Annals of emergency medicine最新文献

{"title":"Information for Readers","authors":"","doi":"10.1016/S0196-0644(25)01167-9","DOIUrl":"10.1016/S0196-0644(25)01167-9","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"86 4","pages":"Page A10"},"PeriodicalIF":5.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095390","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":"Should Routine Intravenous Thrombolysis Be Considered in Patients Receiving Endovascular Thrombectomy for Acute Ischemic Stroke With Large Vessel Occlusions?","authors":"Paul Kim,Joshua Easter,Brit Long","doi":"10.1016/j.annemergmed.2025.08.007","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.007","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"38 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068201","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 Pathway Revision Increases Amoxicillin Monotherapy and 5-Day Durations of Therapy for Pediatric Community-Acquired Pneumonia in the Emergency Department and Urgent Care: A Quality Improvement Initiative.","authors":"Matthew J Weber,Christine E MacBrayne,Leigh Anne Bakel,Lilliam Ambroggio,Jillian M Cotter,Meghan Birkholz,Nicole M Poole","doi":"10.1016/j.annemergmed.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.021","url":null,"abstract":"STUDY OBJECTIVEThe American Academy of Pediatrics recommends 5-day amoxicillin monotherapy as first-line treatment for pediatric uncomplicated community-acquired pneumonia. We aimed to use local quality improvement interventions to increase first-line amoxicillin use, reduce azithromycin use, and increase 5-day therapy durations for uncomplicated community-acquired pneumonia.METHODSA quality improvement initiative took place at a pediatric hospital network, including 4 emergency departments (EDs) and 5 urgent care centers. Children discharged between July 2018 and July 2022 with a community-acquired pneumonia diagnosis and an antibiotic prescribed were included. A 2-part intervention was implemented: (1) an electronic health record order set that preselected 5-day antibiotic therapy (August 2020) and (2) a revised community-acquired pneumonia pathway newly integrated into the electronic health record (April 2021). Proportions of antibiotic encounters receiving amoxicillin, azithromycin, and antibiotic durations of 5 days or fewer were analyzed using statistical process control charts to identify special cause variation.RESULTSOrder set implementation had no effect on pediatric community-acquired pneumonia prescribing. After pathway revision, amoxicillin prescribing increased from 60.6% to 70.9%, azithromycin prescribing decreased from 12.5% to 3.7%, and durations for 5 days or fewer increased from 2.0% to 66.1%.CONCLUSIONA revised, electronic health record-integrated community-acquired pneumonia pathway was associated with improving already high adherence to guideline-recommended antibiotic choice and reducing antibiotic durations for pediatric community-acquired pneumonia in ED and urgent care settings. Local quality improvement efforts, when adapted to institutional workflows and culture, can effectively implement clinical pathways to support evidence-based prescribing for uncomplicated community-acquired pneumonia across diverse health care settings.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"171 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068199","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":"Real-Time Capture of Thrombus Embolization During Point-of-Care Lower-Extremity Compression Ultrasonography.","authors":"Michael F Barton,Kailynn M Barton,Mark Chottiner,Mathew A Saab","doi":"10.1016/j.annemergmed.2025.07.020","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.020","url":null,"abstract":"Compression ultrasonography is the bedside standard for diagnosing lower-extremity deep venous thrombosis. Probe-induced thrombus dislodgement, though rare, can precipitate pulmonary embolism, as well as strokes and other end-organ infarcts in patients with patent foramen ovales. We report a 65-year-old woman whose noncompressible mid-femoral deep venous thrombosis detached during routine point-of-care ultrasound-captured in real time-and resulted in bilateral subsegmental pulmonary emboli (PE) noted on computed tomography pulmonary angiography. The case highlights the possibility of compression-induced embolization, the need for controlled compression pressure, and immediate PE assessment when embolization is observed.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"37 1 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068439","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":"Opportunistic Detection of Atrial Fibrillation in the Emergency Department: Today's Health Care Systems Are Not Prepared to Reap the Benefits.","authors":"Clare L Atzema,Jeff S Healey","doi":"10.1016/j.annemergmed.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.002","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"11 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026032","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":"Two-bag Versus One-bag Method for Adult and Pediatric Diabetic Ketoacidosis Management.","authors":"Arjuna Srikrishnaraj,Allison Ruth Souter,Nicolas Woods,Kristine Van Aarsen,Alla Iansavitchene,Nathan L Haas,Justin W Yan","doi":"10.1016/j.annemergmed.2025.07.032","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.032","url":null,"abstract":"STUDY OBJECTIVEWe conducted a systematic review and meta-analysis to evaluate the safety and efficacy of the two-bag versus one-bag method in diabetic ketoacidosis (DKA) management in adult and pediatric populations.METHODSThe study was registered with the Prospective Register of Systematic Reviews, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was conducted across MEDLINE, EMBASE, and CENTRAL databases up to March 2025, with no restrictions on study design. Two reviewers independently assessed studies for bias using Cochrane Risk of Bias 2 (RoB2) tool and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I), extracted data, and synthesized findings using RevMan software. The Grading of Recommendations, Assessment, Development, and Evaluations tool was used to assess certainty of evidence. Main outcomes of interest were incidence of hypoglycemia and time to DKA resolution.RESULTSOf 4,190 studies screened, 21 met inclusion criteria. These included 9 adult studies with 3,329 patient visits and 12 pediatric studies with 1,385 visits. Of these, one study was at critical risk of bias and was removed from meta-analysis. In both adult and pediatric populations, the two-bag method was associated with reduced incidence of hypoglycemia (risk ratio: 0.50, 95% confidence interval [CI] 0.41 to 0.59; I2=51.8%) and time to DKA resolution (MD: -1.76 hours; 95% CI -2.80 to -0.71; I2=61%). In adults only, the two-bag method was associated with a shortened duration of insulin infusion (MD: -3.74 hours, 95% CI -4.96 to -2.52; I2=0%) and reduced incidence of hypokalemia (risk ratio: 0.84, 95% CI 0.76 to 0.93; I2=47%).CONCLUSIONThe two-bag method is associated with reduced incidence of hypoglycemia and time to DKA resolution in both adult and pediatric populations.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"3 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003190","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":"Sentinel Injuries in Emergency Departments and Subsequent Serious Injury in Children.","authors":"Stephanie M Mitrano,Kenneth A Michelson,Michael C Monuteaux,Daniel M Lindberg,Caitlin A Farrell,Joyce Li","doi":"10.1016/j.annemergmed.2025.07.033","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.033","url":null,"abstract":"STUDY OBJECTIVESentinel injuries in young children are minor injuries that can raise suspicion of physical abuse. Although early identification is critical, widespread screening of patients can incur unintended harm to both children and their families. We determined the frequency of serious abusive injury within 12 months following an emergency department (ED) encounter for a sentinel injury.METHODSUsing the Healthcare Cost and Utilization Project State ED and Inpatient Databases, we identified children 0 to 24 months of age with an ED diagnosis of a sentinel injury between 2014 and 2019. Our primary outcome was serious abusive injury (admission for serious injury or death with a child abuse diagnosis) within 12 months of a sentinel injury ED visit.RESULTSAmong 23,919 children with a sentinel injury ED visit (median age 5 months, 53% boys), bruise or fracture was diagnosed in 14,501 children (60.6%). In the 12 months following the sentinel injury visit, serious abusive injury was diagnosed in 176 (0.7%) patients. At the index ED encounter, abuse was diagnosed in 1,156 children (4.8%); 96 (8.3%) of these patients had an additional serious abusive injury diagnosed within 12 months.CONCLUSIONSubsequent diagnosis of a serious abusive injury was uncommon after an initial ED sentinel injury diagnosis. Of all children in whom abuse was diagnosed during the study period, the majority of patients were diagnosed at the sentinel injury ED visit, with nearly 1 in 12 at risk for subsequent serious injury. Prospective studies are needed to further risk-stratify children with sentinel injuries.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"71 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962617","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":"Feasibility of Pediatric Diagnostic Quality Measurement in All United States Hospitals.","authors":"Kenneth A Michelson,Joseph A Grubenhoff","doi":"10.1016/j.annemergmed.2025.07.035","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.035","url":null,"abstract":"STUDY OBJECTIVETo evaluate the proportion of emergency departments (EDs) with sufficient volumes to measure pediatric misdiagnosis reliably.METHODSWe conducted a cross-sectional study of a nationally representative 20% sample of US EDs within the 2022 Nationwide Emergency Department Sample. We counted the number of child visits (less than 18 years old) at each ED for each of 24 serious pediatric emergency conditions and each ED's total across all conditions. We calculated the proportion of EDs that could reliably measure misdiagnosis rates at least 10% worse than condition-specific national reference standards. We also calculated the proportion of children visiting measurable EDs.RESULTSReliable misdiagnosis measurement across all serious conditions was possible in 614 out of 4,515 EDs (13.6%, 95% confidence interval [CI] 11.5 to 15.9). Appendicitis was the most reliably measurable condition (n=530 EDs, 11.7%, 95% CI 9.8 to 14.0), whereas complicated pneumonia (n=33, 0.7%, 95% CI 0.3 to 1.5), testicular torsion (n=29, 0.6%, 95% CI 0.2-1.4), and intussusception (n=25, 0.6%, 95% CI 0.2 to 1.2) were less frequently measurable. The 20 other included conditions were not reliably measurable in any ED (0.0%, 95% CI 0.0 to 0.4). Midwest, nonmetropolitan, and EDs evaluating less than 1,800 children per year were least likely to be able to support reliable measurement. Among 185,490 children with a serious condition, 130,894 (70.6%) visited an ED in which misdiagnosis was measurable.CONCLUSIONFew EDs have sufficient pediatric volumes to reliably measure diagnostic accuracy generally, and even fewer can do so for individual conditions. Aggregation of EDs could improve power to measure misdiagnosis.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"53 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962615","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":"Making the Diagnosis and Managing Diagnostic Uncertainty in Acute Neurologic Presentations.","authors":"Alexander T Janke, Adrian D Haimovich","doi":"10.1016/j.annemergmed.2025.07.024","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.024","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940194","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":"Emergency Medicine Training in Transition: An Analysis of Program Length and Ownership Models","authors":"Indrani Guzmán Das MD, MPH , Christopher L. Bennett MD, MSc, MA","doi":"10.1016/j.annemergmed.2025.06.617","DOIUrl":"10.1016/j.annemergmed.2025.06.617","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"86 5","pages":"Pages 556-558"},"PeriodicalIF":5.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899444","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}