European Journal of Emergency Medicine最新文献

{"title":"Current sepsis management practices in European emergency departments: the ISG-emergency department European Survey.","authors":"Myrto Bolanaki, Lisa Kurland, Mikkel Brabrand, Ron Daniels, Kiren Govender, Frank Hanses, Francesca Innocenti, Annmarie Lassen, Ignacio Martin-Loeches, Martin Möckel","doi":"10.1097/MEJ.0000000000001255","DOIUrl":"10.1097/MEJ.0000000000001255","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) are often the first point of contact for patients with sepsis, and therefore play a critical role in early recognition and treatment. However, the extent to which sepsis guidelines are implemented across EDs in Europe remains unclear, and variability in adherence may impact patient outcomes.</p><p><strong>Objective: </strong>This study aimed to assess current sepsis management practices in European EDs, evaluate adherence to international guidelines, and identify key challenges limiting effective implementation.</p><p><strong>Methods and design: </strong>A structured survey was developed by sepsis experts from the European Society for Emergency Medicine (EUSEM). The questionnaire included both quantitative and open-ended items and underwent iterative refinement through pilot testing to ensure clarity and relevance.</p><p><strong>Settings and participants: </strong>The survey was distributed to EUSEM members and national emergency medicine societies across Europe. Respondents included medical directors or designated sepsis specialists, with only one response requested per ED.</p><p><strong>Results: </strong>A total of 402 EDs from 28 European countries participated in the survey. While most EDs (72.5%) reported having a sepsis protocol in place, less than half implemented regular monitoring or structured training measures. The 1-h sepsis bundle was described as moderately to highly challenging to implement by the majority of the respondents; just over half (55%) reported completing all its elements within 1 h of ED presentation. Key barriers included high patient volumes, insufficient staffing, and lack of standardized sepsis definitions, leading to delays in recognition and treatment. The results also highlighted concerns regarding increased broad-spectrum antibiotic use following the implementation of the 1-h bundle, emphasizing the need for a balanced approach that considers antimicrobial stewardship.</p><p><strong>Conclusion: </strong>This survey establishes a benchmark for understanding sepsis management practices in European EDs, identifying substantial variations and challenges. Areas for improvement include enhanced training to follow protocols, improved monitoring systems that measure protocol adherence, and alignment with evidence-based guidelines.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"368-376"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medicine practice in low- and middle-income settings: the WHO Acute Care Action Network.","authors":"Vitalii Stetsyk, Ffion Davies, Emmanuel Acheampong","doi":"10.1097/MEJ.0000000000001253","DOIUrl":"10.1097/MEJ.0000000000001253","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"308-309"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741708","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 antithrombotic medications and intracranial hemorrhage among older patients with mild traumatic brain injury: a multicenter cohort study.","authors":"Axel Benhamed, Amandine Crombé, Mylène Seux, Leslie Frassin, Romain L'Huillier, Eric Mercier, Marcel Émond, Domitille Millon, Francis Desmeules, Karim Tazarourte, Guillaume Gorincour","doi":"10.1097/MEJ.0000000000001246","DOIUrl":"10.1097/MEJ.0000000000001246","url":null,"abstract":"<p><strong>Objective: </strong>To measure the association between antithrombotic (AT) medications (anticoagulant and antiplatelet) and risk for traumatic intracranial hemorrhage (ICH) in older adults with a mild traumatic brain injury (mTBI).</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study across 103 emergency departments affiliated with a teleradiology company dedicated to emergency imaging between 2020 and 2022. Older adults (≥65 years old) with mTBI, with a head computed tomography scan, were included. Natural language processing models were used to label-free texts of emergency physician forms and radiology reports; and a multivariable logistic regression model to measure the association between AT medications and occurrence of ICH.</p><p><strong>Results: </strong>A total of 5948 patients [median age 84.6 (74.3-89.1) years, 58.1% females] were included, of whom 781 (13.1%) had an ICH. Among them, 3177 (53.4%) patients were treated with at least one AT agent. No AT medication was associated with a higher risk for ICH: antiplatelet odds ratio 0.98 95% confidence interval (0.81-1.18), direct oral anticoagulant 0.82 (0.60-1.09), and vitamin K antagonist 0.66 (0.37-1.10). Conversely, a high-level fall [1.68 (1.15-2.4)], a Glasgow coma scale of 14 [1.83 (1.22-2.68)], a cutaneous head impact [1.5 (1.17-1.92)], vomiting [1.59 (1.18-2.14)], amnesia [1.35 (1.02-1.79)], a suspected skull vault fracture [9.3 (14.2-26.5)] or of facial bones fracture [1.34 (1.02-1.75)] were associated with a higher risk for ICH.</p><p><strong>Conclusion: </strong>This study found no association between AT medications and an increased risk of ICH among older patients with mTBI suggesting that routine neuroimaging in this population may offer limited benefit and that additional variables should be considered in the imaging decision.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"359-367"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539627","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":"Guideline adhesion in the management of severe acute pulmonary oedema: a French survey involving 1048 cardiologists, emergency physicians, and intensivists.","authors":"Grégoire Muller, Clément Delmas, Tahar Chouihed, Nicolas Danchin, Brice Sauvage, Saïd Laribi, Étienne Puymirat, Denis Angoulvant, Nadia Aissaoui","doi":"10.1097/MEJ.0000000000001247","DOIUrl":"10.1097/MEJ.0000000000001247","url":null,"abstract":"<p><strong>Background and importance: </strong>Acute pulmonary oedema is a frequent and potentially life-threatening emergency. Its management targets four key objectives: improving oxygenation, reducing volume overload, maintaining adequate blood pressure, and treating the underlying cause. Severe cases are mainly handled by cardiologists, emergency physicians, and intensivists, which may lead to variations in care and thus nonadherence to guidelines.</p><p><strong>Objective: </strong>To evaluate interspecialty differences in the management of patients with severe acute pulmonary oedema and compare physicians' practices to 2021 European guidelines.</p><p><strong>Design: </strong>A national cross-sectional survey using clinical vignettes.</p><p><strong>Settings and participants: </strong>Four clinical vignettes, developed by a multidisciplinary scientific committee representing French cardiology, emergency medicine, and intensive care societies were distributed between June and September 2022 to physicians from the three specialties and to a panel of 20 experts.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was adherence to European guidelines. Interspecialty differences and predictors of nonadherence were assessed using univariate and multivariate analyses.</p><p><strong>Main results: </strong>A total of 1048 physicians responded (59% emergency physicians, 22% intensivists, and 19% cardiologists). Adherence rates were 66, 65, 69, and 76%, respectively among cardiologists, emergency physicians, intensivists, and experts. Intensivists and emergency physicians were more prone to initiate noninvasive ventilation than cardiologists (respectively 87, 82, and 71%, P  < 0.001 and P  < 0.01). Intensivists and cardiologists were more likely to intubate patients than emergency physicians (respectively 73, 65, and 43%, P  < 0.001 for both comparisons). Cardiologists more frequently administered intravenous diuretics (98%) compared with emergency physicians and intensivists (both 90%, P  = 0.002). Emergency physicians chose more frequently the correct door-to-balloon delay than cardiologists for ST-segment elevation myocardial infarction-related acute pulmonary oedema (43 versus 28%, P  = 0.003). Multivariate analysis showed lower adherence among physicians compared with experts. Adherence was also lower among physicians older than 40 years and those working in nonuniversity hospitals.</p><p><strong>Conclusions: </strong>This nationwide survey highlights marked discrepancies between European guidelines and clinical practice in the management of acute pulmonary oedema, with substantial variation across specialties regarding initiation of oxygen therapy, invasive ventilation, nitrates, or delay for thrombolysis of an ST-segment elevation myocardial infarction.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"344-350"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247073","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 test accuracy of the Emergency Severity Index: a systematic review and meta-analysis.","authors":"Bettina Wandl, Jan D Kellerer, Verena Fuhrmann, Karina Tapinova, Dominik Roth, Gerhard Müller","doi":"10.1097/MEJ.0000000000001262","DOIUrl":"10.1097/MEJ.0000000000001262","url":null,"abstract":"<p><strong>Background and importance: </strong>Efficient triage of emergency patients is crucial for the immediate identification of critically ill individuals and enables rapid interventions to improve patient outcomes.</p><p><strong>Design: </strong>Systematic review and meta-analysis of the diagnostic test accuracy (DTA) of the Emergency Severity Index (ESI) for identifying critically ill adult patients in the emergency department (ED).</p><p><strong>Settings and participants: </strong>We considered all studies (case-control and cohort studies) that evaluated the DTA of the ESI in adult patients attending an ED. The outcome of a triage system is the high urgency of treatment, commonly used reference standards are short-term mortality or admission to an ICU.</p><p><strong>Methods: </strong>We searched four bibliographic databases up to 13 February 2025. Screening, inclusion, data extraction, and assessment of methodological quality followed standard Cochrane methodology. We calculated measures of DTA for all studies against the reference standards and calculated pooled estimates using a bivariate random effects model.</p><p><strong>Main results: </strong>We included 27 studies, representing 510 777 patients. Methodological quality according to the QUADAS-2 tool was high, except for risk of bias in patient selection, which was high for 12 (44%) studies. A total of 18 studies provided data for the reference standard short-term mortality, with an estimated pooled sensitivity of 81.8 [95% confidence interval (CI): 71.8-88.9], specificity of 70.5 (60.5-78.8), diagnostic odds ratio (DOR) of 10.8 (5.4-21.4), positive likelihood ratio of 2.77 (2.02-3.81), and negative likelihood ratio of 0.26 (0.16-0.41). For the reference standard ICU admission, based on 10 studies, pooled estimates were sensitivity of 81.5 (65.2-91.2), specificity of 81.7 (71.9-88.6), DOR of 19.7 (5.5-70.7), positive likelihood ratio of 4.45 (2.58-7.84), and negative likelihood ratio of 0.23 (0.11-0.49). Those results remained stable in the sensitivity analysis.</p><p><strong>Conclusion: </strong>ESI showed a moderate-to-high diagnostic accuracy for identifying critically ill patients at the ED. These findings support the role of the ESI guided by a principal understanding of the limitations inherent to any triage tool.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"325-334"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency vascular access: intraosseous vs. intravenous? Input from the New German National Guidelines.","authors":"Manuel F Struck","doi":"10.1097/MEJ.0000000000001271","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001271","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 5","pages":"306-307"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947668","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":"Early diagnosis and treatment of acute heart failure in prehospital and emergency settings. Part 1 of the International Expert Opinion Series on acute heart failure management.","authors":"Òscar Miró, Ovidiu Chioncel, Alex Mebazaa, Naoki Sato, Javed Butler, Beth Davison, Jan Biegus, Matteo Pagnesi, Andrew P Ambrosy, Gianluigi Savarese, Marat Fudim, Robert J Mentz, Siti E Nauli, Ivna G C V Lima, Edimar A Bocchi, Karen Sliwa-Hahnle, Anastase Dzudie, Sivadasanpillai Harikrishnan, Mauro Riccardi, Yuhui Zhang, Jingmin Zhou, Gad Cotter, Yonathan Freund","doi":"10.1097/MEJ.0000000000001270","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001270","url":null,"abstract":"<p><p>Acute heart failure (AHF) is diagnosed in about 0.5% of all patients seen by emergency medical systems (EMS) and represents about 1% of emergency department (ED) visits. Leg swelling and shortness of breath are the most frequent patient complaints. Despite significant advancements in patient care pathways, the proper diagnosis, treatment and disposition of AHF may be further improved in emergency settings. The present document is an expert consensus document outlining key points in diagnosis, treatment and decision-making of patients being diagnosed with AHF by EMS and in the ED. Pillars of correct diagnosis include detailed clinical assessment and accurate interpretation of natriuretic peptides, while chest X-ray is still the most frequent image test used in ED, that could be substituted by ultrasonography exploration in appropriate patients. Quick identification of the most severe cases needing intensive care is mandatory, most of them characterized by hemodynamic instability, ventilatory failure or acute coronary syndrome needing intervention. Treatment could be started in prehospital settings by EMS, and loop diuretics are still the cornerstone of decongestive therapy. Measurement of diuresis and natriuresis shortly after provision of the first diuretic bolus is recommended, as it can help in detecting patients with poor diuretic response for dose augmentation or drug escalation with the addition of acetazolamide or thiazides. For selected patients, vasodilators (especially for acute cardiogenic pulmonary edema phenotype) or inotropes/vasopressors (for those with cardiogenic shock) can be needed. Oxygen therapy should be provided to patients with air-room SpO2 below 95%, and noninvasive ventilation is an option for patients with respiratory distress. After provision of ED care, a correct decision of patient discharge or hospitalization is paramount, and risk stratification can help in this regard. Other key points of AHF management in the ED include adequate diagnosis and management of triggers of the AHF episode; to take aspects of patient frailty into account; to avoid lines, catheters, and patient overstay in the ED where possible; and to ensure a proper follow-up plan after discharge from the hospital.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181969","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":"Global job satisfaction among emergency medicine professionals: results from the 2025 Emergency Medicine Day Survey.","authors":"Roberta Petrino, Luis Garcia-Castrillo, Davide Castiglioni, Basak Yilmaz, Ilenia Mascherona","doi":"10.1097/MEJ.0000000000001272","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001272","url":null,"abstract":"<p><strong>Background and importance: </strong>Emergency medicine professionals face persistent challenges, including excessive workloads, shift work, and emotional stress. Job satisfaction is essential for workforce sustainability, quality of care, and retention; however, international research remains limited.</p><p><strong>Objectives: </strong>To evaluate self-reported job satisfaction among emergency medicine professionals globally - including prehospital providers - and explore how individual and institutional factors influence it.</p><p><strong>Design: </strong>International cross-sectional study using a structured, anonymous online survey.</p><p><strong>Settings and participants: </strong>The survey was disseminated via international emergency medicine organizations (European Society for Emergency Medicine, International Federation for Emergency Medicine, South Asian Federation of Emergency Medicine, African Federation for Emergency Medicine, among others) over 3 weeks in April 2025. Eligible respondents included physicians, nurses, and paramedics working in prehospital and in-hospital emergency medicine settings.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was the satisfaction score (range: 9-36), based on the nine-domain Lausanne scale. Overall job satisfaction was assessed separately using a single-item Likert scale (0-9). Descriptive and inferential statistics explored associations with demographic and organizational variables.</p><p><strong>Main results: </strong>A total of 1112 professionals from 79 countries participated (56% female and 85.8% physicians). The mean satisfaction score was 25.37 (SD = 4.36), with a median overall satisfaction estimation of 6.77 (interquartile range = 2). High scores were reported for organisational commitment, co-worker support, and professional fulfilment. The lowest scores concerned career opportunities and work organization. Lower satisfaction was reported in high-volume emergency departments (>100 000 visits/year) and among mid-career professionals (5-20 years of experience). Intention to remain in the current role was significantly associated with higher satisfaction (P < 0.001).</p><p><strong>Conclusion: </strong>The Emergency Medicine Day 2025 Survey provides one of the largest international assessments of job satisfaction in emergency medicine to date. Despite moderate-to-high satisfaction overall, challenges persist regarding career development and workload - particularly in high-pressure settings. These findings support the implementation of targeted interventions to enhance leadership, support mid-career staff, and foster resilient, well-functioning teams.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181896","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":"Promoting uniform data reporting in research on older individuals living with frailty in the emergency department: the Utstein approach.","authors":"","doi":"10.1097/MEJ.0000000000001275","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001275","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069416","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 physician specialty and first-attempt intubation success in the emergency department.","authors":"Lucas Oliveira J E Silva, Rafael Von Hellmann, Bruno A M Pinheiro Besen, Julia M Dorn de Carvalho, Ludhmila Abrahao Hajjar, Daniel Pedrollo, Caio Goncalves Nogueira, Natalia Mansur P Figueiredo, Carlos Henrique Miranda, Danilo Martins, Thiago Dias Baumgratz, Bruno Bergesch, Diogo Costa, Osmar Colleoni, Juliana Zanettini, Ana Paula Freitas, Nicole Pinheiro Moreira, Patricia Lopes Gaspar, Renato Tambelli, Maria Cristina Costa, Samara Silveira, Wilsterman Correia, Rafael Garcia de Maria, Ubirajara A Vinholes Filho, Andre P Weber, Vinicius da Silva Castro, Carlos Fernando D Dornelles, Barbara S Tabach, Hélio P Guimarães, Gabriela Stanzani, Thiago F Gava, Aidan Mullan, Gabriel Petrin Alonso Silva, Giovanna Cardoso de Oliveira, Benjamin J Sandefur, Fernanda Bellolio, Julio C G Alencar, Ian Ward A Maia","doi":"10.1097/MEJ.0000000000001276","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001276","url":null,"abstract":"<p><strong>Background and importance: </strong>Emergency airway management in the emergency department (ED) is a high-risk procedure associated with patient outcomes. First-attempt success is a widely recognized quality metric, as multiple attempts are associated with an increased risk of peri-intubation complications. In Brazil, where emergency medicine is a recently established specialty, many ED are staffed by physicians without formal emergency medicine training. The association between emergency medicine training and intubation outcomes in this setting has not been well characterized.</p><p><strong>Objective: </strong>To assess the association of physician specialty with first-attempt success and immediate peri-intubation complications in Brazilian EDs.</p><p><strong>Design: </strong>Secondary analysis of a multicenter, prospective cohort study from the Brazilian Airway Registry Cooperation.</p><p><strong>Setting and participants: </strong>This study included adult patients who underwent tracheal intubation in EDs between March 2022 and April 2024. Patients were excluded if the intubation occurred outside the ED, during cardiopulmonary resuscitation, or for elective procedures. Intubations performed by medical students were also excluded. Physicians were categorized by specialty as emergency medicine or nonemergency medicine.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was first-attempt success; secondary outcomes included peri-intubation complications (severe hypoxemia, hemodynamic instability, and cardiac arrest). Multivariable logistic regression was used to assess the association between physician specialty and outcomes.</p><p><strong>Main results: </strong>Among 2582 patients, 1087 (42.1%) were intubated by emergency physicians and 1495 (57.9%) by other physicians (mainly internal medicine and surgery). Intubations by emergency physicians were associated with a higher rate of first-attempt success [80.4 vs. 70.9%, adjusted odds ratio [aOR]: 1.63, 95% confidence interval (CI): 1.34-1.97]. There was also a higher odds of intubations without major complications (aOR: 1.20, 95% CI: 1.01-1.42).</p><p><strong>Conclusion: </strong>In this study, there was a higher rate of first-attempt success in intubations performed by board-certified emergency physicians compared with other physicians working in Brazilian EDs.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029209","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}