CJEM最新文献

{"title":"Just the facts: ovarian hyperstimulation syndrome - a primer for emergency physicians.","authors":"Nicholas Prudhomme, Hans Rosenberg, Bryden Magee","doi":"10.1007/s43678-025-00931-4","DOIUrl":"https://doi.org/10.1007/s43678-025-00931-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060707","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":"Validating the falls decision rule: optimizing head CT use in older adults with ground-level falls.","authors":"Emre Kudu, Mustafa Altun, Faruk Danış, Sinan Karacabey, Erkman Sanri, Arzu Denizbasi","doi":"10.1007/s43678-025-00937-y","DOIUrl":"https://doi.org/10.1007/s43678-025-00937-y","url":null,"abstract":"<p><strong>Objective: </strong>Falls are a leading cause of traumatic brain injury in older adults, with ground-level falls being the most common mechanism. Despite the increasing use of head computed tomography (CT) in older adults with ground-level falls, there is an ongoing debate regarding the necessity of routine neuroimaging in all cases. The falls decision rule was developed to safely exclude clinically important intracranial bleeding without head CT in older adults. This study aims to validate the falls decision rule externally and assess its accuracy in identifying low-risk patients while reducing unnecessary imaging.</p><p><strong>Methods: </strong>This prospective cohort study at a Level-1 trauma center enrolled consecutive patients aged ≥ 65 years presenting within 48 h of a ground-level fall. Patient management, including the decision to perform head CT, was determined independently by the treating emergency physician. Patients were followed up for 42 days to identify clinically important intracranial bleeding cases. The rule's diagnostic performance was evaluated using sensitivity, specificity, and predictive values using 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of 800 patients were included, with a median age of 78 years (IQR 72-85), and 59.9% were female. Clinically important intracranial bleeding was identified in 6.1% (n = 49) of patients. Head CT was performed in 67.6% of cases, identifying 43 initial hemorrhages, with six additional cases detected during follow-ups. The falls decision rule demonstrated 97.9% sensitivity (95% CI 89.1-99.9), 31.9% specificity (95% CI 28.6-35.4), and 99.5% negative predictive value (95% CI 97.1-99.9), potentially reducing CTs by one-third.</p><p><strong>Conclusion: </strong>This validation confirms the falls decision rule's high sensitivity and negative predictive value for identifying low-risk older adults after ground-level falls, potentially reducing unnecessary CT scans by approximately one-third. This approach could alleviate ED overcrowding and resource strain while ensuring diagnostic safety.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031905","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":"ED inhaler revolution: a simple method to substantially reduce the carbon footprint and cost of inhaler use in the emergency department.","authors":"Laura F Wilson, Lucas B Chartier, Christian James Turner","doi":"10.1007/s43678-025-00884-8","DOIUrl":"10.1007/s43678-025-00884-8","url":null,"abstract":"<p><strong>Objectives: </strong>As global warming intensifies, the healthcare industry faces a parallel need to treat climate-related illness and scrutinize our greenhouse gas emissions. Metered-dose inhaler medications for reactive airways diseases constitute a substantial portion of healthcare emissions. Metered-dose inhalers are often overprescribed, underlabeled, and lost after a few actuations in the emergency department (ED). Lower greenhouse gas alternatives of similar cost and efficacy are readily available, such as dry-powder inhalers, and numerous guidelines support practice change, yet no published work has shown attempts to change practice patterns in the ED. This quality improvement initiative sought to improve inhaler prescribing, use, and disposal in our ED through a staff education campaign.</p><p><strong>Methods: </strong>In a tertiary care ED, we implemented a two-staged education campaign for ED nurses and doctors. Passive education techniques (posters, emails, presentations) were followed by active education (one-on-one sessions, simulated cases). Objectives included improvement of green-prescribing practices, medication labeling, patient education, proper disposal, and pulmonary function testing prior to prescribing. We encouraged practice change only in mild and moderate cases of reactive airway disease.</p><p><strong>Results: </strong>We showed a 19% reduction over the first 6 months, and a 43% reduction the following 6 months in salbutamol metered-dose inhaler dispensations, relative to the same period the year prior. This may correspond to the carbon equivalent of driving approximately 96,000 km by car, or nearly 2.5 times the Earth's circumference. Process measures revealed increased dispensations of dry-powder inhalers and a quick improvement in prescriber knowledge and comfort with alternatives.</p><p><strong>Conclusion: </strong>Overburdened ED staff remain willing and able to change practice toward environmental sustainability. The rapid success of this project should encourage expansion of sustainability considerations across Canadian EDs, and into clinical and administrative decision-making at all levels of healthcare.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"367-372"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588850","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":"Keeping healthcare running: fighting the forces that drag it down.","authors":"Paul Atkinson","doi":"10.1007/s43678-025-00893-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00893-7","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"327-328"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994183","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":"Correction: CJEM debate: clinical decision rules-thinking beyond the algorithm.","authors":"Justin Morgenstern, Ryan Radecki, Lauren Westafer, Joshua D Niforatos, Paul Atkinson","doi":"10.1007/s43678-025-00894-6","DOIUrl":"10.1007/s43678-025-00894-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"409"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544928","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":"A research grid to support clinician scientists in your emergency department.","authors":"Jeffrey J Perry, Christian Vaillancourt, Krishan Yadav, Guy Hebert, Warren J Cheung, Debra Eagles, Venkatesh Thiruganasambandamoorthy, Cheryl Geymonat, Ian G Stiell","doi":"10.1007/s43678-024-00857-3","DOIUrl":"10.1007/s43678-024-00857-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"342-344"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560405","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":"Activated charcoal in the poisoned patient: beyond the one-hour mark.","authors":"Riley James Hartmann, Joseph Boyle, Kedra Peterson","doi":"10.1007/s43678-025-00916-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00916-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"322-323"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031252","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":"The Goldilocks approach to trauma team activation: getting it 'Just Right'.","authors":"Ryan P Strum, Shawn Mondoux, Winny Li","doi":"10.1007/s43678-025-00917-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00917-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"319-321"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011078","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":"Assessing the rates of overtriaging with prehospital trauma team activation protocols.","authors":"Kevin Durr, Krishan Yadav, Michael Ho, Jacinthe Lampron, Alexandre Tran, Doran Drew, Andrew Petrosoniak, Christian Vaillancourt, Natalia Kruger, Derek Goltz, Marie-Joe Nemnom, Jeffrey J Perry","doi":"10.1007/s43678-025-00885-7","DOIUrl":"10.1007/s43678-025-00885-7","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital trauma team activation protocols are increasingly used to expedite clinical care and potentially improve patient outcomes. However, there is little evidence describing the rates of overtriaging following prehospital activation.</p><p><strong>Methods: </strong>In June 2018, prehospital trauma team activation protocols were implemented at the Ottawa Hospital. We conducted a health records review of all adult trauma team activations at this Lead Trauma Hospital from September 2016 to March 2020. Cases were prospectively recorded in the regional trauma registry. Pre-implementation and post-implementation cohorts were divided based on the implementation date of the local activation protocols. Overtriaging rates were compared between both groups. We defined overtriaging as activating the trauma team without any of the following: death, ≥ 48-h admission, intensive care unit admission, operative management, or an injury severity score ≥ 16. We present descriptive statistics with odds ratios and 95% confidence intervals to describe the rates of overtriaging.</p><p><strong>Results: </strong>We analyzed 762 trauma team activations with 384 in the pre-implementation group and 378 in the post-implementation group. The frequency of prehospital trauma team activation was 25.3% (N = 97) in the pre-implementation period, compared to 47.6% (N = 180) in the post-implementation period. There was no statistically significant increase in overtriaging when comparing the pre-implementation (N = 64, 16.7%) and post-implementation (N = 68, 18.0%) groups (OR 1.10; 95% CI 0.75, 1.60). Furthermore, the rate of overtriaging for each individual criterion of the local protocol adhered to guideline recommendations (< 25-35%). Lastly, in the post-implementation period, there was no significant difference in overtriaging with prehospital (N = 30, 16.7%) compared to in-hospital (N = 38, 19.2%) trauma team activation (OR 0.84; 95% CI 0.50, 1.43).</p><p><strong>Conclusion: </strong>Our study demonstrates that the local prehospital trauma team activation protocol did not result in a statistically significant rise in overtriaging. These findings demonstrate that implementing center-specific prehospital trauma team activation protocols did not increase overtriaging rates.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"390-394"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582416","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":"Global research highlights.","authors":"","doi":"10.1007/s43678-025-00925-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00925-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"400-403"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063518","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}