Annals of emergency medicine最新文献

{"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":"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}

{"title":"Antibody-Drug Conjugates: The Toxicities and Adverse Effects That Emergency Physicians Must Know","authors":"Danna Michelle Markides MD,&nbsp;Angel Guido Hita MD,&nbsp;Jeffrey Merlin MD,&nbsp;Cielto Reyes-Gibby DrPh,&nbsp;Sai-ching J. Yeung MD, PhD","doi":"10.1016/j.annemergmed.2024.10.015","DOIUrl":"10.1016/j.annemergmed.2024.10.015","url":null,"abstract":"<div><div>Antibody-drug conjugates are novel antineoplastic agents whose use is expanding, both in terms of the number of drugs and the number of patients being treated. This article reviews the known toxicities and complications of antibody-drug conjugates that are currently approved for the treatment of cancer in the United States, with a focus on their emergency presentation and management. Similar to many other cancer therapies, most antibody-drug conjugates can cause diarrhea, nausea/vomiting, rash, peripheral neuropathy, and cytopenia, which are generally treated following standard-of-care. Interstitial lung disease, which may mimic pneumonia and cause respiratory failure and death, has been seen with trastuzumab deruxtecan and mirvetuximab soravtansine; emergency treatment of this condition includes oxygenation, ventilatory support, and corticosteroids. Inotuzumab ozogamicin and gemtuzumab ozogamicin are both associated with sinusoidal obstruction syndrome, a potentially fatal liver dysfunction that presents with weight gain, fluid overload, and jaundice. Abnormal liver function tests in patients who have been recently treated with these agents should be cautiously evaluated. Cardiac adverse events with antibody-drug conjugates are rare, but trastuzumab emtansine and trastuzumab deruxtecan may cause a decrease in cardiac contractility, and heart rate corrected QT interval prolongation is a rare effect of trastuzumab deruxtecan. Ocular adverse events, especially blurred vision, and keratopathy, are common with mirvetuximab soravtansine and tisotumab vedotin. Progressive multifocal leukoencephalopathy has been reported with brentuximab vedotin and polatuzumab vedotin. Tumor lysis syndrome may occur after treatment with gemtuzumab ozogamicin, polatuzumab vedotin, and brentuximab vedotin. Patients receiving enfortumab vedotin or brentuximab vedotin may develop hyperglycemia, sometimes presenting as diabetic ketoacidosis. Tisotumab vedotin and trastuzumab emtansine are associated with bleeding; although it is minor in most cases, severe bleeding and intracranial hemorrhage have occurred. Several antibody-drug conjugates can cause an anaphylactoid infusion-related reaction, which occurs most commonly during or soon after infusion but may be delayed up to 24 hours. Further research is needed to establish the real-world incidence of rare complications and how often patients with these complications present to the emergency department.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 3","pages":"Pages 214-229"},"PeriodicalIF":5.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Subcutaneous Insulin Administration Safe and Effective for the Treatment of Mild to Moderate Diabetic Ketoacidosis?","authors":"Thomas Caldwell MD (EBEM Commentator),&nbsp;Steven Walton MD (EBEM Commentator),&nbsp;Brit Long MD (EBEM Commentator)","doi":"10.1016/j.annemergmed.2024.10.020","DOIUrl":"10.1016/j.annemergmed.2024.10.020","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 3","pages":"Pages 273-275"},"PeriodicalIF":5.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783906","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":"Frequency of Fentanyl Exposure in Emergency Department Patients With Illicit Drug Use","authors":"Dana L. Sacco MD, MSc ,&nbsp;Marc A. Probst MD, MS ,&nbsp;Zachary L. Mannes PhD ,&nbsp;Sandra D. Comer PhD ,&nbsp;Silvia S. Martins MD, PhD ,&nbsp;Bernard P. Chang MD, PhD","doi":"10.1016/j.annemergmed.2024.10.016","DOIUrl":"10.1016/j.annemergmed.2024.10.016","url":null,"abstract":"<div><h3>Study objective</h3><div>Addition of illicitly manufactured fentanyl to the opioid and nonopioid illicit drug supply has exacerbated the drug overdose crisis in the United States. People who use drugs are often unaware that their drugs contain fentanyl. Awareness about fentanyl adulteration may be protective against fatal overdose.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional study of a convenience sample of emergency department (ED) patients who presented with illicit drug-related complaints from April 2022 to January 2024 in New York City, NY. Patients were surveyed about their drug use and provided urine samples for fentanyl testing. Results were analyzed according to the patient's intention of using opioids versus only nonopioid substances.</div></div><div><h3>Results</h3><div>Of 338 eligible patients, we enrolled 229 (68% acceptance, men: 78%, mean age: 43 years [SD=12.2], Hispanic/Latino: 57%), with 53% (121/229) and 47% (108/229) intending to use opioids and only nonopioid substances, respectively. Among patients who used opioids and provided urine, 89% (86/97) samples were positive for fentanyl, including 90% (27/30) fentanyl positivity among those who did not believe that they were using fentanyl. Among those intending to use only nonopioids, 24% (23/94) urine samples were positive for fentanyl.</div></div><div><h3>Conclusions</h3><div>Many drug-related ED visits involved fentanyl exposure, even when individuals did not believe they were using fentanyl. Knowledge of fentanyl adulteration can inform people who intend to use opioid and/or nonopioid drugs about harm reduction approaches, such as distribution of fentanyl test strips and educational interventions.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 3","pages":"Pages 199-204"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142725113","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":"Changes in Behavioral Health Visits, Operations, and Boarding in a Pediatric Emergency Department.","authors":"Joel D Hudgins, Michael C Monuteaux, Caitlin Kent, Rebekah Mannix, Andrew Miller, Ashley Marchese, Jason Levy","doi":"10.1016/j.annemergmed.2024.10.017","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.017","url":null,"abstract":"<p><strong>Study objective: </strong>Over the past decade, there has been a dramatic increase in pediatric emergency department (PED) visits seeking mental and behavioral health care. We aimed to determine the relationship between hours of care devoted to patients with mental and behavioral health complaints and markers of PED throughput and timeliness.</p><p><strong>Methods: </strong>We performed a retrospective, single-center, cross-sectional study of PED encounters between 2010 and 2022. We reported effect of care for patients with mental and behavioral health complaints on operational metrics, including 4 throughput metrics and 3 care metrics (eg, vital signs within 30 minutes of arrival or left without being seen rates). We estimated a series of negative binomial regression models with the monthly count of the given metric as the dependent variable and monthly ED volume as the offset.</p><p><strong>Results: </strong>We included a total of 720,914 visits over the study period, of which 22,901 (3.2%) were mental and behavioral health complaints. The total number of mental and behavioral health visits increased over the study period, from 1,113 in 2010 to 2,554 in 2021, whereas the median monthly behavioral health care hours showed a 1,483% increase. All outcomes worsened as behavioral health care hours increased in both operational and care categories.</p><p><strong>Conclusion: </strong>In our single-center study, the increase in mental and behavioral health visits and hours of care was associated with significantly worsened PED throughput and timeliness of care metrics. This relationship highlights the challenges that PEDs face in caring for mental and behavioral health patients while simultaneously providing high-quality care to patients with acute nonmental and behavioral health emergencies.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142725110","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":"Is Broader Better? Piperacillin/Tazobactam, Cefepime, and the Risk of Harm","authors":"Clay B. Smith MD (Guest Contributor)","doi":"10.1016/j.annemergmed.2024.09.005","DOIUrl":"10.1016/j.annemergmed.2024.09.005","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 693-695"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692466","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}