American Journal of Emergency Medicine最新文献

{"title":"Early inotropic support in pediatric shock: evidence and challenges in prehospital setting and interfacility transport","authors":"Laura Cannavò ,&nbsp;Leonardo Capitanio ,&nbsp;Virginia Beretta ,&nbsp;Vincenzo Raitano ,&nbsp;Serafina Perrone","doi":"10.1016/j.ajem.2026.01.035","DOIUrl":"10.1016/j.ajem.2026.01.035","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Pediatric shock requires rapid recognition and timely intervention. In the prehospital and interfacility transport setting, the challenge is further compounded by limited vascular access, limited monitoring capabilities, and the need for rapid decision-making in dynamic, resource-constrained environments. The aim of this review is to summarize the available literature on the use of vasoactive agents in pediatric shock, provide guidance for evidence-based decision-making, and identify key gaps for future research.</div></div><div><h3>Methods</h3><div>A literature search was conducted using electronic databases, including PubMed and Medline. Only articles published in peer-reviewed journals, written in English, and focusing on the use of vasoactive drugs in the pediatric population were selected, bringing the total number of articles selected to 63, of which 21 were original studies (randomized or observational). Two independent reviewers extracted the data, which were then organized thematically in a narrative synthesis given study heterogeneity.</div></div><div><h3>Results</h3><div>This review provides a comprehensive summary of the current evidence regarding vasoactive support in pediatric shock in the prehospital and transport setting. Although fluid administration is the first therapeutic step, there is a growing trend towards early initiation of inotropic/vasoactive agents. Overall, epinephrine and norepinephrine remain the agents of choice for fluid-refractory pediatric shock. Inodilators may offer potential benefit in selected patients with myocardial dysfunction. Evidence regarding adjunctive therapies, such as vasopressin, terlipressin, and catecholamine-sparing agents, remains limited. Available evidence supports the feasibility and safety of timely vasoactive support via peripheral and intraosseous routes with dilute preparations of vasoactive agents.</div></div><div><h3>Conclusions</h3><div>In the context of prehospital and transport settings, central venous catheterization is no longer a prerequisite, and early initiation of inotropic/vasoactive therapy, which is increasingly suggested by literature in different clinical scenarios, may improve outcomes in critically ill children.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 180-189"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079845","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 impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury","authors":"Salih Karakoyun ,&nbsp;Kudret Selki ,&nbsp;Ali Rıza Karakoyun ,&nbsp;Mustafa Boğan","doi":"10.1016/j.ajem.2026.01.005","DOIUrl":"10.1016/j.ajem.2026.01.005","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to identify independent predictors of intracranial pathology in children presenting with acute blunt head trauma, with a particular focus on patients who had a history of previous head trauma or cranial surgery and did not meet the PECARN (Pediatric Emergency Care Applied Research Network) criteria for cranial computed tomography (CCT). The study further sought to evaluate the impact of these historical factors on acute clinical findings and to inform more objective decision-making for CCT use in this specific subgroup.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, indications for cranial computed tomography (CCT) were determined based on PECARN criteria. Demographic characteristics, trauma mechanism, mode of presentation, symptoms, physical examination findings, scalp hematoma characteristics, Glasgow Coma Scale (GCS) scores, and CCT findings were recorded for all patients. Subgroup analyses were performed based on previous head trauma and cranial surgery history.</div></div><div><h3>Results</h3><div>Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (<em>n</em> = 39) on CCT. Lower GCS (≤14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all <em>p</em> &lt; 0.05). Temporal (OR: 16.35; 95% CI: 3.57–74.76; <em>p</em> &lt; 0.001), parietal (OR: 10.38; p &lt; 0.001), occipital (OR: 6.20; <em>p</em> = 0.008), and frontal (OR: 4.99; p &lt; 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p &lt; 0.001) and lower GCS (OR: 0.67; <em>p</em> = 0.021) were also identified as independent risk factors for predicting intracranial injury. Among 361 patients (24.1%) with a history of head trauma and 16 patients (1.1%) with a history of cranial surgery, the rate of intracranial pathology was comparable to that of the general population (all <em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>The PECARN clinical decision rule allows clinicians to safely avoid unnecessary cranial CT imaging in low-risk cases owing to its high sensitivity and negative predictive value. Furthermore, previous head trauma or a history of cranial surgery was not found to increase the risk of new-onset acute intracranial injury.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 21-26"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982059","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 concise review investigating simulation modalities' effects on team efficiency, provider wellbeing, education & clinical outcomes","authors":"Yusra Othman ,&nbsp;Alexandra Kata B.S ,&nbsp;Keshavkiran Jayagopi B.S ,&nbsp;Sukriti Prashar B.S ,&nbsp;Cameron Nishida B.S ,&nbsp;Logan Samuel Rogers B.S ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.ajem.2026.01.002","DOIUrl":"10.1016/j.ajem.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Simulation is increasingly being used in trauma care to improve provider confidence, teamwork, and leadership skills in trauma situations. Additionally, the use of modern technology has introduced virtual reality simulation. However, simulations impact on trauma education, clinical practice, and cost effectiveness remain unclear. This review aims to synthesize current literature on the impact of simulation in trauma care education and clinical practice.</div></div><div><h3>Methods</h3><div>This concise review was performed utilizing five major databases: Cochrane, ProQuest, Google Scholar, PubMed, and Embase to identify relevant studies regarding the role of simulation modalities on team performance, medical education, patient outcomes, provider wellbeing, and cost-effectiveness.</div></div><div><h3>Results</h3><div>This concise review analyzed 1091 articles; 21 studies met inclusion criteria. Simulations demonstrated improved team performance by decreased communication response times (21 to 15 s) and increased teamwork (4.06/5 to 4.40/5). Leadership behavior significantly improved (11.29 vs. 7.23; d = 0.92). Studies demonstrated virtual reality (VR) was non-inferior to mannequins for trauma scores (163.1 vs. 163.2), higher VR assessment scores (158.4 vs. 134.2), and AI serious games reducing under-triage by ∼18%. VR was 40% cheaper than mannequins and reduced per-participant costs ($296 vs $149). Simulation improved completion times (251 vs. 497 s), success rates (100% vs. 64%), and diagnostic accuracy (<em>P</em> = .01) in education. Indirect patient outcomes included faster secondary surveys (14 min vs 6 min) and CT prep times (23 min vs 16 min).</div></div><div><h3>Conclusion</h3><div>Simulation-based training is an effective tool in improving trauma care as evidence throughout the studies showed vast improvements in leadership, communication, efficiency in care, and provider confidence. The findings from this study demonstrate that the implementation of VR, in particular, showed tremendous educational benefits and can be a viable strategy to conventional simulation modalities due to its cost effectiveness.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 27-33"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982060","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":"Lidocaine for diphenhydramine-induced ventricular tachycardia: A case report","authors":"Seth Carroll,&nbsp;Mallory McGee,&nbsp;Megan Audette,&nbsp;Merritt Tuttle,&nbsp;Justin Corcoran,&nbsp;Matthew Stanton,&nbsp;Ryan Feldman","doi":"10.1016/j.ajem.2026.01.040","DOIUrl":"10.1016/j.ajem.2026.01.040","url":null,"abstract":"<div><div>Diphenhydramine overdose can cause life-threatening ventricular dysrhythmias through sodium channel blockade, similar to tricyclic antidepressant (TCA) toxicity. Current management guidelines recommend sodium bicarbonate as first-line therapy, with class Ib antiarrhythmics such as lidocaine considered in refractory cases, though this recommendation is largely extrapolated from TCA data. Clinical reports describing lidocaine use in diphenhydramine toxicity remain exceedingly rare. We report a case where a 16-year-old female who ingested approximately 315 tablets of diphenhydramine and developed pulseless ventricular tachycardia during emergency department resuscitation. Return of spontaneous circulation was achieved after sodium bicarbonate, amiodarone and defibrillation, but recurrent wide-complex tachycardia occurred shortly thereafter. She was treated with a lidocaine bolus and continuous infusion, resulting in progressive QRS narrowing and rhythm stabilization. Diphenhydramine exposure was confirmed with toxicology testing. The lidocaine infusion was weaned, and patient was discharged home without further dysrhythmias. Experimental data demonstrates that diphenhydramine binds preferentially to open sodium channels and dissociates slowly, suggesting a mechanistic basis for lidocaine's therapeutic effect. This case provides additional clinical evidence supporting the use of lidocaine as an adjunct for refractory ventricular dysrhythmias in diphenhydramine induced sodium channel blockade and highlights the important of early recognition and consultation with a poison center in severe antihistamine toxicity.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 131-134"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079846","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":"Point-of-care ultrasound for hip effusion in children: A systematic review and meta-analysis","authors":"Cynthia A. Gravel MD, RDMS ,&nbsp;Jeffrey T. Neal MD ,&nbsp;Joshua Dodderer MD, MPH ,&nbsp;Wendy Kim MD ,&nbsp;Paul A. Bain PhD, MLIS ,&nbsp;Sonal N. Shah MD, MPH","doi":"10.1016/j.ajem.2026.01.034","DOIUrl":"10.1016/j.ajem.2026.01.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Children with hip pain, limp and inability to bear weight often present a diagnostic clinical challenge. Sonography is an ideal first-line imaging modality to assess for effusion, and recent literature suggests that point-of-care ultrasound (POCUS) performed by emergency providers can be safely and accurately performed at the bedside. This systematic review and meta-analysis aims to summarize the diagnostic accuracy of POCUS for pediatric hip effusion.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central databases were searched through July 2025, with no date limits, using pre-defined criteria for articles assessing the diagnostic accuracy of POCUS for pediatric hip effusion. Data were extracted and quality assessment was performed using the QUADAS-2 tool. Test characteristics were pooled using a bivariate mixed effects model for meta-analysis.</div></div><div><h3>Results</h3><div>Four studies, with a total of 526 hips scanned, met our inclusion criteria. The reference standard for all included studies was radiology-performed ultrasonography. POCUS demonstrated a pooled sensitivity of 88% (95% CI, 82%–92%), specificity of 97% (95% CI, 93%–99%), positive likelihood ratio of 35 (95% CI, 12.0–100.8), and negative likelihood ratio of 0.13 (0.08–0.19).</div></div><div><h3>Conclusions</h3><div>POCUS has high specificity and moderate sensitivity for hip effusion in children and is a valuable first-line diagnostic tool for evaluating children with hip pain, limp and inability to bear weight in emergency and acute care settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 148-154"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079869","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":"Prospective evaluation of flexible bronchoscopy in the emergency department: Indications, findings, and complications. A cohort study","authors":"Lorenzo Pelagatti ,&nbsp;Simone Vanni ,&nbsp;Lorenzo Corbetta ,&nbsp;Peiman Nazerian","doi":"10.1016/j.ajem.2026.01.036","DOIUrl":"10.1016/j.ajem.2026.01.036","url":null,"abstract":"<div><h3>Background</h3><div>Flexible bronchoscopy (FBS) is a widely used diagnostic and therapeutic tool in intensive care and pulmonary medicine. However, its role in the emergency department (ED) is less well established, especially in emergency physicians' hands.</div></div><div><h3>Objective</h3><div>The aim of this study was to describe the indications, findings, outcomes, and complications of FBS performed by emergency physicians in the ED following structured training, with a specific focus on its feasibility and safety.</div></div><div><h3>Methods</h3><div>This was a prospective single-center cohort study at Careggi University Hospital (Florence, Italy), including all patients undergoing FBS in the ED between January 1, 2023, and September 1, 2025. Demographic data, clinical indications, outcomes, and complications were prospectively collected and analyzed.</div></div><div><h3>Results</h3><div>We prospectively enrolled 431 patients (median age 69 years, 43.4% female), the majority of whom were non-intubated (86.8%). The main indications were pneumonia or respiratory infection (40.4%), hemoptysis (19.3%), and bronchial toilet for secretion clearance (18.3%). Common bronchoscopic findings included purulent secretions (42.2%), mucus plugs (9.9%), and airway bleeding (12.3%). Bronchoalveolar lavage was performed in 46.6% of cases, and bronchial toilet in 18.3%.</div><div>A clinical improvement was observed in 24.4% of patients, while 70.8% showed no immediate change. Complications were minor and self-limited, with no major adverse events or procedure-related deaths recorded.</div></div><div><h3>Conclusion</h3><div>Flexible bronchoscopy performed by trained emergency physicians appears safe and feasible.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 190-197"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079958","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 CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study","authors":"Tingting Zhao MD ,&nbsp;Dong Li PhD ,&nbsp;Mengshan Wu MD ,&nbsp;Chenyuan Zhang MD ,&nbsp;Xiaoyuan Qu MD ,&nbsp;Xin Tian MD ,&nbsp;Yixi Zhang MD ,&nbsp;Chunlin Song MD ,&nbsp;Xiaoran Wang PhD ,&nbsp;Xianghong Meng PhD ,&nbsp;Zhi Wang MD","doi":"10.1016/j.ajem.2025.12.038","DOIUrl":"10.1016/j.ajem.2025.12.038","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to develop a multimodal predictive model that integrates clinical variables, radiomic features (RFs), and deep learning–based features (DLFs) to improve prognostic accuracy in patients with blunt chest trauma (BCT).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 337 patients with BCT from three medical centers. Clinical and CT imaging data, including emergency and follow-up scans, were obtained. Features including radiomic (RF) and deep learning-based (DLF) descriptors along with delta features representing temporal changes were extracted. After sequential feature selection, the least absolute shrinkage and selection operator (LASSO) regression was applied to identify optimal features. Model development included clinical-only, imaging-only, and fused models, with performance evaluated using AUC, calibration curves, and decision curve analysis.</div></div><div><h3>Results</h3><div>Rib fracture count, multiple injuries, and hemopneumothorax-to-lung ratio (HPR) were identified as independent prognostic factors. The fusion model, particularly the delta-clinical-DLR model, achieved AUCs of 0.85 (95 % CI: 0.80–0.90) and 0.86 (95 % CI: 0.77–0.95) in the training and test sets, respectively. Significant improvements in net reclassification (NRI up to 0.76) and integrated discrimination (IDI up to 0.26) were observed compared to the clinical models alone.</div></div><div><h3>Conclusions</h3><div>Integrating multi-timepoint CT imaging with clinical variables through a multimodal fusion model significantly enhances the prognostic performance of BCT, providing a robust tool for individualized risk prediction and clinical decision-making.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 71-77"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038940","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 profiles and mortality risk modeling in neurocritical care: A retrospective cohort study from high-altitude Xizang","authors":"Bin Wang ,&nbsp;Jian-lei Fu ,&nbsp;Ci-ren Zhuoma ,&nbsp;Qu-zhen Danzeng ,&nbsp;Feng-xue Zhu ,&nbsp;Guo-ying Lin","doi":"10.1016/j.ajem.2026.01.022","DOIUrl":"10.1016/j.ajem.2026.01.022","url":null,"abstract":"<div><h3>Background</h3><div>Neurocritical care patients residing in high-altitude regions such as the Xizang Autonomous Region encounter distinct physiological and logistical challenges, including hypobaric hypoxia, limited medical infrastructure, and delayed access to specialized care. Despite these factors, few studies have systematically characterized their clinical profiles or developed region-specific mortality prediction models. This study aimed to investigate the clinical features of neurocritical care patients admitted to a tertiary hospital in Lhasa, Xizang Autonomous Region, and to construct a predictive model for in-hospital mortality tailored to this high-altitude population.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included 400 neurocritical care patients admitted between October 2021 and December 2023. Demographic data, types of neurological disorders, clinical scores and comorbidities, laboratory examination, pharmacological treatments and blood product transfusion conditions were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of in-hospital mortality. A nomogram-based prediction model was developed and internally validated using bootstrap resampling. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>The overall in-hospital mortality rate was 15.8%. Multivariate analysis identified younger age (95% CI: 0.95–0.97, <em>p</em> = 0.013), higher APACHE II scores (95% CI: 1.02–1.16, <em>p</em> = 0.007), Glasgow Coma Scale ≤8 (95% CI: 1.17–4.56, <em>p</em> = 0.016), and elevated APTT levels (95% CI: 1.00–1.02, <em>p</em> = 0.007) as independent risk factors for mortality. Diuretic use was associated with a protective effect (95% CI: 0.20–0.77, p = 0.007).The final model demonstrated good discrimination (AUC = 0.749), calibration, and clinical utility. The nomogram provides a practical tool for early risk stratification in resource-limited high-altitude neurocritical care settings.</div></div><div><h3>Conclusion</h3><div>Neurocritical care patients in Xizang exhibit distinct clinical profiles and mortality risks. The developed prediction model may assist clinicians in early identification of high-risk patients and guide targeted interventions to improve outcomes in high-altitude regions.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 198-205"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115168","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":"Diagnostic and prognostic value of the risk factor-weighted clinical likelihood model in acute chest pain and negative troponin","authors":"Cayetana Barbeito-Caamaño ,&nbsp;Alberto Bouzas-Mosquera ,&nbsp;Jesús Peteiro-Vázquez ,&nbsp;Antonio Fuentes-Vivero ,&nbsp;Javier Vilasanchez-Vilar ,&nbsp;Domingo López-Vázquez ,&nbsp;María Dolores Martínez-Ruíz ,&nbsp;Juan Carlos Yañez-Wonenburguer ,&nbsp;Miriam Piñeiro-Portela ,&nbsp;Rafael Vidal-Pérez ,&nbsp;Francisco J. Broullón-Molanes ,&nbsp;Ramón Calviño-Santos ,&nbsp;José Manuel Vázquez-Rodríguez","doi":"10.1016/j.ajem.2026.01.033","DOIUrl":"10.1016/j.ajem.2026.01.033","url":null,"abstract":"<div><h3>Background</h3><div>Acute chest pain is a common reason for emergency department consultation. In patients with suspected acute coronary syndrome but with non-elevated troponin and non-ischemic electrocardiogram, identifying those who require further testing remains a clinical challenge. The aim of the study was to assess the value of the risk factor–weighted clinical likelihood (RF-CL) model–derived pre-test probability (PTP) of coronary artery disease (CAD) for detecting obstructive CAD or myocardial ischemia, and for predicting major adverse cardiovascular events (MACE).</div></div><div><h3>Methods</h3><div>Retrospective, single-center study including 3097 patients without prior CAD evaluated in a dedicated chest pain unit in Spain (2011−2021).</div></div><div><h3>Results</h3><div>The prevalence of obstructive CAD or ischemia ranged from 2.3% in patients with very low PTP to 78.3% in those with high PTP. Each 1% increase in PTP was independently associated with higher odds of obstructive CAD or ischemia (OR 1.11, 95% CI 1.09–1.12) and greater risk of MACE (HR 1.04, 95% CI 1.03–1.05). The model showed strong discrimination for diagnosis (AUC 0.83) and acceptable prognostic performance (C-index 0.71). No patient with PTP ≤5% and non-elevated high-sensitivity troponin experienced adverse events within 30 days.</div></div><div><h3>Conclusions</h3><div>The PTP of CAD estimated by the RF-CL model was associated with the presence of obstructive CAD, myocardial ischemia and MACE in patients with suspected ACS, non-elevated troponin and non-ischemic electrocardiogram. Additional diagnostic testing may be safely deferred in patients with very low PTP (≤5%).</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 141-147"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079836","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 global perspective on the accuracy of pediatric weight estimation methods in emergency care: A systematic review","authors":"Irrintzi Fernández-Aedo PhD, RN ,&nbsp;Sendoa Ballesteros-Peña PhD, RN ,&nbsp;Sandra Tobar-Cabrera RN ,&nbsp;Gorka Vallejo-De la Hoz PhD, RN ,&nbsp;Julia Fernandez-Alonso PhD","doi":"10.1016/j.ajem.2026.01.030","DOIUrl":"10.1016/j.ajem.2026.01.030","url":null,"abstract":"<div><h3>Introduction</h3><div>In pediatric emergency services, it is essential to know the patient's weight, for which there are numerous estimation tools. However, these instruments present biases in calculating the patient's weight. Therefore, the objective of this study was to evaluate the validity of pediatric weight estimation methods available worldwide, comparing their accuracy and applicability in medical practice.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following the PRISMA recommendations (PROSPERO Registration Number CRD420251174686). Observational and validation studies with original data published from 2010 to July 2025 were included. Articles were searched for in ProQuest, Web of Science, PubMed/Medline, and Scopus. The inclusion criteria were: patients aged 0 to 18 years, weight estimation methods, and quantitative reports of accuracy.</div></div><div><h3>Results</h3><div>Thirty-one studies from all continents were selected. Two-dimensional methods were generally more accurate than those based solely on age or one-dimensional formulas, especially in populations with a high prevalence of overweight or obesity. Parental estimation also performed well. Heterogeneity was observed in age ranges, acceptable error and validation criteria between studies.</div></div><div><h3>Conclusions</h3><div>Within the limitations of the uneven global evidence base, the tools that appear most reliable for estimating pediatric weight in emergency departments are those that incorporate more than one anthropometric variable or are supported by local validation. Given the scarcity of data from various regions and specific populations, each emergency system must determine the approach that best suits its local demographic profile, invest in staff training, and apply standardized validation criteria before adopting changes in routine practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 81-89"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039441","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}