European Journal of Emergency Medicine最新文献

{"title":"Faster blood tests, faster care? Rethinking front-loaded investigations in crowded emergency departments.","authors":"Matthew J Reed, Barbra E Backus","doi":"10.1097/MEJ.0000000000001386","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001386","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A snapshot of pediatric emergency triage across Europe: a call for further study and action.","authors":"Itai Shavit, Michael Barrett, Spyridon Karageorgos, Niccolo Parri","doi":"10.1097/MEJ.0000000000001388","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001388","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 high-sensitivity point-of-care troponin assays in emergency department for patients presenting with chest pain: a systematic review.","authors":"Lara E van Daalen, Bart L F Schueler, Paul O Collinson, Barbra E Backus","doi":"10.1097/MEJ.0000000000001381","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001381","url":null,"abstract":"<p><p>High-sensitivity cardiac troponin (hs-cTn) assays have significantly enhanced the diagnosis in patients suspected of acute coronary syndrome (ACS). New hs-cTn point-of-care (POC) devices (turnaround time <20 min) may significantly reduce time to diagnosis. We evaluated the diagnostic accuracy of four currently commercially available hs-cTn POC devices to assess their potential for clinical implementation at the emergency department (ED). We conducted a search in PubMed Central on 20 November, 2025. Studies were included if they investigated patients greater than or equal to 18 years presenting with chest pain suggestive of ACS and evaluated commercially available hs-cTn POC devices. Studies had to report diagnostic accuracy [sensitivity, specificity, negative predictive value (NPV), positive predictive value] for the diagnosis of acute myocardial infarction (AMI). Studies were assessed for risk of bias and applicability using the QUADAS-3 tool. We identified 436 articles. The 11 included studies consisted of both derivation and validation studies, including a total of 10 115 patients. The hs-cTn POC assays demonstrated the best diagnostic accuracy when applied as a single-test rule-out upon arrival at the ED, showing the following sensitivity and NPV: Atellica VTLi sensitivity 98.8-100% for troponin less than 4 ng/L (NPV: 99.8-100%) and 100% for troponin less than 7 ng/L (NPV 100%). Pathfast sensitivity 96.3-100% for troponin less than 3 ng/L (NPV: 98.1-100%). i-STAT sensitivity of 99.8% for troponin less than 5 ng/L (NPV: 100%). TriageTrue sensitivity of 100% for troponin less than 3 ng/L (NPV 100%). VTLi, Pathfast, and TriageTrue were also tested using the 99th percentile with a 0 + 1/2/3 h troponin protocol. Reported sensitivities: VTLi 64.8-100%, Pathfast 87% for plasma and 83% for whole blood, and TriageTrue 79.8%. Hs-cTn POC assays are reliable for integration into the diagnostic pathways for patients presenting with chest pain at the ED, mainly when used for rapid rule-out of AMI in patients with very low troponin values upon arrival.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the site of emergency care and patient-centered outcomes in patients with cancer: rationale and design of the French COVER cohort.","authors":"Olivier Peyrony, Vanessa Lemaitre, Melanie Roussel, Frederic Balen, Raphaël Clere-Jehl, Jeremy Guenezan, Thibaut Markarian, Florent Fémy, Thomas Sanchez, Charles-Eric Lavoignet, Alexandra Mourot, Frederic Chapalain, Guillaume Gayraud, Ombeline Susong, Florent Baicry, Xavier Lakermance, Tabassome Simon, Joseph Gligorov, Yonathan Freund","doi":"10.1097/MEJ.0000000000001384","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001384","url":null,"abstract":"<p><p>Patients living with cancer now account for a substantial and growing share of emergency department (ED) visits and carry a high burden of hospitalization and in-hospital death. Their acute presentations are frequently multifactorial - driven by disease progression, treatment toxicity, immunosuppression, or the decompensation of comorbid conditions. They may present with higher rates of complications because of novel therapies, such as immune checkpoint inhibitors and cellular therapies, whose emergency manifestations remain unfamiliar to many emergency physicians. Despite this growing importance, the unscheduled care of patients with cancer has received comparatively little dedicated research. How these patients are managed in the ED, how often the emergency physician can access the oncology medical record and goals of care, how the acute complications of new anticancer therapies present, and how a background of cancer should modify the diagnostic approach to everyday emergencies remain poorly characterized. To address these gaps, the Cohort of Onco-hematologic patients visiting the Emergency depaRtment was designed as a prospective, multicenter French cohort of consecutive adults with active cancer or in remission for less than 1 year, presenting to the ED for any reason. Enrollment took place across a national network of 76 EDs for two 1-week periods (summer 2025 and winter 2025-2026), with follow-up to 90 days, yielding a large sample of patients designed as a platform for multiple analyses. The primary aim of Cohort of Onco-hematologic patients visiting the Emergency depaRtment is to determine whether being managed in an ED located within the patient's own cancer referral center, rather than any other hospital, is associated with improvement in morbidity and mortality, captured by the number of days alive and out of hospital at 30 days. Beyond this primary aim, the cohort will support a broad research program on the place of the ED in the cancer care pathway, from patient profiling and pathway description to the emergency toxicities of anticancer drugs and the cancer-specific features of common presentations.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, clinical profile, and outcomes of older patients with active cancer attending at Spanish emergency departments (EDEN-56 study).","authors":"Òscar Miró, Sira Aguiló, Ana García-Martínez, Aitor Alquézar-Arbé, M Anett Arce Marañón, Guillermo Burillo-Putze, Pere Llorens, Juan González Del Castillo, Ernest Bragulat","doi":"10.1097/MEJ.0000000000001382","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001382","url":null,"abstract":"<p><strong>Background: </strong>Older adults with active cancer are increasing, clinically complex emergency department (ED) population, but large multicenter European data are limited.</p><p><strong>Objective: </strong>To describe the epidemiology, baseline characteristics, diagnoses, and outcomes of older patients with active cancer attending Spanish EDs, and assess whether associations between active cancer and short-term outcomes varied with age and sex.</p><p><strong>Design, setting, and participants: </strong>Secondary analysis of the Emergency Department and Elder Needs retrospective multicenter registry, including all patients aged greater than or equal to 65 years attending 52 Spanish EDs during 1-7 April 2019. Patients with and without active cancer were compared. Annualized incidence was extrapolated overall, by sex, and by age. Age-related patterns were modeled using restricted cubic splines.</p><p><strong>Outcome and analysis: </strong>ED length of stay, hospitalization, length of hospitalization, and index-episode death. Age-by-cancer and age-by-sex interactions were assessed in unadjusted and multivariable models.</p><p><strong>Main results: </strong>Among 25 557 older ED patients, 4701 (18.4%) had active cancer. The estimated annualized incidence of ED presentations was 10 885 per 100 000 inhabitants aged greater than or equal to 65 years [95% confidence interval (CI): 10 576-11 200], higher in men (annualized rate ratio: 1.80, 95% CI: 1.70-1.91) and in the mid-to-late 80s. Patients with cancer had more severe comorbidity (58.9 vs. 12.9%), polypharmacy (26.6 vs. 21.3%), and walking handicaps (31.5 vs. 28.2%). Malignancy accounted for only 7.7% of ED diagnoses in the cancer group; infections, heart failure, and respiratory conditions were frequent. Active cancer was associated with longer median ED stay (4.0 vs. 3.3 h; adjusted difference: 0.3, 95% CI: 0.1-0.4), higher hospitalization [32.5 vs. 24.0%; adjusted odds ratio (OR): 1.34, 95% CI: 1.25-1.44], longer median hospitalization (7.5 vs. 6.9 days; adjusted difference: 0.5, 0.1-0.9), and higher index-episode mortality (5.5 vs. 2.5%; adjusted OR: 2.12, 95% CI: 1.81-2.50). Age significantly modified ED length of stay, hospitalization, and mortality, with significantly different age-related changes between patients with and without cancer. Among patients with cancer, age-related trajectories did not significantly differ by sex.</p><p><strong>Conclusion: </strong>Active cancer is common among older ED patients and associated with substantial resource use and worse short-term outcomes. These associations vary with age, supporting multidimensional assessment beyond chronological age or cancer status alone.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ebola disease in the Democratic Republic of the Congo: challenges and opportunities for emergency and critical care.","authors":"Giles N Cattermole, Emily A Vandamme","doi":"10.1097/MEJ.0000000000001377","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001377","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of burnout and associated moderator factors among emergency medical services personnel: a meta-analysis.","authors":"Garry Huang, Chin-Wang Hsu, Chao-Wei Chou, Wei-Kang Hung, Buddhika Jayasanka Senevirathne, Reymond Ngolombe, Joseph Wangisani Chisaka, Zizwani Brian Chilinda, Kondwani Joseph Banda","doi":"10.1097/MEJ.0000000000001359","DOIUrl":"10.1097/MEJ.0000000000001359","url":null,"abstract":"<p><strong>Background and importance: </strong>Occupational conditions inherent to emergency medical services (EMS) place EMS personnel, including paramedics, emergency medical technicians (EMTs), and firefighters, at increased risk of burnout. Persistent occupational stressors further contribute to burnout, with implications for workforce well-being and quality of care.</p><p><strong>Objectives: </strong>To estimate the prevalence of burnout and associated moderator factors among EMS personnel using meta-analysis.</p><p><strong>Design, settings, and participants: </strong>Meta-analysis of observational studies. Databases: Ovid-Medline, Web of Science, Embase, Scopus, and PubMed. Population: 32 841 EMS personnel.</p><p><strong>Intervention or exposure: </strong>Burnout.</p><p><strong>Outcome measure and analysis: </strong>The study outcome was the prevalence of burnout. Raw prevalence estimates were summarized using range, median, and interquartile range (IQR). Pooled prevalence and prediction interval were reported with proportions and 95% confidence intervals (95% CIs). Between-study heterogeneity was determined by τ2 and I2 statistics, and moderator analysis explored associated moderator factors. All analyses were conducted using a generalized linear mixed model in R software version 4.4.3.</p><p><strong>Main results: </strong>A total of 35 studies were included. The raw prevalence of burnout ranged from 5.3 to 88.8% (median: 36.7%, IQR: 29.1-56.2%). The pooled prevalence was estimated at 40% (95% CI: 33-49%, 95% prediction interval: 9-82%), indicating between-study variability. Among the subtypes, low emotional exhaustion (38%) was most prevalent, followed by high personal accomplishment (35%), and high depersonalization (32%). Personal-related burnout (45%) was most prevalent, followed by work-related burnout (39%) and patient-related burnout (19%). Mixed EMS personnel (52%) had the highest prevalence of burnout, followed by paramedics (41%), EMTs (36%), and firefighters (19%).</p><p><strong>Conclusion: </strong>Burnout is commonly reported among EMS personnel, although prevalence varies substantially across settings. Early assessment of burnout may help strengthen mental health support, EMS system-level interventions, and workforce well-being.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"334-346"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of prehospital resuscitation strategies on mortality for patients with major trauma: a network meta-analysis.","authors":"Chin-Wang Hsu, Wei-Kang Hung, Zizwani Brian Chilinda, Reymond Ngolombe, Christopher Maona, Dumisani Enricho Nkhoma, Kondwani Joseph Banda, Garry Huang","doi":"10.1097/MEJ.0000000000001315","DOIUrl":"10.1097/MEJ.0000000000001315","url":null,"abstract":"<p><strong>Background and importance: </strong>Patients with major trauma face high rates of coagulopathy, hemorrhage, and organ failure, with prehospital resuscitation strategies critical for stabilization. Comparative evidence on prehospital blood [red blood cells (RBCs) and plasma] and non-blood [intravenous crystalloids and dextran, intravenous crystalloids only, and tranexamic acid (TXA)] resuscitation strategies remains limited and inconclusive.</p><p><strong>Objectives: </strong>To evaluate and compare the efficacy of prehospital blood and non-blood resuscitation strategies in patients with major trauma using network meta-analysis.</p><p><strong>Design, settings, and participants: </strong>Network meta-analysis of randomized controlled trials (RCTs). Databases: PubMed, CINAHL, Cochrane Library, and Web of Science and reference lists of relevant previous studies. Participants: patients with major trauma.</p><p><strong>Intervention or exposure: </strong>Prehospital blood (RBC + plasma, RBC, and plasma) and non-blood (intravenous crystalloids + dextran, intravenous crystalloids only, and TXA) resuscitation strategies.</p><p><strong>Outcome measure and analysis: </strong>Study outcomes were 24-h and 28-day mortality. Data analysis was performed using Frequentist and Bayesian frameworks on MetaInsight, an R-Language web-based analytical platform, presenting odds ratio (OR) and corresponding 95% confidence interval (95% CI). Ranking of prehospital resuscitation strategies was confirmed by the surface under cumulative ranking.</p><p><strong>Main results: </strong>A total of 15 RCTs involving 7504 participants were included. Compared with intravenous crystalloids only, RBC + plasma (OR: 0.68, 95% CI: 0.38-1.22), plasma (OR: 0.72, 95% CI: 0.46-1.16), TXA (OR: 0.73, 95% CI: 0.52-1.04), RBC (OR: 0.81, 95% CI: 0.22-3.08), and intravenous crystalloids + dextran (OR: 0.91, 95% CI: 0.65-1.28) demonstrated no significant difference in reducing 24-h mortality. Similarly, TXA (OR: 0.83, 95% CI: 0.35-1.92), intravenous crystalloids + dextran (OR: 0.84, 95% CI: 0.46-1.52), RBC + plasma (OR: 0.88, 95% CI: 0.21-3.73), RBC (OR: 0.94, 95% CI: 0.10-8.64), and plasma (OR: 0.97, 95% CI: 0.38-2.46) revealed no significant difference in reducing 28-day mortality compared with intravenous crystalloids only. Based on ranking probabilities, RBC + plasma (65.8%) for 24-h mortality and TXA (74.6%) for 28-day mortality were ranked highest.</p><p><strong>Conclusion: </strong>Prehospital blood (RBC + plasma, RBC, and plasma) and non-blood (intravenous crystalloids + dextran and TXA) resuscitation strategies were associated with comparable nonsignificant effects on early and late mortality. Current evidence is insufficient to support the superiority of a single prehospital intervention with future large-scale RCTs needed to clarify role of prehospital blood and non-blood resuscitation strategies.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"347-355"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intranasal analgesia as an alternative to intravenous therapy for acute pain in adult emergency department patients: a systematic review.","authors":"Christèle Asmar, Raphaël Asmar, Ryan Hindy, Alain El Asmar, Joëlle Khadra Eid","doi":"10.1097/MEJ.0000000000001341","DOIUrl":"10.1097/MEJ.0000000000001341","url":null,"abstract":"<p><strong>Background: </strong>Analgesia in the emergency department (ED) is often delayed by the need for intravenous (i.v.) access. Intranasal (i.n.) analgesics offer rapid, needle-free delivery, but their effectiveness relative to i.v. therapy in adults remains uncertain.</p><p><strong>Methods: </strong>A descriptive systematic review was conducted in accordance with PRISMA guidelines, searching electronic databases from inception through December 2025. Randomized and observational studies enrolling adults with acute ED pain were included if they compared i.n. and i.v. analgesics. Outcomes included pain intensity or change within 60 min, time to analgesia, rescue analgesia, and adverse events.</p><p><strong>Results: </strong>Eighteen studies involving 1950 patients were included. I.v. analgesics produced faster pain reduction at early timepoints (≤5-10 min). I.n. analgesics, including ketamine and opioids, achieved clinically meaningful pain relief within 15-30 min, with similar pain control to i.v. therapy by 30-60 min. Both rescue analgesia and adverse event rates were comparable between routes.</p><p><strong>Conclusions: </strong>I.n. analgesia is an effective and safe option for selected adult ED patients, particularly when i.v. access is delayed or unnecessary. These findings support the selective use of i.n. analgesics as part of ED pain management strategies.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"313-323"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Before glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 can be recommended for identifying cerebral lesions in mild traumatic brain injury, all influencing factors must be taken into account.","authors":"Josef Finsterer","doi":"10.1097/MEJ.0000000000001316","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001316","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 5","pages":"367"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}