CJEM最新文献

{"title":"Development of a Canadian emergency department checklist to improve care for people who use opioids: a modified Delphi study.","authors":"Bluma Blake Kleiner, Kathryn Dong, Janusz Kaczorowski, Aaron Orkin, Raoul Daoust, Andrew Kestler","doi":"10.1007/s43678-026-01167-6","DOIUrl":"https://doi.org/10.1007/s43678-026-01167-6","url":null,"abstract":"<p><strong>Objective: </strong>Emergency departments (EDs) play a critical role in caring for people who use non-prescribed opioids, but ED services for these patients vary widely across Canada. We sought to develop a Canadian checklist for EDs to use in serving people who use non-prescribed opioids based on existing literature, ED professional consensus, and input from people with lived and living experience of drug use.</p><p><strong>Methods: </strong>We applied a modified online Delphi approach with two rounds of web-based surveys. We identified participants from a Canada-wide collaborator meeting on the ED initiation of opioid agonist therapy, with additional participants recruited by collaborator suggestion. Initial items for review were generated from a literature review and input from ED clinicians and addiction physicians, and reviewed by people with lived and living experience. In Round 1, participants ranked the relative importance of recommendations within eight domains and suggested additional items. In Round 2, participants rated the retained recommendations and offered further feedback.</p><p><strong>Results: </strong>Of 62 participants invited, 30 participated in Round 1 (June-July 2023) and 24 completed both rounds (Round 2: August-November 2023). Participants represented seven Canadian provinces and territories. In Round 1, 37 items were ranked, 15 retained, and 3 new added. In Round 2, 13 of 18 items were rated > 75/100 by at least 75% of participants, spanning six practice domains: ED services offered (n = 3); staffing (n = 2); education and training (n = 2); protocols and policies (n = 2); referrals from the ED (n = 3); and rural and remote services (n = 1).</p><p><strong>Conclusion: </strong>A Delphi process generated a 13-item evidence and consensus-informed checklist of ED practices to support caring for people who use non-prescribed opioids. Implementation of the checklist in Canadian EDs has the potential to standardize care and improve outcomes in this patient group.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the accuracy of high-sensitivity troponin for diagnosing acute myocardial infarction in emergency department patients with kidney dysfunction: a scoping review.","authors":"Madison Morningstar, Morgan Edwards, Linda Yang, Andrew D McRae","doi":"10.1007/s43678-026-01168-5","DOIUrl":"https://doi.org/10.1007/s43678-026-01168-5","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically identify and describe optimal methodology used to improve the diagnostic accuracy of high-sensitivity cardiac troponin for diagnosis of myocardial infarction in patients with kidney dysfunction.</p><p><strong>Methods: </strong>Cochrane, MEDLINE, EMBASE, and Google Scholar were systematically searched for studies describing strategies to increase the diagnostic accuracy of high-sensitivity cardiac troponin testing in emergency department patients with kidney dysfunction and suspected myocardial infarction. Study eligibility ascertainment and data extraction was performed by two independent reviewers. Findings of included studies were summarized and categorized according to methodological approach for improving diagnostic accuracy.</p><p><strong>Results: </strong>Data extraction was organized using Covidence online software. A total of 946 papers were identified in the electronic search. Of these, 878 were excluded based on review of titles and abstracts, 59 were removed after full-text review, and 9 studies were included in the final synthesis. Most studies identified alternative diagnostic troponin concentrations while one adjusted for kidney function using a multivariable model. Optimal cutoff concentrations for single and serial troponin samples varied by glomerular filtration rate and across published studies. Multivariable adjustment did not improve diagnostic accuracy of troponin testing, and glomerular filtration rate was not a significant covariate suggesting that kidney function acts as an effect measure modifier rather than as a confounder.</p><p><strong>Conclusion: </strong>Diagnosing myocardial infarction is particularly challenging in individuals with kidney dysfunction. High initial concentrations and serial changes seem specific for ruling in myocardial infarction, while low initial concentrations and minimal serial changes appear to safely rule out myocardial infarction. However, no strategy has been externally validated for widespread adoption. Further work should focus on identifying diagnostic strategies that use kidney function as an effect measure modifier, and that can be externally validated.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral metoclopramide for pediatric migraine management in the ED: health records review.","authors":"Paola Andrea Rouge Elton, Nathalie Lucas, Evelyne D Trottier, Sarah Mousseau, Geneviève Tourigny-Ruel, Marie-Elaine Métras, Jocelyn Gravel","doi":"10.1007/s43678-026-01169-4","DOIUrl":"https://doi.org/10.1007/s43678-026-01169-4","url":null,"abstract":"<p><strong>Objectives: </strong>Migraine is a common presentation in pediatric emergency departments (ED), and non-invasive treatment options are desirable. This study evaluated what proportion of children treated with oral metoclopramide would not need a rescue medication for the treatment of migraine in the ED.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a tertiary pediatric ED in Montréal, Canada, over a one-year period. Patients aged 8-18 years diagnosed with migraine and treated with either oral or intravenous metoclopramide were included. The primary outcome was headache relief, defined as no need for rescue medication. Secondary outcomes included ED length of stay, adverse events, return visits within 7 days, and reduction in pain scores measured by the 10-point verbal numeric rating scale. The primary analysis was the proportion of children who did not need a rescue medication restricted to children treated with oral metoclopramide. Secondary exploratory analyses compared oral to intravenous administrations on primary and secondary outcomes.</p><p><strong>Results: </strong>Of the 225 patients included, 78 received oral and 147 received intravenous metoclopramide. Headache relief was achieved in 83% (95% CI 73-91%) of the oral group. This compared favorably to the intravenous group (difference: 4%; 95% CI -7 to 14%). ED length of stay was shorter in the oral group (median 314 vs 500 min). Adverse events occurred only in the intravenous group (4%) and return visit proportions were similar between groups (difference 2%; 95% CI - 6 to 12%).</p><p><strong>Conclusions: </strong>Oral metoclopramide is an effective and well-tolerated treatment for 80% of children with migraine in the ED. On exploratory evaluation, it offered comparable outcomes to intravenous administration with the added benefits of shorter ED stays and reduced procedural pain. Oral metoclopramide should be considered as a first-line treatment option for pediatric migraine in the emergency department.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound-guided external aortic compression compared to manual external aortic compression: a prospective crossover trial on healthy volunteers.","authors":"Ann-Sophie Turcotte, Alexis Cournoyer, Jean Paquet, Éric Piette, Nancy Zhu, William Bédard Michel, Laurent Bilodeau, Raoul Daoust","doi":"10.1007/s43678-026-01149-8","DOIUrl":"https://doi.org/10.1007/s43678-026-01149-8","url":null,"abstract":"<p><strong>Objectives: </strong>External compression of the abdominal aorta is a promising bridging therapy to reduce bleeding at non-compressible sites in trauma patients with hemorrhagic shock. This study aimed to evaluate femoral arterial flow reduction and pain associated with ultrasound-guided versus blind manual aortic-compression, performed by a low-weight versus medium-weight clinician.</p><p><strong>Methods: </strong>We conducted a crossover experimental study on healthy volunteers. Ultrasound-guided and manual aortic-compression were performed by two physicians (80 kg and 54 kg). The primary outcome-originally defined as the difference in femoral blood flow reduction measured by Doppler-was modified early in data collection to the proportion of participants with complete flow occlusion, as this was found to be a more objective and physiologically relevant measure. Mixed models with two repeated measures compared complete occlusion between techniques and operator weights (alpha = 0.05). Pain scores and adverse effects at 0, 24 hour, and 7 days were also measured.</p><p><strong>Results: </strong>The study was stopped after 20 volunteers underwent compression (mean BMI: 22; female: 65%) due to significant pain and two vasovagal syncopal episodes. Complete femoral flow occlusion was achieved using either technique in 19 (95%) and 17 (85%) participants for the 80-kg and 54-kg operators, respectively. No significant effect of technique was observed (p = 0.54). A trend toward an operator effect (greater effectiveness for the 80-kg operator; p = 0.07) was noted, with no interaction between operator weight and technique (p = 1.0).</p><p><strong>Conclusion: </strong>This exploratory study on healthy volunteers suggests that both ultrasound-guided and manual external aortic-compression can achieve complete femoral arterial occlusion in most participants but cause significant pain and adverse events. Although the clinical implications remain uncertain, the procedure could be considered as a temporary, last resort measure for temporizing patients with severe, uncontrolled hemorrhagic shock. REGISTERED AT CLINICAL.GOV: NCT04745585.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early diagnosis of infective endocarditis in a patient without known risk factors using PoCUS.","authors":"James P Marks, Kathryn Smith, Katie Rong","doi":"10.1007/s43678-026-01165-8","DOIUrl":"https://doi.org/10.1007/s43678-026-01165-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: a clinical approach for emergency physicians to splanchnic (abdominal) vein thrombosis.","authors":"Kaitlin Endres, Marc Carrier, Nicholas Costain","doi":"10.1007/s43678-025-01074-2","DOIUrl":"https://doi.org/10.1007/s43678-025-01074-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: balancing opioid reversal and withdrawal in emergency care.","authors":"Samuel Blais, Marcel Émond, Maude St-Onge","doi":"10.1007/s43678-026-01143-0","DOIUrl":"https://doi.org/10.1007/s43678-026-01143-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: identifying and managing opioid use disorder in the emergency department.","authors":"Isabelle Miles, Kathryn Dong, Justin J Koh","doi":"10.1007/s43678-026-01163-w","DOIUrl":"https://doi.org/10.1007/s43678-026-01163-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement between point-of-care ultrasonography and the Tokyo guidelines 2018 for acute cholecystitis (PACED study).","authors":"Nonthaka Nipitkul, Rujaporn Kotnarin","doi":"10.1007/s43678-026-01161-y","DOIUrl":"https://doi.org/10.1007/s43678-026-01161-y","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the agreement and diagnostic accuracy of abdominal point-of-care ultrasonography (PoCUS) performed by emergency physicians for suspected acute cholecystitis, using the Tokyo Guidelines 2018 (TG18) as the reference standard.</p><p><strong>Methods: </strong>We conducted a multicenter, diagnostic accuracy study at two university-affiliated tertiary care hospitals in Thailand from October 2019 to June 2024. We included adult patients presenting to the emergency department (ED) with suspected acute cholecystitis who underwent PoCUS by an emergency physician, followed by confirmatory radiological imaging (formal ultrasonography or computed tomography; CT). A positive PoCUS was defined as the presence of gallstones plus a sonographic Murphy's sign, gallbladder wall thickening > 3 mm, or pericholecystic fluid. Blinded reviewers adjudicated the final diagnosis based on the comprehensive TG18 criteria. The primary outcome was the diagnostic agreement between the PoCUS result and the final TG18 diagnosis, measured using Cohen's kappa (κ). Secondary outcomes included sensitivity, specificity, predictive values, and likelihood ratios. The study was reported in accordance with the STARD 2015 guidelines.</p><p><strong>Results: </strong>According to TG18 criteria, 537 patients (68.6%) were diagnosed with acute cholecystitis. PoCUS demonstrated a sensitivity of 86.6% (95% CI, 83.4-89.4) and a specificity of 17.1% (95% CI, 12.5-22.5). The positive predictive value (PPV) was 70.0%, the negative predictive value (NPV) was 37.0%, and the overall diagnostic accuracy was 64.9%. Among individual PoCUS signs, only gallstones were significantly associated with TG18-confirmed cholecystitis (p < 0.01).</p><p><strong>Conclusion: </strong>In this large, real-world cohort, PoCUS performed by emergency physicians showed poor agreement with the definitive TG18 diagnosis of acute cholecystitis. Although sensitive, its extremely low specificity resulted in a high number of false positives, limiting its usefulness as a standalone diagnostic tool. These findings highlight the importance of combining PoCUS findings with clinical and laboratory data, as recommended by the TG18, to prevent diagnostic errors and unnecessary further testing.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the association between undiagnosed prior stroke and short-term mortality among older adults who have fallen.","authors":"Elena Tataru, Mathew Mercuri, Ashkan Shoamanesh, Natasha Clayton, Éric Mercier, Judy Morris, Rebecca Jeanmonod, Debra Eagles, Catherine Varner, David Barbic, Ian Buchanan, Mariyam Ali, Yoan Kagoma, Paul Engels, Sunjay Sharma, Andrew Worster, Shelley McLeod, Marcel Émond, Ian Stiell, Alexandra Papaioannou, Sameer Parpia, Kerstin de Wit","doi":"10.1007/s43678-026-01139-w","DOIUrl":"https://doi.org/10.1007/s43678-026-01139-w","url":null,"abstract":"<p><strong>Objectives: </strong>Older adults commonly present to the emergency department after a fall. Head imaging is frequently ordered for these patients. Occasionally, head imaging finds evidence of chronic stroke when there is no clinical history of stroke. The clinical implications of undiagnosed prior stroke are unknown. Our objective was to explore the association between undiagnosed prior stroke and short-term mortality after a fall.</p><p><strong>Methods: </strong>This was a secondary analysis of a prospective multicenter cohort study enrolling patients ≥ 65 years presenting to the emergency department after a fall. Patients were included if they had a head CT scan during their visit, and their vital status was known at 42 days. We used a logistic regression model to examine the relationship between previously undiagnosed prior stroke and death within 42 days. The model adjusted for age, sex, use of antiplatelet/anticoagulant medications, and Clinical Frailty Scale score.</p><p><strong>Results: </strong>Among 4308 enrolled patients, 2698 had a head CT scan at the index visit, of whom 2307 were known to be alive or dead at 42 days. The median age was 84 (IQR 77-89) years, and 62% were female. At 42 days, 131 patients (6%) had died. There was no association between death at 42 days and undiagnosed prior stroke (aOR 0.84, 95% CI: 0.47-1.49). Male sex (aOR 1.64, 95% CI: 1.14-2.37) and Clinical Frailty Scale score (aOR 1.49, 95% CI: 1.31-1.70) were associated with death.</p><p><strong>Conclusions: </strong>Previously undiagnosed stroke was not associated with short-term survival in older adults after a fall and should not be considered an indicator of worse short-term outcome in the clinical setting.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}