CJEM最新文献

{"title":"Just the facts: evaluation and management of epistaxis.","authors":"Brit Long, Morgan Langille, Hans Rosenberg, Paul Atkinson","doi":"10.1007/s43678-024-00820-2","DOIUrl":"10.1007/s43678-024-00820-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"349-352"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640488","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":"Back so soon?: the role of initial triage category in ED return visits.","authors":"P R Atkinson, D Lewis, J Fraser, M Howlett","doi":"10.1007/s43678-025-00890-w","DOIUrl":"10.1007/s43678-025-00890-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"404"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631125","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}

{"title":"Does a Targeted Engagement and Diversion program reduce emergency department utilization?","authors":"Rebecca Seliga, Krishan Yadav, Caroline Hodgins, Maria Jaramillo, Christina Masters, Jamie Muckle, Marie-Joe Nemnom, Ariel Hendin, Debra Eagles, Rakesh Patel","doi":"10.1007/s43678-025-00888-4","DOIUrl":"10.1007/s43678-025-00888-4","url":null,"abstract":"<p><strong>Objectives: </strong>The Targeted Engagement and Diversion (TED) program in Ottawa provides health care to unhoused or shelter/community housed adults outside of an emergency department (ED) setting. We sought to determine the proportion of patients diverted away from the ED by the TED program.</p><p><strong>Methods: </strong>We conducted a health records review of adult patients who visited the TED program from January to December 2022 using random sampling to account for seasonal variation. Data were extracted from the Ottawa Inner City Health database and hospital records from two university-affiliated EDs. The primary outcome was successful diversion from the ED, defined as any of the following: TED program patients (i) presenting in the evening or overnight; (ii) brought in by police/paramedic services; (iii) referred from the safe consumption site; (iv) assessed by a nurse or physician; (v) admitted for higher level of observation; or (vi) that received an antidote (e.g., naloxone). Data were described using descriptive statistics.</p><p><strong>Results: </strong>We reviewed 500 total visits of 241 unique patients (76.3% male, median age 38 years). The most common reason for presentation was unspecified intoxication (83.4%, n = 417). A total of 359 visits met criteria for successful diversion from the ED (71.8%, 95% confidence interval (CI) 67.7-75.6). Most patients who met diversion criteria revisited the TED program within 7 days (82.8%, n = 323), whereas 7.9% (n = 31) visited an ED within 7 days. At 2 years, 39% (n = 94) of all patients were stably housed and 10.8% (n = 26) died.</p><p><strong>Conclusion: </strong>The TED program may be successful at attracting patients and diverting their care away from busy local EDs, and few patients treated by the TED program visited the ED within the subsequent 7 days. This model of care may provide a solution to offload from overcrowded EDs and improve access to comprehensive care for patients who are unhoused.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"381-389"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694230","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":"Use of activated charcoal in poisoned patients aged over than 5 year old.","authors":"Sophie Gilbert, Maude St-Onge, Xavier Neveu","doi":"10.1007/s43678-025-00881-x","DOIUrl":"10.1007/s43678-025-00881-x","url":null,"abstract":"<p><strong>Background: </strong>Activated charcoal is the primary agent recommended for gastrointestinal decontamination. Current Canadian practices regarding its administration in poisoned patients are not well known. Our objectives were to measure the frequency of administration of activated charcoal in poisoned patient over the age of five, identify the potential determinants of its use, and describe the characteristics as well as the clinical outcomes in intoxicated patients.</p><p><strong>Methods: </strong>In a multicenter health records review, we reviewed poisonings using data collected from health records between January 2015 and January 2016, at different hospitals in Quebec, Canada. We included all poisoned patients over the age of 5 who presented and were managed in the emergency department within 12 h of ingestion of a potentially toxic dose of a carbo-absorbable substance. The primary endpoint was the progression of toxicity, and the secondary endpoints were mortality and length of stay. We calculated the incidence of administration of activated charcoal and identified the observed side effects.</p><p><strong>Results: </strong>A total of 120 of the 935 poisoned patients received activated charcoal (12.8%). A short post-ingestion time (< 90 min) was the preferred indication for its administration. Charcoal-treated patients had a 9.2% lower risk of increased toxicity in the first 12 h, but twice the likelihood of being admitted to the hospital, and of having a length of stay of 12 h or more. The most common side effect was vomiting (20.8%). Only one of the patients who received it had aspiration pneumonia (0.01%) and two patients subsequently had gastrointestinal obstruction after receiving activated charcoal (0.02%).</p><p><strong>Conclusion: </strong>Among patients who were poisoned with a carbo-absorbable substance, 12.8% were treated with activated charcoal in the emergency department. The majority of patients progressed well clinically. Our results will contribute to developing a protocol for a pan-Canadian prospective multicenter randomized controlled trial to evaluate the efficacy of activated charcoal in this population.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"373-380"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712501","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":"Author reply to: Pre-induction vasopressor use to reduce post-intubation hypotension.","authors":"Patricia L G Marks, James Gould","doi":"10.1007/s43678-025-00875-9","DOIUrl":"10.1007/s43678-025-00875-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"407-408"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574926","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":"Evaluating a Canadian tertiary care emergency department physician wellness program.","authors":"Matthew Lipinski, Eusang Ahn, Warren J Cheung, Stella Yiu","doi":"10.1007/s43678-025-00887-5","DOIUrl":"10.1007/s43678-025-00887-5","url":null,"abstract":"<p><strong>Objectives: </strong>In response to increasing physician moral distress, the Department of Emergency Medicine at an academic, tertiary care hospital established a physician wellness program in 2018. We conducted a program evaluation at the 5-year mark which included the development of a program evaluation framework.</p><p><strong>Methods: </strong>We used a utilization-focused logic model for the wellness program as per Van Melle. We identified inputs-outputs-outcomes and analyzed multiple data sources. These sources included qualitative and quantitative feedback from physicians, participation data from wellness initiatives, exit surveys, and engagement in departmental committees.</p><p><strong>Results: </strong>Over 5 years, the program periodically collected data on self-reported wellness of attending physicians along with participation data. In 2023, physicians ranked their occupational wellness at 5.93 on a 10-point Likert scale, with 58% highlighting supportive colleagues as their main protective factor and 42% identifying sequelae of emergency department crowding as a negative factor. Of survey respondents, 65% felt the program positively impacted their occupational wellness. Successful initiatives included public appreciation of physicians and creation of a \"process map\" to help guide physicians through a patient complaint. However, other initiatives such as wellness drop-in sessions were less successful.</p><p><strong>Conclusion: </strong>While social events were appreciated, initiatives focusing on addressing barriers to occupational wellness were valued the most. This program evaluation and logic model guided the planning committee to emphasize enhancing occupational wellness, recognizing physician accomplishments, and improving patient relations. It served as an operational example for the development and implementation of a wellness program within a large, tertiary care emergency department. Other centers can implement similar activities to create or further enhance their wellness programs.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"395-399"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560408","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 say no to metered dose inhalers.","authors":"James C Worrall, Ariel Hendin, Salmaan Kanji","doi":"10.1007/s43678-025-00918-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00918-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"317-318"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044957","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":"CAEP 2024 Academic Symposium: adaptive platform trials in emergency medicine in Canada.","authors":"Nathalie Germain, Martyne Audet, Lorraine Graves, Srinivas Murthy, Shelley L McLeod, Jaspreet Khangura, Shirin Golchi, Andrew D McRae, Corinne M Hohl, Ivy Cheng, Gabrielle Olivier Chevrier, John C Marshall, Patrick M Archambault","doi":"10.1007/s43678-025-00874-w","DOIUrl":"10.1007/s43678-025-00874-w","url":null,"abstract":"<p><strong>Objective: </strong>The Canadian Association of Emergency Physicians 2024 Academic Symposium Panel on adaptive platform trials explored whether adaptive platform trials could be implemented in Canadian emergency departments (EDs). This panel aimed to propose and refine recommendations formulated by the results of a rapid review and responses from a panel of experts about conducting adaptive platform trials in EDs.</p><p><strong>Methods: </strong>From November 2023 to May 2024, a rapid review was conducted on the existing logistical and ethical barriers and facilitators to structuring adaptive platform trials in emergency medicine. The emerging themes and ideas were collected and used to conduct individual semi-structured interviews with key stakeholders, including leaders in emergency medicine research, methodologists and biostatisticians specializing in these designs, patient partners, research personnel, and investigators involved in platform trials across Canada and abroad.</p><p><strong>Results: </strong>From 23 articles and 17 expert interviews, we identified facilitators and barriers to adaptive platform trials in Canadian emergency medicine spread across five domains: evidence strength and quality, relative advantage, adaptability, complexity, and implementation climate and readiness. The most salient needs according to investigators were purposeful and clinically relevant trial design, methodological expertise, and harmonious collaboration with ethics authorities. We provide 14 recommendations across 4 levels: policy, trialist, site, and patient to address barriers to adaptive platform trials in emergency medicine. For each recommendation, we provided corresponding implementation strategies from the Expert Recommendations for Implementing Change (ERIC).</p><p><strong>Conclusions: </strong>Adaptive trial designs are well suited for emergency settings provided the interventions are both easy for clinicians to administer and relevant enough to ameliorate the practice of emergency medicine. These designs are particularly tailored to tackle confirmatory trials, emerging diseases, and trauma care, but barriers like a chaotic ED, complex statistical and methodological requirements, and regulatory considerations persist and require thoughtful implementation strategies.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"329-341"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031946","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}