European Journal of Emergency Medicine最新文献

{"title":"Association between early interleukin 6 and interleukin 8 dynamic patterns and 30-day mortality in elderly patients with community-acquired pneumonia.","authors":"Cheng-Han Chen, Yi-Tzu Lee, Li-Hua Li, Chao-Min Cheng","doi":"10.1097/MEJ.0000000000001335","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001335","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 5","pages":"359-361"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839639","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":"Neuromuscular blocking agents for tracheal intubation of critically ill adults: a systematic review and meta-analysis.","authors":"Pedro Vitale Mendes, Ian Ward Abdalla Maia, Rafael von Hellmann, Danielle Gerberi, Bruno Adler Maccagnan Pinheiro Besen, Lucas Oliveira J E Silva","doi":"10.1097/MEJ.0000000000001338","DOIUrl":"10.1097/MEJ.0000000000001338","url":null,"abstract":"<p><strong>Background and importance: </strong>Emergency tracheal intubation in critically ill adults is associated with a high risk of peri-intubation adverse events, making first-attempt success a key safety target.</p><p><strong>Objective: </strong>This study aimed to evaluate whether the use of neuromuscular blocking agents (NMBAs) improves the proportion of first-attempt success and reduces adverse events during emergent intubations outside the operating room.</p><p><strong>Methods: </strong>This was a systematic review and meta-analysis of randomized clinical trials or nonrandomized studies comparing sedative-hypnotic plus NMBA versus sedative-hypnotic alone in critically ill adults undergoing emergency endotracheal intubation in nonoperative settings. Animal, cadaveric, manikin/simulation, and pediatric studies were excluded. Articles were screened on 21 August 2025, in Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection.</p><p><strong>Main results: </strong>Of 4736 screened citations, 13 studies (8 cohort; 5 before-after studies) were included in the quantitative analysis, with 14 072 participants. NMBA use was associated with higher first-attempt success, which ranged from 69 to 92% (pooled odds ratio, 2.72; 95% onfidence interval: 1.42-5.21; low-certainty evidence). Secondary outcomes related to adverse events were rated as very low certainty due to sparse data, inconsistent reporting, and serious imprecision.</p><p><strong>Conclusion: </strong>NMBA use during emergency intubation was associated with improved first-attempt success, although the certainty of evidence was low.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"324-333"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644384","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":"Patient safety incidents reported by patients and witnesses in prehospital emergency medical services: a multicentre prospective study.","authors":"Juan Antonio Péculo-Carrasco, Carlos Romero-Olóriz, Carmen Gutiérrez-García, Lorena Cuesta-García, Cristina López-López, María José Luque-Hernández","doi":"10.1097/MEJ.0000000000001380","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001380","url":null,"abstract":"<p><strong>Background and importance: </strong>Patient safety incidents - events or circumstances that could have resulted, or did result, in unnecessary harm to a patient, and referred to hereafter as incidents - fall into four categories: reportable circumstances, near misses, no-harm incidents, and harmful incidents ('adverse events'). In prehospital emergency medical services (EMS), most research has addressed only harmful incidents, leaving the other three categories poorly characterized.</p><p><strong>Objectives: </strong>The primary objective was to determine the frequency of incidents reported by patients and witnesses after prehospital EMS care.</p><p><strong>Design: </strong>Multicenter prospective study, following the Strengthening the Reporting of Observational Studies in Epidemiology statement.</p><p><strong>Settings and participants: </strong>The eight provincial EMS services of Andalusia, Spain (April 2021-March 2022). Recruitment was consecutive. Eligible participants were patients transported to the hospital by EMS teams, or a witness if not possible, interviewed by telephone 15-20 days after the episode (the EMS attendance and hospital transport).</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was incident reporting frequency; secondary outcomes were reported harm, sociodemographic characteristics, and a single-item safety self-rating (a four-point scale: 'very safe', 'safe', 'fairly safe', or 'unsafe'). Rather than relying on spontaneous or passive reporting, data were collected through a systematic, structured telephone interview in which participants were explicitly asked whether four specific incidents - error, fall, harm or injury, or another incident described in their own words - had occurred. Frequencies were reported with confidence intervals (CIs); secondary associations used bivariable analyses and, for sociodemographic characteristics, binary logistic regression, with CIs unadjusted for multiplicity.</p><p><strong>Main results: </strong>Among 3156 episodes (1756 patients and 1400 witness respondents; response rate 40.4%), an incident was reported in 166 (5.3%; 95% CI = 4.55-6.08). Reported harm was identified in 58 of these incidents (34.9%), leaving two-thirds without reported harm. During the same interview, incident reporting rose from 2.8% among respondents who felt 'very safe' to 26.3% among those who felt 'unsafe'.</p><p><strong>Conclusions: </strong>In this prospective study, systematic follow-up of patients and witnesses of EMS transportation identified a declared safety incident in 5.3% of episodes, most of them without reported harm.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073881","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":"Workplace violence and safety perception in emergency medicine system: The Emergency Medicine Day International Survey across 81 countries.","authors":"Roberta Petrino, Luis Garcia Castrillo, Abdo Khoury, Diana Cimpoesu, Saleyha Ahsan, Alberto Teggi, Elisabetta Mariotto, Ilenia Mascherona","doi":"10.1097/MEJ.0000000000001375","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001375","url":null,"abstract":"<p><strong>Background and importance: </strong>Workplace violence is a major occupational hazard in emergency care, yet most evidence derives from single-country studies. International data on workplace safety climate and organizational preparedness remain limited.</p><p><strong>Objectives: </strong>To assess workplace safety perception by describing the epidemiology and characteristics of workplace violence among emergency department (ED) and emergency medical services (EMS) professionals, and to identify factors associated with safety perceptions, organizational preparedness, reporting practices, and violence prevention measures.</p><p><strong>Design, settings, and participants: </strong>International cross-sectional online survey conducted from May to June 2026 among ED and EMS professionals. The questionnaire was distributed through the European Society for Emergency Medicine and partner organizations. Of 2199 consenting respondents, 1306 complete questionnaires from 81 countries were included in the analysis.</p><p><strong>Outcomes measure and analysis: </strong>The primary outcome was overall safety estimation, measured on a 7-point Likert scale (0 = very safe; 6 = very unsafe). Secondary outcomes included workplace violence exposure, organizational preparedness, prevention strategies, and reporting practices. Descriptive statistics and comparative analyses were performed using complete-case analysis.</p><p><strong>Main results: </strong>The mean overall safety estimation score was 3.26, indicating moderate concern regarding workplace safety. Overall, 75.04% of respondents witnessed workplace violence in the previous year; 68.8% experienced psychological harm, and 40.3% physical harm. Verbal aggression (87.8%) was the most common form of violence, with patients as the principal perpetrators (67.6%). Alcohol/drug intoxication and ED crowding were identified as the leading contributors. Only 51.1% had received formal violence-prevention training, and 57.3% had access to psychosocial support following violent incidents.</p><p><strong>Conclusion: </strong>Workplace violence is highly prevalent across emergency care systems worldwide and reflects broader organizational safety challenges. Comprehensive prevention strategies, including staff training, improved organizational measures, effective reporting systems, and psychological support, are needed to strengthen workplace safety and emergency care resilience.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037421","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":"Focused transthoracic echocardiography in acute pulmonary embolism: a systematic review and meta-analysis of diagnostic accuracy.","authors":"Nick Mani, Eleanor Morris, Amir Tahvili","doi":"10.1097/MEJ.0000000000001378","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001378","url":null,"abstract":"<p><p>Computed tomography pulmonary angiography is the diagnostic gold standard for acute pulmonary embolism, but delays and radiation risks necessitate rapid bedside alternatives. To evaluate the diagnostic accuracy of isolated point-of-care focused echocardiography and a combined approach of focused echocardiography and lower limb deep vein ultrasound for suspected acute pulmonary embolism. Systematic review and meta-analysis. Adult patients presenting to acute healthcare settings with suspected acute pulmonary embolism. Specific morphological signs [dilated right ventricle (RV), tricuspid annular plane systolic excursion] and highly specific functional signs [McConnell's sign, the 60/60 sign, abnormal interventricular motion, RV outflow tract early systolic notching (ESN), and clot-in-transit] assessed via isolated focused echocardiography, alongside a combined echocardiography and deep vein ultrasound strategy. Bivariate random-effects meta-analysis to determine pooled sensitivity and specificity. Thirty-three studies (3981 patients) were included. Isolated focused echocardiography signs demonstrated poor sensitivities (0.03-0.65) but high specificities, including McConnell's sign (0.98), the 60/60 sign (0.93), and RV outflow tract ESN (0.98). The combined echocardiography and deep vein ultrasound approach yielded a pooled sensitivity of 0.62 and a pooled specificity of 0.98. In this meta-analysis, isolated focused echocardiography signs demonstrated a reportedly low sensitivity but high specificity for the diagnosis of acute pulmonary embolism. Integrating lower limb deep vein ultrasound improves diagnostic sensitivity, though definitive exclusion still requires computed tomography.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030087","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":"Utility and outcomes of prehospital vasopressors infusion in trauma patients: a systematic review.","authors":"Ayman El-Menyar, Fernando Spencer Netto, Ibrahim Al-Hassani, Airton Leonardo de Oliveira Manoel, Sandro Rizoli, Ahammed Mekkodathil, Ian Ronald Howland, Ahmad Kloub, Gustav Strandvik, Łukasz Szarpak, Basar Cander, Hassan Al-Thani","doi":"10.1097/MEJ.0000000000001379","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001379","url":null,"abstract":"<p><p>Traumatic hemorrhagic shock (THS) remains a leading cause of potentially preventable mortality in the prehospital setting. The role of prehospital vasopressors (PhVP) before definitive hemorrhage control during prehospital trauma management remains uncertain. We aimed to evaluate the utility and association between PhVP use and clinical outcomes in trauma patients presenting with hypotension or at risk of the THS. A systematic review of observational studies was conducted and studies were retrieved through MEDLINE/PubMed and CENTRAL databases search between 2015 and 2026. Studies participants were adult trauma patients with hypotension or at risk of THS receiving continuous infusion of PhVP compared with those who received prehospital standard care alone. Outcomes included all-cause in-hospital mortality, massive blood transfusion use, and trauma-induced coagulopathy (TIC). Risk of bias, study selection, and certainty of evidence were independently evaluated, followed by qualitative synthesis. Among 678 records identified, five retrospective studies (31 849 patients) were eligible. A total of 1443 patients received PhVP, with substantial variation in exposure across studies. Two studies reported no significant association between PhVP and mortality after adjustment, while another two showed a significant association. A military study revealed significantly lower adjusted survival [adjusted odds ratio (aOR): 0.32, 95% confidence interval (CI): 0.18-0.56]. One study showed a significant association between PhVP and massive blood transfusion use (aOR: 4.97, 95% CI: 1.24-19.91) and TIC (aOR: 3.05, 95% CI: 1.58-5.90). Current evidence on the utility and outcomes of PhVP in trauma is limited to very low-certainty observational data. Only one study showed a significant association between PhVP use and increased mortality after adjustment. Prospective studies are required to establish safety and specific clinical indications.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073862","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":"Real-time recording of senior emergency physicians' decisions in two NHS emergency departments: a feasibility study.","authors":"Kumater Iyol, Mehak Pirzada, Ahmad Mustafa","doi":"10.1097/MEJ.0000000000001374","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001374","url":null,"abstract":"<p><strong>Background and importance: </strong>Emergency physicians make repeated high-stakes decisions under sustained cognitive and operational pressure. However, the number of real-time decisions has not been studied in NHS emergency departments.</p><p><strong>Objective: </strong>This study aimed to assess the feasibility of prospectively recording decisions made by senior emergency physicians using handheld tally counters and describe variation across shift types.</p><p><strong>Design: </strong>Prospective, cross-sectional observational study.</p><p><strong>Settings and participants: </strong>Senior emergency physicians, including consultants, senior associate specialists, and registrars, at two district general hospitals within Sandwell and West Birmingham NHS Trust, UK.</p><p><strong>Intervention or exposure: </strong>Participants recorded each diagnostic, therapeutic, disposition, or operational decision during day (08:00-16:00), evening (16:00-22:00), and night (22:00-08:00) shifts using handheld counters.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was decisions per hour by site and shift. Counts were analyzed using Poisson regression with observation time as an offset, and additional sensitivity analyses were conducted to assess the consistency of the findings.</p><p><strong>Main results: </strong>A total of 5180 decisions were recorded over 504 observation hours, equivalent to 10.3 decisions per hour. Recorded decisions per hour were highest during evening shifts (12.6 per hour) compared with day (9.6 per hour) and night shifts (9.4 per hour). At both sites, evening rates were approximately 30% higher than day and night rates, which were similar to each other. This pattern remained consistent in sensitivity analyses.</p><p><strong>Conclusion: </strong>Real-time recording of senior emergency physicians' decisions using handheld counters was feasible in routine NHS emergency practice. Larger multicenter studies are needed to validate the method and explore associations with contextual and clinical outcomes.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015827","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 versus in-hospital unfractionated heparin in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis.","authors":"Yee-Jen Wu, Hung-Ju Lin, Yen-Hung Lin, Chi-Sheng Hung","doi":"10.1097/MEJ.0000000000001371","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001371","url":null,"abstract":"<p><strong>Background and importance: </strong>In patients with ST-segment elevation myocardial infarction (STEMI), myocardial loss continues until coronary reperfusion is achieved.</p><p><strong>Objective: </strong>To evaluate whether prehospital administration of unfractionated heparin (UFH) improves preprocedural infarct-related artery patency and clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI).</p><p><strong>Design: </strong>Systematic review and meta-analysis. Electronic databases (PubMed, EMBASE, CENTRAL, and Web of Science) and clinical trial registries were systematically searched through March 2026.</p><p><strong>Settings and participants: </strong>Patients with STEMI scheduled for primary PCI across seven included studies (two randomized controlled trials and five observational studies), totaling 10 954 participants, with 78.1% male patients.</p><p><strong>Intervention or exposure: </strong>Prehospital UFH administration compared with PCI-capable hospital UFH administration.</p><p><strong>Outcome measures and analysis: </strong>Prespecified endpoints included pre- and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade, 30-day mortality, a composite endpoint of 30-day or in-hospital mortality, and major bleeding events.</p><p><strong>Main results: </strong>Prehospital UFH was associated with a significantly higher rate of preprocedural TIMI 2-3 flow compared with control [odds ratio (OR): 1.49, 95% confidence interval (CI): 1.28-1.74; P < 0.001). Prehospital UFH was not associated with a significant reduction in 30-day all-cause mortality (OR: 0.70, 95% CI: 0.44-1.13; P = 0.141; I2 = 60.9%), although a significant reduction was observed for the composite endpoint of 30-day or in-hospital mortality across all seven studies (OR: 0.68, 95% CI: 0.49-0.95; P = 0.023). Prehospital UFH was not associated with a significantly increased risk of major bleeding (OR: 0.77, 95% CI: 0.57-1.05; P = 0.099; I2 = 0%).</p><p><strong>Conclusion: </strong>In patients with STEMI undergoing primary PCI, prehospital UFH was associated with improved preprocedural coronary patency without an apparent increase in major bleeding. However, no statistically significant reduction was observed in 30-day mortality. Large-scale randomized controlled trials adequately powered for clinical endpoints are needed to establish the role of prehospital UFH in contemporary STEMI care.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879584","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":"Point-of-care ultrasound during advanced life support: beyond reversible causes.","authors":"Dorota Sobczyk, Robert K Szymczak, Jakub Czerwiec","doi":"10.1097/MEJ.0000000000001372","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001372","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873294","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":"Expected benefits from artificial intelligence in out-of-hospital cardiac arrest.","authors":"Chiara Lazzeri, Adriano Peris","doi":"10.1097/MEJ.0000000000001367","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001367","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668741","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}