Journal of Emergency Medicine最新文献

{"title":"Emergency Care for Patients with Cancer on Immune Checkpoint Inhibitors: A Retrospective Analysis of Immune-Related Adverse Events","authors":"Alice Ferrua ,&nbsp;Jacopo Davide Giamello ,&nbsp;Chiara Fulcheri ,&nbsp;Michela Milanesio ,&nbsp;Giulia Bernardi ,&nbsp;Elena Fea ,&nbsp;Salvatore D’Agnano ,&nbsp;Nicoletta Artana ,&nbsp;Daniela Caruso ,&nbsp;Giovanna Greco ,&nbsp;Tiziana Ponza ,&nbsp;Enrico Lupia ,&nbsp;Luigi Fenoglio ,&nbsp;Giuseppe Lauria ,&nbsp;Gianmauro Numico","doi":"10.1016/j.jemermed.2025.08.025","DOIUrl":"10.1016/j.jemermed.2025.08.025","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, but can lead to immune-related adverse events (irAEs), some of which require emergency care.</div></div><div><h3>Objective</h3><div>To evaluate the prevalence, clinical features and outcomes of emergency department (ED) visits related to irAEs among patients receiving ICIs.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed ED visits from 2013 to 2021 among patients with solid tumors treated with ICIs at a single tertiary cancer center in Italy. Each visit was independently reviewed and classified as definitely, potentially, or not related to irAEs.</div></div><div><h3>Results</h3><div>Of 457 ED visits from 216 patients, 27 (5.9%) were definitely and 15 (3.3%) potentially related to irAEs. The most frequent irAEs were pneumonitis (<em>n</em> = 19), colitis (<em>n</em> = 5), and hepatitis (<em>n</em> = 3). Dyspnea was more common in irAE-related visits (28.6% vs 13%, <em>p</em> = 0.006). 74.1% of irAE-related visits resulted in hospital admission and 30-day mortality was 14.3%. The median time from ICI initiation to ED presentation for irAEs was 21 weeks.</div></div><div><h3>Conclusions</h3><div>irAEs account for a significant portion of ED visits in patients receiving ICIs, with pneumonitis being the most frequent. Emergency clinicians should be aware of this delayed toxicity spectrum, especially in patients presenting with respiratory symptoms.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 235-240"},"PeriodicalIF":1.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156239","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":"Improvised Medicine","authors":"Tarek Zieneldien","doi":"10.1016/j.jemermed.2025.08.024","DOIUrl":"10.1016/j.jemermed.2025.08.024","url":null,"abstract":"<div><div>This poem reflects on the collapse of the healthcare system in my homeland. It is a testimony to how medicine survives not through protocols, but through memory, improvisation, and the resilience of the community.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Page 41"},"PeriodicalIF":1.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048237","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 National Analysis on Statewide Prehospital Adult Behavioral Sedation Protocols with a Focus on Trends in Ketamine Administration","authors":"Benjamin Mearkle BS ,&nbsp;John Su MD ,&nbsp;Eric Quinn MD","doi":"10.1016/j.jemermed.2025.08.010","DOIUrl":"10.1016/j.jemermed.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital clinicians are trained to treat medical emergencies and operate under treatment protocols that may be statewide, regional, or agency-specific. Prehospital treatment of behavioral health emergencies (BHE), especially with ketamine, has gained public attention over the past decade.</div></div><div><h3>Objectives</h3><div>This study describes the current characteristics of prehospital statewide adult BHE protocols used across the United States (US) with a focus on trends in ketamine administration.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional review of mandatory and model statewide emergency medical service protocols and identified adult BHE protocols for inclusion. State protocols with a median publication year of 2023 were examined to evaluate protocol characteristics and the use of benzodiazepines, antipsychotics, and ketamine. A subset of current protocols was compared to archived versions to assess changes in ketamine use.</div></div><div><h3>Results</h3><div>Thirty-two states representing 47% of the US population had statewide BHE protocols. Most protocols included verbal de-escalation, physical restraint, and postrestraint monitoring requirements. Less commonly found were objective scoring systems for agitation, process assurance indicators, and alternative destinations. The most frequently used medications included midazolam (<em>n</em> = 29; 91%), ketamine (<em>n</em> = 29; 91%), and haloperidol (<em>n</em> = 21; 66%). A temporal assessment of ketamine in BHE protocols revealed increasing adoption accompanied by expanded safety precautions.</div></div><div><h3>Conclusion</h3><div>This cross-sectional study of 32 US prehospital BHE protocols found relative inter-regional agreement except for a few notable differences, such as medication choice between protocols. During the study period, ketamine use in BHE protocols became more common with a shift toward enhanced safety precautions and uniform dosage guidelines.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 324-335"},"PeriodicalIF":1.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156223","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 Outcomes between Standard Cardiopulmonary Resuscitation (S-CPR) and Over-the-Head Cardiopulmonary Resuscitation (OTH-CPR): A Systematic Review and Meta-Analysis","authors":"Seyyed-Abolfazl Tabatabaei-Aghda MSc ,&nbsp;Ebrahim Nasiri-Formi Ph.D ,&nbsp;Seyyed-Jamaleddin Tabatabaei-Aghda MSc","doi":"10.1016/j.jemermed.2025.08.023","DOIUrl":"10.1016/j.jemermed.2025.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Different conditions and methods of cardiopulmonary resuscitation (CPR) can yield varying results.</div></div><div><h3>Objectives</h3><div>This systematic review aimed to compare the outcomes of Over-the-Head CPR (OTH<img>CPR) with Standard or Lateral CPR (S-CPR), Following PRISMA guidelines,</div></div><div><h3>Methods</h3><div>Following the PRISMA guidelines, we searched 6 databases and retrieved 111 articles. After excluding duplicates and irrelevant studies, 14 articles were selected for analysis. The outcomes assessed included the average rate of correct chest compressions per minute, the average depth of compressions, the rate of high-quality ventilations, and correct chest recoil.</div></div><div><h3>Results</h3><div>The meta-analysis indicated that OTH<img>CPR had a significantly higher average compression rate compared to S-CPR (Mean Differences = 0.13, CI 95% = –0.01 to 0.27, I² = 18.96%). However, there was no significant difference in compression depth (CI 95% = –0.38 to 0.40, MD = 0.009) or ventilation quality (CI 95% = –0.69 to 0.69, MD = –0.00). While OTH<img>CPR showed a higher rate of correct chest recoil, this difference was not statistically significant (CI 95% = –0.96 to 2.59, MD = 0.81).</div></div><div><h3>Conclusions</h3><div>The findings suggest that OTH<img>CPR is comparable in quality to S-CPR and may serve as an effective alternative in specific situations.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 275-290"},"PeriodicalIF":1.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156399","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":"Home Use of Nonpharmacologic Interventions For Fracture Pain After Pediatric Emergency Department Discharge","authors":"Alexandria J Wiersma MD ,&nbsp;Blake Nielsen MSTAT ,&nbsp;Michael Webb MS ,&nbsp;Elizabeth Alpern MD, MSCE ,&nbsp;David C. Brousseau MD ,&nbsp;James M. Chamberlain MD ,&nbsp;Joseph J. Zorc MD, MSCE ,&nbsp;Lynn Babcock MD MS ,&nbsp;Theresa Frey MD ,&nbsp;Julie C. Leonard MD, MPH ,&nbsp;Samina Ali MD ,&nbsp;Bradley J. Barney PHD ,&nbsp;Amy L. Drendel DO, MS ,&nbsp;PECARN IMPROVE and PECARN Registry Study Groups","doi":"10.1016/j.jemermed.2025.08.018","DOIUrl":"10.1016/j.jemermed.2025.08.018","url":null,"abstract":"<div><h3>Background</h3><div>Nonpharmacologic (physical and psychological) interventions are recommended for the treatment of acute pain after pediatric emergency department (PED) discharge. Frequency of use and relation to analgesia and patient characteristics have not been well described.</div></div><div><h3>Objectives</h3><div>We aimed to determine the types and duration of nonpharmacologic interventions, describe their relationship with analgesic use, and identify clinically relevant associated variables.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of a multi-site prospective observational cohort study of children aged 4–17 years discharged from 7 PEDs July 2019 through September 2021 with an isolated long bone fracture. Parents/guardians reported nonpharmacologic interventions and analgesic use via daily text messaging.</div></div><div><h3>Results</h3><div>1,819 children were included. During the first week after PED discharge, 96% used nonpharmacologic interventions at least 1 day, with distraction and elevation being the most frequently and consistently used. Only 3% reported using analgesia alone during the first week, while the proportion using only nonpharmacologic interventions tripled from 9% to 27%. Children aged 11–13 years had increased likelihood of nonpharmacologic use compared to those aged 4-7 years (OR 3.7 95% CI [1.4, 9.8]). Children with moderate to severe pain at discharge were also more likely to use nonpharmacologic interventions (OR 2.1 [95% CI 1.1, 3.9]).</div></div><div><h3>Conclusions</h3><div>Children with long bone fractures used nonpharmacologic interventions more frequently and for a longer duration than analgesic medications. Increasing age and pain severity at discharge were associated with greater use. Interventional studies are needed to provide evidence-informed recommendations for these interventions after PED discharge.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 202-213"},"PeriodicalIF":1.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120050","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":"Fast Track Dialysis 2: Improving Protocolized Management of Hemodialysis Patients in an Emergency Department Observation Unit","authors":"Christopher O’Donnell MD ,&nbsp;Traci Leong PhD ,&nbsp;Kyle James MD ,&nbsp;George Hughes MD ,&nbsp;Daniel Wood MD ,&nbsp;Tahsin Masud MD ,&nbsp;Sarah Nicholls DNP ,&nbsp;Vena Crichlow MA ,&nbsp;Michael A Ross MD ,&nbsp;Nicole Franks MD","doi":"10.1016/j.jemermed.2025.08.008","DOIUrl":"10.1016/j.jemermed.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>There is little literature comparing efficiency between Hospitalist (HMS) and Emergency Department (ED) clinician management for end stage renal disease (ESRD) patients based on type of observation unit.</div></div><div><h3>Objective</h3><div>To compare the impact of a communication and triage protocol, Fast Track Dialysis 2, (FTD2) on the primary outcomes of total and ED length of stay (LOS), charges, and observation time of ESRD patients managed by ED clinicians in a closed Type 1 observation unit versus a HMS-run Type 3 unit or ED-run Type 2 unit.</div></div><div><h3>Methods</h3><div>Retrospective chart analysis of ESRD patients requiring urgent hemodialysis at tertiary and quaternary academic hospitals under an ED managed FTD program versus an HMS managed program and a usual care ED program. Two-sample T-tests were used to compare geographic means.</div></div><div><h3>Results</h3><div>Respectively, there were 77 and 143 encounters at institutions 1 and 2 in the historical cohort and 161 and 225 encounters in the intervention cohorts. Institution 1 showed a significantly reduced overall LOS (13.2 h vs 10.5 h, <em>p &lt;</em> 0<em>.</em>01), ED LOS (2.9 h vs 2.2 h, <em>p &lt;</em> 0<em>.</em>01), and no difference in charges ($5,642 vs $5,361, <em>p =</em> 0<em>.</em>37). Institution 2 had no significant change in overall LOS (17.9 h vs 17.3 h, <em>p =</em> 0<em>.</em>65) due to significantly increased ED LOS (3.5 h vs 2.4 h, <em>p &lt;</em> 0<em>.</em>01) when implementing FTD2. Institution 2 had a significant reduction in charges ($27,314 vs $8,391, <em>p &lt;</em> 0<em>.</em>01) when implementing FTD2.</div></div><div><h3>Conclusions</h3><div>Introduction of FTD2 in the ED for ESRD patients is associated with reduced charges and is non-inferior in terms of total observation time.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 389-399"},"PeriodicalIF":1.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221236","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":"Applying Lessons from the COVID-19 Pandemic to Everyday Crises: The Role of Policy, Innovation, and Stewardship in Healthcare Emergencies","authors":"Rachel Lauren Welch BS, MD-PhD ,&nbsp;Rebeca Vergara Greeno MD ,&nbsp;Benjamin Tolchin MD, MS ,&nbsp;Nitu Kashyap MD ,&nbsp;Mary Showstark PhD, MPAS, PA-C ,&nbsp;Jennifer L. Herbst MBIO, JD, LLM ,&nbsp;Nancy Kim MD, PhD ,&nbsp;Karen Jubanyik MD","doi":"10.1016/j.jemermed.2025.08.011","DOIUrl":"10.1016/j.jemermed.2025.08.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;During the COVID-19 pandemic, supply chain disruptions and resource shortages—such as limited intensive care unit (ICU) beds, COVID-19 testing, and personal protective equipment (PPE)—placed significant burdens on emergency departments (EDs). These constraints contributed to high levels of moral distress among front-line clinicians.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To address these challenges, one health system implemented a two-physician resuscitation policy for changing code status to “do not resuscitate” (DNR) during the COVID-19 public health emergency. This policy aimed to support clinician decision-making around potentially non-beneficial care, promote responsible resource utilization, and mitigate the ethical and psychological burdens faced by clinicians. The current study sought to evaluate frontline clinicians’ awareness, use, and experiences with this contingency policy, focusing on its ethical and psychological impact.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This mixed-methods quality improvement study included clinicians from emergency medicine, critical care, and other specialties who managed COVID-19-positive patients. Data were collected through an online survey assessing awareness and acceptance of the two-physician DNR policy and its impact on moral distress. Correlation analyses were performed to examine relationships between resource shortages and moral distress. Qualitative data were gathered through open-ended survey responses and interviews thematically coded to elucidate clinicians’ experiences with policy implementation and its influence on care delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over half of participants (53%) reported moral distress, which was significantly correlated with the severity of resource shortages (&lt;em&gt;p&lt;/em&gt; &lt; 0.05). ED staff in particular attributed distress to inadequate ICU bed capacity (64%), limited COVID-19 tests (64%), and insufficient (63%). Most respondents (70.2%) felt supported by the policy, especially in emergency medicine (79%) and critical care (79%). Qualitative findings indicated that the policy supported difficult decision-making around nonbeneficial care, reinforced resource stewardship, and enabled flexibility to reverse DNR status if patients’ clinical conditions improved.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;These findings underscore the value of contingency policies in reducing moral distress and facilitating resource allocation during crises. By providing a clear framework for end-of-life decisions, the two-physician DNR policy was perceived by most clinicians as fostering shared accountability and prudent use of scarce resources. The flexibility inherent in this policy—such as the option to revise code status—was particularly important as patient conditions evolved. Notably, EDs continue to face “everyday crises” marked by supply shortages (e.g., IV fluids, blood culture bottles) and boarding. This study highlights the need for proacti","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 192-201"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145098010","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 Necessity of Whole-Body Computed Tomography Scanning in Patients Admitted to the Emergency Department Due to Blunt Trauma","authors":"Mehmet Bozkurt MD ,&nbsp;Muge Gulen MD, PhD ,&nbsp;Salim Satar MD ,&nbsp;Selen Acehan MD ,&nbsp;Sarper Sevdimbas MD ,&nbsp;Cagdas Ince MD ,&nbsp;Muhammet Balcik MD ,&nbsp;Mustafa Sencer Segmen MD","doi":"10.1016/j.jemermed.2025.08.012","DOIUrl":"10.1016/j.jemermed.2025.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous studies in the trauma literature, there is no definitive indication score or model for the use of whole-body computed tomography (WBCT).</div></div><div><h3>Objective</h3><div>This study aims to determine clinical characteristics and assess trauma scores in predicting positive WBCT findings in emergency trauma patients.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted at a level I trauma center. Patients over the age of 18 who presented to the emergency department due to high-energy trauma and were indicated for WBCT were included. Demographic characteristics, injury mechanisms, vital signs, physical examination findings, and trauma scores (Injury Severity Score (ISS), Triage Revised Trauma Score (T-RTS), Circulation, Respiration, Abdomen, Motor, and Speech (CRAMS) score of the patients were recorded.</div></div><div><h3>Results</h3><div>The study included 1363 patients. 75.7% (<em>n</em> = 1032) of the patients were male, with a mean age of 36 years. 36.8% (<em>n</em> = 502) of patients had a positive (+) WBCT. Falls &gt; 5 meters (<em>p</em> = 0.002) and injury to more than 2 body regions (<em>p</em> = 0.009) were statistically significantly associated with a higher rate of (+) WBCT in trauma patients. Patients with (+) WBCT had statistically significantly higher mean pulse rate (<em>p</em> = 0.001), respiratory rate (<em>p</em> &lt; 0.001), and shock index (<em>p</em> = 0.007), while the mean oxygen saturation was lower (<em>p</em> &lt; 0.001). The CRAMS score demonstrated higher predictive power than the T-RTS (AUC: 0.618; 95% CI: 0.586–0.650; <em>p</em> &lt; 0.001; cutoff: 7.5) for identifying the presence of CT findings.</div></div><div><h3>Conclusions</h3><div>In multitrauma patients, the indication for WBCT should be determined not only based on trauma mechanism but also by considering physical examination findings, vital signs, and trauma scores collectively.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 291-301"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156199","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 Sound Recognition-Based Basic Life Support Training Program on Cardiopulmonary Resuscitation Performance: A Randomized Simulation Study","authors":"Dong Hyun Choi MD PHD ,&nbsp;Jeong Ho Park MD PHD ,&nbsp;Yoon Ha Joo PHD ,&nbsp;Ki Hong Kim MD PHD ,&nbsp;Hyunjin Joo MSC ,&nbsp;Hyoun-Joong Kong PHD ,&nbsp;Kyoung Jun Song MD PHD ,&nbsp;Sang Do Shin MD PHD","doi":"10.1016/j.jemermed.2025.08.022","DOIUrl":"10.1016/j.jemermed.2025.08.022","url":null,"abstract":"<div><h3>Background</h3><div>Decentralized self-instruction basic life support (BLS) training is gaining interest.</div></div><div><h3>Objectives</h3><div>We evaluated the feasibility and effectiveness of Beep-cardiopulmonary resuscitation (CPR), a cost-effective, at-home, self-instruction BLS training program, on CPR performance.</div></div><div><h3>Methods</h3><div>This randomized noninferiority simulation trial compared CPR performance between Beep-CPR and conventional BLS training in healthy adults. Beep-CPR training comprised a 30-min self-instruction session using a smartphone and low-cost CPR manikin with real-time sound-based feedback. Conventional training involved a 30-min instructor-led group session. CPR performance was assessed by a blinded assessor using a standardized scenario. Primary outcome was mean compression depth. Secondary outcomes included mean compression rate, mean chest compression release velocity (CCRV), and overall BLS performance score.</div></div><div><h3>Results</h3><div>One hundred participants (mean age [standard deviation (SD)]: 41.8 years [14.0], 36% male) were randomized. Beep-CPR training was noninferior to conventional BLS training in compression depth (mean [SD]: 6.1 [0.8] cm vs. 6.0 [0.8] cm; mean difference [95% confidence interval], 0.1 [0.0–0.1] cm; noninferiority <em>p</em> &lt; 0.001). There were no significant differences in the mean (SD) compression rate (111 [14]/min vs. 111 [13]/min), mean CCRV (451 [76] mm/s vs. 444 [76] mm/s), or overall BLS performance score (7.4 [1.1] vs. 7.7 [0.6]). The mean System Usability Score for Beep-CPR was 80.4 (SD: 12.9), indicating “good” usability and user satisfaction.</div></div><div><h3>Conclusion</h3><div>Beep-CPR training is feasible for use in real-world CPR training environments and is not inferior to conventional BLS training in terms of CPR performance. This program offers a promising approach to expanding decentralized, at-home BLS education.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 248-257"},"PeriodicalIF":1.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156238","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":"Infectious Disease and Supportive Care Outcomes in Adult Oncology Patients","authors":"Sidharth Iyer BS ,&nbsp;Jason J Bischof MD","doi":"10.1016/j.jemermed.2025.04.036","DOIUrl":"10.1016/j.jemermed.2025.04.036","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cancer on immunosuppressive drugs face an increased risk for serious bacterial infections and commonly present to the emergency department (ED) with bacterial bloodstream infections (BSIs), making prompt administration of antibiotics critical. However, for ED oncology patients presenting with fever in the absence of neutropenia, there is limited data to guide their management. To address this gap in care, the Esbenshade model was developed to stratify BSI risk in febrile non-neutropenic pediatric oncology patients. In this study, we aimed to evaluate whether this model retains its predictive accuracy in an adult population.</div></div><div><h3>Methods</h3><div>This retrospective single site chart review analyzed adult oncology patients presenting to an urban, academic ED in the Midwest affiliated with a Comprehensive Cancer Center. Inclusion criteria encompassed patients diagnosed with malignancy and presenting with non-neutropenic fever. Patients with a history of remote cancer or without fever within 24 hours of presentation were excluded. Retrospective chart review data was collected using the Esbenshade (EsVan2b) model variables and were analyzed using descriptive statistics, and sensitivity and specificity calculations to evaluate the model's predictive accuracy.</div></div><div><h3>Results</h3><div>284 patients met the inclusion criteria. The median patient age was 63 years, with 58% being male and 81% identifying as white. Blood cultures were positive in 66 out of the 284 febrile episodes (BSI rate = 23%). The Esbenshade model in an adult population demonstrated a sensitivity of 0% and a specificity of 98%, and an AUC of 0.680.</div></div><div><h3>Conclusion</h3><div>The retrospective data demonstrate that the EsVan2b model performed poorly in predicting BSI risk in adult cancer patients presenting with non-neutropenic fever. This suggests that the model may not be suitable for use in the adult population and highlights the need for further research to develop or adapt predictive tools for this demographic.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Page 142"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858409","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}