Clinical and Experimental Emergency Medicine最新文献

Background: Abdominal pain is the most common emergency department (ED) chief complaint, with many patients experiencing recurrent episodes due to non-life-threatening etiologies such as Disorders of Gut-Brain Interaction (DGBI). This pilot study aimed to characterize patients with recurrent low-risk abdominal pain, focusing on pain severity, management, biopsychosocial factors, opioid use, and 30- day return visits.

Methods: This prospective observational pilot study enrolled adult ED patients with recurrent abdominal pain at a single academic center between July 2022 and June 2023. Inclusion required at least one similar episode in the prior year with symptom resolution between episodes. Exclusions included unstable clinical status or high-risk conditions. Patient-reported outcomes, social determinants of health, and clinical data were collected. Primary outcomes included pain severity, opioid use, and 30-day return visit rates.

Results: A total of 101 participants were enrolled (mean age 43.7 years; 65.3% female; 70.8% Black). Pain severity was high (mean triage pain score 7.1, SD = 2.6). Frequent prior CT imaging was noted in 56.4% of participants. Opioids were administered in 49.5% of cases, while PROMIS-29 scores highlighted risks of anxiety (mean T-score 56.0, SD = 11.1) and pain interference (T-score 60.8, SD = 8.2). Return visits occurred in 10.9% of participants within 30 days.

Conclusion: In this pilot study, patients with recurrent low-risk abdominal pain showed high symptom burden and healthcare utilization. Targeted interventions addressing biopsychosocial factors and improving pain management are needed to reduce ED revisits and improve outcomes.

Objectives: Foreign body airway obstruction (FBAO) is one of the leading causes of accidental death worldwide. Among the most common causes of FBAO is food. The aim of this study is to provide an overview of the most common foreign bodies in the airway that were removed with an anti-choking suction device.

Methods: In this retrospective cohort study, we analysed a database obtained from LifeVac LLC, which has been collecting data on the use of the LifeVac device since 2016.

Results: We analyzed data from 1,062 patients who experienced FBAO and had the obstruction removed using a LifeVac device. These cases spanned 16 countries, with the majority from the USA (80.3%; 853/1,062), where infants were the most represented age group (26.7%; 283/1,062). The most common foreign body was meat (16.8%; 178/1,062). Most victims had no documented medical conditions (70.2%; 746/1,062). LifeVac device was successful on the first attempt in approximately one-third of cases (36.0%; 382/1,062), and fewer than half of the victims (34.7%; 368/1,062) sought medical attention afterward. The highest success rate for first-attempt removal occurred in the supine position (40.0%; 247/612).

Conclusion: FBAO can occur at any age, but is more common in children, the elderly and people with various health conditions. Some foreign bodies, such as steak, chicken, grapes, candy and hot dog, are thought to be more likely to enter the airway than others. These common foreign bodies and individuals with risk factors require special attention to ensure that such accidents are detected and prevented in time.

Objective: Despite disparities in availability and quality of emergency care, the extent to which countries with different incomes participate in emergency medicine (EM) research remains understudied. This study evaluated academic productivity in the EM field depending on country income.

Methods: Research published in Scopus-indexed journals of the EM subject area since 2004 was analysed quantitatively. Publication, citation, journal impact, and national socioeconomic data were compared. Automated topic modelling was applied using a latent Dirichlet allocation model.

Results: The analysis included 154,458 publications (89.7% in English) from 177 countries, which received 1,817,635 citations. High-income countries (HIC) outperformed upper-middle-income (UMIC), lower-middle-income (LMIC), and low-income countries (LIC) 11, 41, and 72 fold, respectively, by the weighted (per million population per country) number of publications, and 21, 54, and 171 fold, respectively, by the weighted count of citations. The annual number of publications was predicted to considerably rise for HIC, in less extent for UMIC, and far less for LMIC, but not for LIC. Research productivity showed a significant relationship with national socioeconomic indicators. Based on the topic modelling, HIC paid relatively higher attention to advancements in resuscitation, whereas lower income countries were more focused on injuries.

Conclusion: While global research productivity for EM is progressively rising, lower income countries lag far behind high-income ones. Countries with different incomes have distinct priorities in EM research. The development of country-specific EM research agendas would help boost national academic productivity and determine context-appropriate interventions for improving outcomes in emergency care.

Objective: s Abdominal pain is the most common emergency department (ED) complaint, with many patients experiencing recurrent episodes due to Cannabinoid Hyperemesis Syndrome (CHS), a syndrome characterized by pain and vomiting in the setting of chronic cannabis use. This pilot aimed to demonstrate the ability to enroll patients with CHS, characterize patient-reported outcomes (PRO's), and estimate 30-day revisit rates.

Methods: This prospective observational study enrolled adult ED patients with CHS at an academic center and community affiliate. The inclusion required a prior diagnosis of CHS and ED clinician judgment that symptoms at time of enrollment were likely due to CHS. Exclusions included unstable clinical status or other high-risk conditions. Primary outcomes included a characterization of symptoms, assessment of multiple domains of PRO's, measurement of the use of both CT scans and opioid analgesia, and frequency of 30-day ED return visits.

Results: A total of 18 participants were enrolled (mean age 34 years; 55.6% female). Automated chart reviews were completed for each outcome of interest at 30 days and 12 months. Pain severity was high (mean triage pain score 6.4, SD = 4.3) and prior CT imaging was noted in 72.2% of participants in the past five years. Opioids were administered in 22.2% of cases, while PROMIS-29 scores highlighted high risks of anxiety (mean T-score 56.1, SD = 11.5) and how pain interfered with normal activities of living (T-score 62.2, SD = 11.1). Return visits occurred in 16.7% of participants (3/18) within 30 days.

Conclusion: ED patients with CHS show significant burden on PRO's and high 30-day revisits. Future studies should consider interventions that address PRO's and reduce ED revisits.

Objective: To explore the distinctions between different types of traumatic facial fractures in predicting intracranial lesions using data from the National Trauma Registry of Iran (NTRI).

Methods: This retrospective registry-based study analyzed six years of data from four NTRI trauma centers, focusing on patients with facial fractures. Patients with at least one facial fracture were included, with data on demographics, injury mechanisms, fracture patterns, and intracranial lesions. The multiple logistic regression model explored the association between clinical variables and intracranial lesions.

Results: Among 32,525 patients, 1,166 (3.6%) had facial fractures. Motorcycle riders had a higher probability of malar-maxillary fractures than mandibular fractures (p < 0.001). Non-RTA injuries were significantly associated with mandibular fractures compared to malar-maxillary fractures (p < 0.001). Intracranial lesions were identified in 14.8% of patients, with subarachnoid hemorrhage (SAH) (38.4%), subdural hemorrhage (SDH) (19.8%), and epidural hemorrhage (EDH) (18.6%) being the most common. Most intracranial lesions developed in patients with malar-maxillary fractures (N = 82 (47.7%)). Also, patients with malar-maxillary fractures had the highest chance of developing intracranial lesions among different types of facial fractures (OR = 15.33, 95% CI: 6.57 to 35.79, p < 0.001), remained significant after adjustment (adjusted OR (aOR) = 7.20, 95% CI: 2.97 to 17.42, p < 0.001).

Conclusion: Traumatic facial fractures, particularly malar-maxillary fractures, significantly increase the risk of intracranial lesions. Road traffic accidents (RTA) are major contributors to such injuries. Prompt management, especially for malar-maxillary fractures, is critical for reducing risks and improving outcomes, necessitating further research on treatment strategies.

Objective: Children are particularly vulnerable to heat-related illnesses due to their unique physiological and behavioral characteristics. Understanding the epidemiology and clinical features of heat-related illnesses in children is crucial for guiding targeted preventive measures and management strategies. This descriptive study aims to investigate the characteristics of pediatric patients with heat-related illness who were transferred to emergency departments in Japan.

Methods: This study was a secondary analysis of the Heatstroke Study, led by the Heatstroke and Hypothermia Surveillance Committee of the Japanese Association for Acute Medicine. This study included pediatric patients (<18 years) with heat-related illness transferred to emergency departments in the summer from 2017 to 2021. We summarized the circumstances of onset, clinical characteristics, and outcomes.

Results: Of the 3,154 registered patients, 146 children were included. Of them, 60% were male, with a median age of 15 years (interquartile range, 13-16 years). The most cases occurred in August (47%), and most (80%) were associated with sports activities and with outdoor settings (70%). Cases with a body temperature above 40 °C were rare (3%). Most cases were admitted to hospitals (75% to the general ward and 16% to the intensive care unit), and patients admitted to intensive care unit had altered consciousness with increased serum creatinine. There were two cases of mortality, both of which were out-of-hospital cardiac arrest.

Conclusion: Most pediatric cases with heat-related illness were middle or high school students, occurred in August, and were related to outdoor sports activity. Patients admitted to hospitals suffered altered consciousness, dehydration, and acute kidney injury.

In a case of contrast media-induced anaphylactic shock managed with epinephrine, a 57-year-old male patient developed lactic acidosis without cardiogenic shock or global hypoperfusion, highlighting epinephrine's potential to trigger lactic acidosis. Despite the previous management of similar reactions with antihistamines and corticosteroids, this case required intensive care unit admission and emergency intervention for alarmingly high lactate level. The rapid resolution of acidosis following epinephrine discontinuation underscores the need for careful monitoring and consideration of alternative vasopressor strategies in severe anaphylaxis, illustrating the complex relationship between epinephrine's metabolic effects and anaphylaxis-induced tissue hypoperfusion.

Objective: Etomidate and ketamine are hemodynamically stable induction agents for rapid sequence intubation (RSI) of critically ill patients. Despite their relative stability in terms of hemodynamics, how the choice of agent affects mortality and the success of the procedure is debatable and has not yet been explored via systematic review and meta-analysis. The objective of this systematic review is to compare the efficacy of ketamine and etomidate for RSI in terms of mortality, hemodynamic parameters, and success rate.

Methods: A comprehensive search of PubMed, Embase, and the Web of Science was conducted from the starting date of each database until April 2024. Randomized controlled trials comparing the safety and efficacy of ketamine and etomidate as induction drugs for critically ill patients undergoing RSI were included. The primary outcome was the risk of 28-day mortality, and the secondary outcomes included the success rate and postinduction hypotension. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis.

Results: Four studies with 1,663 patients were meta-analyzed, and no statistically significant difference between the two drugs was found for 28-day mortality (RR, 0.95; 95% CI, 0.72-1.25; heterogeneity I2=39%; level of certainty of evidence per GRADE, moderate), first-pass success rate (RR, 1.00; 95% CI, 0.97-1.03), or postinduction cardiac arrest (RR, 1.10; 95% CI, 0.62-1.96). Postinduction hypotension was higher in the ketamine group (RR, 1.30; 95% CI, 1.03-1.64), but the result was not statistically significant.

Conclusion: Mortality outcomes did not differ when ketamine or etomidate was used for RSI in critically ill patients. Ketamine, however, was associated with a non-significantly higher risk of postinduction hypotension.

Objective: We aimed to determine whether there are similar rates of regional wall motion abnormalities (RWMAs) in patients with acute coronary occlusion myocardial infarction (OMI) with and without ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG).

Methods: We performed a retrospective review of a database of patients at high risk for acute coronary syndrome with previously established outcomes for the presence of OMI in order to compare rates of RWMA in patients presenting with STEMI(+) OMI versus STEMI(-) OMI. Furthermore, we compared how often the RWMA aligned with the anatomical territory observed on ECG.

Results: Among 808 patients, 551 underwent formal echocardiography, including 256 of 265 OMI patients and 295 of 543 patients with no occlusion. Of the 256 OMI patients that underwent formal echocardiography, only 105 (41.0%) met STEMI criteria. Among them, 94 of 105 (89.5%) STEMI(+) OMI patients had RWMAs compared to 124 of 151 (82.1%) STEMI(-) OMI patients (P=0.10; 95 confidence interval, -1.63% to 15.6%). Both groups had a greater prevalence of RWMA than the non-OMI group (45%). RWMA matched the anatomic territory predicted by ECG in 92.5% of STEMI(+) OMI, 82.3% of STEMI(-) OMI, and 2.9% of the no-occlusion cohort.

Conclusion: Location of RWMAs was well-correlated with ECG findings regardless of the presence or absence of STEMI criteria. A prospective study is warranted to determine the utility of echocardiography in the detection of STEMI(-) OMI.