CJEM最新文献

{"title":"Global Research Highlights.","authors":"","doi":"10.1007/s43678-026-01244-w","DOIUrl":"10.1007/s43678-026-01244-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"994-996"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120031","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":"Fibrinogen in trauma patients: finding the needle or shrinking the haystack?","authors":"Andrew Petrosoniak, Jeannie Callum","doi":"10.1007/s43678-026-01278-0","DOIUrl":"https://doi.org/10.1007/s43678-026-01278-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"28 10","pages":"891-892"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168874","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":"Automated quality assurance for emergency department documentation: pilot comparison with physician peer review of simulated chest pain cases.","authors":"Yara Mohajerani, Seyed-Alireza Mohajerani, Stephenson Strobel, Corrine Mitges, Craig Brick, Suneel Upadhye, Roveena Sequeira, Melanie Senechal, Paulo De Gouveia","doi":"10.1007/s43678-026-01230-2","DOIUrl":"10.1007/s43678-026-01230-2","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility and reliability of an artificial intelligence-driven quality assurance system for emergency chest pain documentation in simulated cases, compared to traditional physician reviewers.</p><p><strong>Methods: </strong>We developed an automated quality assurance solution leveraging commercial Large Language Models that are customized based on College of Physicians and Surgeons of Ontario peer review standards. Seventeen simulated emergency chest pain cases of varying quality were independently reviewed by an automated auditor, six community emergency physicians, and original case writers using a 3-point evaluation scale across nine dimensions. Agreement was measured using Lin's Concordance Correlation Coefficient for overall score agreement, Root Mean Square Error for overall score accuracy, and Cohen's Kappa statistics for categorical dimension scores.</p><p><strong>Results: </strong>Inter-rater agreement among human reviewers showed substantial variability with overall score concordances ranging from 0.28 to 0.86. The automated auditor demonstrated agreement levels within the range of human variability within the limited sample of simulated cases with the best performing model (guideline-customized Claude Sonnet 4) with a concordance value of 0.85 and root mean square error of 0.25 with respect to the average human scores on the 3-point scale. For pass/fail decisions, agreement with human reviewers ranged from 65 to 94% with Kappa scores of 0.27 to 0.85, comparable to inter-human reviewer agreement Kappa scores of - 0.12 to 0.68.</p><p><strong>Conclusions: </strong>The performance of the automated auditor showed agreement within the range of variability observed among that of the small group of uncalibrated human reviewers for the simulated cases in determining documentation quality and pass/fail outcomes. Given the potential variability in human assessments, automated quality assurance may provide a more consistent evaluation of quality, with the added advantage of the mass-processing of many cases in near real-time.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"982-987"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474797","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":"Successes and failures of ED trauma intubations.","authors":"Paul Clerc, Valerie Athaide, John Taylor, Jeff Yoo, Vesna Ivkov, Kuljit Minhas, Elizabeth Rohrs, Samantha Jang-Stewart, Jade Zhong, Regina-Veronicka Kalaydina, Karanvir Gill, Brendan Tao, Celestina Tanase, Victoria Forcina","doi":"10.1007/s43678-026-01153-y","DOIUrl":"10.1007/s43678-026-01153-y","url":null,"abstract":"<p><strong>Purpose: </strong>Approximately, 12% of trauma activations require intubation and 25% of all emergency department (ED) intubations are in trauma patients. The first-pass success rate in trauma patient intubation is 64-90%. This study aims to explore factors associated with first-pass success and adverse event rates in trauma patients in a Canadian context.</p><p><strong>Methods: </strong>We conducted a health records and registry review of a cohort of trauma patients requiring intubation at two Level 1 trauma sites in British Columbia (January 2017-March 2022). Primary outcome was first-pass success rate. Secondary outcomes were adverse events rates as well as identifying factors associated with first-pass success and adverse events. Multivariate logistic regression explored associations with key covariates and estimated adjusted odds ratios.</p><p><strong>Results: </strong>Among 440 patients, 85% experienced first-pass success and 22% experienced adverse events. DASH-1A rates were 72%. Adjusted logistic regression revealed that video laryngoscopy was positively associated with first-pass success (OR 2.38 CI 1.13-4.99 p = 0.02). Trauma to head, face, or neck was negatively associated with first-pass success (OR 0.09 CI 0.01-0.65, p = 0.02). Intubations by junior residents and higher injury severity scores were associated with an increased odds ratio of adverse events (OR 2.12 CI 1.02-4.42 p = 0.05 and OR 1.04 CI 1.02-1.06 p = 0.001 respectively).</p><p><strong>Conclusions: </strong>Our project is the first to comprehensively report first-pass success, adverse events, intubation operator/equipment, and trauma characteristics for Canadian trauma patients intubated in the ED. Video laryngoscopy was associated with improved first-pass success, while head, face, or neck trauma was associated with reduced first-pass success. Further, intubations by junior residents and extensive injuries were found to be associated with a greater frequency of adverse events. Ongoing quality improvement and trauma-specific intubation training should continue in order to improve first-pass success, reduce adverse events, and address patient-oriented outcomes.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"958-967"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582798","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":"Clinical and physiologic factors associated with early hypofibrinogenemia in trauma.","authors":"Fayad Al-Haimus, Ehsan Ghamarian, Rosane Nisenbaum, Amanda McFarlan, Melissa McGowan, Katerina Pavenski, Andrew Beckett, Brodie Nolan","doi":"10.1007/s43678-026-01217-z","DOIUrl":"10.1007/s43678-026-01217-z","url":null,"abstract":"<p><strong>Objectives: </strong>Fibrinogen plays a critical role in hemostasis and may be depleted early during trauma resuscitation. Although balanced resuscitation strategies have improved trauma care, early identification of trauma patients who are hypofibrinogenemic remains challenging in many real-world settings. We aimed to identify clinical and physiologic characteristics associated with early hypofibrinogenemia in trauma patients.</p><p><strong>Methods: </strong>We conducted a health records review of adult trauma patients (≥ 18 years) who triggered a trauma team activation at a single trauma center between 2016 and 2021. Patients who died prior to blood sampling or had no usable initial fibrinogen measurement were excluded. The primary outcome was hypofibrinogenemia defined as the initial fibrinogen level collected in the trauma bay below 1.5 g/L. A multivariable logistic regression model was used to explore factors associated with early hypofibrinogenemia. This was an exploratory association analysis.</p><p><strong>Results: </strong>Among 4,936 included patients, 155 (3%) had early hypofibrinogenemia. Patients with early hypofibrinogenemia experienced high in-hospital mortality (51%). In adjusted analyses, the odds of early hypofibrinogenemia increased with greater blood component transfusion in trauma bay (OR 1.2 per unit, 95% CI 1.09-1.24), reflecting resuscitation intensity, and systolic blood pressure < 90 mmHg (OR 2.5, 95% CI 1.04-5.84). The odds decreased with higher (less negative) base excess (OR 0.84 per mmol/L, 95% CI 0.81-0.87) and with penetrating injury compared with non-penetrating injury (OR 0.43, 95% CI 0.21-0.83). Time from injury to presentation had an increased odds of hypofibrinogenemia (OR 1.03 per hour, 95% CI 0.99-1.07).</p><p><strong>Conclusion: </strong>Early hypofibrinogenemia occurred in a small subset of trauma patients but was associated with marked physiologic derangement and high mortality. These hypothesis-generating findings contribute to understanding the physiologic context of fibrinogen deficiency in trauma and provide a foundation for future prospective validation studies.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"949-957"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042772","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":"Finding your focus.","authors":"Paul Atkinson","doi":"10.1007/s43678-026-01181-8","DOIUrl":"10.1007/s43678-026-01181-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"988-989"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936361","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":"Public awareness and satisfaction with the centre antipoison du quebec (CAPQ): a population-based survey.","authors":"Maude St-Onge, Audrée Elliott, Win Sweeris Vong, Megan Bergeron","doi":"10.1007/s43678-026-01186-3","DOIUrl":"10.1007/s43678-026-01186-3","url":null,"abstract":"<p><strong>Objectives: </strong>To describe public awareness of the Centre antipoison du Québec (CAPQ), expectations regarding acute poisoning management and service delivery, and satisfaction among prior users.</p><p><strong>Methods: </strong>We conducted a cross-sectional, bilingual online survey of Quebec residents aged ≥ 14 years between April 13, 2024, and June 27, 2025. The questionnaire collected demographic data, assessed awareness and prior use of the CAPQ, explored past poisoning events and expectations for acute poisoning management, and measured satisfaction among previous users using a 5-point Likert scale, with open-ended questions for qualitative input. Participants were recruited through convenience and snowball sampling via public settings, social media, and CIUSSS newsletters. Descriptive statistics summarized responses and explored trends.</p><p><strong>Results: </strong>A total of 611 respondents were included; 541 (88.5%) were aware of the CAPQ, including 152 prior users, while 70 (11.5%) were unaware. Unawareness was more common among females (60.0%), non-healthcare workers (91.4%), respondents with a non-North American ethnic background (34.2% vs. 10.1%), and those not primarily French-speaking (12.9% vs. 3.0%). Regional variation was observed, with Capitale-Nationale contributing the largest number of unaware respondents (35/70) and Laurentides showing the highest proportion (26.7%). Among respondents without prior CAPQ use who reported a poisoning event, most contacted emergency services or presented to the emergency department. Expectations were similar among aware and unaware respondents, particularly for acute poisoning management, with nurses expected to respond within five minutes. Among prior users, overall satisfaction was high across all domains, though communication and outreach were identified as areas for improvement. Key service expectations included rapid 24/7 access (76.9%), responder expertise (69.9%), and clear, adapted recommendations (56.1%). Most respondents preferred French (84.9%), telephone communication (94.1%), and follow-up calls (81.7%).</p><p><strong>Conclusions: </strong>User satisfaction with the CAPQ was high, but gaps in public awareness and service expectations remain. These findings highlight opportunities to improve accessibility, communication and outreach strategies.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"929-938"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive toxicology testing and clinical outcomes of ED patients with unregulated drug poisoning.","authors":"Anastasia Martens, Elva Li, Katerina Georgi, Shannon Erdelyi, Aman A Mohammed, Jessica Moe, Amrit Pal Bhela, Jeffrey R Brubacher","doi":"10.1007/s43678-026-01156-9","DOIUrl":"10.1007/s43678-026-01156-9","url":null,"abstract":"<p><strong>Objectives: </strong>Unregulated drugs place a significant burden on individuals and the healthcare system, yet relatively little is known about the mix of substances implicated in the current polydrug crisis and their clinical effects. The current study aims to describe the toxicology and clinical outcomes of unregulated drug poisoning.</p><p><strong>Methods: </strong>We conducted a cross-sectional study at a tertiary hospital in Vancouver, British Columbia. Eligible patients were those presenting to the emergency department (ED) with suspected unregulated drug overdose and residual blood samples available for analysis. Chart review was performed to extract relevant clinical data, and liquid chromatography-tandem quadruple mass spectrometry was applied to blood samples to detect a broad panel of substances beyond routine ED toxicology screens.</p><p><strong>Results: </strong>From 148 eligible patients, we randomly selected 69 for toxicology testing (mean age 43 years; 74% male). Amphetamines (94%), fentanyl or analogues (67%), and unregulated benzodiazepines (64%) were most prevalent. Polysubstance exposure was nearly universal, with 91% positive for three or more drug classes, 83% for four or more, and nearly half (49%) for six or more concurrently. Clinical interventions were frequent, with naloxone administered to 59% of patients, 25% requiring-assisted ventilation (including two who required intubation). Twenty-eight percent of patients were admitted to hospital, with 4% admitted to intensive care. Complications included loss of consciousness (55%), hypoxia (22%), seizures (9%), severe agitation (6%) and rhabdomyolysis (3%).</p><p><strong>Conclusion: </strong>Unregulated drug poisoning in Vancouver, British Columbia was characterized by polysubstance exposure and frequent complications. Detailed toxicological analysis revealed high rates of unregulated benzodiazepines and stimulant co-detection with opioids, underscoring risks beyond opioid toxicity alone. Clinicians should be aware that unregulated drug poisoning involves multiple substances and may therefore have atypical presentations and/or incomplete response to standard therapy.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"915-919"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583211","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: tumour lysis syndrome.","authors":"Brit Long, Arleigh McCurdy, Hans Rosenberg","doi":"10.1007/s43678-026-01197-0","DOIUrl":"10.1007/s43678-026-01197-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"908-911"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The few survivors: rethinking futility in traumatic cardiac arrest.","authors":"Kavish Chandra, Paul Atkinson","doi":"10.1007/s43678-026-01277-1","DOIUrl":"https://doi.org/10.1007/s43678-026-01277-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"28 10","pages":"889-890"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169253","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}