European Journal of Emergency Medicine最新文献

{"title":"Awareness and preparedness of health systems and emergency medicine systems to the climate change challenges and threats: an international survey.","authors":"Roberta Petrino, Luis Garcia-Castrillo, Graziano Uccheddu, Letizia Meucci, Roberta Codecà","doi":"10.1097/MEJ.0000000000001196","DOIUrl":"10.1097/MEJ.0000000000001196","url":null,"abstract":"<p><strong>Background and importance: </strong>Climate change is widely recognised as a critical public health challenge.</p><p><strong>Objective: </strong>The objective of this study was to assess the awareness, preparedness and mitigation plans for climate change threats.</p><p><strong>Design, settings and participants: </strong>A cross-sectional observational study targeting emergency medical societies in different countries was conducted between 15 February and 15 March 2024.</p><p><strong>Intervention or exposure: </strong>The survey featured 16 closed questions on climate change awareness, preparedness and risks. Focus groups of 4-6 members were organised by country. Results were correlated to income levels, United Nations (UN) regional classification and the World Risk Index.</p><p><strong>Outcome measure and analysis: </strong>The questions were ranked using a Likert-like scale from 0 to 9 (9 being the highest). Descriptive statistics used central tendency estimators, and inferential analysis used chi-square and Kruskal-Wallis tests, with the significance level set at P  < 0.05.</p><p><strong>Results: </strong>Forty-two focus groups responded, representing 36 countries: 21 (50%) high-income, seven (16.7%) low-income, five (11.9%) lower middle-income and nine (21.4%) upper middle-income countries, representing 31 of the 22 UN regions. According to the World Risk Index, the respondent countries belonged to the different categories as follows: very low risk, 6 (14%); low risk, 8 (19%); medium risk, 5 (12%); high risk, 8 (19%) and very high risk, 14 (34%). The estimated impact of climate change on national health systems had a mean score of 6.75 (SD = 2.16), while on Emergency Medical Systems was 6.96 (SD = 2.05). Overall, assessment and preparedness measures were reported by just 21.4 and 37.6% of respondents, respectively. Analysis by income did not show significant differences, with the exception of food supply. The main differences in the analysis by region were the risks of extreme weather events, vector-borne diseases and wildfires, whereas the World Risk Index was food and chain of supplies. Education and integration of health services were indicated by all as the main mitigation actions.</p><p><strong>Conclusion: </strong>Geographical position and country risk index influence risk perception among focus groups more than income economy, with vector-borne diseases, extreme weather events and food shortages being the threats with the most variability. The most important actions identified to mitigate Climate Change effects are educational and strategic plans.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"100-108"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590271","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":"Euglycemic diabetic ketoacidosis: pitfalls, challenges, and perspectives in emergency medicine.","authors":"Beng Leong Lim, Kee Vooi Loo, Wei Feng Lee","doi":"10.1097/MEJ.0000000000001189","DOIUrl":"10.1097/MEJ.0000000000001189","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"83-84"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399745","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":"Highlights from the abstracts of EUSEM 2024 in Copenhagen.","authors":"Barbra E Backus","doi":"10.1097/MEJ.0000000000001211","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001211","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 2","pages":"73-74"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514703","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":"Contribution of point-of-care ultrasound in the prehospital management of patients with non-trauma acute dyspnea: a systematic review and meta-analysis.","authors":"Omide Taheri, Julie Samain, Frédéric Mauny, Marc Puyraveau, Thibaut Desmettre, Tania Marx","doi":"10.1097/MEJ.0000000000001205","DOIUrl":"10.1097/MEJ.0000000000001205","url":null,"abstract":"<p><p>Acute dyspnea is a common symptom whose management is challenging in prehospital settings. Point-of-care ultrasound (POCUS) is increasingly accessible because of device miniaturization. To assess the contribution of POCUS in the prehospital management of patients with acute nontraumatic dyspnea, we performed a systematic review on nontrauma patients of any age managed in the prehospital setting for acute dyspnea and receiving a POCUS examination. We searched seven databases and gray literature for English-language studies published from January 1995 to November 2023. Two independent reviewers completed the study selection, data extraction, and risk of bias assessment. The primary outcome was the assessment of the contribution of POCUS to feasibility, diagnostic, therapeutic, prognosis, patient referral, and transport vector modification. Twenty-three studies were included. The risk of bias assessment identified 3 intermediate-risk, 18 serious-risk, and 2 critical-risk studies. Three studies reported moderate to excellent feasibility for lung POCUS, and three studies reported poor to mediocre feasibility for cardiac POCUS. The median duration of the POCUS examination was less than 5 minutes (six studies). POCUS improved diagnostic identification (seven studies). The diagnostic accuracy of POCUS was excellent for pneumothorax (sensitivity = 100%, specificity = 100%, two studies), very good for acute heart failure (sensitivity = 71-100%, specificity = 72-95%, eight studies), good for pneumonia (sensitivity = 88%, specificity = 59%, one study), and moderate for pleural effusion (sensitivity = 26-53%, specificity = 83-92%, two studies). Treatment was modified in 11 to 54% of the patients (seven studies). POCUS had no significant effect on patient prognosis (two studies). POCUS contributed to patient referrals and transport vectors in 51% (four studies) and 25% (three studies) of patients, respectively. The evidence supports the use of POCUS for managing acute nontraumatic dyspnea in the prehospital setting in terms of feasibility, overall diagnostic contribution, and, particularly, lung ultrasound for acute heart failure diagnosis. Moreover, POCUS seems to have a therapeutic contribution. There is not enough evidence supporting the use of POCUS for pneumonia, pleural effusion, pneumothorax, chronic obstructive pulmonary disease, or asthma exacerbation diagnosis, nor does it support prognostic, patient referral, and transport vector contribution. A high level of evidence is lacking and needed.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"87-99"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11855997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779659","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":"Association between time to antibiotic and mortality in patients with suspected sepsis in the Emergency Department: post hoc analysis of the 1-BED randomized clinical trial.","authors":"Anne-Laure Philippon, Soufiane Lebal, Marta Cancella de Abreu, Camille Gerlier, Oscar Mirò, Tabassome Simon, Yonathan Freund","doi":"10.1097/MEJ.0000000000001212","DOIUrl":"10.1097/MEJ.0000000000001212","url":null,"abstract":"<p><strong>Importance: </strong>The impact of early antibiotics on mortality in patients with suspected sepsis in the emergency department (ED) remains debated, particularly in patients with less severe presentations or before infection confirmation.</p><p><strong>Objective: </strong>To evaluate the association between time to antibiotic administration and 28-day in-hospital mortality among patients with suspected sepsis in the ED.</p><p><strong>Design, setting, and participants: </strong>Post hoc analysis of the 1-bundle emergency department trial, a multicenter, stepped-wedge cluster-randomized controlled trial conducted in 23 EDs in France and Spain. A total of 872 patients with suspected sepsis were included between June 2022 and September 2023. All patients with available data on antibiotic administration were analyzed, and a subgroup of patients with no hypotension was also assessed.</p><p><strong>Exposures: </strong>Time to antibiotic administration. The effect of time to fluid resuscitation was also assessed.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was in-hospital mortality at 28 days. Secondary outcomes included all-cause 28-day mortality, ICU length of stay, number of days without vasopressors at day 28, and change in Sequential Organ Failure Assessment score at 72 h.</p><p><strong>Results: </strong>Among 872 patients (mean age 66 years; 41% female), 859 had available data on antibiotic administration (primary analysis) and 791 (92%) received antibiotics. The median time to antibiotic administration was 61 min (IQR 14-169), with 457 patients (58%) receiving antibiotics within 1 h. In-hospital mortality at 28 days was 14.7% for patients who did not received antibiotic within 1 h versus 9.6% for patients who did [adjusted odds ratio (aOR) 2.00 (1.24-3.23)]. There was an aOR of 1.06 (1.02-1.1) for each hour of delay for antibiotic administration. This effect was confirmed in patients without hypotension [aOR 2.02 (1.08-3.76) for patients who received antibiotics beyond 1 h]. Time to fluid resuscitation was not associated with 28-day in-hospital mortality.</p><p><strong>Conclusion and relevance: </strong>In patients with suspected sepsis presenting to the ED antibiotic administration beyond 1 h was associated with a two-fold increased 28-day in-hospital mortality. This effect persisted in patients without hypotension.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"109-115"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863717","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":"Predicting emergency department revisits with hospitalization in a multihospital network: a large-scale assessment.","authors":"Chiara Morlotti, Mattia Cattaneo, Francesco Paleari, Filippo Manelli, Francesco Locati","doi":"10.1097/MEJ.0000000000001190","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001190","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 2","pages":"141-143"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514967","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":"External validation of the HEART, HEAR, and HET scores for prediction of major adverse cardiac events in adult patients with acute chest pain.","authors":"Maximilian Niederer, Karina Tapinova, Larissa Bernert, Wilhelm Behringer, Dominik Roth","doi":"10.1097/MEJ.0000000000001228","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001228","url":null,"abstract":"<p><strong>Background and importance: </strong>In the cohort of patients presenting to the emergency department (ED) with acute chest pain differentiating between those at high risk of major adverse cardiac event (MACE), and those who can safely be discharged, remains a challenge. The history, ECG, age, risk factors, troponin (HEART) score, as well as several abridged versions [history, ECG, age, risk factors (HEAR), history, ECG, troponin (HET)]. are commonly used for this purpose. As with many clinical risk scores, they might be useful, but often lack proper validation. We aimed to externally validate the HEART, HEAR, and HET scores in the setting of a high-volume tertiary care ED in a healthcare system without gatekeeping functions and thus a low-risk population. We further aimed to compare the prognostic performance (discrimination and calibration) of the scores to each other.</p><p><strong>Design: </strong>External validation study.</p><p><strong>Settings and participants: </strong>On the basis of a-priori sample size calculations, we prospectively included consecutive adult patients presenting to the ED with acute chest pain.</p><p><strong>Outcome measures and analysis: </strong>We assessed overall model performance, discrimination, and calibration of all scores, analyzed reclassification from the HEART score and performed decision curve analysis.</p><p><strong>Main results: </strong>A total of 3273 patients were included, 383 (12%) suffered MACE within 30 days. Classification differed significantly between scores (HEART: 810; 25% low risk; HET: 55; 2%; HEAR: 195; 6%), as did overall performance (area under the curve: 0.85, 0.80, and 0.79, respectively; P < 0.001). HEART score misclassified 7/810 patients (0.9%; 95% confidence interval: 0.4-1.8%) with MACE as low risk, HET 2/55 (3.6%, 0.9-13.8%), and HEAR 0/195, whereas 2087 (72%), 2837 (98%), and 2695 (93%) patients without MACE were erroneously not classified as low risk.</p><p><strong>Conclusion: </strong>The abridged scores fell short of their results in derivation studies, identifying only very few low-risk patients, and showing inferior model performance compared with the original HEART score. Instead of developing new scores, existing scores should be recalibrated to local population characteristics, as needed.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700050","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":"Emergency medicine training in Europe: the Young Emergency Medicine Doctors perspective.","authors":"Kiren Govender, Eugenia Lupan-Muresan","doi":"10.1097/MEJ.0000000000001197","DOIUrl":"10.1097/MEJ.0000000000001197","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"5-7"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779660","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 new European Training Requirements for emergency medicine: rationale and implementation.","authors":"Ruth Brown, Gregor Prosen, Eric Dryver","doi":"10.1097/MEJ.0000000000001200","DOIUrl":"10.1097/MEJ.0000000000001200","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"8-9"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686391","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 impact of prehospital transport method on time to first computed tomography scan in patients with acute stroke: a retrospective district-wide analysis.","authors":"Shai Geron, Tomer Kaplan, Elad Brav, Rafael Strugo, Ohad Gabay, Oren Wacht, Amit Frenkel","doi":"10.1097/MEJ.0000000000001185","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001185","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 1","pages":"64-65"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893165","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}