American Journal of Emergency Medicine最新文献

{"title":"Use of lipoglycopeptides for moderate to severe ABSSSI in the emergency department","authors":"Cierra N. Treu Pharm.D., BCCCP ,&nbsp;Allison M. Stilwell Pharm.D., BCIDP, AAHIVP ,&nbsp;Eunah Cheon Pharm.D., BCPS, BCCCP ,&nbsp;Nicole M. Acquisto Pharm.D, FASHP, FCCM, FCCP, BCCCP","doi":"10.1016/j.ajem.2024.10.040","DOIUrl":"10.1016/j.ajem.2024.10.040","url":null,"abstract":"<div><div>The burden of acute bacterial skin and skin structure infections (ABSSSI) continue to plague the healthcare system. One approach to managing moderate-to-severe ABSSSI in low-risk patients involves use of a single dose lipoglycopeptide (LGP), dalbavancin or oritavancin, in the emergency department (ED) and discharge to home with follow-up care. Limited ED studies indicate decreased hospital stays, ED revisits, readmissions, and healthcare costs, as well as improved patient satisfaction with use of these antibiotics. However, existing literature has limitations and gaps, such as insufficient quantifiable data on patient selection criteria, outcome predictors, and risk factors leading to treatment failure. Moreover, there is lack of research on the impact of LGPs on organizational productivity, patient quality of life, and utility in indications beyond ABSSSI. This review focuses on the role of long-acting LGPs in the ED setting for select patients presenting with ABSSSI, aiming to avoid hospitalizations, expedite patient discharge, and prevent readmissions while acknowledging potential limitations of therapy. Additionally, it provides insights into strategies and considerations specifically relevant to implementing this therapeutic approach in the ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570511","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":"Utility of iron concentration two to four hours post ingestion in predicting toxicity","authors":"Haley Fox PharmD ,&nbsp;Abigail Jansen PharmD ,&nbsp;Jillian Theobald MD, PhD ,&nbsp;Matthew Stanton PharmD ,&nbsp;Ryan Feldman PharmD","doi":"10.1016/j.ajem.2024.10.042","DOIUrl":"10.1016/j.ajem.2024.10.042","url":null,"abstract":"<div><h3>Introduction</h3><div>Iron products are widely available over the counter and have the potential to cause serious toxicity. Iron concentrations can be used to prognosticate and guide treatment during acute ingestions. Traditionally, a concentration of 350 μg/dL with symptoms, or 500 μg/dL without symptoms, is considered toxic and will likely need treatment to prevent decompensation. It is generally recommended that an iron concentration is obtained at least 4 h after exposure to provide adequate absorption time and avoid falsely low iron concentrations. Despite this, many iron overdoses have concentrations drawn immediately upon patient presentation. The utility of an iron concentration drawn before 4 h in assessing exposure risk is not clear. The purpose of this study is to determine if patients' symptoms and iron concentrations obtained between 2 and 4 h can predict the development of iron concentrations after 4 h.</div></div><div><h3>Methods</h3><div>This is a single-center, retrospective study of patient cases with a primary ingestion of oral iron reported to a regional poison center from January 1, 2015 to January 1, 2020. The primary outcome is the incidence of an iron concentration of 350 μg/dL or greater at or beyond 4 h. Secondary outcomes include the incidence of antidotal deferoxamine administration, incidence of iron concentration &gt; 500 μg/dL, incidence of positive findings on abdominal radiography, and time to highest reported iron concentration.</div></div><div><h3>Result</h3><div>A total of 75 patients were included in this study. No patients who developed at most minor symptoms (abdominal discomfort, nausea, vomiting, or diarrhea without evidence of systemic toxicity) and had a 2–4 h concentration ≤ 300 μg/dL symptoms had a subsequent concentration ≥ 350 μg/dL (negative predictive value [NPV] 100 %). Deferoxamine was used to treat five patients, all reached concentrations of &gt; 300 μg/dL 2–4 h post-ingestion.</div></div><div><h3>Conclusion</h3><div>Patients with only minor GI symptoms and an iron concentration of ≤ 300 μg/dL between 2 and 4 h post-ingestion are unlikely to develop further toxicity. In this case series, a concentration of 300 μg/dL or less between 2 and 4 h was the ideal cutoff to predicting subsequent potentially toxic concentrations, with a sensitivity of 100 % and a specificity of 54 %.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592993","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":"Association between patient race and emergency department physical restraint use in a statewide hospital system","authors":"J. David Gatz MD ,&nbsp;Benoit Stryckman MA ,&nbsp;Laurence S. Magder PhD ,&nbsp;Sanyukta Deshmukh ,&nbsp;Mark Sutherland MD ,&nbsp;Daniel B. Gingold MD, MPH","doi":"10.1016/j.ajem.2024.10.033","DOIUrl":"10.1016/j.ajem.2024.10.033","url":null,"abstract":"<div><h3>Objective</h3><div>To measure the association between patient race and physical restraint use in the ED.</div></div><div><h3>Methods</h3><div>Adult patients presenting to eight rural, suburban, and urban EDs in a mid-Atlantic statewide hospital system ED between January 1, 2019 and June 30, 2022 were included. Those arriving already restrained, transported from detention centers, or who left before services were provided were excluded. Multivariable logistic regression measured the association of physical restraint use with patient race, adjusting for age, sex, weight, height, mode of arrival, history of violent behavior, comorbidities, ESI acuity level, homelessness, and site.</div></div><div><h3>Results</h3><div>Of 896,527 patient encounters included in the analysis, 3459 (0.39 %) had a physical restraint order. The study population was 48.7 % non-Hispanic White and 43.7 % non-Hispanic Black. Black patients had higher adjusted odds of being restrained relative to White patients (OR 1.26, 95 % CI 1.15–1.37). Other key variables associated with physical restraint use were an ESI level of 1 vs 3+ (OR 13.15, 95 % CI 11.49–15.04), arrival by law enforcement (8.39, 95 % CI 7.47–9.43), and arrival by EMS (5.36, 95 % CI 4.93–5.83 Among those who were restrained, the hazard of restraint was higher among Black compared to White patients in the first hour after ED arrival (adjusted hazard ratio 1.14, 95 % CI 1.01–1.30).</div></div><div><h3>Conclusion</h3><div>Black patients were more likely to be physically restrained compared to White patients, though the magnitude of this association was small compared to that of other clinical risk factors. Future work should evaluate if these findings are driven by differences in patient characteristics or clinician decision-making to best inform interventions to reduce this disparity.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578297","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":"Handheld ultrasound versus standard machines for placement of peripheral IV catheters: A randomized, non-inferiority study","authors":"Adrienne N. Malik MD ,&nbsp;Stephanie Thom MD ,&nbsp;Travis Helberg MD ,&nbsp;Bradley S. Jackson MD ,&nbsp;Nima Sarani MD ,&nbsp;Melissa Thomas MD ,&nbsp;Matthew Cook MD ,&nbsp;Dana Thompson MD ,&nbsp;Austin Petz MD ,&nbsp;Magen Gunsolley DNP, FNP-C ,&nbsp;Robert R. Ehrman MD, MS","doi":"10.1016/j.ajem.2024.10.036","DOIUrl":"10.1016/j.ajem.2024.10.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Ultrasound guided IV catheter (USGIV) access occurs frequently in Emergency Departments (EDs). This task is often performed using large, expensive, cart-based ultrasound systems (CBUS) which are frequently needed for other ED ultrasound functions and can be cumbersome to use and store. Handheld ultrasounds (HHUs) may be able to meet this need, but it is unknown if they function interchangeably with CBUS for USGIV placement. We performed a prospective, randomized, noninferiority study to compare the success rate of HHUs to CBUSs for placing USGIVs.</div></div><div><h3>Methods</h3><div>ED patients 18 and older needing an USGIV were approached for enrollment and randomized to receive an USGIV placed by CBUS or HHU. USGIVs were placed by any ED physician or nurse trained in placement. A placement was considered attempted upon needle entry into the skin. An USGIV was successful if it was immediately flushable with saline. Data was collected on the success of IV placement, number of attempts, IV and provider characteristics, patient demographics, and length of time the USGIV lasted. Demographics and operator and IV characteristics were analyzed using Pearson's Chi square, Fischer's Exact test, or Wilcoxon rank sum tests. Non-inferiority was assessed using the Farrington-Manning test. Results were approached per protocol and analyzed in R.</div></div><div><h3>Results</h3><div>312 patients were enrolled. Patient and IV characteristics were similar between groups. There was no difference in the number of successful USGIVs placed in either group (<em>p</em>≥0.9) with 146 in the CBUS group and 145 in the HHU group. There was no difference in the first attempt success rate between groups (<em>p</em> = 0.8) and HHU was noninferior to CBUS for successful USGIV placement (<em>p</em> = 0.0001). The rate of premature USGIV failure was similar between HHU and CBUS (4.0 % and 6.7 %).</div></div><div><h3>Conclusion</h3><div>HHU was noninferior to CBUS for successful USGIV placement. There was no difference in the rate of first attempt success at placement or USGIV survival to a patient's ED disposition between groups. No significant additional training was required for ED providers of all levels to use the HHUs.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549143","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":"National Early Warning Score (NEWS) system for improving response time in an acute care setting: A retrospective study.","authors":"TongYan Zhang, YaZhu Hou, Yan Li, Xin Yang, Shengyuan Zhou, Guoxian Lu, Pengyun Shen, Xiumei Gao","doi":"10.1016/j.ajem.2024.10.038","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.038","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570493","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":"Droperidol use in emergency patients with abdominal pain, nausea, and vomiting requires further analysis.","authors":"Ryan Ernst","doi":"10.1016/j.ajem.2024.10.035","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.035","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513492","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":"From memory to mastery: Optimizing AI models for ECG diagnostics in clinical practice.","authors":"Adem Az","doi":"10.1016/j.ajem.2024.10.034","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.034","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513493","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":"Quality improvement interventions to reduce coagulation testing overuse in the emergency department.","authors":"Arjun K Venkatesh, Jessica Duke, Silas Wong, Aman Shah, Craig Rothenberg, Amitkumar Patel, Wendy W Sun, Marc Shapiro, Andrew Ulrich, Vivek Parwani","doi":"10.1016/j.ajem.2024.10.037","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.037","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570498","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":"Balancing admissions from the ED and from elective surgeries: Caring for the entire community","authors":"Peter B. Smulowitz MD, MPH","doi":"10.1016/j.ajem.2024.10.032","DOIUrl":"10.1016/j.ajem.2024.10.032","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586132","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":"A new score predicting renal replacement therapy in patients with crush injuries: Analysis of a major earthquake","authors":"Mustafa Comoglu,&nbsp;Fatih Acehan,&nbsp;Osman Inan,&nbsp;Burak Furkan Demir,&nbsp;Yusufcan Yılmaz,&nbsp;Enes Seyda Sahiner","doi":"10.1016/j.ajem.2024.10.031","DOIUrl":"10.1016/j.ajem.2024.10.031","url":null,"abstract":"<div><h3>Background</h3><div>It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT.</div></div><div><h3>Methods</h3><div>This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction.</div></div><div><h3>Results</h3><div>Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09–4.39, <em>p</em> = 0.026), albumin (OR:0.11, 95 % CI: 0.04–0.32, <em>p</em> &lt; 0.001), and CK (OR: 1.00, 95 % CI 1.00–1.00, p &lt; 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT.</div></div><div><h3>Conclusions</h3><div>The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513497","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}