":"Max E R Marsden, Zane B Perkins, Erhan Pisirir, William Marsh, Evangelia Kyrimi, Andrea Rossetto, Richard L Lyon, Anne Weaver, Ross Davenport, Nigel Rm Tai","doi":"10.1136/emermed-2024-214396","DOIUrl":"https://doi.org/10.1136/emermed-2024-214396","url":null,"abstract":"<p><strong>Background: </strong>Early intervention in patients with major traumatic injuries is critical. Decision support can improve clinicians' ability to identify high-risk patients. The aim of this study was to compare the performance of a machine-learning (ML) decision support system to that of expert clinicians and to assess the ML system's impact on augmenting human risk prediction after injury in the prehospital phase of care.</p><p><strong>Methods: </strong>This early clinical evaluation study compared a ML risk prediction system to expert clinicians in assessing a patient's risk of trauma-induced coagulopathy (TIC). The study was conducted between 1 January 2019 and 31 June 2019 at two air ambulance sites in the south of England. The ML system used a Bayesian Network algorithm to predict TIC. Comparisons in predictive performance were made first between expert clinicians and the ML system and second, between expert clinicians and expert clinicians exposed to the ML system's outputs.</p><p><strong>Results: </strong>Overall, 51 expert clinicians were enrolled in the study and 184 patient assessments from 135 patients were analysed. The median age of included patients was 31 years old (IQR 23, 47), 75% were male and median Injury Severity Score 17 (IQR 9, 34). 62 patients (46%) received blood within 4 hours of injury and 26 patients (19%) developed TIC. The ML system did not outperform expert clinicians in discriminating between patients with and without TIC (area under the curve (AUC) ML: 0.87 (95% CI 0.79, 0.95) vs AUC clinician: 0.83 (95% CI 0.74, 0.92), p=0.330)). Calibration and overall accuracy of the ML system were superior. Expert clinicians' risk prediction, when augmented by the ML system, showed potential for improvement compared with unassisted human performance.</p><p><strong>Conclusions: </strong>Early after injury, an ML system performs well compared with expert prehospital clinicians in the prediction of TIC and blood transfusion. The study suggests that ML systems may augment clinical risk prediction in trauma.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974513","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":"Deprivation is associated with hospital conveyance among patients who are terminally ill.","authors":"Maddy French, Michelle Waddington, Pete Dixon, Kieran Potts, Sandra Igbodo, Jane Simpson, Nancy Preston","doi":"10.1136/emermed-2023-213742","DOIUrl":"https://doi.org/10.1136/emermed-2023-213742","url":null,"abstract":"<p><strong>Background: </strong>Hospital admissions of patients who are terminally ill can be associated with poor experiences and unwanted outcomes, such as dying away from home. While area deprivation is associated with emergency hospital admissions in the last year of life, few studies have explored the relationship between deprivation and ambulance clinicians' decisions to convey a patient to the hospital. The aim of this study is to understand the overall proportion of terminally ill patients conveyed to hospitals by paramedics in North West England, and to explore the associations between hospital conveyance and area deprivation.</p><p><strong>Methods: </strong>This is an observational study using routinely collected ambulance data held by the North West Ambulance Service NHS Trust in England, UK. Data on adult patients (aged 18+ years) who were coded by ambulance personnel as having a terminal illness were extracted for the period from March 2021 to February 2022. Logistic regression mixed models were used to examine the associations between hospital conveyance and area deprivation. To control for confounding variables, additional data were collected on age, gender, ethnicity, location, clinical assessment codes and place of residence.</p><p><strong>Results: </strong>The number of calls attended by ambulance clinicians for terminally ill patients included in the analysis was 1737. Ten per cent of these calls resulted in the patient being taken to the hospital. The odds of being taken to hospital were 1.51 (95% CI 1.06 to 2.16) times greater for patients living in the 20% most deprived areas compared with those in less deprived areas, in the final model adjusted for age, gender, place of residence and the initial coded reason for the call.</p><p><strong>Conclusion: </strong>This study suggests that patients with terminal illnesses living in the most deprived areas are more likely to be taken to hospital by ambulance clinicians, compared with those in less deprived areas. Overall, however, a small proportion of patients classed as terminally ill in all areas were taken to hospital. This implies that most end-of-life care provided by ambulance clinicians in this region will be in a patient's place of residence, with implications for time, resources and training.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984439","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":"Blood product use in paediatric trauma: lessons from the TARN data.","authors":"Kathryn Mullan, Peter McAlister, Shane Michael Mc Veigh, Sophie Jones, Omar Bouamra, Fiona Lecky, Stephen Mullen","doi":"10.1136/emermed-2024-214397","DOIUrl":"https://doi.org/10.1136/emermed-2024-214397","url":null,"abstract":"<p><strong>Background: </strong>Trauma contributes significantly to childhood morbidity and mortality. Uncontrolled haemorrhage leading to cardiovascular collapse remains the leading cause of preventable death in paediatric trauma. Evidence to support the early and accurate identification of paediatric trauma patients requiring blood products is growing. Consensus guidelines advocating for more liberal blood product use based on the concept of damage control resuscitation and the introduction of risk predictor tools to identify children requiring resuscitation with blood products may have altered use in recent years. We aimed to identify trends in blood product prescribing practice in paediatric trauma resuscitation over the last decade.</p><p><strong>Methods: </strong>In this retrospective, observational study, data were abstracted from Trauma Audit Research Network (TARN) from sites in England, Wales and Northern Ireland over a 10-year period (2012-2021). Eligible cases were defined as injured children or young people aged less than 16 years who received blood products, including in the prehospital environment.</p><p><strong>Results: </strong>During the study period, 2.5% (n=678) of injured children received blood products within 24 hours of hospital arrival, including the prehospital environment. Blood product administration over the study period remained largely unchanged (p=0.190). Over the 10-year period, we saw a significant increase in blood product use among paediatric trauma patients of increasing age and those with penetrating injuries (p<0.03). By contrast, there was a decrease in blood product use across the same 10-year period among paediatric trauma related to road traffic collisions (p=0.01). On analysing the paediatric trauma population that received blood products, the distribution across locations can be seen as follows: 60.5% received blood products at the scene of the incident, 25% in the ED and 12.8% in critical care settings. The most common blood product given was packed red blood cells (84%), with fresh frozen plasma, platelets and cryoprecipitate administered in 9.7%, 2.4% and 1.6% of cases, respectively.</p><p><strong>Conclusion: </strong>UK trauma centres have not significantly changed blood product use in paediatric trauma over the last decade. Monitoring and understanding national blood product use in paediatric trauma is integral to understanding trends and current practice.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957224","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":"Erector spinae plane block as analgesia for acute renal colic.","authors":"Alice Barrett, Megan Kerr","doi":"10.1136/emermed-2024-214585","DOIUrl":"https://doi.org/10.1136/emermed-2024-214585","url":null,"abstract":"<p><p>A brief systematic review was conducted to assess the effectiveness of erector spinae plane block (ESPB) as an analgesic option for adults attending the emergency department with renal colic. MEDLINE and EMBASE databases were searched, and supplementary searches undertaken using Google Scholar and PubMed Medical Subject Headings. Two randomised controlled trials, two case series, one meta-analysis and one individual case were identified. Patient details, key results and study limitations were recorded in table format. Our findings support the use of ESPB as an effective form of analgesia in renal colic for initial treatment and refractory pain. Further studies should include a cost-effectiveness analysis to evaluate the suitability of ESPB for everyday management of renal colic.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810839","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":"Rapid cycle QI methods ensure prompt paediatric emergency care during 2022 respiratory surge.","authors":"Alexandria Wiersma, Anthony Watkins, Traci Ertle, Bernadette Johnson, Sandra Spencer","doi":"10.1136/emermed-2024-214180","DOIUrl":"https://doi.org/10.1136/emermed-2024-214180","url":null,"abstract":"<p><strong>Objectives: </strong>In fall 2022, paediatric EDs (PEDs) and urgent cares (PUCs) cared for an unprecedented number of children, leading to long waits and boarding patients. This surge mimicked the adult ED/UC COVID-19 pandemic experience. Learning from published data and surge response plans, we adapted our response using rapid cycle quality improvement methodology.</p><p><strong>Methods: </strong>A multidisciplinary PUC/PED team met to determine the current state and create interventions. After the standard seasonal surge response did not have a significant impact, we further expanded inpatient capacity, created new physical PUC space, started provider intake and transitioned PED beds to inpatient.</p><p><strong>Results: </strong>Statistical control charts were used to monitor metrics from 4 weeks prior to the surge to when volumes returned to baseline, but improvement was seen prior to this. Our primary outcome measure, left without being seen (LWBS) rates, decreased from a peak of 40% to <5% and PUC door-to-provider time (process measure) decreased from 158 min to 106 min before the surge was over. These metrics also dropped below the prior baseline after volumes returned to normal. PED door-to-provider time (process measure) and PUC lengths of stay (LOS) (balancing measure) were maintained throughout.</p><p><strong>Conclusions: </strong>Using rapid cycle methodology, we responded quickly to an unprecedented patient volume by innovatively increasing staffing and space. We improved LWBS rates and PUC door-to-provider time despite high volumes and large numbers of boarding patients. We created efficiencies that allowed us to maintain PUC LOS and PED door-to-provider times during the surge. This resulted in sustained improvement, and we now operate with shorter LOS and door-to-provider times than historically achieved.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779530","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":"Inhaled or nebulised salbutamol for exacerbations of asthma and chronic obstructive pulmonary disease?","authors":"Ame Kumba Saidy, Bethany Foo","doi":"10.1136/emermed-2024-214699","DOIUrl":"https://doi.org/10.1136/emermed-2024-214699","url":null,"abstract":"<p><p>A short review of the literature was conducted to compare the length of emergency department (ED) stay and hospital admission rates in patients with exacerbations of asthma or chronic obstructive pulmonary disease (COPD) treated with salbutamol via a metered dose inhaler with a spacer (MDIS) versus nebulisation. Database searches were conducted using Cochrane, EMBASE, MEDLINE and Google Scholar. Six papers met our inclusion criteria and underwent analysis. Our results suggest that delivery of salbutamol via MDIS may reduce hospital admissions and ED length of stay in this patient cohort.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763436","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 tongue coating in identifying acute appendicitis: a prospective cohort study.","authors":"Hideki Mori, Kazumi Yamasaki, Yusuke Saishoji, Yuichi Torisu, Takahiro Mori, Yuki Nagai, Yasumori Izumi","doi":"10.1136/emermed-2024-214210","DOIUrl":"https://doi.org/10.1136/emermed-2024-214210","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis requires timely diagnosis. The diagnostic efficacy of tongue examination in making this diagnosis has not been established. This study investigates whether the Tongue Coating Index (TCI), a validated measure of tongue coating, can aid in diagnosing acute appendicitis.</p><p><strong>Methods: </strong>We conducted a prospective cohort study (1 September 2018-31 December 2020) at a single Japanese hospital. Adults (≥20 years) with suspected acute appendicitis, presenting to either the emergency department or general outpatient clinic, were enrolled. Tongue images were taken at presentation; two independent examiners-unrelated to clinical care and blinded to patient data-later scored these images using the TCI. A composite reference standard (clinical findings, imaging, histopathology, follow-up) was used to confirm appendicitis. We compared the TCI's diagnostic performance with the Alvarado score and its components using C-index, area under the curve (AUC), sensitivity and specificity.</p><p><strong>Results: </strong>Of 145 included patients, 69 (47.6%) were diagnosed with acute appendicitis. The TCI demonstrated comparable discriminative ability (C-index AUC 0.62; 95% CI, 0.53 to 0.71) to that of the Alvarado score (0.66; 95% CI, 0.57 to 0.75). Of Alvarado score components, migration of pain had an AUC of 0.63 (95% CI, 0.55 to 0.71), anorexia 0.58 (95% CI, 0.50 to 0.66) and tenderness in the right lower quadrant 0.55 (95% CI, 0.50 to 0.60). At a cut-off of 3, the TCI demonstrated high sensitivity of 96% (95% CI, 88% to 98%) but low specificity of 21% (95% CI, 13% to 32%). Conversely, at a cut-off of 10, the TCI showed increased specificity of 83% (95% CI, 73% to 90%) but reduced sensitivity of 29% (95% CI, 20% to 41%).</p><p><strong>Conclusion: </strong>The TCI showed comparable diagnostic performance to the Alvarado score and its individual components. TCI may potentially serve as an additional non-invasive indicator for diagnosing or ruling out acute appendicitis. Further research is essential to validate its clinical utility.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763433","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}