European Journal of Emergency Medicine最新文献

{"title":"Management of syncope in the Emergency Department: a European prospective cohort study (SEED).","authors":"Matthew J Reed, Suvi Karuranga, David Kearns, Salma Alawiye, Ben Clarke, Martin Möckel, Mehmet Karamercan, Kelly Janssens, Luis Garcia-Castrillo Riesgo, Francisco Moya Torrecilla, Adela Golea, Juan Antonio Fernández Cejas, Eugenia Maria Lupan-Muresan, Edmond Zaimi, Alexander Nuernberger, Ondřej Rennét, Christian Skjaerbaek, Effie Polyzogopoulou, Judit Imecz, Paolo Groff, Rene Camilleri, Diana Cimpoesu, Miljan Jovic, Òscar Miró, Rory Anderson, Said Laribi","doi":"10.1097/MEJ.0000000000001101","DOIUrl":"10.1097/MEJ.0000000000001101","url":null,"abstract":"<p><strong>Background and importance: </strong>In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe.</p><p><strong>Objectives: </strong>To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope).</p><p><strong>Design: </strong>Prospective, multicentre, observational cohort study.</p><p><strong>Settings and participants: </strong>Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin.</p><p><strong>Main results: </strong>Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries.</p><p><strong>Conclusion: </strong>This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451262","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":"Sequence of administration of anesthetic agents during rapid sequence induction for emergency intubation: a French survey on current practices.","authors":"Pierre Catoire, Mélanie Roussel, Dorian Teissandier","doi":"10.1097/MEJ.0000000000001085","DOIUrl":"10.1097/MEJ.0000000000001085","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41095529","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":"Metabolomics, the future of biomarkers?","authors":"Céline Occelli, Jacques Levraut, Thierry Pourcher","doi":"10.1097/MEJ.0000000000001097","DOIUrl":"10.1097/MEJ.0000000000001097","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290726","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":"Authors' reply to the comment on 'Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in patients with hip fracture: a randomized trial'.","authors":"Camille Gerlier, Rami Mijahed, Olivier Ganansia, Gilles Chatellier","doi":"10.1097/MEJ.0000000000001116","DOIUrl":"10.1097/MEJ.0000000000001116","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138797959","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":"Out of hospital cardiac arrest and organ donation: the innovative approach for emergency physicians.","authors":"Chiara Lazzeri, Bonizzoli Manuela, Adriano Peris","doi":"10.1097/MEJ.0000000000001098","DOIUrl":"10.1097/MEJ.0000000000001098","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41095528","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":"Conflict in the Middle East and political affiliation in the workplace.","authors":"Benjamin M Bloom, Mamoun Abu-Habsa","doi":"10.1097/MEJ.0000000000001115","DOIUrl":"10.1097/MEJ.0000000000001115","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487068","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":"Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey.","authors":"Pierrick Le Borgne, Karine Alamé, Aline Chenou, Anne Hoffmann, Véronique Burger, Sabrina Kepka, Pascal Bilbault, Quentin Le Bastard, Maelle Martin, Jean-Baptiste Lascarrou","doi":"10.1097/MEJ.0000000000001091","DOIUrl":"10.1097/MEJ.0000000000001091","url":null,"abstract":"<p><strong>Background and importance: </strong>Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation.</p><p><strong>Objectives: </strong>The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs).</p><p><strong>Settings and participants: </strong>We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022.</p><p><strong>Intervention: </strong>A single questionnaire was sent to a sole referent physician in each ED.</p><p><strong>Outcome measures and analysis: </strong>The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet.</p><p><strong>Main results: </strong>Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%).</p><p><strong>Conclusion: </strong>In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41106683","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":"Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study.","authors":"Juan González Del Castillo, Emília Mirò, Iria Miguens, Patricia Trenc, Begoña Espinosa, Lourdes Piedrafita, María Jesús Pérez Elías, Santiago Moreno, Federico García, Alberto Villamor, Míriam Carbó, Emili Gené, Òscar Mirò","doi":"10.1097/MEJ.0000000000001078","DOIUrl":"10.1097/MEJ.0000000000001078","url":null,"abstract":"<p><strong>Background and importance: </strong>The rates of hidden infection and late diagnosis of HIV still remain high in Western countries. Missed diagnostic opportunities represent the key point in changing the course of the epidemic.</p><p><strong>Objective: </strong>To evaluate the feasibility and results of implementation of a selective strategy to test for HIV in the emergency department (ED) in patients with six pre-defined medical situations: sexually transmitted infections, herpes zoster, community-acquired pneumonia, mononucleosis syndrome, practice of chemsex (CS) or request of post-exposure prophylaxis.</p><p><strong>Design: </strong>This quasi-experimental longitudinal study evaluated the pre- and post-implementation results of HIV testing in the six aforementioned clinical scenarios.</p><p><strong>Settings and participants: </strong>Patients attended 34 Spanish EDs.</p><p><strong>Intervention or exposure: </strong>The intervention was an intensive educational program and pathways to facilitate and track orders and results were designed. We collected and compared pre- and post-implementation ED census and diagnoses, and HIV tests requested and results.</p><p><strong>Outcome measures and analysis: </strong>The main outcome was adherence to the recommendations. Secondary outcomes were to evaluate the effectiveness of the program by the rate of positive test and the new HIV diagnoses. Differences between first and second periods were assessed. The magnitude of changes (absolute and relative) was expressed with the 95% confidence interval (CI).</p><p><strong>Main results: </strong>HIV tests increasing from 7080 (0.42% of ED visits) to 13 436 (relative increase of 75%, 95% CI from 70 to 80%). The six conditions were diagnosed in 15 879 and 16 618 patients, and HIV testing was ordered in 3393 (21%) and 7002 (42%) patients (increase: 97%; 95% CI: 90-104%). HIV testing significantly increased for all conditions except for CS. The positive HIV test rates increased from 0.92 to 1.67%. Detection of persons with undiagnosed HIV increased from 65 to 224, which implied a 220% (95% CI: 143-322%) increase of HIV diagnosis among all ED comers and a 71% (95% CI: 30-125%) increase of positive HIV tests.</p><p><strong>Conclusion: </strong>Implementation of a strategy to test for HIV in selective clinical situations in the ED is feasible and may lead to a substantial increase in HIV testing and diagnoses.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133534","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 prospective intervention study to identify drug-related emergency department visits comparing a standard care group and a pharmaceutical care group.","authors":"Benjamin J Hellinger, André Gries, Susanne Schiek, Yvonne Remane, Thilo Bertsche","doi":"10.1097/MEJ.0000000000001070","DOIUrl":"10.1097/MEJ.0000000000001070","url":null,"abstract":"<p><strong>Background and importance: </strong>Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions.</p><p><strong>Objective: </strong>The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support.</p><p><strong>Design/setting/participants: </strong>This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related.</p><p><strong>Outcome measures and analysis: </strong>The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated.</p><p><strong>Main results: </strong>A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25-Q75) 63.5-83.5] and took 7 [(Q25-Q75) 5-8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25-Q75) 66-83] and number of drugs taken was 9 [(Q25-Q75) 5.25-11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35-5.38). An intervention on the patient's pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group.</p><p><strong>Conclusion: </strong>In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10122659","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":"Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis.","authors":"Svenja Ravioli, Raeesa Jina, Omar Risk, Fleur Cantle","doi":"10.1097/MEJ.0000000000001093","DOIUrl":"10.1097/MEJ.0000000000001093","url":null,"abstract":"<p><strong>Background and importance: </strong>Healthcare worker strikes are a global phenomenon. Mortality and morbidity seem to be unaffected by doctor strikes, but there is little evidence on the impact on emergency department (ED) flow and patient characteristics. In March and April 2023, two consecutive UK junior doctor strikes occurred.</p><p><strong>Objectives: </strong>This study investigated the impact of junior doctor strikes on ED patient flow. Additionally, variation in patient presentations was compared between non-strike and strike days.</p><p><strong>Design, setting and participants: </strong>This cross-sectional study was conducted at King's College Hospital ED, a university hospital in London. All ED attendances during the 72- and 96-hour strike actions were compared with the corresponding non-strike days of the previous week.</p><p><strong>Outcome measures and analysis: </strong>National key performance indicators (KPIs) were analysed and compared between non-strike and strike days. Patients' demographics, acuity and diagnoses were compared. Outcome measures included number of 4-hour breaches, number of patients admitted or discharged and ED mortality. Staff seniority was categorised into levels for analysis.</p><p><strong>Main results: </strong>There was increased ED patient flow during strike days with a significantly shorter total time in department in March [240 min (IQR 155-469) vs. 286 min (IQR 198.5-523.5), P  < 0.001] and in April [222.5 min (IQR 147-351) vs. 251.5 min (IQR 174-443), P  < 0.001]. Time to first clinician, treatment, and decision to admit were all shorter during both strike actions. Number of attendances, acuity, diagnoses, admission, discharge, and mortality rates were similar during strike and non-strike days. Staffing numbers were lower or equivalent on strike days but level of seniority was higher ( P  < 0.001).</p><p><strong>Conclusion: </strong>The improved KPIs and increased patient flow during strike days, while multifactorial, seem largely attributed to the higher number of senior staff. Patient presentations and outcomes were unaffected by junior doctor strike action.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49675768","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}