American Journal of Emergency Medicine最新文献

{"title":"Impact of desmopressin on hematoma expansion in patients presenting to the emergency department on antiplatelet therapy: Don't expand study","authors":"Megan A. Rech PharmD, MS, FCCP, FCCM, BCCCP ,&nbsp;Caitlin Brown PharmD, BCCCP ,&nbsp;Giles W. Slocum PharmD, BCCCP, BCEMP ,&nbsp;Brian W. Gilbert PharmD, MBA, FCCM, FNCS, BCCCP ,&nbsp;Deep Aggarwal MD ,&nbsp;Gavin T. Howington PharmD, BCCCP, BCPS ,&nbsp;Tara Flack PharmD, BCCCP, FCCM ,&nbsp;Atul Malik MD ,&nbsp;Brett A. Faine PharmD, MS","doi":"10.1016/j.ajem.2025.03.052","DOIUrl":"10.1016/j.ajem.2025.03.052","url":null,"abstract":"<div><h3>Introduction</h3><div>Current guidelines state the effectiveness of desmopressin to reduce hematoma expansion in antiplatelet-related intracerebral hemorrhage (ICH) is uncertain. This study sought to determine if desmopressin decreased hematoma expansion in ICH patients on antiplatelet agents.</div></div><div><h3>Methods</h3><div>We conducted a multi-center, retrospective propensity-matched cohort study at 11 US emergency departments (ED) that participate in EMPHARM-NET. Adult patients ≥18 years with a primary diagnosis of spontaneous ICH on antiplatelets prior to admission from January 1, 2017 through May 1, 2021 were included. The primary endpoint was good or excellent hemostatic efficacy within the first 24 h following ICH between patients that did and did not receive desmopressin. Brain imaging was reviewed using 3D-Slicer by blinded expert physicians.</div></div><div><h3>Results</h3><div>Overall, 1408 patients were evaluated for inclusion. A total of 324 patients were included, of which 13.8 % (<em>n</em> = 45) received desmopressin and 86.1 % (<em>n</em> = 279) did not. After propensity matching, 35 patients receive desmopressin compared to 140 controls. Baseline hematoma volume (27.6 mL vs. 2.1 mL) and was significantly higher in the desmopressin group. The primary endpoint of good or excellent hemostatic efficacy was similar between groups (74.3 % desmopressin group vs. 85 % control group, −10.7 % [−28.1 % to 6.7 %]). There was no difference in secondary outcomes.</div></div><div><h3>Conclusion</h3><div>In this multicenter cohort, patients receiving desmopressin had higher baseline intraparenchymal hematoma volume, and did not appear to result in improved hemostatic efficacy relative to the control group. These results suggest against routine administration of desmopressin for antiplatelet-related ICH, though future study in a randomized trial design is necessary.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 126-131"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768303","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":"Evaluating a large language model's accuracy in chest X-ray interpretation for acute thoracic conditions","authors":"Adam M. Ostrovsky","doi":"10.1016/j.ajem.2025.03.060","DOIUrl":"10.1016/j.ajem.2025.03.060","url":null,"abstract":"<div><h3>Background</h3><div>The rapid advancement of artificial intelligence (AI) has great ability to impact healthcare. Chest X-rays are essential for diagnosing acute thoracic conditions in the emergency department (ED), but interpretation delays due to radiologist availability can impact clinical decision-making. AI models, including deep learning algorithms, have been explored for diagnostic support, but the potential of large language models (LLMs) in emergency radiology remains largely unexamined.</div></div><div><h3>Methods</h3><div>This study assessed ChatGPT's feasibility in interpreting chest X-rays for acute thoracic conditions commonly encountered in the ED. A subset of 1400 images from the NIH Chest X-ray dataset was analyzed, representing seven pathology categories: Atelectasis, Effusion, Emphysema, Pneumothorax, Pneumonia, Mass, and No Finding. ChatGPT 4.0, utilizing the “X-Ray Interpreter” add-on, was evaluated for its diagnostic performance across these categories.</div></div><div><h3>Results</h3><div>ChatGPT demonstrated high performance in identifying normal chest X-rays, with a sensitivity of 98.9 %, specificity of 93.9 %, and accuracy of 94.7 %. However, the model's performance varied across pathologies. The best results were observed in diagnosing pneumonia (sensitivity 76.2 %, specificity 93.7 %) and pneumothorax (sensitivity 77.4 %, specificity 89.1 %), while performance for atelectasis and emphysema was lower.</div></div><div><h3>Conclusion</h3><div>ChatGPT demonstrates potential as a supplementary tool for differentiating normal from abnormal chest X-rays, with promising results for certain pathologies like pneumonia. However, its diagnostic accuracy for more subtle conditions requires improvement. Further research integrating ChatGPT with specialized image recognition models could enhance its performance, offering new possibilities in medical imaging and education.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 99-102"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747895","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":"Evaluation of limiting PEEP effectiveness in preventing barotrauma in critically ill COVID-19 patients: A retrospective study","authors":"Yuhei Irie MD,&nbsp;Yoshito Izutani MD,&nbsp;Junta Noake MD,&nbsp;Shun Ninomiya MD,&nbsp;Mami Kastumura MD,&nbsp;Maiko Nakashio MD,&nbsp;Junichi Maruyama MD,&nbsp;Yoshihiko Nakamura MD,&nbsp;Hiroyasu Ishikura MD","doi":"10.1016/j.ajem.2025.03.050","DOIUrl":"10.1016/j.ajem.2025.03.050","url":null,"abstract":"<div><h3>Background</h3><div>Severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, requiring prolonged invasive mechanical ventilation. However, patients with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation experience barotrauma. We assessed whether limiting the maximum positive end-expiratory pressure (PEEP) may prevent barotrauma more effectively than using PEEP/fraction of inspired oxygen (FiO₂) in patients with COVID-19 undergoing invasive mechanical ventilation.</div></div><div><h3>Materials and methods</h3><div>We retrospectively included patients who met the diagnostic criteria at our center; they were divided into an ordinary PEEP group (PEEP/higher FiO₂ table) and a limited PEEP group (maximum PEEP of &lt;10 cmH₂O) during intensive care unit admission. We evaluated the maximum ventilator variables for mechanical ventilation and limited PEEP to inhibit barotrauma as the primary outcome.</div></div><div><h3>Results</h3><div>Patients in the ordinary PEEP group (<em>n</em> = 34) were significantly older and had higher body mass indexes than those in the limited PEEP group (<em>n</em> = 27). The maximum PEEP and maximum peak inspiratory pressure were significantly higher in the ordinary PEEP group than in the limited PEEP group. The ordinary PEEP group had a significantly higher incidence of barotrauma than the limited PEEP group.</div></div><div><h3>Conclusions</h3><div>Limiting the maximum PEEP to &lt;10 cmH₂O may prevent barotrauma in patients with COVID-19 undergoing invasive mechanical ventilation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 73-79"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738120","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 comment on \"Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury\".","authors":"Jeng-Luen Hong, Giou-Teng Yiang, Meng-Yu Wu","doi":"10.1016/j.ajem.2025.03.053","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.053","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765955","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: \"Artificial Intelligence for the Diagnosis of Pediatric Appendicitis: A Systematic Review\".","authors":"Ashutosh Bhosale, Mahesh Gore","doi":"10.1016/j.ajem.2025.03.056","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.056","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733398","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":"External validation of three scores for predicting prehospital return of spontaneous circulation in out-of-hospital cardiac arrest","authors":"Cheng-Yi Fan MD ,&nbsp;Edward Pei-Chuan Huang MD, MS ,&nbsp;Chun-Hsiang Huang MD ,&nbsp;Sih-Shiang Huang MD ,&nbsp;Chien-Tai Huang MD ,&nbsp;Yi-Ju Ho MD ,&nbsp;Ching-Yu Chen MD ,&nbsp;Chi-Hsin Chen MD ,&nbsp;Chun-Ju Lien MD ,&nbsp;Wei-Tien Chang MD, PhD ,&nbsp;Chih-Wei Sung MD, PhD","doi":"10.1016/j.ajem.2025.03.048","DOIUrl":"10.1016/j.ajem.2025.03.048","url":null,"abstract":"<div><h3>Background</h3><div>Although three established models for predicting the return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) exist, combinational external validation of these models remains limited. This study aimed to externally validate and compare the performance of three predictive models—RACA, P-ROSC, and UB-ROSC–and provide evidence to guide the selection and application of predictive models for prehospital ROSC in diverse settings.</div></div><div><h3>Methods</h3><div>A retrospective validation was conducted using the National Taiwan University Hospital Hsinchu and Yunlin Branch Out-of-Hospital Cardiac Arrest Research Databases. Patients with EMS-treated OHCAs admitted to the hospital between January 2016 and July 2023 were recruited. The primary outcome was prehospital ROSC. Model performance was evaluated using discrimination, calibration, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio. Calibration and density distribution plots were generated.</div></div><div><h3>Results</h3><div>All three models demonstrated moderate-to-high discrimination with AUROCs of 0.758 (RACA), 0.755 (P-ROSC), and 0.747 (UB-ROSC). The RACA score exhibited better calibration across the risk deciles, whereas the P-ROSC and UB-ROSC scores tended to overestimate the probabilities at higher predicted risk levels. The P-ROSC score required fewer variables and showed the best separation between prehospital and non-prehospital ROSC cases. Optimal cut-off values for the RACA, P-ROSC, and UB-ROSC scores were 0.45, 41, and − 13, respectively, with corresponding sensitivities of 62 %, 56 %, and 71 % and specificities of 78 %, 82 %, and 69 %. All models achieved high NPVs (&gt;96 %), but PPVs remained low (16–21 %).</div></div><div><h3>Conclusions</h3><div>The P-ROSC, which requires fewer variables, has emerged as the most practical model for Taiwanese populations. However, the choice of the model should be guided by the availability of variables, regional EMS characteristics, and trends in prehospital ROSC rates.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 57-63"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705417","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":"Cephalexin twice daily versus four times daily for the treatment of urinary tract infections diagnosed in the emergency department","authors":"Abigail Rath PharmD ,&nbsp;Taylor Morrisette PharmD, MPH ,&nbsp;Aaron Hamby PharmD, BCIDP ,&nbsp;Rachel Burgoon PharmD, BCIDP ,&nbsp;Kelsey Billups PharmD, BCPS, BCEMP","doi":"10.1016/j.ajem.2025.03.058","DOIUrl":"10.1016/j.ajem.2025.03.058","url":null,"abstract":"<div><h3>Background</h3><div>Cephalexin is an oral cephalosporin approved for the treatment of urinary tract infections (UTIs). Data regarding the optimal dosing interval for cephalexin in UTIs, including uncomplicated UTIs (uUTI) and complicated UTIs (cUTI), remains limited.</div></div><div><h3>Objective</h3><div>The primary objective of this study was to compare the rates of treatment failure between patients prescribed cephalexin twice daily versus four times daily for the management of uUTIs and cUTIs once discharged from the emergency department (ED).</div></div><div><h3>Methods</h3><div>This retrospective, single-center cohort study conducted between July 31st, 2016 and July 31st, 2023, included patients who were ≥ 18 years of age, discharged from the ED with a diagnosis of UTI, prescribed cephalexin 500 mg twice or four time daily, and a urine culture positive for <em>Escherichia coli, Klebsiella pneumoniae,</em> or <em>Proteus mirabilis</em> susceptible to cefazolin. Treatment failure was defined as return to the ED or outpatient clinic with similar or worsening UTI symptoms or change in antibiotic therapy within 30 days of the initial ED visit. Sub-group analyses were performed for both uUTI and cUTIs.</div></div><div><h3>Results</h3><div>In total, 214 patients were included in this analysis (50.0 % in each group). Treatment failure rates between the twice daily and four times daily dosing groups were 18.7 % versus 15.0 % (<em>P</em> = 0.465). Treatment failure rates in those with uUTI were 14.9 % versus 8.1 % (<em>P</em> = 0.197) and those with cUTI were 27.3 % versus 30.3 % (<em>P</em> = 0.786).</div></div><div><h3>Conclusion</h3><div>For patients with UTIs, there was no statistically significant difference in treatment failure rates between patients prescribed cephalexin twice daily versus four times daily. These findings suggest cephalexin dosed twice daily may be a reasonable option for the outpatient management of UTIs diagnosed in the ED, thus increasing adherence and decreasing cost without statistically compromising effectiveness.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 80-85"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768291","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 Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury.","authors":"Jen-Yu Hsu, Kazuhiro Komine, Fu-Shan Jaw, Chien-Chieh Hsieh","doi":"10.1016/j.ajem.2025.03.055","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.055","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789437","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 limitations of delta shock index in the emergency department.","authors":"Sungwook Park","doi":"10.1016/j.ajem.2025.03.054","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.054","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744497","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: \"Chest tubes and cardiac complications: Time to reevaluate placement strategies\".","authors":"Julia A Holtmann","doi":"10.1016/j.ajem.2025.03.042","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.042","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765958","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}