Journal of Emergency Medicine最新文献

{"title":"A Critical Appraisal of Troponin as a Prognostic Biomarker in Stable Supraventricular Tachycardia: Contextualizing Recent Findings","authors":"Artur Dziewierz MD, PhD , Piotr Jarosz MD , Tomasz Rakowski MD, PhD","doi":"10.1016/j.jemermed.2025.10.029","DOIUrl":"10.1016/j.jemermed.2025.10.029","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 334-335"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977106","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 Cold Exposure on Neurological Mortality of Out-of-Hospital Cardiac Arrest Patients","authors":"Takahiro Uechi MD, PhD ,&nbsp;Shigeki Shibata MD, PhD ,&nbsp;Tomoya Suda MD, PhD ,&nbsp;Noritaka Hata MD ,&nbsp;Kazukuni Hirabuki MD, PhD ,&nbsp;Takehiro Tsukada MD, PhD ,&nbsp;Ai Hirasawa PhD ,&nbsp;Takeaki Matsuda MD, PhD","doi":"10.1016/j.jemermed.2025.09.030","DOIUrl":"10.1016/j.jemermed.2025.09.030","url":null,"abstract":"<div><h3>Background</h3><div>Survival rates after out-of-hospital cardiac arrest (OHCA) are lower at night than during the day. Cold exposure may stimulate the sympathetic nervous system and provoke and sustain ventricular tachycardia (VT)/ventricular fibrillation (VF). Diurnal temperature changes and sympathetic stimulation may explain these.</div></div><div><h3>Objective</h3><div>The aim of this study was to investigate our hypothesis that the colder the ambient temperature, the worse the neurologic outcome in VT/VF OHCA patients.</div></div><div><h3>Methods</h3><div>We used the All-Japan Registry (2005–2010) combined with atmospheric temperature data and enrolled adult OHCA patients who had been witnessed and resuscitated. The primary outcome was a favorable neurological outcome 1 month after OHCA, and the secondary outcome was the return of spontaneous circulation (ROSC) before hospital admission. Ambient temperature on the primary and secondary outcomes was assessed with adjustment for factors known to potentially affect OHCA outcomes by classifying the initial cardiac rhythm.</div></div><div><h3>Results</h3><div>Among 263,750 witnessed OHCA patients, neurological survival rates significantly increased with adjusted ORs of 1.09 (95% CI, 1.05–1.13) and 1.07 (95% CI, 1.05–1.10) for 9°C (1 SD) temperature increase in VT/VF patients and overall population, respectively. ROSC rates significantly increased with adjusted HRs of 1.11 (95% CI, 1.08–1.13), 1.06 (95% CI, 1.03–1.08), 1.06 (95% CI, 1.02–1.09), and 1.09 (95% CI, 1.07–1.10) for 9°C (1 SD) temperature increase in VT/VF, pulseless electrical activity (PEA), asystole, and overall population, respectively.</div></div><div><h3>Conclusions</h3><div>Cold exposure during OHCA in patients with initial VT/VF rhythm resulted in lower 1-month neurological survival rates, likely due to prolonged time to ROSC. Avoiding cold exposure may improve survival by reducing the time to ROSC.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 119-133"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578328","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":"ST-Segment Elevation in Lead aVR in Acute Intracranial Pathologies: A Diagnostic Pitfall?","authors":"Benedek Z. Túri MD ,&nbsp;Kornél Ádám MSc ,&nbsp;Alíz Szakáll MD ,&nbsp;Bánk G. Fenyves PhD ,&nbsp;Zsolt Kálmán MD ,&nbsp;Szabolcs Gaál-Marschal MD ,&nbsp;Henriette Mészáros MD ,&nbsp;Judit Imecz MD ,&nbsp;Csaba Varga PhD","doi":"10.1016/j.jemermed.2025.10.023","DOIUrl":"10.1016/j.jemermed.2025.10.023","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 54-59"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573121","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":"Beyond the Beats: Disparities in Prehospital Cardiac Care","authors":"Nicholas P. Wleklinski MD,&nbsp;Lauren B. Nickel PhD,&nbsp;M. Riccardo Colella DO, MPH,&nbsp;Erin McGlynn MD, MPH,&nbsp;Benjamin W. Weston MD, MPH","doi":"10.1016/j.jemermed.2025.10.017","DOIUrl":"10.1016/j.jemermed.2025.10.017","url":null,"abstract":"<div><h3>Background</h3><div>While disparities in care between demographic groups (e.g., race/ethnicity, gender, age) have been demonstrated across the spectrum of health care, limited research exists for ST-segment elevation myocardial infarction (STEMI) patients in the prehospital setting.</div></div><div><h3>Objective</h3><div>The purpose of this study was to describe disparities specific to the prehospital care of STEMI using data from a large urban fire-based emergency medical services (EMS) system.</div></div><div><h3>Methods</h3><div>Electronic patient care records for all STEMI activations from 02/01/2020 to 09/01/2022 were reviewed. National benchmark variables evaluated included administration of analgesia (either fentanyl or nitroglycerin), nitroglycerin administration, aspirin administration, scene time, transport time, STEMI alert time, and electrocardiogram (ECG) time. Analyses were conducted using logistic and linear regression.</div></div><div><h3>Results</h3><div>A total of 888 patients were evaluated. The average age was 63.9 years, 575 (63.9%) were male, and 479 (53.9%) were White. Black patients were less likely than White patients to be administered analgesia, as were patients 75 years and older compared to patients 60–74. Female patients were less likely than male patients to receive nitroglycerin or aspirin. Both Black and Hispanic patients were less likely to receive aspirin compared to White patients. Differences in age groups emerged for two-time metrics: Patients 75 years and older had longer scene times and STEMI alert times than patients 60–74. None of the demographic variables were statistically significant predictors of transport time or ECG time.</div></div><div><h3>Conclusions</h3><div>This evaluation of comprehensive demographic information from a large fire-based EMS system revealed disparities among STEMI patients in analgesia administration, specifically aspirin and nitroglycerin based on gender and race/ethnicity.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 23-32"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573795","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 Woman with Leg Numbness and Weakness","authors":"Andrew D. Luo MD, MBA ,&nbsp;Peter C. Hou MD ,&nbsp;Carrie Li MD ,&nbsp;Derek Monette MD, MHPE ,&nbsp;Kathleen A. Wittels MD","doi":"10.1016/j.jemermed.2025.10.040","DOIUrl":"10.1016/j.jemermed.2025.10.040","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 220-223"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621996","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":"Building a Psychiatric Boarding Toolkit: An Emergency Nursing Perspective on a Collaborative Approach to Care","authors":"Lisa Wolf PhD, RN, CEN, FAEN, FAAN ,&nbsp;L. Anthony Cirillo MD, FACEP","doi":"10.1016/j.jemermed.2025.09.023","DOIUrl":"10.1016/j.jemermed.2025.09.023","url":null,"abstract":"<div><h3>Background</h3><div>The boarding of psychiatric patients is a significant problem in the United States (US) and creates burden for both patients and emergency department (ED) staff. Most triage processes in US EDs rely on nurses, and triage is considered a fundamental core nursing skill. However, the triage and continuing care of behavioral health (BH) patients may require a more interdisciplinary approach.</div></div><div><h3>Objectives</h3><div>To explore the perspective of emergency nurses to inform a collaborative interdisciplinary approach to the care of boarding BH patients.</div></div><div><h3>Methods</h3><div>After a presentation by an emergency physician, a guided discussion on ED behavioral health boarding and ED care led by a physician-nurse team was held in person in September 2024. Data were analyzed using content analysis to develop a set of recommendations for improving care for boarding BH patients.</div></div><div><h3>Results</h3><div>Emergency nurses identified key points where appropriate care pathways may improve care for BH patients boarding in the ED. Education and cultural changes related to behavioral health assessments and care were also identified as critical needs for both physicians and nurses.</div></div><div><h3>Conclusions</h3><div>Emergency nurses recognize a need for standardized approaches to BH to improve care for BH patients boarding in the ED. This interdisciplinary approach, which includes emergency nurses at the first encounter, may allow for collaborative standardized approaches that could improve care for this patient population.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 1-7"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546582","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":"Author’s Response to Letter to the Editor “Critical insights on Safety of Diltiazem for Acute Management of Atrial Fibrillation (AF) in Patients with Heart Failure and Reduced Ejection Fraction in the Emergency Department”","authors":"Cassandra J. Schmitt PharmD ,&nbsp;Alicia E. Mattson PharmD ,&nbsp;Daniel Cabrera MD ,&nbsp;Fernanda Bellolio MD, MSc","doi":"10.1016/j.jemermed.2025.04.020","DOIUrl":"10.1016/j.jemermed.2025.04.020","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 317-318"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976202","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":"Use of In-Hospital Mild Traumatic Brain Injury Symptom Checklist Within 24 Hours of Injury to Predict 3-Month Symptom Outcome","authors":"Samuel Gray BA ,&nbsp;Grace Amadon MS ,&nbsp;Nancy Temkin PhD ,&nbsp;Marin Darsie MD ,&nbsp;Joseph T. Giacino PhD ,&nbsp;John D. Corrigan PhD ,&nbsp;Frederick Korley MD, PhD ,&nbsp;John Whyte MD, PhD ,&nbsp;Murray B. Stein MD, MPH ,&nbsp;Geoffrey T. Manley MD, PhD ,&nbsp;Michael A. McCrea PhD ,&nbsp;Lindsay D. Nelson PhD","doi":"10.1016/j.jemermed.2025.10.008","DOIUrl":"10.1016/j.jemermed.2025.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13–15 (“mild” TBI [mTBI]) in adult emergency departments (EDs). However, such assessment is not routine, partly due to limited guidance on interpreting symptom scores.</div></div><div><h3>Objectives</h3><div>Assess the utility of Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores, assessed in-hospital within 24 h of injury (day 1), in discriminating individuals with, vs. without, persistent TBI-related symptoms (persistent post-concussive symptoms [PPCS]) at 3 months post-injury, and provide interpretive guidance.</div></div><div><h3>Methods</h3><div>Adults with mTBI across three Level I trauma centers completed the RPQ at day 1 and 3 months post-injury. Using binary logistic regression models and fivefold internal cross-validation, we calculated the mean area under the curve (AUC) for day 1 RPQ total score in predicting 3-month PPCS. Clinical interpretation tables were provided.</div></div><div><h3>Results</h3><div>Two hundred fifty-two participants who completed a day 1 RPQ were included in the analysis. Inverse probability weighting was used to adjust for bias in attrition (n = 168 followed). The mean cross-validated AUC was 0.84 using day 1 RPQ score alone. Multivariable models, including those using previously validated sets of variables, did not outperform day 1 RPQ alone.</div></div><div><h3>Conclusions</h3><div>In adults presenting to Level I trauma centers for acute mTBI, symptom burden (RPQ total score) is robustly associated with 3-month symptom outcome. The RPQ, which can be completed in about 3 min, may support recognition of mTBI symptoms in the ED and risk stratification for triage into appropriate follow-up pathways.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 211-219"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621942","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":"No Pulse? No Problem. Navigating Left Ventricular Assist Device Emergencies in the Emergency Department","authors":"Paulyne Lee MD ,&nbsp;Mina Ghobrial MD ,&nbsp;Kylee Greider MD ,&nbsp;Adam Hryniewicki MD ,&nbsp;Elizabeth Luu MD ,&nbsp;Amir Aminlari MD ,&nbsp;Matthew Murray MD ,&nbsp;Jal Trivedi MD ,&nbsp;Quan Bui MD ,&nbsp;Gabriel Wardi MD, MPH ,&nbsp;Michael Self MD","doi":"10.1016/j.jemermed.2025.10.041","DOIUrl":"10.1016/j.jemermed.2025.10.041","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist devices (LVADs) are increasingly used in patients with advanced heart failure. As their prevalence grows, emergency physicians (EPs) are more likely to encounter these patients. However, LVAD-supported physiology differs from native cardiac function and can lead to unique complications. Prompt recognition and appropriate initial management are critical.</div></div><div><h3>Objective of the Review</h3><div>The objective of this literature review is to examine carefully selected pieces of literature regarding the initial assessment, stabilization, and emergency management of patients with LVADs. Not all EPs are comfortable with LVADs, and we hope that this review will help identify key physiologic principles, common complications, and practical algorithms that can guide frontline EPs in delivering timely and effective care to this complex patient population.</div></div><div><h3>Discussion</h3><div>The emergency management of patients with LVADs requires a nuanced understanding of altered physiology, an approach to rapid stabilization, and device-specific complications. EPs can lack familiarity with essential LVAD principles, including interpreting non-pulsatile vital signs and identifying unique complications such as pump thrombosis, driveline infections, and right heart failure. While evidence supports early consultation with LVAD coordinators, standardized protocols remain inconsistent across institutions. Focused training and greater dissemination of evidence-based summaries and guidelines are necessary to help close knowledge gaps and improve outcomes in this growing patient population.</div></div><div><h3>Conclusions</h3><div>Incorporating evidence-based research and promoting familiarity with LVAD physiology and complications can enhance both patient safety and provider readiness in these high-stakes encounters.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 276-286"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774704","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":"Analgesia Disparities in Hispanic vs White Patients with Long Bone Fractures","authors":"Dietrich von Kuenssberg Jehle MD ,&nbsp;Krisha Mehta BS ,&nbsp;Emily M. Kim MS ,&nbsp;Lauren G. Bothwell BS ,&nbsp;Blake Mireles MBS ,&nbsp;Mbinui Ghogomu BS ,&nbsp;Christina M. Davis DO ,&nbsp;Krishna K. Paul BS ,&nbsp;Ronald W. Lindsey MD ,&nbsp;Charles P. Mouton MD","doi":"10.1016/j.jemermed.2025.11.003","DOIUrl":"10.1016/j.jemermed.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients presenting to the emergency department (ED) with long bone fractures often require opioid or nonopioid analgesics. Historical data reveal racial disparities, with White patients more likely to receive pain medications than Hispanic patients.</div></div><div><h3>Study Objectives</h3><div>This study investigates differences in the administration of opioid and nonopioid analgesics to Hispanic and White ED patients with long bone and femur fractures over the last 20 years.</div></div><div><h3>Methods</h3><div>Opioid and nonopioid analgesic administration rates in Hispanic and White patients with femur and long bone fractures were analyzed from 2004 to 2024 at 5-year intervals using data from 112 million patients within 64 U.S. healthcare organizations. Propensity matching was performed on demographic variables.</div></div><div><h3>Results</h3><div>There were 771,945 Hispanic or White patients identified with long bone fractures and 159,196 patients with femur fractures before propensity matching, and 248,008 with long bone fractures and 26,210 with femur fractures after propensity matching. In the propensity matched dataset, there was a significant gap in opioid analgesia use for long bone (10.4% vs. 21.4%, <em>p</em> &lt; 0.001) and femur fractures (16.6% vs. 40.0%, <em>p</em> &lt; 0.001) between Hispanic and White patients from 2004 to 2009. This disparity persisted through 2019–2024 for long bone (42.0% vs. 49.3%, <em>p</em> &lt; 0.001) and femur (66.7% vs 77.7%, <em>p</em> &lt; 0.001) fractures. Trends were comparable in the nonopioid cohorts.</div></div><div><h3>Conclusion</h3><div>Over the past two decades, Hispanic patients with long bone and femur fractures were administered lower rates of opioid and nonopioid analgesia compared to White patients. This suggests that ethnic differences may still contribute significantly to disparities in analgesia administration in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 287-296"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786580","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}