Journal of Emergency Medicine最新文献

{"title":"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;Aidan Mullan MA ,&nbsp;Coral Marí Chantada BS ,&nbsp;Annelise S. Howick BA ,&nbsp;Garvan C. Kane MD, PhD ,&nbsp;Fernanda Bellolio MD, MSc","doi":"10.1016/j.jemermed.2024.06.010","DOIUrl":"10.1016/j.jemermed.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Diltiazem is an effective rate control agent for atrial fibrillation with rapid ventricular rate (AF RVR). However, its negative inotropic effects may increase the risk for worsening heart failure in patients with a reduced ejection fraction (EF).</div></div><div><h3>Objectives</h3><div>This observational study aims to describe the incidence of worsening heart failure in patients who receive intravenous diltiazem for acute atrial fibrillation management.</div></div><div><h3>Methods</h3><div>Adult patients that received diltiazem in the emergency department (ED) for AF RVR (heart rate ≥ 100 beats/min) from 2021 to 2022 and had a prior documented EF were included. The primary outcome is worsening heart failure within 24 h of diltiazem administration. Secondary outcomes include return ED visits and death within 7 days. EF percentage was compared across outcomes using Wilcoxon rank-sum tests. Outcomes were compared by reduced EF (&lt; 50%) and preserved EF (≥ 50%). Continuous data were summarized with medians and interquartile ranges, and categorical features were summarized with frequency counts and percentages. Wilcoxon rank-sum tests were used for numeric outcomes and chi-squared tests or Fisher's exact tests for categorical outcomes, with a <em>p</em>-value &lt; 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>There were 674 patients with AF RVR that received diltiazem, and 386 patients met the inclusion criteria for analysis. Baseline demographics included a median age of 72 (64–81) years, with 14.5% of patients having a prior diagnosis of congestive heart failure. EF &lt; 50% was identified in 13.7% of patients (n = 53), of which approximately 30% of these patients safely discharged home after receiving i.v. diltiazem. The primary outcome of worsening heart failure occurred in 7/41 (17%) and 10/207 (4.8%) patients with reduced and preserved ejection fractions, respectively, who were admitted to the hospital (<em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>The development of worsening heart failure is multifactorial and may include the use of diltiazem in critically ill patients requiring hospital admission.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e560-e568"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141415447","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 Testicular Trauma in Sports: Analysis of the National Electronic Injury Surveillance System Database","authors":"Rishubh Jain BA,&nbsp;Mohnish Nadella BS,&nbsp;Rory Byrne BA,&nbsp;Nishant Jayachandran,&nbsp;Matthew Quinn MD,&nbsp;Brett D. Owens MD","doi":"10.1016/j.jemermed.2024.06.005","DOIUrl":"10.1016/j.jemermed.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>The epidemiology of testicular trauma in sports on a national scale has not been well studied. Timely management and treatment after testicular trauma is critical to avoid serious, long-term ramifications of mismanagement.</div></div><div><h3>Objective</h3><div>The aim was to analyze trends in sports-related testicular trauma based on specific sports and patient demographic characteristics over time.</div></div><div><h3>Methods</h3><div>The National Electronic Injury Surveillance System was queried for emergency department cases between 2012 and 2021 with injuries in the pubic region related to 10 commonly played sports. Variables examined included patient age, race, disposition, and sport using incidence rate, incidence rate ratios, and χ² analysis.</div></div><div><h3>Results</h3><div>There were an estimated 28,844 emergency department cases of sports-related testicular trauma between 2012 and 2021. Young patients, aged between 10 and 14 years and 15 and 19 years, accounted for most cases, and results of χ² analysis showed a significant difference in incidence based on age group (<em>p</em> &lt; 0.01). Most injuries occurred while athletes played basketball, football, and soccer (73.6%).</div></div><div><h3>Conclusions</h3><div>Sports-related testicular trauma injury rates remained steady between 2012 and 2021, which suggests greater efforts are necessary to reduce the incidence of sports-related testicular trauma. Education efforts should focus on 10- to 19-year-olds because they have the highest incidence. Given the high incidence in sports like basketball and soccer compared with football and lacrosse, testicular trauma seems to be a risk for athletes competing both recreationally and competitively.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e544-e552"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705502","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":"Intubation Appears Safe in Moderate Salicylate Poisoning But Not Necessarily in Severe Poisoning","authors":"Michael E. Mullins MD","doi":"10.1016/j.jemermed.2024.06.015","DOIUrl":"10.1016/j.jemermed.2024.06.015","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e608-e609"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813343","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 Young Woman with Apparent Brain Death","authors":"Christiana K. Prucnal MD, ScM ,&nbsp;Paul S. Jansson MD, MS ,&nbsp;Peter R. Chai MD, MS ,&nbsp;Stephen D. Hallisey MD ,&nbsp;Derek L. Monette MD, MHPE ,&nbsp;Kathleen A. Wittels MD","doi":"10.1016/j.jemermed.2024.06.003","DOIUrl":"10.1016/j.jemermed.2024.06.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e634-e640"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258905","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":"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}