American Journal of Emergency Medicine最新文献

{"title":"Evaluating smartwatch-based detection of supraventricular tachycardia and atrial fibrillation in the emergency department","authors":"Süleyman Alpar ,&nbsp;Ali Cankut Tatlıparmak","doi":"10.1016/j.ajem.2025.05.037","DOIUrl":"10.1016/j.ajem.2025.05.037","url":null,"abstract":"<div><h3>Background</h3><div>In this study, we categorized smartwatches into two groups: those with electrocardiogram (ECG) capability and those utilizing photoplethysmography (PPG) sensors. The aim was to evaluate the diagnostic performance of these devices in differentiating atrial fibrillation (AF) from supraventricular tachycardia (SVT) among patients presenting to the emergency department (ED) with an irregular rhythm alert.</div></div><div><h3>Methods</h3><div>This retrospective, single-center observational study was conducted in the ED of a tertiary hospital over a two-year period. The study included adult patients (≥22 years) who presented to the ED following an irregular rhythm alert generated by their smartwatch. Smartwatches were classified as either ECG-capable devices or PPG-based devices. Final rhythm diagnoses were confirmed by two independent emergency physicians based on 12‑lead ECG findings obtained during the ED evaluation.</div></div><div><h3>Results</h3><div>A total of 424 patients were included. Of these, 63.7 % (<em>n</em> = 270) used ECG-capable smartwatches, and 66.3 % (<em>n</em> = 281) received an AF alert. Among all alerts, 60.8 % (<em>n</em> = 258) were ECG-based and 39.2 % (<em>n</em> = 166) were PPG-based. Common presenting symptoms included palpitations (56.1 %), dizziness (21.7 %), and dyspnea (23.6 %), while 8.5 % of patients were asymptomatic. In total, 44.6 % (<em>n</em> = 189) required pharmacologic or electrical interventions. Smartwatches demonstrated moderate accuracy for AF and SVT detection. PPG-based detection showed higher sensitivity than ECG-based detection (AF: 54.3 % vs. 44.9 %; SVT: 83.6 % vs. 79.2 %). Agreement with final ECG diagnoses was poor (Cohen's Kappa = 0), with significant misclassification for both arrhythmias (McNemar's <em>p</em> &lt; 0.001), except for PPG-based SVT (<em>p</em> = 0.072). No significant predictors of false-positive AF alerts were found (area under the curve [AUC] = 0.538). False-positive SVT alerts were more common in younger patients (odds ratio [OR] = 0.92, <em>p</em> = 0.039), females (OR = 0.55, <em>p</em> = 0.048), and less frequent in diabetic patients (OR = 0.24, <em>p</em> = 0.001; AUC = 0.685).</div></div><div><h3>Conclusion</h3><div>Among patients presenting to the ED with smartwatch-reported irregular rhythm alerts, PPG-based detection demonstrated higher sensitivity for SVT compared to ECG-based methods; however, the overall diagnostic agreement for both AF and SVT was limited.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"95 ","pages":"Pages 101-106"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147817","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":"Found down, pulseless and cold: Outcomes following unwitnessed hypothermic cardiac arrest","authors":"Christopher R. Wyatt MD ,&nbsp;Aaron S. Perez DO ,&nbsp;Matteo P. Garofalo MD ,&nbsp;Lawrence H. Brown PhD","doi":"10.1016/j.ajem.2025.05.035","DOIUrl":"10.1016/j.ajem.2025.05.035","url":null,"abstract":"<div><h3>Objective</h3><div>Hypothermic out-of-hospital cardiac arrest (OOHCA) without an apparent abrupt cause for hypothermia presents a dilemma for emergency physicians. This study compared outcomes among hypothermic and normothermic OOHCA arrest patients “found down” following unwitnessed arrest who required ongoing chest compressions in the emergency department (ED).</div></div><div><h3>Methods</h3><div>This secondary analysis of Resuscitation Outcomes Consortium (ROC) Epistry 3 data included OOHCA patients ≥15 years old transported to hospital by EMS who required continued or recurrent chest compressions in the ED. Per current resuscitation guidelines, patients with initial core temperatures &lt;30 °C were considered hypothermic; temperatures between 35 °C and 38 °C were classified as normothermic. We excluded patients with initial temperatures recorded &gt;30 min after arrival. We compared survival to hospital admission, survival to hospital discharge and survival with good neurologic status (i.e., Modified Rankin Scale ≤2) for hypothermic and normothermic patients. Sensitivity analyses explored alternate hypothermia cut-points (&lt; 35 °C; 28 °C).</div></div><div><h3>Results</h3><div>The primary analysis included 22 hypothermic and 416 normothermic patients. Outcomes for hypothermic and normothermic patients did not significantly differ: survival to hospital admission was 13.6 % vs. 28.6 % (difference −15 %, CI: −30.0 %; +0.01 %); survival to hospital discharge was 4.6 % vs. 3.1 % (difference + 1.4 %, CI: −4.2 %; +13.3 %); survival with good neurologic status was 4.6 % vs. 1.2 % (difference + 3.4 %, CI: −5.4 %; +12.1 %). Using alternative cut-points to define hypothermia did not meaningfully alter the results.</div></div><div><h3>Conclusion</h3><div>In this analysis, outcomes did not differ for hypothermic and normothermic adult OOHCA patients “found down” following unwitnessed OOHCA who required continued chest compressions in the ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"95 ","pages":"Pages 83-88"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147973","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 of dilated aortic root on point-of-care ultrasound with aortic aneurysm and dissection","authors":"Mina Hesami MD,&nbsp;Ryan Denkewicz MD,&nbsp;Zachary Boivin MD,&nbsp;Sonali Bhalodkar MD,&nbsp;Jia Jian Li MD,&nbsp;Christopher Moore MD","doi":"10.1016/j.ajem.2025.05.039","DOIUrl":"10.1016/j.ajem.2025.05.039","url":null,"abstract":"<div><h3>Objectives</h3><div>Thoracic aortic dissection (TAD) is a life-threatening condition with a mortality rate of 1–2 % per hour, highlighting the importance of prompt diagnosis. Thoracic aortic aneurysm (TAA) is associated with TAD and can be detected by point-of-care ultrasound (POCUS). We sought to evaluate the diagnostic accuracy of POCUS in detecting TAA and the prevalence of TAD in patients with TAA by POCUS. We hypothesized that a dilated aortic root on POCUS would be strongly associated with TAA and TAD.</div></div><div><h3>Methods</h3><div>Patients with a dilated aortic root measurement of ≥4.5 cm on transthoracic cardiac POCUS between 2013 and 2023 who received either chest CT or cardiology echocardiogram (c-echo) were retrospectively selected by querying a POCUS database (QpathE) from three EDs in our system. Comprehensive demographic, clinical, and imaging data were retrieved from electronic medical records. For both CT and c-echo, aortic measurements of ≥4 cm were considered aneurysmal, using the largest reported measurement. If both CT and c-echo were performed, the largest CT measure was used. We also investigated how many patients with TAA also had TAD. Statistical analysis was performed using IBM SPSS version 29.</div></div><div><h3>Results</h3><div>Our cohort included 304 patients with TAA (≥4.5 cm) on POCUS, with a median age of 67.5 years (IQR:58–80) of which 247 (81.3 %) were male. 227 (74.6 %) had CT performed, and 77 (25.3 %) had a c-echo without CT. There was a significant positive correlation between POCUS measurements and those of CT and c-echo (<em>r</em> = 0.62, <em>p</em> &lt; 0.001). Comparing the measurements on POCUS with those derived from our ground truths, the mean difference for the Bland-Altman plot was 0.13 cm (95 % confidence interval; −0.71 to 0.97), with the average POCUS measure being slightly higher. Overall, the positive predictive value (PPV) of POCUS for TAA was 96 % (95 % CI, 93.8 %–98 %). TAD was present in 45 (15.4 %) of patients with TAA.</div></div><div><h3>Conclusion</h3><div>Although POCUS measurement tended to be slightly higher than that of CT or c-echo on average, it demonstrated a high accuracy and predictive value for TAA. More than one in seven patients with TAA on POCUS had TAD. Our results underscore the efficacy of POCUS for the prompt detection of thoracic aortic aneurysm and dissection.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"95 ","pages":"Pages 89-94"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147813","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 comments on \"ChatGPT-Supported Patient Triage with Voice Commands in the Emergency Department: A Prospective Multicenter Study\".","authors":"Sinan Paslı, Esma Nilay Kırımlı, Metin Yadigaroğlu","doi":"10.1016/j.ajem.2025.05.033","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.05.033","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144427","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":"Comments on \"ChatGPT-supported patient triage with voice commands in the emergency department: A prospective multicenter study\".","authors":"Ming Yuan, Lihua Ye","doi":"10.1016/j.ajem.2025.05.034","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.05.034","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144423","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":"Corrigendum to \"Diagnostic value of ultrasound in detecting forearm fractures in pediatric patients in the emergency department\" [The American Journal of Emergency Medicine, volume 94 (2025) start page 21 - end page 24].","authors":"Ahmet Furkan Nalbant, Taner Şahin, İsmail Kürtüncü, Fatma Hançer Çelik, İbrahim Toker","doi":"10.1016/j.ajem.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.05.008","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128699","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":"Time to adequate preoxygenation when using flush rate oxygen","authors":"Alec J. Bunting DO ,&nbsp;Brian E. Driver MD ,&nbsp;Andrew M. Pearson BA ,&nbsp;Matthew E. Prekker MD, MPH ,&nbsp;Gregg A. Jones MD ,&nbsp;Ian W. Macomber BS ,&nbsp;Aaron E. Robinson MD, MPH","doi":"10.1016/j.ajem.2025.05.018","DOIUrl":"10.1016/j.ajem.2025.05.018","url":null,"abstract":"<div><h3>Objective</h3><div>Preoxygenation utilizing a non-rebreather mask (NRB) to deliver oxygen at the maximal flow rate (&gt;50 L/min) from a standard hospital gas flowmeter (i.e., the flush rate) is an accepted technique during emergency airway management. Existing guidance to preoxygenate patients for at least 3 min is based on use of oxygen-delivery devices not commonly used in the emergency department (e.g., a closed anesthesia circuit). We sought to determine the median length of time needed to achieve adequate preoxygenation utilizing an NRB with flush rate oxygen.</div></div><div><h3>Methods</h3><div>Healthy volunteers performing tidal breathing underwent a 5-min trial of preoxygenation with NRB mask with flush rate oxygen. End-tidal oxygen (EtO2), a measure of the degree of adequate preoxygenation, was recorded every 15 s. Adequate preoxygenation was defined as EtO2 ≥ 85 %.</div></div><div><h3>Results</h3><div>We enrolled 50 participants. The median maximum EtO2 achieved during preoxygenation was 87 % (interquartile range [IQR] 87–89 %) and all participants achieved an EtO2 &gt; 80 %. The median time to reach an EtO2 of 85 % was 90 s (IQR 60–135 s). By 3 min, 86 % (95 % CI 73 % to 94 %) of participants had achieved adequate preoxygenation.</div></div><div><h3>Conclusions</h3><div>In healthy participants undergoing preoxygenation with an NRB mask with flush rate oxygen, the median time to adequate preoxygenation was 90 s and 86 % were adequately preoxygenated at 3 min. This suggests that 3 min of preoxygenation is a reasonable target using this technique.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"95 ","pages":"Pages 63-66"},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123934","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":"Reevaluating PCC-associated mortality in warfarin-related gastrointestinal bleeding: A call for caution and comprehensive adjustment.","authors":"Ali Çelik","doi":"10.1016/j.ajem.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.05.025","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144425","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":"An analysis of sample size calculations in randomized control trials in emergency medicine","authors":"Önder Limon MD ,&nbsp;Nurettin Özgür Doğan MD ,&nbsp;Gülsüm Limon MD ,&nbsp;Ersin Aksay MD","doi":"10.1016/j.ajem.2025.05.020","DOIUrl":"10.1016/j.ajem.2025.05.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Sample size calculation enhances the quality of randomized clinical trials (RCTs) and, according to the CONSORT statement, should be reported and justified in published articles. This study aimed to evaluate the current quality of sample size calculation reporting in RCTs published in emergency medicine journals.</div></div><div><h3>Methods</h3><div>The Web of Science (WoS) database was used for article retrieval. Journals indexed in WoS, published in English, categorized under “emergency medicine,” and ranked in Q1 were included in the search. The sample size calculation method, power value, alpha value, effect size, and consideration of missing data were evaluated.</div></div><div><h3>Results</h3><div>A total of 252 RCTs from 12 emergency medicine journals were included in the study. Only 30 % of the articles explicitly stated compliance with CONSORT guidelines. Sample size calculations were reported in 84 % of the articles. Alpha values were omitted in 12 % and beta (power) values in 8 % of the articles. Effect sizes were not reported in 90 % of the studies. Notably, 11 % of the articles claiming CONSORT compliance did not include a sample size analysis. In the logistic regression analysis, none of the variables showed a statistically significant association with the presence of sample size analysis.</div></div><div><h3>Conclusion</h3><div>Although emergency medicine journals show relatively better adherence to sample size calculation reporting compared to some other disciplines, their overall performance remains suboptimal. The findings highlight ongoing and significant deficiencies in the quality of RCT reporting, indicating that even leading journals in the field fall short of fully meeting recommended standards.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"95 ","pages":"Pages 67-71"},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123937","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 the Letter to the Editor Regarding: \"Automated Computation of the HEART Score with the GPT-4 Large Language Model\".","authors":"Richard Andrew Taylor, Donald S Wright","doi":"10.1016/j.ajem.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.05.027","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133171","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}