European Journal of Emergency Medicine最新文献

Background: Understanding refugee emergency medical services (EMS) utilization patterns is critical for forecasting demand, optimizing triage, and planning route-adapted surge capacity in border regions. Van Province is Turkey's border gateway on the Eastern Mediterranean migration route.

Objective: This study aimed to quantitatively characterize refugee EMS utilization patterns and compare them with same-day randomly sampled citizen encounters along this migration route.

Design, settings, and participants: A retrospective, observational cohort study of adult EMS encounters in Van Province was conducted for the years 2018-2024, using 1 : 1 same-day random sampling to select citizen controls. Refugee status referred to noncitizen patients presenting without official identification, corresponding to undocumented irregular migrants in the EMS registry.

Outcomes measure and analysis: Primary outcomes were the distributions of mutually exclusive prehospital presentation categories derived from EMS-assigned International Classification of Diseases 10 th Revision codes and clinical narratives. Associations with refugee status were assessed using logistic regression adjusted for age and sex.

Main results: The analytic sample comprised 4924 encounters (refugees n  = 2462 and citizens n  = 2462). Refugees were younger (median 27 vs. 42 years) and more often male (63.6 vs. 39.5%). Rural scenes were more frequent (39.0 vs. 28.2%). Refugees had a greater trauma burden: traffic accidents [12.9 vs. 3.5%; adjusted odds ratio (aOR): 2.24, 95% confidence interval (CI): 1.71-2.94], other physical trauma (16.1 vs. 6.5%; aOR: 2.02, 95% CI: 1.62-2.51), cold-related emergencies (4.0 vs. 0.3%; aOR: 7.15, 95% CI: 3.21-15.90), and gunshot injuries (2.6 vs. 0.1%; aOR: 10.14, 95% CI: 3.05-33.63). Chronic presentations were lower: respiratory (5.3 vs. 14.1%; aOR: 0.58, 95% CI: 0.45-0.73) and cardiovascular (3.7 vs. 12.7%; aOR: 0.55, 95% CI: 0.42-0.72). Medico-legal cases were more common among refugees (22.0 vs. 5.0%; P  < 0.001). Simple Triage and Rapid Treatment (START) triage distributions showed fewer green (57.6 vs. 62.9%) and more yellow (35.8 vs. 31.3%) among refugees; red was similar (5.1 vs. 5.2%), while black was higher (1.5 vs. 0.6%).

Conclusion: Along this migration route, refugee EMS utilization showed a distinctly trauma-dominant pattern, marked by transport injuries, violence-related events, cold-exposure emergencies, and a higher burden of medico-legal presentations compared with citizens.

Background and importance: Nontraumatic abdominal pain is a common and challenging presentation in the emergency department (ED). Point-of-care ultrasound (PoCUS) offers rapid, bedside imaging, but its association with ED length of stay (LOS), resource use, and patient safety, particularly concerning unscheduled return visits, remains unclear.

Objective: To evaluate the association of early PoCUS (within 1 h) with ED LOS and safety in adults with nontraumatic abdominal pain.

Design, settings, and participants: A propensity score-weighted retrospective cohort analysis in a tertiary medical center in Taiwan (2021-2023). This study included 39 443 adult patients with nontraumatic abdominal pain (12 399 PoCUS < 1 h and 27 044 no PoCUS), excluding transfers.

Intervention or exposure: PoCUS performed by an emergency physician within 1 h of ED arrival.

Outcomes measure and analysis: Primary: ED LOS; secondary: ED costs, computed tomography (CT) use, outpatient disposition, and rate of admission after an unscheduled return visit. A key subanalysis evaluated outcomes (costs, hospital LOS, and mortality) for admissions after an unscheduled return visit. Analysis used inverse probability of treatment weighting-adjusted regression.

Main result: PoCUS performed within 1 h was associated with a 16% reduction in first ED LOS [ratio of means 0.84, 95% confidence interval (CI): 0.83-0.86] and 50% increased odds of outpatient disposition [odds ratio (OR): 1.50, 95% CI: 1.42-1.58]. 1st ED costs were slightly increased by 4% (ratio of means: 1.04, 95% CI: 1.03-1.06), and CT use was not reduced (OR: 0.98, 95% CI: 0.93-1.03). While associated with a 25% increased odds of admission after an unscheduled return visit (OR: 1.25, 95% CI: 1.02-1.53), this subgroup had 33% lower admission costs (ratio of means: 0.67, 95% CI: 0.57-0.80), 26% shorter hospital LOS (ratio of means: 0.74, 95% CI: 0.64-0.85), and 94% lower odds of ED death on return (ratio of means: 0.06, 95% CI: 0.01-0.54).

Conclusion: PoCUS performed within 1 h of ED arrival was associated with shorter ED LOS and more outpatient dispositions, without reducing CT use. However, it was also associated with an increased probability of admission following an unscheduled return visit. Future studies are needed to elucidate the causal impact of this practice on patient safety and downstream resource use.

Importance: The Olympic Games, as the world's largest sporting event, present significant logistical challenges for healthcare delivery, especially regarding emergency medical service (EMS) and emergency department (ED) preparedness. Evaluating their impact on emergency services supports better planning of future Olympic or other such events and helps align emergency healthcare provision with demand. Nevertheless, data on their real-world impact remain limited.

Objective: The objective of this study is to assess whether the 2024 Paris Olympic and Paralympic Games were associated with an increase in ED visits and EMS activity in the most exposed geographical areas.

Design, setting, and participants: This retrospective, population-based study analyzed routinely collected administrative data from all EDs and EMS dispatch centers in the departments of Paris (75) and Seine-Saint-Denis (93), which hosted most Olympic venues. Weekly ED visits, EMS calls (SAMU), and physician-staffed mobile ICU (MICU) dispatches were extracted from January 2019 through December 2024. Pandemic years (2020-2021) were excluded.

Main outcomes and measures: The primary outcome was the adjusted mean weekly number of ED visits during the core Olympic period (weeks 30-32). Secondary outcomes included call center activity and MICU dispatch volume. These were also analyzed during an extended period (weeks 27-35), encompassing the Paralympic Games. Data for 2019, 2022, and 2023 were standardized to 2024 levels using annual mean activity excluding Olympic weeks.

Results: Over 3.7 million ED visits were analyzed. During the core Olympic weeks, adjusted weekly ED visits were slightly lower in 2024 compared with previous years (-3.3%, -3.6%, and -0.9% vs 2019, 2022, and 2023 respectively). Conversely, EMS calls increased by approximately 10% and MICU dispatch activity by 5-8%. Mean patient age (47.4 years) remained stable, and no clinically meaningful differences were observed.

Conclusions and relevance: The 2024 Paris Olympic and Paralympic Games were not associated with an increase in ED utilization but with a slight increase in EMS calls and MICU activity. This study offers a baseline reference for futures large-scale international events with mass gathering.

Renal colic pain is typically managed using intravenous opioids, but the intranasal route has emerged as a less invasive and time-efficient alternative. Intranasal ketamine has shown promise as a safe and effective analgesic for acute pain in emergency settings. To compare the efficacy and safety of intranasal ketamine versus intravenous opioids for renal colic pain management in the emergency department. PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing intranasal ketamine to intravenous morphine or intravenous fentanyl in patients with renal colic. Intranasal ketamine as the primary intervention; comparators were intravenous morphine or fentanyl. The primary outcome was pain intensity at various time points, measured using the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Secondary outcomes: need for rescue analgesia, incidence of adverse events, nausea, and dizziness. Data were pooled using random-effects models to calculate mean differences for continuous outcomes and risk ratios for binary outcomes, with 95% confidence intervals (CIs). All statistical analyses were performed using R Software, version 4.2.3. We included four RCTs, involving 454 patients, of whom 230 (50.6%) received intranasal ketamine. There were no significant differences between groups in pain scores at 5 min (mean difference: -0.41 VAS/NRS, 95% CI: -1.88 to 1.07, P = 0.59), 15 min (mean difference: -0.20 VAS/NRS, 95% CI: -0.86 to 0.46, P = 0.56), and 30 min (mean difference: 0.53 VAS/NRS, 95% CI: -0.08 to 1.13, P = 0.09). No significant differences were found between groups in the need for rescue analgesia or in the incidence of adverse events, nausea, or dizziness. Intranasal ketamine demonstrated analgesic efficacy comparable to intravenous opioids at 5, 15, and 30 min, with no increase in adverse events or rescue analgesia requirements.

Background and importance: The bacterial meningitis score (BMS) is a validated clinical prediction rule for identifying children at very low risk of bacterial meningitis based on five criteria. Whether BMS is safe to rule out bacterial meningitis in adults is unknown.

Objectives: The primary objective was to evaluate the performance of the BMS to identify adults at low risk of bacterial meningitis.

Design: This 4-year-period multicentric retrospective diagnostic study was conducted in 15 adult emergency departments (EDs) in France. Immunocompetent patients with meningitis, defined as cerebrospinal fluid (CSF) pleocytosis (CSF white blood cells ≥ 5/µl), were included among patients with an ED report including a lumbar puncture code procedure or a diagnosis of meningitis according to the International Classification of Diseases, 10th Revision classification. The reference standard for bacterial meningitis was a positive bacterial CSF culture.

Outcome measures and analysis: The main outcome was the negative predictive value (NPV) of the BMS for the diagnosis of bacterial meningitis. The secondary outcome was the proportion of meningeal-dose antibiotic treatments that could have been avoided for patients with BMS = 0. The performances of the BMS when combined with intrathecal lactate, blood procalcitonin (PCT), and C-reactive protein (CRP) were also assessed.

Main results: Among the 995 patients identified, 531 (13.3%) were eligible, and 456 patients (85.9%) with meningitis and a usable BMS were included. Seventy-three (16.0%) presented bacterial meningitis, with a majority of Streptococcus pneumoniae (n = 35, 47.9%) and Neisseria meningitidis (n = 10, 13.7%), and 383 (84.0%) had aseptic meningitis. There was one patient with bacterial meningitis and a BMS score of 0 [NPV: 99.5%, 95% confidence interval (CI): 97.4-100]. The proportion of avoidable antibiotics was 64.1% (95% CI: 57.3-70.3). The NPV was 100% (95% CI: 94.6-100), 97.9% (95% CI: 92.5-99.7), and 98.9% (95% CI: 96.1-99.9) for combined BMS with intrathecal lactate greater than or equal to 2 mmol/l, blood PCT greater than or equal to 0.29 µg/l, and blood CRP greater than or equal to 24 mg/l, respectively.

Conclusion: The BMS score presents a very high NPV, with the potential of safely ruling out bacterial meningitis among ED patients with positive CSF results.

Objectives: Survivors of out-of-hospital cardiac arrest (OHCA) often develop psychiatric and epilepsy problems. When arrest occurs with trauma, hypoxic-ischemic, and injury-related insults may heighten risks vs. nontraumatic OHCA. This study aimed to estimate 5-year risks of psychiatric disorders and epilepsy after traumatic vs. nontraumatic OHCA, and to examine whether early pharmacologic treatment relates to outcomes.

Methods: This retrospective cohort study utilized deidentified records from the TriNetX U.S. Collaborative Network (January 2010-June 2023). Adults who achieved return of spontaneous circulation and survived longer than 30 days were categorized into traumatic (n = 1477) and nontraumatic (n = 5165) groups. Propensity score matching (1:1, caliper 0.1) was employed to balance the cohorts. Primary outcomes were overall psychiatric disorders including categories of schizophrenia, mood disorders, depressive disorder, other nonpsychotic mental disorders, anxiety disorders (including phobic and other types), and posttraumatic stress disorder (PTSD). The secondary outcome was epilepsy. Kaplan-Meier and Cox models were used to calculate 5-year cumulative incidence and hazard ratios (HRs) with 95% confidence intervals (CI).

Results: The primary outcomes showed that survivors of traumatic OHCA faced greater 5-year risks of overall psychiatric disorders (HR, 1.38; 95% CI, 1.13-1.7) including multiple categories. Hazard ratios of categories were: schizophrenia, 2.23 (95% CI, 1.06-4.68); mood disorders, 1.38 (1.07-1.78); depressive episodes, 1.57 (1.19-2.08); other nonpsychotic mental disorders, 1.51 (1.20-1.92), including phobic anxiety disorders, 1.46 (0.72-2.93) and other anxiety disorders, 1.51 (1.17-1.95); and PTSD, 1.60 (1.02-2.50). The risk of secondary outcome epilepsy increased progressively over time, reaching the highest level at 5 years post-OHCA (HR, 2.06; 95% CI, 1.30-3.26).

Conclusion: Traumatic OHCA survivors had higher long-term risks of psychiatric disorders and epilepsy. Early targeted interventions and structured follow-up may help mitigate these risks, warranting confirmation in future prospective studies.