American Journal of Emergency Medicine最新文献

{"title":"Diagnostic accuracy of an automated classifier for the detection of pleural effusions in patients undergoing lung ultrasound","authors":"Rushil Chaudhary MD ,&nbsp;Jordan Ho MD ,&nbsp;Delaney Smith BSc ,&nbsp;Saad Hossain ,&nbsp;Jaswin Hargun ,&nbsp;Blake VanBerlo BESc ,&nbsp;Niall Murphy ,&nbsp;Ross Prager MD ,&nbsp;Kiran Rikhraj MD ,&nbsp;Jared Tschirhart MD ,&nbsp;Robert Arntfield MD","doi":"10.1016/j.ajem.2025.01.041","DOIUrl":"10.1016/j.ajem.2025.01.041","url":null,"abstract":"<div><h3>Rationale</h3><div>Lung ultrasound, the most precise diagnostic tool for pleural effusions, is underutilized due to healthcare providers' limited proficiency. To address this, deep learning models can be trained to recognize pleural effusions. However, current models lack the ability to diagnose effusions in diverse clinical contexts, which presents significant challenges.</div></div><div><h3>Objective</h3><div>To develop and validate a deep learning model for detecting pleural effusions in lung ultrasound images, with adaptable performance characteristics tailored to specific clinical scenarios.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at two Canadian tertiary hospitals to evaluate the detection of pleural effusions of varying sizes and complexities using lung ultrasound. A deep learning model incorporating a frame-level convolutional neural network and a clip-level prediction algorithm was developed and validated against expert annotations.</div></div><div><h3>Results</h3><div>The model was evaluated using a holdout dataset of 103 lung ultrasound clips from 46 patients with pleural effusion and 136 clips from 83 patients without effusion. The general model achieved a sensitivity of 0.90 for small-to-large effusions, with a specificity of 0.89. The large effusion model demonstrated a sensitivity of 0.97 for large effusions while maintaining a specificity of 0.90. The trauma model showed high sensitivity to all effusions, including trace (0.91) and small (0.97) effusions.</div></div><div><h3>Conclusion</h3><div>Our research highlights the development of a deep learning model that effectively detects pleural effusions of varying sizes and complexities on lung ultrasound in different clinical settings. This tool has the potential to enhance emergency physicians' ability to quickly and accurately diagnose effusions, particularly in time-sensitive situations.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Pages 142-150"},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061633","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":"Authors reply: ChatGPT's ECG interpretations: Sensitivity or specificity? Which matters more in the emergency department?","authors":"Arian Zaboli, Gianni Turcato","doi":"10.1016/j.ajem.2025.01.026","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.026","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042343","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":"Risk of mortality among adolescents and young adults following hospitalization from an intentional overdose.","authors":"Jung-Chi Chiang, I Kuan Wu, Chien-Chieh Hsieh","doi":"10.1016/j.ajem.2025.01.048","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.048","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061597","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":"Global research trends of BRUE (brief resolved unexplained event) or formerly ALTE (apparent life-threatening event): A comprehensive visualization and bibliometric analysis from 1988 to 2024","authors":"Derşan Onur ,&nbsp;Murat Çetin","doi":"10.1016/j.ajem.2025.01.045","DOIUrl":"10.1016/j.ajem.2025.01.045","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to conduct a comprehensive bibliometric analysis of the literature on Brief Resolved Unexplained Event (BRUE) and its predecessor, Apparent Life-Threatening Event (ALTE), from 1988 to 2024, in order to identify research trends, collaborative networks, and areas of focus in this field.</div></div><div><h3>Methods</h3><div>We analyzed articles indexed in Scopus and Web of Science using various bibliometric indicators. The visualization of bibliometric networks was performed using VOSviewer and bibliometrix. Publication trends, citation analysis, co-authorship networks, and keyword co-occurrence were examined.</div></div><div><h3>Results</h3><div>A total of 270 articles were analyzed, of which 85.56 % were research articles and 14.44 % were review articles. The number of publications showed a significant increase over time (<em>r</em> = 0.73, <em>p</em> &lt; 0.001). The United States emerged as the leading contributor with strong international collaborations. The most prolific journals were Pediatrics, Pediatric Emergency Care, and Journal of Pediatrics. Keyword analysis revealed a shift from terms associated with life-threatening events (e.g., SIDS, sleep apnea syndrome) to more specific terminology (BRUE) and methodological keywords over time. However, the 2016 redefinition of ALTE to BRUE did not result in a corresponding increase in publications.</div></div><div><h3>Conclusion</h3><div>This bibliometric analysis provides valuable insights into the evolution and current state of BRUE/ALTE research. The findings highlight the field's progression toward more precise, evidence-based approaches. The identified research trends and gaps, particularly the limited studies from developing countries, offer direction for future research. These results can inform clinical practice, guide research priorities, and support the development of standardized guidelines for BRUE/ALTE management.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Pages 129-141"},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048918","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":"Association of ketamine administration with intubation and cardiac arrest for prehospital patients with behavioral and substance-related complaints in the US.","authors":"Ryan Huebinger, Dorothy Habrat, Christie L Fritz, Andrew J Harrell, Whitney J Barrett","doi":"10.1016/j.ajem.2025.01.047","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.047","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076572","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":"Should digoxin immune fab be administered based solely on reported ingested amount in acute digoxin poisoning?","authors":"Jon B Cole, Lesley C Pepin, Carrie L Oakland, Elisabeth F Bilden","doi":"10.1016/j.ajem.2025.01.038","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.038","url":null,"abstract":"<p><p>Acute digoxin poisoning is increasingly uncommon in emergency medicine. Furthermore, controversy exists regarding indications for antidotal digoxin immune fab in acute poisoning. In healthy adults, the fab prescribing information recommends administration based on \"known consumption of fatal doses of digoxin: ≥10mg,\" while many emergency medicine textbooks suggest fab administration be driven by clinical features or potassium concentration. A 54 kg adult, not on digoxin, presented one hour after ingesting 12.5 mg. Electrocardiogram revealed only ST depression and first degree heart block. Initial pulse was 102 beats/min, systolic blood pressure was 170 mmHg. The patient was otherwise asymptomatic. Poison center recommended immediately obtaining serum potassium and digoxin concentrations; call-back was planned for two hours. The emergency physician was instructed to have ≥10 fab vials bedside and to administer if instability ensued. Thirty-five minutes later (≈90 min post-ingestion) ventricular fibrillation cardiac arrest occurred; initial serum potassium resulted at this time at 3.3 mEq/L. Bicarbonate, insulin and glucose, amiodarone, magnesium, calcium, and 10 fab vials were administered. Cardioversion resulted in wide-complex tachycardia which became ventricular fibrillation then asystole and the patient died. Serum digoxin concentration drawn on hospital arrival resulted after death at 44 ng/mL. In this fatal case of acute digoxin poisoning, fab was not empirically recommended because the patient initially did not have significant signs or symptoms that accompanied the history of ingesting ≥10 mg digoxin. While the bedside team was given clear anticipatory guidance by the regional poison center, the patient died despite fab administration once instability occurred.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030342","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":"Use of psychoactive medications in topical cream: Need for regulation and vigilance!","authors":"Anju Gupta, Amiya Kumar Barik, Chitta Ranjan Mohanty, Rakesh Vadakkethil Radhakrishnan, Surya Kumar Maddala","doi":"10.1016/j.ajem.2025.01.037","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.037","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030347","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":"Risks associated with opioid prescriptions for headache in the emergency department","authors":"Hayward Jake MD MPH ,&nbsp;MacLean Davis MD MPH ,&nbsp;Rosychuk Rhonda PhD ,&nbsp;Lonergan Kevin ,&nbsp;Innes Grant MD MHSc","doi":"10.1016/j.ajem.2025.01.028","DOIUrl":"10.1016/j.ajem.2025.01.028","url":null,"abstract":"<div><h3>Study hypothesis</h3><div>Use of opioids for treatment of headache in the emergency department (ED) is associated with an increased 1-year risk of opioid-related adverse events.</div></div><div><h3>Objective</h3><div>To assess the safety and efficacy of opioid prescribing for ED patients with headache.</div></div><div><h3>Methods</h3><div>We performed a multicenter observational cohort study using linked administrative data. All patients discharged from an ED in the province of Alberta, Canada with a headache diagnosis between 2010 and 2020 were included. Opioid-treated patients filled opioid prescriptions within 72 h of their ED visit, and were matched to untreated controls using propensity scores. The 1-year primary outcome was a composite of long-term prescription opioid use (LTU), opioid-related ED visit or hospitalization, or new opioid agonist therapy (OAT). Secondary outcomes included all-cause acute care utilization and 7-day ED return headache visits.</div></div><div><h3>Results</h3><div>Of 323,932 eligible headache visits, 5.7 % received opioids. Opioid-treated patients were comparable to controls on all baseline characteristics. The primary outcome occurred in 8.7 % of opioid-treated patients and 5.8 % of controls (aOR 1.65 [1.49–1.82]; NNH = 29). Opioid-treated patients had higher rates of LTU (7.7 % vs. 4.8 %), all-cause ED visit (20.8 % vs. 19.0 %), all-cause hospitalization (16.7 % vs. 14.8 %), and 7-day revisit (aOR = 1.61 [1.49–1.74]; NNH = 21) but did not experience more opioid-related ED visits or hospitalizations, or new OAT. Opioid prescription potency and duration were strong predictors of harm.</div></div><div><h3>Conclusion</h3><div>Opioid prescriptions are associated with ED revisits, hospitalizations and LTU in headache patients, without improved efficacy. These findings support the growing notion that opioids are not indicated for ED headache management.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Pages 109-114"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic STEMI in a male trauma patient due to coronary artery compression by a left sided chest tube.","authors":"J A Holtmann, B Kipfer, B Lehmann, M Galanis, W Hautz, A Exadaktylos","doi":"10.1016/j.ajem.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.01.040","url":null,"abstract":"<p><p>Iatrogenic ST segment elevation myocardial infarction (STEMI) after insertion of a left sided thoracic tube is a rare insertional complication. We present a case of coronary artery compression of the left anterior descending artery (LAD) caused by a left sided chest tube placed after blunt thoracic trauma with pneumothorax resulting in a STEMI. A 53-year-old male patient with severe blunt thoracic trauma presented in the emergency department. After diagnosing a left sided pneumothorax in the primary survey according to ATLS, a chest drain was inserted. Shortly after insertion of the chest tube, a STEMI pattern appeared on the ECG (electrocardiogram). CT scans showed proximity of the chest tube to the LAD. Immediate pullback of the chest tube led to resolution of the electrocardiographic abnormalities. Complications after chest tube insertion can occur in up to 30 % of patients. However, no similar case with iatrogenic ST segment elevation myocardial infarction due to compression of a coronary artery has been reported in the literature so far. Knowledge of the possible complications of an intervention is important and a 'high level of suspicion' is required in order to recognize and resolve them quickly.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257489","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":"PEN-FAST-ED: Utilizing the PEN-FAST decision tool to guide antibiotic prescribing in the emergency department","authors":"Kimberly Tran PharmD ,&nbsp;Jeremy Lund PharmD ,&nbsp;Chloe Sealy PharmD ,&nbsp;David Langley DO ,&nbsp;Jamie Kisgen PharmD","doi":"10.1016/j.ajem.2025.01.039","DOIUrl":"10.1016/j.ajem.2025.01.039","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Patient-reported penicillin allergies are frequently encountered in the emergency department (ED), which often lead to non-beta-lactam antibiotic use despite beta-lactams' place as first-line therapy in most bacterial infections. The PEN-FAST clinical decision tool was developed and validated to identify patients with a low risk of true penicillin allergies that do not require formal skin testing for rechallenging. The tool consists of four questions that add up to a total score ranging from 0 to 5. Scores of 0–2 are associated with low risk of true penicillin allergy (&lt;5% risk of true reaction); scores of 3 with moderate risk (&lt;20% risk); and scores of 4–5 with high risk (50% risk). The purpose of our study was to determine the safety and efficacy of our facility's implementation of pharmacist utilization of the PEN-FAST screening tool to assess purported penicillin allergies and rechallenge low to moderate risk patients in the ED.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a single-center, prospective, observational cohort study conducted from October 2023 to March 2024. Adult ED patients with a documented penicillin allergy with an order for aztreonam, levofloxacin, clindamycin, or a consult for pharmacy to assist with antibiotic selection were included. Patients were excluded if the order or consult was placed by a non-ED physician, no penicillin allergy was documented, the patient had previously tolerated a penicillin or cephalosporin per chart review, was unable to participate in the interview, or the completion of the assessment would delay patient care. The primary outcome was the percent of patients with a PEN-FAST score of 0–2 who tolerated a beta-lactam antibiotic after pharmacist intervention. Secondary safety and logistical outcomes included the incidence of immune-mediated reactions within one hour of beta-lactam administration, timing of the assessment, and antibiotic selection in transitions of care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 361 patients screened, 100 patients were included. There were 61% of patients who had a PEN-FAST score of 0–2, 30% had a score of 3, and 9% had a score of 4–5. For the primary outcome, all 52 (100%) patients with a PEN-FAST score of 0–2 who were rechallenged tolerated a beta-lactam antibiotic in the ED. For secondary outcomes, 6 patients with PEN-FAST score of 3 were rechallenged and tolerated a beta-lactam. There were 0 incidences of any immune-mediated reactions within one hour of beta-lactam administration. The median time from initial order placement to change in therapy and to antibiotic administration was 17 min and 41 min, respectively. Of those rechallenged, 13 of 14 discharged (93%) and 39 of 44 admitted patients (89%) were continued on beta-lactam antibiotics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this prospective, observational study, administration of beta-lactam antibiotics to ED patients with previously reported penicillin allergies an","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"90 ","pages":"Pages 124-128"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048920","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}