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.
{"title":"A Physician Nurse Team Adjacent to Triage Improves Length of Stay and Decreases Left Without Being Seen.","authors":"Samita M Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alison Rowe, Henry Thode, Adam J Singer","doi":"10.15441/ceem.24.248","DOIUrl":"https://doi.org/10.15441/ceem.24.248","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139439","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}
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.
{"title":"Applications of Ocular Point-of-Care Ultrasound for Optic Nerve Sheath Assessment in the Emergency Setting: A Systematic Review.","authors":"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","doi":"10.15441/ceem.24.249","DOIUrl":"https://doi.org/10.15441/ceem.24.249","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139441","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}
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.
{"title":"A rapid non-invasive wearable device for assessing cardiac troponin.","authors":"William Franklin Peacock, Karina Melissa Soto-Ruiz, Allan S Jaffe, Brian R Tiffany, Simon A Mahler, Brian W Patterson, Alan Hb Wu, Robert Christenson","doi":"10.15441/ceem.24.294","DOIUrl":"https://doi.org/10.15441/ceem.24.294","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Objectives: </strong>To perform a pilot study describing the performance of the Infrasensor in cTnI defined cohorts.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>The Infrasensor identifies elevated cTnI within 3 minutes of application.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139440","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}
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.
{"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":" ","pages":""},"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}
Pub Date : 2024-09-01Epub Date: 2024-01-29DOI: 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.
{"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":" ","pages":"304-308"},"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}
Pub Date : 2024-09-01Epub Date: 2024-01-29DOI: 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":" ","pages":"295-303"},"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}
Pub Date : 2024-09-01Epub Date: 2024-09-30DOI: 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":"11 3","pages":"238-242"},"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}
Pub Date : 2024-09-01Epub Date: 2024-07-19DOI: 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":" ","pages":"309-313"},"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}
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.
{"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":" ","pages":"286-294"},"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}