American Journal of Emergency Medicine最新文献

{"title":"Early sepsis prediction in the emergency department using machine learning","authors":"Raymond J. van Wijk MSc ,&nbsp;Sunil Belur Nagaraj PhD ,&nbsp;Jan C. ter Maaten MD, PhD ,&nbsp;Hjalmar R. Bouma MD, PhD","doi":"10.1016/j.ajem.2025.09.034","DOIUrl":"10.1016/j.ajem.2025.09.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Early recognition of sepsis is critical for timely intervention. Early intervention (eg. with antibiotics) can reduce the risk on organ injury and eventually death. Commonly used clinical scores, such as qSOFA and NEWS, have limited predictive performance to predict organ failure and mortality in patients with early sepsis. Moreover, they require to be estimated by a human operator and lack the capacity to use diverse input sources. Machine learning (ML) models may improve risk stratification by integrating a broader range of parameters.</div></div><div><h3>Methods</h3><div>This study is a post-hoc analysis of prospectively collected data from 1431 patients presenting to the ED with suspected sepsis. A total of 149 clinical parameters, which were routinely collected as part of clinical care during ED stay, were extracted from electronic health records and bedside measurements. Machine learning (ML) models were developed in 10-fold cross validation to predict organ injury and 30-day mortality. Model performance was validated afterwards and compared to qSOFA and NEWS.</div></div><div><h3>Results</h3><div>The ML models achieved an AUROC (area under the receiver operator curve) of 0.798, 95 % CI [0.775, 0.821] for organ injury and 00.808, 95 % CI [0.777, 0.839] for 30-day mortality, outperforming qSOFA (AUROC 0.557–0.577) and NEWS (AUROC 0.576–0.610). Serum creatinine, SOFA score, ISAR-HP score, and clinical impression contributed to most to the model's score.</div></div><div><h3>Conclusion</h3><div>Machine learning models using routinely available ED data were associated with improved predictive performance of organ injury and 30-day mortality in early sepsis compared to conventional scoring systems, highlighting their potential for clinical decision support.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 143-150"},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202125","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":"Ultrasound-guided multifidus injection with 5 % dextrose for lumbar facet syndrome in the emergency department.","authors":"Gabriel Rose, William Shank, Dasia Esener","doi":"10.1016/j.ajem.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.033","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar facet syndrome is an under-recognized cause of chronic lower back pain. Treatment typically occurs in outpatient settings, with few procedural options available in the emergency department (ED).</p><p><strong>Case presentation: </strong>We present the case of a 92-year-old female with refractory lower back pain and severe functional limitation due to lumbar facet syndrome, successfully treated with ultrasound-guided multifidus injections using 5 % dextrose (D5W) in the ED.</p><p><strong>Discussion: </strong>This approach is novel in emergency medicine and offers a simple and effective treatment alternative. It is easier to perform and more accessible than medial branch or facet joint blocks and avoids the risks associated with local anesthetics.</p><p><strong>Conclusion: </strong>Ultrasound-guided multifidus injection with D5W may represent a practical, opioid-sparing option for older adults presenting to the ED with severe back pain.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139553","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 risk and low incidence diseases: Meningococcal disease","authors":"Mounir Contreras Cejin ,&nbsp;Alex Koyfman ,&nbsp;Brit Long","doi":"10.1016/j.ajem.2025.09.031","DOIUrl":"10.1016/j.ajem.2025.09.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Meningococcal disease is a serious condition that carries with it a high rate of morbidity and mortality.</div></div><div><h3>Objective</h3><div>This review highlights the pearls and pitfalls of meningococcal disease, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.</div></div><div><h3>Discussion</h3><div>Invasive meningococcal disease is a severe, rapidly progressive infection caused by <em>Neisseria meningitidis</em> associated with high morbidity and mortality. Emergency physicians must maintain a high index of suspicion, as early symptoms may mimic a benign viral illness, potentially delaying treatment with serious consequences. This early phase is typically followed by the emergence of more specific features of meningococcal infection, such as meningococcal meningitis, meningococcemia, or a combination of both. Suspected cases warrant immediate implementation of droplet precautions and strict isolation to reduce the risk of healthcare worker exposure and secondary transmission. Prompt treatment, ideally within one hour of clinical suspicion, is essential. Management includes empiric parenteral antibiotics, and in cases of suspected meningitis, adjunctive corticosteroids should be administered prior to or concurrently with the first antibiotic dose. Patients with meningococcemia and shock require aggressive fluid resuscitation, vasopressor support as indicated, and prompt admission to a critical care setting. All close contacts of confirmed cases should receive chemoprophylaxis, regardless of their meningococcal immunization status.</div></div><div><h3>Conclusions</h3><div>An understanding of meningococcal disease can assist emergency clinicians in diagnosing and managing this potentially deadly disease.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 114-122"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187426","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":"Impact of initial rhythm, rhythm at hospital admission and cause of arrest on the outcome of extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest","authors":"Piotr Foszcz ,&nbsp;Adrian Springer ,&nbsp;Ansgar Dreher ,&nbsp;Johannes Feldhege ,&nbsp;Peter Wohlmuth ,&nbsp;Tobias Spangenberg ,&nbsp;Alexander Ghanem ,&nbsp;Berthold Bein ,&nbsp;Nele Gessler ,&nbsp;Stephan Willems ,&nbsp;Eike Tigges","doi":"10.1016/j.ajem.2025.09.032","DOIUrl":"10.1016/j.ajem.2025.09.032","url":null,"abstract":"<div><h3>Objectives</h3><div>The use of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is increasing, although including patients with non-shockable rhythms remains controversial and data addressing the influence of rhythm remains scarce. This study aimed to assess the impact of initial rhythm, its conversion, and the underlying cause of arrest on ECPR outcomes in a real-life patient cohort.</div></div><div><h3>Methods</h3><div>A cohort of 281 consecutive patients undergoing ECPR for OHCA between 2016 and 2023 was retrospectively stratified based on initial and admission rhythm as well as cause of arrest. Outcomes were survival to discharge and favorable neurological function (cerebral performance category ≤2).</div></div><div><h3>Results</h3><div>An initial shockable rhythm was associated with higher survival (23.9 % vs. 7.4 %, <em>p</em> &lt; 0.001) and better neurological outcome (17 % vs. 4.1 %, p &lt; 0.001). In 45 % of cases, shockable rhythm persisted upon admission, while in 38 % converted to pulseless electrical activity, which did not impact outcomes (<em>p</em> = 0.32). Within the subgroup of patients with an initial non-shockable rhythm, those with initial PEA appeared to have a more favorable prognosis, as the presence of asystole at any point was associated with poorer outcomes. Notably, in cases where OHCA was caused by pulmonary embolism, survival with favorable neurological outcome was higher compared to other causes within the initial PEA subgroup.</div></div><div><h3>Conclusions</h3><div>While routine ECPR in initial non-shockable rhythm cannot recommended, selected patients, such as those with pulmonary embolism, may benefit. Asystole at any time is associated with a poor prognosis. Detailed contemplation of pre-hospital rhythm and its dynamic changes might be reasonable.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 90-96"},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159316","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":"Gastric mucosal necrosis caused by ingestion of crystalline sodium chloride: A case report.","authors":"Hiroyuki Tamura, Masahiro Kashiura, Haruka Taira, Shunsuke Amagasa, Takashi Moriya","doi":"10.1016/j.ajem.2025.09.026","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.026","url":null,"abstract":"<p><p>Acute sodium chloride (NaCl) poisoning is a life-threatening condition primarily known to cause systemic hypernatremia. However, the local gastrointestinal effects of ingesting a large mass of crystalline NaCl are not well-documented. This case illustrates that crystalline NaCl can cause a severe corrosive injury pattern akin to that of classic caustic agents. We present a 42-year-old woman with abdominal pain and hematemesis after ingesting 200 g of crystalline NaCl in a suicide attempt. She had hypernatremia (155 mmol/L) and hyperosmolality (serum osmolality 324 mOsm/kg). An upper endoscopy revealed severe corrosive gastritis with mucosal necrosis and exudates, concentrated in the gastric antrum, with relative sparing of the esophagus and duodenum. The patient was managed supportively with intravenous fluids and a proton pump inhibitor, and her gastric lesions showed healing with significant scarring on a follow-up endoscopy. In conclusion, massive NaCl ingestion can cause severe, localized corrosive gastritis, in addition to systemic hypernatremia. The physical form of NaCl (solid crystals) is a critical determinant of injury. Clinicians should maintain a high suspicion for severe gastrointestinal chemical injury.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103207","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":"Opioid utilization patterns and predictors for emergency department visits related to ankle sprains between 2016 and 2021: A National Analysis Utilizing Neural Networks.","authors":"Christine Ramdin, Jamey Lister, Stephanie Shiau, Mara Domider, Lewis S Nelson","doi":"10.1016/j.ajem.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.030","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103239","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":"Gender influences on clinical decisions in pediatric emergency department headache visits","authors":"Lea Ohana Sarna Cahan ,&nbsp;Miram Ben Hamo ,&nbsp;Jehad Edrees ,&nbsp;Adi Bracha Moshe ,&nbsp;Itai Gross ,&nbsp;Saar Hashavya","doi":"10.1016/j.ajem.2025.09.028","DOIUrl":"10.1016/j.ajem.2025.09.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited data exist on sex- and gender-related differences in pediatric emergency care. This study assessed sex-related differences in patient presentation and diagnosis and examined gender-related influences on provider management of adolescents presenting with headaches to the PED.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort review was conducted of patients aged 10–17 years who presented to the Pediatric Emergency Department (PED) with headache-related complaints between 2010 and 2022. The data included demographics, diagnosis, tests and consultations performed, hospitalization, readmission, time to discharge, and admitting physician gender.</div></div><div><h3>Results</h3><div>Over 13 years, 1915 PED visits were recorded, of which 998 (52.1 %) were for females. Female patients were more likely to be referred to a subspecialist (14.3 % vs. 10.3 %; CI 12.2–16.7 % / 8.4–12.4 %, <em>p</em> = 0.028), particularly ophthalmology (<em>p</em> = 0.042). Overall, providers were more likely to direct female patients to a specialist (<em>p</em> = 0.009), regardless of provider gender. No differences were found in the order of ancillary laboratory or imaging tests. Women providers were more likely to order blood chemistry tests (p = 0.042) and psychiatric consultations (<em>p</em> = 0.002), and their patients had longer PED stays with difference in length of stay: 0.15 day [95 % CI -0.30-0.00]). Male patients treated by man providers had higher odds of return visits compared to males treated by women providers (OR 2.00; 95 % CI: 1.08–4.07).</div></div><div><h3>Conclusion</h3><div>Minor differences were observed in the assessment of male and female adolescents. Women healthcare providers were more likely to utilize more PED resources and conduct longer evaluations, which correlated with fewer revisit rates. These findings suggest potential gender related influences on provider decision making.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 83-89"},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120997","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":"Virtual consensus: Peer review and quality alignment in telemedicine.","authors":"Anisa Heravian, Mindy Stimell, Mariah Salerno, Bernard P Chang, Erica Olsen","doi":"10.1016/j.ajem.2025.09.029","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.029","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103238","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":"Every minute blinds: Temporal artery ultrasound in the real-time diagnosis of stroke of the eye","authors":"Jagannadha Avasarala MD, PhD, FAAN ,&nbsp;Suhas Gangadhara MD ,&nbsp;Joseph Bobadilla MD ,&nbsp;Romil Chadha MD, MBA, MPH","doi":"10.1016/j.ajem.2025.09.027","DOIUrl":"10.1016/j.ajem.2025.09.027","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate a) whether failure to consider ocular vascular ischemia in patients ≥50 years of age presenting with acute, isolated ocular symptoms leads to missed diagnoses of ‘stroke of the eye’ caused by giant cell arteritis (GCA) and b) to assess the role of temporal artery ultrasound (TAUS) in the diagnosis of GCA in the emergency department (ED).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective cohort analysis using data from patients aged ≥50 years presenting to the emergency department (ED) with isolated ocular symptoms between 2021 and 2024 was done. Datasets included the University of Kentucky (UKY) Epic (Electronic Health Records EHR) data and Epic Cosmos, a nationwide healthcare data analytics platform developed by Epic Systems, a provider of EHR software (299 million patients nationwide). Patients were stratified into occult GCA, central retinal artery occlusion (CRAO), and ischemic optic neuropathy (ION). The full UKY cohort (&lt;em&gt;n&lt;/em&gt; = 787) included patients presenting with occult GCA, CRAO and ION. Multivariable logistic regression was performed using standard statistical software to estimate predictors of GCA diagnosis, adjusting for TAUS, temporal artery biopsy (TAB) and corticosteroid administration prior to a diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the UKY cohort of 103 patients with acute and isolated ocular symptoms (occult GCA), 38.8 % had confirmed GCA, 27.2 % were clinically diagnosed, and 34 % were ruled out. Of the confirmed cases, 67.5% underwent TAUS and 17.5% underwent TAB. A total of 66/103 (64 %) received steroids before testing and 46/66 (69.7 %) tested negative for GCA. In the Epic Cosmos data, 62.8 % of 17,372 patients lacked any testing; TAUS-specific data were unavailable. Among patients with CRAO (&lt;em&gt;n&lt;/em&gt; = 90) in the UKY cohort, 12.2 % underwent TAUS, with 63.6 % diagnosed with GCA; workup for stroke revealed an embolic stroke 22/90 (24.4 %); 75.5 % received no further workup after stroke evaluation was unrevealing and 1/90 underwent TAB that was negative; with the patient having steroids prior. In Epic Cosmos, of 18,621 patients with CRAO, 561 underwent TAB (3 %), and 5908 (31 %) had ultrasound findings but TAUS-specific data was unavailable. Among 594 UKY patients with ION, 28 had carotid ultrasound or TAUS; 15 had TAUS, with 33 % diagnosed as having GCA; 9 underwent TAB and 33 % had GCA. Additionally, 94.1 % of the UKY cohort had no testing for GCA; In Epic Cosmos, of the 56,554 patients with ION, 2686 (4.7 %) underwent carotid U/S or TAUS, or both. 901(1.6 %) underwent TAB, while 52,967/56554 (93.6 %) had no formal testing for GCA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Recognition of GCA with acute ocular symptoms in the ED remains challenging. Neurologists and ophthalmologists play a central role in the diagnostic workup but delays often occur because no real-time diagnostic tool exists. Integrating TAUS into ED protocols for ocular ischemia may reduce dia","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 97-101"},"PeriodicalIF":2.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159469","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 medicine updates: Point-of-care ultrasound in cardiac arrest","authors":"Brit Long MD ,&nbsp;Robert James Adrian MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.09.021","DOIUrl":"10.1016/j.ajem.2025.09.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac arrest is a commonly managed condition in the emergency department (ED). Point-of-care ultrasound (POCUS) has demonstrated utility in multiple components of cardiac arrest.</div></div><div><h3>Objective</h3><div>This paper summarizes evidence-based updates concerning the use of POCUS in cardiac arrest.</div></div><div><h3>Discussion</h3><div>POCUS can be used for both cardiac and non-cardiac applications. Common cardiac assessments include the evaluation of pericardial effusion and tamponade physiology, right ventricular dilation, occult ventricular fibrillation, and optimizing chest compressions. Non-cardiac applications include the assessment of intraperitoneal free fluid, aortic pathology, hypovolemia, endotracheal tube position, and pneumothorax. In addition, POCUS can evaluate for the presence or absence of a pulse more quickly and accurately than manual palpation. POCUS can also guide prognosis by assessing cardiac activity.</div></div><div><h3>Conclusions</h3><div>An understanding of literature updates focused on POCUS can improve the ED care of patients in cardiac arrest.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 176-187"},"PeriodicalIF":2.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221712","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}