American Journal of Emergency Medicine最新文献

{"title":"Risk of mortality among adolescents and young adults following hospitalization from an intentional overdose.","authors":"Jung-Chi Chiang, I Kuan Wu, Chien-Chieh Hsieh","doi":"10.1016/j.ajem.2025.01.048","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.048","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061597","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":"Global research trends of BRUE (brief resolved unexplained event) or formerly ALTE (apparent life-threatening event): A comprehensive visualization and bibliometric analysis from 1988 to 2024.","authors":"Derşan Onur, Murat Çetin","doi":"10.1016/j.ajem.2025.01.045","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.045","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to conduct a comprehensive bibliometric analysis of the literature on Brief Resolved Unexplained Event (BRUE) and its predecessor, Apparent Life-Threatening Event (ALTE), from 1988 to 2024, in order to identify research trends, collaborative networks, and areas of focus in this field.</p><p><strong>Methods: </strong>We analyzed articles indexed in Scopus and Web of Science using various bibliometric indicators. The visualization of bibliometric networks was performed using VOSviewer and bibliometrix. Publication trends, citation analysis, co-authorship networks, and keyword co-occurrence were examined.</p><p><strong>Results: </strong>A total of 270 articles were analyzed, of which 85.56 % were research articles and 14.44 % were review articles. The number of publications showed a significant increase over time (r = 0.73, p < 0.001). The United States emerged as the leading contributor with strong international collaborations. The most prolific journals were Pediatrics, Pediatric Emergency Care, and Journal of Pediatrics. Keyword analysis revealed a shift from terms associated with life-threatening events (e.g., SIDS, sleep apnea syndrome) to more specific terminology (BRUE) and methodological keywords over time. However, the 2016 redefinition of ALTE to BRUE did not result in a corresponding increase in publications.</p><p><strong>Conclusion: </strong>This bibliometric analysis provides valuable insights into the evolution and current state of BRUE/ALTE research. The findings highlight the field's progression toward more precise, evidence-based approaches. The identified research trends and gaps, particularly the limited studies from developing countries, offer direction for future research. These results can inform clinical practice, guide research priorities, and support the development of standardized guidelines for BRUE/ALTE management.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"129-141"},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048918","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 ketamine administration with intubation and cardiac arrest for prehospital patients with behavioral and substance-related complaints in the US.","authors":"Ryan Huebinger, Dorothy Habrat, Christie L Fritz, Andrew J Harrell, Whitney J Barrett","doi":"10.1016/j.ajem.2025.01.047","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.047","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076572","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":"Should digoxin immune fab be administered based solely on reported ingested amount in acute digoxin poisoning?","authors":"Jon B Cole, Lesley C Pepin, Carrie L Oakland, Elisabeth F Bilden","doi":"10.1016/j.ajem.2025.01.038","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.038","url":null,"abstract":"<p><p>Acute digoxin poisoning is increasingly uncommon in emergency medicine. Furthermore, controversy exists regarding indications for antidotal digoxin immune fab in acute poisoning. In healthy adults, the fab prescribing information recommends administration based on \"known consumption of fatal doses of digoxin: ≥10mg,\" while many emergency medicine textbooks suggest fab administration be driven by clinical features or potassium concentration. A 54 kg adult, not on digoxin, presented one hour after ingesting 12.5 mg. Electrocardiogram revealed only ST depression and first degree heart block. Initial pulse was 102 beats/min, systolic blood pressure was 170 mmHg. The patient was otherwise asymptomatic. Poison center recommended immediately obtaining serum potassium and digoxin concentrations; call-back was planned for two hours. The emergency physician was instructed to have ≥10 fab vials bedside and to administer if instability ensued. Thirty-five minutes later (≈90 min post-ingestion) ventricular fibrillation cardiac arrest occurred; initial serum potassium resulted at this time at 3.3 mEq/L. Bicarbonate, insulin and glucose, amiodarone, magnesium, calcium, and 10 fab vials were administered. Cardioversion resulted in wide-complex tachycardia which became ventricular fibrillation then asystole and the patient died. Serum digoxin concentration drawn on hospital arrival resulted after death at 44 ng/mL. In this fatal case of acute digoxin poisoning, fab was not empirically recommended because the patient initially did not have significant signs or symptoms that accompanied the history of ingesting ≥10 mg digoxin. While the bedside team was given clear anticipatory guidance by the regional poison center, the patient died despite fab administration once instability occurred.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030342","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":"Use of psychoactive medications in topical cream: Need for regulation and vigilance!","authors":"Anju Gupta, Amiya Kumar Barik, Chitta Ranjan Mohanty, Rakesh Vadakkethil Radhakrishnan, Surya Kumar Maddala","doi":"10.1016/j.ajem.2025.01.037","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.037","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030347","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":"Risks associated with opioid prescriptions for headache in the emergency department.","authors":"Hayward Jake, MacLean Davis, Rosychuk Rhonda, Lonergan Kevin, Innes Grant","doi":"10.1016/j.ajem.2025.01.028","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.028","url":null,"abstract":"<p><strong>Study hypothesis: </strong>Use of opioids for treatment of headache in the emergency department (ED) is associated with an increased 1-year risk of opioid-related adverse events.</p><p><strong>Objective: </strong>To assess the safety and efficacy of opioid prescribing for ED patients with headache.</p><p><strong>Methods: </strong>We performed a multicenter observational cohort study using linked administrative data. All patients discharged from an ED in the province of Alberta, Canada with a headache diagnosis between 2010 and 2020 were included. Opioid-treated patients filled opioid prescriptions within 72 h of their ED visit, and were matched to untreated controls using propensity scores. The 1-year primary outcome was a composite of long-term prescription opioid use (LTU), opioid-related ED visit or hospitalization, or new opioid agonist therapy (OAT). Secondary outcomes included all-cause acute care utilization and 7-day ED return headache visits.</p><p><strong>Results: </strong>Of 323,932 eligible headache visits, 5.7 % received opioids. Opioid-treated patients were comparable to controls on all baseline characteristics. The primary outcome occurred in 8.7 % of opioid-treated patients and 5.8 % of controls (aOR 1.65 [1.49-1.82]; NNH = 29). Opioid-treated patients had higher rates of LTU (7.7 % vs. 4.8 %), all-cause ED visit (20.8 % vs. 19.0 %), all-cause hospitalization (16.7 % vs. 14.8 %), and 7-day revisit (aOR = 1.61 [1.49-1.74]; NNH = 21) but did not experience more opioid-related ED visits or hospitalizations, or new OAT. Opioid prescription potency and duration were strong predictors of harm.</p><p><strong>Conclusion: </strong>Opioid prescriptions are associated with ED revisits, hospitalizations and LTU in headache patients, without improved efficacy. These findings support the growing notion that opioids are not indicated for ED headache management.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"109-114"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042881","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":"PEN-FAST-ED: Utilizing the PEN-FAST decision tool to guide antibiotic prescribing in the emergency department.","authors":"Kimberly Tran, Jeremy Lund, Chloe Sealy, David Langley, Jamie Kisgen","doi":"10.1016/j.ajem.2025.01.039","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.039","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patient-reported penicillin allergies are frequently encountered in the emergency department (ED), which often lead to non-beta-lactam antibiotic use despite beta-lactams' place as first-line therapy in most bacterial infections. The PEN-FAST clinical decision tool was developed and validated to identify patients with a low risk of true penicillin allergies that do not require formal skin testing for rechallenging. The tool consists of four questions that add up to a total score ranging from 0 to 5. Scores of 0-2 are associated with low risk of true penicillin allergy (&lt;5% risk of true reaction); scores of 3 with moderate risk (&lt;20% risk); and scores of 4-5 with high risk (50% risk). The purpose of our study was to determine the safety and efficacy of our facility's implementation of pharmacist utilization of the PEN-FAST screening tool to assess purported penicillin allergies and rechallenge low to moderate risk patients in the ED.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a single-center, prospective, observational cohort study conducted from October 2023 to March 2024. Adult ED patients with a documented penicillin allergy with an order for aztreonam, levofloxacin, clindamycin, or a consult for pharmacy to assist with antibiotic selection were included. Patients were excluded if the order or consult was placed by a non-ED physician, no penicillin allergy was documented, the patient had previously tolerated a penicillin or cephalosporin per chart review, was unable to participate in the interview, or the completion of the assessment would delay patient care. The primary outcome was the percent of patients with a PEN-FAST score of 0-2 who tolerated a beta-lactam antibiotic after pharmacist intervention. Secondary safety and logistical outcomes included the incidence of immune-mediated reactions within one hour of beta-lactam administration, timing of the assessment, and antibiotic selection in transitions of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 361 patients screened, 100 patients were included. There were 61% of patients who had a PEN-FAST score of 0-2, 30% had a score of 3, and 9% had a score of 4-5. For the primary outcome, all 52 (100%) patients with a PEN-FAST score of 0-2 who were rechallenged tolerated a beta-lactam antibiotic in the ED. For secondary outcomes, 6 patients with PEN-FAST score of 3 were rechallenged and tolerated a beta-lactam. There were 0 incidences of any immune-mediated reactions within one hour of beta-lactam administration. The median time from initial order placement to change in therapy and to antibiotic administration was 17 min and 41 min, respectively. Of those rechallenged, 13 of 14 discharged (93%) and 39 of 44 admitted patients (89%) were continued on beta-lactam antibiotics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this prospective, observational study, administration of beta-lactam antibiotics to ED patients with previously reported penicillin allergies and a PEN-FAST score","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"124-128"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048920","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 empirical antibiotic regimens in emergency department and prognosis of septic patients: A single-Centre real-world study.","authors":"Dejiang Hong, Ze Chen, Jie Zhang, Kai Peng, Yi Yao, Wenjin Li, Guangju Zhao, Jiang Luo","doi":"10.1016/j.ajem.2025.01.043","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.043","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we aimed to explore the association between the choice of empirical antibiotic therapy and outcomes in ED patients with sepsis.</p><p><strong>Methods: </strong>Patients admitted to ED with sepsis were identified from a single center in the United States, and the data is stored in the MIMIC-IV-ED database. Propensity score matched model was used to match patients receiving empirical mono or combination antibiotic therapy. Logistic regression model was used to assess the associations between empirical antibiotic therapy and in-hospital mortality.</p><p><strong>Results: </strong>A total of 11,380 ED patients with sepsis were included in the data analysis. After PSM, 3920 pairs of patients were matched between the empirical mono-antibiotic therapy group and combination antibiotic therapy group. No significant benefit was observed among the empirical combination antibiotic therapy patients compared with the mono-antibiotic therapy in in-hospital mortality (OR, 0.96; 95 % CI, 0.81-1.15; P: 0.684). Empirical quinolones mono-therapy was associated with significantly lower mortality compared to cephalosporins (OR, 2.12; 95 % CI, 1.35-3.50; P:0.002), penicillins (OR, 1.87; 95 % CI, 1.08-3.34; P:0.029) and vancomycin mono-therapy (OR, 2.15; 95 % CI, 1.19-3.97; P:0.012).</p><p><strong>Conclusions: </strong>Empirical combination antibiotic therapy was not associated with reduced mortality in ED patients with sepsis. Compared with cephalosporins, penicillins and vancomycin, quinolone mono-antibiotic therapy was significantly associated with a decreased risk of in-hospital mortality, especially in patients with respiratory tract infections.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"98-105"},"PeriodicalIF":2.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030352","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":"ChatGPT's ECG interpretations: Sensitivity or specificity? Which matters more in the emergency department?","authors":"Ekrem Taha Sert, Muhammed Akay","doi":"10.1016/j.ajem.2025.01.024","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.024","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030327","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 \"Comparison of transvaginal ultrasound utilization between radiology and point-of-care ultrasound in first-trimester pregnancy\".","authors":"Ali Çelik","doi":"10.1016/j.ajem.2025.01.035","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.035","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030329","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}