CJEM最新文献

{"title":"Need to Know: CJEM Journal Club-Does IV tenecteplase treatment before endovascular thrombectomy lead to improved functional outcomes than endovascular thrombectomy alone in patients with acute ischemic stroke due to large-vessel occlusion?","authors":"Ming K Li, Rohit Mohindra","doi":"10.1007/s43678-025-01007-z","DOIUrl":"https://doi.org/10.1007/s43678-025-01007-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226510","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: Coaching in emergency medicine.","authors":"Brittany Cameron, Sara Gray","doi":"10.1007/s43678-025-01011-3","DOIUrl":"https://doi.org/10.1007/s43678-025-01011-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093110","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":"Timeliness of management of button battery impactions in children in the province of Ontario: a multi-center analysis.","authors":"Nikolaus E Wolter, Jennifer M Siu, Jacob Davidson, Ayushi Bhatt, Olivia Ostrow, Ryan Rourke, Xinyuan Hong, Jonathan Maclean, Jakob Pugi, Kristina H Pulkki, Justine G Philteos, M Elise Graham, Natashia M Seemann","doi":"10.1007/s43678-025-01010-4","DOIUrl":"https://doi.org/10.1007/s43678-025-01010-4","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal button battery impactions represent a life-threatening medical emergency in children. There are established clinical benchmarks to help reduce the risk of injury. Our objective was to describe the care pathways of children presenting with esophageal button battery impactions in the four main pediatric centers in Ontario.</p><p><strong>Methods: </strong>A multi-institutional health records review of button battery ingestion cases in children from 2012 to 2023 at four large-volume tertiary pediatric hospitals was conducted. Participants included children under 18 years who underwent esophagoscopy for battery removal.</p><p><strong>Results: </strong>Eighty-six children with button battery impactions were identified. The median age was 2.6 years. Fifteen children presented directly to a tertiary institution, while 71 (82.6%) were transferred from a community hospital. The median total distance traveled was 44.6 km. The median time from button battery diagnosis to removal was 7.9 h. Honey or sucralfate was administered in < 5% of cases. The median hospital stay was 3.1 days. Complications included esophageal perforation (2.3%), esophageal stricture (8.5%), tracheoesophageal fistula (1.2%), and vascular injury (1.2%), with one death reported. No cases met the benchmark of button battery removal within 2 h of ingestion, with significant delays occurring at every management stage.</p><p><strong>Conclusion: </strong>Despite efforts to increase awareness and rapid management of button battery ingestion, significant delays, poor adherence to mitigation strategies, and serious complications persist. These findings emphasize the need for prevention and the development of regional and institution-specific protocols to provide timely and streamlined care.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076921","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":"Topical non-steroidal anti-inflammatory drug use for pediatric acute musculoskeletal pain: a scoping review.","authors":"Domenic F Alaimo, Marah Al Masri, Mohamed Eltorki","doi":"10.1007/s43678-025-00982-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00982-7","url":null,"abstract":"<p><strong>Objective: </strong>Topical non-steroidal anti-inflammatory drugs (NSAIDs) effectively treat acute musculoskeletal pain in adults, but evidence in children is limited. This scoping review aims to summarize current evidence for use in children and identify literature gaps to inform future research.</p><p><strong>Methods: </strong>We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines. Our electronic search included published studies across six databases, grey literature, and unpublished or ongoing trials. Studies involving children (< 18 years) with acute musculoskeletal pain treated with topical NSAIDs in Emergency Department (ED), urgent care, or ambulatory settings were included. We extracted data on study methodology, participant characteristics, clinical outcomes, adverse events, and rescue analgesia use. We performed critical appraisal using Joanna Briggs Institute tools.</p><p><strong>Results: </strong>Three studies met inclusion criteria: two randomized-controlled trials and one non-randomized trial, totaling 467 participants aged 6-18 years. Interventions included ketoprofen gel, methyl salicylate/1-menthol patch, and diclofenac epolamine patch for ankle sprains or minor soft tissue injuries. Treatment durations ranged from 30 minutes to 14 days. Studies varied in design, intervention protocols, outcome measures, and reporting quality. Common outcomes included pain reduction, rescue medication use, and adverse events. Overall, findings suggest topical NSAIDs may be effective and well tolerated for managing acute musculoskeletal pain in children. However, the available evidence has low credibility with high risk of bias and methodological heterogeneity. No studies compared topical with oral NSAIDs, and few assessed long-term safety, functional recovery, or participant-centered outcomes such as satisfaction or adherence.</p><p><strong>Conclusion: </strong>Topical NSAIDs may be a potential option for relief of acute musculoskeletal pain in children, although evidence is grossly limited. High-quality randomized-controlled trials are needed to evaluate the efficacy and safety of topical NSAIDs in children before recommendations for use in clinical practice can be made.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066326","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 U-POCUS protocol: urinalysis and point-of-care ultrasound to exclude symptomatic ureterolithiasis in emergency department patients.","authors":"Matthew Tripod, Kendra Mendez, Matthew Berger, Claire Shaffer, Timothy Yeung, Thomas G Costantino, Steven Peterson, Ryan C Gibbons","doi":"10.1007/s43678-025-00998-z","DOIUrl":"https://doi.org/10.1007/s43678-025-00998-z","url":null,"abstract":"<p><strong>Objective: </strong>Urolithiasis is a common urological condition accounting for more than 1.3 million emergency department visits annually with costs exceeding $2.8 billion (Scales et al. in Eur Urol. 62:160-5, 2012;Eaton et al. in J Endourol 27:1535-1538, 2013;Antonelli et al. in Eur Urol 66:724-729, 2014;). Non-contrast computed tomography of the abdomen and pelvis remains the diagnostic gold standard. Studies assessing urinalysis and renal point-of-care ultrasound (PoCUS), individually, to diagnose symptomatic ureterolithiasis demonstrate inadequate sensitivities (Mefford et al. in West J Emerg Med 18:775, 2017;Eray et al. in Am J Emerg Med 21:152-4, 2003;Luchs et al. in Urology 59:839-842, 2002;Smith-Bindman et al. in N Engl J Med 371:1100-1110, 2014;Riddell et al. in West J Emerg Med 15:96-100, 2014;Rosen et al. in J Emerg Med 16:865-870, 1998;Gaspari and Horst in Acad Emerg Med 12:1180-1184, 2005;Watkins et al. in Emerg Med Australas 19:188-195, 2007;). The primary objective of this study was to assess the test characteristics of the U-PoCUS (urinalysis with renal point-of-care ultrasound) protocol.</p><p><strong>Methods: </strong>This was an Institutional Review Board approved, multi-center, retrospective chart review at a university-based healthcare system. Study investigators included all patients who presented from January 1, 2016 through June 30, 2020, and underwent computed tomography of the abdomen and pelvis and had a urinalysis and PoCUS for suspected ureterolithiasis. Investigators utilized MedCalc (Version 19.1.6) and standard 2 × 2 tables to calculate test characteristics with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Study investigators enrolled 183 patients, including 122 patients diagnosed with computed tomography confirmed ureterolithiasis and 61 patients without it. The combination of hematuria and/or hydronephrosis on PoCUS had a sensitivity of 99.2% (95.6-100) and a specificity of 14.8% (7-26.2) for the presence of urolithiasis. Positive predictive value and negative predictive value were 69.9% (67.7-72.1) and 90% (53.9-98.6), respectively.</p><p><strong>Conclusion: </strong>The presence of hematuria and/or hydronephrosis was 99.2% sensitive for the presence of ureterolithiasis diagnosed on computed tomography of the abdomen and pelvis. The U-PoCUS protocol missed only one symptomatic ureterolithiasis.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058836","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":"Takotsubo cardiomyopathy induced by opioid withdrawal: a case report.","authors":"Ariella Gartenberg, Toby Mathew, Mikhail Blyakher, Andrew Chertoff","doi":"10.1007/s43678-025-00979-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00979-2","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo cardiomyopathy is a stress-induced non-ischemic cardiomyopathy that can result from trauma, stimulant use, financial strain, and opioid withdrawal. Opioid withdrawal induced cardiomyopathy is rarely reported in the literature and is thought to result from increased sympathetic activity and catecholamine surge. Early management of opioid withdrawal with opioid agonists, like methadone or buprenorphine, can be crucial. With the opioid epidemic and ongoing rise in opioid-related overdoses, emergency department physicians should maintain a high clinical suspicion for this serious cardiac complication.</p><p><strong>Case report: </strong>This case report details a rare association of opioid withdrawal induced Takotsubo Cardiomyopathy and highlights the need for heightened clinician suspicion in the emergency department.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056497","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/s43678-025-01014-0","DOIUrl":"https://doi.org/10.1007/s43678-025-01014-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056518","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":"Do billing codes accurately reflect pediatric emergency physician workload? A cross-sectional study.","authors":"Erica Qureshi, Kenneth McKinley, Justin Park, Trang Ha, Gord McInnes, Yijinmide Buren, Quynh Doan","doi":"10.1007/s43678-025-01001-5","DOIUrl":"https://doi.org/10.1007/s43678-025-01001-5","url":null,"abstract":"<p><strong>Background: </strong>Measuring physician workload in the pediatric emergency department (ED) could help optimize staffing, improve department efficiency, and provide a metric to assess interventions aimed at improving pediatric ED flow. However, no accepted measure of physician workload exists. Billing codes, which reflect the perceived complexity of treating a patient, may serve as a surrogate for physician workload. Our objective was to evaluate whether billing codes are a valid surrogate for pediatric ED physician workload.</p><p><strong>Methods: </strong>We conducted a health records review to determine if billing codes were associated with measures of pediatric ED physician work. Visit information was extracted for 150 pediatric ED visits. We used multivariable ordinal logistic regression models to assess the association between pediatric ED physician-assigned billing codes, with measures of visit complexity, and measures of pediatric ED physician work. We also completed a sensitivity analysis considering a billing auditors-assigned billing codes.</p><p><strong>Results: </strong>Three measures of pediatric ED physician work were independently associated with increased physician-assigned billing codes: receiving labs (OR 5.6, 95% CI 2.2-15.4), ordering medications (OR 2.3, 95% CI 1.1-5.1), and having specialist consultation (OR 4.4, 95% CI 1.6-12.5). We did not find any statistically significant associations between physician-assigned billing codes and measures of physician work after adjusting for visit complexity, age, and sex. Visit acuity (PaedsCTAS 1-3) was associated with increased billing codes (aOR 5.1 95% CI 1.9-15.7). These results were largely consistent with our sensitivity analysis considering billing auditor-assigned codes.</p><p><strong>Conclusions: </strong>Overall, we found limited evidence supporting the content validity of billing code as a surrogate of pediatric ED physician workload. These results, coupled with the potential value of tracking physician workload, highlight the necessity to develop a valid and reliable measure specifically considering pediatric ED physician workload.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056468","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: cannabinoid hyperemesis syndrome.","authors":"Eddy Lang, Wayne Qin, Paul Atkinson","doi":"10.1007/s43678-025-01009-x","DOIUrl":"https://doi.org/10.1007/s43678-025-01009-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042598","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":"Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines 2025.","authors":"Justin N Hall, Joy McCarron, Cristian Toarta, Shelley L McLeod","doi":"10.1007/s43678-025-00996-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00996-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042565","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}