European Journal of Emergency Medicine最新文献

{"title":"Topical anesthetic cream vs. lidocaine infiltration for superficial laceration repair in the emergency department: a randomized clinical trial.","authors":"Jean-Christophe Callahan, Marion Le Pottier, Mario Di Rollo, Benjamin Wintenberger, Delphine Douillet","doi":"10.1097/MEJ.0000000000001342","DOIUrl":"10.1097/MEJ.0000000000001342","url":null,"abstract":"<p><strong>Background and importance: </strong>Superficial skin lacerations requiring local anesthesia before suture are common in emergency departments (EDs). Lidocaine infiltration is effective but involves needle use, which may cause pain, discomfort, and increase patient anxiety. Topical anesthetic cream offers a needle-free alternative, yet comparative evidence in adult ED populations remains limited.</p><p><strong>Objectives: </strong>To compare the analgesic efficacy of topical anesthetic cream with lidocaine infiltration for anesthesia during the repair of superficial skin lacerations in adult ED patients.</p><p><strong>Design: </strong>Randomized, open-label, superiority multicentric clinical trial.</p><p><strong>Settings and participants: </strong>The study was conducted in two EDs in France. Adult patients presenting with a superficial laceration requiring suturing were eligible.</p><p><strong>Intervention: </strong>Participants were randomized to receive either topical anesthetic cream applied before the procedure (a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) (intervention group) or standard lidocaine infiltration for local anesthesia (control group).</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was the maximum pain experienced throughout the waiting, preparation, and suturing phases, measured using a Numeric Rating Scale (NRS: 0-10). Secondary endpoints were patient and provider satisfaction, rescue infiltrations, the patients' self-assessment of their maximum pain during each phase, ED length of stay, 15-day adverse effects, and wound healing. Analyses were conducted in the as-randomized population.</p><p><strong>Main results: </strong>Between December 2017 and 2021, a total of 126 patients were enrolled [mean age: 47 ± 23, 40 (31.7%) were women]. Among them, 62 (49.2%) were randomized to receive topical anesthetic cream, and 64 (50.8%) received lidocaine infiltration. The mean maximum NRS pain score was 4.63 (±2.3) in the topical anesthetic cream group and 4.25 (±2.5) in the lidocaine group, with a mean difference of 0.38 (95% confidence interval: -0.47 to 1.22), indicating no statistically significant difference. Patient tolerance and ED length of stay were comparable between groups. No meaningful differences were observed in 15-day wound-healing complications.</p><p><strong>Conclusion: </strong>Among patients with superficial lacerations requiring suturing in the ED, the application of topical anesthetic cream was not associated with a significant difference in pain relief compared with lidocaine infiltration.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"264-271"},"PeriodicalIF":5.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671767","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":"Reaffirming the use of original pediatric parameters in the adult application of the Bacterial Meningitis Score.","authors":"Thomas Volpe, Anthony Chauvin","doi":"10.1097/MEJ.0000000000001311","DOIUrl":"10.1097/MEJ.0000000000001311","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 3","pages":"209-210"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766347","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":"Thermal comfort: the sixth vital sign?","authors":"Thomas Spadoni, Marc Leone, Thomas Dumontier","doi":"10.1097/MEJ.0000000000001319","DOIUrl":"10.1097/MEJ.0000000000001319","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"150-151"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212498","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":"Ten persistent misconceptions in sepsis and septic shock.","authors":"Matteo Guarino","doi":"10.1097/MEJ.0000000000001299","DOIUrl":"10.1097/MEJ.0000000000001299","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"144-146"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905969","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":"Artificial intelligence in emergency medicine: hallucination risks of large language models and mitigation approaches.","authors":"Sinan Pasli","doi":"10.1097/MEJ.0000000000001320","DOIUrl":"10.1097/MEJ.0000000000001320","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 3","pages":"141-143"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766274","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 2026 Surviving Sepsis Campaign guidelines: a turning point for emergency medicine.","authors":"Robert Leach, Myrto Bolanaki, Wilhelm Behringer, Hallie C Prescott, Yonathan Freund","doi":"10.1097/MEJ.0000000000001348","DOIUrl":"10.1097/MEJ.0000000000001348","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 3","pages":"139-140"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766330","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":"Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension.","authors":"Chaeeun Lee, Gil Joon Suh, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Tae Ho Lim, Sangchun Choi, Tae Gun Shin, Sangun Nah, Sangsoo Han","doi":"10.1097/MEJ.0000000000001317","DOIUrl":"10.1097/MEJ.0000000000001317","url":null,"abstract":"<p><strong>Background and importance: </strong>Hypotension and advanced-age are significant risk factors for increased sepsis-related mortality. However, the relationship between the timing of hypotension in the emergency department (ED) and the prognosis of elderly patients with septic shock is little understood.</p><p><strong>Objective: </strong>To determine the effect of hypotension on arrival at the ED with the prognosis of elderly patients with septic shock.</p><p><strong>Design, settings, and participants: </strong>A retrospective analysis of a multicenter registry that was prospectively collected from 12 EDs. Patients aged older than 65 years who were diagnosed with septic shock requiring vasopressor support from October 2015 to December 2022 were included. Hypotension was defined as a systolic blood pressure less than 90 mmHg or a mean arterial pressure less than 65 mmHg. Based on the timing of the first hypotension episode, patients were divided into two groups: the initial hypotension group (hypotension on arrival at the ED) and the delayed hypotension group (developed hypotension while staying in the ED).</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was 28-day mortality of elderly patients with septic shock, and the secondary outcomes were ICU admission, mechanical ventilation within 24 h, and renal replacement therapy (RRT) within 24 h. A multivariable Cox proportional hazards model was used to analyze the association between initial hypotension and the outcomes. A Kaplan-Meier curve was constructed to investigate the survival probabilities of the patients.</p><p><strong>Main results: </strong>This study included 1444 patients [868 (60.1%) with initial hypotension and 576 (39.9%) with delayed hypotension]. Initial hypotension was significantly associated with 28-day mortality [hazard ratio: 1.20, 95% confidence interval (CI): 1.00-1.45, P  = 0.049]. However, initial hypotension was not associated with ICU admission (hazard ratio: 1.13, 95% CI: 0.96-1.33, P  = 0.154), mechanical ventilation within 24 h (hazard ratio: 0.85, 95% CI: 0.69-1.06, P  = 0.147), or RRT within 24 h (hazard ratio: 1.05, 95% CI: 0.76-1.46, P  = 0.775).</p><p><strong>Conclusion: </strong>This study highlights the prognostic value of initial hypotension in elderly patients with septic shock, showing its association with a high risk of 28-day mortality.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"169-175"},"PeriodicalIF":5.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282995","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 application of the Bacterial Meningitis Score in adults requires that the assessed parameters are the same as in children.","authors":"Josef Finsterer","doi":"10.1097/MEJ.0000000000001308","DOIUrl":"10.1097/MEJ.0000000000001308","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 3","pages":"208-209"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766323","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 sex on syncope management in European emergency departments: the European Society for Emergency Medicine Research network Syncope in European Emergency Departments study.","authors":"Prabakar Vaittinada Ayar, David Kearns, Pradeebane Vaittinada Ayar, Said Laribi","doi":"10.1097/MEJ.0000000000001294","DOIUrl":"10.1097/MEJ.0000000000001294","url":null,"abstract":"","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":"33 3","pages":"197-202"},"PeriodicalIF":4.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766299","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":"Defining the need for analgesia in the emergency department: an international consensus statement.","authors":"Barbara Scotti, Christian H Nickel, Bojana Degen, Olivier Hugli, Sandy Jean-Scherb, Lucrezia Rovati, Monika Kirsch, Fiona C Sampson, Gernot Mayer, Heike Thomys, Bruno Minotti","doi":"10.1097/MEJ.0000000000001321","DOIUrl":"10.1097/MEJ.0000000000001321","url":null,"abstract":"<p><strong>Background and importance: </strong>The high prevalence of acute pain in the emergency department (ED) underscores the need for accurate pain assessment to guide effective interventions. A pain assessment tool for ED patients with acute pain should enable clinicians to distinguish those who require analgesia from those who do not. However, a universally accepted definition of the 'need for analgesia' is lacking.</p><p><strong>Objective: </strong>To identify predictors of the need for analgesia in ED patients through a consensus-based interdisciplinary approach.</p><p><strong>Design/setting and participants: </strong>A three-stage modified Delphi was conducted. In stage 1, 63 international panel members, including clinicians, researchers, patients, and patient representatives from 15 countries, answered three open-ended questions to generate candidate predictor variables. In stage 2, the same participants rated these variables using a five-point Likert scale. In stage 3, randomly selected clinicians and patients were recruited internationally to complete a survey rating the consensus-derived variables.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was the identification of variables defining the need for analgesia in ED patients without communication or cognitive impairments. Consensus was defined a priori as more than or equal to 80% of participants selecting 'agree' or 'strongly agree' after stage 2. Variables meeting this threshold were considered in the final consensus-derived items. Stage 3 aimed to evaluate agreement with these variables among a broader panel of frontline clinicians and patients, to assess alignment with the expert panel, primarily composed of researchers, while also addressing potential geographic and professional biases.</p><p><strong>Results: </strong>Stage 1 generated 20 potential clinical predictor variables to define the need for analgesia. In stage 2, the six consensus-derived variables were: (a) patient's perception of pain, (b) patient's desire for analgesia, (c) pain tolerance, (d) patient observation, (e) caregiver/relative's perception of the patient's pain, and (f) provider's perception of the patient's pain. In stage 3, the rating of these variables reached combined agreement ('agree' or 'strongly agree') ranging from 72% to 91%.</p><p><strong>Conclusion: </strong>The six consensus-derived variables provide a foundation for a multidimensional, patient-centered pain assessment framework, which will serve as the basis for developing and validating a new tool to improve analgesia for ED patients with acute pain.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":"176-184"},"PeriodicalIF":5.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282915","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}