American Journal of Emergency Medicine最新文献

{"title":"Shock index pediatric age-adjusted for predicting severe outcomes in patients with pediatric trauma.","authors":"Tai-Jung Chen, Min-Po Ho","doi":"10.1016/j.ajem.2024.09.052","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.052","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333046","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":"Implementation of a clinical pathway for the evaluation of asymptomatic hypertension in the emergency department","authors":"Andrew Farkas MD ,&nbsp;Tyler Turner MD ,&nbsp;Katherine Sherman MS ,&nbsp;Ashley Pavlic MD","doi":"10.1016/j.ajem.2024.09.042","DOIUrl":"10.1016/j.ajem.2024.09.042","url":null,"abstract":"<div><h3>Introduction</h3><div>According to the guidelines of the American Heart Association and American College of Emergency Physicians, respectively, there is no indication for immediate lowering of asymptomatic hypertension in the Emergency Department (ED), and no requirement for routine diagnostic testing in these patients. Despite this, asymptomatic hypertension represents a recurring source of referrals for ED evaluation from other healthcare settings, or from patient self-referral, with significant practice variation in the evaluation and treatment of this complaint.</div></div><div><h3>Methods</h3><div>This is a pre-post study of a pathway to standardize care of patients presenting to a tertiary academic Veteran's Health Administration ED with asymptomatic hypertension. Inclusion criteria were patients with ICD10 codes of hypertension who were confirmed via chart review to have sought care for a complaint of elevated blood pressure readings from 2018 to 2022, with the pathway having been implementing in 2022. Patients were excluded if they had symptoms of possible end organ pathology due to hypertension, such as chest pain, headache, or shortness of breath, or if they were reproductive age women who had not undergone a sterilization procedure. The primary outcome was major adverse cardiovascular event within 30 days of ED visit. Secondary outcomes included: diagnostic tests performed, administration of antihypertensives in the ED, and length of stay. Descriptive statistics and statistical analysis were performed.</div></div><div><h3>Results</h3><div>There were a total of 295 unique patients and 324 patient encounters that met the inclusion/exclusion criteria, with 46 encounters that took place after pathway implementation. There were no major adverse cardiovascular events either before or after pathway implementation. Chest radiographs were reduced from 10 % to 0 % (<em>p</em> = 0.005) after pathway respectively. There were also declines in laboratory testing, EKGs, and administration of oral antihypertensives, but these differences were not statistically significant. At no point did any diagnostic testing identify any previously undiagnosed medical conditions. There were no instances of intravenous hypertensives being given after pathway implementation. Despite the reductions in diagnostic testing, there was no change in ED length of stay for patients with asymptomatic hypertension.</div></div><div><h3>Conclusion</h3><div>Our findings redemonstrate that patients presenting to the ED with asymptomatic hypertension are at low risk for short-term complications of hypertension, and that diagnostic testing is low yield in this population. While we were able to achieve reductions in unnecessary testing, further work is needed to educate clinicians and improve adherence to evidence based principles when caring for these patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314211","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":"Emergency department discharges directly to hospice: Longitudinal assessment of a streamlined referral program","authors":"Daniel W. Markwalter MD ,&nbsp;Jared Lowe MD ,&nbsp;Ming Ding MBBS, ScD ,&nbsp;Michelle Lyman MD, MPH ,&nbsp;Kyle Lavin MD, MPH","doi":"10.1016/j.ajem.2024.09.049","DOIUrl":"10.1016/j.ajem.2024.09.049","url":null,"abstract":"<div><h3>Introduction</h3><div>80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice.</div></div><div><h3>Methods</h3><div>We implemented a QI program in September 2021 consisting of three components: (1) clarification and streamlining of referral workflows, (2) staff/provider education on hospice and workflows, and (3) electronic medical record (EMR) tools to facilitate hospice transitions. The primary outcome was the change in monthly ED-to-hospice cases pre- and post-implementation. We also calculated the monthly incidence rate of ED-to-hospice transfers. The secondary outcome was ED length of stay (LOS).</div></div><div><h3>Results</h3><div>202 patients completed ED-to-hospice transfers from January 1, 2019 to February 29, 2024. 98 patients transitioned from the ED to hospice before QI implementation, and 104 patients transitioned after implementation. We observed a slight but insignificant increase in the mean monthly ED-to-hospice cases from 3.16 patients per month pre-implementation to 3.47 patients per month post-implementation (<em>P</em> = 0.46). We found no significant difference in the monthly incidence rate of ED-to-hospice cases before and after implementation (<em>P</em> = 0.78). ED LOS was unaffected (<em>P</em> = 0.21).</div></div><div><h3>Conclusion</h3><div>In this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322196","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 \"Prehospital, post-ROSC blood pressure and associated neurologic outcome: Do not dismiss other outcome cofounders\" [Am J Emerg Med. 2022 Jun:56:280-281].","authors":"Romain Jouffroy, Benoit Vivien","doi":"10.1016/j.ajem.2024.09.023","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.023","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301786","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":"Optimizing emergency dispatcher pre-arrival guidance on first aid for snakebites.","authors":"Adhish Gautam, Alexei A Birkun","doi":"10.1016/j.ajem.2024.09.045","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.045","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333043","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":"Safety and efficacy of a hybrid intravenous and oral diltiazem protocol for acute rate control in the emergency department.","authors":"Jung-Chi Chiang, Chien-Chieh Hsieh, Fu-Shan Jaw, Yin-Chen Yeh, Tang-Sai Tat, Rong-Rong Luo","doi":"10.1016/j.ajem.2024.09.047","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.047","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333044","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":"Achieving successful CPR protocol training on schoolchildren: Insights from experiences in developing countries.","authors":"Ricardo Allende-Carrera, Jorge Álvarez de la Cadena-Sillas, Agustín Urzúa-González, Alan Rodrigo Gutiérrez-Vega, David Martínez-Dunker, Manuel Celaya-Cota, Luisa F Aguilera-Mora, José Salvador Lainez-Zelaya, Luis Lojero-Wheatley, Enrique Asensio-Lafuente, Erik H González-Cruz","doi":"10.1016/j.ajem.2024.09.044","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.044","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333039","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":"Factors influencing secondary overtriage in trauma patients undergoing interhospital transfer: A 10-year multi-center study in Hong Kong","authors":"Kenneth Ka Kam Chui ,&nbsp;Yan Yi Chan ,&nbsp;Ling Yan Leung ,&nbsp;Eunice Siu Shan Hau ,&nbsp;Chun Yu Leung ,&nbsp;Pauline Pui Kwan Ha ,&nbsp;Chi Hung Cheng ,&nbsp;Nai Kwong Cheung ,&nbsp;Kevin Kei Ching Hung ,&nbsp;Colin A. Graham","doi":"10.1016/j.ajem.2024.09.039","DOIUrl":"10.1016/j.ajem.2024.09.039","url":null,"abstract":"<div><h3>Background</h3><div>With the development of regionalised trauma networks, interhospital transfer of trauma patients is an inevitable component of the trauma system. However, unnecessary transfer is a common phenomenon, and it is not without risk and cost. A better understanding of secondary overtriage would enable emergency physicians to make better decisions about trauma transfers and allow guidelines to be developed to support this decision making. This study aimed to describe the pattern of secondary overtriage in Hong Kong and identify its associated factors.</div></div><div><h3>Methods</h3><div>This was a retrospective review of 10-years of prospectively collected multi-center data from two trauma registries in the New Territories of Hong Kong (2013−2022). The primary outcome is secondary overtriage, which was defined as early discharge alive within 48 h, Injury Severity Score (ISS) &lt;15, and no surgical operation done. Patient characteristics, physiology, anatomy and investigation variables were compared against secondary overtriage using univariate and multivariable analyses.</div></div><div><h3>Results</h3><div>During the study period, 3852 patients underwent interhospital transfer from a non-trauma center to a trauma center, and 809 (21 %) of the transfers were considered secondary overtriage. The secondary overtriage rate was higher in pediatric age groups at 34.8 % (97/279). Logistic regression analysis showed secondary overtriage to be associated with blunt trauma and an Abbreviated Injury Scale (AIS) score of &lt;3 for head or neck, thorax, abdomen and extremities.</div></div><div><h3>Conclusion</h3><div>Interhospital transfer is an essential component of the trauma system. However, over one-fifth of the transfers were considered unnecessary in Hong Kong, and this could be considered to be an inefficient use of resources as well as cause inconvenience to patients and their families. We have identified related factors including blunt trauma, AIS &lt;3 scores for head or neck, thorax, abdomen and extremities, and opportunities to establish and improve on transfer protocols. Further research should be aimed to safely reduce interhospital transfers in the future to improve the efficiency of the Hong Kong trauma system.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311330","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":"Flooding crisis in Poland: A global call to fortify healthcare against climate disasters.","authors":"Krzysztof Goniewicz","doi":"10.1016/j.ajem.2024.09.046","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.046","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301789","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":"Mapping Glasgow Coma scale to AVPU scores among adults in the prehospital setting","authors":"Sriram Ramgopal ,&nbsp;Rebecca E. Cash ,&nbsp;Masashi Okubo ,&nbsp;Christian Martin-Gill","doi":"10.1016/j.ajem.2024.09.043","DOIUrl":"10.1016/j.ajem.2024.09.043","url":null,"abstract":"<div><h3>Objective</h3><p>To develop a translation between the Glasgow Come Scale and the Alert-Verbal-Pain-Unresponsive (AVPU) scale among adults with out-of-hospital emergencies.</p></div><div><h3>Methods</h3><p>We performed a retrospective analysis of adults (≥18 years) from the 2022 National Emergency Medical Services (EMS) Information System with a ground scene encounter with a concurrently documented GCS and AVPU assessment. Using a training partition of 2.5 million encounters, we performed a grid search to identify all combinations of mutually exclusive cutpoints which divided the GCS into four segments. We identified the combination with the highest Kappa statistic and reported metrics of performance in this sample in the <em>test partition.</em></p></div><div><h3>Results</h3><p>We identified 16,321,299 encounters with a concurrent AVPU and GCS. Using the AVPU scale, 93.3 % were classified as Alert; 2.9 % as Verbal; 1.5 % as Pain; and 2.3 % as Unresponsive. Using a grid-based search, optimal cutpoints were identified when using a GCS of 14–15 for Alert, 10–13 for Verbal, 7–9 for Pain, and 3–6 for Unresponsive. Cohen's Kappa was 0.63 in the test partition, indicating substantial agreement. Intraclass F1 score varied across different alertness levels and were 0.97 for “Alert”, 0.43 for “Verbal”, 0.49 for “Pain”, and 0.83 for “Unresponsive”. Findings were similar in analyses performed by age group and by the presence or absence of trauma.</p></div><div><h3>Conclusion</h3><p>We report an optimal crosswalk between the AVPU and GCS scales. Performance in the Verbal and Pain categories was lower than the Alert and Unresponsive categories. These findings may facilitate clinician handovers between EMS and non-EMS clinicians.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272889","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}