American Journal of Emergency Medicine最新文献

{"title":"Trends in cardiac arrest care and mortality in United States emergency departments over eight years","authors":"Kevin G. Buell MBBS, MS ,&nbsp;Robert Hlavin MD ,&nbsp;Emily Wusterbarth MD ,&nbsp;Eric Moyer MD ,&nbsp;Kyle Bernard MD, MHSM ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.03.012","DOIUrl":"10.1016/j.ajem.2025.03.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac arrest in the emergency department (ED) is a rare event. Prior studies have used dedicated cardiac arrest registries, but few have leveraged “big data” from electronic healthcare vendors to analyze trends in the care of patients excluded from registries.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of adult patients in the ED with cardiac arrest from Epic Cosmos, a database with 277 million patients. Patients with ICD-10 codes corresponding to cardiac arrest in the ED were included. Outcomes included the incidence of cardiac arrest, mortality, code length, and extracorporeal membrane oxygenation (ECMO). Data were compared using odds ratio with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 196,834,283 ED visits from 1/1/2016 to 12/31/2023, there were 429,917 (0.22 %) cardiac arrests and 197,233 (45.88 %) patients who died in the ED. The incidence of cardiac arrest (0.26 %) and death in the ED (55.70 %) peaked in 2020. Cardiac arrest was more common in male and older patients, between 00:00–05:59, on weekends, and in the South (<em>p</em> &lt; 0.001). The median code length was 10–20 min. Only 0.29 % of cardiac arrest patients received ECMO. Compared to 2016, the odds of a code length &gt; 90 min and ECMO in 2023 were 1.43 (95 % CI 1.32–1.54) and 3.58 (95 % CI 2.41–5.31) times greater, respectively.</div></div><div><h3>Conclusion</h3><div>Although cardiac arrest in the ED is a rare event, almost half of patients die in the ED. The use of ECMO after cardiac arrest is increasing but remains low. Further research is needed to mitigate these differences in care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 126-134"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643199","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":"Will LqSOFA lactate measurement become the future standard for assessing emergency septic patients?","authors":"Michal Pruc, Karol Momot, Kacper Dziedzic, Lukasz Szarpak","doi":"10.1016/j.ajem.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.022","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674698","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":"Correspondence on: Predictors of mortality among sepsis patients transferred from a rural, low-volume ED to an urban, high-volume hospital.","authors":"Teng-Fei Li, Fang-Jie Zhang","doi":"10.1016/j.ajem.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.005","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659967","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":"Info for authors","authors":"","doi":"10.1016/S0735-6757(25)00129-9","DOIUrl":"10.1016/S0735-6757(25)00129-9","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Page A8"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611703","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":"TOC","authors":"","doi":"10.1016/S0735-6757(25)00128-7","DOIUrl":"10.1016/S0735-6757(25)00128-7","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Pages A3-A7"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611702","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":"The role of peripheral perfusion index in predicting biphasic reactions in anaphylaxis patients","authors":"Handan Özen Olcay MD ,&nbsp;Emine Emektar MD ,&nbsp;Emel Atayik MD ,&nbsp;Seda Dağar MD ,&nbsp;Zeynep Saral Öztürk MD ,&nbsp;Yunsur Çevik MD","doi":"10.1016/j.ajem.2025.03.017","DOIUrl":"10.1016/j.ajem.2025.03.017","url":null,"abstract":"<div><h3>Background/aim</h3><div>Anaphylaxis is a rapidly onset, life-threatening hypersensitivity reaction, and in some patients, a biphasic reaction may develop following initial treatment. This study aims to investigate the prognostic value of the peripheral perfusion index (PPI) in predicting biphasic reactions among patients presenting to the emergency department with anaphylaxis.</div></div><div><h3>Material and methods</h3><div>The study is prospective and single-centered. A total of 104 patients aged 18 years and older, diagnosed with anaphylaxis in the emergency department, were included. PPI values, along with other vital signs, were measured at 0, 10, 20, and 30 min, as well as after symptom resolution. All patients were observed for a minimum of 6 h to monitor for the development of biphasic reactions.</div></div><div><h3>Results</h3><div>The median PPI value at the 0-min mark was 2.20 (IQR, 1.52–3.67), while the median PPI value after symptom resolution was 4.20 (IQR, 3.10–6.35). A biphasic reaction occurred in 10.6 % of patients. Among patients who developed a biphasic reaction, PPI values at 0, 10, 20, and 30 min were significantly lower compared to those who did not (<em>p</em> &lt; 0.05). In ROC analysis, a PPI cutoff of ≤2.17 for predicting biphasic reactions yielded 57 % sensitivity and 91 % specificity (AUC = 0.75).</div></div><div><h3>Conclusion</h3><div>PPI may serve as an accessible and cost-effective test in emergency departments for continuous monitoring of patients diagnosed with anaphylaxis, allowing for assessment of treatment response, early detection of biphasic reactions, and risk evaluation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 120-125"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643198","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":"Prolonged atraumatic back pain in an adolescent female: Emergency department presentation of Ewing's Sarcoma.","authors":"Jesse Butler, Amanda Geiger, Peter Croft, Jesse Butler","doi":"10.1016/j.ajem.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.021","url":null,"abstract":"<p><p>Back pain and syncope are two common complaints encountered in the emergency department. However, prolonged atraumatic back pain in a pediatric patient should always be considered a \"red flag\" symptom. We describe a case of a 14-year-old female who presented to the emergency department with syncope and hypotension due to low back pain who was ultimately diagnosed with Primary Ewing's Sarcoma (ES) of the lumbar spine with extensive pulmonary metastasis. The diagnosis was expedited by the use of a bedside RUSH exam that identified an otherwise asymptomatic, unilateral pleural effusion. ES is the second most common primary bone malignancy in adolescents and young adults and unfortunately has a delayed diagnosis due to vague and non-specific symptoms. Survival rates of metastatic ES are still quite poor despite advances in therapies and treatments. This case emphasizes the importance of obtaining a focused history and physical exam, and how targeted point-of-care ultrasonography can aid in the diagnosis of rare and life-threatening conditions.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659919","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":"Refining the approach to erector spinae plane block for gastritis and gastroparesis.","authors":"Richard J Gawel, Michael Gottlieb, Frances S Shofer, Michael Shalaby","doi":"10.1016/j.ajem.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.019","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627176","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":"Comment on treatment of gastritis and gastroparesis symptoms with erector spinae plane block in the emergency department.","authors":"Amiya Kumar Barik, Anju Gupta, Chitta Ranjan Mohanty, Rakesh Vadakkethil Radhakrishnan, Pearl S Konikkara, Neha Singh","doi":"10.1016/j.ajem.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.020","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634966","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":"Ultrasound accuracy in acute diverticulitis: A systematic review and Meta-analysis","authors":"Hamid Shokoohi MD, MPH ,&nbsp;Gary D. Peksa PharmD, MBA ,&nbsp;Ainsley Hutchison BS ,&nbsp;Nour Al Jalbout MD ,&nbsp;Kristofer Montoya MD ,&nbsp;Jennifer C. Westrick MSLIS, AHIP ,&nbsp;Andrew Goldsmith MD, MBA ,&nbsp;Peiman Nazerian MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.03.002","DOIUrl":"10.1016/j.ajem.2025.03.002","url":null,"abstract":"<div><h3>Objectives</h3><div>The utility of ultrasound for diagnosing diverticulitis, especially in high-risk cases with complicated diverticulitis, remains debated. This study aimed to provide contemporary quantitative data synthesis of the diagnostic accuracy of ultrasound in patients with suspected diverticulitis.</div></div><div><h3>Methods</h3><div>Scopus, PubMed, Google Scholar, and CENTRAL were searched from January 1st,1990 to September 15th, 2023, for potentially relevant articles. Selected studies evaluated and reported estimates of diagnostic accuracy of ultrasound for the diagnosis of acute diverticulitis using CT as the gold standard. Subgroup analyses were conducted for simple versus complicated diverticulitis, and for point-of-care ultrasound (POCUS) versus radiology-performed ultrasound (RADUS). Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Diagnostic odds ratios, sensitivity, specificity, likelihood ratio, and area under the receiver operating characteristic curve with 95 % confidence intervals (CI) were reported.</div></div><div><h3>Results</h3><div>A total of 12 diagnostic studies (<em>n</em> = 2056 patients) were identified. Ultrasound showed a sensitivity of 92.5 % (95 % CI 86.9 %–95.8 %) and specificity of 87.7 % (95 % CI 75.7 %–94.2 %) for detecting acute diverticulitis. The positive likelihood ratio (LR+) was 8.28 (95 % CI 4.74–14.45) and negative likelihood ratio (LR-) was 0.08 (95 % CI 0.05–0.15). For complicated diverticulitis ultrasound had a sensitivity of 58.3 % (95 % CI 46.1 %–69.8 %) and specificity of 98.2 % (95 % CI 96.4–99.2). The LR+ was 31.86 (95 % CI 15.61–65.06) and LR- was −0.42 (95 % CI 0.32–0.56)). Subgroup analysis showed POCUS had 94.1 % (95 % CI 91.4 %–95.9 %) sensitivity and 89.8 % (95 % CI 77.6 %–95.7 %) specificity, while RADUS had 83.2 % (95 % CI 68.3 %–91.9 %) sensitivity and 88.7 % (95 % CI 76.1 %–95.1 %) specificity for detecting acute diverticulitis.</div></div><div><h3>Conclusions</h3><div>Ultrasound had high accuracy for diagnosing acute diverticulitis with greater sensitivity when performed by emergency physicians and surgeons at the bedside. For complicated diverticulitis, the overall sensitivity was lower, while the specificity was higher.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 96-103"},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619443","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}