Emergency medicine journal : EMJ最新文献

{"title":"Predictive performance of the common red flags in emergency department headache patients: a HEAD and HEAD-Colombia study.","authors":"Kevin H Chu, Anne-Maree Kelly, W. Kuan, Frances B Kinnear, G. Keijzers, D. Horner, Said Laribi, Alejandro Cardozo, M. Karamercan, S. Klim, Tissa Wijeratne, Sinan Kamona, Colin A Graham, Richard Body, Tom Roberts","doi":"10.1136/emermed-2023-213461","DOIUrl":"https://doi.org/10.1136/emermed-2023-213461","url":null,"abstract":"OBJECTIVES\u0000Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headache.\u0000\u0000\u0000METHODS\u0000Secondary analysis of data obtained in the HEAD and HEAD-Colombia studies. The outcome of interest was serious secondary headache. The predictive performance of 10 red flag criteria from the SNNOOP10 criteria list was estimated individually and in combination.\u0000\u0000\u0000RESULTS\u00005293 patients were included, of whom 6.1% (95% CI 5.5% to 6.8%) had a defined serious cause identified. New neurological deficit, history of neoplasm, older age (>50 years) and recent head trauma (2-7 days prior) were independent predictors of a serious secondary headache diagnosis. After adjusting for other predictors, sudden onset, onset during exertion, pregnancy and immune suppression were not associated with a serious headache diagnosis. The combined sensitivity of the red flag criteria overall was 96.5% (95% CI 93.2% to 98.3%) but specificity was low, 5.1% (95% CI 4.3% to 6.0%). Positive predictive value was 9.3% (95% CI 8.2% to 10.5%) with negative predictive value of 93.5% (95% CI 87.6% to 96.8%).\u0000\u0000\u0000CONCLUSION\u0000The sensitivity and specificity of the red flag criteria in this study were lower than previously reported. Regarding clinical practice, this suggests that red flag criteria may be useful to identify patients at higher risk of a serious secondary headache cause, but their low specificity could result in increased rates of CT scanning.\u0000\u0000\u0000TRIAL REGISTRATION NUMBER\u0000ANZCTR376695.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic awareness of seriously ill older adults in the emergency department.","authors":"Kei Ouchi, Adrian Haimovich, Jason K Bowman","doi":"10.1136/emermed-2024-214007","DOIUrl":"https://doi.org/10.1136/emermed-2024-214007","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"51 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GP patients in the emergency department.","authors":"Gerry FitzGerald","doi":"10.1136/emermed-2023-213721","DOIUrl":"https://doi.org/10.1136/emermed-2023-213721","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"31 11","pages":"296-297"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation","authors":"A. Cooper, Michelle Edwards, F. Davies, D. Price, Pippa Anderson, A. Carson-Stevens, Matthew Cooke, Jeremy Dale, Liam Donaldson, B. Evans, B. Harrington, Julie Hepburn, P. Hibbert, Thomas Hughes, Alison Porter, A. Siriwardena, Alan Watkins, H. Snooks, Adrian Edwards","doi":"10.1136/emermed-2023-213426","DOIUrl":"https://doi.org/10.1136/emermed-2023-213426","url":null,"abstract":"Background Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context. Methods We conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work. Results GP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the ‘right patients’ are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role. Conclusion GP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"21 9","pages":"287 - 295"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal update monthly top five.","authors":"Ashleigh Trimble, Bethany Sampson, Charlotte Grace Underwood, Roshan Cherian, Fiona McDonald, Victoria Webster, John Shepherd, J. V. van Oppen","doi":"10.1136/emermed-2024-214077","DOIUrl":"https://doi.org/10.1136/emermed-2024-214077","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"75 3","pages":"333-334"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent calf pain after sport activity.","authors":"Antoni Martín-Jiménez, Francisco Miralles-Aguiar, Daniel García-Gil","doi":"10.1136/emermed-2023-213638","DOIUrl":"https://doi.org/10.1136/emermed-2023-213638","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"5 2","pages":"295-340"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent with painful swallowing.","authors":"En-Jui Liu, Chung-Yi Wang, Yen-Yu Liu","doi":"10.1136/emermed-2023-213759","DOIUrl":"https://doi.org/10.1136/emermed-2023-213759","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"100 30","pages":"331-339"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is arrival by ambulance a risk factor for myocardial infarction in emergency department patients with cardiac sounding chest pain?","authors":"James Murray, Edwin Almaraj Raja, Josip Plascevic, Mark Jacunski, Jamie G. Cooper","doi":"10.1136/emermed-2023-213643","DOIUrl":"https://doi.org/10.1136/emermed-2023-213643","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"33 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acutely shaky hand.","authors":"You-Jiang Tan, Chee Hao Teo, Cassandra Chan","doi":"10.1136/emermed-2023-213733","DOIUrl":"https://doi.org/10.1136/emermed-2023-213733","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":"17 1","pages":"303-326"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECG worth a 'few hundred' words.","authors":"Shonda Ng, Kevin Ming Wei Leong, Pow-Li Chia","doi":"10.1136/emermed-2021-212252","DOIUrl":"https://doi.org/10.1136/emermed-2021-212252","url":null,"abstract":"10 Padmanabhan P, Berkenbosch JW, Lorenz D, et al. Evaluation of cerebral oxygenation during procedural sedation in children using near infrared spectroscopy. Ann Emerg Med 2009;54:205–13. 11 Vranken NPA, Weerwind PW, Sutedja NA, et al. Cerebral oximetry and autoregulation during cardiopulmonary bypass: a review. J Extra Corpor Technol 2017;49:182–91 https://www.ncbi.nlm.nih.gov/pubmed/28979042 12 Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol 1990;10:244–51 https://www.ncbi.nlm.nih.gov/pubmed/ 2286697 13 Miner JR, Biros M, Krieg S, et al. Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med 2003;10:931–7. 14 Miner JR, Biros MH, Seigel T, et al. The utility of the bispectral index in procedural sedation with propofol in the emergency department. Acad Emerg Med 2005;12:190–6. 15 O’BrienLambert A, Driver B, Moore JC, et al. Using near infrared spectroscopy for tissue oxygenation monitoring during procedural sedation: the occurrence of peripheral tissue oxygenation changes with respiratory depression and supportive airway measures. Acad Emerg Med 2016;23:98–101. 16 Bhatt M, Kennedy RM, Osmond MH, et al. Consensusbased recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children. Ann Emerg Med 2009;53:426–35. 17 Mille T, Tachimiri ME, Klersy C, et al. Near infrared spectroscopy monitoring during carotid endarterectomy: which threshold value is critical? Eur J Vasc Endovasc Surg 2004;27:646–50. 18 Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)--a metadatadriven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 19 Fleck T, Schubert S, Ewert P, et al. Propofol effect on cerebral oxygenation in children with congenital heart disease. Pediatr Cardiol 2015;36:543–9. 20 Oddo M, Crippa IA, Mehta S, et al. Optimizing sedation in patients with acute brain injury. Crit Care 2016;20:128. 21 Moerman A, De Hert S. Cerebral oximetry: the standard monitor of the future? Curr Opin Anaesthesiol 2015;28:703–9. 22 Khan I, Rehan M, Parikh G, et al. Regional cerebral oximetry as an indicator of acute brain injury in adults undergoing venoarterial extracorporeal membrane Oxygenationa prospective pilot study. Front Neurol 2018;9:993. 23 Wong JK, Smith TN, Pitcher HT, et al. Cerebral and lower limb nearinfrared spectroscopy in adults on extracorporeal membrane oxygenation. Artif Organs 2012;36:659–67.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"887-917"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}