Annals of emergency medicine最新文献

{"title":"Managing Awake Intubation.","authors":"Benjamin J Sandefur, Brian E Driver, Brit Long","doi":"10.1016/j.annemergmed.2024.07.017","DOIUrl":"10.1016/j.annemergmed.2024.07.017","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":"21-30"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543349","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":"Assessment of Prognostic Scores for Emergency Department Patients With Upper Gastrointestinal Bleeding.","authors":"Pierre-Clément Thiebaud, Eliana Wassermann, Mathilde de Caluwe, Clément Prebin, Florent Noel, Agnès Dechartres, Pierre-Alexis Raynal, Judith Leblanc, Youri Yordanov","doi":"10.1016/j.annemergmed.2024.06.024","DOIUrl":"10.1016/j.annemergmed.2024.06.024","url":null,"abstract":"<p><strong>Study objective: </strong>Early prognostic stratification could optimize the management of patients with upper gastrointestinal bleeding and reduce unnecessary hospitalizations. The aim of this study was to assess and compare the performance of existing prognostic scores in predicting therapeutic intervention and death.</p><p><strong>Methods: </strong>A systematic search of the literature identified existing prognostic scores. A multicenter retrospective cohort study included adult patients hospitalized for upper gastrointestinal bleeding from January 1, 2019, to December 31, 2020. The primary outcome was a composite including therapeutic intervention within 7 days (blood transfusion, endoscopic, surgical, or interventional radiology hemostasis) and/or 30-day death. Discrimination performance was estimated by the area under the curve (AUC). The ability to identify low-risk patients was analyzed using sensitivity and negative predictive value (NPV) for defined thresholds.</p><p><strong>Results: </strong>The systematic search identified 39 prognostic scores, 12 of which could be analyzed. Among the 990 patients included, therapeutic intervention and/or death occurred in 755 (76.4%) patients. Scores with the highest discriminative performance to predict the primary composite outcome were Glasgow-Blatchford score (GBS) (AUC 0.869 [0.842 to 0.895]), modified GBS (AUC 0.872 [0.847 to 0.898]) and modified GBS 2 (AUC 0.855 [0.827 to 0.884]). The best performance to identify low-risk patients was for GBS≤1 (sensitivity 0.99 [0.99 to 1.00], NPV 0.89 [0.75 to 0.97]) and modified GBS=0 (sensitivity 0.99 [0.98 to 1.00], NPV 0.84 [0.71 to 0.94]).</p><p><strong>Conclusions: </strong>The GBS and the modified GBS are the 2 best performing scores because they achieve both key objectives: stratifying patients based on their risk of therapeutic intervention and/or death and identifying low-risk patients who may qualify for outpatient management.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":"31-42"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874030","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":"Pigtail Catheters Are Effective and Provide Added Benefits in Traumatic Hemothorax Management.","authors":"Oluwafemi P Owodunni, Sarah A Moore, Allyson M Hynes","doi":"10.1016/j.annemergmed.2024.06.021","DOIUrl":"10.1016/j.annemergmed.2024.06.021","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":"74-75"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632483","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 Emergency Endotracheal Intubation Utilizing a Bougie.","authors":"Ryan N Barnicle, Alexander Bracey, Scott D Weingart","doi":"10.1016/j.annemergmed.2024.04.021","DOIUrl":"10.1016/j.annemergmed.2024.04.021","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":"14-20"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442070","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":"Tube Thoracostomy Should Remain the Preferred Intervention for Traumatic Hemothorax.","authors":"Leydricah S Saint Louis, Eric N Klein, Daniel Jafari","doi":"10.1016/j.annemergmed.2024.07.018","DOIUrl":"10.1016/j.annemergmed.2024.07.018","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":"76-77"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103823","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":"Effectiveness and Safety of Pharmacologic Therapies for Migraine in the Emergency Department: A Systematic Review and Bayesian Network Meta-analysis.","authors":"Ian S deSouza, Nicole Anthony, Henry Thode, Robert Allen, Jane Belyavskaya, Jessica Koos, Adam Singer","doi":"10.1016/j.annemergmed.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.004","url":null,"abstract":"<p><strong>Study objective: </strong>We performed a systematic review and Bayesian network meta-analysis to determine which pharmacologic therapies are relatively more effective and safer for migraine in adult patients who present to the emergency department (ED).</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and Web of Science from inception to February 9, 2024. Eligible studies were randomized controlled trials that enrolled adult participants presenting to ED with migraine and compared one pharmacologic therapy to another or placebo. Outcomes were as follows: 1) adequate pain relief at 2 hours, 2) change in pain intensity at 1 hour, 3) need for rescue drug at 2 hours, and 4) significant adverse reaction. We extracted data according to PRISMA-network meta-analysis and appraised trials using Cochrane RoB 2. For dichotomous outcomes, we performed Bayesian network meta-analysis to calculate odds ratios with 95% credible intervals; for continuous outcomes, we performed frequentist network meta-analysis to calculate mean differences with 95% confidence intervals. We assessed confidence using Confidence in Network Meta-analysis. We used Surface under the cumulative ranking curve (SUCRA) to rank agents.</p><p><strong>Results: </strong>Chlorpromazine intravenous (IV)/intramuscular (IM) (SUCRA=87.3%) was most likely to be superior for \"adequate pain relief at 2 hours\" (24 trials; n=2,361); metoclopramide IV-ibuprofen IV (SUCRA=94.6%) was most likely to be superior for \"need for rescue drug\" (not needing rescue drug) at 2 hours (27 trials; n=2,942); dexamethasone IV (SUCRA=79.5%) was most likely to be superior for \"significant adverse reaction\" (not causing adverse reaction) (22 trials; n=2,450). The network for change in pain intensity demonstrated statistically significant incoherence at the overall level. Confidence in network meta-analysis estimates (certainty of evidence) varied and was mostly \"low\" or \"very low,\" limiting the validity of the probabilistic analyses.</p><p><strong>Conclusions: </strong>According to Bayesian network meta-analysis, ibuprofen IV is definitely among the least effective for adequate pain relief; chlorpromazine IV/IM is definitely among the most effective; valproate IV is definitely among the least effective, and ketorolac IV/IM is possibly among the least effective as single agents. The relative safety of the pharmacologic therapies cannot be determined with sufficient certainty.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827242","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":"Trends in Firearm Injuries Treated in Emergency Departments by Individual- and County-Level Characteristics, 2019 to 2023.","authors":"Marissa L Zwald, Kristin M Holland, Steven A Sumner, Michael Sheppard, Yushiuan Chen, Anika Wallace, Norah W Friar, Thomas R Simon","doi":"10.1016/j.annemergmed.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.003","url":null,"abstract":"<p><strong>Study objective: </strong>To understand trends in nonfatal firearm injuries by examining rates of firearm injury emergency department (ED) visits stratified by individual- and county-level characteristics.</p><p><strong>Methods: </strong>Data from participating EDs within 10 jurisdictions in the United States funded through the Centers for Disease Control and Prevention's Firearm Injury Surveillance Through Emergency Rooms program, including the District of Columbia, Florida, Georgia, New Mexico, North Carolina, Oregon, Utah, Virginia, Washington, and West Virginia, were analyzed. We examined trends in firearm injury ED visits by sex, age group, jurisdiction, county-level urbanicity, and county-level social vulnerability from January 2019 to August 2023. Mean weekly rates of firearm injury ED visits and visit ratios (or the proportion of firearm injury-related ED visits of all visits during the surveillance periods with the same period in 2019) were calculated.</p><p><strong>Results: </strong>Compared with 2019, the proportion of ED visits for firearm injury was elevated each year during 2020 to 2023 overall, with the largest observed increase in 2020 (visit ratio=1.59). All 10 Firearm Injury Surveillance Through Emergency Rooms jurisdictions experienced an increase in the proportion of firearm injury ED visits in 2020 (visit ratios ranging from 1.26 in West Virginia and 2.31 in Washington, DC) when compared with 2019. By county-level social vulnerability, the mean weekly rate of firearm injury ED visits was highest in counties with the highest social vulnerability over the entire study period.</p><p><strong>Conclusion: </strong>Results highlight the continued burden of firearm injuries in communities with higher social vulnerability. Timely ED data by community social vulnerability can inform public health interventions and resource allocation at local, state, and national levels.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827244","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":"Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting.","authors":"Tony Zitek, Kenneth A Scheppke, Peter Antevy, Charles Coyle, Sebastian Garay, Eric Scheppke, David A Farcy","doi":"10.1016/j.annemergmed.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.002","url":null,"abstract":"<p><strong>Study objective: </strong>To determine if ketamine, when added to midazolam for the treatment of out-of-hospital seizures, is associated with an increase in the rate of cessation of convulsions prior to hospital arrival.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of out-of-hospital patients with an active convulsive seizure being transported to a hospital by a large emergency medical services system in Florida, using data from August 1, 2015 and August 5, 2024. Per protocol, patients received midazolam first for their seizure. Starting in June 2017, a new protocol was developed in which patients who continued to convulse after midazolam received ketamine. We used propensity score matching and multivariable logistic regression to determine if patients who received ketamine were more likely to stop convulsing prior to hospital arrival than those who received midazolam alone.</p><p><strong>Results: </strong>Overall, 479 (80.1%) of 598 actively convulsing patients who received 2 doses of midazolam (without subsequent ketamine) had resolution of their convulsions prior to hospital arrival compared with 85 (94.4%) of 90 who received ketamine after midazolam, an absolute difference between groups of 14.3% (95% CI 8.6% to 20.1%). After propensity matching, 82.0% of those in the midazolam only group had resolution of convulsions compared to 94.4% in the ketamine group, a difference of 12.4% (95% CI 3.1% to 21.7%).</p><p><strong>Conclusion: </strong>In this retrospective study of out-of-hospital patients with active convulsive seizures, patients who received ketamine were more likely to have stopped convulsing prior to hospital arrival than those who received midazolam alone.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827243","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":"Utilization of Video Laryngoscopy in Rural and Urban Emergency Departments in Minnesota: A Survey Study.","authors":"Matthew E Prekker, Thomas Pahl, Paul C Allegra, Sarah J Lock, Michael A Puskarich, Brian E Driver","doi":"10.1016/j.annemergmed.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.007","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811973","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":"It's Time to Get on Board: Solutions to the Pediatric Behavioral Health Boarding Crisis.","authors":"Jennifer A Hoffmann","doi":"10.1016/j.annemergmed.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.006","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811970","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}