Journal of Emergency Medicine最新文献

{"title":"Receiver Operating Characteristic Curve Analysis of the Value of Exertional Heat Stroke Score in Predicting the Prognosis of Exertional Heat Stroke Patients","authors":"Heliang Ke MM ,&nbsp;Dong Li MM ,&nbsp;Yi Lin MM","doi":"10.1016/j.jemermed.2024.11.023","DOIUrl":"10.1016/j.jemermed.2024.11.023","url":null,"abstract":"<div><h3>Background</h3><div>Exertional heat stroke (EHS) frequently affects individuals participating in high-intensity physical labor under conditions of elevated temperature and humidity. Therefore, it is essential to investigate the prognosis of EHS.</div></div><div><h3>Objective</h3><div>This study aims to evaluate the utility of the Exertional Heat Stroke Score (EHSS) system in predicting the prognosis of EHS patients by employing the receiver operating characteristic (ROC) curve.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center analysis of 178 patients with EHS who were hospitalized between March 2020 and June 2023. These patients were categorized into two groups: those with poor prognosis and those with good prognosis, based on their prognostic outcomes. We compared the clinical data of both groups, including Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and EHSS scores. Additionally, we analyzed the predictive value of the EHSS system for the prognosis of EHS patients by constructing an ROC curve.</div></div><div><h3>Results</h3><div>Significant differences were observed between the poor prognosis group and the good prognosis group concerning several clinical parameters, including platelet count, urine creatinine, pH value, body temperature, lactate concentration, troponin I (TNL), prothrombin time, total bilirubin, fibrinogen, aspartate aminotransferase, and Glasgow Coma Scale. Additionally, the APACHE II and EHSS scores were notably higher in the poor prognosis group compared to the good prognosis group. The area under the curve (AUC) for the EHSS score in predicting the prognosis of EHS patients was 0.972, significantly surpassing the AUC of 0.872 for the APACHE II score.</div></div><div><h3>Conclusion</h3><div>The EHSS system accurately predicts the prognosis of EHS patients and has potential of clinical promotion to predict patient outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 1-8"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912242","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 Physician Age and Imaging Utilization in Emergency Department Abdominal Pain Evaluation","authors":"Lauren B. Querin MD, MEd ,&nbsp;Alyssa McGary MS ,&nbsp;Nicole R. Hodgson MD ,&nbsp;Ryan Allen BA ,&nbsp;Wayne A. Martini MD","doi":"10.1016/j.jemermed.2024.11.016","DOIUrl":"10.1016/j.jemermed.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) workup of abdominal pain commonly utilizes substantial healthcare resources including laboratory tests and advanced imaging. Although studies have explored various characteristics that influence resource utilization, the relationship between physician age and use of imaging modalities is unclear.</div></div><div><h3>Objectives</h3><div>Determine the correlation between physician age and ordering of abdominal imaging in the ED.</div></div><div><h3>Methods</h3><div>We extracted data from 5 years of patient visits across multiple EDs. The primary outcome was use of abdominal imaging, with secondary outcomes of hospital admission, ED length of stay (LOS), and 72-h revisits. Multivariable logistic regression was used to assess binary outcomes, and multivariable linear regression was used for LOS. Physician age was categorized into cohorts of &lt;36, 36-44, 45-54, ≥55 years.</div></div><div><h3>Results</h3><div>Evaluation of 91,922 unique encounters revealed that the most senior physicians had lower odds of ordering imaging than younger physicians of any group and had lower odds of 72-h revisits with no difference in admission or ED LOS when compared to physicians &lt;36 years. The middle groups (36–44 and 45–54 years) had higher odds of hospital admission than the youngest. The 2 most senior groups had lower odds of 72-h ED revisits than physicians &lt;36 years.</div></div><div><h3>Conclusion</h3><div>For patients presenting to the ED with abdominal pain, more senior physicians utilize fewer imaging resources, have fewer 72-h revisits, while maintaining equivalent hospital admissions and ED LOS as the youngest cohort of physicians. Further research is needed to discern what specific features of senior physicians contribute to the associations highlighted in this study.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 9-16"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912246","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 Airway Lead and the Creation of a Comprehensive Emergency Airway Quality Program","authors":"Scott D. Weingart MD ,&nbsp;Ryan N Barnicle MD ,&nbsp;Somair Malik MD ,&nbsp;Matthew Tanzi MD ,&nbsp;Brian Wright MD ,&nbsp;Pete McKenna MD ,&nbsp;Mike Frost MD ,&nbsp;Christina Lu MD ,&nbsp;Candice King NP ,&nbsp;Adam Singer MD ,&nbsp;Alexander Bracey MD","doi":"10.1016/j.jemermed.2024.11.010","DOIUrl":"10.1016/j.jemermed.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Department (ED) Intubation is one of the most critical times during a patient's hospital course. Ideal performance requires training, equipment, and mindset to overcome the barriers of anatomy, physiology, and human factors.</div></div><div><h3>Objectives</h3><div>We believe that EDs should use the same model of quality improvement and leadership for intubation as other critical procedures such as ED ultrasound.</div></div><div><h3>Discussion</h3><div>This paper delineates one program's creation of a comprehensive airway quality improvement (QI) program and will hopefully serve as a roadmap for other centers.</div></div><div><h3>Conclusions</h3><div>The creation of an airway QI program headed by a designated airway lead has the potential to improve patient care and procedural success in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 104-111"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912788","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":"Determinants of Early Mortality Among Deaths at Adult Emergency Departments in Southern Ethiopia","authors":"Amnuay Kleebayoon PhD ,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.jemermed.2024.11.008","DOIUrl":"10.1016/j.jemermed.2024.11.008","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 137-138"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912791","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 HEART Score Best Practice Alert on Discharge Decisions and Outcomes of Patients Presenting to an Emergency Department with Chest Pain","authors":"Adrianna Vaskas BS ,&nbsp;Kyle Marshall MD ,&nbsp;Ria Garg MD ,&nbsp;Ciaran Fisher BS ,&nbsp;Cindi L. Bower-Stout BSN, RN ,&nbsp;Muzna Hussain MD ,&nbsp;Martin E. Matsumura MD","doi":"10.1016/j.jemermed.2024.11.022","DOIUrl":"10.1016/j.jemermed.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary evaluation of chest pain (CP) utilizes a high-sensitivity troponin (hsTn) accelerated diagnostic protocol (ADP). Whether the addition of a bioclinical risk score such as the HEART score improves performance of a hsTn ADP is not clear.</div></div><div><h3>Objectives</h3><div>To determine the effect of an automated best practice alert (BPA) that guided capture of the HEART score on emergency department (ED) discharge decision-making and outcomes when added to a hsTn ADP.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients evaluated for CP in a 6 month period before and 10-month period following launch of a HEART score BPA in May 2022. Discharge percentages and 30-day major adverse cardiac event (MACE) rates were determined for the pre- vs. post-BPA cohort and stratified by both peak hsTnT value and HEART score.</div></div><div><h3>Results</h3><div>Compared to the pre-BPA cohort (<em>n</em> = 4438), post-BPA (<em>n</em> = 6794) with a completed HEART score had a higher rate of ED discharge (5.5% vs. 3.6%, <em>p</em> &lt; 0.001). Patients with low (≤3) risk HEART scores had significantly lower (1.6% vs. 0.6%, <em>p</em> = 0.001) and patients with high-risk scores had significantly higher (1.6% vs. 6.6%, <em>p</em> &lt; 0.001) rates of 30-day MACE vs. pre-BPA. The relationship of HEART score to MACE had the most discriminatory power in patients with peak hsTnT 12/51 ng/dL (3.9% vs. 6.7%, <em>p</em> &lt; 0.028).</div></div><div><h3>Conclusion</h3><div>The addition of a HEART score BPA to a hsTnT ADP was associated with a higher rate of discharge and improved risk stratification of 30-day MACE among patients for whom a discharge disposition was made, particularly among patients with moderate elevations (12–51 ng/dL) of hsTnT.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 17-24"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912848","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 Patients with Para-Fluorofentanyl Overdose","authors":"Kim Aldy DO ,&nbsp;Alex Krotulski PhD ,&nbsp;Jeffrey Brent MD, PhD ,&nbsp;Sharan Campleman PhD ,&nbsp;Rachel Culbreth PhD, MPH ,&nbsp;Barry Logan PhD ,&nbsp;Paul Wax MD ,&nbsp;Alexandra Amaducci DO ,&nbsp;Bryan Judge MD ,&nbsp;Michael Levine MD ,&nbsp;Evan Schwarz MD ,&nbsp;Diane P. Calello MD ,&nbsp;Christopher W. Meaden MD ,&nbsp;Joshua Shulman MD ,&nbsp;Adrienne Hughes MD ,&nbsp;Robert Hendrickson MD ,&nbsp;Joseph Carpenter MD ,&nbsp;Jennie Buchanan MD ,&nbsp;Alex F. Manini MD, MS ,&nbsp;Toxicology Investigators Consortium (ToxIC) Fentalog Study Group","doi":"10.1016/j.jemermed.2024.11.020","DOIUrl":"10.1016/j.jemermed.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Fentanyl analogs, such as para-fluorofentanyl (PFF), are increasing in the illicit opioid supply.</div></div><div><h3>Objectives</h3><div>This study characterizes demographics, clinical effects, and sex differences for naloxone administration in emergency department (ED) patients with confirmed PFF overdose compared with fentanyl.</div></div><div><h3>Methods</h3><div>This prospective observational cohort is from the ToxIC Fentalog Study between 2020 and 2023 at 10 participating U.S. hospitals. Adult patients with suspected opioid overdose presenting to EDs were screened and eligible if waste serum samples were available for comprehensive toxicological analysis. Fentanyl-positive patients were included in this analysis examining associations between PFF and naloxone administration, with stratified analyses for sex differences.</div></div><div><h3>Results</h3><div>Of 4873 screened, 833 were included; 694 PFF negative (PFFN) and 139 PFF positive (PFFP). Mean age was 41 years, and men were predominant (PFFN 73.1% vs. PFFP 69.8%). More than half of PFFP patients presented at 2 of the 10 participating sites, New York (29.8%) and Pennsylvania (21.3%). The most common indication for naloxone was depressed level of consciousness (PFFN 82.1% vs. PFFP 79.8%). PFFP were less likely to receive naloxone doses &gt; 2 mg compared with PFFN (48.2% vs. 60.8%, <em>p</em> = 0.002). After controlling for covariates, PFFP were less likely to receive out-of-hospital naloxone (adjusted odds ratio 0.87; 95% confidence interval 0.81–0.94). PFFP men were less likely to receive naloxone doses ≥ 2 mg (adjusted odds ratio 0.64; 95% confidence interval 0.42–0.97), but this association was not significant for women.</div></div><div><h3>Conclusion</h3><div>PFF was present in almost 20% of ED patients with confirmed fentanyl overdose. Although naloxone administration was lower for PFF compared with fentanyl, differences were more pronounced in men. Clinicians and public health officials should be aware of the evolving illicit opioid supply. Future study is warranted to explore the PFF dose response and mechanism behind these observed sex differences due to fentanyl analogs.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 56-69"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912850","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":"Toxic Shock Syndrome due to Streptococcus Pyogenes: Case Report","authors":"A. Ganss ,&nbsp;S. Venturini ,&nbsp;I. Reffo ,&nbsp;M. Avolio ,&nbsp;M. Domini ,&nbsp;D. Rufolo ,&nbsp;L. Corich ,&nbsp;G. Del Fabro ,&nbsp;A. Callegari ,&nbsp;M. Crapis ,&nbsp;G. Basaglia ,&nbsp;G. Nadalin","doi":"10.1016/j.jemermed.2024.11.009","DOIUrl":"10.1016/j.jemermed.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Toxic shock syndrome (TSS) is one of the most devastating clinical manifestations of <em>Streptococcus pyogenes</em> (also known as Group A Streptococci or GAS), characterized by an overwhelming production of toxins. The incidence of TSS is increasing worldwide, and the mortality rate remains unacceptably high. Due to the rapid progression of infection, rapid diagnosis is crucial, as early initiation of aggressive supportive measures, along with antibiotics, source control, immunoglobulin, and steroids, can improve patient outcomes. IgM- and IgA-enriched immunoglobulins represents a new therapeutic option, as highlighted in the case reported here.</div></div><div><h3>Case report</h3><div>A 66-year-old man was admitted for cellulitis of the right arm with shock, disseminated intravascular coagulation (DIC), renal and hepatic compromise, suggestive of toxic shock syndrome (TSS). Blood cultures revealed <em>S. pyogenes</em>, confirming the diagnosis. The patient was treated with combination antibiotic therapy (clindamycin, piperacillin/tazobactam), steroids and enriched immunoglobulins in addition to vasopressor and high flow oxygen. He was discharged home with complete recovery after 1 month.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>In the emergency department, the primary goals of management of TSS include aggressive resuscitation, prompt administration of appropriate antibiotics, source control if feasible, and early intensive care unit admission.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 77-82"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772420","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":"Shedding Light: How One Family's Tragedy Became Another's Beacon","authors":"Alexandra Reens MD","doi":"10.1016/j.jemermed.2024.10.007","DOIUrl":"10.1016/j.jemermed.2024.10.007","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 114-115"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433047","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":"Diverse by Design: A Comprehensive Guide to Inclusive Hiring for Emergency Medicine Faculty","authors":"Cortlyn Brown MD, MCSO, FAAEM","doi":"10.1016/j.jemermed.2024.10.016","DOIUrl":"10.1016/j.jemermed.2024.10.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency medicine (EM) lacks diversity, with only 9.9% of physicians from underrepresented backgrounds and women comprising 25% of the workforce. Diverse faculty enhance patient outcomes, innovation, and equitable education. This manuscript introduces the Brown Academic Emergency Medicine Faculty Inclusive Hiring Guide to address these disparities.</div></div><div><h3>Methods</h3><div>Developed through literature review, stakeholder input, and pilot testing, the guide identifies best practices for equitable hiring. Key metrics such as patient outcomes and faculty retention informed the recommendations, refined through feedback from faculty and DEI experts.</div></div><div><h3>Results</h3><div>The guide provides strategies to mitigate bias, standardize evaluations, and create inclusive job postings. It emphasizes training search committees, equitable interviews, and ongoing assessment of DEI metrics.</div></div><div><h3>Discussion</h3><div>This resource offers practical, evidence-based solutions for advancing diversity in academic EM, addressing systemic barriers, and fostering equity. Continuous evaluation is critical for sustained progress.</div></div><div><h3>Conclusion</h3><div>The guide is a vital tool for creating inclusive academic EM environments, improving diversity, and enhancing patient care and educational outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 133-139"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501901","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 Ten Test and Sensory Evaluation of Hand and Finger Injuries in the Emergency Department","authors":"Emilie H. Lothet MD,&nbsp;Aaron J. Lacy MD,&nbsp;Elizabeth B. Odom MD","doi":"10.1016/j.jemermed.2024.10.008","DOIUrl":"10.1016/j.jemermed.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Hand and finger injuries are a common presenting complaint to the emergency department (ED) and are associated with significant morbidity. Neurologic evaluation of these injuries is a crucial component of the patient assessment and can be done via a variety of testing methods.</div></div><div><h3>Discussion</h3><div>Although most taught and cited in the ED literature, the two-point discrimination test for sensation has several drawbacks, including limited reproducibility and reliability. Although often utilized by hand surgical specialists, the Semmes-Weinstein monofilament test and the Weinstein Enhanced Sensory Test are not practical for the emergency physician due to the need for specialized equipment and frequent calibration. The Ten Test, a relatively new sensory evaluation method, has been shown to be reliable, reproducible, and pragmatic in varying types of clinical environments.</div></div><div><h3>Conclusion</h3><div>The Ten Test is a pragmatic alternative method of evaluation to two-point that is utilized by specialists in hand surgery and injuries. The emergency physician should consider adding the Ten Test to their evaluation and reporting of hand and finger injuries in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"71 ","pages":"Pages 54-59"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472554","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}