American Journal of Emergency Medicine最新文献

{"title":"Reflections on preventable emergency department visits in cancer patients: The role of G-CSF and telehealth.","authors":"Chen-Xiong Hsu, Sang-Hue Yen","doi":"10.1016/j.ajem.2024.12.018","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.018","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830936","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 a large language model (LLM) for ambulance dispatch and triage.","authors":"Aditya C Shekhar, Joshua Kimbrell, Aaryan Saharan, Jacob Stebel, Evan Ashley, Ethan E Abbott","doi":"10.1016/j.ajem.2024.12.032","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.032","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) have grown in popularity in recent months and have demonstrated advanced clinical reasoning ability. Given the need to prioritize the sickest patients requesting emergency medical services (EMS), we attempted to identify if an LLM could accurately triage ambulance requests using real-world data from a major metropolitan area.</p><p><strong>Methods: </strong>An LLM (ChatGPT 4o Mini, Open AI, San Francisco, CA, USA) with no prior task-specific training was given real ambulance requests from a major metropolitan city in the United States. Requests were batched into groups of four, and the LLM was prompted to identify which of the four patients should be prioritized. The same groupings of four requests were then shown to a panel of experienced critical care paramedics who voted on which patient should be prioritized.</p><p><strong>Results: </strong>Across 98 groupings of four ambulance requests (392 total requests), the LLM agreed with the paramedic panel in most cases (76.5 %, n = 75). In groupings where the paramedic panel was unanimous in their decision (n = 48), the LLM agreed with the unanimous panel in 93.8 % of groupings (n = 45).</p><p><strong>Conclusions: </strong>Our preliminary analysis indicates LLMs may have the potential to become a useful tool for triage and resource allocation in emergency care settings, especially in cases where there is consensus among subject matter experts. Further research is needed to better understand and clarify how they may best be of service.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"27-29"},"PeriodicalIF":2.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830956","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 role of point-of-care ultrasound for diverticulitis in the emergency department.","authors":"Michael Gottlieb, Emily Wusterbarth, Eric Moyer, Kyle Bernard","doi":"10.1016/j.ajem.2024.12.025","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.025","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830939","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":"Effect of hypercapnia on neurologic outcomes after cardiac arrest: A systematic review and meta-analysis.","authors":"Xianming Qiu, Yuke Zhang, Quanzhen Wang, Zhiming Jiang, Li Kong, Lei Zhou","doi":"10.1016/j.ajem.2024.12.030","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.030","url":null,"abstract":"<p><strong>Background: </strong>Brain injury often occurs after cardiac arrest, and the regulation of PaCO₂ plays a crucial role in mediating cerebral blood flow. The current guidelines recommend maintaining normocapnia through ventilation in post-arrest patients. However, the effects of hypercapnia on neurological outcomes remain controversial. To address this issue, we undertook a meta-analysis to compare the effects of hypercapnia and normocapnia on the neurological outcomes in patients with cardiac arrest.</p><p><strong>Methods: </strong>As of December 5, 2023, we conducted a search on eligible studies, including EMBASE, PubMed, and WOS databases. Our primary outcome of interest was a good neurological outcome, and two authors independently screened the studies and extracted relevant data. For analysis, a fixed effects model was used when the I² values were less than 50 %, whereas a random effects model was used for higher I² values.</p><p><strong>Results: </strong>From the 2137 studies initially identified, seven studies involving 2770 patients were ultimately included. Compared with normocapnia, hypercapnia significantly improved the neurological outcomes of patients with cardiac arrest (OR 0.73; 95 % CI 0.56-0.96; P = 0.02). According to the subgroup analysis, the hypercapnic group achieved better neurological outcomes in the short-term than did the normocapnia group (OR 0.61; 95 % CI 0.42-0.88; P = 0.008), whereas no significant difference was observed in long-term (OR 0.91; 95 % CI 0.76-1.10; P = 0.35). Moreover, there was no significant difference in mortality between the two groups (OR 1.03; 95 % CI 0.65-1.63; P = 0.91).</p><p><strong>Conclusion: </strong>Our results suggest that hypercapnia is associated with a good neurological prognosis, especially in the short-term setting. However, further well-powered randomized controlled trials are necessary to confirm the optimal PaCO₂ targets.</p><p><strong>Prospero: </strong>CRD42023457027. Registered 3 September 2023.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"5-11"},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830941","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":"Colonic diverticulitis in the emergency department.","authors":"Wu-Cheng Ying, Min-Po Ho","doi":"10.1016/j.ajem.2024.12.026","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.026","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830933","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":"Characteristics of patients enrolled in hospice presenting to the emergency department.","authors":"Kayla P Carpenter, Fernanda Bellolio, Cory Ingram, Aaron B Klassen, Sarayna S McGuire, Alisha A Morgan, Aidan F Mullan, Alexander D Ginsburg","doi":"10.1016/j.ajem.2024.12.016","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Multicenter, retrospective cohort study of patients enrolled in hospice who presented to an ED within a health system between 2018 and 2023. Descriptive analysis included patient characteristics, chief complaint, interventions, disposition, ED return visits and mortality. Comparisons were made via logistic regression between patients with a hospice enrollment diagnosis of cancer vs non-cancer diagnosis, patients enrolled in hospice for &lt;30 days vs those enrolled for ≥30 days, and patients admitted to the hospital compared with patients not admitted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 119 ED visits by patients enrolled in hospice were identified. Patient median age was 85 (IQR: 68-92) years, 38 % were female, and 86 % were White. Hospice diagnoses included cancer (31 %), heart disease (21 %), lung disease (13 %), and dementia (13 %). At the time of ED visit, patients were enrolled in hospice for a median of 71 (IQR: 17-162) days. Patients primarily presented via emergency medical services (EMS) (76 %) from a home residence (51 %). The most common reasons for ED visit were trauma (36 %), pain (15 %) and catheter/tube malfunction (12 %). Most patients received laboratory studies (60 %), medications (66 %) and imaging (64 %). A total of 45 % were admitted to the hospital, with 2 % expiring in the ED. Patients admitted to the hospital were more likely to be receiving hospice services at home (66 % vs. 34 %, p = 0.003). Seven-day mortality was 20 % and 30-day mortality was 38 %. Ten percent returned to the ED within 7 days and 17 % within 30 days. Patients enrolled in hospice for ≥30 days were less likely to return (30 % vs. 51 %, OR 0.26, 95 % CI 0.075-0.94) or die (30 % vs 51 %, OR 0.40, 95 % CI 0.19-0.87) within 30 days compared to those enrolled for &lt;30 days. Patients with a hospice diagnosis of cancer were more likely to die within 7 days (32 % vs 15 %, OR 2.78, 95 % CI 1.11-7.04) compared to patients with a non-cancer hospice diagnosis. In addition, those with a cancer hospice diagnosis (62 % vs 27 %, OR 4.48, 95 % CI 1.96-10.22) and those admitted to the hospital (48 % vs 16 %, OR 2.38, 95 % CI 1.11-5.11) were more likely to die at 30 days than those with a non-cancer enrollment diagnosis or those not admitted, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients enrolled in hospice most frequently presented to the ED for trauma. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for &lt;30 days, enrolled with a hospice diagn","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824895","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":"Clinical observation of 4 cases of cerebral infarction caused by left ventricular noncompaction.","authors":"Yu Shufeng, Zhong Changyang, Jin Yi, Wu Cong, Wang Peng","doi":"10.1016/j.ajem.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>Cerebral infarction associated with myocardial hypertrabeculation is a rare condition that requires optimal management to reduce the risk of thromboembolism and stroke. As intravenous thrombolysis (IVT) is a standard treatment for acute ischemic stroke, it is important to investigate whether it is safe and effective in patients with this rare condition.</p><p><strong>Case report: </strong>Four patients with cerebral infarction associated with myocardial hypertrabeculation were included. The clinical data of these patients were retrospectively analyzed to investigate the efficacy and safety of IVT in their treatment. The results showed that IVT was safe and effective for all the four adult patients. The treatment process and complications were summarized, and the prognosis was evaluated using the modified Rankin Scale (mRS). at 24 h after IVT, there was no evidence of hemorrhagic transformation on CT scan for any of the four patients in this case report.In addition, the results showed that IVT was effective in reducing the severity of the cerebral infarction in all four patients. The prognosis was evaluated using the modified Rankin Scale (mRS).</p><p><strong>Conclusion: </strong>This case report provides evidence that IVT is safe and effective in the treatment of cerebral infarction associated with myocardial hypertrabeculation in adults.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"1-4"},"PeriodicalIF":2.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824909","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":"Hospice patients in the emergency department: Challenging high-risk encounters with unanswered questions and unquestioned answers.","authors":"Jason K Bowman, Joan M Teno, Kei Ouchi","doi":"10.1016/j.ajem.2024.12.017","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.017","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824898","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":"Comparing antihypertensive strategies in hypertensive emergencies with heart failure.","authors":"David Bronstein, Michael Holman, Ryan Wu, Jeremy Hayward, Zeina Bani Hani, Courtney Paul, Katrina Hawkins","doi":"10.1016/j.ajem.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.001","url":null,"abstract":"<p><strong>Background: </strong>6.2 million Americans live with heart failure (HF) and are at risk for hospitalization due to hypertensive emergencies. Optimal treatment strategy for acute hypertensive heart failure remains unclear. Our study investigates what treatment modality is most effective in achieving guideline-directed blood pressure control.</p><p><strong>Methods: </strong>This was a retrospective cohort study of hypertensive emergency with HF exacerbation from 2019 to 2021. The primary outcome was length of time for a 25 % decrease in systolic BP or BP of <160/110 mmHg. Patients were categorized into 4 groups: only oral medications, IV bolus, continuous IV infusion (CIVI), or both CIVI and IV bolus.</p><p><strong>Results: </strong>A total of 120 admissions were analyzed after applying exclusion criteria to a total of 1041 reviewed. Groups were well balanced and similar in characteristics. There were no significant differences in achieving the target BP among groups (ANOVA p = 0.662). CIVI had a nonsignificant trend towards achieving target BP fastest, however, IV bolus administration resulted in significantly fewer days in ICU compared to CIVI without a significant change in total hospital length of stay. Acute kidney injury was the most common complication, occuring in 31 (25.83 %) patients without differences across groups (p = 0.825).</p><p><strong>Conclusions: </strong>Acute hypertensive heart failure was managed adequately with any treatment modality. Use of IV bolus therapy in these patients was associated with shorter ICU length of stay. Our results add to growing evidence that hypertensive emergencies may be less clinically significant than previously thought.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"88 ","pages":"192-196"},"PeriodicalIF":2.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820309","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 optimal temperature control strategy in patients receiving ECPR after cardiac arrest.","authors":"Chien-Chieh Hsieh, Fu-Shan Jaw, Yu-Hsuan Lee, Che-Ming Yeh, Chien-Chieh Hsieh","doi":"10.1016/j.ajem.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.12.008","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820306","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}