Journal of Emergency Medicine最新文献

{"title":"Factors Associated with Take Home Naloxone Refusal among Emergency Department Patients Participating in an Opioid Overdose Prevention Program","authors":"Clare O'Brien-Lambert MPH ,&nbsp;Keri Althoff PhD ,&nbsp;Jennifer Barvincak MPH ,&nbsp;Halle Cirbus MS ,&nbsp;Safia Singer-Pomerantz ,&nbsp;Ethan Cowan MD, MS","doi":"10.1016/j.jemermed.2024.05.016","DOIUrl":"10.1016/j.jemermed.2024.05.016","url":null,"abstract":"<div><h3>Background</h3><div>Increasing the equitable distribution of take home naloxone (THN) may result in reduced deaths from opioid overdose (OD).</div></div><div><h3>Objectives</h3><div>The primary study objective is to describe the demographic and clinical characteristics of emergency department (ED) patients who decline THN. The findings of this descriptive study may generate new hypotheses for successful THN distribution.</div></div><div><h3>Methods</h3><div>Retrospective chart review using prospectively collected program evaluation data from a single urban EDs Health Education THN database and electronic health record. Characteristics of participants who refused versus accepted THN were compared using Chi-square testing for categorical variables and t-tests for continuous variables. A multivariate model was built to assess associations of statistical and clinically relevant characteristics with THN refusal.</div></div><div><h3>Results</h3><div>A total of 711 ED patients were offered THN of which 334 (46%) declined. In unadjusted analysis, with the independent variable being refusal of the THN offer, being currently on medication for opioid use disorder (MOUD) was associated with a greater odds of refusal (OR 1.9, 95%CI 1.3-2.6) while any drug related overdose (OR 0.6, 95%CI 0.4-0.8) or being given a prescription for buprenorphine in the ED (OR 0.2, 95%CI 0.1-0.9) were both associated with a lower odds of refusal.</div></div><div><h3>Conclusions</h3><div>Demographic characteristics did not differ between those who accept versus refuse THN. Patients already receiving MOUD were more likely to refuse THN while those starting MOUD in the ED were less likely to refuse THN. Further studies are needed to determine the root causes of patients’ declination of THN and develop targeted interventions to address these causes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e590-e598"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141276784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AAEM Clinical Practice Statement: Addressing Social Risks and Needs in the Emergency Department","authors":"Richelle J. Cooper MD, MSHS, FACEP, FAAEM,&nbsp;Jerome R. Hoffman MA, MD, FAAEM","doi":"10.1016/j.jemermed.2024.11.021","DOIUrl":"10.1016/j.jemermed.2024.11.021","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e641-e646"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813340","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":"In Reply: Preventing Intubation in Salicylism does not in and of itself Prevent Iatrogenic","authors":"Brooke A. McDonald DO, MA ,&nbsp;Jon B. Cole MD, FACEP, FACMT, FAACT ,&nbsp;Matthew E. Prekker MD, MPH ,&nbsp;Travis D. Olives MD, MPH, MED","doi":"10.1016/j.jemermed.2024.08.002","DOIUrl":"10.1016/j.jemermed.2024.08.002","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e610-e612"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813342","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(24)00393-7","DOIUrl":"10.1016/S0736-4679(24)00393-7","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e647-e648"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139620","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":"Pulmonary Embolism Rule-out Criteria: Diagnostic Accuracy and Impact of COVID-19","authors":"Seda Kilicoglu Tanir MD ,&nbsp;Merve Eksioglu MD ,&nbsp;Tuba Cimilli Ozturk MD","doi":"10.1016/j.jemermed.2024.06.007","DOIUrl":"10.1016/j.jemermed.2024.06.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The Pulmonary Embolism Rule-Out Criteria (PERC), developed to minimize unnecessary testing in low-risk pulmonary embolism (PE) cases, lacks clear validation in the context of COVID-19.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To assess the validity of the PERC in emergency department patients having undergone computed tomography pulmonary angiography (CTPA) during the COVID-19 pandemic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective analysis of emergency department patients who underwent CTPA for suspected PE. COVID-19 status was based on the results of a reverse transcription-polymerase chain reaction (RT-PCR) test performed in the emergency department, or within 30 days prior to visiting the emergency department. We collected data on demographics, symptoms, &lt;span&gt;d&lt;/span&gt;-dimer levels, and medical history relevant to thrombosis and conducted the PERC test using the criteria including age, oxygen saturation, heart rate, and the absence of hemoptysis or recent trauma. We categorized outcomes based on the concordance between the PERC results and CTPA findings, with specific definitions for true positive and negative, as well as false positive and negative results. We also evaluated the impact of COVID-19 status on the diagnostic performance of the PERC by analyzing the prevalence of PE in patients testing positive and negative for COVID-19.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among the 2.430 participants, 45.1% tested negative for COVID-19, 43.4% tested positive, and 11.5% were untested. The PERC identified 91.2% of the cases as positive, 6.9% of which were confirmed to have PE. Overall, 84.9% of cases (n = 2.062) showed a discordant result between the PERC and CTPA findings. The lack of significant correspondence between the PERC positivity and actual PE presence (&lt;em&gt;p&lt;/em&gt; = 0.001; &lt;em&gt;p&lt;/em&gt; &lt; 0.01) indicated low diagnostic concordance. In patients with a positive COVID-19 test result, the PERC demonstrated a sensitivity of 95.3% (95% CI: 86.91–99.02), a specificity of 9.1% (95% CI: 7.46–11.15), a positive predictive value of 6.3% (95% CI: 6.01–6.70), a negative predictive value of 96.8% (95% CI: 90.81–98.94), and an accuracy of 14.4% (95% CI: 12.34–16.67). In patients who tested negative for COVID-19, the sensitivity was 95.4% (95% CI: 88.64–98.73), the specificity was 7.8% (95% CI: 6.25–9.66), the positive predictive value was 8.1% (95% CI: 7.83–8.57), the negative predictive value was 95.1% (95% CI: 88.11–98.14), and the accuracy was 14.7% (95% CI: 12.73–17.02).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The study demonstrates that the sensitivity and negative predictive value of the PERC are comparable in COVID-19 positive and negative patients. Furthermore, the incidence of PE among patients presenting to the emergency department did not significantly differ based on COVID-19 status. While this study highlights the relevance of the PERC in clinical decision-making, caution is advised as the ","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e507-e515"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408096","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":"An Unusual Case of Failure to Thrive: Respiratory Failure from a Vallecular Cyst in a Young Infant","authors":"Tamara Casas MD ,&nbsp;Matthew Murray MD ,&nbsp;Tara Glenn MD ,&nbsp;Karen Yaphockun DO","doi":"10.1016/j.jemermed.2024.05.015","DOIUrl":"10.1016/j.jemermed.2024.05.015","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e574-e577"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408535","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":"","authors":"Edward J. Otten MD, FACMT, FAWM","doi":"10.1016/j.jemermed.2024.08.001","DOIUrl":"10.1016/j.jemermed.2024.08.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e620-e621"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142212510","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 Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis","authors":"Thomas Vincent MD ,&nbsp;Tiphaine Lefebvre PhD ,&nbsp;Mikaël Martinez MD ,&nbsp;Guillaume Debaty MD, PhD ,&nbsp;Cyril Noto-Campanella MD, MSc ,&nbsp;Valentine Canon PhD ,&nbsp;Karim Tazarourte MD, PhD ,&nbsp;Axel Benhamed MD, MSc ,&nbsp;RéAC Investigators","doi":"10.1016/j.jemermed.2024.06.008","DOIUrl":"10.1016/j.jemermed.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Out of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown.</div></div><div><h3>Objectives</h3><div>To investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used.</div></div><div><h3>Results</h3><div>2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e533-e543"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Takotsubo Cardiomyopathy, Left Ventricular Outflow Tract Obstruction, and Hypotension","authors":"Oscar M P Jolobe","doi":"10.1016/j.jemermed.2024.06.012","DOIUrl":"10.1016/j.jemermed.2024.06.012","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e615-e617"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813345","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":"Case Report of an Obstructive Endotracheal Mass from a Blood Clot: An Airway Nightmare.","authors":"Sara Bradley, Verena Schandera, Mary L Bing","doi":"10.1016/j.jemermed.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.10.005","url":null,"abstract":"<p><strong>Background: </strong>Central airway obstruction from a mass is a rare but deadly manifestation of advanced primary lung cancer that can cause considerable challenges during endotracheal intubation, including airway debris or bleeding, ventilation difficulties, and prolonged postintubation hypoxia.</p><p><strong>Case report: </strong>This case report describes a patient presenting with the chief symptom of massive hemoptysis who was difficult to ventilate and oxygenate after an easy intubation. On bedside bronchoscopy, an obstructing mass was found at the carina that was later determined to be caused by a blood clot. Patient course was complicated by tension pneumothoraces, prolonged hypoxia, and cardiopulmonary arrest. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recognition of an obstructing airway mass can be achieved with bedside fiberoptic bronchoscopy and allow for prompt mobilization of specialty services with rigid bronchoscopy capabilities for mass removal.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425431","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}