Annals of emergency medicine最新文献

{"title":"An Elderly Man With Anterior Neck Pain.","authors":"Po-Jung Chen,Yen-Wei Chiu,Wei-Jing Lee","doi":"10.1016/j.annemergmed.2025.04.026","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.04.026","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"31 1","pages":"541-542"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying National Institutes of Health Investment Estimates for Sepsis Research.","authors":"Ryan A Coute,Patrick J Siler,Michael C Kurz","doi":"10.1016/j.annemergmed.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.05.027","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"101 1","pages":"559-560"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine as First-Line Treatment in Status Epilepticus? How Generalizability Affects Data Interpretation: November 2025 Annals of Emergency Medicine Journal Club.","authors":"Brendan Freeman,Kathryn Zabinski,Anand K Swaminathan","doi":"10.1016/j.annemergmed.2025.07.031","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.031","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"98 1","pages":"547-548"},"PeriodicalIF":6.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intranasal Versus Subcutaneous Ketamine for the Treatment of Acute Traumatic Pain in the Emergency Department: A Randomized Clinical Trial.","authors":"Randa Dhaoui,Cyrine Kouraichi,Marwa Toumia,Khaoula Bel Haj Ali,Adel Sekma,Rahma Jaballah,Hajer Yaakoubi,Lotfi Boukadida,Kaouthar Beltaief,Zied Mezgar,Mariem Khrouf,Amira Sghaier,Nahla Jerbi,Imen Zemni,Wahid Bouida,Mohamed Habib Grissa,Jamel Saad,Hamdi Boubaker,Riadh Boukef,Mohamed Amine Msolli,Semir Nouira","doi":"10.1016/j.annemergmed.2025.09.019","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.019","url":null,"abstract":"STUDY OBJECTIVETo compare the efficacy and safety of subcutaneous versus intranasal ketamine in controlling pain following acute musculoskeletal trauma.METHODSWe conducted a randomized, double-blinded, double-dummy prospective study, including adult participants aged 18 to 65 years, presenting to the emergency department (ED) for acute musculoskeletal trauma with moderate to severe pain. Participants were randomly assigned to receive either 20 mg subcutaneous or intranasal ketamine. Our primary outcome was the reduction in the numerical rating scale (NRS) at 30 minutes, with additional measures at 5, 10, 15, 60, 90, and 120 minutes. Other secondary outcomes were the percentage of patients with a NRS score of less than 3 at the end of the protocol, adverse events, and the need for additional pain medications.RESULTSWe enrolled 599 patients in the subcutaneous group and 595 in the intranasal group. At 30 minutes, the mean NRS decrease from baseline was -3.70 (1.88) in the subcutaneous group and -4.42 (2.15) in the intranasal group, yielding a mean difference of -0.72 (95% confidence interval -0.95 to -0.48). Although statistically significant, this difference, as well as those observed at all other time points, remained below the 1.3 NRS threshold for clinical importance. There was no difference in secondary outcomes except more minor adverse events in the subcutaneous group.CONCLUSIONFor patients presenting to the ED with acute musculoskeletal trauma, we found no clinically important differences in pain reduction between ketamine 20 mg, subcutaneous and ketamine 20 mg, intranasal.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"1 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial Doppler Ultrasound Blood Flow Waveforms During Chest Compressions to Detect Arterial Line Pulsatility.","authors":"Daniel M Rolston,Nicholas Bielawa,Xueqi Huang,Alexander V Nello,Ghania Haddad,Daniel Jafari,Timmy Li,Lance B Becker,Allison L Cohen","doi":"10.1016/j.annemergmed.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.018","url":null,"abstract":"STUDY OBJECTIVEDoppler ultrasound blood flow waveforms during active chest compressions are unique and may allow identification of return of spontaneous circulation. We assessed diagnostic accuracy of 4 identified Doppler ultrasound blood flow waveforms-(1) bidirectional blood flow, (2) minimal blood flow, (3) anterograde dominant blood flow, and (4) pulsatility through compressions-during chest compressions to detect arterial line (a-line) pulsatility during a subsequent pulse check. Secondarily, we assessed if pulsatility through compressions was associated with higher systolic blood pressure (SBP) at pulse check than anterograde dominant blood flow.METHODSWe conducted a retrospective, diagnostic accuracy study on a prospectively collected convenience sample of adult, emergency department cardiac arrest patients. All patients had a femoral a-line. Prior to a pulse check, Doppler ultrasound clips of the femoral artery were saved and reviewed. During a pulse check, the presence or absence of an arterial line waveform and the highest SBP were recorded. Accuracy, sensitivity, and specificity of the blood flow waveforms were calculated using generalized estimating equation models.RESULTSForty-four patients with 123 Doppler ultrasound waveforms and subsequent pulse checks were analyzed. Accuracy of the Doppler ultrasound waveforms was 88.9% (95% confidence interval [CI] 81.3 to 93.7), sensitivity of pulsatility through compressions or anterograde dominant blood flow to detect a-line pulsatility was 97.7% (95% CI 87.7 to 99.6), and specificity of bidirectional blood flow or minimal blood flow for the absence of a-line pulsatility was 81.5% (95% CI 69.3 to 89.6). Estimated least-squares mean SBP was higher (50.9 mmHg [95% CI 25.6 to 76.1 mmHg]) for pulsatility through compressions than anterograde dominant blood flow waveforms.CONCLUSIONArterial Doppler ultrasound waveforms during chest compressions had good diagnostic test characteristics for detecting arterial line pulsatility at subsequent pulse check.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"19 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 for Acute Traumatic Intracranial Lesions: The PIONEER Diagnostic Accuracy Study.","authors":"Nathan B Roberts,Tian Xie,Hayley Falk,Jayapalli Bapuraj,Debra Demski,Carmen Gherasim,Christopher M Fung,Nathan L Haas,Keith E Kocher,Katharine S Seagly,Richard P Medlin,Adrianna Kallabat,Andrew Askar,Jacob Joseph,Matthew J Schipper,Frederick K Korley","doi":"10.1016/j.annemergmed.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.012","url":null,"abstract":"OBJECTIVETo determine the diagnostic accuracy of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) for detecting clinically significant acute traumatic intracranial lesions in emergency department patients who undergo brain computed tomography (CT) after blunt trauma.METHODSWe conducted a retrospective study of 1,867 patients aged more than or equal to 18 years, who presented with trauma-related complaints, underwent brain CT, and had residual samples collected less than or equal to 24 hours postinjury. We evaluated the diagnostic accuracy of GFAP and UCH-L1 using the Abbott i-STAT TBI Plasma test. Additionally, we assessed diagnostic accuracy within key clinical subgroups to define a proposed implementation cohort and assessed the diagnostic accuracy of the biomarkers within this cohort.RESULTSAmong 1,867 patients, 49 (2.6%) had clinically significant traumatic intracranial lesions. Elevated GFAP or UCH-L1 demonstrated 96% sensitivity (95% confidence interval [CI] 86% to 99%), 30% specificity (95% CI 28% to 32%), positive likelihood ratio (LR+) of 1.38 (95% CI 1.29 to 1.47), and negative likelihood ratio (LR-) of 0.13 (95% CI 0.03 to 0.53). Two patients had clinically significant CT lesions without elevated GFAP or UCH-L1. In the proposed implementation cohort of adults aged more than or equal to 18 years without coagulopathy elevated GFAP or UCH-L1 had a sensitivity of 100% (95% CI 86% to 100%), specificity of 33% (95% CI 31% to 36%), LR+ of 1.50 (95% CI 1.44 to 1.56), and LR- of 0.00 (95% CI 0.00 to 0.95).CONCLUSIONPlasma GFAP and UCH-L1 in combination, measured ≤24 hours postinjury, demonstrated high sensitivity for clinically significant acute traumatic intracranial lesions. Further research is needed to determine whether deploying these biomarkers in the proposed implementation cohort decreases avoidable brain CT scans.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"8 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discharge Time From the Emergency Department and the Frequency of Revisits.","authors":"Andreas Roos,Gustaf Edgren","doi":"10.1016/j.annemergmed.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.014","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"88 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation, Stabilization, and Transfer of Pregnant and Postpartum Patients Presenting to Emergency Departments Without Inpatient Obstetric Services.","authors":"Elisabeth Erekson,Guy Nuki,Nathan Mick,Kelley Conroy,Maria D Padin,Emily Watson,Regan N Theiler","doi":"10.1016/j.annemergmed.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.011","url":null,"abstract":"More than 50% of rural critical access hospitals in the United States no longer provide inpatient obstetric services. As more hospitals close their hospital-based obstetric services, emergency physicians must still be ready to care for pregnant patients who present emergently for care. Ideally, this will include immediate medical screening examination, stabilization and transfer to a hospital with obstetric services. In other circumstances, it will result in the need to provide basic obstetric emergency care for conditions such as unanticipated delivery, postpartum hemorrhage, eclamptic seizure, and neonatal resuscitation. Emergency physicians working in hospitals without inpatient obstetric services need to have knowledge of both the closest obstetric unit they can transfer a full-term patient for obstetric triage and delivery, and where they can transfer a preterm patient at any gestational age. Level I Obstetrical Units (low-risk units) can typically accept patients with more than 37 weeks gestation. Regional maternal centers (Level III/Level IV) can typically accept any gestational age. It is critical for emergency physicians working in facilities without inpatient obstetrics to be familiar with both resources in their catchment area (eg, nearby low-risk and regional high-risk centers). This article examines the emergency physician's role in evaluation, stabilization, and transfer of pregnant and postpartum patients seeking emergency medical care at facilities without inpatient obstetric services.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"38 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Opioid Use Disorder Across a National Emergency Department Practice Improvement Network.","authors":"Scott G Weiner,Arjun K Venkatesh,Prateek B Sharma,Craig Rothenberg,Sam Shahid,Megan Sambell,Pawan Goyal,Kathryn F Hawk","doi":"10.1016/j.annemergmed.2025.09.010","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.010","url":null,"abstract":"STUDY OBJECTIVEThis study aimed to assess practices surrounding opioid use disorder (OUD), specifically provision of naloxone and medication for OUD (MOUD), in a large sample of emergency departments (EDs) participating in a quality improvement initiative.METHODSData were obtained from EDs participating in the American College of Emergency Physicians' Emergency Quality Network substance use disorder program, a national practice-based quality improvement initiative. ED sites abstracted data elements from a random sample of discharged visits with diagnosis codes for opioid overdose or OUD. Data were reported in May and October 2023 for visits that occurred up to 6 months prior to the reporting period. The percentages of visits for which naloxone was prescribed or dispensed and MOUD was administered or prescribed were determined.RESULTSThere were 6,749 included visits for overdose or OUD reported from 300 unique EDs. Naloxone was either dispensed or prescribed in 1,874 (27.8%) of visits. There were 752 visits (11.1%) in which it was reported that the patient was already taking MOUD. Excluding those visits, MOUD was either administered in the ED or prescribed at discharge 438 times, representing 7.3% of potentially eligible visits.CONCLUSIONIn this large sample of visits for OUD and overdose, just over a quarter of patients with visits related to opioids were prescribed or dispensed naloxone, and administration or prescription of MOUD to patients not already on it was also low. These findings indicate opportunity for improvement in ED OUD care.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"18 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Clinical Uncertainty: Formalizing Management Reasoning in Emergency Care Delivery.","authors":"Adrian D Haimovich,Alexander T Janke,Keith E Kocher,Courtney W Mangus,Andrew S Parsons,Liam McCoy,Richard Andrew Taylor,Adam Rodman,Martin Pusic","doi":"10.1016/j.annemergmed.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.007","url":null,"abstract":"Emergency care faces a persistent tension between the imperative for diagnostic accuracy and the complex social, environmental, resource, and time constraints inherent to clinical practice. Classical diagnostic reasoning, typically portrayed as convergent, binary, and occurring in serial, linear steps, often conflicts with the necessary pragmatism of emergency department care where clinicians routinely act under conditions of uncertainty. This article argues that diagnostic reasoning occurs in parallel to the broader and less explored framework of management reasoning. We contrast management reasoning as a multidimensional, context-sensitive process wherein clinical decisions-ranging from test ordering and therapeutic interventions to patient disposition-are continuously shaped by evolving information, patient preferences, clinician judgment, and system constraints. Although interrelated, diagnostic and management reasoning represent complementary cognitive processes, each with its own objectives, methods, and measures of quality. In this piece, we argue that management reasoning is both a teachable and assessable skill and should be systematically formalized into clinical care, research, and education to support high-quality, safe, patient-centered emergency care.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"122 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}