European Journal of Emergency Medicine最新文献

{"title":"Effect of a liquid crystal vein locator on intravenous catheterization in young children: a randomized trial.","authors":"Han-Ping Wu, Bei-Cyuan Guo, Yu-Jun Chang, Chun-Yu Chen, Sheng-Ling Jan, En-Pei Lee","doi":"10.1097/MEJ.0000000000001355","DOIUrl":"10.1097/MEJ.0000000000001355","url":null,"abstract":"<p><strong>Background and importance: </strong>Peripheral intravenous catheterization (PIVC) in young children is notoriously challenging because of factors like poor patient cooperation and small vessel diameter. Repeated attempts cause distress and delay critical emergency treatment.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effect of a novel liquid crystal display-based near-infrared vein locator on PIVC performance in children aged under 3 years.</p><p><strong>Design: </strong>This is a prospective, randomized controlled trial.</p><p><strong>Settings and participants: </strong>A total of 105 children aged 0-3 years requiring PIVC were enrolled in a pediatric emergency department.</p><p><strong>Intervention: </strong>Participants were randomly assigned to undergo PIVC using either a liquid crystal vein locator (study group, n  = 50) or the traditional landmark-based method (control group, n  = 55).</p><p><strong>Outcome measures and analysis: </strong>The primary endpoint was the first-attempt success rate. Secondary endpoints included the number of puncture attempts, vein localization time, and total insertion time. Multivariable logistic and Poisson regression models were used to adjust for covariates, such as vein difficulty and patient demographics. Analyses included effect sizes with 95% confidence intervals (CIs).</p><p><strong>Main results: </strong>The baseline characteristics of both groups were comparable. The first-attempt success rate was significantly higher in the study group compared to the control group (86.0% vs. 54.5%; absolute difference: 31.5%; 95% CI: 15.2-47.8%). The study group also demonstrated a significantly shorter median vein localization time (16.5 vs. 60.0 s) and median total insertion time (40.0 vs. 185.0 s). In addition, the device significantly reduced the median number of puncture attempts (adjusted rate ratio: 0.77; 95% CI: 0.66-0.90). Multivariable analysis revealed that device assistance was an independent predictor of first-attempt success (adjusted odds ratio: 3.35; 95% CI: 1.13-9.95).</p><p><strong>Conclusion: </strong>In this study, the use of a liquid crystal vein locator was associated with a significantly higher first-attempt success rate, fewer puncture attempts, and reduced procedural times for PIVC in young children.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"248-254"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971506","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 department-based computed tomography scanners: rationale and clinical importance.","authors":"Wilhelm Behringer, Martin W Dünser, Harald Herkner, Christian Loewe, Christoph Testori","doi":"10.1097/MEJ.0000000000001344","DOIUrl":"10.1097/MEJ.0000000000001344","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"214-216"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867283","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 effect of feedback on the diagnostic process of physicians at the emergency department: a systematic review.","authors":"Laurens A Schols, Laura Zwaan, Andrea M Woltman, Renee A Scheepers, Juanita A Haagsma, Pleunie P M Rood","doi":"10.1097/MEJ.0000000000001337","DOIUrl":"10.1097/MEJ.0000000000001337","url":null,"abstract":"<p><p>In the emergency department (ED), the diagnostic process is complex. Discrepancies between the initial diagnosis in the ED and the final discharge diagnosis occur in 12-15%. Emergency physicians are often unaware of these discrepancies. Systematic feedback could serve as a valuable tool to enhance the diagnostic process. The potential methods and impact of such feedback remain poorly understood. This systematic review (PROSPERO: CRD42024491077) aimed to obtain insight into the types and timing of feedback provided to ED physicians about the diagnostic process and examined the effect on ED physicians' performance and confidence. Studies were included if they examined feedback on the diagnostic process to physicians in the ED. Five large international databases (MEDLINE, EMBASE, Cochrane libraries, Google Scholar, and Web of Science) were searched. Quality assessment was performed using Grading of Recommendations Assessment, Development and Evaluation. In total 1897 articles were screened, of which 11 were included in this review. Most of them were qualified as low-grade evidence. Feedback was given through in-person sessions, monthly group meetings, rapid diagnostic discussions, and computer-based feedback. Six studies reported feedback methods to improve diagnostic accuracy. Furthermore, reduction of adverse outcomes after feedback introduction was reported by two articles. Confidence was reported in one study. This review showed that - although there were few studies and generally of low quality - structured feedback may positively influence the diagnostic performance of ED physicians. The feedback strategies identified in this review could be used for future studies on their effectiveness. Furthermore, rigorous study designs, standardized outcome measures, and scalable feedback methods are needed.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"228-236"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697887","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 effect of oxygen administration on systemic oxidative stress in patients presenting in the emergency department: a prospective cohort study.","authors":"Renate Stolmeijer, Arno R Bourgonje, Harry van Goor, Ewoud Ter Avest","doi":"10.1097/MEJ.0000000000001347","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001347","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 4","pages":"289-291"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301370","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 a point-of-care ultrasound-driven diagnostic pathway on diagnostic certainty in emergency department patients with dyspnea: a randomized controlled substudy.","authors":"Stig Holm Ovesen, Søren Helbo Skaarup, Rasmus Aagaard, Bo Løfgren, Stefan Posth, Michael Dan Arvig, Christian B Laursen, Hans Kirkegaard, Jesper Weile","doi":"10.1097/MEJ.0000000000001331","DOIUrl":"10.1097/MEJ.0000000000001331","url":null,"abstract":"<p><strong>Background and importance: </strong>In emergency department (ED) patients with dyspnea, diagnostic uncertainty has been linked to poorer outcomes. Point-of-care ultrasound (POCUS) may help reduce this uncertainty.</p><p><strong>Objective: </strong>To explore how POCUS influences ED physicians' diagnostic thinking and perceived uncertainty.</p><p><strong>Design, settings, and participants: </strong>This preplanned substudy of a randomized controlled trial across 10 Danish EDs compared diagnostic pathways with vs. without focused lung and cardiac ultrasound.</p><p><strong>Outcomes measure and analysis: </strong>Paired physician surveys and electronic health record data were used to evaluate predefined outcomes: (a) physicians' experienced benefit of diagnostic tests; (b) the number of differential diagnoses; (c) posttest probability estimates; (d) concurrent treatment; and (e) concordance between tentative diagnoses. The primary outcome of the parent trial was discharge alive within 24 h; this substudy focused on early diagnostic reasoning and certainty.</p><p><strong>Main results: </strong>Between 25 January 2023 and 23 August 2024, 40 physicians enrolled 674 patients. The median number of differential diagnoses was similar between groups [intervention: 3 (interquartile range - IQR: 2-4); control: 3 (IQR: 2-4)]. The proportion of patients with a reduced differential count was 65.3 vs. 72.9% [risk difference: -7.6, 95% confidence interval (CI): -14.9 to -0.3]. The median estimated probability of the leading diagnosis was higher with POCUS (80 vs. 73%). Concordance between initial and revised physician diagnoses was also higher (70.6 vs. 63.1%; risk difference: 7.5, 95% CI: 0.1-15.0), while concordance with final hospital diagnoses was similar (35.9 vs. 38.9%, risk difference: -3.0, 95% CI: -10.4 to 4.4).</p><p><strong>Conclusion: </strong>A POCUS-driven diagnostic pathway increased early diagnostic certainty, but not diagnostic certainty at the time of patient disposition. This was reflected in a higher initial diagnostic probability for the primary diagnosis and greater concordance between the primary tentative diagnoses recorded in the paired surveys.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"272-281"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497947","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":"Public awareness and attitudes toward sudden cardiac arrest in Lebanon.","authors":"Sabah Hammoud, Raghida Damaj, Racha Daher, George W Booz, Mazen Kurdi","doi":"10.1097/MEJ.0000000000001334","DOIUrl":"10.1097/MEJ.0000000000001334","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"282-284"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940498","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 patient-to-nurse ratios in emergency departments and patient, staff, and organizational outcomes: a systematic review.","authors":"Clémence Rivet, Hélène Amazouz, Matthieu Gratacap, Quentin Delannoy, Youri Yordanov, Judith Leblanc","doi":"10.1097/MEJ.0000000000001350","DOIUrl":"10.1097/MEJ.0000000000001350","url":null,"abstract":"<p><p>Background In many settings, studies have shown that establishing patient-to-nurse ratios has benefits for both patients and staff. Whether this is transposable to emergency department (ED) is unclear. Objective The primary objective was to assess the association between patient-to-nurse ratios in EDs and mortality. Design In this systematic review, a search strategy identified studies published in 2004-2025 in MEDLINE, Cochrane, and CINAHL. Two independent reviewers performed selection and data extraction, followed by a narrative synthesis. Outcomes The primary outcome was in-hospital mortality. Secondary outcomes were other patient outcomes, staff, and organizational outcomes. Results Of 2214 identified references, 17 studies were included and all of which were observational. The primary outcome was assessed in only one cohort study ( n  = 73 EDs), where an increase in the number of nurses per patient was associated with a reduction in ED mortality (adjusted odds ratio = 0.68; 95% confidence interval: 0.49; 0.94). An increase in the number of nurses per patient was also associated with a reduction in cardiac arrests (one study: relative risk = 1.33, 95% confidence interval: 1.05, 1.67 for ≥8.5 patients/nurse vs. <8.5) and medication errors (one of two studies), and an improvement in patient experience (two studies) and nurse satisfaction (one study). Mixed results were observed with regard to reducing length of stay (one of two studies), administration time (three of four studies) and the number of patients who left without being seen (three of four studies), while waiting time before diagnosis or treatment improved (three studies). Conclusion Although evidence is limited, several observational studies suggest that a higher nurse-to-patient ratio is associated with better patient, nurse, and ED organizational outcomes.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"237-247"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971527","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":"Low-value care in prehospital emergency medicine: the unspoken challenge.","authors":"Marián Sedlák","doi":"10.1097/MEJ.0000000000001326","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001326","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 4","pages":"217-218"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301388","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":"Trends in ketamine-related emergency department presentations across European centres: a Euro-DEN Plus Study (2013-2023).","authors":"Matthew L Naylor, Alison M Dines, David M Wood","doi":"10.1097/MEJ.0000000000001343","DOIUrl":"https://doi.org/10.1097/MEJ.0000000000001343","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 4","pages":"285-288"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301341","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":"Response to the letter 'Mental illness and epilepsy are not attributable to out-of-hospital resuscitation after cardiac arrest unless other causes have been ruled out'.","authors":"Ping-Kun Tsai, Han-Wei Yeh, Chung-Hsien Chaou, Pei-Lun Liao, Jing-Yang Huang, Chao-Bin Yeh","doi":"10.1097/MEJ.0000000000001339","DOIUrl":"10.1097/MEJ.0000000000001339","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 4","pages":"293-294"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301373","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}