Emergency medicine journal : EMJ最新文献

{"title":"Man with shortness of breath and pulmonary consolidation.","authors":"Mesut Mutluoglu, Ruben Vandenbulcke, Kristof De Smet","doi":"10.1136/emermed-2022-212323","DOIUrl":"https://doi.org/10.1136/emermed-2022-212323","url":null,"abstract":"RefeRences 1 Trout AT, Towbin AJ, Zhang B. Journal club: the pediatric appendix: defining normal. AJR Am J Roentgenol 2014;202:936–45. 2 Searle AR, Ismail KA, Macgregor D, et al. Changes in the length and diameter of the normal appendix throughout childhood. J Pediatr Surg 2013;48:1535–9. 3 Coyne SM, Zhang B, Trout AT. Does appendiceal diameter change with age? A sonographic study. AJR Am J Roentgenol 2014;203:1120–6. 4 Chicaiza HP, Malia L, Mulvey CH, et al. Revisiting the appendiceal diameter via ultrasound for the diagnosis of acute appendicitis. Pediatr Emerg Care 2018;34:757–60. 5 Trout AT, Sanchez R, LadinoTorres MF. Reevaluating the sonographic criteria for acute appendicitis in children: a review of the literature and a retrospective analysis of 246 cases. Acad Radiol 2012;19:1382–94. 6 Partain KN, Patel A, Travers C, et al. Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children. J Pediatr Surg 2016;51:1655–60. 7 Telesmanich ME, Orth RC, Zhang W, et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol 2016;46:1539–45. 8 Estey A, Poonai N, Lim R. Appendix not seen: the predictive value of secondary inflammatory sonographic signs. Pediatr Emerg Care 2013;29:435–9. 9 Mirza WA, Naveed MZ, Khandwala K. Utility and accuracy of primary and secondary ultrasonographic signs for diagnosing acute appendicitis in pediatric patients. Cureus 2018;10:e3779. 10 Wiersma F, Toorenvliet BR, Bloem JL, et al. US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs. Eur Radiol 2009;19:455–61. 11 Nah SA, Ong SS, Lim WX, et al. Clinical relevance of the Nonvisualized appendix on ultrasonography of the abdomen in children. J Pediatr 2017;182:164–9. 12 Held JM, McEvoy CS, Auten JD, et al. The nonvisualized appendix and secondary signs on ultrasound for pediatric appendicitis in the community hospital setting. Pediatr Surg Int 2018;34:1287–92. 13 Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 2000;36:39–51. 14 Lounis Y, Hugo J, Demarche M, et al. Influence of age on clinical presentation, diagnosis delay and outcome in preschool children with acute appendicitis. BMC Pediatr 2020;20:151. 15 Tsuji M, Puri P, Reen DJ. Characterisation of the local inflammatory response in appendicitis. J Pediatr Gastroenterol Nutr 1993;16:43–8. 16 Beltrán MA, Almonacid J, Vicencio A, et al. Predictive value of white blood cell count and Creactive protein in children with appendicitis. J Pediatr Surg 2007;42:1208–14. 17 Hansen AJ, Young SW, De Petris G, et al. Histologic severity of appendicitis can be predicted by computed tomography. Arch Surg 2004;139:1304–8. 18 DeLong ER, DeLong DM, ClarkePearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837–45. ","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"930-958"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700805","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":"Performance of early warning and risk stratification scores versus clinical judgement in the acute setting: a systematic review.","authors":"Lars Ingmar Veldhuis,&nbsp;Milan L Ridderikhof,&nbsp;Lyfke Bergsma,&nbsp;Faridi Van Etten-Jamaludin,&nbsp;Prabath Wb Nanayakkara,&nbsp;Markus Hollmann","doi":"10.1136/emermed-2021-211524","DOIUrl":"https://doi.org/10.1136/emermed-2021-211524","url":null,"abstract":"<p><strong>Objective: </strong>Risk stratification is increasingly based on Early Warning Score (EWS)-based models, instead of clinical judgement. However, it is unknown how risk-stratification models and EWS perform as compared with the clinical judgement of treating acute healthcare providers. Therefore, we performed a systematic review of all available literature evaluating clinical judgement of healthcare providers to the use of risk-stratification models in predicting patients' clinical outcome.</p><p><strong>Methods: </strong>Studies comparing clinical judgement and risk-stratification models in predicting outcomes in adult patients presenting at the ED were eligible for inclusion. Outcomes included the need for intensive care unit (ICU) admission; severe adverse events; clinical deterioration and mortality. Risk of bias among the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.</p><p><strong>Results: </strong>Six studies (6419 participants) were included of which 4 studies were judged to be at high risk of bias. Only descriptive analysis was performed as a meta-analysis was not possible due to few included studies and high clinical heterogeneity. The performance of clinical judgement and risk-stratification models were both moderate in predicting mortality, deterioration and need for ICU admission with area under the curves between 0.70 and 0.89. The performance of clinical judgement did not significantly differ from risk-stratification models in predicting mortality (n=2 studies) or deterioration (n=1 study). However, clinical judgement of healthcare providers was significantly better in predicting the need for ICU admission (n=2) and severe adverse events (n=1 study) as compared with risk-stratification models.</p><p><strong>Conclusion: </strong>Based on limited existing data, clinical judgement has greater accuracy in predicting the need for ICU admission and the occurrence of severe adverse events compared with risk-stratification models in ED patients. However, performance is similar in predicting mortality and deterioration.</p><p><strong>Prospero registration number: </strong>CRD42020218893.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"918-923"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40598198","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":"COP27 climate change conference: urgent action needed for Africa and the world.","authors":"Chris Zielinski","doi":"10.1136/emermed-2022-212903","DOIUrl":"https://doi.org/10.1136/emermed-2022-212903","url":null,"abstract":"The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods. These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021— that the rise in global temperature must be limited to <1.5°C compared with preindustrial levels. While the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to lowincome and middleincome countries, this support has yet to materialise. COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential for the health of those countries, and for the health of the whole world.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"e10"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9691825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40340409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal update monthly top five.","authors":"Liam Barrett,&nbsp;Owen Hibberd,&nbsp;Daniel P Whitehouse,&nbsp;Thomas Adams,&nbsp;James Price,&nbsp;Sophie Richter,&nbsp;Ed Benjamin Graham Barnard,&nbsp;Anisa Jabeen Nasir Jafar","doi":"10.1136/emermed-2022-212922","DOIUrl":"https://doi.org/10.1136/emermed-2022-212922","url":null,"abstract":"This month’s update is from the Emergency Medicine team in Cambridge. We used a multimodal search strategy, drawing on free open- access medical education resources and literature searches. We iden-tified the five most interesting and relevant papers (decided by consensus) and high-light the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as:","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"954-955"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700803","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 your clinical prediction model past its sell by date?","authors":"Charles Reynard,&nbsp;David Jenkins,&nbsp;Glen P Martin,&nbsp;Evan Kontopantelis,&nbsp;Richard Body","doi":"10.1136/emermed-2021-212224","DOIUrl":"https://doi.org/10.1136/emermed-2021-212224","url":null,"abstract":"To cite: Reynard C, Jenkins D, Martin GP, et al. Emerg Med J Epub ahead of print: [please include Day Month Year]. doi:10.1136/ emermed-2021-212224 Handling editor Edward Carlton Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"956-958"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40534955","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":"Pulmonary embolism diagnosis part 1: clinical assessment at the front door.","authors":"John Cafferkey,&nbsp;Philippa Serebriakoff,&nbsp;Kerstin de Wit,&nbsp;Daniel E Horner,&nbsp;Matthew James Reed","doi":"10.1136/emermed-2021-212000","DOIUrl":"https://doi.org/10.1136/emermed-2021-212000","url":null,"abstract":"<p><p>This first of two practice reviews addresses pulmonary embolism (PE) diagnosis considering important aspects of PE clinical presentation and comparing evidence-based PE testing strategies. A companion paper addresses the management of PE. Symptoms and signs of PE are varied, and emergency physicians frequently use testing to 'rule out' the diagnosis in people with respiratory or cardiovascular symptoms. The emergency clinician must balance the benefit of reassuring negative PE testing with the risks of iatrogenic harms from over investigation and overdiagnosis.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"945-951"},"PeriodicalIF":3.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40617870","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":"Potential impact of a novel pathway for suspected myocardial infarction utilising a new high-sensitivity cardiac troponin I assay.","authors":"Rob Meek,&nbsp;Louise Cullen,&nbsp;Zhong Xian Lu,&nbsp;Arthur Nasis,&nbsp;Lisa Kuhn,&nbsp;Laurence Sorace","doi":"10.1136/emermed-2020-210812","DOIUrl":"https://doi.org/10.1136/emermed-2020-210812","url":null,"abstract":"<p><strong>Background: </strong>High-sensitivity cardiac troponin I (hs-cTnI) assays promise high diagnostic accuracy for myocardial infarction (MI). In an ED where conventional cTnI was in use, we evaluated an assessment pathway using the new Access hsTnI assay.</p><p><strong>Methods: </strong>This retrospective analysis recruited ED patients with suspected MI between June and September 2019. All patients received routine care with a conventional cTnI assay (AccuTnI +3: limit of detection (LoD) 10 ng/L, 99th centile upper reference limit (URL) 40 ng/L, abnormal elevation cut-point 80 ng/L). Arrival, then 90-minute or 360-minute cTnI levels for low and non-low risk patients, respectively (ED Assessment of Chest pain score) guided diagnosis and disposition which was at treating physician discretion. The same patients had arrival and 90-minute or 180-minute samples drawn for hs-cTnI levels (Access hsTnI: LoD 2 ng/L, 99th centile URL 10 ng/L (females) and 20 ng/L (males); abnormal elevation above the URL and delta >30%). Treating physicians were blinded to the hs-cTnI results. Using the hs-cTnI values, investigators retrospectively assigned likely diagnosis, disposition and likelihood of a 30-day major adverse cardiac event (MACE). Admission was recommended for significantly rising hs-cTnI elevations. The primary objective was to demonstrate an acceptable unexpected 30-day post-discharge MACE rate of <1%. cTnI elevation rates, diagnostic outcomes and ED disposition were also compared between pathways.</p><p><strong>Results: </strong>For the 935 patients, unexpected 30-day post-discharge MACE rates were 0/935 (0%, 95% CI 0% to 0.4%) with the conventional or novel pathway. For the high-sensitivity and conventional assays, respectively, abnormal elevation rates were 29% (95% CI 26% to 32%) and 19% (95% CI 17% to 22%), for MI were 9% (95% CI 8% to 11%) and 8% (95% CI 6% to 10%), and for hospital admission were 42% (95% CI 39% to 45%) and 43% (95% CI 40% to 47%).</p><p><strong>Conclusion: </strong>The novel pathway using the Access hsTnI assay has an acceptably low 30-day MACE rate.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"847-852"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39861324","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":"How to recognise an LV thrombus when you see one: a review of cardiac point-of-care ultrasound.","authors":"Eric Tam,&nbsp;Sally Graglia","doi":"10.1136/emermed-2021-211210","DOIUrl":"https://doi.org/10.1136/emermed-2021-211210","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. CASE PRESENTATION A 47yearold man presents to the ED with shortness of breath and chest pain. The shortness of breath has been progressively worsening in the setting of running out of his medications 3 days prior, while the chest pain started after smoking methamphetamines the day prior to presentation. He denies any fevers, new cough, sputum production or sick contacts. He has a 20year history of daily methamphetamine use. His medical history is notable for heart failure with a reduced ejection fraction (HFrEF) of 20%, type 2 diabetes, coronary artery disease (CAD), untreated deep vein thrombosis and depression. His prescribed medications include furosemide, carvedilol, lisinopril, atorvastatin, metformin and aspirin. On physical examination, the patient has a BP of 118/83 mm Hg, HR of 121, temperature of 36.4°C, RR of 22, and an oxygen saturation of 100% on 11 L with a nonrebreather mask. He is nontoxic appearing, but in clear respiratory distress with tachypnoea and increased work of breathing. His pulmonary examination is notable for crackles at the bases. Cardiac examination is notable for tachycardia without murmurs, rubs or gallops. His abdomen is soft but protuberant. Lower extremities are warm and well perfused with 2+ pitting oedema from the ankle to the midshin, bilaterally. Intravenous access is obtained; blood is obtained and sent for processing. A pointofcare ultrasound (POCUS) is performed.","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"867-870"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39095587","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":"Wrist deformity following falling down.","authors":"Chih-Yao Lee,&nbsp;Cheng-Chang Lu","doi":"10.1136/emermed-2021-211860","DOIUrl":"https://doi.org/10.1136/emermed-2021-211860","url":null,"abstract":"","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"866-880"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/34/emermed-2021-211860.PMC9613873.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40564378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT.","authors":"James Vassallo,&nbsp;Chris G Moran,&nbsp;Philip Cowburn,&nbsp;Jason Smith","doi":"10.1136/emermed-2022-212569","DOIUrl":"https://doi.org/10.1136/emermed-2022-212569","url":null,"abstract":"<p><p>Triage is a key principle in the effective management of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity. However, work published over the last decade has demonstrated that existing methods of triage perform poorly when trying to identify patients in need of life-saving interventions. As a result, a review of major incident triage was initiated by NHS England with the remit to determine the optimum way in which to triage patients of all ages in a major incident for the UK. This article describes the output from this review, the changes being undertaken to UK major incident triage and the introduction of the new NHS Major Incident Triage Tool from the Spring of 2023.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"800-802"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/56/emermed-2022-212569.PMC9613863.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33514476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}