Annals of emergency medicine最新文献

{"title":"Antibody-Drug Conjugates: The Toxicities and Adverse Effects That Emergency Physicians Must Know.","authors":"Danna Michelle Markides, Angel Guido Hita, Jeffrey Merlin, Cielto Reyes-Gibby, Sai-Ching J Yeung","doi":"10.1016/j.annemergmed.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.015","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-03","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":"","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, Steven Walton, Brit Long","doi":"10.1016/j.annemergmed.2024.10.020","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.020","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-03","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, Marc A Probst, Zachary L Mannes, Sandra D Comer, Silvia S Martins, Bernard P Chang","doi":"10.1016/j.annemergmed.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.016","url":null,"abstract":"<p><strong>Study objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</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":"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}

{"title":"Cost-Effectiveness of Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder.","authors":"Thanh Lu, Danielle Ryan, Techna Cadet, Marek C Chawarski, Edouard Coupet, E Jennifer Edelman, Kathryn F Hawk, Kristen Huntley, Ali Jalali, Patrick G O'Connor, Patricia H Owens, Shara H Martel, David A Fiellin, Gail D'Onofrio, Sean M Murphy","doi":"10.1016/j.annemergmed.2024.10.001","DOIUrl":"10.1016/j.annemergmed.2024.10.001","url":null,"abstract":"<p><strong>Study objective(s): </strong>To evaluate the cost-effectiveness of implementation facilitation compared with a standard educational strategy to promote emergency department (ED)-initiated buprenorphine with linkage to ongoing opioid use disorder care in the community, from a health care-sector perspective.</p><p><strong>Methods: </strong>A prospective cost-effectiveness analysis was conducted alongside \"Project ED Health\" (CTN-0069), a hybrid type 3 implementation-effectiveness study conducted at 4 academic EDs. Resources were gathered and valued according to the health care-sector perspective. Three effectiveness measures were evaluated: quality-adjusted life-years, opioid-free years, and patient engagement in community-based opioid use disorder care on the 30th day following the index ED visit. An incremental cost-effectiveness ratio was calculated for each measure of effectiveness. Likelihood of cost-effectiveness was evaluated across a wide range of \"value\" thresholds through cost-effectiveness acceptability curves.</p><p><strong>Results: </strong>The mean, per-person, health care-sector cost associated with ED-administered buprenorphine following implementation facilitation did not differ significantly from that of standard education ($3,239 versus $4,904), whereas the mean effectiveness for all 3 measures significantly favored the implementation facilitation strategy. Implementation facilitation has a 74% to 75% probability of being considered cost-effective from a health care-sector perspective at the recommended value range of $100,000 to $200,000 per quality-adjusted life-year. Incremental cost-effectiveness ratios estimated using secondary effectiveness measures had a 75% probability of being considered cost-effective at $25,000 per opioid-free year and $38,000 per engagement.</p><p><strong>Conclusion: </strong>Implementation facilitation, relative to a standard educational strategy, has a moderate-to-high likelihood of being considered cost-effective from a health care-sector perspective, depending on decisionmakers' willingness to pay for units of effectiveness.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680794","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":"ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine","authors":"Theresa M. van der Vlugt MD","doi":"10.1016/j.annemergmed.2024.07.016","DOIUrl":"10.1016/j.annemergmed.2024.07.016","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 700-703"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706111","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":"Demystifying Gestalt","authors":"Jayshil J. Patel MD,&nbsp;Jamie Jasti MD,&nbsp;Katherine Gavinski MD","doi":"10.1016/j.annemergmed.2024.06.027","DOIUrl":"10.1016/j.annemergmed.2024.06.027","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 696-697"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692450","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":"Clinical Policy Executive Summary","authors":"","doi":"10.1016/S0196-0644(24)01188-0","DOIUrl":"10.1016/S0196-0644(24)01188-0","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 678-679"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706612","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":"Information for Readers","authors":"","doi":"10.1016/S0196-0644(24)01175-2","DOIUrl":"10.1016/S0196-0644(24)01175-2","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Page A11"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706364","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}