American Journal of Emergency Medicine最新文献

{"title":"Association of pre-intubation bag-valve-mask ventilation with hypoxemia and regurgitation in the ED: A multicenter cohort study","authors":"Jin Takahashi ,&nbsp;Haruka Tsuji ,&nbsp;Hiraku Funakoshi ,&nbsp;Hiroshi Okamoto ,&nbsp;Yusuke Hagiwara ,&nbsp;Hiroko Watase ,&nbsp;Takao Ono ,&nbsp;Sakina Kadomatsu ,&nbsp;Tatsuhiko Hata ,&nbsp;Kohei Hasegawa ,&nbsp;Takashi Shiga ,&nbsp;Tadahiro Goto ,&nbsp;Japanese Emergency Medicine Network Investigators","doi":"10.1016/j.ajem.2026.01.012","DOIUrl":"10.1016/j.ajem.2026.01.012","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness of pre-intubation bag-valve-mask (BVM) ventilation for rapid sequence intubation (RSI) in the emergency department (ED) remains uncertain. In this study, we investigated whether pre-intubation BVM ventilation was associated with a lower risk of peri-intubation hypoxemia.</div></div><div><h3>Methods</h3><div>We analyzed data from a multicenter prospective observational study conducted in 14 EDs across Japan. Adult (≥18 years) patients who underwent RSI between 2020 and 2023 were included. The primary outcome was peri-intubation hypoxemia (SpO₂ &lt;90%), and the secondary outcome was regurgitation. Missing data were imputed using multiple imputations. Propensity scores were estimated using predefined covariates (age, sex, body mass index, COVID-19, modified LEMON score, intubation indication, device, intubator's specialty, preoxygenation method, pre-intubation SpO₂, and participating institutions). Treatment effects were evaluated using stabilized inverse probability of treatment weighting (IPTW) and sensitivity analysis with 1:1 matching.</div></div><div><h3>Results</h3><div>Among the 1481 patients, 589 (40%) received pre-intubation BVM. Overall, 204 patients (14%) experienced peri-intubation hypoxemia. The BVM group had a lower unadjusted risk of hypoxemia than the non-BVM group (10% vs. 16%; <em>p</em> &lt; 0.001). However, after stabilized IPTW, BVM ventilation was not significantly associated with hypoxemia (adjusted risk difference −3.2%; 95% CI, −7.8% to 1.5%). Sensitivity analysis using 1:1 matching yielded consistent results (risk difference 0.9%; 95% CI, −3.8% to 5.6%). There was no significant difference in the incidence of regurgitation between the BVM and non-BVM groups (1% vs. 1%; <em>p</em> = 0.24).</div></div><div><h3>Conclusion</h3><div>In this multicenter study, pre-intubation BVM ventilation during RSI in the ED was not associated with a reduced risk of peri-intubation hypoxemia.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 108-113"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038939","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":"Remote real-time ambulatory ECG monitoring of the longest RR interval and corresponding arrhythmias during altitude ascent","authors":"Li-Hong Zheng,&nbsp;Yan Wang,&nbsp;Xue-Wen Huang,&nbsp;Miao Li,&nbsp;Hai-Ying Xian,&nbsp;Chun-Xia Guo,&nbsp;Zi-Yang He,&nbsp;Lin Ma","doi":"10.1016/j.ajem.2026.01.020","DOIUrl":"10.1016/j.ajem.2026.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to characterize the longest RR intervals and associated arrhythmias during the early phase of rapid ascent to high altitude environments using ambulatory electrocardiography (AECG), with the aim of informing strategies to prevent acute high-altitude illness and cardiovascular adverse events.</div></div><div><h3>Methods</h3><div>Participants residing at low altitude underwent rapid ascent to high-altitude locations at 3060 m, 3460 m, and 4014 m. Beginning on the first day at altitude, AECG monitoring was conducted for more than 24 h using a Model 401 wearable ECG monitor, enabling remote, real-time data transmission via a 4G network and immediate clinical response to high-risk arrhythmias. Cloud-based storage and analytic platforms facilitated statistical evaluation of the longest RR intervals and corresponding rhythm types.</div></div><div><h3>Results</h3><div>(1) The longest RR intervals and associated arrhythmias were primarily observed during nighttime sleep. (2) Statistically significant differences (<em>p</em> &lt; 0.05) were found among the three altitude groups in the incidence of the longest RR intervals &lt;1.00 s, abnormal rhythms associated with the longest RR intervals, premature beats corresponding to the longest RR intervals, and sinus pause episodes. (3) The primary arrhythmias associated with the longest RR intervals included ventricular premature beats, second-degree type II atrioventricular block, high-degree atrioventricular block, sinus pause, and atrial fibrillation.</div></div><div><h3>Conclusion</h3><div>Clinically significant bradyarrhythmia may occur during rapid ascent to altitudes between 3060 m and 4014 m, particularly during nocturnal hours. These findings highlight the need to consider targeted preventive attention during nighttime exposure, given the high prevalence of nocturnal bradyarrhythmias. Remote real-time AECG monitoring may serve as a useful tool for early detection and intervention in populations at risk of altitude-related cardiac rhythm disturbances.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 98-103"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039487","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":"Are antibiotics an effective initial treatment for acute appendicitis compared to appendectomy?","authors":"Peter Victoria,&nbsp;Joshua Easter,&nbsp;Brit Long","doi":"10.1016/j.ajem.2026.01.018","DOIUrl":"10.1016/j.ajem.2026.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Acute appendicitis is among the most common emergency presentations and has traditionally been treated with appendectomy. However, recent randomized controlled trials suggest that antibiotic therapy is a reasonable, non-operative alternative for appropriately selected patients who understand the risks. The purpose of this review article was to summarize findings from a recent individual patient data meta-analysis comparing antibiotic therapy versus appendectomy in adults with imaging-confirmed acute appendicitis.</div></div><div><h3>Methods</h3><div>The reviewed meta-analysis included six randomized controlled trials encompassing 2101 adult patients. A one-stage analysis was performed applying an intention-to-treat analysis. A mixed-effects model accounted for study-level clustering. Complications were standardized using the Clavien-Dindo classification, a widely used tool for classification of surgical complications. The primary endpoint was the overall complication rate at one year, and secondary outcomes included rate of step-up appendectomy, hospital length of stay, and time away from work.</div></div><div><h3>Results</h3><div>No significant difference in overall, major, or minor complication rates was found at one year between patients receiving initial antibiotic therapy and those undergoing appendectomy. 34% of patients treated with antibiotics required delayed appendectomy within one year and 25% of those patients were found to have complicated appendicitis. In contrast, patients with an appendicolith demonstrated significantly higher complication rates, and 49% required subsequent appendectomy.</div></div><div><h3>Conclusions</h3><div>Antibiotic therapy is a reasonable initial management strategy for adults with uncomplicated, imaging-confirmed acute appendicitis as long as patients understand the risks. However, caution is warranted in those with an appendicolith due to increased risk of complications and treatment failure with antibiotic therapy.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 104-107"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038937","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":"Rapid feedback on my emergency department hemorrhagic stroke care? It improves telestroke and in-person treatment times","authors":"Nick M. Murray MD ,&nbsp;Paul D. Johnson MD ,&nbsp;Gabriel V. Fontaine PharmD, MBA ,&nbsp;Trina Johnson RN ,&nbsp;Jami Hassler RN ,&nbsp;Heidi Hafen RN, NP ,&nbsp;Michelle Aucoin RN ,&nbsp;Lesley Miller RN ,&nbsp;Anne M. Anderson RN ,&nbsp;Chamonix Johnston RN, MPH ,&nbsp;Marilyn McKasson MD ,&nbsp;Kyle Hobbs MD ,&nbsp;H. Adrian Püttgen MD","doi":"10.1016/j.ajem.2026.01.023","DOIUrl":"10.1016/j.ajem.2026.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Rapid time to treatment of intracerebral hemorrhage (ICH) is important but not consistently achieved in emergency departments (EDs). The concept of CODE-ICH is now well-described, yet mechanisms to improve ED provider and system operation to reduce treatment times are lacking.</div></div><div><h3>Objective</h3><div>We aim to evaluate ICH treatment time metrics before and after a standardized ICH provider feedback intervention, individualized for each patient with an acute spontaneous ICH in the ED.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort of consecutive patients ≥18 years old with an acute ICH were identified from March 1, 2022 to January 1, 2025 within a network of an integrated healthcare system in the U.S. A rapid feedback intervention for all providers involved in the patient case was developed to contain specific treatment times compared to goals, which, when not met, prompted a root cause analysis. Patients were grouped into pre- and post-intervention cohorts. The primary endpoints were CT scout time to antihypertensive and/or anticoagulation reversal agent administration and ICH orderset utilization. Secondary outcomes were effect of in-person daytime versus telehealth nighttime coverage, length of stay, and discharge disposition.</div></div><div><h3>Results</h3><div>A total of 226 patients met inclusion criteria, 108 pre- and 118 post-intervention, with similar age (median: 68 vs. 69 years) and 54% were female. Pre- to post-intervention median NIHSS was the same (10; <em>p</em> = 0.25), as were median ICH scores (pre: 2.0, interquartile range, IQR, 0–3 vs. post: 1.0, IQR 1–3; <em>p</em> = 0.90). Median post-intervention CT to antihypertensive treatment was 7 min faster (pre: 21 min, IQR 23–52 vs. post: 14 min, IQR 7–26; <em>p</em> = 0.0012), and median CT to anticoagulation reversal agent administration was 11 min faster (pre: 40 min, IQR 30–64 vs. post: 29 min, IQR 18–40; <em>p</em> = 0.03). The intervention was associated with increased orderset usage (54% pre- to 96% post-intervention; <em>p</em> = 0.0001).</div></div><div><h3>Conclusions</h3><div>A rapid, root-cause focused ICH feedback intervention improved standardized orderset usage and resultant faster treatment times for blood pressure and anticoagulation reversal in the ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 65-70"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038936","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":"Info for authors","authors":"","doi":"10.1016/S0735-6757(26)00017-3","DOIUrl":"10.1016/S0735-6757(26)00017-3","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Page A6"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396913","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":"Beyond survival: Early markers of poor outcome in pediatric trauma","authors":"Kubra Boydag Guvenc ,&nbsp;Ebru Guney Sahin ,&nbsp;Idris Abdullah Yılmaz ,&nbsp;Refik Ozturk ,&nbsp;Ceyhan Sahin ,&nbsp;Fatih Varol ,&nbsp;Cansu Durak","doi":"10.1016/j.ajem.2025.12.028","DOIUrl":"10.1016/j.ajem.2025.12.028","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the prognostic value of clinical scoring systems and admission-based laboratory biomarkers in predicting mortality and morbidity among pediatric trauma patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 88 pediatric trauma patients admitted to a tertiary-level pediatric intensive care unit between August 2024 and July 2025. Patients who died within the first 24 h were excluded. PRISM III, PELOD-2, SIPA, GCS, and VIS scores were calculated on the day of admission. Laboratory parameters including lactate, procalcitonin, and albumin levels were recorded. Morbidity was defined as persistent organ-specific dysfunction at discharge. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance.</div></div><div><h3>Results</h3><div>The overall mortality rate was 5.7 %, while 13.6 % of patients developed sequelae. Non-survivors had significantly higher PRISM III, PELOD-2, lactate, lactate/albumin ratio, and procalcitonin levels, along with longer PICU stay and greater need for mechanical ventilation and inotropic support. The lactate/albumin ratio showed the highest predictive value for mortality (AUC = 0.828). Patients with sequelae had significantly higher illness severity scores and elevated lactate-related markers. Transfusion needs were also more common in this group. Lactate/albumin ratio demonstrated strong negative predictive value (NPV = 95.6 %) for morbidity.</div></div><div><h3>Conclusion</h3><div>Both clinical severity scores and lactate-related biomarkers were associated with mortality and morbidity in pediatric trauma patients. In particular, the lactate/albumin ratio emerged as a useful early indicator of poor outcomes. These findings support the incorporation of combined scoring and biomarker strategies into early risk stratification protocols in pediatric trauma care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 103-109"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914224","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":"Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial","authors":"Christian Kroll ,&nbsp;Mahnoor Khan ,&nbsp;Jiayi Sun ,&nbsp;Priyanka Vakkalanka ,&nbsp;Kasheng Lee ,&nbsp;Marianne Said ,&nbsp;Joseph Halfpap","doi":"10.1016/j.ajem.2025.12.031","DOIUrl":"10.1016/j.ajem.2025.12.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Hyperkalemia is a potentially life-threatening electrolyte disturbance that is present in 2 % to 3 % of emergency department (ED) patient admissions. These patients are commonly treated with intravenous (IV) insulin. Standard of care consists of administering IV insulin regular, but other insulin formulations might be safer and/or more effective, however this has yet to be explored.</div></div><div><h3>Objective</h3><div>To evaluate the safety and effectiveness of insulin lispro and insulin regular administered intravenously for the treatment of hyperkalemia in ED patients.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study that investigated adults that were admitted to the ED of two academic centers and treated for hyperkalemia with 5 units of IV insulin therapy from January 1, 2022, through January 1, 2023. The primary outcome was the change in serum potassium within 6 h following IV insulin regular compared to IV insulin lispro. The primary safety outcome was the proportion of patients who had a hypoglycemic event (blood glucose &lt;70 mg/dl) or required supplemental dextrose administration within 6 h post-insulin administration. Demographic, clinical characteristics, clinical management, and the outcome of change in potassium were associated using linear regression. Dichotomous outcomes pertaining to hypoglycemia were estimated using logistic regression.</div></div><div><h3>Results</h3><div>Among the 237 patients who met inclusion criteria, 129 received insulin regular, and 108 patients received insulin lispro. We observed a larger decrease in potassium in those that received insulin lispro compared to those that received insulin regular (uMD: -0.24; 95 %CI: −0.42, −0.06). The odds of hypoglycemia were greater among those who received insulin lispro (16 %) compared to insulin regular (7 %) (uOR: 2.49; 95 %CI: 1.08, 6.09).</div></div><div><h3>Conclusions</h3><div>Intravenous insulin lispro resulted in a statistically significant reduction of serum potassium but resulted in a higher likelihood of hypoglycemia compared to IV insulin regular. Further prospective, controlled studies are needed to assess the clinical significance of the differences between insulin formulations.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 92-98"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885753","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 hemodialysis timing on survival in paraquat poisoning: Experience from a tertiary care hospital in West Bengal, India","authors":"Amit Kumar Singh ,&nbsp;Uttam Biswas ,&nbsp;Ritwik Ghosh ,&nbsp;Anwesha Sohrab ,&nbsp;Arnab Bhattacharjee ,&nbsp;Julián Benito-León","doi":"10.1016/j.ajem.2025.12.026","DOIUrl":"10.1016/j.ajem.2025.12.026","url":null,"abstract":"<div><h3>Background</h3><div>Paraquat is a highly toxic herbicide that frequently causes multiorgan failure and death. In many resource-limited settings, hemodialysis is the only available extracorporeal modality, and the impact of its timing on survival remains uncertain. We evaluated whether the timing of hemodialysis initiation (Day 1 vs Days 2–3) is associated with in-hospital survival in acute paraquat poisoning.</div></div><div><h3>Methods</h3><div>We conducted a single-center prospective cohort study of 100 consecutive patients with confirmed paraquat ingestion admitted to a tertiary hospital in West Bengal, India. Patients were categorized by hemodialysis timing: early (Day 1) or delayed (Days 2–3). Continuous variables were compared using Mann–Whitney tests and categorical variables using χ² or Fisher's exact tests. Multivariable logistic regression, including age, sex, respiratory distress, serum bilirubin, creatinine at presentation, and timing of hemodialysis, was used to identify independent predictors of survival. Survival was further evaluated with Kaplan–Meier curves and the log-rank test.</div></div><div><h3>Results</h3><div>Baseline demographic, clinical, and laboratory features were similar between early and delayed hemodialysis groups (<em>n</em> = 50 each). Overall, 21 patients (21 %) survived to discharge. Survival was higher with early hemodialysis (15/50, 30 %) than with delayed hemodialysis (6/50, 12 %; <em>p</em> = 0.048). Early hemodialysis was independently associated with increased odds of survival (adjusted OR 3.44, 95 % CI 1.07–11.09, <em>p</em> = 0.038). Absence of respiratory distress strongly predicted survival (adjusted OR 16.18, 95 % CI 1.97–132.99, <em>p</em> = 0.010).</div></div><div><h3>Conclusion</h3><div>In this cohort, hemodialysis initiated on Day 1 after paraquat ingestion was independently associated with improved in-hospital survival compared with initiation on Days 2–3.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 48-53"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842534","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":"Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional risk scores","authors":"Harun Yildirim ,&nbsp;Murtaza Kaya ,&nbsp;Suleyman Cosgun","doi":"10.1016/j.ajem.2025.12.020","DOIUrl":"10.1016/j.ajem.2025.12.020","url":null,"abstract":"<div><h3>Background</h3><div>Upper gastrointestinal bleeding (UGIB) is a common, potentially life-threatening emergency. Early risk stratification is essential for effective triage and management. Although scores like AIMS65, Glasgow-Blatchford (GBS), and pre-endoscopic Rockall (PERS) are widely used, the roles of NEWS-2 and its lactate-enhanced version (NEWS-2 L) in UGIB have not been fully assessed.</div></div><div><h3>Objective</h3><div>To compare the prognostic performance of NEWS-2 and NEWS2-L with conventional scoring systems in predicting in-hospital mortality in UGIB patients presenting to the ED.</div></div><div><h3>Methods</h3><div>In this prospective observational study, adult patients admitted to the ED with clinically confirmed UGIB were enrolled. A total of 178 patients were included in the final analysis. For each patient, GBS, PERS, AIMS65, NEWS-2, and NEWS2-L scores were calculated at presentation. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of each scoring system. Sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and area under the curve (AUC) values were reported. Multivariate logistic regression was conducted to identify independent predictors of in-hospital mortality.</div></div><div><h3>Results</h3><div>Mortality occurred in 20.2 % of patients. All scoring systems significantly predicted mortality. AIMS65 had the highest sensitivity and lowest negative LR, while NEWS-2 showed the highest specificity and strongest positive LR. NEWS2-L offered minimal improvement over NEWS-2. In multivariate analysis, AIMS65 and NEWS-2 remained independent predictors; lactate alone did not.</div></div><div><h3>Conclusion</h3><div>Among patients with upper gastrointestinal bleeding, AIMS65 and NEWS-2 were both useful for mortality prediction. The lactate-augmented NEWS2-L provided modest additional benefit.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 14-21"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835389","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":"Utilizing an ultrasound-guided nerve block for management of sciatica in the ED: A national simulation-based cost savings analysis","authors":"Lachlan Driver ,&nbsp;Carrie D. Walsh ,&nbsp;Caroline Schissel ,&nbsp;David A. Meguerdichian ,&nbsp;Nicole M. Duggan ,&nbsp;Christopher W. Baugh ,&nbsp;Andrew J. Goldsmith","doi":"10.1016/j.ajem.2025.12.045","DOIUrl":"10.1016/j.ajem.2025.12.045","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute sciatica is a frequent cause of emergency department (ED) visits and hospital admissions. We evaluated the potential national cost savings of using ultrasound-guided transgluteal sciatic nerve block (TGSNB) in patients with acute sciatica who would otherwise be admitted.</div></div><div><h3>Methods</h3><div>We performed a Monte Carlo simulation with 10,000 iterations to compare the costs of usual care versus TGSNB targeted to patients who would otherwise require admission. Model inputs included national ED visits for acute sciatica, pre-block admission rates, admission costs, and procedural costs. The primary outcomes were per-patient savings among admitted patients and projected annual national savings.</div></div><div><h3>Results</h3><div>Targeted use of TGSNB in admission-eligible patients yielded mean per-patient savings of $11,974 (95 % UI: $6702–$18,527). Extrapolated nationally, this corresponds to $45.8 M (95 % UI $22.9 M–$74.0 M) in annual savings. Block costs were modest ($0.67 M (95 % UI: $0.46 M–$0.93 M)), and sensitivity analysis identified admission rates and costs as the main drivers of savings.</div></div><div><h3>Conclusions</h3><div>Adoption of TGSNB for severe sciatica in the ED may reduce admissions and generate meaningful healthcare savings. Prospective studies are needed to confirm clinical efficacy and implementation feasibility.</div><div>Capsule Summary:<ul><li><span>1.</span><span><div>What is already known on this topic:</div><div>Ultrasound-guided transgluteal sciatic nerve block (TGSNB) can rapidly relieve radicular pain; ED adoption is limited.</div></span></li><li><span>2.</span><span><div>What question this study addressed:</div><div>What national cost savings could result if EDs target TGSNB to patients with acute sciatica who would otherwise be admitted?</div></span></li><li><span>3.</span><span><div>What this study adds to our knowledge:</div><div>A Monte Carlo model (10,000 iterations) projects $11,974 per-treated-patient savings and $45.8 M annual national savings, with admission rate and admission cost as primary drivers.</div></span></li><li><span>4.</span><span><div>How this is relevant to clinical practice:</div><div>Targeted ED TGSNB could reduce admissions and overall costs while supporting opioid-sparing pain management.</div></span></li></ul></div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 135-140"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927290","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}