American Journal of Emergency Medicine最新文献

{"title":"Antiseizure medication practices in the adult traumatic brain injury patient population","authors":"Aubree J. Houston PharmD ,&nbsp;Charles S. Wilson Jr PharmD, BCCCP ,&nbsp;Brian W. Gilbert PharmD, MBA, BCCCP, FCCM, FNCS","doi":"10.1016/j.ajem.2024.10.009","DOIUrl":"10.1016/j.ajem.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Antiseizure medication (ASM) use in traumatic brain injuries (TBI) reduces the risk of early post-traumatic seizure (PTS). Agent selection and dosing strategies remain inconsistent among trauma centers in the United States.</div></div><div><h3>Objective</h3><div>The purpose of this study was to identify and characterize the most common PTS prophylaxis regimens among adult trauma centers in brain injured patients throughout the United States.</div></div><div><h3>Methods</h3><div>A survey assessing PTS prophylaxis practices of trauma centers was created and distributed in March 2023. Data was then evaluated based on practice site demographics and various sub-group analyses including academic vs. non-academic centers, trauma center designation, geographic practice location, and total number of TBI activations annually.</div></div><div><h3>Results</h3><div>A total of 84 different trauma centers responded of which, 82 (97.6 %) respondents reporting levetiracetam (LEV) as their ASM of choice for PTS prophylaxis. The most reported dosing regimen included an initial dose of 1000 mg (<em>n</em> = 24, 46.2 %) followed by a maintenance dose of 500 mg BID (<em>n</em> = 39, 48.8 %). There were no statistically significant differences in practice between sub-group analyses evaluated.</div></div><div><h3>Conclusion and relevance</h3><div>This multicenter, survey study, identified variances in practice for PTS prophylaxis for brain injured patients throughout the U.S. Interestingly, the overwhelming majority of trauma centers do not conform to the Brain Trauma Foundation guidelines and utilize LEV as their agent of choice. Further studies should evaluate ideal patient selection for PTS prophylaxis, optimal agent, and dosing schemes within this cohort.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481692","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":"Basic resuscitation training for prison inmates in Khon Kaen Province, Thailand.","authors":"Supaluck Chaleepad, Nutsara Wanla, Tawatchai Impool, Shinji Nakahara","doi":"10.1016/j.ajem.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.011","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481681","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":"Corrigendum to \"Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine\", [The American Journal of Emergency Medicine, Volume 85, November 2024, Pages 130-139].","authors":"Kory London, Yutong Li, Jennifer L Kahoud, Davis Cho, Jamus Mulholland, Sebastian Roque, Logan Stugart, Jeffrey Gillingham, Elias Borne, Benjamin Slovis","doi":"10.1016/j.ajem.2024.10.006","DOIUrl":"10.1016/j.ajem.2024.10.006","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395531","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":"Diverticulitis evaluation and management among United States emergency departments over an eight-year period","authors":"Michael Gottlieb MD ,&nbsp;Emily Wusterbarth MD ,&nbsp;Eric Moyer MD ,&nbsp;Kyle Bernard MD","doi":"10.1016/j.ajem.2024.10.002","DOIUrl":"10.1016/j.ajem.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Diverticulitis is a common reason for presentation to the Emergency Department (ED). However, as imaging options, risk stratification tools, and antibiotic options have expanded, there is a need for current data on the changes in incidence, computed tomography (CT) performance, antibiotic usage, and disposition over time.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study of ED patients with a diagnosis of diverticulitis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, all ED visits for acute diverticulitis were identified using ICD-10 codes. Outcomes included total ED presentations for diverticulitis, admission rates, CTs performed, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients.</div></div><div><h3>Results</h3><div>There were 186,138,130 total ED encounters, with diverticulitis representing 927,326 (0.50 %). The rate of diverticulitis diagnosis increased from 0.40 % to 0.56 % over time. The admission rate declined over time from 33.6 % to 27.7 %, while the CT rate rose from 83.0 % to 92.6 %. Among those discharged, 90.4 % received an antibiotic, which remained consistent over time. Metronidazole (55.1 %) and ciprofloxacin (40.8 %) were the most commonly prescribed antibiotics, followed by amoxicillin-clavulanate (36.1 %). Among those admitted, most received either metronidazole (62.0 %), a fluoroquinolone (40.4 %), a third-generation cephalosporin (18.9 %), or a penicillin-based agent (38.1 %). Among both discharged and admitted patients, there was a marked shift to penicillin-based agents as the primary antibiotic regimen.</div></div><div><h3>Conclusion</h3><div>Diverticulitis remains a common ED presentation, with a gradually rising incidence over time. Admission rates have decreased, while CT imaging has become more common. Most patients receive antibiotics, though the specific antibiotic has shifted in favor of penicillin-based agents. These findings can provide key benchmarking data and inform future initiatives to guide imaging and antibiotic use.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402088","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":"Brain natriuretic peptide as a predictor of 30-day mortality after return of spontaneous circulation in cardiac arrest patients","authors":"Xiaxia Jin ,&nbsp;Qiaofei Zheng ,&nbsp;Ying Cheng ,&nbsp;Lingling Hu ,&nbsp;Wenhui Yang ,&nbsp;Jun Li ,&nbsp;Tao Li","doi":"10.1016/j.ajem.2024.10.010","DOIUrl":"10.1016/j.ajem.2024.10.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the predictive value of brain natriuretic peptide (BNP) levels for 30-day mortality after return of spontaneous circulation (ROSC) in patients with cardiac arrest (CA) of presumed cardiac etiology.</div></div><div><h3>Methods</h3><div>This retrospective study included 260 patients with CA of presumed cardiac etiology who regained ROSC and was conducted between November 2013 and June 2022 at two tertiary comprehensive hospitals. Cox regression and nomogram models were used to demonstrate the value of BNP level in predicting 30-day mortality rates. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare the ability of the two models to predict 30-day mortality risk.</div></div><div><h3>Results</h3><div>BNP level was a predictive factor for 30-day mortality (hazard ratio [HR] = 1.441; 95 % confidence interval [CI] = 1.198–1.734). The area under curves (AUCs) of BNP level alone and model 2 (male sex, age, non-shockable rhythm, epinephrine, and time to ROSC &gt;30 min) for predicting 30-day mortality were similar(0.813 versus 0.834). Model 1 that included the variables in model 2 and BNP level showed good predictive value (area under curve = 0.887; 95 % CI = 0.836–0.939). Compared to Model 2, Model 1 showed improved comprehensive differentiation and net weight classification of mortality prediction, further demonstrating the predictive value of BNP for 30-day mortality (NRI = 0.451, 95 % CI = 0.267–0.577; IDI = 0.109, 95 % CI = 0.035–0.191).</div></div><div><h3>Conclusion</h3><div>BNP level was a predictive factor for 30-day mortality after ROSC in patients with CA of presumed cardiac etiology who regained ROSC. The nomogram model included BNP may provide a reference for predicting 30-day mortality.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407248","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":"An umbrella review of systematic reviews and meta-analyses for assessment and treatment of acute shoulder dislocation","authors":"Shiro Gonai MD, MPH ,&nbsp;Takahiro Miyoshi MD, DrPH ,&nbsp;Katharina da Silva Lopes PhD, MPH ,&nbsp;Stuart Gilmour PhD","doi":"10.1016/j.ajem.2024.09.060","DOIUrl":"10.1016/j.ajem.2024.09.060","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to provide a comprehensive review of the current evidence on accurate and rapid diagnostic methods, effective and safe shoulder dislocation reduction techniques, pharmacological treatment, and post-reduction care for acute anterior shoulder dislocation in the emergency department (ED).</div></div><div><h3>Methods</h3><div>We conducted a systematic review of the literature up to December 31, 2022, with an additional search conducted up to August 31, 2024. Databases searched included Cochrane Database of Systematic Reviews, MEDLINE, Embase, CINAHL, DARE, PROSPERO, OpenGrey, and Google Scholar. We reviewed systematic reviews and meta-analyses on assessment and intervention for acute anterior shoulder dislocation. Data extraction and quality assessment were performed independently by two reviewers. The quality of evidence was evaluated using the Cochrane Risk of Bias tool and the GRADE approach, while the methodology was assessed using AMSTAR 2.</div></div><div><h3>Results</h3><div>From an initial 1345 records, 30 studies met the inclusion criteria. These included 4 articles on point-of-care ultrasound (POCUS), 5 on analgesia and anesthesia, 3 on closed reduction techniques, 10 on surgical Bankart repair, 9 comparing external and internal rotation immobilization, and 1 on nerve injuries, including duplicates. POCUS demonstrated high diagnostic accuracy comparable to radiography for shoulder dislocations and associated fractures. Analgesia and anesthesia studies showed that intra-articular anesthesia (IAA) is as effective as intravenous sedation (IVS) with fewer adverse events and shorter ED stays. Three meta-analyses on closed reduction techniques revealed no significant differences in success rates among various methods, but the FARES method was noted for superior pain management. Ten reviews on surgical Bankart repair consistently showed reduced redislocation rates, especially in younger patients, compared to non-surgical treatments including internal and external rotation immobilization. Four recent reviews reported external rotation immobilization was more effective than internal rotation in preventing redislocations. Nerve injuries were common, with the axillary nerve most frequently affected.</div></div><div><h3>Conclusions</h3><div>Emergency physicians managing anterior shoulder dislocation should employ POCUS for diagnosis, prioritize intra-articular anesthesia, master various reduction techniques including the FARES method, refer patients to an orthopedic surgeon for follow-up and potential surgery to prevent redislocation, and be vigilant about nerve damage.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513499","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 \"Base excess is superior to creatinine in predicting haemodialysis: A multicenter study conducted Kahramanmaraş earthquake victims\".","authors":"Uğur Durmuş","doi":"10.1016/j.ajem.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.007","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407247","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":"Airway ultrasound for endotracheal tube depth in critically ill children requires additional parameters.","authors":"Sagar Galwankar, Lukasz Szarpak, Basar Cander, Bartosz Maj, Michal Pruc","doi":"10.1016/j.ajem.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.004","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481680","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":"Airway ultrasound for endotracheal tube depth in critically Ill children: Need further validation in emergency settings.","authors":"Jhuma Sankar","doi":"10.1016/j.ajem.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.003","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402086","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 MIS-C treatment: Is glucocorticoid monotherapy enough for mild cases?","authors":"Laura Calderón Suárez, Sravani Modumudi, Chandana Padmanabham Reddy","doi":"10.1016/j.ajem.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.001","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402087","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}