CJEM最新文献

{"title":"Improving quality and safety in emergency department cardiac ultrasound: an urgent need for change.","authors":"Joseph Bednarczyk, Tom Jelic","doi":"10.1007/s43678-025-00889-3","DOIUrl":"10.1007/s43678-025-00889-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"584-587"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412017","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":"Massive Hemorrhage Protocol adoption and standardization with a provincial toolkit: a follow-up survey of Ontario hospitals.","authors":"Chantalle L Grant, Omar I Hajjaj, Kimmo Murto, Stephanie Cope, Andrew Petrosoniak, Troy Thompson, Katerina Pavenski, Jeannie L Callum","doi":"10.1007/s43678-025-00929-y","DOIUrl":"10.1007/s43678-025-00929-y","url":null,"abstract":"<p><strong>Purpose: </strong>Massive Hemorrhage Protocols improve outcomes for adults with severe hemorrhage, yet only 65% of Ontario hospitals had implemented one by 2018. In response, a Massive Hemorrhage Protocol toolkit was developed and disseminated province-wide in 2021. This study compares Massive Hemorrhage Protocol adoption and content in Ontario hospitals in 2023 versus 2018 using a pre- and post-toolkit rollout survey.</p><p><strong>Methods: </strong>A 98-question survey was emailed to transfusion medicine laboratory directors or their delegate at 159 hospitals in 2023, 2 years after a provincial Massive Hemorrhage Protocol toolkit rollout that included a 1-day virtual symposium. Results were compared with the 2018 survey containing 82 identical core questions using Chi-square test, Fisher exact test, and Wilcoxon rank-sum nonparametric tests for quantitative data, and content analysis for qualitative data.</p><p><strong>Results: </strong>The 2023 survey achieved a 100% response rate (n = 159); most respondents (n = 156) were transfusion staff. Hospitals with a Massive Hemorrhage Protocol increased significantly from 65% (n = 150) in 2018 to 77% (n = 159) in 2023 (p = 0.02). Small transfusion hospitals (< 5000 red blood cell units transfused/year) saw an increase in Massive Hemorrhage Protocol adoption from 60 to 74% (p = 0.02). By 2023, 95% (n = 159) of hospitals had/were implementing a Massive Hemorrhage Protocol. However, gaps in alignment to evidence-based recommendations remained, including hypothermia monitoring (missing in 25% of Massive Hemorrhage Protocols) tranexamic acid dosing (missing in 19%), and quality metric tracking (missing in 55%). Pediatric content was absent in 45% of Massive Hemorrhage Protocols in health centers caring for children.</p><p><strong>Conclusion: </strong>The provincial Massive Hemorrhage Protocol toolkit's dissemination was feasible and associated with increased adoption in Ontario hospitals. Two-years post rollout, 77% of provincial hospitals have Massive Hemorrhage Protocols in place. Opportunities remain to align contents with evidence-based recommendations and expand to remaining hospitals. This strategy could guide other jurisdictions to improve Massive Hemorrhage Protocol adoption and harmonize practices.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"614-625"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121671","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":"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":"10.1007/s43678-025-00931-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"596-599"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","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":"Discharge with insufficient or inappropriate care in Canada's EDs: overcoming the challenges for people who use drugs.","authors":"Nance E Cunningham, James Pierzchalski, Sandra Smiley, Jeffrey Eisen","doi":"10.1007/s43678-025-00944-z","DOIUrl":"10.1007/s43678-025-00944-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"588-591"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112827","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/s43678-025-01005-1","DOIUrl":"https://doi.org/10.1007/s43678-025-01005-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 8","pages":"665-669"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982411","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":"Sex differences in the 1-year outcomes of emergency department patients with alcohol withdrawal.","authors":"Frank Scheuermeyer, Skye Barbic, M Eugenia Socias, Amanda Slaunwhite","doi":"10.1007/s43678-025-00986-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00986-3","url":null,"abstract":"<p><strong>Background: </strong>Alcohol withdrawal is a common emergency department (ED) presentation, but differences in long-term outcomes between female and male patients are not clear.</p><p><strong>Methods: </strong>From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, British Columbia, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics and ED treatments. We linked with regional ED and provincial data to obtain the outcomes of 1-year return ED visits and mortality, respectively. The primary outcome was at least one return visit to the ED, and secondary outcomes included ED revisits and 1-week, 1-month, and 1-year mortality. We compared female patients with male patients using descriptive methods.</p><p><strong>Results: </strong>We identified 1,019 unique patients with 273 (26.8%) female. Median ages, ambulance arrival, initial withdrawal severity score, and index visit admission rates were similar. At 1 year, 186 (68.1%) female and 515 (69.0%) male patients reattended an ED, for a difference of 0.9%; (95% CI - 5.5 to 7.7%). A significantly greater proportion of male patients reattended at 1 week and 1 month, and the average number of male ED revisits was greater at 1 week, 1 month, and 1 year. By 1 year, a female patient (0.4%) and 19 males (2.6%) died, for a difference of 2.2% (95% CI 0.3-3.6%).</p><p><strong>Conclusion: </strong>Despite similar ED presentations, female patients with alcohol withdrawal had fewer 1-year ED visits and lower mortality. EDs may wish to incorporate sex-specific approaches to post-discharge management.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762679","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":"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":"629-637"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031905","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":"Should we apply the pressure in preoxygenation?","authors":"Patrick Fisk, Wilson Lam, Jim Yang, Curtis Nickel","doi":"10.1007/s43678-025-00936-z","DOIUrl":"10.1007/s43678-025-00936-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"600-602"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112978","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":"Adherence, acuity, and the evolving role of D-dimer in pulmonary embolism rule-out.","authors":"Paul Atkinson, Abel Wakai","doi":"10.1007/s43678-025-00962-x","DOIUrl":"https://doi.org/10.1007/s43678-025-00962-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 8","pages":"582-583"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982408","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: assessment and management of trauma patients with ankylosing spondylitis.","authors":"Jeffrey J Perry, Hans Rosenberg","doi":"10.1007/s43678-025-00920-7","DOIUrl":"10.1007/s43678-025-00920-7","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"626-628"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038103","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}