Annals of emergency medicine最新文献

{"title":"Intubation Practices in Community Emergency Departments.","authors":"Jonathan Kei, Travis Eurick, Tom A Hauck","doi":"10.1016/j.annemergmed.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.021","url":null,"abstract":"<p><strong>Study objective: </strong>This study analyzes emergency medicine airway management trends and outcomes among community emergency departments.</p><p><strong>Methods: </strong>A multicenter, retrospective chart review was conducted on 11,475 intubations from 15 different community emergency departments between January 1, 2015, and December 31, 2022. Data collected included patient's age, sex, rapid sequence intubation medications, use of cricoid pressure, method of intubation, number of attempts, admission diagnosis, and all-cause mortality rates.</p><p><strong>Results: </strong>Active cardiopulmonary resuscitation occurred in 11.4% of intubations. When rapid sequence intubation was employed, the most frequently used induction agents were etomidate (91.6%), propofol (4.3%), and ketamine (4.1%). From 2015 to 2022, the use of rocuronium (versus succinylcholine) increased from 33.9% to 61.9%, a difference of 28% (95% confidence interval [CI] 21.1% to 34.9%). During the same period, video laryngoscopy (versus direct laryngoscopy) increased from 27.4% to 77.7%, a difference of 50.3% (95% CI 44.2% to 56.4%). Only 46% of intubations used cricoid pressure. Physicians had a first-pass success rate of 80.5% and a failure rate of 0.2%. The most common documented admission diagnoses among intubated patients were respiratory etiologies (27.8%), neurologic causes (21.4%), and sepsis (16.0%). All-cause mortality rates were high for intubated patients at 24 hours (19.7%), 7 days (29.4%), 30 days (38.4%), and 1 year (45.4%).</p><p><strong>Conclusion: </strong>Physicians intubating in community emergency departments have similar rates of first-pass success and failure seen in academic Level-1 trauma centers despite treating medically sick patients with high all-cause mortality rates. Dramatic shifts in choice of paralytic and method for intubation were seen.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963678","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":"Skin Glue to Reduce Intravenous Catheter Failure in Children.","authors":"Owen Chauhan, Amy C Plint, Nick Barrowman, Natasha Wills-Ibarra, Tyrus Crawford, Mei Han, Maala Bhatt","doi":"10.1016/j.annemergmed.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.014","url":null,"abstract":"<p><strong>Study objective: </strong>The peripheral intravenous catheter (IV) is the most common and painful invasive medical device in acute care settings. Our objective was to determine whether adding skin glue to secure IVs reduced catheter failure rate in children.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial in a tertiary-care pediatric emergency department (ED). ED patients younger than 18 years old with an IV who were anticipated to be admitted to hospital were eligible for enrollment. Children were randomized to receive standard IV securement with cloth-bordered transparent polyurethane dressing (control) or application of cyanoacrylate glue at the catheter insertion site in addition to standard securement (intervention). Participants were followed until device removal due to failure or physician order. The primary outcome was IV failure before the intended treatment course was complete. Patients who were randomized with primary outcome data were included in the intention-to-treat analysis.</p><p><strong>Results: </strong>Of the 557 participants enrolled between December 2020 and April 2023, 278 (50%) and 279 (50%) were allocated to the glue and control groups, respectively. A total of 527 participants were included in the intention-to-treat analysis. Intravenous failure rates in the glue and control groups were 83 of 265 (31.3%) and 82 of 262 (31.3%), respectively. The odds of intravenous catheter failure were not different between groups (adjusted odds ratio 0.98; 95% confidence interval, 0.67 to 1.42). Time to device failure was similar between groups (hazard ratio 0.99; 95% confidence interval, 0.73 to 1.35).</p><p><strong>Conclusions: </strong>This study found no benefit in using skin glue to secure IVs in the ED in children.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963679","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 Woman With Dizziness, Slurred Speech, and Dyspnea","authors":"Jordan C. Sheehan MD","doi":"10.1016/j.annemergmed.2024.07.015","DOIUrl":"10.1016/j.annemergmed.2024.07.015","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"Pages 89-90"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871120","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":"Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials","authors":"Stephanie C. DeMasi MD ,&nbsp;Wesley H. Self MD, MPH ,&nbsp;Neil R. Aggarawal MD, MHSc ,&nbsp;Michael D. April MD ,&nbsp;Luke Andrea MD ,&nbsp;Christopher R. Barnes MD ,&nbsp;Jason Brainard MD ,&nbsp;Veronika Blinder DO ,&nbsp;Alon Dagan MD ,&nbsp;Brian Driver MD ,&nbsp;Kevin C. Doerschug MD ,&nbsp;Ivor Douglas MD ,&nbsp;Matthew Exline MD, MPH ,&nbsp;Daniel G. Fein MD ,&nbsp;John P. Gaillard MD ,&nbsp;Sheetal Gandotra MD ,&nbsp;Kevin W. Gibbs MD ,&nbsp;Adit A. Ginde MD, MPH ,&nbsp;Stephen J. Halliday MD, MSCI ,&nbsp;Jin H. Han MD ,&nbsp;Matthew W. Semler MD, MSc","doi":"10.1016/j.annemergmed.2024.08.509","DOIUrl":"10.1016/j.annemergmed.2024.08.509","url":null,"abstract":"<div><h3>Study objective</h3><div>To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).</div></div><div><h3>Results</h3><div>Among the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26).</div></div><div><h3>Conclusion</h3><div>Among critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"Pages 6-13"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436114","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":"Knowing Ourselves: The Annals Effort to Achieve Insight","authors":"Richelle J. Cooper MD, MSHS ,&nbsp;David L. Schriger MD, MPH ,&nbsp;Donald M. Yealy MD","doi":"10.1016/j.annemergmed.2024.11.001","DOIUrl":"10.1016/j.annemergmed.2024.11.001","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"Pages 1-3"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871131","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":"Artificial Intelligence to Predict Billing Code Levels of Emergency Department Encounters","authors":"Jacob Morey MD, MBA,&nbsp;Richard Winters MD, MBA,&nbsp;Derick Jones MD, MBA","doi":"10.1016/j.annemergmed.2024.07.011","DOIUrl":"10.1016/j.annemergmed.2024.07.011","url":null,"abstract":"<div><h3>Study objective</h3><div>To use artificial intelligence (AI) to predict billing code levels for emergency department (ED) encounters.</div></div><div><h3>Methods</h3><div>We accessed ED encounters from our health system from January to September 2023. We developed an ensemble model using natural language processing and machine learning techniques to predict billing codes from clinical notes combined with clinical characteristics and orders. Explainable AI techniques were used to help determine the important model features. The main endpoint was to predict evaluation and management professional billing codes (levels 2 to 5 [Current Procedural Terminology codes 99282 to 99285] and critical care). Secondary endpoints included predicting professional billing codes at different decision boundary thresholds and generalizability of the model at other EDs.</div></div><div><h3>Results</h3><div>There were 321,893 adult ED encounters coded at levels 2 (&lt;1%), 3 (5%), 4 (38%), 5 (51%), and critical care (5%). Model performance for professional billing code levels of 4 and 5 yielded area under the receiver operating characteristic curve values of 0.94 and 0.95, accuracy values of 0.80 and 0.92, and F1-scores of 0.79 and 0.91, respectively. At a 95% decision boundary threshold, level 5 predicted charts had a precision/positive predictive value of 0.99 and recall/sensitivity of 0.57. The most important features using Shapley Additive Explanations values were critical care note, number of orders, discharge disposition, cardiology, and psychiatry.</div></div><div><h3>Conclusion</h3><div>Currently available AI models accurately predict billing code levels for ED encounters based on clinical notes, clinical characteristics, and orders. This has the potential to automate coding of ED encounters and save administrative costs and time.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"Pages 63-73"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320978","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":"Result Push Notifications Improve Time to Emergency Department Disposition: A Pragmatic Observational Study","authors":"Sayon Dutta MD, MPH ,&nbsp;Lisette Dunham MSPH, MPS ,&nbsp;Dustin S. McEvoy BS ,&nbsp;Rebecca E. Cash PhD ,&nbsp;Melissa A. Meeker PhD ,&nbsp;Benjamin A. White MD","doi":"10.1016/j.annemergmed.2024.07.010","DOIUrl":"10.1016/j.annemergmed.2024.07.010","url":null,"abstract":"<div><h3>Study objective</h3><div>Emergency department (ED) crowding has multiple causative factors, including delayed patient throughput. Patient care efficiency may be improved by addressing delays in decisionmaking following diagnostic testing results. We examined the influence of sending subscribed result push notifications to ED clinicians' smartphones on reducing the time to disposition decision.</div></div><div><h3>Results</h3><div>All ED patient visits between October 2022 and October 2023 with a laboratory or imaging result during the ED visit and a disposition within 6 hours of the last result were included. We identified whether the last resulted study before the ED disposition decision had a subscribed push notification by the clinician who dispositioned the patient. The primary outcome was the time between the last study result and the first disposition decision. Generalized estimating equation analysis was used to control for variables including patient demographics, clinical factors, and discharging clinician.</div></div><div><h3>Results</h3><div>The final study population included 237,872 encounters. The median patient age was 50 years, and 55.6% of patients were women. During the study period, 27.1% of clinicians used push notifications at least once. Of unique orders, 1.5% had a subscribed result push notification, including 0.9% of laboratory orders and 4.7% of imaging orders. The time between last result to disposition decision was 18 minutes (95% confidence interval [CI] 15 to 21) faster when a push notification was requested.</div></div><div><h3>Conclusion</h3><div>Elective push notification of test results was associated with reduced time between the last laboratory or imaging result and ED disposition decision. Further study is needed to determine its effect on overall ED throughput.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"Pages 53-62"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321242","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 Awake Intubation","authors":"Benjamin J. Sandefur MD, MHPE ,&nbsp;Brian E. Driver MD ,&nbsp;Brit Long MD","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":"85 1","pages":"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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply","authors":"Nicholas R. Pettit DO, PhD,&nbsp;Kathleen A. Lane MS,&nbsp;Leslie Gibbs NP,&nbsp;Paul Musey MD, MSC,&nbsp;Xiaochun Li PhD,&nbsp;Joshua R. Vest PhD, MPH","doi":"10.1016/j.annemergmed.2024.08.007","DOIUrl":"10.1016/j.annemergmed.2024.08.007","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"Pages 98-99"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871061","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 MSc ,&nbsp;Eliana Wassermann PhD ,&nbsp;Mathilde de Caluwe ,&nbsp;Clément Prebin ,&nbsp;Florent Noel MD ,&nbsp;Agnès Dechartres PhD ,&nbsp;Pierre-Alexis Raynal MD ,&nbsp;Judith Leblanc PhD ,&nbsp;Youri Yordanov PhD","doi":"10.1016/j.annemergmed.2024.06.024","DOIUrl":"10.1016/j.annemergmed.2024.06.024","url":null,"abstract":"<div><h3>Study objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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]).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 1","pages":"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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}