European Journal of Emergency Medicine最新文献

{"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}

{"title":"Refrigerated crystalloids as a cooling adjunct in the hyperthermic older adult during heatwaves.","authors":"Paolo Sossai","doi":"10.1097/MEJ.0000000000001366","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001366","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668743","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":"Mental illness and epilepsy are not attributable to out-of-hospital resuscitation after cardiac arrest unless other causes have been ruled out.","authors":"João Gama-Marques, Josef Finsterer","doi":"10.1097/MEJ.0000000000001340","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001340","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 4","pages":"292-293"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301414","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 infection and mortality in acute heart failure in the emergency department: a cohort study.","authors":"Marianne Klinguer, Florian Zores, Mathieu Oberlin, Virginie Restouilh, Pierre Boyer, Sabrina Kepka, Pascal Bilbault, Julien Godet, Pierrick Le Borgne","doi":"10.1097/MEJ.0000000000001345","DOIUrl":"10.1097/MEJ.0000000000001345","url":null,"abstract":"<p><strong>Background and importance: </strong>Acute heart failure (AHF) is a frequent cause of emergency department (ED) admissions, yet the prognostic impact of infection as a trigger remains insufficiently characterized.</p><p><strong>Objective: </strong>To evaluate the impact of infection as a trigger of AHF on in-hospital mortality and postdischarge survival.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Settings and participants: </strong>All adult patients presenting with AHF to the ED of Strasbourg University Hospital in 2020 were included. Clinical and outcome data were collected from 1296 ED visits.</p><p><strong>Intervention or exposure: </strong>Infection and other AHF triggers were defined through adjudication based on clinical, imaging, and microbiological data collected throughout the hospital stay.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was in-hospital mortality. Analyses were performed using inverse probability weighting (IPW). Postdischarge survival was assessed using IPW-weighted Kaplan-Meier estimates and Cox models.</p><p><strong>Main results: </strong>Infection was identified in 119 ED visits [9.2%, 95% confidence interval (CI): 7.7-10.9]. Patients with infection had higher in-hospital mortality than those without infection (30.3% vs. 9.0%, P  < 0.001). In IPW-weighted analyses, infection was independently associated with in-hospital mortality [odds ratio (OR) = 2.76, 95% CI: 1.64-4.66]. In contrast, atrial fibrillation (OR = 0.45, 95% CI: 0.23-0.87) and acute coronary syndrome (OR = 0.08, 95% CI 0.01-0.58) were associated with lower in-hospital mortality. Infection was also associated with reduced postdischarge survival (hazard ratio = 1.64, 95% CI: 1.14-2.37, P  = 0.008).</p><p><strong>Conclusion: </strong>Infection is a strong and independent predictor of short- and long-term mortality in patients presenting with AHF in the ED.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"255-263"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766283","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":"Quality improvement in emergency medicine: a structured approach.","authors":"Jay Banerjee, Rosa McNamara, Una Geary","doi":"10.1097/MEJ.0000000000001327","DOIUrl":"10.1097/MEJ.0000000000001327","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"211-213"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431734","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":"Prevalence and incidence of pulmonary embolism in China: a scoping review.","authors":"Yulin Li, Mathilde Papin, Théophile Vieux, Amélie Vromant, Yonathan Freund, Héloïse Bannelier","doi":"10.1097/MEJ.0000000000001353","DOIUrl":"10.1097/MEJ.0000000000001353","url":null,"abstract":"<p><p>Pulmonary embolism is associated with significant in-hospital mortality and represents a major challenge to health systems worldwide. In Europe and North America, the reported incidence of pulmonary embolism has been reported more extensively, but data from China remain insufficient, with substantial discrepancies compared with Western epidemiology. To synthesize contemporary evidence on the epidemiology and diagnostic evaluation of pulmonary embolism in China, with emphasis on incidence and prevalence by denominator, care setting, and geographic distribution. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews-compliant scoping review of studies published from database inception to 30 May 2025, across international and Chinese databases. Eligible studies reported pulmonary embolism epidemiology in Chinese healthcare settings and provided calculable denominators (population, hospital admissions, or emergency department visits). Outcomes were analyzed separately by denominator and synthesized descriptively. Of 5199 records identified, 29 studies met the inclusion criteria, and 12 could be assessed for incidence or prevalence. Population-based incidence ranged from 1.2 to 11.7 per 100 000 person-years (four studies; median = 6.25). Among hospital admissions, pulmonary embolism prevalence ranged from 0.1 to 5.9‰ ( N  = 11), with multicenter and nationwide datasets reporting more consistent estimates around 1.1-1.2‰ ( N  = 2). Among emergency department visits, reported prevalences were 0.04and 1.1‰ ( N  = 2). No study reported the prevalence of pulmonary embolism among patients presenting with clinical suspicion of pulmonary embolism; estimates were rather derived from cohorts evaluated with imaging. Most studies were retrospective and conducted in tertiary hospitals, with geographic clustering in South China and North China. Reported pulmonary embolism incidence and prevalence in China vary substantially across different clinical settings. Population-based incidence is lower than in Western cohorts, whereas among selected emergency department patients undergoing imaging or diagnostic work-up for pulmonary embolism, positivity rates are higher than those reported in Western countries. These findings may suggest under-testing among Chinese emergency department patients.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"219-227"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867334","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}