American Journal of Emergency Medicine最新文献

{"title":"Phospholipase A₂ inhibitors: Potential treatment options for future snakebite envenomation!","authors":"Chitta Ranjan Mohanty, Amiya Kumar Barik, Rakesh Vadakkethil Radhakrishnan, Srikant Behera, Gobinath Jayaraman","doi":"10.1016/j.ajem.2024.10.023","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.023","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481687","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: Data units, population estimates, and comorbidities.","authors":"Sangil Lee, Leon Sun, J Priyanka Vakkalanka","doi":"10.1016/j.ajem.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.026","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481690","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 \"The effect of intravenous ondansetron on QT interval in the emergency department\".","authors":"Uğur Durmuş","doi":"10.1016/j.ajem.2024.10.017","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.017","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481683","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":"High- versus low-dose ketamine for analgesia in older adults in the emergency department","authors":"Alexander D. Ginsburg M.D. ,&nbsp;Heather A. Heaton M.D., M.S. ,&nbsp;Aeryana Beaudrie-Nunn Pharm.D., R.Ph. ,&nbsp;Lucas Oliveira J. e Silva M.D., Ph.D. ,&nbsp;Elizabeth Canterbury Pharm.D., R.Ph. ,&nbsp;Caitlin S. Brown Pharm.D., R.Ph. ,&nbsp;Allyson K. Palmer M.D., Ph.D. ,&nbsp;Kristin C. Cole M.S. ,&nbsp;Erin D. Wieruszewski Pharm.D., R.Ph. ,&nbsp;Fernanda Bellolio M.D., M.Sc.","doi":"10.1016/j.ajem.2024.10.015","DOIUrl":"10.1016/j.ajem.2024.10.015","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Ketamine is increasingly being utilized in the management of acute pain in the emergency department (ED), including for older adults, a population at increased risk of adverse effects from medications. We aimed to compare the safety and analgesic effects of high-dose (≥0.3<!--> <!-->mg/kg) to low-dose (&lt;0.3<!--> <!-->mg/kg) intravenous (IV) ketamine among older ED patients.</div></div><div><h3>Methods</h3><div>Multi-center, retrospective cohort study of adults ≥60<!--> <!-->years who received IV ketamine for pain between 2018 and 2021. The primary outcome was pain improvement as measured by the Numerical Rating Scale (NRS) pain score within 60<!--> <!-->min after administration. Secondary outcomes included adverse effects (early discontinuation, nausea, rescue benzodiazepines and intubation) and the need for rescue analgesia. Linear regression was used to assess the association between the change in NRS pain scores and dose after adjusting for baseline pain, requiring an additional dose of ketamine, and receiving an opioid.</div></div><div><h3>Results</h3><div>A total of 130 older adults received ketamine as an analgesic (37 high-dose, 93 low-dose). Median age was 69.2<!--> <!-->years, 52 % were women, 40 % had a history of substance use disorder. Prior to ketamine, 76 % received alternate analgesics and 23 % antiemetics. Baseline mean pain score was lower in the high-dose group (6.7 vs. 8.3, difference −1.7 [95 % CI −2.6 to −0.7], <em>p</em> = 0.013). Change in NRS pain scores were similar between the high-dose and low-dose groups (−2.4 [95 % CI −3.6 to −1.3] vs −1.6 [95 % CI −2.2 to −0.9], <em>p</em> = 0.27). After adjustment for baseline pain score, the high-dose group had a larger reduction in pain scores (−1.3 [95 % CI −2.6 to −0.1], <em>p</em> = 0.042) and percent change of pain (−23.8 % [95 % CI −42.1 % to −5.4 %], <em>p</em> = 0.012). There was no significant difference in rates of rescue analgesia (35.1 % vs. 44.1 %, <em>p</em> = 0.35) or early discontinuation (29.7 % vs. 32.3 %, <em>p</em> = 0.78). Rates of adverse effects were similar.</div></div><div><h3>Conclusion</h3><div>High-dose and low-dose ketamine reduced pain scores in older adults. High-dose ketamine led to a greater reduction in pain scores, and there was no observed difference in adverse effects or the need for rescue analgesia. One-third needed discontinuation of ketamine in both groups.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481694","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 \"Depression after traumatic brain injury: A systematic review and meta-analysis\".","authors":"Akshat Kumar, Muhammed Shabil, Sanjit Sah","doi":"10.1016/j.ajem.2024.10.018","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.018","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481682","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 importance of comprehensive documentation of snakebite envenoming: Is \"the 'devil' in the details\" or in their deficiency?","authors":"Ahmad Khaldun Ismail, Scott A Weinstein, David A Warrell","doi":"10.1016/j.ajem.2024.10.024","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.024","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513495","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 clinical prediction model for safe early discharge of patients with an infection at the emergency department","authors":"Merijn C.F. Mulders ,&nbsp;Sevilay Vural ,&nbsp;Lisanne Boekhoud ,&nbsp;Tycho J. Olgers ,&nbsp;Jan C. ter Maaten ,&nbsp;Hjalmar R. Bouma","doi":"10.1016/j.ajem.2024.10.014","DOIUrl":"10.1016/j.ajem.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Every hospital admission is associated with healthcare costs and a risk of adverse events. The need to identify patients who do not require hospitalization has emerged with the profound increase in hospitalization rates due to infectious diseases during the last decades, especially during the COVID-19 pandemic. This study aimed to identify predictors of safe early discharge (SED) in patients presenting to the emergency department (ED) with a suspected infection meeting the Systemic Inflammatory Response Syndrome (SIRS) criteria.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study on adult non-trauma patients with a suspected infection and at least two SIRS criteria. We defined SED as hospital discharge within 24 h (e.g. direct ED discharge or rapid ward discharge) without disease-related readmission to our hospital or death during the first seven days. A prediction model for SED was developed using multivariate logistic regression analysis and tested with k-fold cross-validation.</div></div><div><h3>Results</h3><div>We included 1381 patients, of whom 1027 (74.4 %) were hospitalized for longer than 24 h or re-admitted within seven days and 354 (25.6 %) met SED criteria. Parameters associated with SED were relatively young age, absence of comorbidities, living independently, yellow or green triage urgency, lack of ambulance transport or general practitioner referral, normal clinical impression scores, and risk scores (i.e., qSOFA, PIRO, MEDS, NEWS, and SIRS), normal vital sign measurements and absence of kidney and respiratory failure. The model performance metrics showed an area under the curve of 0.824. The validation showed a minimal drop in performance and indicated a good fit.</div></div><div><h3>Conclusion</h3><div>We developed and validated a model to identify patients with an infection at the ED who can be safely discharged early.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513496","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":"External evaluation of Brain Injury Guideline (BIG) low risk criteria for traumatic brain injury","authors":"Elena A. Puccio BS ,&nbsp;Joshua B. Brown MD MSc ,&nbsp;Clifton W. Callaway MD PhD ,&nbsp;Adam N. Frisch MD ,&nbsp;David O. Okonkwo MD PhD ,&nbsp;David J. Barton MD","doi":"10.1016/j.ajem.2024.10.013","DOIUrl":"10.1016/j.ajem.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Fewer than 20 % of traumatic brain injury (TBI) cases with traumatic intracranial hemorrhage (ICH) result in clinical deterioration. The Brain Injury Guideline (BIG) criteria were published in 2014 and categorize patients with TBI into three risk groups (BIG 1, 2, and 3) based on CT scan findings, neurological examination, anti-coagulant/platelet medications, and intoxication. Early data is promising, suggesting no instances of neurosurgical intervention or death in the low-risk BIG1 category within 30 days. We sought to externally validate the BIG criteria and identify patients with TBI at low risk of clinical deterioration. We hypothesized that patients meeting the BIG1 low risk criteria have less than a 1 % risk of death or neurosurgical intervention.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of a level 1 trauma center's trauma registry records from 2011 to 2022 to identify patients with head trauma. We abstracted demographics, injury characteristics, clinical course, CT imaging results, and outcomes, and we categorized patients according to the BIG criteria. The Clopper-Pearson Exact method was used to estimate outcome frequency with confidence intervals. The primary outcome was death or neurosurgical intervention within 30 days. Secondary outcomes included progression on repeat head CT (RHCT), ICU admission with neurocritical care intervention, and TBI-related hospital readmission within 30 days.</div></div><div><h3>Results</h3><div>A total of 1714 patients with TBI with ICH were identified from the trauma registry. 325 patients were excluded due to missing data, pregnancy, incarceration, polytrauma, or GCS &lt; 13, leaving 1389 for analysis. 193 patients (13.9 %) were classified as BIG1. No patients classified as BIG1 experienced the primary outcome measures of death or neurosurgical intervention (95 % confidence interval [CI]: 0 %–1.9 %). The number of patients who experienced the secondary outcome measures of progression on RHCT, ICU admission with neurocritical care intervention, or TBI-related hospital readmission within 30 days were 9 (4.7 %, 95 % CI: 2.2 %–8.7 %), 1 (0.5 %, 95 % CI: 0 %–2.9 %), and 4 (2.1 %, 95 % CI: 0.6 %–5.2 %), respectively.</div></div><div><h3>Conclusion</h3><div>BIG1 criteria identified a low-risk subset of patients with TBI with ICH. However, an upper 95 % CI of 1.9 % does not exclude the risk of neurologic deterioration being &lt;1 %. Validation of these criteria in larger cohorts is warranted.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442173","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":"Regarding 'Development of prognostic models for predicting 90-day neurological function and mortality after cardiac arrest'.","authors":"Tingting Jin, Yan Shen","doi":"10.1016/j.ajem.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.005","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513494","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 author replies-sample size issue and overfitting.","authors":"Guangqian Ding, Yi Chen","doi":"10.1016/j.ajem.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.012","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481689","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}