European Journal of Emergency Medicine最新文献

{"title":"Ventilation feedback devices in cardiopulmonary resuscitation: bridging the gap for optimal resuscitation practices.","authors":"Abdo Khoury, Said Hachimi-Idrissi","doi":"10.1097/MEJ.0000000000001252","DOIUrl":"10.1097/MEJ.0000000000001252","url":null,"abstract":"","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":"144599772","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":"Prelaryngoscopy predictors of first-attempt success in pediatric out-of-hospital intubation: a retrospective cohort study.","authors":"François Javaudin, Mathilde Papin, Louis-Marie Bodet, Joël Jenvrin, Philippe Pes, Quentin Le Bastard","doi":"10.1097/MEJ.0000000000001256","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001256","url":null,"abstract":"<p><strong>Background: </strong>Pediatric out-of-hospital tracheal intubation is associated with lower success rates compared with adult populations and presents distinct clinical challenges. Achieving success on the first attempt is critical, as multiple intubation attempts are associated with an increased risk of adverse events.</p><p><strong>Objectives: </strong>The aims were to identify factors available before laryngoscopy that are independently associated with first-attempt success in pediatric out-of-hospital intubation and to evaluate the performance of a gestalt evaluation of intubation difficulty scale.</p><p><strong>Methods: </strong>Data were extracted from a retrospective, observational, multicenter cohort study conducted in three physician-staffed mobile intensive care units (ICUs) in France. The study included patients aged 0-17 years who required out-of-hospital airway management. The primary outcome was successful intubation on the first attempt. A multivariable logistic regression model was constructed including clinically relevant variables available before laryngoscope insertion.</p><p><strong>Results: </strong>A total of 206 pediatric patients were included in the analysis, with a median age of 6 years (interquartile range: 1-16). The overall first-attempt success rate was 59.7% [95% confidence interval (CI): (52.7-66.4)]. In the multivariable analysis, patient age [adjusted odds ratio (aOR): for 2-9 years, 2.33, 95% CI: (1.00-5.39); for 10-17 years, 3.86, 95% CI: (1.55-9.60); reference: 0-1 years] and presence of a soiled airway before laryngoscopy [aOR, 0.38, 95% CI: (0.20-0.71)] were independent predictors of successful intubation on the first attempt. The gestalt evaluation of the intubation difficulty scale yielded an area under the receiver operating characteristic curve of 0.63, 95% CI: (0.56-0.71), and it showed only a weak correlation with the Cormack-Lehane grade (Kendall tau-b = 0.36; P < 0.001).</p><p><strong>Conclusion: </strong>In this cohort of pediatric tracheal intubation procedures performed by physician-staffed mobile ICUs, soiled airways and younger age were associated with a lower incidence of first-attempt success. The gestalt evaluation of intubation difficulty demonstrated poor discriminative ability.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539628","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":"Reducing administrative burden in emergency departments using artificial intelligence: a workflow-based analysis.","authors":"Danusha Sanchez, Frederic Paris, Said Laribi, Allison Gilbert","doi":"10.1097/MEJ.0000000000001251","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001251","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539629","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":"Mild traumatic injuries evaluation using caller smartphone camera by medical dispatchers: a randomized controlled study.","authors":"Salomé Nanou, Edouard Magimel Pelonnier, Jérémy Guenezan, Nicolas Marjanovic","doi":"10.1097/MEJ.0000000000001215","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001215","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"213-215"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968464","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":"Systematic vitamin K antagonist reversal with prothrombin complex concentrate in patients with mild traumatic brain injury: randomized controlled trial.","authors":"Delphine Douillet, Karim Tazarourte, Emilie Dehours, Christian Brice, Hery Andrianjafy, Albert Trinh-Duc, Sigismond Lasocki, Matthieu Labriffe, Jérémie Riou, Pierre-Marie Roy","doi":"10.1097/MEJ.0000000000001199","DOIUrl":"10.1097/MEJ.0000000000001199","url":null,"abstract":"<p><strong>Background and importance: </strong>Traumatic brain injury (TBI) in patients on vitamin K antagonists (VKAs) is linked to a high rate of intracranial hemorrhage (ICH). Rapid reversal can reduce ICH progression and mortality, but its effectiveness depends on the time between bleeding onset and coagulation normalization.</p><p><strong>Objective: </strong>The PREVACT study aimed to assess the efficacy and safety of prompt systematic reversal of anticoagulation in patients presenting to emergency departments (EDs) for recent mild-TBI while receiving a VKA.</p><p><strong>Intervention: </strong>A randomized, open-label, blinded-endpoint clinical trial was conducted in 21 French EDs. Patients receiving a VKA, having experienced a TBI within the last 6 h, and presenting a Glasgow Coma Score ≥13 were included. Patients were randomized to systematic immediate VKA reversal with 25 IU/kg of four-factor prothrombin complex concentrate (4f-PCC) before any investigation (intervention group) or standard-of-care signifying reversal only if the initial cranial computed tomography (CT) scan indicated ICH (control group). The primary outcome was the rate of ICH detected on a cranial CT scan 24 h post-inclusion.</p><p><strong>Results: </strong>The study was prematurely stopped for logistic reasons after the randomization of 202 patients (101 and 101 in the intervention and control groups, respectively, mean age 90; 51.8% female). On the 24-h cranial CT scan, 6 of 98 patients (6.1%) in the intervention group manifested ICH vs. 12 of 99 patients (12.1%) in the control group [odds ratio: 0.47 (95% confidence interval: 0.14-1.44); P  = 0.215].</p><p><strong>Conclusion: </strong>In patients with recent mild-TBI receiving a VKA, systematic prompt reversal with 4f-PCC did not statistically significantly reduce ICH rate at 24 h. However, the study was prematurely stopped and does not exclude a clinically relevant benefit of the strategy tested.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT01961804).</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"180-187"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996300","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":"Changes in emergency healthcare use following intervention by Navigator, an emergency department social support programme: a multi-centre retrospective before-and-after study.","authors":"Ryan D McHenry, Christine A Goodall","doi":"10.1097/MEJ.0000000000001206","DOIUrl":"10.1097/MEJ.0000000000001206","url":null,"abstract":"<p><strong>Background and importance: </strong>Patients living with social deprivation, and those with experiences of violence, substance misuse, mental ill-health and homelessness are known to use emergency departments (EDs) more often. It is not known whether a programme of social support initiated during ED attendance may lead to a reduction in healthcare use.</p><p><strong>Objectives: </strong>The objective of this study is to determine the change in emergency, inpatient and outpatient healthcare use following a social support programme, Navigator, initiated during an ED attendance.</p><p><strong>Design: </strong>Retrospective before-and-after study.</p><p><strong>Settings and participants: </strong>Adult patients ≥16 years, attending EDs in the West of Scotland from 14 th September 2016 to 10 th March 2023, with a Navigator programme encounter.</p><p><strong>Intervention or exposure if any: </strong>The Navigator social support programme, delivered by trained support workers, initiated during ED attendance, and targeting patients affected by issues including violence, substance misuse, mental ill-health, domestic abuse and homelessness.</p><p><strong>Outcome measures and analysis: </strong>Healthcare use rates in the 365 days following intervention, as change compared to those in the 365 days prior to the intervention. The primary outcome was the number of ED attendances in the year following intervention compared with the year prior to intervention. Secondary outcomes included inpatient admissions, inpatient bed days, outpatient appointments and outpatient appointments where the patient did not attend. Changes in use rates were analysed with negative binomial regression and reported as incidence rate ratios for interpretation as percentage change. Analysis was repeated for a subgroup of frequent attenders to the ED.</p><p><strong>Main results: </strong>Of 1421 Navigator programme encounters, 1056 were included for analysis. Median attendance in the year prior to intervention was 3 [interquartile range (IQR) 1-5], and in the year following intervention was 2 (IQR 0-4). Negative binomial regression demonstrated that in the year following Navigator intervention, there was a 29% (95% confidence interval: 24-33%) reduction in ED attendances.</p><p><strong>Conclusion: </strong>The Navigator programme was associated with reduced emergency and acute healthcare use in the year following intervention, with increased scheduled outpatient care. There is the potential for a social support programme, delivered from the ED, to change patterns of healthcare use, and future work should consider prospectively assessing the impact of such an intervention.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"188-193"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766876","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":"Qualitative research in emergency medicine, closing the implementation gap.","authors":"Marc Sabbe, Annmarie Lassen, Bas de Groot","doi":"10.1097/MEJ.0000000000001232","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001232","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"151-152"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975681","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":"Fifty years of emergency medicine randomized controlled trials in the four major medical journals.","authors":"Antoine Letzelter, Nicolas Peschanski, Jeannot Schmidt, Jean-Baptiste Bouillon-Minois","doi":"10.1097/MEJ.0000000000001209","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001209","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"153-154"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063027","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":"Procedural sedation in the emergency department by Italian emergency physicians: results of the SEED SIMEU registry.","authors":"Davide Lison, Bartolomeo Lorenzati, Elisabetta Segre, Emanuele Bernardi, Peiman Nazerian, Adriana Gianno, Alice Bruno, Federico Baldassa, Maria Tizzani, Valerio T Stefanone, Matteo Borselli, Luca Dutto, Maria Grazia Veglio, Andrea Landi, Flavia Soardo, Gian A Cibinel","doi":"10.1097/MEJ.0000000000001210","DOIUrl":"10.1097/MEJ.0000000000001210","url":null,"abstract":"<p><strong>Background and importance: </strong>Effective and safe procedural sedation is pivotal for the quality of care in the emergency department (ED).</p><p><strong>Objectives: </strong>The aim of this work is to evaluate the feasibility, effectiveness, and safety procedural sedation performed by emergency physicians in the ED setting in Italy.</p><p><strong>Design/setting and participants/intervention: </strong>Following a specific training of the staff and with the adoption of a standardized protocol, a registry of procedural sedations performed on adult patients in 10 Italian EDs was compiled from 2019 to 2022; the following basic data were recorded: demographic and clinical information, procedure's indication, administered drugs, predefined, and actual sedation level.</p><p><strong>Outcome measures and analysis: </strong>Effectiveness was evaluated considering three parameters: successful completion of the procedure, absence of procedural pain, and no memory of the procedure; adverse events were classified according to the World Society of Intravenous Anaesthesia criteria and evaluated taking into account clinical and procedural variables.</p><p><strong>Main results: </strong>The study included 1349 patients (median age 68 years, male 64%). Sedation was performed for electrical cardioversion (66.3%), orthopedic procedures (23.2%), or other procedures (10.5%). Propofol (67%) and midazolam (24.2%) were the two most frequently used sedatives and 70.6% of the patients achieved a deep level of sedation.Procedural failure occurred in 4.6% of cases, with no significant differences between procedure types or drugs used. Recall of the procedure and procedural related pain were reported by 2.9% and 2.6% of patients, respectively, and were more frequently related to orthopedic procedures, midazolam use - if compared with propofol, and lower levels of sedation.A total of 135 adverse events were observed, with an overall incidence of 10%: 38 minimal adverse events (2.8%), 38 minor adverse events (2.8%), and 59 moderate adverse events (4.4%). There were no adverse events requiring unplanned hospital admission or escalation of care, and no sentinel adverse events were observed. All adverse events were resolved with simple and noninvasive treatments. The incidence of adverse events was greater with higher American Society of Anesthesiologists class, intermediate/difficult airway, and deeper sedation levels.</p><p><strong>Conclusion: </strong>Procedural sedation performed in Italian EDs by emergency physicians, with propofol as main sedative, was effective and safe, and has comparable adverse event rates with previous international studies.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"194-201"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881578","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":"A valuable assessment, yet the horizon shifts beyond traditional point-of-care echocardiography.","authors":"Martin Jakl, Petr Grenar","doi":"10.1097/MEJ.0000000000001218","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001218","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"32 3","pages":"225"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974183","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}