American Journal of Emergency Medicine最新文献

{"title":"TOC","authors":"","doi":"10.1016/S0735-6757(25)00174-3","DOIUrl":"10.1016/S0735-6757(25)00174-3","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages A3-A7"},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Info for authors","authors":"","doi":"10.1016/S0735-6757(25)00175-5","DOIUrl":"10.1016/S0735-6757(25)00175-5","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Page A8"},"PeriodicalIF":2.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated computation of the HEART score with the GPT-4 large language model","authors":"Donald S. Wright ,&nbsp;Vimig Socrates ,&nbsp;Thomas Huang ,&nbsp;Conrad W. Safranek ,&nbsp;Rohit B. Sangal ,&nbsp;Monisha Dilip ,&nbsp;Zachary Boivin ,&nbsp;Nickolas Srica ,&nbsp;Catherine X. Wright ,&nbsp;Attila Feher ,&nbsp;Edward J. Miller ,&nbsp;David Chartash ,&nbsp;Richard Andrew Taylor","doi":"10.1016/j.ajem.2025.03.065","DOIUrl":"10.1016/j.ajem.2025.03.065","url":null,"abstract":"<div><h3>Background</h3><div>Automated computation of the HEART score has the potential to facilitate clinical decision support and safety interventions. The goal of this study was to assess the performance of the GPT-4 large language model (LLM) in computation of the HEART score and prediction of 60-day major adverse cardiac events (MACE).</div></div><div><h3>Methods</h3><div>In this retrospective cohort study from February 2022 to September 2023, patients admitted to a chest pain observation unit were identified. HEART scores were calculated by a physician assistant or nurse practitioner (APP) as part of routine care. Separately, the LLM calculated a HEART score utilizing an iteratively developed prompt from deidentified chart documentation. Any cases of disagreement with the APP score were adjudicated by an emergency physician blinded to clinical outcomes. Agreement on HEART score was assessed, and 60-day MACE was obtained via linkage to an institutional registry.</div></div><div><h3>Results</h3><div>Of the 601 participants, 50 were utilized for prompt development. Among the remaining 551 participants, agreement by Cohen's weighted kappa between the LLM and adjudicators was 0.67 which was similar to the agreement of 0.66 between the APP and adjudicators. The LLM predicted a higher average HEART score (mean 5.06) compared to the adjudicators (mean 4.69) or APP (mean 4.23). No significant difference was seen in diagnostic performance for 60-day MACE by DeLong pairwise comparison (all <em>p</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Automated risk score computation with language models has the potential to power interventions such as clinical decision support but has systematic differences from physician judgment. Prospective investigation is needed.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 120-125"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in troponin and ECG testing among emergency department patients with chest pain","authors":"Michael Gottlieb MD ,&nbsp;Eric Moyer MD ,&nbsp;Vinodinee Dissanayake MD, MPH ,&nbsp;Yanina Purim-Shem-Tov MD, MS ,&nbsp;Garth Walker MD, MPH ,&nbsp;Theodore Corbin MD, MPP ,&nbsp;Kyle Bernard MD ,&nbsp;Kevin Buell MBBS, MS","doi":"10.1016/j.ajem.2025.03.064","DOIUrl":"10.1016/j.ajem.2025.03.064","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies have highlighted disparities in the evaluation of chest pain based on patient race and sex. However, these studies were limited by small sample sizes and may not represent national practice patterns. This study evaluated differences in electrocardiogram (ECG) and troponin testing among emergency department (ED) patients presenting with chest pain or anginal-equivalent symptoms, focusing on variations by sex, race, ethnicity, and primary spoken language.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of patients presenting with chest pain or anginal-equivalent symptoms from 01/01/2016–12/31/2023 was conducted by searching the Epic Cosmos research platform separately for ECG and troponin testing. ECG and troponin testing rates were stratified and analyzed by age, sex, race, ethnicity, and primary language. Conditional logistic regression was used to calculate odds ratios (OR) with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 205,526,173 adult ED visits, 37,138,334 (18.1 %) met the inclusion criteria for chest pain or anginal-equivalent symptoms. For patients with full demographic data available, 30,648,879 of 36,672,008 (83.6 %) and 26,615,155 of 36,672,075 (72.6 %) underwent ECG and troponin testing, respectively. ECG testing was more frequent in male patients (OR:1.059; 95 %CI:1.058–1.060), Asian patients (OR:1.006; 95 %CI:1.004–1.009), and patients primarily speaking Spanish (OR:1.039; 95 %CI:1.040–1.042) or other non-English languages (OR:1.054; 95 %CI:1.051–1.056). However, it was less frequent among Black or African American patients (OR:0.955; 95 %CI:0.954–0.956) and individuals identifying as other races (OR:0.961; 95 %CI:0.959–0.963). Troponin testing was also more common in male patients (OR:1.087; 95 %CI:1.086–1.087) and those primarily speaking Spanish (OR:1.016; 95 %CI:1.014–1.019) or other non-English languages (OR:1.064; 95 %CI:1.061–1.067), but less common among Hispanic or Latino patients (OR:0.923; 95 %CI:0.921–0.924) and non-white patients (OR range:0.918–0.950).</div></div><div><h3>Conclusions</h3><div>Disparities in ECG and troponin testing were identified among ED patients presenting with chest pain or anginal-equivalent symptoms. Testing rates were lower in female and non-white patients, while patients primarily speaking non-English languages had higher testing rates.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 109-114"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating the performance of the modified LEMON criteria in predicting difficult intubation among pediatric emergency patients","authors":"Shima Ohnishi ,&nbsp;Yusuke Hagiwara ,&nbsp;Shunsuke Amagasa ,&nbsp;Satoko Uematsu","doi":"10.1016/j.ajem.2025.03.067","DOIUrl":"10.1016/j.ajem.2025.03.067","url":null,"abstract":"<div><h3>Objective</h3><div>The current study aimed to investigate the use of the modified LEMON (which stands for Look externally, Evaluate the 3–3-2 rule, Obstructed airway, and Neck mobility) criteria in predicting difficult intubation in pediatric patients in the emergency department (ED).</div></div><div><h3>Methods</h3><div>An observational multicenter analysis of data from the 4th Japanese Emergency Airway Network (JEAN-4) study was conducted from October 2018 to September 2022. Patients aged &lt;18 years who were intubated and registered in the JEAN-4 study were included in this analysis. The primary outcomes were the sensitivity, specificity, positive predictive value, and negative predictive value of the modified LEMON criteria for predicting difficult tracheal intubation (defined as ≥3 intubation attempts by pediatric emergency attending physicians or fellows).</div></div><div><h3>Results</h3><div>In total, 546 patients were included in this study. There were 34 (6 %) and 512 (94 %) cases of difficult tracheal intubation and nondifficult tracheal intubation. The sensitivity, specificity, positive predictive value, and negative predictive value of the modified LEMON criteria for predicting difficult tracheal intubation in the ED were 41 % (95 % confidence interval [CI]: 25 %–59 %), 73 % (95 % CI: 69 %–77 %), 9 % (95 % CI: 5 %–15 %), and 95 % (95 % CI: 92 %–97 %), respectively.</div></div><div><h3>Conclusion</h3><div>Based on this multicenter observational study, the modified LEMON criteria presented with neither a high sensitivity nor specificity for predicting difficult intubation in pediatric patients in the ED. Therefore, with consideration of age and physical characteristics, standards individualized based on the specific needs of pediatric patients must be developed.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waveform conversion as a prognostic factor of poor prognosis in patients undergoing extracorporeal cardiopulmonary resuscitation","authors":"Ken Inoue ,&nbsp;Keita Shibahashi ,&nbsp;Taichi Kato ,&nbsp;Akihiko Inoue ,&nbsp;Toru Hifumi ,&nbsp;Tetsuya Sakamoto ,&nbsp;Yasuhiro Kuroda ,&nbsp;Kazuhiro Sugiyama ,&nbsp;on behalf of the SAVE-J II Study Group","doi":"10.1016/j.ajem.2025.03.041","DOIUrl":"10.1016/j.ajem.2025.03.041","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) is a resource-intensive treatment for refractory out-of-hospital cardiac arrest (OHCA), underscoring the importance of identifying patients with favorable neurological outcomes. We investigated whether waveform changes from initial shockable cardiac rhythm to alternative cardiac rhythm upon hospital arrival can predict the outcomes of patients undergoing ECPR for OHCA.</div></div><div><h3>Methods</h3><div>This secondary analysis of the SAVE-J II study included patients with OHCA who received ECPR at 36 emergency departments in Japan. We identified patients who experienced OHCA with shockable cardiac rhythm at the scene and subsequently underwent ECPR. We performed multivariable logistic regression analysis to assess the association between the waveform at hospital arrival and outcomes. The primary outcome was a favorable neurological outcome (cerebral performance category 1 or 2) at 1 month after arrest.</div></div><div><h3>Results</h3><div>Overall, 1114 patients were eligible for analysis. The rate of achieving a favorable neurological outcome was highest in patients who had sustained shockable cardiac rhythm on hospital arrival, followed by those with pulseless electrical activity and asystole (22.4 % vs. 9.5 % vs. 2.7 %, <em>P</em> &lt; 0.001). The difference remained significant after adjusting for confounding factors, with adjusted odds ratio (95 % CI) of 0.35 (0.21–0.58) and 0.08 (0.03–0.20) for pulseless electrical activity and asystole groups, respectively.</div></div><div><h3>Conclusions</h3><div>The waveform transition from shockable to alternate cardiac rhythm was associated with significantly poor outcomes after ECPR for OHCA. Patients with waveform conversion from VF/VT to asystole upon hospital arrival had exceedingly low probabilities of achieving favorable neurological outcomes, necessitating careful consideration of ECPR's appropriateness in this population.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 103-108"},"PeriodicalIF":2.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of desmopressin on hematoma expansion in patients presenting to the emergency department on antiplatelet therapy: Don't expand study","authors":"Megan A. Rech PharmD, MS, FCCP, FCCM, BCCCP ,&nbsp;Caitlin Brown PharmD, BCCCP ,&nbsp;Giles W. Slocum PharmD, BCCCP, BCEMP ,&nbsp;Brian W. Gilbert PharmD, MBA, FCCM, FNCS, BCCCP ,&nbsp;Deep Aggarwal MD ,&nbsp;Gavin T. Howington PharmD, BCCCP, BCPS ,&nbsp;Tara Flack PharmD, BCCCP, FCCM ,&nbsp;Atul Malik MD ,&nbsp;Brett A. Faine PharmD, MS","doi":"10.1016/j.ajem.2025.03.052","DOIUrl":"10.1016/j.ajem.2025.03.052","url":null,"abstract":"<div><h3>Introduction</h3><div>Current guidelines state the effectiveness of desmopressin to reduce hematoma expansion in antiplatelet-related intracerebral hemorrhage (ICH) is uncertain. This study sought to determine if desmopressin decreased hematoma expansion in ICH patients on antiplatelet agents.</div></div><div><h3>Methods</h3><div>We conducted a multi-center, retrospective propensity-matched cohort study at 11 US emergency departments (ED) that participate in EMPHARM-NET. Adult patients ≥18 years with a primary diagnosis of spontaneous ICH on antiplatelets prior to admission from January 1, 2017 through May 1, 2021 were included. The primary endpoint was good or excellent hemostatic efficacy within the first 24 h following ICH between patients that did and did not receive desmopressin. Brain imaging was reviewed using 3D-Slicer by blinded expert physicians.</div></div><div><h3>Results</h3><div>Overall, 1408 patients were evaluated for inclusion. A total of 324 patients were included, of which 13.8 % (<em>n</em> = 45) received desmopressin and 86.1 % (<em>n</em> = 279) did not. After propensity matching, 35 patients receive desmopressin compared to 140 controls. Baseline hematoma volume (27.6 mL vs. 2.1 mL) and was significantly higher in the desmopressin group. The primary endpoint of good or excellent hemostatic efficacy was similar between groups (74.3 % desmopressin group vs. 85 % control group, −10.7 % [−28.1 % to 6.7 %]). There was no difference in secondary outcomes.</div></div><div><h3>Conclusion</h3><div>In this multicenter cohort, patients receiving desmopressin had higher baseline intraparenchymal hematoma volume, and did not appear to result in improved hemostatic efficacy relative to the control group. These results suggest against routine administration of desmopressin for antiplatelet-related ICH, though future study in a randomized trial design is necessary.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 126-131"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a large language model's accuracy in chest X-ray interpretation for acute thoracic conditions","authors":"Adam M. Ostrovsky","doi":"10.1016/j.ajem.2025.03.060","DOIUrl":"10.1016/j.ajem.2025.03.060","url":null,"abstract":"<div><h3>Background</h3><div>The rapid advancement of artificial intelligence (AI) has great ability to impact healthcare. Chest X-rays are essential for diagnosing acute thoracic conditions in the emergency department (ED), but interpretation delays due to radiologist availability can impact clinical decision-making. AI models, including deep learning algorithms, have been explored for diagnostic support, but the potential of large language models (LLMs) in emergency radiology remains largely unexamined.</div></div><div><h3>Methods</h3><div>This study assessed ChatGPT's feasibility in interpreting chest X-rays for acute thoracic conditions commonly encountered in the ED. A subset of 1400 images from the NIH Chest X-ray dataset was analyzed, representing seven pathology categories: Atelectasis, Effusion, Emphysema, Pneumothorax, Pneumonia, Mass, and No Finding. ChatGPT 4.0, utilizing the “X-Ray Interpreter” add-on, was evaluated for its diagnostic performance across these categories.</div></div><div><h3>Results</h3><div>ChatGPT demonstrated high performance in identifying normal chest X-rays, with a sensitivity of 98.9 %, specificity of 93.9 %, and accuracy of 94.7 %. However, the model's performance varied across pathologies. The best results were observed in diagnosing pneumonia (sensitivity 76.2 %, specificity 93.7 %) and pneumothorax (sensitivity 77.4 %, specificity 89.1 %), while performance for atelectasis and emphysema was lower.</div></div><div><h3>Conclusion</h3><div>ChatGPT demonstrates potential as a supplementary tool for differentiating normal from abnormal chest X-rays, with promising results for certain pathologies like pneumonia. However, its diagnostic accuracy for more subtle conditions requires improvement. Further research integrating ChatGPT with specialized image recognition models could enhance its performance, offering new possibilities in medical imaging and education.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 99-102"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of limiting PEEP effectiveness in preventing barotrauma in critically ill COVID-19 patients: A retrospective study","authors":"Yuhei Irie MD,&nbsp;Yoshito Izutani MD,&nbsp;Junta Noake MD,&nbsp;Shun Ninomiya MD,&nbsp;Mami Kastumura MD,&nbsp;Maiko Nakashio MD,&nbsp;Junichi Maruyama MD,&nbsp;Yoshihiko Nakamura MD,&nbsp;Hiroyasu Ishikura MD","doi":"10.1016/j.ajem.2025.03.050","DOIUrl":"10.1016/j.ajem.2025.03.050","url":null,"abstract":"<div><h3>Background</h3><div>Severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, requiring prolonged invasive mechanical ventilation. However, patients with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation experience barotrauma. We assessed whether limiting the maximum positive end-expiratory pressure (PEEP) may prevent barotrauma more effectively than using PEEP/fraction of inspired oxygen (FiO₂) in patients with COVID-19 undergoing invasive mechanical ventilation.</div></div><div><h3>Materials and methods</h3><div>We retrospectively included patients who met the diagnostic criteria at our center; they were divided into an ordinary PEEP group (PEEP/higher FiO₂ table) and a limited PEEP group (maximum PEEP of &lt;10 cmH₂O) during intensive care unit admission. We evaluated the maximum ventilator variables for mechanical ventilation and limited PEEP to inhibit barotrauma as the primary outcome.</div></div><div><h3>Results</h3><div>Patients in the ordinary PEEP group (<em>n</em> = 34) were significantly older and had higher body mass indexes than those in the limited PEEP group (<em>n</em> = 27). The maximum PEEP and maximum peak inspiratory pressure were significantly higher in the ordinary PEEP group than in the limited PEEP group. The ordinary PEEP group had a significantly higher incidence of barotrauma than the limited PEEP group.</div></div><div><h3>Conclusions</h3><div>Limiting the maximum PEEP to &lt;10 cmH₂O may prevent barotrauma in patients with COVID-19 undergoing invasive mechanical ventilation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 73-79"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comment on \"Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury\".","authors":"Jeng-Luen Hong, Giou-Teng Yiang, Meng-Yu Wu","doi":"10.1016/j.ajem.2025.03.053","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.053","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}