Journal of Emergency Medicine最新文献

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00250-1","DOIUrl":"10.1016/S0736-4679(25)00250-1","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"74 ","pages":"Pages 142-143"},"PeriodicalIF":1.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322870","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":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00204-5","DOIUrl":"10.1016/S0736-4679(25)00204-5","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 130-131"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212501","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":"Evaluation of Barriers and Interventions for Emergency Department-Initiated Naltrexone for the Treatment of Alcohol Use Disorder","authors":"Ivan Covarrubias MD ,&nbsp;Hannah Dart MS ,&nbsp;Laurel Adams MBA ,&nbsp;Jeffrey Calvin Moon MD, MPH ,&nbsp;Samantha Huo MD, MPH ,&nbsp;Nicole O'Donnell ,&nbsp;Jeffrey Ebert PHD ,&nbsp;Madeline Fagen BA ,&nbsp;Ruiqi (Rachel) Yan MS ,&nbsp;Jeanmarie Perrone MD, FACMT ,&nbsp;Kit Delgado MD, MS","doi":"10.1016/j.jemermed.2025.01.001","DOIUrl":"10.1016/j.jemermed.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Alcohol use disorder (AUD) impacts 100 million people globally and frequently leads to emergency department (ED) visits. Although recent studies have shown that starting naltrexone in the ED can effectively reduce drinking behaviors, it remains underutilized.</div></div><div><h3>Objectives</h3><div>This study aims to identify the barriers clinicians and patients encounter when considering the initiation of naltrexone in the ED, and the interventions that could promote its prescription.</div></div><div><h3>Methods</h3><div>Using contextual inquiry, we observed ED operations and conducted open-ended interviews with clinicians, hospital staff, and patients in November 2023 to understand impediments to starting medications for AUD. In March 2024, a mixed-method survey was sent to 160 staff members within the University of Pennsylvania Health System, achieving a 61% response rate. This survey assessed comfort levels with various aspects of AUD treatment and the impact of potential interventions using a 10-point scale.</div></div><div><h3>Results</h3><div>Findings revealed significant barriers, including the absence of an AUD screening protocol, limited awareness about treatment options among clinicians, and a tendency to defer nonemergent treatments. Patients reported discomfort in ED settings, a lack of familiarity with treatment options, and challenges in accessing follow-up care. Clinicians felt least comfortable prescribing naltrexone and addressing related inquiries. Effective interventions identified included establishing a naltrexone order set for discharging patients and employing substance use navigators to facilitate continuing care.</div></div><div><h3>Conclusion</h3><div>The study finds that the under-treatment of AUD in the ED is a multifaceted issue that underscores the need to provide educational interventions to both patients and clinicians. Additionally, the results emphasize the need to simplify and streamline the process both clinicians and patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 63-70"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969479","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":"Intravenous Thrombolysis Plus Tirofiban in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis","authors":"Yuhan Liu MD ,&nbsp;Libin Zheng MD ,&nbsp;Chengcheng Zhang MD ,&nbsp;Pingping Wang MD ,&nbsp;Yixin Zhang MD ,&nbsp;Peiyue Peng MD ,&nbsp;Xinyu Zhang MD ,&nbsp;Qingfeng Ma MD, PhD ,&nbsp;Xun Li MD, PhD ,&nbsp;Lu Liu MD, PhD","doi":"10.1016/j.jemermed.2024.12.007","DOIUrl":"10.1016/j.jemermed.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Acute ischemic stroke is a cerebrovascular disease associated with high disability and mortality. Tirofiban, a platelet glycoprotein IIb/IIIa receptor antagonist, is used in conjunction with IV thrombolysis for bridging therapy, but its effectiveness and safety compared with IV thrombolysis alone in patients with stroke are not well-established.</div></div><div><h3>Objective</h3><div>The aim was to conduct a systematic review and meta-analysis to determine whether tirofiban increased the risk of poor outcomes and mortality in patients with stroke and accepted IV thrombolysis within the time window, or whether it can improve functional prognosis in follow-up.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, Cochrane Library, and Web of Science were searched for randomized controlled trials and observational studies from inception to June 15, 2023. Trials reporting the effectiveness and safety of tirofiban bridging after IV thrombolysis compared with thrombolysis only in patients with acute ischemic stroke were included.</div></div><div><h3>Results</h3><div>Two randomized controlled trials and 5 observational studies with 771 participants were included. Tirofiban plus IV thrombolysis significantly favored improved neurologic function based on both modified Rankin Scale 0–2 (risk ratio [RR] 1.38; <em>p</em> &lt; 0.001) and 0–1 (RR 1.54; <em>p</em> &lt; 0.001) at month 3. There was no significant difference in 3-month mortality risk, symptomatic intracranial hemorrhage on the seventh day, and systemic bleeding between the 2 groups (RR 1.11; <em>p</em> = 0.780; RR 0.68; <em>p</em> = 0.670; RR 1.97; <em>p</em> = 0.510).</div></div><div><h3>Conclusions</h3><div>Tirofiban plus intravenous thrombolysis was associated with better functional outcomes, but not symptomatic intracranial hemorrhage, systemic bleedings, or mortality among patients with acute ischemic stroke compared with IV thrombolysis only. Further studies should focus on its safety profile and application to target patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 102-111"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971524","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 of Glasgow Coma Scale with Delayed Neuropsychiatric Sequelae in Carbon Monoxide Poisoning: A Systematic Review","authors":"Giacomo Ramponi MD ,&nbsp;Eleni Karlafti MD ,&nbsp;Marco Paganuzzi MD ,&nbsp;Arturo De Buoi MD ,&nbsp;Giovanni Casazza PhD ,&nbsp;Francesco Albertoni PhD ,&nbsp;Anna Garegnani MD ,&nbsp;Giorgio Costantino MD","doi":"10.1016/j.jemermed.2025.01.006","DOIUrl":"10.1016/j.jemermed.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>Delayed neurological sequelae (DNS) are a significant complication of acute carbon monoxide poisoning (COP). The Glasgow Coma Scale (GCS) is frequently used to assess neurological status, but its prognostic value for DNS is not universally established.</div></div><div><h3>Objectives</h3><div>To evaluate the association between GCS at emergency department (ED) presentation and the development of DNS in COP patients</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted on observational studies that reported on GCS and the subsequent occurrence of DNS. The search was performed from January 1980 to February 2024. We evaluated risk of bias with the QUIPS tool. We used a random-effects model. Sensitivity analyses were performed for studies at low risk of bias and with different GCS cut-off. Quality of evidence was evaluated according to an adapted GRADE framework.</div></div><div><h3>Results</h3><div>After screening 1067 unique records, we included 24 studies, with 6153 patients, of whom 1002 (16.2%) developed DNS. Our primary analysis included 19 studies, revealing that patients developing DNS had significantly lower GCS scores at ED arrival, with a pooled mean difference (MD) of 4.06 points [95% CI, 3.09–5.02]. When considering GCS categorically with any cut-off, the pooled odds ratio (OR) for development of DNS was 3.00 [95% CI, 1.80–5.01]. Analysis with GCS as a continuous variable also confirmed GCS predictive value, with a pooled OR of 1.26 [95% CI, 1.19–1.32] for DNS per one-point decrease in GCS.</div></div><div><h3>Conclusions</h3><div>GCS scores are a valuable prognostic tool for predicting DNS in COP patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 112-126"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970157","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":"Examining the Effect of Intramuscular versus Intravenous Metoclopramide for Treatment of Acute Headaches to Expedite Throughput in the Emergency Department","authors":"Andrew R. Barbera MD ,&nbsp;Lauren A. Gould DO, MS ,&nbsp;Walter B. Wills MS ,&nbsp;Eden Crowsey MS ,&nbsp;Kenneth Rosever II MA, MBA ,&nbsp;Brandon Montes BS ,&nbsp;Kellcee Johnson MS ,&nbsp;Fred Blind MD ,&nbsp;James Melton MD","doi":"10.1016/j.jemermed.2025.01.007","DOIUrl":"10.1016/j.jemermed.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Numerous therapies exist for both prophylactic and abortive treatments of migraine headache symptoms. Although many of these treatments are nonspecific to migraine headache, they show sufficient evidence and have garnered significant medical professional consensus for off-label use to treat acute migraine headache. One antiemetic known to be particularly effective in ceasing migraine headache symptoms is metoclopramide.</div></div><div><h3>Objective</h3><div>The purpose of this study is to examine the difference between intramuscular (i.m.) vs. intravenous (i.v.) metoclopramide on emergency department (ED) length of stay (LOS) and pain relief in patients presenting with presumed migraine headache. As a secondary outcome, we also assess the efficacy in treating subjective pain between these groups.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective study of adult ED patients presenting between January 2020 and September 2022 with a principal diagnosis of acute migraine or nonspecific headache and receiving i.m. or i.v. metoclopramide during their visit. Propensity matching was utilized to balance covariates between the i.m. and i.v. groups and adjust for confounding factors, including adjuvant therapies.</div></div><div><h3>Results</h3><div>LOS was decreased when i.m. metoclopramide was utilized as opposed to i.v. metoclopramide, both prior to and after propensity matching. Prior to propensity score matching, patients who received i.m. metoclopramide had a median LOS of 67 min (interquartile range [IQR] 42.50, 99.50), and patients with i.v. administration had a median LOS of 168 min (IQR 137, 234) (median difference = 102, 95% confidence interval [CI] 93–112, <em>r</em> = 0.44, <em>p</em> &lt; 0.001). After propensity matching, median LOS for i.m. administration was 73 min (IQR 47, 103) and i.v. administration was 166 min (IQR 129, 259) (median difference = 97, 95% CI 81–144, <em>r</em> = 0.68, <em>p</em> &lt; 0.001). A 95% CI was utilized for all outcomes. There was no significant difference in pain reduction between the two groups.</div></div><div><h3>Conclusion</h3><div>Intramuscular administration of metoclopramide for the treatment of acute headache in the ED is associated with a decreased median LOS compared with i.v. administration with similar clinical efficacy.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 52-62"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004133","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":"Erratum to “Efficact of Supplemental Oxygen During Procedural Sedation and Analgesia in Elderly Patients in the Emergency Department” [J Emerg Med. 2023 Oct;65(4):e310-e319]","authors":"Kentaro Fukano MD ,&nbsp;Yosuke Homma MD, MPH ,&nbsp;Tatsuya Norii MD ,&nbsp;Japanese Procedural Sedation and Analgesia Registry Investigators","doi":"10.1016/j.jemermed.2024.12.011","DOIUrl":"10.1016/j.jemermed.2024.12.011","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Page 129"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011381","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":"Racial Disparities in Police Transportation of Trauma Patients Over Time","authors":"Stephanie Jarvis MPH ,&nbsp;David Acuna MD ,&nbsp;Tyler Crawley MD ,&nbsp;Kelsey Staudinger MD ,&nbsp;Carlos Palacio Lascano MD ,&nbsp;Glenda Quan MD ,&nbsp;Mark McMellen MD ,&nbsp;Andrea Tsoris MD ,&nbsp;Gina Berg PhD ,&nbsp;David Bar-Or MD, FACEP","doi":"10.1016/j.jemermed.2024.12.008","DOIUrl":"10.1016/j.jemermed.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies observed racial disparities in police transport (PT) of trauma patients, but did not compare injury characteristics or outcomes by race. Examining the association between race, injury characteristics, and outcomes will help elucidate the significance and implications of racial disparities among PTs.</div></div><div><h3>Objective</h3><div>Describe temporal trends, injuries, and outcomes of PT patients by race.</div></div><div><h3>Materials and Methods</h3><div>This retrospective cohort study included adult trauma patients admitted to six level I–II trauma centers in Colorado, Texas, and Kansas (January 1, 2016–July, 15, 2022). Transfer patients, and other/unknown races were excluded. Comparisons were made by race: non-Hispanic (NH-) White, Black, or Hispanic. The primary outcome was PT, α &lt; 0.05. Among PTs, outcomes included length of stay (LOS) and discharge disposition.</div></div><div><h3>Results</h3><div>Of 46,581 patients (77% NH-White, 17% Hispanic, 5% Black), there was a significantly higher proportion of PT for Hispanic (0.9%) and Black (0.4%) patients than NH-White (0.1%) patients; <em>p</em> &lt; 0.01. Hispanic PTs experienced falls significantly more than Black or NH-White PTs; <em>p</em> &lt; 0.01. Black PTs suffered assaults more than NH-White or Hispanic PTs; <em>p</em> = 0.03. The proportion of NH-White PT remained relatively stable over time (moderate <em>r</em>² = 0.4). For Black PTs, there was a negative quadratic association over time, peaking in 2019 (moderate <em>r</em>² = 0.3). Conversely, for Hispanic PTs, there was a positive quadratic correlation over time, with a notable drop in PT in 2019, (strong r² = 0.7). There was no difference in hospital LOS between the groups. Hispanic and Black PTs were discharged to jail significantly more (<em>p</em> = 0.001) and home significantly less (<em>p</em> = 0.04) than NH-White PTs (<em>p</em> = 0.01); other discharge dispositions were similar between groups.</div></div><div><h3>Conclusions</h3><div>Hispanic and Black patients were PTs and subsequently discharged to jail more frequently than NH-White patients. Since 2019 there has been an increase in Hispanic PTs and a decrease in Black PTs.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 12-23"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994917","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":"Effects of Spinal Immobilization with Backboard at 20 Degrees on Pain and Discomfort Levels","authors":"Sedat Akkan MD,&nbsp;Seda Dağar MD,&nbsp;Emine Emektar MD,&nbsp;Şeref Kerem Çorbacioğlu MD,&nbsp;Hüseyin Uzunosmanoglu MD,&nbsp;Handan Özen Olcay MD,&nbsp;Zeynep Saral Öztürk MD,&nbsp;Yunsur Çevik MD","doi":"10.1016/j.jemermed.2025.01.004","DOIUrl":"10.1016/j.jemermed.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Although spinal immobilization (SI) in the form of reverse Trendelenburg at a 20-degree angle has been shown to reduce undesirable side effects, such as decreased respiratory function seen with 0-degree SI, concerns exist that SI at 20 degrees might increase pain and discomfort, particularly in the lower body, because of gravity.</div></div><div><h3>Objective</h3><div>This study aims to evaluate whether SI at a 20-degree angle results in different levels of pain and discomfort in various body regions compared to SI at a 0-degree angle.</div></div><div><h3>Methods</h3><div>This experimental study was conducted with healthy adult volunteers aged 25 to 45 years who had no chronic illnesses or obesity (body mass index &lt;30). Each volunteer underwent two separate immobilization sessions on different days: once at a 0-degree angle (0-degree group) and once at a 20-degree angle (20-degree group), each lasting 1 hour. Vital signs and pain/discomfort levels by visual analog scale (VAS) were recorded at baseline, 15, 30, and 60 min.</div></div><div><h3>Results</h3><div>A total of 51 volunteers participated in the study. While a statistically significant increase in pain and discomfort was observed over time in both the 0-degree and 20-degree groups, no statistically significant difference in VAS scores was found between the two groups at any time point.</div></div><div><h3>Conclusion</h3><div>Although SI at a 20-degree angle does not reduce the pain and discomfort associated with the 0-degree position, it also does not increase these symptoms.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 80-86"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988482","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":"We Didn't Start the Fire","authors":"Joelle Borhart MD","doi":"10.1016/j.jemermed.2025.01.002","DOIUrl":"10.1016/j.jemermed.2025.01.002","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 127-128"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022300","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}