Academic Emergency Medicine最新文献

{"title":"Response.","authors":"Layla Parast, Megan Mathews, Marc N Elliott","doi":"10.1111/acem.15069","DOIUrl":"https://doi.org/10.1111/acem.15069","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost of saving lives: Complications arising from prehospital tourniquet application.","authors":"Mor Rittblat, Sami Gendler, Nir Tsur, Irina Radomislensky, Arnona Ziv, Moran Bodas","doi":"10.1111/acem.15070","DOIUrl":"https://doi.org/10.1111/acem.15070","url":null,"abstract":"<p><strong>Background: </strong>Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors.</p><p><strong>Methods: </strong>This retrospective observational study reviewed the medical records of adult trauma casualties (>18 years) hospitalized at Chaim Sheba Medical Center (SMC) between 2010 and 2020 who had a TQ applied in the prehospital setting. The primary outcome was the rate and type of complications. Logistic regression analyses identified risk factors using demographic, injury, and clinical data.</p><p><strong>Results: </strong>From 2010 to 2020, a total of 84 trauma casualties with documented prehospital TQ application were hospitalized at SMC. Of these, 20 (23.81%) experienced TQ-related complications, including local infection, compartment syndrome, and thromboembolism. The average TQ application time was 44.2 min, with no significant difference between those with and without complications. However, significant differences were noted in the mechanism of injury (MOI), wound contamination levels, indications for TQ application, and initial blood test results (p < 0.05). Logistic regression analyses revealed length of stay (LOS) and injuries from falls were significantly associated with the development of complications.</p><p><strong>Conclusions: </strong>This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833415","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":"Algorithmic identification of overlapping abstract submissions at the Society for Academic Emergency Medicine annual meeting.","authors":"Patrick Maher, Ryan LaFollette, Colin F Greineder, Paul I Musey","doi":"10.1111/acem.15062","DOIUrl":"https://doi.org/10.1111/acem.15062","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833410","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":"Leveraging artificial intelligence to reduce diagnostic errors in emergency medicine: Challenges, opportunities, and future directions.","authors":"R Andrew Taylor, Rohit B Sangal, Moira E Smith, Adrian D Haimovich, Adam Rodman, Mark S Iscoe, Suresh K Pavuluri, Christian Rose, Alexander T Janke, Donald S Wright, Vimig Socrates, Arwen Declan","doi":"10.1111/acem.15066","DOIUrl":"https://doi.org/10.1111/acem.15066","url":null,"abstract":"<p><p>Diagnostic errors in health care pose significant risks to patient safety and are disturbingly common. In the emergency department (ED), the chaotic and high-pressure environment increases the likelihood of these errors, as emergency clinicians must make rapid decisions with limited information, often under cognitive overload. Artificial intelligence (AI) offers promising solutions to improve diagnostic errors in three key areas: information gathering, clinical decision support (CDS), and feedback through quality improvement. AI can streamline the information-gathering process by automating data retrieval, reducing cognitive load, and providing clinicians with essential patient details quickly. AI-driven CDS systems enhance diagnostic decision making by offering real-time insights, reducing cognitive biases, and prioritizing differential diagnoses. Furthermore, AI-powered feedback loops can facilitate continuous learning and refinement of diagnostic processes by providing targeted education and outcome feedback to clinicians. By integrating AI into these areas, the potential for reducing diagnostic errors and improving patient safety in the ED is substantial. However, successfully implementing AI in the ED is challenging and complex. Developing, validating, and implementing AI as a safe, human-centered ED tool requires thoughtful design and meticulous attention to ethical and practical considerations. Clinicians and patients must be integrated as key stakeholders across these processes. Ultimately, AI should be seen as a tool that assists clinicians by supporting better, faster decisions and thus enhances patient outcomes.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The private-sector \"auxiliary EMS\" model complementing formal EMS in Japan.","authors":"Shinji Nakahara, Mari Yokota, Masamichi Nishida","doi":"10.1111/acem.15068","DOIUrl":"https://doi.org/10.1111/acem.15068","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827199","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":"Response to Bourke and Douglas.","authors":"Yonathan Freund","doi":"10.1111/acem.15072","DOIUrl":"https://doi.org/10.1111/acem.15072","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816993","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-velocity nasal insufflation versus noninvasive positive pressure ventilation for moderate acute exacerbation of chronic obstructive pulmonary disease in the emergency department: A randomized clinical trial.","authors":"David P Yamane, Christopher W Jones, R Gentry Wilkerson, Joshua J Oliver, Soroush Shahamatdar, Aditya Loganathan, Taylor Bolden, Ryan Heidish, Connor L Kelly, Amy Bergeski, Jessica S Whittle, George C Dungan, Richard Maisiak, Andrew C Meltzer","doi":"10.1111/acem.15038","DOIUrl":"https://doi.org/10.1111/acem.15038","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) involve dyspnea, cough, and chest discomfort; frequent exacerbations are associated with increased mortality and reduced quality of life. Noninvasive positive pressure ventilation (NiPPV) is commonly used to help relieve symptoms but is limited due to patient intolerance. We aimed to determine whether high-velocity nasal insufflation (HVNI) is noninferior to NiPPV in relieving dyspnea within 4 h in ED patients with acute hypercapnic respiratory failure.</p><p><strong>Methods: </strong>This randomized control trial was conducted in seven EDs in the United States. Symptomatic patients with suspected COPD, partial pressure of carbon dioxide (pCO₂) ≥ 60 mm Hg, and venous pH 7.0-7.35 were randomized to receive HVNI (n = 36) or NiPPV (n = 32). The primary outcome was dyspnea severity 4 h after the initiation of study intervention, as measured by the Borg score. Secondary outcomes included vital signs, oxygen saturation, venous pCO₂, venous pH, patient discomfort level, and need for endotracheal intubation.</p><p><strong>Results: </strong>Sixty-eight patients were randomized between November 5, 2020, and May 10, 2023 (mean age 65.6 years; 47% women). The initial pCO₂ was 77.7 ± 13.6 mm Hg versus 76.5 ± 13.6 mm Hg and the initial venous pH was 7.27 ± 0.063 versus 7.27 ± 0.043 in the HVNI and NiPPV groups, respectively. Dyspnea was similar in the HVNI and NiPPV groups at baseline (dyspnea scale score 5.4 ± 2.93 and 5.6 ± 2.41) and HVNI was noninferior to NiPPV at the following time points: 30 min (3.97 ± 2.82 and 4.54 ± 1.65, p = 0.006), 60 min (3.09 ± 2.70 and 4.07 ± 1.77, p < 0.001), and 4 h (3.17 ± 2.59 and 3.34 ± 2.04, p = 0.03). At 4 h, there was no difference between the groups in the pCO₂ mm Hg (68.76 and 67.29, p = 0.63). Patients reported better overall comfort levels in the HVNI group at 30 min, 60 min, and 4 h (p = 0.003).</p><p><strong>Conclusions: </strong>In participants with symptomatic COPD, HVNI was noninferior to NiPPV in relieving dyspnea 4 h after therapy initiation. HVNI may be a reasonable treatment option for some patients experiencing moderate acute exacerbations of COPD in the ED.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811776","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":"Assessment of sous vide water baths in the acute rewarming of frostbitten extremities: A multicenter study.","authors":"Nicholas J Daniel, Johndavid M Storn, Nicholas E Weinberg, William A Galvin, Hillary R Irons, Aaron N Barksdale, Megan L Rischall, Sean M Bilodeau, Jasmine Y Gale, Katherine G Willet, Amalya Wilson, Kara Keiper, Jessica Chevalier","doi":"10.1111/acem.15061","DOIUrl":"https://doi.org/10.1111/acem.15061","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798950","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":"Respiratory pathogen testing in children in the postpandemic era in Illinois.","authors":"Sriram Ramgopal, Kenneth A Michelson","doi":"10.1111/acem.15060","DOIUrl":"https://doi.org/10.1111/acem.15060","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798955","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":"Low sexually transmitted infection (STI) screening and presumptive treatment and high STI positivity among United States females visiting the emergency department after sexual assault.","authors":"Guoyu Tao, Chirag G Patel, Kimberly A Stanford","doi":"10.1111/acem.15058","DOIUrl":"https://doi.org/10.1111/acem.15058","url":null,"abstract":"<p><strong>Objective: </strong>The Centers for Disease Control and Prevention sexually transmitted infection (STI) treatment guidelines state that the decision to provide STI/human immunodeficiency virus (HIV) testing and presumptive treatment after sexual assault (SA) should be made on an individual basis to minimize retraumatization of the patient. However, little is known about STI screening, presumptive treatment, and positivity in the emergency department (ED) setting. The objective of this study was to evaluate STI testing rates and positivity, presumptive gonorrhea and chlamydia treatment, pregnancy testing, and emergency contraception offered to SA survivors in the ED in the United States.</p><p><strong>Methods: </strong>The Premier Healthcare Database, a national administrative data set containing health care information from inpatient and hospital-based outpatient encounters, was used. Approximately 30% of encounters have available laboratory test results. ED visits for SA (identified by ICD-10-CM codes) among female patients aged 15-44 years between 2019 and 2023 were included. For patients presenting multiple times to the ED, only the first ED visit after SA was included.</p><p><strong>Results: </strong>Of 49,047 total visits where females ages 15-44 years presented to the ED for SA, chlamydia, gonorrhea, syphilis, and HIV tests were conducted in 18.6%, 18.6%, 13.4%, and 16.9%, respectively, and pregnancy tests in 33.1% of visits. Presumptive gonorrhea and chlamydia treatment was provided in 53.7% and 52.2%, respectively, and emergency contraception in 27.2% of visits. Approximately 40% of patients were neither tested nor treated for either chlamydia or gonorrhea. Of patients with available laboratory test results, chlamydia, gonorrhea, and syphilis positivity rates were 10.0%, 3.8%, and 1.0%, respectively.</p><p><strong>Conclusions: </strong>Low STI testing and treatment rates and high STI positivity identified in this study suggest that an important opportunity exists for improving STI screening and presumptive treatment for female patients presenting to the ED after SA.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765336","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}