European Journal of Emergency Medicine最新文献

{"title":"Ageism in emergency departments: impact and solutions.","authors":"Alessandra Colantoni, Irene Belletti, Cristina Carini, Alessio Bertini","doi":"10.1097/MEJ.0000000000001230","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001230","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"155-157"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959487","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":"Resuscitative endovascular balloon occlusion of the aorta for trauma patients with uncontrolled hemorrhage: a retrospective target trial emulation (the AT-REBOA target trial).","authors":"Barbara Hallmann, Gabriel Honnef, Nicolas Eibinger, Michael Eichlseder, Martin Posch, Paul Puchwein, Philipp Zoidl, Paul Zajic","doi":"10.1097/MEJ.0000000000001183","DOIUrl":"10.1097/MEJ.0000000000001183","url":null,"abstract":"<p><strong>Background: </strong>Noncompressible truncal hemorrhage is a major contributor to preventable deaths in trauma patients and, despite advances in emergency care, still poses a big challenge.</p><p><strong>Objectives: </strong>This study aimed to assess the clinical efficacy of trauma resuscitation care incorporating Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) compared to standard care for managing uncontrolled torso or lower body hemorrhage.</p><p><strong>Methods: </strong>This study utilized a target trial design with a matched case-control methodology, emulating randomized 1 : 1 allocation for patients receiving trauma resuscitation care with or without the use of REBOA. The study was conducted at a high-volume trauma center in Southern Austria, including trauma patients treated between January 2019 and October 2023, aged 16 and above, with suspected severe non-compressible torso hemorrhage. The primary outcome was 30-day in-hospital mortality. Secondary outcomes were in-hospital mortality rates at 3, 6, 24 h, and 90 days, need for damage control procedures, time to these procedures, computed tomography (CT) scan rates during resuscitation, complications, length of intensive care and in-hospital stay, and causes of death.</p><p><strong>Results: </strong>Median age was 55 [interquartile range (IQR) 42-64] years. Median total injury severity, assessed by Injury Severity Score, was 46.5 (IQR: 43-57). There was no significant difference in 30-day in-hospital mortality between groups [9/22 (41%) vs. 9/22 (41%), odds ratio: 1.00, 95% confidence interval (CI): 0.3-3.36, P  > 0.999]. Lower mortality rates within 3, 6, and 24 h were observed in the REBOA group; in a Cox proportional hazards model, hazard ratio (95% CI) for mortality in the REBOA group was 0.87 (0.35-2.15). Timing to damage control procedures did not significantly differ between groups, although patients in the REBOA group underwent significantly more CT scans. Bleeding was cited as the main cause of death less frequently in the REBOA group.</p><p><strong>Conclusion: </strong>In severely injured patients presenting with possible major non-compressible torso hemorrhage, a systematically implemented resuscitation strategy including REBOA during the initial hospital phase, is not associated with significant changes in mortality.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"202-209"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913985","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":"Assessment of sleep quality and fatigue management among residents in emergency medicine.","authors":"Sebastien Denis, Stéphanie Mazza, Marion Douplat","doi":"10.1097/MEJ.0000000000001221","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001221","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"222-224"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975618","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 lactate determined at emergency department arrival and the probability of inhospital mortality and intensive care admission in elderly patients.","authors":"Aitor Alquézar-Arbé, Sergio Pérez-Baena, Cesáreo Fernández, Sira Aguiló, Guillermo Burillo, Javier Jacob, Pere Llorens, Jesús Santianes Patiño, Paula Queizán García, Diana Rosendo Mesino, Osvaldo Jorge Troiano Ungerer, Aarati Vaswani-Bulchand, Montserrat Rodríguez-Cabrera, Mabel Coromoto Suárez Pineda, Patricia Gantes Nieto, Francesc Xavier Alemany González, Ana Puche Alcaraz, María Bóveda García, Mónica Veguillas Benito, Francisco Chamorro, Coral Suero Méndez, Eva Fragero Blesa, Rodrigo Javier Gil Hernández, Paula Pedraza Ramírez, Juan González Del Castillo, Òscar Miró","doi":"10.1097/MEJ.0000000000001207","DOIUrl":"10.1097/MEJ.0000000000001207","url":null,"abstract":"<p><strong>Background and importance: </strong>Elderly patients often have atypical clinical presentations. Lactate measurement on arrival at the Emergency Department (ED) could be useful to identify elderly patients with a bad prognosis.</p><p><strong>Objective: </strong>The study aimed to investigate the relationship between serum lactate determined at ED arrival and the probability of inhospital mortality and intensive care (ICU) admission in elderly patients.</p><p><strong>Design: </strong>Retrospective multipurpose registry. Secondary analysis of the EDEN cohort (Elderly Department and Elder Needs).</p><p><strong>Settings and participants: </strong>All patients ≥65 years attending 52 Spanish EDs during 2 week and in whom serum lactate was determined at ED arrival.</p><p><strong>Outcome measures and analysis: </strong>The relationship between serum lactate values and the risk of inhospital all-cause death and transfer from the ED to the ICU was assessed by unadjusted and adjusted logistic regression assuming linearity and restricted cubic spline models assuming nonlinearity.</p><p><strong>Results: </strong>The cohort included 25 557 patients. The 3024 patients in whom lactate was measured were analyzed. The median age was 81 years (74-87), 1506 (27.2%) were women, 591 (19.5%) had serious comorbidities, 475 (15.7%) severe dependency, and 648 (21.4%) dementia. Death occurred during hospitalization in 217 patients (7.2%) and 53 patients (1.75%) were admitted to the ICU. Serum lactate values were nonlinear related to inhospital mortality and ICU admission. Serum lactate >3.1 mmol/L [odds ratio (OR): 1.60, 95% confidence interval (CI): 1.02-2.50] for inhospital mortality and 3.2 mmol/L (OR: 2.83, 95% CI: 1.03-6.79) for ICU admission were associated with significantly increased ORs in the adjusted models.</p><p><strong>Conclusion: </strong>Serum lactate measured at ED arrival has a significant and exponential relationship with inhospital mortality and ICU admission in elderly patients.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"171-179"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853445","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":"The Swedish National Emergency Registry (SVAR), a modern emergency care registry.","authors":"Lisa Kurland, Lina Holmqvist, Ulf Ekelund","doi":"10.1097/MEJ.0000000000001214","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001214","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"216-218"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978069","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":"Etomidate versus ketamine for in-hospital rapid sequence intubation: a systematic review and meta-analysis.","authors":"Mohamed Aziz Daghmouri, Mohamed Ali Chaouch, Mohamed Noomen, Wael Chaabene, Benjamin Deniau, Ellington Barnes, Georges Mion, Cherifa Cheurfa, Besma Gafsi, Matthieu Camby","doi":"10.1097/MEJ.0000000000001237","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001237","url":null,"abstract":"<p><p>Rapid sequence intubation (RSI) is a critical procedure in emergency and intensive care settings. Etomidate has been favored for its hemodynamic stability; however, concerns about adrenal insufficiency have prompted interest in ketamine as an alternative induction agent. This systematic review and meta-analysis aimed to compare the effects of etomidate vs ketamine on 30-day survival and other clinical outcomes in critically ill patients undergoing in-hospital RSI. A comprehensive literature search was conducted until 1 November 2024, across PubMed, Embase, Web of Science, Cochrane databases, and clinical trial registries. Eligible studies included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing etomidate vs ketamine for RSI. The primary outcome was 30-day survival. Secondary outcomes encompassed intubation difficulty, post-intubation vasopressor use, cardiovascular collapse, Sequential Organ Failure Assessment score, systemic steroid use, organ support-free days, and adrenal insufficiency. Fourteen studies comprising 23 926 patients (19 288 receiving etomidate; 4638 receiving ketamine) met the inclusion criteria. Pooled analyses of RCTs and CCTs revealed no significant difference in 30-day survival between the two agents [RCTs: odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.68-1.24, P  = 0.58; CCTs: OR = 1.16, 95% CI: 0.92-1.45, P  = 0.58]. Ketamine was associated with a higher requirement for post-intubation vasopressor support (OR = 0.71, 95% CI: 0.53-0.96, P  = 0.03) and an increase in ICU-free days. Etomidate use correlated with a significantly higher incidence of adrenal insufficiency (OR = 2.43, 95% CI: 1.67-3.53, P  < 0.001). No significant differences were observed in intubation difficulty, cardiovascular collapse, or systemic steroid use between the groups. Ketamine and etomidate showed no significant difference in 30-day survival among critically ill patients undergoing RSI. However, etomidate was associated with a higher incidence of adrenal insufficiency, while ketamine required more post-intubation vasopressor support. Provenance and peer review: Not commissioned, externally peer-reviewed.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"160-170"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997032","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":"In reply, point-of-care ultrasound for chest pain patients.","authors":"Paolo Bima, Fulvio Morello, Peiman Nazerian","doi":"10.1097/MEJ.0000000000001226","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001226","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"225-226"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975678","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":"Prehospital intubation in patients with severe traumatic brain injury: a review.","authors":"Arnout Lauriks, Martijn Missiaen, Marc Sabbe","doi":"10.1097/MEJ.0000000000001240","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001240","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a global health burden, with an incidence of 874-1005/100 000. It is a leading cause of morbidity and mortality in all ages. TBI is a heterogeneous entity, with a variety of definitions. Treatment starts at a prehospital level and aims to prevent secondary injury. Airway management is vital to prevent hypoxia, hypercapnia, and aspiration which could contribute to secondary injuries. In some systems, it is current practice to perform endotracheal intubation in the prehospital setting to secure the airway and permit controlled ventilation, as opposed to using basic maneuvers and adjuncts with supplemental oxygen. This study aims to review the effect of prehospital tracheal intubation on mortality and functional outcome in adult and pediatric patients with severe TBI compared with patients not intubated in the prehospital setting. A digital literary search of four databases using variations of the terms 'Endotracheal Intubation', 'Laryngeal Mask Airway', and 'Traumatic Brain Injury\" included reports up to 31 March 2023. Of 7242, 33 studies were included. The overall risk of bias was moderate to serious. Nine studies noted an increase in mortality associated with prehospital intubation, four studies demonstrated a significant decrease in mortality and five studies reported poorer functional outcomes using various scales. Only three reports, including the only randomized controlled trial (RCT), showed improved functional outcomes with prehospital intubation. In eight studies, the prehospital intubation cohort had significantly more severe injuries. The majority of studies showed no effect on or increased mortality, and no significant association with functional outcome in patients with severe TBI who underwent prehospital intubation. However, all but one were retrospective and with a moderate to serious risk of bias. The cause of the mortality increase is uncertain and possibly a result of more severe injuries in the prehospital intubation group. The single available RCT reported improved functional outcomes with prehospital intubation but has yet to be replicated. The current evidence for prehospital intubation is uncertain in either direction, and there is a need for new prospective research, ideally with uniform outcome measures and the application of up-to-date intubation practices in the prehospital field.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988637","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":"Viewpoint: Multitasking in emergency medicine.","authors":"Christoph Dodt","doi":"10.1097/MEJ.0000000000001236","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001236","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978881","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":"The Norwegian emergency healthcare system: organization and challenges.","authors":"Sarah King, Oddvar Uleberg, Lars Petter Bjørnsen","doi":"10.1097/MEJ.0000000000001238","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001238","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974223","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}