American Journal of Emergency Medicine最新文献

{"title":"Early vasopressin plus norepinephrine versus delayed or no vasopressin in septic shock: A systematic review and meta-analysis","authors":"Isadora Mamede MD ,&nbsp;Lucas Arêa ,&nbsp;Giulia Carvalhal ,&nbsp;Rodrigo Bessa ,&nbsp;Manoela Lenzi ,&nbsp;Marcel Catão Ferreira dos Santos MD","doi":"10.1016/j.ajem.2025.10.003","DOIUrl":"10.1016/j.ajem.2025.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Norepinephrine is the first-line vasopressor in septic shock, with vasopressin commonly added if shock persists. Evidence suggests that early initiation of vasopressin may improve hemodynamic and clinical outcomes; however, data remain conflicting. This meta-analysis evaluates early vasopressin administration.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane for studies comparing early vasopressin plus norepinephrine versus norepinephrine alone or later vasopressin initiation in septic shock. Outcomes included hospital and ICU length of stay (LOS), SOFA score, vasopressor duration, mortality (in-hospital and 28-day), arrhythmias, and renal replacement therapy (RRT). A random-effects model was used. Risk of bias was assessed using RoB2 and ROBINS-I tools.</div></div><div><h3>Results</h3><div>Six studies (<em>n</em> = 1167 patients) met inclusion criteria, including two RCTs. Early vasopressin was associated with a significantly shorter hospital LOS (mean difference [MD] -4.48 days; 95 % CI -8.37 to −0.60; <em>p</em> = 0.02; I² = 44 %). No significant differences were observed for ICU LOS (MD -0.73 days; <em>p</em> = 0.42), vasopressor duration (MD -8.77 h; <em>p</em> = 0.18), SOFA scores at 24 or 72 h, in-hospital mortality (OR 0.86; <em>p</em> = 0.38), 28-day mortality (OR 0.84; <em>p</em> = 0.20), arrhythmia risk (OR 0.99; <em>p</em> = 0.98), or RRT use (OR 1.02; <em>p</em> = 0.91). Risk of bias was high in most included studies, particularly among observational designs.</div></div><div><h3>Conclusion</h3><div>Early vasopressin may reduce hospital LOS in septic shock but does not improve mortality or other outcomes. Even though there is a possible benefit, current evidence does not support routine early use.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 225-231"},"PeriodicalIF":2.2,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260011","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":"Pre-stroke emergency department utilization in the Brain Attack Surveillance in Corpus Christi (BASIC) project","authors":"Christopher J. Becker ,&nbsp;James F. Burke ,&nbsp;Chun Chieh Lin ,&nbsp;Brian Stamm ,&nbsp;William J. Meurer ,&nbsp;Joseph F. Carrera ,&nbsp;Regina Royan ,&nbsp;Lauren Mamer ,&nbsp;Melinda A. Smith ,&nbsp;Erin Case ,&nbsp;Lewis B. Morgenstern ,&nbsp;Lynda D. Lisabeth","doi":"10.1016/j.ajem.2025.10.005","DOIUrl":"10.1016/j.ajem.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Pre-stroke ED visits may represent opportunities for stroke prevention. We evaluated the prevalence and predictors of ED visits in the 90-days preceding a stroke, and the frequency of visits for “high-risk” diagnoses known to be associated with short-term stroke risk, including neurologic symptoms, atrial fibrillation, falls, and hypertensive disorders.</div></div><div><h3>Methods</h3><div>Within an ongoing population-based stroke surveillance study in South Texas, we identified all physician-validated ischemic and hemorrhagic strokes from April 2003 to December 2020. Linked Medicare claims data were used to identify ED visits in the 90 days before each stroke. Logistic regression was used to evaluate clinical and sociodemographic factors associated with pre-stroke ED utilization. High risk diagnoses were identified by manual review.</div></div><div><h3>Results</h3><div>A total of 2498 validated stroke cases were matched to Medicare claims data. Patients were 57 % female and 47 % Mexican American with a mean age of 77 (SD 11). A total of 209 patients (8.4 %) had an ED visit in the 90-days before their stroke, including 102 (4.1 %) with multiple visits. Medicaid insurance (OR 1.54, 95 %CI 1.05–2.26) and diabetes (OR 1.73, 95 %CI 1.21–2.47) were associated with greater odds of a pre-stroke ED visit. Of 430 total ED visits, 87 (20.0 %) were for a high-risk diagnosis, including 70 (16.3 %) for a neurologic diagnosis, 12 (2.8 %) for a hypertensive disorder, and 5 (1.2 %) for atrial fibrillation.</div></div><div><h3>Conclusions</h3><div>Pre-stroke ED visits were common, particularly among patients with diabetes or Medicaid insurance, and were often associated with high-risk primary diagnoses, potentially representing opportunities for stroke prevention or early treatment.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 220-224"},"PeriodicalIF":2.2,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269614","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":"Process implementation and outcomes associated with patient-controlled analgesia in the emergency department for adult sickle cell patients","authors":"Marin Valentino Pharm.D., BCCCP ,&nbsp;Nicole M. Acquisto Pharm.D., FASHP, FCCM, FCCP, BCCCP ,&nbsp;Rebekah Torchon Pharm.D ,&nbsp;Grace Ng MD ,&nbsp;Jeff Huntress PharmD ,&nbsp;Matthew McIntosh MD ,&nbsp;Melissa Evans RN ,&nbsp;Bruce Blaine PhD ,&nbsp;Francis Coyne MD","doi":"10.1016/j.ajem.2025.10.001","DOIUrl":"10.1016/j.ajem.2025.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This pre/post retrospective observational study evaluates outcomes associated with initiation of hydromorphone patient-controlled analgesia (PCA) in the emergency department (ED) for adult sickle cell disease (SCD) patients presenting with vaso-occlusive episode (VOE).</div></div><div><h3>Methods</h3><div>Patients served as their own controls to reduce variability. Therefore, an ED presentation and admission between August 2023–November 2024 (post-implementation) was compared to a previous encounter between May 2021–May 2023 (pre-implementation).</div></div><div><h3>Results</h3><div>A total of 23 patients were included: mean age 31 years (IQR 27.5, 38), 62.5 % male, genotypes hemoglobin SC and SS (39.1 %, 39.1 %). Time to PCA initiation was reduced in the post-implementation group; 153 min (IQR 58.5, 478) vs. 91 min (IQR 60.5, 142), respectively (<em>p</em> = 0.045). There was no difference in highest reported pain score in the first 48 h of hospital admission, 8 (7, 9) for both groups (<em>p</em> = 0.21). Median morphine milligram equivalents (MME)/day was increased in post- compared to pre-implementation groups, 1208 mg (IQR 979, 3070) vs. 1171 mg (IQR 424, 1478) (<em>p</em> = 0.02), with higher opioid analgesia MME used in days 1–4 but then lower MME by days 5–7 comparatively. There was lower MME change from total prior to admission prescription dose to hospital discharge and less patients had an increase in opioid prescription dose in the post-implementation group in both cases. Length of stay and adverse events were similar.</div></div><div><h3>Conclusion</h3><div>Availability for PCA use in the ED for adult SCD patients shortened time to PCA initiation. This approach contributed to more consistent and timely pain management for SCD patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 256-263"},"PeriodicalIF":2.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269613","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 posterior reversible encephalopathy syndrome in a young patient with goodpasture's disease","authors":"Blandin Maël ,&nbsp;de Longeaux Kahaia ,&nbsp;Gourier Sylvain","doi":"10.1016/j.ajem.2025.06.022","DOIUrl":"10.1016/j.ajem.2025.06.022","url":null,"abstract":"<div><h3>Background</h3><div>Posterior reversible encephalopathy syndrome<span><span> (PRES) is a neurovascular condition characterized by headache, </span>seizures<span><span>, altered mental status, and visual disturbances. It is associated with risk factors such as hypertension, renal failure, and immunosuppressive therapy. The occurrence of PRES in patients with </span>Goodpasture's disease is rare and often under-recognized in emergency settings.</span></span></div></div><div><h3>Case presentation</h3><div><span><span><span>A 27-year-old man with recently diagnosed Goodpasture's disease<span><span> presented to the emergency department<span> with a thunderclap headache. He subsequently developed </span></span>status epilepticus, associated with severe hypertension and </span></span>acute kidney injury. CT imaging revealed bilateral posterior juxtacortical hypodensities suggestive of PRES, later confirmed by magnetic resonance imaging. Emergency treatment included intravenous </span>nicardipine, </span>clonazepam<span>, and levetiracetam<span><span> adjusted for renal impairment. The patient was admitted to the intensive care unit, where he developed transient </span>cortical blindness<span>, a well-documented complication of PRES. Following multiple dialysis sessions and clinical stabilization, his visual and neurological function fully recovered.</span></span></span></div></div><div><h3>Conclusion</h3><div>This case highlights the importance of considering PRES in patients presenting with seizures and hypertension, particularly in the context of autoimmune disease and renal impairment. Early recognition and prompt treatment in the emergency department are crucial to prevent potentially irreversible neurological damage. Emergency clinicians should maintain a high index of suspicion when evaluating thunderclap headaches with seizure activity, especially in immunosuppressed patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 299.e5-299.e7"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303699","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":"The Authors Respond to Reader Comment Regarding Waveform conversion as a prognostic factor of poor prognosis in patients undergoing extracorporeal cardiopulmonary resuscitation","authors":"Ken Inoue,&nbsp;Keita Shibahashi,&nbsp;Kazuhiro Sugiyama","doi":"10.1016/j.ajem.2025.05.005","DOIUrl":"10.1016/j.ajem.2025.05.005","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Page 275"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065303","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":"The Authors Respond to Reader Comment Regarding “Comparative Analysis of APUA, APUA-RO2, and CURB-65 scores for Mortality Risk in Hospitalized Pneumonia Patients”","authors":"Abdullah Algin ,&nbsp;Serdar Özdemir ,&nbsp;Abuzer Özkan","doi":"10.1016/j.ajem.2025.08.015","DOIUrl":"10.1016/j.ajem.2025.08.015","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Page 269"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849723","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":"The missing piece in The Pitt: A call for emergency medicine pharmacist representation","authors":"Kevin J. Mercer PharmD, MPH ,&nbsp;Brian W. Gilbert PharmD, MBA, FCCM, FCNS, FKCHP ,&nbsp;Alyssa Robertson PharmD ,&nbsp;Heather Blue PharmD, FMSHP ,&nbsp;Christian E. Kroll PharmD ,&nbsp;Fernanda Bellolio MD, MS","doi":"10.1016/j.ajem.2025.08.037","DOIUrl":"10.1016/j.ajem.2025.08.037","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 291-292"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979840","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":"Reassessing risk stratification in the ED: HEART, HET, SVEAT, and the emerging role of HASI","authors":"Hsih-Hao Huang ,&nbsp;Chien-Chieh Hsieh ,&nbsp;Fu-Shan Jaw ,&nbsp;Che-Ming Yeh","doi":"10.1016/j.ajem.2025.06.064","DOIUrl":"10.1016/j.ajem.2025.06.064","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 278-279"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562088","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":"Reader Comment Regarding Cardiac arrest in critical care transport: A case-control study","authors":"Hui Long ,&nbsp;Yanmin Song","doi":"10.1016/j.ajem.2025.07.032","DOIUrl":"10.1016/j.ajem.2025.07.032","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 280-281"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719156","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":"Reader comment regarding SHAP analysis and comparative performance of the HEART, HET, and SVEAT scores in 30-day MACE prediction","authors":"Lukasz Szarpak ,&nbsp;Andrzej Krupa ,&nbsp;Karol Momot ,&nbsp;Michal Pruc","doi":"10.1016/j.ajem.2025.06.063","DOIUrl":"10.1016/j.ajem.2025.06.063","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 276-277"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555918","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}