Journal of Emergency Medicine最新文献_第2页

A Cluster-Randomized Control Study Comparing a New Cue “Two Compressions per Second” with “100–120 Compressions per Minute” in Training of Bystander Cardiopulmonary Resuscitation 在旁观者心肺复苏培训中比较新提示 "每秒按压两次 "与 "每分钟按压 100-120 次 "的分组随机对照研究。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-10 DOI: 10.1016/j.jemermed.2024.07.011

Background

Chest compression at a rate of 100–120 compressions per minute (cpm) during cardiopulmonary resuscitation (CPR) is associated with the highest survival rates. Performing compressions at a faster rate may exhaust the rescuers.

Objectives

To compare a new cue of ‘two compressions per second’ to the traditional cue of ‘100–120 compressions per minute’ on compression rate in CPR training.

Methods

In this cluster-randomized study, students from two senior high schools were assigned into two groups. For the experimental group, the cue for the compression rate was ‘two compressions per second’. For the control group, the cue was ‘100–120 cpm’. Except the different cues, all participants underwent the same standardized CPR training program. Verbal compression rate-related feedback was not obtained during practice. Quality indicators of chest compressions were recorded by a sensorized manikin. The primary outcome measure was mean compression rate at course conclusion. The secondary outcome measures were individual compression quality indicators at course conclusion and 3 months after training.

Results

We included 164 participants (85 participants, experimental group; 79 participants, control group). Both groups had similar characteristics. The experimental group had a significantly lower mean compression rate at course conclusion (144.3 ± 16.17 vs. 152.7 ± 18.38 cpm, p = 0.003) and at 3 months after training (p = 0.09). The two groups had similar mean percentage of adequate compression rate (≥ 100 cpm), mean compression depth, and mean percentage of complete recoil at course conclusion and 3 months after training.

Conclusion

The new cue of ‘two compressions per second’ resulted in participants having a lower compression rate, although it still exceeded 120 cpm.

背景：在心肺复苏（CPR）过程中，以每分钟 100-120 次（cpm）的速度进行胸外按压，存活率最高。以更快的速度进行按压可能会使施救者筋疲力尽：目的：比较 "每秒按压两次 "的新提示和 "每分钟按压 100-120 次 "的传统提示在心肺复苏培训中对按压速度的影响：在这项分组随机研究中，来自两所高中的学生被分为两组。实验组的按压频率提示为 "每秒按压两次"。对照组的提示语为 "100-120 cpm"。除提示语不同外，所有参与者都接受了相同的标准化心肺复苏训练。在练习过程中没有获得与按压频率相关的口头反馈。胸外按压的质量指标由感应式人体模型记录。主要结果指标是课程结束时的平均按压率。次要结果指标是课程结束时和培训 3 个月后的个人按压质量指标：共有 164 人参加了培训（实验组 85 人；对照组 79 人）。两组学员的特征相似。实验组在课程结束时（144.3 ± 16.17 对 152.7 ± 18.38 cpm，P = 0.003）和培训 3 个月后的平均压迫率明显较低（P = 0.09）。在课程结束时和训练后 3 个月，两组的平均充分按压率百分比（≥ 100 cpm）、平均按压深度和完全反冲的平均百分比相似：结论："每秒按压两次 "的新提示使参与者的按压率降低，尽管仍超过 120 cpm。

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引用次数: 0

Examining Emergency Medical Services: Delay Time, Response Time, On-Scene Time In Six Peaks of the COVID-19 Pandemic in Eastern Iran 考察紧急医疗服务：在伊朗东部 COVID-19 大流行的六个峰值中的延迟时间、响应时间和现场时间。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-10 DOI: 10.1016/j.jemermed.2024.07.008

Background

Time indices are key elements in prehospital medical emergencies. The number of calls to Emergency Medical Services (EMS) and the number of missions they have undertaken have been impacted by the COVID-19 epidemic.

Objectives

This study's goal was to evaluate prehospital EMS time indices at the apex of the COVID-19 outbreak.

Methods

Data were extracted retrospectively from the Asayar Automation System, which records details on all emergency medical calls resulting in patient transport. The study period was from March 2018 to March 2021, covering the pre-COVID period and the first through sixth peaks of the pandemic in Iran. Standardized data extraction procedures were used to minimize bias in this retrospective review.

Results

In this study, most transport missions occurred during the fifth peak (n = 2811). In addition, the most missions were related to the age group above 60 years (31.1%), and the highest rate of patient transport (65.9%) was observed in male patients. Traumatic events, cardiac emergencies, impaired consciousness, and psychiatric disorders were, respectively, the main causes of patient transport. Moreover, a significant difference was observed between time indices of various COVID-19 peaks (p < 0.001).

Conclusions

Even though the structure of Iran's emergency system is based on the American-Anglo model, and rapid patient transfers to medical facilities are prioritized, the COVID-19 epidemic resulted in increased calls and missions and affected time indices. Therefore, it is suggested that the method and type of service provision be modified during similar crises.

背景：时间指数是院前医疗急救的关键因素。COVID-19疫情影响了紧急医疗服务（EMS）的呼叫数量和任务数量：本研究的目的是评估 COVID-19 疫情爆发时的院前急救时间指数：数据从 Asayar 自动化系统中回顾性提取，该系统记录了所有导致患者转运的紧急医疗呼叫的详细信息。研究期间为 2018 年 3 月至 2021 年 3 月，涵盖了 COVID 爆发前的时期以及伊朗疫情的第一至第六次高峰期。这项回顾性研究采用了标准化的数据提取程序，以尽量减少偏差：在这项研究中，大多数运输任务发生在第五次高峰期（n = 2811）。此外，大多数转运任务与 60 岁以上年龄组有关（31.1%），男性患者的转运率最高（65.9%）。外伤事件、心脏急症、意识障碍和精神疾病分别是转运病人的主要原因。此外，各种 COVID-19 峰值的时间指数之间也存在明显差异（P < 0.001）：尽管伊朗的急救系统结构以美英模式为基础，并优先考虑将患者快速转运至医疗机构，但 COVID-19 的流行导致呼叫和任务增加，影响了时间指数。因此，建议在发生类似危机时修改提供服务的方法和类型。

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引用次数: 0

Development of a bleeding arteriovenous fistula task trainer 开发动静脉瘘出血任务培训器。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-06 DOI: 10.1016/j.jemermed.2024.07.010

Background

As end-stage renal disease becomes more prevalent in the United States, the number of Americans with arteriovenous (AV) fistulas continues to increase. One of the most feared complications of AV fistulas is life-threatening hemorrhage, as patients can exsanguinate within minutes.

Objectives

As frontline healthcare workers, emergency medicine (EM) providers need to be able to provide rapid and effective treatment for this rare presentation. We developed a task trainer model to simulate AV fistula hemorrhage to prepare and train EM residents.

Methods

This task trainer model was constructed with readily available materials and takes about 30 minutes to make. Twenty-one EM residents participated in the training session. The session consisted of a brief didactic on AV fistula hemorrhage control followed by hands on usage of the task-trainer model. The participants filled out an anonymous survey afterwards rating the model.

Results

Residents completed anonymous postcourse surveys rating the session on a five-point Likert scale. Both the overall teaching session and the task trainer were rated very highly. Compared to precourse ratings, residents reported statistically significant postcourse improvements in their level of confidence in managing AV fistula hemorrhage.

Conclusions

To our knowledge, this is the first published task trainer model to simulate a bleeding AV fistula for EM residents. The model was well received by our trainees, is relatively inexpensive, and made from easily sourced materials. We believe this model can be used for trainees of all disciplines to prepare them for this potentially catastrophic patient presentation.

背景：随着终末期肾病在美国越来越普遍，患有动静脉（AV）瘘的美国人也在不断增加。动静脉瘘最令人担忧的并发症之一是危及生命的大出血，因为患者可能在几分钟内就会失血过多：作为一线医护人员，急诊医学（EM）提供者需要能够对这种罕见的表现提供快速有效的治疗。我们开发了一个模拟动静脉瘘出血的任务训练器模型，用于培训急诊科住院医生：这个任务训练器模型是用现成的材料制作的，大约需要 30 分钟。21 名急诊科住院医师参加了培训课程。培训课程包括关于动静脉瘘出血控制的简短说教，然后是任务训练器模型的实际操作。培训结束后，学员们填写了一份匿名调查问卷，对该模型进行评分：结果：住院医师在课后填写了匿名调查问卷，以李克特五点量表对课程进行评分。整体教学课程和任务培训师都获得了很高的评价。与课程前的评分相比，课程后住院医师对处理动静脉瘘出血的信心水平有了统计学意义上的显著提高：据我们所知，这是首个针对急诊科住院医师发布的模拟动静脉瘘出血的任务训练器模型。该模型受到了学员们的欢迎，价格相对便宜，而且材料易于采购。我们相信，该模型可用于所有学科的受训人员，让他们为这种潜在的灾难性病人表现做好准备。

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引用次数: 0

Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female. 一名无性生活的年轻女性体内的人类绒毛膜促性腺激素水平升高。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-03 DOI: 10.1016/j.jemermed.2024.07.020

Natalie Mira Elder, Ashley McCormick

Background: Quantitative and qualitative human chorionic gonadotropin (hCG) tests are obtained in the emergency department (ED) to determine if a female of child-bearing age is pregnant. A positive hCG result is commonly assumed to indicate an intrauterine or other form of pregnancy. However, elevated hCG levels can also result from various other conditions, such as ovarian tumors, pituitary tumors, and thyroid disorders. Intracranial germ cell tumors, rare central nervous system tumors capable of secreting hCG, primarily affect adolescent and young adult females.

Case report: A 16-year-old female student without significant past medical history presented to our ED with a complaint of intermittent bilateral frontal headache for two days. Last menstrual period started two days prior to presentation. The headache was associated with phonophobia, photophobia, nausea, and vomiting. Serum quantitative hCG was elevated. She denied history of sexual activity or sexual assault. Transabdominal ultrasound was negative for intrauterine pregnancy. Obstetrics and gynecology as well as pediatric oncology were consulted. Subsequent investigations, including brain imaging, revealed a 3.5 cm mass in the right caudate nucleus and corpus callosum. The patient was diagnosed with an intracranial nongerminomatous germ cell tumor, necessitating hospitalization and prompt initiation of chemotherapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: An elevated quantitative hCG is not always indicative of pregnancy, especially in a young patient without sexual history. In the case of a nonrevealing transabdominal ultrasound, obstetrics and gynecology should be consulted for discussion of further testing and imaging. Emergency physicians should include malignancy high on their differential since prompt initiation of chemotherapy, evaluation by surgical services, and family planning will be required.

背景：在急诊科（ED）进行人绒毛膜促性腺激素（hCG）定量和定性检测，以确定育龄女性是否怀孕。通常认为 hCG 阳性结果表明宫内妊娠或其他形式的妊娠。然而，hCG 水平升高也可能是由卵巢肿瘤、垂体瘤和甲状腺疾病等其他疾病引起的。颅内生殖细胞瘤是罕见的能分泌 hCG 的中枢神经系统肿瘤，主要影响青少年和年轻女性：一名 16 岁的女学生因间歇性双侧额部头痛两天到我院急诊就诊，既往无明显病史。末次月经开始于就诊前两天。头痛伴有畏声、畏光、恶心和呕吐。血清定量 hCG 升高。她否认有性活动或性侵犯史。经腹超声检查未发现宫内妊娠。妇产科和儿科肿瘤科会诊。随后的检查，包括脑部成像，发现右侧尾状核和胼胝体有一个3.5厘米的肿块。患者被诊断为颅内非erminomatous生殖细胞肿瘤，需要住院治疗并立即开始化疗。急诊医生为什么要注意这一点？定量 hCG 升高并不总是怀孕的征兆，尤其是对于没有性生活史的年轻患者。在经腹超声检查未显示妊娠的情况下，应咨询妇产科，讨论进一步的检查和成像。急诊医生应将恶性肿瘤列为鉴别诊断的重点，因为需要及时进行化疗、外科评估和计划生育。

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引用次数: 0

Leg Pain—An Unexpected Twist 腿痛--意想不到的转折

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-03 DOI: 10.1016/j.jemermed.2024.07.017

Background

Obturator hernia is a rare condition, often presenting with non-specific symptoms, such as thigh pain, groin pain, nausea, or vomiting. Obturator hernias are most common in thin, elderly women. Oftentimes, they are diagnosed late in the disease course resulting in complications and high morbidity and mortality.

Case Report

We present the case of a 75-year-old female who presented with right thigh pain with no other symptoms. After computed tomography (CT) of the abdomen/pelvis, the patient was found to have an incarcerated obturator hernia complicated by a small bowel obstruction, ultimately requiring urgent surgical intervention.

Why Should an Emergency Physician Be Aware of This?

Given the very general symptoms associated with the condition, the diagnosis of obturator hernia can easily be missed, leading to a delayed diagnosis, more complications, and a higher morbidity and mortality rate. Due to the risk associated with a delayed diagnosis, it is important for emergency physicians to maintain a high clinical suspicion for the diagnosis.

背景：闭孔疝是一种罕见疾病，通常表现为非特异性症状，如大腿疼痛、腹股沟疼痛、恶心或呕吐。闭孔疝最常见于瘦弱的老年妇女。病例报告：本病例是一名 75 岁女性的病例，她出现右大腿疼痛，但无其他症状。经过腹部/骨盆计算机断层扫描（CT），发现患者患有嵌顿性闭孔疝，并伴有小肠梗阻，最终需要紧急手术治疗。急诊医生为什么要注意这个问题？由于闭孔疝的症状非常普遍，因此很容易被漏诊，导致诊断延误、并发症增多、发病率和死亡率升高。由于延误诊断带来的风险，急诊医生在临床诊断中保持高度怀疑非常重要。

引用次数: 0

Direct Fetal Head Injury after Maternal Motor Vehicle Crash 孕产妇车祸后胎儿头部直接受伤。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-03 DOI: 10.1016/j.jemermed.2024.07.014

引用次数: 0

Mortality Outcomes with Tenecteplase Versus Alteplase in the Treatment of Massive Pulmonary Embolism 特奈普酶与阿替普酶治疗大面积肺栓塞的死亡率结果。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-03 DOI: 10.1016/j.jemermed.2024.07.007

Background

Pulmonary embolism (PE) leads to many emergency department visits annually. Thrombolytic agents, such as alteplase, are currently recommended for massive PE, but genetically modified tenecteplase (TNK) presents advantages. Limited comparative studies exist between TNK and alteplase in PE treatment.

Objective

The aim of this study was to assess the safety and mortality of TNK compared with alteplase in patients with PE using real-world evidence obtained from a large multicenter registry. Primary outcomes included mortality, intracranial hemorrhage, and blood transfusions.

Methods

This retrospective cohort study used the TriNetX Global Health Research Network. Patients aged 18 years or older with a PE diagnosis (International Classification of Diseases, 10^th Revision, Clinical Modification code I26) were included. The following two cohorts were defined: TNK-treated (29 organizations, 266 cases) and alteplase-treated (22,864 cases). Propensity matching controlled for demographic characteristics, anticoagulant use, pre-existing conditions, and vital sign abnormalities associated with PE severity. Patients received TNK or alteplase within 7 days of diagnosis and outcomes were measured at 30 days post thrombolysis.

Results

Two hundred eighty-three patients in each cohort were comparable in demographic characteristics and pre-existing conditions. Mortality rates at 30 days post thrombolysis were similar between TNK and alteplase cohorts (19.4% vs 19.8%; risk ratio 0.982; 95% CI 0.704–1.371). Rates of intracerebral hemorrhages and transfusion were too infrequent to analyze.

Conclusions

This study found TNK to exhibit a similar mortality rate to alteplase in the treatment of PE with hemodynamic instability. The results necessitate prospective evaluation. Given the cost-effectiveness and ease of administration of TNK, these findings contribute to the ongoing discussion about its adoption as a primary thrombolytic agent for stroke and PE.

背景：肺栓塞（PE）每年导致许多人到急诊科就诊。目前，阿替普酶等溶栓药物被推荐用于治疗大面积肺栓塞，但转基因替奈普酶（TNK）具有优势。关于 TNK 和阿替普酶治疗 PE 的比较研究有限：本研究旨在利用从大型多中心登记处获得的实际证据，评估 TNK 与阿替普酶在 PE 患者中的安全性和死亡率。主要结果包括死亡率、颅内出血和输血：这项回顾性队列研究使用了 TriNetX 全球健康研究网络。研究纳入了年龄在 18 岁或 18 岁以上、确诊为 PE（《国际疾病分类》第 10 版，临床修改代码 I26）的患者。定义了以下两个队列：TNK治疗组（29个组织，266个病例）和阿替普酶治疗组（22864个病例）。倾向匹配控制了与 PE 严重程度相关的人口统计学特征、抗凝药物使用、既往病症和生命体征异常。患者在确诊后 7 天内接受 TNK 或阿替普酶治疗，结果在溶栓后 30 天进行测量：结果：每个队列中的 283 名患者在人口统计学特征和原有病症方面具有可比性。TNK 组和阿替普酶组溶栓后 30 天的死亡率相似（19.4% vs 19.8%；风险比 0.982；95% CI 0.704-1.371）。脑出血和输血的发生率较低，无法进行分析：本研究发现，在治疗血流动力学不稳定的 PE 时，TNK 的死亡率与阿替普酶相似。有必要对研究结果进行前瞻性评估。考虑到 TNK 的成本效益和给药简便性，这些研究结果有助于目前关于采用 TNK 作为治疗中风和 PE 的主要溶栓药物的讨论。

{"title":"Mortality Outcomes with Tenecteplase Versus Alteplase in the Treatment of Massive Pulmonary Embolism","authors":"","doi":"10.1016/j.jemermed.2024.07.007","DOIUrl":"10.1016/j.jemermed.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary embolism (PE) leads to many emergency department visits annually. Thrombolytic agents, such as alteplase, are currently recommended for massive PE, but genetically modified tenecteplase (TNK) presents advantages. Limited comparative studies exist between TNK and alteplase in PE treatment.</p></div><div><h3>Objective</h3><p>The aim of this study was to assess the safety and mortality of TNK compared with alteplase in patients with PE using real-world evidence obtained from a large multicenter registry. Primary outcomes included mortality, intracranial hemorrhage, and blood transfusions.</p></div><div><h3>Methods</h3><p>This retrospective cohort study used the TriNetX Global Health Research Network. Patients aged 18 years or older with a PE diagnosis (International Classification of Diseases, 10<sup>th</sup> Revision, Clinical Modification code I26) were included. The following two cohorts were defined: TNK-treated (29 organizations, 266 cases) and alteplase-treated (22,864 cases). Propensity matching controlled for demographic characteristics, anticoagulant use, pre-existing conditions, and vital sign abnormalities associated with PE severity. Patients received TNK or alteplase within 7 days of diagnosis and outcomes were measured at 30 days post thrombolysis.</p></div><div><h3>Results</h3><p>Two hundred eighty-three patients in each cohort were comparable in demographic characteristics and pre-existing conditions. Mortality rates at 30 days post thrombolysis were similar between TNK and alteplase cohorts (19.4% vs 19.8%; risk ratio 0.982; 95% CI 0.704–1.371). Rates of intracerebral hemorrhages and transfusion were too infrequent to analyze.</p></div><div><h3>Conclusions</h3><p>This study found TNK to exhibit a similar mortality rate to alteplase in the treatment of PE with hemodynamic instability. The results necessitate prospective evaluation. Given the cost-effectiveness and ease of administration of TNK, these findings contribute to the ongoing discussion about its adoption as a primary thrombolytic agent for stroke and PE.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients 原发感染部位是急诊科患者发生败血症的预测因素

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.01.016

Background

Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.

Objective

This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.

Methods

Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable.

Results

LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.

Conclusions

Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.

背景败血症是一种危及生命的疾病，但预测其发展和恶化仍是一项挑战。目标本研究旨在评估感染部位对急诊科患者败血症发展的影响。方法数据收集自 2016 年 1 月至 2019 年 12 月期间的单中心急诊科。根据《医学术语系统化-临床术语》（SNOMED-CT）定义的上呼吸道（URI）、下呼吸道（LRI）、泌尿道（UTI）或皮肤/软组织（SSTI）感染，纳入有感染记录的患者就诊情况。主要结果是根据 SEP-1/2 标准定义的脓毒症和/或脓毒性休克的发生情况。次要结果包括医院处置和住院时间、血和尿培养阳性率、抗生素用量、血管加压药使用、院内死亡率和 30 天死亡率。结果LRI与脓毒症（RRR 5.63；95% CI：5.07-6.24）和脓毒性休克（RRR 21.2；95% CI 17.99-24.98）的发生以及住院时间最相关。98），以及入院率（OR 8.23；95% CI 7.41-9.14）、入住 ICU（OR：4.27；95% CI 3.84-4.74）、住院死亡率（OR：6.93；95% CI：5.60-8.57）和 30 天死亡率（OR：7.34；95% CI：5.86-9.19）。结论包括 LRI 和 UTI 在内的原发感染部位与急诊科感染患者的败血症、住院、住院时间和死亡率密切相关。

{"title":"Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients","authors":"","doi":"10.1016/j.jemermed.2024.01.016","DOIUrl":"10.1016/j.jemermed.2024.01.016","url":null,"abstract":"<div><h3>Background</h3><p>Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.</p></div><div><h3>Objective</h3><p>This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.</p></div><div><h3>Methods</h3><p><span><span><span>Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), </span>lower respiratory tract (LRI), </span>urinary tract<span> (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and </span></span>urine culture<span><span> positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different </span>logistic regression approaches were used for analysis with URI used as the reference variable.</span></p></div><div><h3>Results</h3><p><span>LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), </span>intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.</p></div><div><h3>Conclusions</h3><p><span>Primary infection sites including LRI and </span>UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk Factors and Emergency Department Outcomes in Methamphetamine-Associated Cardiomyopathy: A Case-Control Study 甲基苯丙胺相关心肌病的风险因素和急诊室结果：病例对照研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.019

Background

Methamphetamine-associated cardiomyopathy (MACM) is a known complication of methamphetamine use; however, risk factors and outcomes of patients with MACM are not well understood.

Study Objectives

This study aims to identify risk factors, emergency department (ED) interventions, and outcomes for MACM.

Methods

This case-control study was conducted between 2012 and 2020 at two academic EDs. ED patients ≥18 years with an index visit that included documented methamphetamine use were included. Patients with documented MACM during follow-up (3 months–3 years) were considered cases (MACM). A control group comprised of patients with documented methamphetamine use but no known MACM was matched at a 2:1 ratio. Logistic regression was used to model risk factors for MACM.

Results

A total of 9833 patients with methamphetamine use were identified. From this, 160 MACM patients were matched to 322 controls. The mean age was 48.4 years, and 143 patients (29.7%) were female. MACM patients were more likely to be admitted on their index visit (45.6% vs. 34.8%, p = 0.021). Significant variables associated with MACM included: admission at the index visit (odds ratio [OR] 1.51), diabetes (OR 3.02), kidney disease (OR 5.47), and pulmonary disease (OR 2.39). MACM patients had more ED visits in the follow-up period (10.1 vs. 7, p = 0.009) and were admitted at a higher rate across all visits (32.5% vs. 15.4%, p = 0.009). Additionally, MACM patients had significantly longer hospital stays than controls (mean 18 additional days, p = 0.009).

Conclusion

Patients who developed MACM had traditional risk factors for heart failure and experienced significantly more ED visits, more hospitalizations, and longer hospital stays than matched controls.

背景甲基苯丙胺相关心肌病（MACM）是使用甲基苯丙胺的一种已知并发症；然而，人们对 MACM 患者的风险因素和预后并不十分了解。研究纳入了年龄≥18 岁、就诊指数包括有记录的甲基苯丙胺使用情况的急诊科患者。随访期间（3 个月至 3 年）记录有甲基苯丙胺使用的患者被视为病例（MACM）。对照组由有记录使用甲基苯丙胺但未发现 MACM 的患者按 2:1 的比例进行匹配。结果共发现9833名使用甲基苯丙胺的患者。其中，160 名使用甲基苯丙胺的患者与 322 名对照者进行了配对。平均年龄为 48.4 岁，143 名患者（29.7%）为女性。澳门巴黎人娱乐官网患者更有可能在就诊时入院（45.6% 对 34.8%，P = 0.021）。与澳门巴黎人娱乐官网相关的重要变量包括：首次就诊时入院（几率比 [OR] 1.51）、糖尿病（OR 3.02）、肾脏疾病（OR 5.47）和肺部疾病（OR 2.39）。澳门巴黎人娱乐官网患者在随访期间去急诊室就诊的次数更多（10.1 次对 7 次，P = 0.009），而且在所有就诊中入院率更高（32.5% 对 15.4%，P = 0.009）。此外，澳门巴黎人娱乐官网患者的住院时间明显长于对照组（平均增加 18 天，p = 0.009）。

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引用次数: 0

Single Intravenous Dose Dalbavancin Pathway for the Treatment of Acute Bacterial Skin and Skin Structure Infections: Considerations for Emergency Department Implementation and Cost Savings 单次静脉注射达尔巴万星治疗急性细菌性皮肤和皮肤结构感染的途径：急诊科实施和节约成本的考虑因素

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.003

Background

A pathway for the treatment of acute bacterial skin and skin structure infections (ABSSSI) with a single intravenous (IV) dose of dalbavancin was previously shown to reduce hospital admissions and shorten inpatient length of stay (LOS).

Objectives

To describe pathway implementation at the emergency department (ED) and evaluate cost-effectiveness of a single-dose dalbavancin administered to ED patients who would otherwise be hospitalized to receive usual care with multidose IV antibiotics.

Methods

The dalbavancin pathway was previously implemented at 11 U.S. EDs (doi:10.1111/acem.14258). Patients with ABSSSI, without an unstable comorbidity or infection complication requiring complex management, were treated with a single dose of dalbavancin. At the emergency physicians’ discretion, patients were either discharged and received outpatient follow-up or were hospitalized for continued management. A decision analytic cost-effectiveness model was developed from the U.S. healthcare's perspective to evaluate costs associated with the dalbavancin pathway compared with inpatient usual care. Costs (2021 USD) were modeled over a 14-day horizon and included ED visits, drug costs, inpatient stay, and physician visits. One-way and probabilistic sensitivity analyses examined input parameter uncertainty.

Results

Driven largely by the per diem inpatient cost and LOS for usual care, the dalbavancin pathway was associated with savings of $5133.20 per patient and $1211.57 per hospitalization day avoided, compared with inpatient usual care. The results remained robust in sensitivity and scenario analyses.

Conclusion

The new single-dose dalbavancin ED pathway for ABSSSI treatment, which was previously implemented at 11 U.S. EDs, offers robust cost savings compared to inpatient usual care.

背景以前曾有研究表明，使用单剂量静脉注射达巴万星治疗急性细菌性皮肤和皮肤结构感染（ABSSSI）可减少入院人数并缩短住院时间（LOS）。目的描述急诊科（ED）的路径实施情况，并评估为急诊科患者注射单剂量达巴万星的成本效益，否则这些患者将住院接受多剂量静脉注射抗生素的常规治疗。).ABSSSI患者如果没有不稳定的合并症或需要复杂治疗的感染并发症，则采用单剂量达巴万星治疗。根据急诊医生的决定，患者要么出院接受门诊随访，要么住院继续治疗。我们从美国医疗保健的角度开发了一个决策分析成本效益模型，以评估与住院常规治疗相比，达巴万星疗法的相关成本。成本（2021 美元）以 14 天为期限进行建模，包括急诊室就诊、药物成本、住院和医生就诊。单向和概率敏感性分析检验了输入参数的不确定性。结果与住院常规护理相比，达巴万星路径主要受住院每日成本和住院日的影响，每位患者可节省 5133.20 美元，每个住院日可节省 1211.57 美元。结论与住院常规护理相比，新的单剂量达巴万星 ED 治疗 ABSSSI 途径可显著节约成本。

{"title":"Single Intravenous Dose Dalbavancin Pathway for the Treatment of Acute Bacterial Skin and Skin Structure Infections: Considerations for Emergency Department Implementation and Cost Savings","authors":"","doi":"10.1016/j.jemermed.2024.03.003","DOIUrl":"10.1016/j.jemermed.2024.03.003","url":null,"abstract":"<div><h3>Background</h3><p>A pathway for the treatment of acute bacterial skin and skin structure infections (ABSSSI) with a single intravenous (IV) dose of dalbavancin was previously shown to reduce hospital admissions and shorten inpatient length of stay (LOS).</p></div><div><h3>Objectives</h3><p>To describe pathway implementation at the emergency department (ED) and evaluate cost-effectiveness of a single-dose dalbavancin administered to ED patients who would otherwise be hospitalized to receive usual care with multidose IV antibiotics.</p></div><div><h3>Methods</h3><p>The dalbavancin pathway was previously implemented at 11 U.S. EDs (doi:10.1111/acem.14258). Patients with ABSSSI, without an unstable comorbidity or infection complication requiring complex management, were treated with a single dose of dalbavancin. At the emergency physicians’ discretion, patients were either discharged and received outpatient follow-up or were hospitalized for continued management. A decision analytic cost-effectiveness model was developed from the U.S. healthcare's perspective to evaluate costs associated with the dalbavancin pathway compared with inpatient usual care. Costs (2021 USD) were modeled over a 14-day horizon and included ED visits, drug costs, inpatient stay, and physician visits. One-way and probabilistic sensitivity analyses examined input parameter uncertainty.</p></div><div><h3>Results</h3><p>Driven largely by the per diem inpatient cost and LOS for usual care, the dalbavancin pathway was associated with savings of $5133.20 per patient and $1211.57 per hospitalization day avoided, compared with inpatient usual care. The results remained robust in sensitivity and scenario analyses.</p></div><div><h3>Conclusion</h3><p>The new single-dose dalbavancin ED pathway for ABSSSI treatment, which was previously implemented at 11 U.S. EDs, offers robust cost savings compared to inpatient usual care.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924000714/pdfft?md5=f641f301f7b9ad697d3513c2fea77c9f&pid=1-s2.0-S0736467924000714-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0