European Journal of Emergency Medicine最新文献

{"title":"Multitasking in emergency medicine.","authors":"Christoph Dodt","doi":"10.1097/MEJ.0000000000001236","DOIUrl":"10.1097/MEJ.0000000000001236","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"231-232"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","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":"In memory of Dr Eric Revue.","authors":"Abdo Khoury, Youri Yordanov, Anthony Chauvin, Patrick Plaisance","doi":"10.1097/MEJ.0000000000001248","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001248","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 4","pages":"227-228"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483622","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":"Role of emergency departments in HIV screening in Barcelona (Spain) and impact of a targeted opt-in strategy for HIV testing.","authors":"Míriam Carbó, Emília Miró, Juan Carlos Hurtado, Agustín Ávila, Neus Robert, Gema Fernández Rivas, Jordi Llaneras, Ariadna Randó Segura, Josep Maria Guardiola, Elisenda Miró, Laia Sentís, Juan González Del Castillo, Emili Gené, Òscar Miró","doi":"10.1097/MEJ.0000000000001229","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001229","url":null,"abstract":"<p><strong>Background: </strong>Undiagnosed HIV-infected patients are mainly responsible for viral transmission in Western countries. Emergency departments (EDs) could represent a strategic point in healthcare systems to uncover HIV infection.</p><p><strong>Objective: </strong>This study aimed to analyze the time trends of HIV testing in EDs in Barcelona (Spain) and investigate if EDs have changed HIV screening patterns after the implementation of a targeted opt-in strategy for HIV testing.</p><p><strong>Design: </strong>This is a quasiexperimental (pre/post) study.</p><p><strong>Setting and participants: </strong>Monthly HIV tests performed by Microbiology Departments of four hospitals in Barcelona were recorded over 78 months, classified as ordered by ED or at other healthcare levels. Monthly ED attendances were compiled, along with new HIV diagnoses.</p><p><strong>Intervention: </strong>Implementation of an opt-in strategy to test every ED patient with targeted conditions (community-acquired pneumonia, herpes zoster, mononucleosis syndrome, chemsex, postexposure prophylaxis, sexually transmitted diseases) in addition to other classical reasons for HIV testing.</p><p><strong>Outcome measures and analysis: </strong>Determination of trends over time in HIV screening and new diagnoses in EDs during the 60-month preintervention and 18-month postimplementation periods, and estimation of the impact of intervention using interrupted time series analyses.</p><p><strong>Main results: </strong>A total of 659 885 HIV tests were performed, with 11 442 (1.7%) being ordered by EDs (0.29% of ED comers were tested), and 287 new HIV diagnoses made (positivity rate: 2.8%). During the preintervention period, HIV testing increased over time (overall and in EDs), new HIV diagnoses in EDs remained stable, and the rate of positive HIV tests decreased. The intervention increased the monthly average of HIV tests ordered in the ED by 106 (95% CI = 86-125), proportion of ED comers screened by 0.075% (95% CI = 0.032-0.118), and proportion of HIV tests made in Barcelona performed by EDs by 0.728% (95% CI = 0.424-1.032), but had no impact on new HIV diagnoses and rate of positive HIV tests in the EDs.</p><p><strong>Conclusion: </strong>In the last years, HIV screening in Barcelona increased, with EDs having a significant and increasing role in the overall HIV testing in Barcelona. The implementation of a targeted opt-in strategy for HIV screening in EDs increased the number of HIV tests performed, but not the number of HIV diagnoses made in EDs.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 4","pages":"278-287"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483625","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 socioeconomic status and nonurgent presentations to pediatric emergency departments: a retrospective study.","authors":"Alexandre Mancheron, Christophe Vincent-Cassy, Romain Guedj, Hélène Chappuy, Thibault De Groc, Marc Duval Arnould, Vincent Gajdos, Aurélien Galerne, Valérie Soussan-Banini, Luigi Titomanlio, Morgane Michel, Camille Aupiais","doi":"10.1097/MEJ.0000000000001217","DOIUrl":"10.1097/MEJ.0000000000001217","url":null,"abstract":"<p><strong>Background and importance: </strong>Access to healthcare remains a persistent challenge. Socially disadvantaged populations often encounter barriers to care and may frequently seek out emergency departments (EDs), including for nonurgent medical care.</p><p><strong>Objective: </strong>The objective of this study is to study the association between nonurgent presentations to pediatric EDs and patients' socioeconomic environment in an urban setting.</p><p><strong>Design, setting, and participants: </strong>A retrospective study of all visits to a pediatric ED in eight participating centers of the Paris metropolitan area (France) between 1 January 2017 and 31 December 2021 was carried out. Routinely collected data were analyzed.</p><p><strong>Exposure: </strong>Socioeconomic status was evaluated using ecological variables defined at the municipality level. These variables were collected from public sources and included a social deprivation index, the accessibility to general practitioners, the proportion of single-parent families, and the proportion of immigrants.</p><p><strong>Outcome measure and analysis: </strong>The primary endpoint was a nonurgent ED presentation, defined as being assigned one of the two lowest triage categories on a five-point scale. A multilevel logistic model assessed the association between nonurgent ED presentations and patients' characteristics, socioeconomic environment, and healthcare accessibility.</p><p><strong>Main results: </strong>Nonurgent visits accounted for 51.6% of the 1 499 108 visits during the study period. The admission rate was 2.1% for nonurgent presentations and 18.8% for urgent presentations. In the final multivariate model ( n  = 1 412 895 visits), after adjustment for sex, age, time of day, day of the week, month, and year, the risk of nonurgent presentation was significantly higher for children living in less advantaged areas and in areas where the rate of single-parent families was high. It was also higher for children living close to the ED.</p><p><strong>Conclusion: </strong>This extensive retrospective multicenter study emphasizes the increased risk of visiting EDs for nonurgent medical care among children from disadvantaged urban areas.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"268-277"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032783","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":"Detection of pathogenic microorganisms using metagenomic next generation sequencing for patients with suspected infection presenting in the emergency department.","authors":"Torsten H Schroeder, Mélissa Vanwynsberghe, Albion Dervishi, Heiner Stäudle","doi":"10.1097/MEJ.0000000000001239","DOIUrl":"10.1097/MEJ.0000000000001239","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 4","pages":"288-290"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483619","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":"Automated measurement of overnight stays in the emergency department: reliability of an indicator using electronic health records.","authors":"Mathieu Oberlin, Arnaud Etienne, Marc Noizet, Romain Hellmann, Tahar Chouihed","doi":"10.1097/MEJ.0000000000001245","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001245","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 4","pages":"295-296"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483618","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 performances of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis.","authors":"Chiao-Li Chuang, Hsin-Tzu Yeh, Kuang-Yu Niu, Chen-Bin Chen, Chen-June Seak, Chieh-Ching Yen","doi":"10.1097/MEJ.0000000000001235","DOIUrl":"10.1097/MEJ.0000000000001235","url":null,"abstract":"<p><strong>Background: </strong>The Sepsis-3 2016 definition defined sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Procalcitonin (PCT) and C-reactive protein (CRP) have been widely studied for the detection of sepsis according to the former definitions. This study aimed to evaluate the diagnostic performances of PCT and CRP for sepsis, according to the Sepsis-2 and Sepsis-3 definitions.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were searched. Original articles that reported both diagnostic performances of PCT and CRP for sepsis were included. The pooled sensitivity, specificity, diagnostic odds ratio, likelihood ratio, and the area under the summary receiver operating characteristic curve (AUC) were calculated using the multiple thresholds model.</p><p><strong>Results: </strong>Forty-four studies with 10 755 patients between 1997 and 2024 were included. PCT exhibited a higher pooled AUC of 0.74 [95% confidence interval (CI), 0.62-0.84] compared with CRP, which had an AUC of 0.67 (95% CI, 0.56-0.77). Using sensitivity weighting of 50%, the optimal PCT and CRP cutoffs were 0.54 ng/ml (sensitivity: 0.70; specificity: 0.67) and 48 mg/L (sensitivity: 0.72; specificity: 0.55), respectively. The pooled AUC of PCT did not significantly differ between the Sepsis-2 and Sepsis-3 criteria. Sensitivity analyses showed overall performance was higher using the traditional bivariate model than the multiple thresholds model.</p><p><strong>Conclusions: </strong>Although PCT seems to slightly outperform CRP for the diagnosis of sepsis, its discriminatory power remains limited, highlighting the need for additional tools to improve sepsis diagnosis.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"248-258"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986662","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":"Effectiveness of venous transillumination on peripheral venous line placement in emergency departments patients with difficult vascular access: a multicentre cluster-randomised trial.","authors":"Maïa Simon, Catherine Staszewski, Séverine Luette, Cédric Quignard, Thomas Moitrier, Béatrix Ficher-Faivre, Anne Laure Matagne, Brigitte Goudot, Amandine Luc, Isabelle Adam, Charlène Duchanois, Déborah Jaeger, Tahar Chouihed, Nathalie Thilly","doi":"10.1097/MEJ.0000000000001258","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001258","url":null,"abstract":"<p><strong>Background and importance: </strong>Peripheral venous line placement is an essential procedure, but sometimes technically complex in emergency departments, particularly among patients with difficult vascular access. First-attempt failure rates are a commonly reported adverse event. Alternative procedures, such as ultrasound-guided peripheral venous line placement, require specialised training and resources, thus limiting their feasibility in urgent settings.</p><p><strong>Objective: </strong>This trial evaluated the effectiveness of a venous transillumination device compared with the usual method.</p><p><strong>Design, settings, and participants: </strong>This was a prospective, multicentre, cluster-randomised, and open-label study conducted across three hospitals in France between December 2021 and July 2023. Patients aged greater than or equal to18 years were included if they met at least one of nine predefined criteria for difficult vascular access: extreme BMI; hypotension; nonsupportive environment (e.g. poor lighting, incarceration, and external temperature <3 °C); history of drug abuse; limited venous capital (e.g. chemotherapy, long-term corticosteroid use, and radiotherapy); restricted puncture sites (e.g. arteriovenous fistula, hemiplegia, skin lesions, lymph node dissection, and postmastectomy); dehydration; generalised oedema; and hypothermia.</p><p><strong>Interventions: </strong>Participants were allocated to either the venous transillumination device group (intervention) or the usual method group (control) based on the week of inclusion.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was the percentage of first-attempt success rate. The secondary outcomes included the number of attempts before success, patients' pain, and nurses' stress levels.</p><p><strong>Main results: </strong>A total of 401 patients were included (181 in the control group and 220 in the intervention group). Median age was 62 (43-76), and 62% were women. Compared with the control group, the first-attempt success rate was significantly higher in the venous transillumination group: 70 vs. 41% [difference in percentage 29% (28 - 30%); P < 0.001]. The median number of attempts before success was lower [0.0 (0.0-1.0) vs. 1.0 (0.0-2.0); P < 0.001]. Patients' pain and nurses' stress scores did not differ between groups.</p><p><strong>Conclusion: </strong>In this study, the use venous transillumination device was associated to a significant improvement of the first-attempt success rate of peripheral venous line placement in patients with difficult access.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636527","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":"Rethinking defibrillation: a viewpoint on alternative strategies for refractory ventricular fibrillation.","authors":"Benedetta Perna, Michele Domenico Spampinato, Roberto De Giorgio, Matteo Guarino","doi":"10.1097/MEJ.0000000000001260","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001260","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636528","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":"Effect of pretreatment opioids on hemodynamics during emergency intubations: a systematic review.","authors":"Rafael Von Hellmann, Ian Ward A Maia, Brian E Driver, Julia M Dorn De Carvalho, Danielle Gerberi, Fernanda Bellolio, Lucas Oliveira J E Silva","doi":"10.1097/MEJ.0000000000001259","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001259","url":null,"abstract":"<p><p>Rapid sequence intubation in emergency settings may involve opioid pretreatment to blunt hemodynamic responses during laryngoscopy and intubation; however, opioids may lead to postintubation hypotension, increasing morbidity and mortality. Global clinical practice varies significantly, reflecting uncertainty about opioids' benefits and risks. Our goal was to evaluate the association between opioid pretreatment and hemodynamic instability, focusing on postintubation hypotension in adult patients undergoing emergency intubation. We performed a systematic review of randomized controlled trials and observational studies comparing opioid administration vs. no opioids before adult emergency intubations. Searches included Cochrane, Embase, Medline, Scopus, and Web of Science databases until November 2024. Elective intubations were excluded. Eight (6708 patients) studies met criteria. The primary outcome was postintubation hypotension, variably defined across studies. Secondary outcomes included hypoxemia, first-attempt success, cardiac arrest, and vasopressor use. Independent reviewers conducted data extraction, risk-of-bias assessments, and certainty evaluation. Results were qualitatively synthesized. Among 6708 (2757 opioids and 3951 controls) patients, postintubation hypotension incidence varied widely (risk differences: -12.5% favoring opioids to +13.2% favoring controls). The single low-risk randomized study reported opioids increased hypotension (risk difference: 13%, odds ratio: 2.15, 95% confidence interval: 1.22-3.78). Observational studies yielded inconsistent results. Secondary outcomes showed no consistent differences. Evidence certainty was very low because of risk of bias, inconsistency, and imprecision. Current evidence regarding opioid pretreatment effect on postintubation hypotension risk during emergency intubation is limited and conflicting.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599771","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}