Annals of emergency medicine最新文献

{"title":"Emergency Department Interventions for Youth With Assault-Related Injuries: A Scoping Review.","authors":"Samaa Kemal, Jethel Hernandez, Katie Donnelly, Denise Nunes, Michael N Levas, Karen M Sheehan, Joel A Fein","doi":"10.1016/j.annemergmed.2025.01.013","DOIUrl":"10.1016/j.annemergmed.2025.01.013","url":null,"abstract":"<p><p>Assault-related injuries in youth are associated with poor outcomes related to physical and mental health. These youth often seek acute injury-related care in the emergency department (ED), making this an important location for violence prevention and intervention efforts. This scoping review sought to describe ED-initiated and ED-based interventions for youth with assault-related injury. We searched 6 databases from their inception to October 2023: Ovid MEDLINE, Cochrane Library, Embase, Web of Science, PsycInfo, and CINAHL. We included original research on interventions for youth (0 to 18 years) presenting to the ED with assault-related injury (including firearm-related injury). We excluded non-English studies, conference proceedings, and editorials. Two independent reviewers performed title and abstract screening, full text review, and data abstraction and synthesis. We found 5,021 unique articles and excluded 4,955 after the title and abstract screening. The remaining 66 articles underwent full text review, and 25 were included. The primary types of ED interventions identified were case management, behavioral and psychosocial interventions, and mentorship. Although all interventions were initiated in the ED, the majority primarily occurred following discharge, required high levels of resources, and were often performed by hospital-based personnel in partnership with community-based organizations. Most studies described outcomes related to injury recidivism, criminal justice involvement, violence-related risk factors, health care usage, and mortality. Few described strengths-based and other quality-of-life outcomes. Although many studies demonstrated improved outcomes with interventions, they were often limited by sample size, study attrition, and short-term follow-up. Overall, our findings indicate that current research on ED interventions for youth with assault-related injuries is skewed toward resource-intensive services such as hospital-based violence intervention programs. Further work is needed to develop, implement, and rigorously evaluate community-informed ED-based interventions that could complement these resource-intensive interventions. Future studies should also examine strengths-based and patient-centered outcomes.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424765","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":"PEAChY-O: Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication.","authors":"Elyssia M Bourke, Amit Kochar, Deborah Shellshear, Meredith L Borland, Shefali Jani, Shane George, Doris Tham, Michael Gordon, Kate Klein, Catherine L Wilson, Chidambaram Prakash, Natalie Phillips, Gaby Nieva, Chris J Selman, Katherine J Lee, Andrew Davidson, Jonathan C Knott, Simon S Craig, Franz E Babl","doi":"10.1016/j.annemergmed.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.01.007","url":null,"abstract":"<p><strong>Study objective: </strong>To determine whether oral olanzapine or oral diazepam was more effective at achieving behavioral containment for young people presenting to the emergency department with acute severe behavioral disturbance.</p><p><strong>Methods: </strong>We conducted an open-label, multicenter, randomized controlled trial from October 22, 2021, to November 6, 2023. We enrolled young people aged between 9 and 17 years with acute severe behavioral disturbance deemed to require oral medication across 9 Australian emergency departments. We randomly assigned participants to a single weight-based oral dose of olanzapine or diazepam. The primary outcome was successful sedation (Sedation Assessment Tool score less than or equal to 0) without the need for additional sedatives one hour postrandomization. Secondary outcomes included adverse events; length of stay; aggression toward staff, participants, or parent/guardians; disposition; and satisfaction with care.</p><p><strong>Results: </strong>We recruited 348 participants, with 176 assigned to olanzapine and 172 to diazepam. Successful sedation without the requirement for additional sedatives occurred in 103/168 (61%) in the olanzapine group and 90/158 (57%) in the diazepam group (adjusted risk difference 3.6%, 95% confidence interval -6.7% to 14.0%). No serious adverse events were reported in either group.</p><p><strong>Conclusions: </strong>There was no evidence that oral olanzapine resulted in a greater proportion of participants with acute severe behavioral disturbance achieving successful sedation at one hour postrandomization than oral diazepam. Neither medication resulted in any serious adverse events; however, approximately 40% of participants in each group did not achieve successful sedation.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424714","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 Versus Human Authors: Assessing Efficacy in Title and Abstract Creation in Pediatric Emergency Medicine Research.","authors":"Graham Aufricht, Matt Wilkinson, Jesse Pines, Sriram Ramgopal, Tim Ruttan","doi":"10.1016/j.annemergmed.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.01.004","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405038","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":"Tranexamic Acid in Pediatric Traumatic Brain Injury: A Multicenter Retrospective Observational Study","authors":"Shu Utsumi MD ,&nbsp;Shingo Ohki MD, PhD ,&nbsp;Shunsuke Amagasa MD, PhD ,&nbsp;Shinichiro Ohshimo MD, PhD ,&nbsp;Nobuaki Shime MD, PhD","doi":"10.1016/j.annemergmed.2024.07.014","DOIUrl":"10.1016/j.annemergmed.2024.07.014","url":null,"abstract":"<div><h3>Study objective</h3><div>Tranexamic acid (TXA) can be used after trauma to prevent bleeding. Our goal was to examine the influence of TXA on morbidity and mortality for children with severe traumatic brain injury (TBI).</div></div><div><h3>Methods</h3><div>We identified children aged &lt;18 years with a severe TBI (Glasgow Coma Scale score less than 8) presenting to 1 of the 291 hospitals contributing to the Japanese Trauma Data Bank between 2019 and 2023. The primary outcome was inhospital death, and the secondary outcome was poor neurologic outcome defined with Glasgow Outcome Scale (GOS) score of 1 to 3 at hospital discharge. Our primary exposure was any TXA administered in the hospital. Using propensity score-based inverse probability weighting, we used logistic regression to measure the association between TXA administration and death as well as poor neurologic outcome.</div></div><div><h3>Results</h3><div>Of the 342 included patients, 30 (14%) died, and 102/225 (45%) had a GOS score less than 4 at discharge. After inverse propensity weighting, TXA administration was not associated with either mortality (adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.61 to 2.54) or poor neurologic outcome (aOR 0.86, 95% CI 0.47 to 1.56).</div></div><div><h3>Conclusions</h3><div>TXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 101-108"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370836","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":"Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography","authors":"Felipe Teran MD, MSCE ,&nbsp;Clark G. Owyang MD ,&nbsp;Trenton C. Wray MD ,&nbsp;John E. Hipskind MD ,&nbsp;Justine Lessard MD ,&nbsp;William Bédard Michel MD ,&nbsp;Chantal Lanthier ,&nbsp;Peiman Nazerian MD ,&nbsp;Eleonora de Villa MD ,&nbsp;Jonathan Nogueira DO ,&nbsp;Daniel Doynow DO, MPH ,&nbsp;Michelle Clinton MD ,&nbsp;Frank Myslik MD ,&nbsp;Ross Prager MD ,&nbsp;Robert Arntfield MD ,&nbsp;Pedro D. Salinas MD ,&nbsp;Vladyslav Dieiev MD ,&nbsp;Michael Y. Woo MD ,&nbsp;Rajiv Thavanathan MD ,&nbsp;Graeme Puskas BSc ,&nbsp;Benjamin S. Abella MD, MPhil","doi":"10.1016/j.annemergmed.2024.08.004","DOIUrl":"10.1016/j.annemergmed.2024.08.004","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs.</div></div><div><h3>Methods</h3><div>We established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images.</div></div><div><h3>Results</h3><div>A total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare.</div></div><div><h3>Conclusions</h3><div>A prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 147-162"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443766","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":"Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic","authors":"Sriram Ramgopal MD ,&nbsp;Oluwakemi Badaki-Makun MD, PhD ,&nbsp;Mohamed Eltorki MBChB, MSc ,&nbsp;Pradip Chaudhari MD ,&nbsp;Timothy T. Phamduy DO ,&nbsp;Daniel Shapiro MD, MPH ,&nbsp;Chris A. Rees MD, MPH ,&nbsp;Kelly R. Bergmann DO ,&nbsp;Mark I. Neuman MD, MPH ,&nbsp;Douglas Lorenz PhD ,&nbsp;Kenneth A. Michelson MD, MPH","doi":"10.1016/j.annemergmed.2024.08.508","DOIUrl":"10.1016/j.annemergmed.2024.08.508","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024).</div></div><div><h3>Results</h3><div>We included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (−17.80%; 95% CI −17.90 to −17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic.</div></div><div><h3>Conclusion</h3><div>Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 111-121"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451860","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":"In Adult Patients With Spontaneous Cervical Artery Dissection, Is Anticoagulation Associated With Reduced Risk of Ischemic Stroke When Compared With Antiplatelet Therapy?","authors":"Steven Walton MD (EBEM Commentators),&nbsp;Michael Gottlieb MD (EBEM Commentators),&nbsp;Brit Long MD (EBEM Commentators)","doi":"10.1016/j.annemergmed.2024.09.012","DOIUrl":"10.1016/j.annemergmed.2024.09.012","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 144-146"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490550","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":"Elderly Man With Abdominal Pain","authors":"Matthew Lynberg BS ,&nbsp;Jacob Isserman MD ,&nbsp;Jonathan E. Davis MD","doi":"10.1016/j.annemergmed.2024.08.002","DOIUrl":"10.1016/j.annemergmed.2024.08.002","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 183-184"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021972","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":"Modeling the Mottled Child: Evaluating a Pediatric Septic Shock Predictive Modeling Screening Tool","authors":"Frederick L. Gmora DO (Guest Contributor) ,&nbsp;Allyson M. Hynes MD (Guest Contributor)","doi":"10.1016/j.annemergmed.2024.12.006","DOIUrl":"10.1016/j.annemergmed.2024.12.006","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 193-195"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021978","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":"Adolescent Girl With Lower Abdominal Pain","authors":"Ashley Booth BS ,&nbsp;Rosemary Thomas-Mohtat MD","doi":"10.1016/j.annemergmed.2024.08.003","DOIUrl":"10.1016/j.annemergmed.2024.08.003","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 185-186"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021933","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}