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A Physician Nurse Team Adjacent to Triage Improves Length of Stay and Decreases Left Without Being Seen. 与分诊室毗邻的医生护士团队可缩短住院时间,减少未就诊时间。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.248
Samita M Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alison Rowe, Henry Thode, Adam J Singer

Introduction: Staffing significantly influences ED throughput, however there is a shortage of Registered Nurses (RNs), impacting ED flow and crowding. Non-RN providers, like Licensed Practical Nurses (LPNs), could potentially assist with tasks traditionally assigned to RNs. To improve the front-end ED process, we implemented an Attending Physician-Licensed Practical Nurse Team (PNT) positioned next to triage and utilized existing ED hallway space.

Methods: This study took place at a tertiary care ED with over 110,000 annual visits. We compared postintervention (Post-PNT) data (11/1/22-2/28/23) to pre-intervention (Pre-PNT) data (7/31/22-10/31/22). The PNT, positioned adjacent to triage, expedited care for ED patients awaiting open rooms. They selected patients from the waiting room to bypass the Main ED, evaluated them in a private room, and then moved them to the hallway pending further care. Multivariable Regression Analysis was utilized to measure the impact of different factors on ED Length of Stay (LOS).

Results: We analyzed 23516 patient visits, 10288 in the Pre-PNT period and 13288 in the Post-PNT period. Post-PNT consisted of 2454 PNT visits and 10834 non-PNT visits. The intervention led to significant improvements, including a decrease in mean ED LOS from 492 to 425 minutes, decrease in 72-hour revisits from 5.1% to 4.0%, decrease in Left Without Being Seen from 6.7% to 3.3%, and decrease in mean Arrival-to-Provider time from 74 minutes to 60 minutes. Multivariable Regression Analysis showed that ED LOS was significantly lower for Post-PNT patients than Pre-PNT.

Conclusion: By leveraging the scope of LPNs and utilizing existing ED space, the PNT model successfully reduced front-end bottlenecks, leading to improved throughput, revisit rate, and LWBS rate.

导言:人员配备对急诊室的吞吐量有很大影响,但目前注册护士(RN)短缺,影响了急诊室的流量和拥挤程度。非注册护士提供者,如执业护士(LPN),有可能协助完成传统上分配给注册护士的任务。为了改善急诊室的前端流程,我们在分诊室旁设立了主治医师-执业护士团队(PNT),并利用现有的急诊室走廊空间:本研究在一家年门诊量超过 11 万人次的三级医疗急诊室进行。我们比较了干预后(PNT 后)数据(11/1/22-2/28/23)和干预前(PNT 前)数据(7/31/22-10/31/22)。PNT 设在分诊室旁边,为等待开放病房的急诊室患者提供快速护理。他们从候诊室挑选病人绕过主急诊室,在单人病房对他们进行评估,然后将他们转移到走廊等待进一步治疗。我们利用多变量回归分析来衡量不同因素对急诊室住院时间(LOS)的影响:我们分析了 23516 人次的患者就诊情况,其中 10288 人次就诊于 PNT 前阶段,13288 人次就诊于 PNT 后阶段。PNT后包括2454次PNT就诊和10834次非PNT就诊。干预措施带来了明显改善,包括急诊室平均住院时间从 492 分钟降至 425 分钟,72 小时复诊率从 5.1% 降至 4.0%,未就诊而离开的比例从 6.7% 降至 3.3%,到达医疗机构的平均时间从 74 分钟降至 60 分钟。多变量回归分析显示,"PNT 后 "患者的 ED LOS 明显低于 "PNT 前":结论:通过利用 LPNs 的工作范围和现有的急诊室空间,PNT 模型成功地减少了前端瓶颈,从而提高了吞吐量、复诊率和 LWBS 率。
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引用次数: 0
Applications of Ocular Point-of-Care Ultrasound for Optic Nerve Sheath Assessment in the Emergency Setting: A Systematic Review. 眼科护理点超声波在急诊视神经鞘评估中的应用:系统回顾。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.249
Christopher D Yang, Christine K Kim, Melissa M Chang, Pooya Khosravi, Ajeet Pal Bayo Bhatia, Amanda Dos Santos, Kyle Dornhofer, Megan Guy, Edmund Hsu, Soheil Saadat, John C Fox

Objective: To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department.

Methods: A comprehensive literature search was conducted on SCOPUS, Web of Science, MEDLINE, and Cochrane CENTRAL. Inclusion criteria included studies written in English only and primary clinical studies involving ocular POCUS scans in an emergency department setting. Exclusion criteria included non-primary studies (e.g. reviews or case reports), studies written in a non-English language, non-human studies, studies performed in a non-emergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published outside of the last decade. Data extraction was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Results: The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met inclusion criteria. These 24 included studies encompassed 2448 patients across prospective, retrospective, cross sectional, and case series study designs. We found that a majority of included studies focus on the use of POCUS in the emergency department to measure ONSD as a proxy for papilledema and metabolic aberrations, while a minority use ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology.

Conclusion: The vast majority of articles investigating the use of ocular POCUS in recent years emphasize its utility in measuring ONSD and fluctuations in intracranial pressure, though additional outcomes of interest include posterior segment, orbit, and globe pathology.

目的评估目前与急诊科使用眼科护理点超声波(POCUS)相关的文献:方法:在 SCOPUS、Web of Science、MEDLINE 和 Cochrane CENTRAL 上进行了全面的文献检索。纳入标准包括仅以英语撰写的研究以及涉及急诊科眼科 POCUS 扫描的主要临床研究。排除标准包括非主要研究(如综述或病例报告)、用非英语撰写的研究、非人类研究、在非急诊环境下进行的研究、涉及非 POCUS 眼科超声模式的研究或过去十年以外发表的研究。数据提取以系统综述和荟萃分析首选报告项目(PRISMA)建议为指导:最初的搜索结果有 391 项,其中 153 项重复。在其余 238 项被选中进行检索和筛选的研究中,有 24 项符合纳入标准。这 24 项纳入研究涵盖了 2448 名患者,研究设计包括前瞻性、回顾性、横断面和病例系列研究。我们发现,大部分纳入的研究侧重于在急诊科使用 POCUS 测量 ONSD 作为乳头水肿和代谢畸变的替代指标,而少数研究则使用眼部 POCUS 协助诊断眼眶骨折或眼后节病变:结论:近年来,绝大多数研究眼科 POCUS 应用的文章都强调了其在测量 ONSD 和颅内压波动方面的实用性,但其他值得关注的结果还包括后段、眼眶和眼球病变。
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引用次数: 0
A rapid non-invasive wearable device for assessing cardiac troponin. 用于评估心肌肌钙蛋白的快速无创可穿戴设备。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.294
William Franklin Peacock, Karina Melissa Soto-Ruiz, Allan S Jaffe, Brian R Tiffany, Simon A Mahler, Brian W Patterson, Alan Hb Wu, Robert Christenson

Background: Chest pain, a common emergency department 35 (ED) presentation, requires rapid evaluation. Optical technology-based non-invasive wearable devices (Infrasensor, RCE, Carlsbad, CA) rapidly and transcutaneously assesses cardiac Troponin I (cTnI).

Objectives: To perform a pilot study describing the performance of the Infrasensor in cTnI defined cohorts.

Methods: This was a 10-hospital prospective observational study in healthy US subjects with a normal cTnI, and in patients with an elevated local cTnI. Healthy subjects were without disease, defined by a negative questionnaire and bloodwork, had a 3-minute Infrasensor measurement and blood samples for high-sensitivity cardiac troponin I (hs-cTnI), n-terminal pro-B-type natriuretic peptide (NTproBNP), creatinine, and glycosylated hemoglobin (HbA1c). Elevated cTnI's patients had the same Infrasensor and blood sample measurements. Using a cross validation technique, a cTnI based binary classification model that did, and did not, include age was trained with 80%, and validated on 20% (n=168; elevated hs-cTnI equally distributed across 5 folds) of the overall cohort.

Results: Of 840 patients, 727 (87.5%) were non-elevated cTnI controls and the remainder, n=113, had elevated cTnI. Median (25th, 75th percentiles) age was 61 (52, 71) and 48 (32, 57) years for the elevated and healthy control cohorts, respectively. Overall, 50.5% were female, with 29.2% and 52.7% in the elevated and non-elevated troponin cohorts respectively. Overall, the sensitivity, specificity, negative and positive predictive values of the Infrasensor for identifying an elevated cTnI were 0.9, 0.7, 0.98 and 0.48 respectively, with a C-statistic of 0.90 (0.89-0.99).

Conclusions: The Infrasensor identifies elevated cTnI within 3 minutes of application.

背景:胸痛是急诊科的常见病,需要快速评估。基于光学技术的无创可穿戴设备(Infrasensor,RCE,加利福尼亚州卡尔斯巴德)可快速经皮评估心肌肌钙蛋白 I(cTnI):进行一项试验性研究,描述 Infrasensor 在 cTnI 定义群组中的性能:这是一项由 10 家医院参与的前瞻性观察研究,研究对象包括 cTnI 正常的美国健康受试者和当地 cTnI 升高的患者。健康受试者无疾病,由阴性问卷和血液检查界定,接受了 3 分钟 Infrasensor 测量和血液样本检测,包括高敏心肌肌钙蛋白 I(hs-cTnI)、n-末端前 B 型钠尿肽(NTproBNP)、肌酐和糖化血红蛋白(HbA1c)。cTnI 升高患者的 Infrasensor 和血液样本测量值相同。使用交叉验证技术,训练了一个基于 cTnI 的二元分类模型,该模型包含或不包含年龄,并在整个队列的 20% (n=168;hs-cTnI 升高平均分布在 5 个褶皱中)中进行了验证:在 840 名患者中,727 人(87.5%)为 cTnI 未升高的对照组,其余(n=113)为 cTnI 升高的对照组。cTnI 升高组和健康对照组的中位年龄(第 25 百分位数和第 75 百分位数)分别为 61(52,71)岁和 48(32,57)岁。总体而言,女性占 50.5%,其中肌钙蛋白升高组和非升高组分别占 29.2% 和 52.7%。总体而言,Infrasensor 识别肌钙蛋白升高的灵敏度、特异性、阴性和阳性预测值分别为 0.9、0.7、0.98 和 0.48,C 统计量为 0.90(0.89-0.99):结论:Infrasensor 可在使用后 3 分钟内识别出升高的 cTnI。
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引用次数: 0
Tricuspid Annular Plane Systolic Excursion (TAPSE) in COPD Patients, A Systematic Review and Meta-Analysis. 慢性阻塞性肺病患者的三尖瓣瓣环平面收缩期偏移 (TAPSE),系统回顾和元分析。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-06 DOI: 10.15441/ceem.24.228
M Groussis, Q K Tran, M Hoffer, J Ahari, A Pourmand

Introduction: Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter that serves as a prognostic indicator for severity of COPD clinical course. This study, consisting of a systematic review and meta-analysis, evaluates the current literature to elucidate the relationship between TAPSE measurement in COPD patients versus control subjects to discern baseline evidence of right heart strain.

Methods: PubMedTM, ScopusTM, CINAHL, Web of Science, and Cochrane Review databases were searched from their beginning through November 1, 2023, for eligible studies. Outcomes included the difference of TAPSE measurement and right ventricular wall thickness between COPD patients and control patients. The Newcastle-Ottawa Scale was applied to assess risk of bias; Q-statistics and I2 values were used to assess for heterogeneity; and Egger's and Begg's test used to assess for publication bias.

Results: The search yielded eleven studies reporting TAPSE values involving 1671 patients, 800 (47.9%) patients with COPD. The unadjusted mean TAPSE values for COPD patients was 18.9 mm (SD+/- 4), while the mean TAPSE value for control patients was 22.2 mm (SD+/- 0.8). The presence of COPD was significantly associated with decreased TAPSE values with the meta-analysis reporting the mean difference of TAPSE value between COPD and control patients was -3.0 (95% CI -4.3 to -1.7, P=0.001). Six studies reported the RV free wall thickness. The unadjusted mean RV free wall thickness for COPD patients was 4.9 mm (SD+/- 1.2), and control patients was 3.4 mm (SD+/- 0.7), respectively.

Conclusions: This meta-analysis demonstrated statistically-significantly lower TAPSE values and thicker RV free wall among COPD patients versus control patients.

简介三尖瓣环平面收缩期偏移(TAPSE)是一种超声心动图参数,可作为慢性阻塞性肺病临床病程严重程度的预后指标。本研究通过系统综述和荟萃分析对现有文献进行评估,以阐明慢性阻塞性肺病患者与对照受试者的 TAPSE 测量之间的关系,从而发现右心负荷的基线证据:方法:检索了 PubMedTM、ScopusTM、CINAHL、Web of Science 和 Cochrane Review 数据库中从开始到 2023 年 11 月 1 日符合条件的研究。研究结果包括 COPD 患者与对照组患者之间 TAPSE 测量值和右心室壁厚度的差异。采用纽卡斯尔-渥太华量表评估偏倚风险;采用Q统计量和I2值评估异质性;采用Egger和Begg检验评估发表偏倚:搜索结果显示,有 11 项研究报告了 TAPSE 值,涉及 1671 名患者,其中 800 人(47.9%)为 COPD 患者。慢性阻塞性肺病患者未经调整的平均 TAPSE 值为 18.9 mm (SD+/-4),而对照组患者的平均 TAPSE 值为 22.2 mm (SD+/-0.8)。荟萃分析表明,慢性阻塞性肺病患者与对照组患者的 TAPSE 值平均相差-3.0(95% CI -4.3 至-1.7,P=0.001)。六项研究报告了 RV 游离壁厚度。未经调整的COPD患者平均RV游离壁厚度为4.9毫米(SD+/- 1.2),对照组患者为3.4毫米(SD+/- 0.7):这项荟萃分析表明,与对照组患者相比,慢性阻塞性肺病患者的 TAPSE 值明显更低,RV 游离壁更厚。
{"title":"Tricuspid Annular Plane Systolic Excursion (TAPSE) in COPD Patients, A Systematic Review and Meta-Analysis.","authors":"M Groussis, Q K Tran, M Hoffer, J Ahari, A Pourmand","doi":"10.15441/ceem.24.228","DOIUrl":"https://doi.org/10.15441/ceem.24.228","url":null,"abstract":"<p><strong>Introduction: </strong>Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter that serves as a prognostic indicator for severity of COPD clinical course. This study, consisting of a systematic review and meta-analysis, evaluates the current literature to elucidate the relationship between TAPSE measurement in COPD patients versus control subjects to discern baseline evidence of right heart strain.</p><p><strong>Methods: </strong>PubMedTM, ScopusTM, CINAHL, Web of Science, and Cochrane Review databases were searched from their beginning through November 1, 2023, for eligible studies. Outcomes included the difference of TAPSE measurement and right ventricular wall thickness between COPD patients and control patients. The Newcastle-Ottawa Scale was applied to assess risk of bias; Q-statistics and I2 values were used to assess for heterogeneity; and Egger's and Begg's test used to assess for publication bias.</p><p><strong>Results: </strong>The search yielded eleven studies reporting TAPSE values involving 1671 patients, 800 (47.9%) patients with COPD. The unadjusted mean TAPSE values for COPD patients was 18.9 mm (SD+/- 4), while the mean TAPSE value for control patients was 22.2 mm (SD+/- 0.8). The presence of COPD was significantly associated with decreased TAPSE values with the meta-analysis reporting the mean difference of TAPSE value between COPD and control patients was -3.0 (95% CI -4.3 to -1.7, P=0.001). Six studies reported the RV free wall thickness. The unadjusted mean RV free wall thickness for COPD patients was 4.9 mm (SD+/- 1.2), and control patients was 3.4 mm (SD+/- 0.7), respectively.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated statistically-significantly lower TAPSE values and thicker RV free wall among COPD patients versus control patients.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139481","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}
引用次数: 0
Diffuse incidental dural calcifications. 弥漫性硬膜钙化
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.15441/ceem.24.234
Emily Wusterbarth, Jenna Pederson, Michael Gottlieb
{"title":"Diffuse incidental dural calcifications.","authors":"Emily Wusterbarth, Jenna Pederson, Michael Gottlieb","doi":"10.15441/ceem.24.234","DOIUrl":"10.15441/ceem.24.234","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080664","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}
引用次数: 0
Inappropriate use of intravenous epinephrine leading to atrial fibrillation during prehospital anaphylaxis treatment: a case report. 院前过敏性休克治疗过程中静脉注射肾上腺素不当导致心房颤动:病例报告。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-01-29 DOI: 10.15441/ceem.23.129
Haewon Jung, Hyun Wook Ryoo, Jungbae Park, Seung Hyuk Choi, Jae Hyuk Lee, Sujeong Kim

In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director's comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.

在院前环境中,由于肾上腺素的治疗窗口较窄,因此在治疗过敏性休克时必须谨慎用药。在本病例中,一名 46 岁的男子出现了严重的过敏性休克症状。按照标准方案,急救医疗技术员(EMT)肌肉注射了肾上腺素,但症状依然存在。在急诊医疗服务(EMS)医疗主管的监督下,又追加了静脉注射肾上腺素,不幸导致心房颤动。这一案例凸显了静脉注射肾上腺素的潜在风险,在没有持续监测的情况下,通常不建议对过敏性休克患者使用肾上腺素。自 2019 年起,韩国启动了一项试点计划,以扩大急救医生的执业范围,使其有权为过敏性休克患者注射肾上腺素。在强调患者安全的前提下,有关使用肾上腺素治疗过敏性休克的最终决定权在急救医疗服务医疗总监手中。对急救医生进行适当的培训,再加上急救医疗服务医疗总监的全面知识和对协议的严格遵守,可以确保患者的安全和最佳治疗效果。
{"title":"Inappropriate use of intravenous epinephrine leading to atrial fibrillation during prehospital anaphylaxis treatment: a case report.","authors":"Haewon Jung, Hyun Wook Ryoo, Jungbae Park, Seung Hyuk Choi, Jae Hyuk Lee, Sujeong Kim","doi":"10.15441/ceem.23.129","DOIUrl":"10.15441/ceem.23.129","url":null,"abstract":"<p><p>In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director's comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575125","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}
引用次数: 0
The accuracy of the Hounsfield unit in pulmonary embolism diagnostics. 肺栓塞中 Hounsfield 单位值的诊断准确性。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-01-29 DOI: 10.15441/ceem.23.113
Mümin Murat Yazici, Sümeyye Sekmen, Ali Çelik, Özcan Yavaşi, Nur Hürsoy

Objective: Pulmonary embolism (PE) is a vascular disease that is most frequently diagnosed using the radiological imaging technique computed tomography pulmonary angiography (CTPA). In this study, we aimed to demonstrate the diagnostic accuracy of the Hounsfield unit (HU) for PE based on the hypothesis that acute thrombosis causes an increase in HU value on CT.

Methods: This research was a single-center, retrospective study. Patients presenting to the emergency department diagnosed with PE on CTPA were enrolled as the study group. Patients admitted to the same emergency department who were not diagnosed with PE and had noncontrast CT scans were included as the control group. A receiver operating curve was produced to determine the diagnostic accuracy of HU values in predicting PE.

Results: The study population (n=74) consisted of a study group (n=46) and a control group (n=28). The sensitivity and specificity of the HU value for predicting PE on thoracic CT were as follows: for the right main pulmonary artery, 61.5% and 96.4% at a value of 54.8 (area under the curve [AUC], 0.690); for the left main pulmonary artery, 65.0% and 96.4% at a value of 55.9 (AUC, 0.736); for the right interlobar artery, 44.4% and 96.4% at a value of 62.7 (AUC, 0.615); and for the left interlobar artery, 60.0% and 92.9% at a value of 56.7 (AUC, 0.736).

Conclusion: HU may exhibit high diagnostic specificity on CT for thrombi up to the interlobar level. An HU value exceeding 54.8 up to the interlobar level may raise suspicion of the presence of PE.

目的:肺栓塞(PE)是一种血管疾病。计算机断层扫描肺血管造影术(CTPA)是用于诊断肺栓塞的放射成像技术。在本研究中,我们根据急性血栓形成会导致计算机断层扫描(CT)上的 HU 值增加这一假设,旨在证明 Hounsfield 单位(HU)值对 PE 的诊断准确性:本研究为单中心回顾性研究。方法:本研究为单中心回顾性研究,研究对象为急诊科(ED)CTPA 诊断为 PE 的患者。此外,同一急诊科收治的未被诊断为 PE 且接受非对比 CT 扫描的患者作为对照组。对 HU 值预测 PE 的诊断准确性绘制了接收者操作曲线(ROC):研究对象(74 人)包括研究组(46 人)和对照组(28 人)。右主肺动脉的 HU 值为 54.8(曲线下面积(AUC):0.690)时,预测胸部 CT PE 的灵敏度为 61.5%,特异度为 96.4%;HU 值为 55.9(曲线下面积(AUC):0.7)时,预测右主肺动脉 PE 的灵敏度为 65.0%,特异度为 96.4%。9(AUC:0.736);右肺间动脉的 HU 值为 62.7(AUC:0.615)时,分别为 44.4% 和 96.4%;左肺间动脉的 HU 值为 56.7(AUC:0.736)时,分别为 60.0% 和 92.9%:结论:CT 上的 HU 值对叶间动脉血栓的诊断特异性较高。结论:CT 上的 HU 值对叶间水平的血栓具有较高的诊断特异性,如果叶间水平的 HU 值超过 54.8,则可怀疑存在 PE。
{"title":"The accuracy of the Hounsfield unit in pulmonary embolism diagnostics.","authors":"Mümin Murat Yazici, Sümeyye Sekmen, Ali Çelik, Özcan Yavaşi, Nur Hürsoy","doi":"10.15441/ceem.23.113","DOIUrl":"10.15441/ceem.23.113","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary embolism (PE) is a vascular disease that is most frequently diagnosed using the radiological imaging technique computed tomography pulmonary angiography (CTPA). In this study, we aimed to demonstrate the diagnostic accuracy of the Hounsfield unit (HU) for PE based on the hypothesis that acute thrombosis causes an increase in HU value on CT.</p><p><strong>Methods: </strong>This research was a single-center, retrospective study. Patients presenting to the emergency department diagnosed with PE on CTPA were enrolled as the study group. Patients admitted to the same emergency department who were not diagnosed with PE and had noncontrast CT scans were included as the control group. A receiver operating curve was produced to determine the diagnostic accuracy of HU values in predicting PE.</p><p><strong>Results: </strong>The study population (n=74) consisted of a study group (n=46) and a control group (n=28). The sensitivity and specificity of the HU value for predicting PE on thoracic CT were as follows: for the right main pulmonary artery, 61.5% and 96.4% at a value of 54.8 (area under the curve [AUC], 0.690); for the left main pulmonary artery, 65.0% and 96.4% at a value of 55.9 (AUC, 0.736); for the right interlobar artery, 44.4% and 96.4% at a value of 62.7 (AUC, 0.615); and for the left interlobar artery, 60.0% and 92.9% at a value of 56.7 (AUC, 0.736).</p><p><strong>Conclusion: </strong>HU may exhibit high diagnostic specificity on CT for thrombi up to the interlobar level. An HU value exceeding 54.8 up to the interlobar level may raise suspicion of the presence of PE.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575296","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}
引用次数: 0
Therapeutic hypothermia is not dead, but hibernating! 治疗性低温症不是死亡,而是冬眠!
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI: 10.15441/ceem.24.291
Robert J Freedman, Robert B Schock, W Frank Peacock
{"title":"Therapeutic hypothermia is not dead, but hibernating!","authors":"Robert J Freedman, Robert B Schock, W Frank Peacock","doi":"10.15441/ceem.24.291","DOIUrl":"10.15441/ceem.24.291","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399590","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}
引用次数: 0
Barriers to utilization of intraosseous vascular access in pediatric emergencies. 在儿科急诊中使用骨内血管通路的障碍。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-07-19 DOI: 10.15441/ceem.24.247
Hussein Omari Sombi
{"title":"Barriers to utilization of intraosseous vascular access in pediatric emergencies.","authors":"Hussein Omari Sombi","doi":"10.15441/ceem.24.247","DOIUrl":"10.15441/ceem.24.247","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723140","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}
引用次数: 0
Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients. 将改良的快速器官功能衰竭顺序评估模型作为发热病人的分诊工具进行比较。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-01-29 DOI: 10.15441/ceem.23.125
Dong-Young Lee, Seung Ryu, So-Young Jeon, Jung-Soo Park, Yeon-Ho You, Won-Joon Jeong, Yong-Chul Cho, Hong-Joon Ahn, Chang-Shin Kang, Se-Kwang Oh

Objective: Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score.

Methods: We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC).

Results: Through multivariable analysis, the identified factors were age ("A" factor), male sex ("M" factor), oxygen saturation measured by pulse oximetry (SpO2; "S" factor), and lactate level ("L" factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789-0.835]; ICU admission: 0.794 [95% confidence interval, 0.771-0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0.

Conclusion: We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.

目的:在急诊科人满为患时,有效地分流发热病人对于确定护理的优先次序和分配资源至关重要,尤其是在大流行病期间。然而,现有的分诊工具往往需要实验室数据,缺乏准确性。我们的目标是通过修改 qSOFA 评分,为发热患者开发一种简单而准确的分诊工具:我们回顾性分析了 7303 名发热患者的数据,并利用多变量分析确定的因素创建了修改版 qSOFA。使用接收者操作特征曲线下面积(AUROC)比较了这些修正版 qSOFA 在预测住院死亡率和重症监护病房(ICU)入院率方面的表现:通过多变量分析,确定的因素包括年龄(A)、男性(M)、SpO2(S)和乳酸水平(L)。ASqSOFA的AUROCs(院内死亡率:0.812;95% CI:0.789-0.835;ICU入院率:0.794;95% CI:0.771-0.817),包括年龄和SpO2与qSOFA,是简单的,并不比其他更复杂的模型(如ASMqSOFA、ASLqSOFA和ASMLqSOFA)差。ASqSOFA 的 AUROC 也明显高于其他分诊量表,如改良早期预警评分和韩国分诊与敏锐度量表。ASqSOFA 结果的最佳临界值为 2 分,而重新分配到下一级急诊科的分数为 0.结论:我们证明,ASqSOFA 可作为一种简单有效的急诊发热患者分诊工具,在人满为患时帮助资源分配。它也可用于院前发热病人的分流。
{"title":"Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients.","authors":"Dong-Young Lee, Seung Ryu, So-Young Jeon, Jung-Soo Park, Yeon-Ho You, Won-Joon Jeong, Yong-Chul Cho, Hong-Joon Ahn, Chang-Shin Kang, Se-Kwang Oh","doi":"10.15441/ceem.23.125","DOIUrl":"10.15441/ceem.23.125","url":null,"abstract":"<p><strong>Objective: </strong>Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>Through multivariable analysis, the identified factors were age (\"A\" factor), male sex (\"M\" factor), oxygen saturation measured by pulse oximetry (SpO2; \"S\" factor), and lactate level (\"L\" factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789-0.835]; ICU admission: 0.794 [95% confidence interval, 0.771-0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0.</p><p><strong>Conclusion: </strong>We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575152","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}
引用次数: 0
期刊
Clinical and Experimental Emergency Medicine
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