Journal of Emergency Medicine最新文献

{"title":"Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis: A Pilot Study","authors":"Hani I. Kuttab MD ,&nbsp;Sara C. Damewood MD ,&nbsp;Jessica Schmidt MD, MPH ,&nbsp;Amber Lin MS ,&nbsp;Kevin Emmerich MD ,&nbsp;Nikolai Schnittke MD, PhD","doi":"10.1016/j.jemermed.2024.07.009","DOIUrl":"10.1016/j.jemermed.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>It is challenging to identify emergency department (ED) patients with sepsis who will require resources such as positive-pressure ventilation, vasopressors, or intensive care unit (ICU) admission.</div></div><div><h3>Objectives</h3><div>Describe the correlation of cardiopulmonary ultrasound (CPUS) with need for care escalation.</div></div><div><h3>Methods</h3><div>Single center, prospective, observational study of adult patients with suspected sepsis. CPUS assessed left ventricular systolic function (LVF), right ventricular (RV) size and function, inferior vena cava (IVC) collapsibility, and thoracic B lines. The primary composite outcome was need for care escalation within 12 hours of ED presentation defined as: ICU admission or positive-pressure ventilation or vasopressor infusion.</div></div><div><h3>Results</h3><div>A total of 92 patients were enrolled; 18 (19.6%) required care escalation. A logistic regression model identified the presence of ≥4 thoracic B-lines as a statistically significant predictor of care escalation (OR 7.8, 95% CI [1.3–26.4], <em>p =</em> 0.002). Other features positively correlated with care escalation were: reduced LVF (OR 4.26, 95% CI [0.06–12.9], <em>p =</em> 0.14), and dilated RV size (OR 2.8, 95% CI [0.4–11.8], <em>p =</em> 0.16). A retrospective stepwise regression model incorporating these three variables to predict care escalation showed an AUROC = 0.75 (95% CI [0.63–0.88]). When 2 or more variables were abnormal the model showed excellent specificity of 95% (LR+ 6.2), but low sensitivity of 33% (LR- 0.7).</div></div><div><h3>Conclusions</h3><div>In patients with concern for sepsis early findings of ≥4 B-lines is associated with care escalation. Combining this finding with LVF and RV size assessment improves the positive predictive power and may be useful in rapid identification of patients likely to require care escalation.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 54-65"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785967","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":"Respecting autonomy and capacity in patients with opioid use disorder","authors":"Michael E. Mullins MD ,&nbsp;Melissa R. Kroll MD ,&nbsp;David B. Liss MD","doi":"10.1016/j.jemermed.2024.08.003","DOIUrl":"10.1016/j.jemermed.2024.08.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 111-112"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006717","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":"External Validation of Vision, Aphasia and Neglect, Ventura Emergent Large Vessel Occlusion and Large Artery Intracranial Occlusion Screening Tools for Emergent Large Vessel Occlusion Stroke: A Multicenter, Prospective, Cross-Sectional Study","authors":"İbrahim Ulaş Özturan MD ,&nbsp;Duygu Ferek Emir MD ,&nbsp;Adnan Karadaş MD ,&nbsp;Cansu Alyeşil Özturan MD ,&nbsp;Uğur Durmuş MD ,&nbsp;Nurettin Özgür Doğan MD ,&nbsp;Elif Yaka MD ,&nbsp;Serkan Yılmaz MD ,&nbsp;Murat Pekdemir MD","doi":"10.1016/j.jemermed.2024.07.004","DOIUrl":"10.1016/j.jemermed.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Vision, Aphasia, and Neglect (VAN), Ventura Emergent Large Vessel Occlusion (VES), and Large Artery Intracranial Occlusion (LARIO) are promising stroke screening tools that were shown to have high diagnostic performance to detect Emergent Large Vessel Occlusion (ELVO) in their derivation studies.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the validation of VAN, VES, and LARIO in predicting ELVO among patients presenting at emergency department (ED) triage with suspected acute ischemic stroke.</div></div><div><h3>Methods</h3><div>This is a prospective multicenter study conducted in five EDs of tertiary stroke centers between June and October 2023. Patients with suspected stroke admitted to ED for triage were evaluated using the VAN, VES, and LARIO stroke screening tools. Diagnostic performances of these tools for predicting ELVO were determined and compared with the National Institute of Health Stroke Scale (NIHSS).</div></div><div><h3>Results</h3><div>A total of 614 patients were included. The prevalence of ELVO was found to be 23.5% in the study population. VAN exhibited a sensitivity of 70.1% and specificity of 78.7%, VES showed a higher sensitivity (79.1%) with lower specificity (63.4%), while LARIO displayed high specificity (86%) with lower sensitivity (56.3%). Receiver operating characteristic curve analysis showed that LARIO and NIHSS had similar diagnostic performance (areas under the curve [AUC] 0.801 and 0.805, <em>p</em> = 0.7, respectively), while VES showed a modestly poorer performance (AUC 0.746, <em>p</em> &lt; 0.001 and <em>p</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>The comparable diagnostic performance of VAN, VES, and LARIO to the NIHSS, in addition to their straightforwardness and rapid evaluation time, can facilitate optimal care for patients with ELVO in prehospital or ED triage settings.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 15-24"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785971","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":"Differentiating Vestibular Migraine and Posterior Circulation Transient Ischemic Attack in the Emergency Department: An Expert Practice Review","authors":"Sameer Sharif MD MSc ,&nbsp;Susrutha Kotwal MBBS MD ,&nbsp;Jonathan A. Edlow MD","doi":"10.1016/j.jemermed.2024.07.002","DOIUrl":"10.1016/j.jemermed.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Vestibular migraine (VM) is a subset of migraine and, as its name suggests, presents with both migrainous and vestibular symptoms. However, a more worrisome diagnosis that can present with similar features is posterior circulation transient ischemic attack (pc-TIA) presenting as episodes of isolated dizziness.</div></div><div><h3>Objectives</h3><div>The purpose of this article is to introduce emergency physicians to the diagnostic features of VM focusing on epidemiological context, timing and quality of symptoms that help differentiate vestibular migraine from pc-TIA.</div></div><div><h3>Discussion</h3><div>Our comprehensive search of epidemiologic data of VM patients found that they are more likely to be younger and female than patients with pc-TIA. Traditional vascular risk factors and a recent history of head or neck trauma are more common in pc-TIA patients. The onset of dizziness is sudden in pc-TIA with symptoms often lasting less than one hour. Moreover, symptoms tend to be positive in VM versus negative in pc-TIA.</div></div><div><h3>Conclusions</h3><div>Medical decision making should be individualized. A new nontriggered episode of isolated dizziness or those with new transient neurological findings should be evaluated for pc-TIA. VM should be considered in younger patients who have had multiple episodes over a greater time period with other migraine-related symptoms.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 113-121"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780391","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":"Rescue Sedation after 5 mg or 10 mg of Droperidol as the Initial Treatment for Acute Agitation in the Emergency Department","authors":"Jon B. Cole MD ,&nbsp;Kathryn A. Glass PharmD ,&nbsp;Quin T. Stevens MD ,&nbsp;Amber R. LeBrun PharmD ,&nbsp;Nicholas A. Beaupre PharmD ,&nbsp;Brian E. Driver MD","doi":"10.1016/j.jemermed.2024.07.005","DOIUrl":"10.1016/j.jemermed.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Droperidol is used commonly to treat agitation in the emergency department (ED), however, data comparing doses are lacking.</div></div><div><h3>Objective</h3><div>The aim of this study was to compare the effectiveness of 5 mg vs. 10 mg as initial droperidol dose for acute agitation in the ED.</div></div><div><h3>Methods</h3><div>This single-center, retrospective study examined adult ED patients receiving either 5 mg or 10 mg droperidol as the first agent to treat agitation from 2010 to 2023. The primary outcome was need for additional (rescue) sedation within 1 h of initial droperidol dose.</div></div><div><h3>Results</h3><div>The authors identified 11,568 patients who received droperidol as their first medication (n = 8603 [74%] via intramuscular route); 10,293 received 5 mg and 1275 received 10 mg. Median age was 39 years (interquartile range 28–50 years); 8372 (72%) were male. Rescue sedation within 1 h was administered to 987 patients (9.6%) in the 5-mg group and 189 patients (14.8%) in the 10-mg group (difference 5.2%; 95% CI 3.2–7.3%). Additional sedation at any time was administered to 1776 patients (17.3%) in the 5-mg group and 318 (24.9%) in the 10-mg group (difference 7.7%; 95% CI 5.2–10.2%). Median length of stay was 471 min (interquartile range 347–611 min) in the 5 mg group and 487 min (interquartile range 364–641 min) in the 10-mg group (median difference 24 min; 95% CI 11–37 min).</div></div><div><h3>Conclusions</h3><div>In this large cohort, patients deemed appropriately treated with 5 mg of droperidol required less rescue sedation than patients determined to need 10 mg.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 73-83"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791987","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":"Characteristics of High Utilizer Patients in the Emergency Department at a University Hospital in the Kingdom of Bahrain","authors":"Naser Aljawder MD ,&nbsp;Israa Sinan BSc ,&nbsp;Faisal Qureshi MD ,&nbsp;Eyad Bucheer MD ,&nbsp;Aysha Aljawder MD","doi":"10.1016/j.jemermed.2024.07.003","DOIUrl":"10.1016/j.jemermed.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) around the world are facing a crippling crisis of overcrowding, a complex problem caused by a variety of factors. One contributing factor is the overutilization of EDs by patients with frequent visits.</div></div><div><h3>Objective</h3><div>This study aims at measuring the prevalence of this phenomenon and better understanding the characteristics of high utilizers.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted in a tertiary care teaching hospital, for patients aged 14 years and above during the year 2022. The definition of a high utilizer is set as any patient that fits the inclusion criteria with four or more visits to the ED during 1 year.</div></div><div><h3>Results</h3><div>The prevalence of high utilizers in our ED is 3.9%, accounting for 12.1% of visits in 2022, where 135 was the highest number of visits made by one patient. Visits mostly consisted of level 3, Yellow (48.9%) and level 4, Green (42.8%) triage. The top three chief complaints were sore throat (16.8%), unwell adult (15.1%), and abdominal pain (12.8%). The total length of stay was 3.6 ± 3.2 h in the ED. Time of arrival was observed; 23.9% presented at night, 37.8% in the morning, and 38.8% in the evening.</div></div><div><h3>Conclusions</h3><div>The prevalence rate of high utilizers was found to be 3.9% in our study, falling within the range based on literature. Due to the parallel issues raised by many studies, the importance of developing convenient corrective strategies and conducting further national-based studies to get better insight of high utilizers is required.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 100-108"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006703","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":"Integrating Longitudinal Simulation-Based Education: Enhancing Trainee Competence in U.S. Emergency Medicine Residency Programs","authors":"Sara Hock MD ,&nbsp;Afrah A. Ali MBBS ,&nbsp;Kimberly Sokol MD, MS, MACM ,&nbsp;Jerome Balbin MD ,&nbsp;Suzanne K. Bentley MD, MPH ,&nbsp;Vivienne Ng MD, MPH","doi":"10.1016/j.jemermed.2024.07.001","DOIUrl":"10.1016/j.jemermed.2024.07.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 96-99"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006713","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 Review of Pediatric Appendicitis Imaging Trends from 2006–2020 Using the Nationwide Emergency Department Sample","authors":"Bradley End MD ,&nbsp;Kimberly Quedado PhD ,&nbsp;Garrick Anderson MD ,&nbsp;Syed Kazmi MD ,&nbsp;Hansol Chung MD ,&nbsp;Jessica Neidhardt MD ,&nbsp;Courtney Cundiff MD ,&nbsp;Wei Fang PhD ,&nbsp;Joseph Minardi MD","doi":"10.1016/j.jemermed.2024.07.012","DOIUrl":"10.1016/j.jemermed.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Appendicitis is a common surgical emergency in the pediatric population, affecting over 70,000 children per year in the United States alone. While historically practitioners predominately used computed tomography (CT) as the main diagnostic imaging modality, multiple professional societies have released guidelines recommending an ultrasound (US) first strategy when using imaging to confirm suspected appendicitis in pediatric populations. To date, no studies have quantified the change in imaging trends for pediatric appendicitis across the spectrum of healthcare facilities in the United States utilizing the Nationwide Emergency Department Sample (NEDS).</div></div><div><h3>Objectives</h3><div>We aimed to evaluate the imaging trends for pediatric appendicitis across the nation, stratified by age and gender. Specifically, we wanted to delineate the use of CT alone versus US alone or US first imaging strategies.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study utilized data from the NEDS spanning from 2006 through 2020. We examined and analyzed the total number of patients, the number of patients with available imaging data, sex, age, and included imaging modalities utilizing descriptive statistics and regression analyses. Similarly, regression analysis was employed to discern differences in imaging rates in time intervals following societal imaging recommendations.</div></div><div><h3>Results</h3><div>From 2006 to 2020 the database recorded 160,828 encounters for pediatric appendicitis. Imaging data was available for 101,248 encounters, accounting for 63% of the total sample. Over the study period, both rates of “US only” and “US first” imaging modalities increased (from 5.5% to 38.9% and 8.9% to 55.6%, respectively), while rates of CT utilization in isolation declined (from 91.1% to 44%).</div></div><div><h3>Conclusion</h3><div>While there is an increasing trend towards US being used as the first imaging modality to diagnose pediatric appendicitis across the spectrum of facilities included in the NEDS, continued utilization of CT to diagnose appendicitis remains unacceptably high in the pediatric population within the limits of this retrospective study.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 25-33"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854400","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 Shortness of Breath","authors":"William Bleifuss MD,&nbsp;Brian Mehus MD","doi":"10.1016/j.jemermed.2024.08.007","DOIUrl":"10.1016/j.jemermed.2024.08.007","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 93-95"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983700","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":"Visual Diagnosis in Emergency Medicine: A Shock to the System: The Uncommon Encounter of a Transcranial TASER Injury","authors":"Ritika Gudhe MD,&nbsp;Batsheva Sholomson DO,&nbsp;Adil Husain MD,&nbsp;Abbas Husain MD,&nbsp;Barry Hahn MD","doi":"10.1016/j.jemermed.2024.07.013","DOIUrl":"10.1016/j.jemermed.2024.07.013","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 89-92"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983771","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}