Journal of Emergency Medicine最新文献

{"title":"Association of Troponin Elevation with Cardiovascular Event in Stable Supraventricular Tachycardia in the Emergency Department","authors":"Maha Khan MD ,&nbsp;Ching-Fang Tiffany Tzeng MD, MPH ,&nbsp;Yu-Lin Hsieh MD ,&nbsp;Jack Healy MD ,&nbsp;Christian Lee MD ,&nbsp;Kevin Ku MD ,&nbsp;Andrew Shedd MD ,&nbsp;Toral Bhakta DO ,&nbsp;Eric H. Chou MD","doi":"10.1016/j.jemermed.2025.09.011","DOIUrl":"10.1016/j.jemermed.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac troponin is routinely measured in the emergency department (ED) to evaluate patients with chest discomfort or dysrhythmias. However, its prognostic value in patients presenting with stable supraventricular tachycardia (SVT) remains uncertain.</div></div><div><h3>Objectives</h3><div>To assess the prognostic value of troponin for 30-day major adverse cardiac events (MACE) in adult patients presenting with stable SVT in the ED.</div></div><div><h3>Methods</h3><div>This was a retrospective, multi-center cohort study conducted in EDs in North Texas. Adult patients presenting with stable SVT in the ED were included. The primary endpoint was the occurrence of 30-day MACE, defined as a composite outcome of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, and all-cause mortality.</div></div><div><h3>Results</h3><div>A total of 493 patient encounters met inclusion criteria. Of these, 34 (6.9%) did not have troponin measured, 349 (70.8%) had non-elevated troponin levels, and 110 (22.3%) had elevated troponin levels. Patients who underwent troponin testing were at higher risk of MACE compared with those without testing (<em>p</em> &lt; 0.001). Among patients with troponin testing, MACE occurred in 28.2% of those with elevated troponin versus 4.6% of those with non-elevated troponin (<em>p</em> &lt; 0.001). Elevated troponin was associated with higher odds of 30-day MACE (OR 5.32, 95% CI: 1.92–14.7; <em>p</em> &lt; 0.001). Compared to non-elevated troponin group, patients with elevated troponin had higher rates of ED SVT recurrence, hospital, and intensive care unit (ICU) admission.</div></div><div><h3>Conclusion</h3><div>Elevated troponin levels were associated with a significantly increased risk of 30-day MACE in our cohort. These findings highlight a potential role for troponin in identifying patients at higher risk for adverse short-term cardiac outcomes, even after successful rhythm conversion.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 134-144"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578333","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":"Ultrasound Guided Erector Spinae Plane Block for Pain Management in the Emergency Department: A Scoping Review","authors":"Richard J. Gawel MD ,&nbsp;Zhengqiu Zhou MD ,&nbsp;Claudia Urban DO ,&nbsp;Joshua Middleton MD ,&nbsp;Michael Shalaby MD","doi":"10.1016/j.jemermed.2025.09.021","DOIUrl":"10.1016/j.jemermed.2025.09.021","url":null,"abstract":"<div><h3>Background</h3><div>The ultrasound-guided erector spinae plane block (ESPB) is a relatively new regional anesthesia technique increasingly used in the emergency department (ED) for multimodal analgesia.</div></div><div><h3>Objectives</h3><div>To summarize the existing literature on ESPBs performed by emergency physicians (EPs).</div></div><div><h3>Methods</h3><div>Following PRISMA-ScR guidelines, we searched five databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, and CINAHL) from inception to June 10, 2025. Records were screened in duplicate, and data were extracted for quantitative and qualitative synthesis in accordance with best practices.</div></div><div><h3>Results</h3><div>Of 157 unique records, 42 articles met inclusion criteria, reporting 341 ESPBs performed on 279 patients. Most studies were case reports (25 articles, 60%) or small case series (8 articles, 19%), with only six randomized clinical trials (14%). Common indications included visceral abdominal pain (18 articles, 43%), rib fractures (8 articles, 19%), and low back pain (4 articles, 9.5%). Technical approaches varied widely in terms of block laterality, patient positioning, and transducer type. Adverse events were infrequent (9 cases, 3.2%), with only one suspected case of local anesthetic systemic toxicity (0.4%).</div></div><div><h3>Conclusions</h3><div>Emergency physician-performed ESPBs are increasingly described for diverse indications, but the current evidence base is limited and heterogeneous. Further research should focus on standardizing techniques, enhancing safety monitoring, and conducting high-quality studies to support broader implementation in emergency medicine.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 95-103"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578370","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":"Comment on “Evaluating the Accuracy of Artificial Intelligence Chatbots in Triaging Emergency Cases”","authors":"Hinpetch Daungsupawong PhD ,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.jemermed.2025.10.001","DOIUrl":"10.1016/j.jemermed.2025.10.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 323-324"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972798","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":"Epidemiology of Boxing-Related Upper Extremity Injuries Presenting to Emergency Departments in the United States from 2014 to 2023","authors":"Michael N. Megafu DO, MPH ,&nbsp;Noelle Nerenberg BS ,&nbsp;Hirshal Pandya MS ,&nbsp;Omar Guerrero BS ,&nbsp;Jacob Speechley DO ,&nbsp;Samuelson E. Osifo MD ,&nbsp;Paul Tornetta III MD ,&nbsp;Robert L. Parisien MD ,&nbsp;Antonio Cusano MD ,&nbsp;Investigation performed by the Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group","doi":"10.1016/j.jemermed.2025.10.003","DOIUrl":"10.1016/j.jemermed.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>The epidemiology of boxing-related upper extremity injuries in the United States (US) has been minimally described, with only one prior study examining data up to 2016.</div></div><div><h3>Objective</h3><div>To update and extend national estimates of these injuries through 2023, highlighting post-2016 trends and the impact of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>The National Electronic Surveillance System database was queried for upper extremity boxing-related injuries presenting to US emergency departments from January 1, 2014, to December 31, 2023. Injuries were categorized by body part, diagnosis, and disposition. National estimates (NE) were calculated based on each hospital's assigned statistical sample weight. Linear regression assessed trends over time.</div></div><div><h3>Results</h3><div>A total of 106,903 boxing-related upper extremity injuries were identified. The hand (48.3%), wrist (18.9%), and shoulder (14.2%) were the most commonly affected areas. Fractures were the most frequent diagnosis (26.4%), followed by strains/sprains (24.1%), other injuries (21.3%), and contusions/abrasions (17.9%). Only 3.3% of cases required hospital admission. Injury counts dropped sharply in 2020 during the COVID-19 pandemic (NE = 7282; <em>p</em> &lt; 0.01 compared to pre-COVID years of 2014–2019), followed by a rebound in subsequent years, peaking in 2023 (NE = 13,258). Linear regression showed a nonsignificant annual decrease of 76 injuries over 10 years (<em>p</em> = 0.70; coefficient = −75.6; 95% CI: −508.7 to 357.5).</div></div><div><h3>Conclusion</h3><div>Boxing-related upper extremities most commonly involve the hand, with fractures representing the most common diagnosis. In conclusion, the rebound in injury rates in 2023, which diverges from the pre-COVID trend of gradual decline, warrants attention.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 44-50"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573106","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":"Point-of-Care Ultrasound vs. Manual Palpation for Pulse Check in Cardiac Arrest Patients: A Systematic Review","authors":"Sin Yin Ko MD ,&nbsp;Shooka Ghotb Razmjou BSc ,&nbsp;Juanita Haagsma PhD ,&nbsp;Rob Verdonschot MD, PhD","doi":"10.1016/j.jemermed.2025.09.019","DOIUrl":"10.1016/j.jemermed.2025.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Accurate pulse checks are extremely important in the management of cardiac arrest patients. Pulse check through manual palpation is known to be difficult and unreliable, even for health care providers. Given the increasing role of point-of-care ultrasound (POCUS) in cardiac arrest care, it may offer a more effective method for pulse check.</div></div><div><h3>Objective</h3><div>This systematic review aimed to investigate whether POCUS of the great arteries would be a more accurate and faster alternative to manual palpation for the pulse check during cardiac arrest.</div></div><div><h3>Methods</h3><div>We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A search was performed through Medline, Embase, Web of Science Core, Cochrane Central, and Google Scholar. The articles were screened for eligibility and assessed for risk of bias by two independent reviewers through the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool.</div></div><div><h3>Results</h3><div>The search yielded 437 articles, of which six matched our inclusion criteria. All three studies that reported about the accuracy had a higher accuracy for pulse check with POCUS. All five studies that reported about the speed of the pulse check had a shorter mean pulse check duration for POCUS.</div></div><div><h3>Conclusion</h3><div>This systematic review suggests that POCUS is quicker and more accurate than manual palpation for checking the pulse during cardiac arrest. However, the evidence is limited by the scarcity, variable quality, and the heterogeneity of the studies.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 112-118"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578326","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":"Seconds Matter: Novel Transport Solutions in Urban Settings Reduce Transport Times","authors":"Zachary Miles MD,&nbsp;Jonathan Thornton MD","doi":"10.1016/j.jemermed.2025.10.016","DOIUrl":"10.1016/j.jemermed.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) due to ST-elevation myocardial infarction (STEMI) requires immediate intervention to optimize survival and neurological outcomes. Rapid recognition and treatment are critical, especially in prehospital settings.</div></div><div><h3>Case Report</h3><div>A 61-year-old female with a history of coronary artery disease suffered a witnessed cardiac arrest while riding a city bus. Bystanders activated Emergency Medical Services (EMS), who promptly initiated cardiopulmonary resuscitation (CPR) and defibrillation, achieving return of spontaneous circulation (ROSC). Due to the patient’s proximity to a tertiary care STEMI center, EMS made the unconventional decision to continue resuscitative efforts en route using the city bus, bypassing traditional ambulance transport. Upon arrival, she underwent emergent percutaneous coronary intervention (PCI) and achieved full neurological recovery.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case illustrates the importance of flexibility and innovation in prehospital care. However, it also highlights the need to balance innovation with adherence to EMS safety protocols and statutory requirements. Uninterrupted CPR, rapid defibrillation, and expedited transport—even via unconventional means—can dramatically impact outcomes in STEMI-related cardiac arrest, but such strategies must always be weighed against provider and patient safety.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 20-22"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546581","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":"Prolonged Emergency Department Stays for Patients With Autism and Acute Mental Health Concerns","authors":"Joanna S Cohen MD ,&nbsp;Priyal Patel BS ,&nbsp;Amanda Finney MHS ,&nbsp;Meilin Zheng ,&nbsp;Oluwakemi Badaki MD PhD ,&nbsp;Laura Prichett PhD, MHS","doi":"10.1016/j.jemermed.2025.10.042","DOIUrl":"10.1016/j.jemermed.2025.10.042","url":null,"abstract":"<div><h3>Background</h3><div>Children with autism spectrum disorders face high rates of mental health emergencies often requiring hospitalization, but limited psychiatric unit access often leaves them waiting in emergency departments (EDs).</div></div><div><h3>Objective</h3><div>To determine if autism is an independent risk factor for prolonged emergency department (ED) stays (&gt;90%), ED psychiatric boarding (&gt;24 hours), and prolonged ED boarding (&gt;48 or 72 hours) for children with mental health concerns requiring hospitalization</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study using the PECARN Registry Dataset from 2016 through 2021. All ED encounters for patients ages 5 to 18 years of age requiring admission for a primary mental health diagnosis were included. The primary outcome was ED length of stay, the primary exposure variable was autism, and potential confounding variables were age, sex, race/ethnicity, and insurance status.</div></div><div><h3>Results</h3><div>A total of 73,624 ED visits were included, 66,113 visits without autism and 7511 with autism. When adjusted for age, sex, race and insurance, admitted patients with autism had higher odds of a prolonged ED stay (aOR 1.26, 95% CI 1.15–1.38), ED boarding (aOR 1.68, 95% CI 1.41–2.00), and prolonged ED boarding &gt; 48 hours (aOR 3.91, 95% CI 2.62–5.84) and &gt; 72 hours (aOR 3.91, 95% CI 2.14–7.14).</div></div><div><h3>Conclusion</h3><div>Autism is an independent risk factor for having a prolonged ED stay, for boarding in the ED, and for prolonged ED boarding when presenting to the ED with a mental health crisis that requires hospitalization.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 253-265"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661027","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":"Predicting Early Diuretic Success in the Emergency Department: Operational and Pathophysiologic Implications of Urine Sodium and Conductivity","authors":"Schawanya Kaewpitoon Rattanapitoon MD ,&nbsp;Nav La MD, PhD ,&nbsp;Chadaporn Nuchjungreed Gordon PhD ,&nbsp;Nathkapach Kaewpitoon Rattanapitoon PhD","doi":"10.1016/j.jemermed.2025.10.002","DOIUrl":"10.1016/j.jemermed.2025.10.002","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 325-327"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563813","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":"Can Real-Time Prehospital Medical Record Data Presented on A Screen Enhance Team Readiness in the Emergency Department? A Pilot Study","authors":"René Christian Bleeg ,&nbsp;Ninna Rysholt Poulsen ,&nbsp;Mona Kyndi Pedersen ,&nbsp;Peter Skrejborg ,&nbsp;Morten Breinholt Søvsø","doi":"10.1016/j.jemermed.2025.10.020","DOIUrl":"10.1016/j.jemermed.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Medical Services (EMS) continuously document treatment and patient condition information in the electronic prehospital medical record (ePMR) during care. Only selected information is communicated via telephone to the emergency department (ED) and the waiting ED team, potentially leading to loss of valuable information.</div></div><div><h3>Objectives</h3><div>To pilot-test whether implementing real-time, screen-based access to prehospital medical records before patient arrival enhances the ED team’s readiness.</div></div><div><h3>Methods</h3><div>Pilot study of implementing wall-mounted screens connected to the ePMR system in the ED trauma rooms in the North Denmark Regional Hospital. Three months before and four months after implementation, we measured the overall self-reported readiness of the ED team by questionnaires. The readiness rating was based on a visual analogue scale (VAS 0–15) and three sub-questions.</div></div><div><h3>Results</h3><div>We included 393 questionnaires (traumas N = 199, medical emergencies N = 194) corresponding to capture of 46% (141/307) of all events. For all questionnaires combined, overall readiness increased from a median of 7.1 (IQR 6.5–12.9) to 12.8 (IQR 9.7–14), <em>p</em> &lt; 0.001. Stratified by event type, results persisted. Trauma: 7.1 (6.8–12.7) to 13.4 (9–14), <em>p</em> &lt; 0.001; medical emergency: 7.1 (5.7–12.9) to 12.2 (9.7–13.9), <em>p</em> &lt; 0.001.</div></div><div><h3>Conclusions</h3><div>Measured by questionnaires, we found that easy access to real-time EMS patient data, visualized on a screen in the trauma room before receiving patients with traumas or medical emergencies, significantly increases the overall self-reported readiness of the ED team members.</div></div><div><h3>Trial registration</h3><div>None.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 199-210"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621941","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":"Answer the Comment on “Is ChatGPT-40 Truly Ineffective at Trauma X-Ray Interpretation, or Does Machine Learning Simply Need More Practice?”","authors":"Öztürk Ahmet MD ,&nbsp;Günay Serkan MD ,&nbsp;Ateş Serdal MD ,&nbsp;Yiğit Yavuz MD","doi":"10.1016/j.jemermed.2025.10.026","DOIUrl":"10.1016/j.jemermed.2025.10.026","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 328-329"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977105","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}