Journal of Emergency Medicine最新文献_第3页

Nonfatal Emergency Department Visits Associated with Fall-Related Fractured Skulls of Infants Aged 0–4 Months 0-4 个月婴儿因摔倒导致颅骨骨折引起的非致命性急诊就诊。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.015

Background

Children aged 0–4 years have the highest rate of emergency department (ED) visits for traumatic brain injury (TBI); falls are the leading cause. Infants younger than 2 years are more likely to sustain a fractured skull after a fall.

Objective

This study examined caregiver actions and products associated with ED visits for fall-related fractured skulls in infants aged 0–4 months.

Methods

Data were analyzed from the 2001–2017 National Electronic Injury Surveillance System-All Injury Program. Case narratives of infants aged 0–4 months who visited an ED for a fall-related skull fracture were examined to code caregiver actions preceding the fall. Product codes determined fall location and product type involved (e.g., flooring, bed, or stairs). All national estimates were weighted.

Results

There were more than 27,000 ED visits (weighted estimate) of infants aged 0–4 months for a nonfatal fall-related fractured skull between 2001 and 2017. Most were younger than 2 months (46.7%) and male (54.4%). Falls occurred primarily in the home (69.9%) and required hospitalization (76.4%). Primary caregiver actions coded involved placing (58.6%), dropping (22.7%), and carrying an infant (16.6%). Floor surfaces were the most common product (mentioned in 24.0% of the cases).

Conclusions

Fall-related fractured skulls are a health and developmental concern for infants, highlighting the importance of a comprehensive assessment at the time of the injury to better understand adult actions. Findings indicated the need to develop prevention messages that include safe carrying and placement of infants.

背景0-4岁儿童因创伤性脑损伤（TBI）到急诊科（ED）就诊的比例最高；跌倒是主要原因。本研究调查了因跌倒导致颅骨骨折而到急诊室就诊的 0-4 个月大婴儿的护理人员行为和产品。对因跌倒导致颅骨骨折而到急诊室就诊的 0-4 个月婴儿的病例叙述进行了研究，以对护理人员在跌倒前的行为进行编码。产品代码决定了坠落地点和所涉及的产品类型（如地板、床或楼梯）。结果2001年至2017年间，有超过2.7万名0-4个月大的婴儿因与跌倒相关的非致命性颅骨骨折而到急诊室就诊（加权估计值）。大多数婴儿年龄小于 2 个月（46.7%），且为男性（54.4%）。跌倒主要发生在家中（69.9%），需要住院治疗（76.4%）。护理人员的主要行为包括放置（58.6%）、摔倒（22.7%）和抱起婴儿（16.6%）。结论与高处坠落有关的颅骨骨折是婴儿健康和发育方面的一个问题，突出了在受伤时进行全面评估以更好地了解成人行为的重要性。研究结果表明，有必要制定包括安全携带和放置婴儿在内的预防信息。

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引用次数: 0

Navigating Care Refusal and Noncompliance in Patients with Opioid Use Disorder 引导阿片类药物使用障碍患者拒绝和不遵守医嘱的行为

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.008

Background

For many emergency physicians (EPs), deciding whether or not to allow a patient suffering the ill effects of opioid use to refuse care is the most frequent and fraught situation in which they encounter issues of decision-making capacity, informed refusal, and autonomy. Despite the frequency of this issue and the well-known impacts of opioid use disorder on decision-making, the medical ethics community has offered little targeted analysis or guidance regarding these situations.

Discussion

As a result, EPs demonstrate significant variability in how they evaluate and respond to them, with highly divergent understandings and application of concepts such as decision-making capacity, informed consent, autonomy, legal repercussions, and strategies to resolve the clinical dilemma. In this paper, we seek to provide more clarity to this issue for the EPs.

Conclusions

Successfully navigating this issue requires that EPs understand the specific effects that opioid use disorder has on decision-making, and how that in turn bears on the ethical concepts of autonomy, capacity, and informed refusal. Understanding these concepts can lead to helpful strategies to resolve these commonly-encountered dilemmas.

背景对于许多急诊医生（EPs）来说，决定是否允许因使用阿片类药物而受到不良影响的患者拒绝接受治疗是他们遇到决策能力、知情拒绝和自主权等问题时最常见和最棘手的情况。因此，EPs 在评估和应对这些情况时表现出很大的差异，对决策能力、知情同意、自主权、法律后果和解决临床困境的策略等概念的理解和应用也大相径庭。在本文中，我们试图为急诊科医生澄清这一问题。结论要成功解决这一问题，急诊科医生必须了解阿片类药物使用障碍对决策的具体影响，以及这反过来又如何影响到自主性、能力和知情拒绝等伦理概念。了解这些概念可以为解决这些经常遇到的困境提供有益的策略。

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引用次数: 0

Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study 在急诊室接触静脉注射类阿片六个月后持续使用类阿片的频率。前瞻性队列研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.018

Background

As rates of opioid use disorder in the general population have increased, some have questioned whether IV opioids should be used routinely for treatment of acute severe pain in the emergency department (ED).

Objectives

We determined the incidence of persistent opioid use among opioid-naïve patients exposed to IV opioids in the ED.

Methods

This was a prospective observational cohort study conducted in two EDs in the Bronx, NY. Opioid-naïve adults with severe pain who received IV opioids in the ED were followed-up 6 months later by telephone interview and review of the state opioid prescription database. We defined persistent opioid use as filling 6 or more prescriptions for opioids in the 6 months following the ED visit or an average of one prescription per month.

Results

We screened 1555 patients. Of these, 506 patients met entry criteria and provided analyzable data. Morphine was the IV opioid most frequently administered in the ED (478, 94%), followed by hydromorphone (20, 4%). Of the 506, 8 (2%) received both IV morphine and hydromorphone and 63 (12%) participants were prescribed an opioid for use after the ED visit. One patient/506 (0%) met our apriori criteria for persistent opioid use within 6 months.

Conclusion

Among 506 opioid naïve ED patients administered IV opioids for acute severe pain, only one used opioids persistently during the subsequent 6 months.

背景随着阿片类药物使用障碍在普通人群中发病率的上升，一些人对静脉注射阿片类药物是否应常规用于急诊科（ED）急性剧烈疼痛的治疗提出了质疑。方法这是一项前瞻性观察性队列研究，在纽约布朗克斯区的两家急诊科进行。通过电话访问和查阅州阿片类药物处方数据库，对在急诊室接受静脉注射阿片类药物治疗的成年重度疼痛患者进行了 6 个月的随访。我们将持续使用阿片类药物定义为在急诊室就诊后的 6 个月内开出 6 张或更多阿片类药物处方，或平均每月开出一张处方。其中，506 名患者符合入选标准，并提供了可分析的数据。吗啡是急诊室最常使用的静脉注射阿片类药物（478 例，94%），其次是氢吗啡酮（20 例，4%）。在 506 人中，8 人（2%）同时接受了吗啡和氢吗啡酮静脉注射，63 人（12%）在急诊室就诊后被开具了阿片类药物处方。结论在 506 名因急性剧烈疼痛而接受静脉注射阿片类药物治疗的阿片类药物新手急诊患者中，只有一人在随后的 6 个月内持续使用阿片类药物。

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引用次数: 0

Grey-to-White Matter Ratio Values in Early Head Computed Tomography (CT) as a Predictor of Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Based on Severity of Hypoxic-Ischemic Brain Injury 根据缺氧缺血性脑损伤的严重程度预测院外心脏骤停幸存者早期头部计算机断层扫描 (CT) 中灰白质比值的神经功能预后。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.037

Background

Hypoxic-ischemic brain injury (HIBI) is a common complication of out-of-hospital cardiac arrest (OHCA).

Objectives

We investigated whether grey-to-white matter ratio (GWR) values, measured using early head computed tomography (HCT), were associated with neurologic outcomes based on the severity of HIBI in survivors of OHCA.

Methods

This retrospective multicenter study included adult comatose OHCA survivors who underwent an HCT scan within 2 h after the return of spontaneous circulation. HIBI severity was assessed using the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) scale (low, moderate, and severe). Poor neurologic outcomes were defined as Cerebral Performance Categories 3 to 5 at 6 months after OHCA.

Results

Among 354 patients, 27% were women and 224 (63.3%) had poor neurologic outcomes. The distribution of severity was 19.5% low, 47.5% moderate, and 33.1% severe. The area under the receiver operating curves of the GWR values for predicting rCAST severity (low, moderate, and severe) were 0.52, 0.62, and 0.79, respectively. The severe group had significantly higher predictive performance than the moderate group (p = 0.02). Multivariate logistic regression analysis revealed a significant association between GWR values and poor neurologic outcomes in the moderate group (adjusted odds ratio = 0.012, 95% CI 0.0–0.54, p = 0.02).

Conclusions

In this cohort study, GWR values measured using early HCT demonstrated variations in predicting neurologic outcomes based on HIBI severity. Furthermore, GWR in the moderate group was associated with poor neurologic outcomes.

背景：缺氧缺血性脑损伤（HIBI）是院外心脏骤停（OHCA）的常见并发症：我们研究了使用早期头部计算机断层扫描（HCT）测量的灰白质比值（GWR）是否与基于缺氧缺血性脑损伤严重程度的 OHCA 幸存者神经系统预后相关：这项回顾性多中心研究纳入了在自主循环恢复后 2 小时内接受 HCT 扫描的成人昏迷 OHCA 幸存者。HIBI严重程度采用修订后的心脏骤停后治疗性低温综合征（rCAST）量表（低度、中度和重度）进行评估。OHCA发生6个月后，脑功能分级为3至5级，即为不良神经功能结果：在354名患者中，27%为女性，224人（63.3%）的神经系统结果不佳。严重程度分布为低度19.5%、中度47.5%和重度33.1%。预测 rCAST 严重程度（低度、中度和重度）的 GWR 值的接收器操作曲线下面积分别为 0.52、0.62 和 0.79。重度组的预测性能明显高于中度组（p = 0.02）。多变量逻辑回归分析显示，中度组的 GWR 值与神经系统不良预后之间存在显著关联（调整后的几率比 = 0.012，95% CI 0.0-0.54，p = 0.02）：在这项队列研究中，使用早期 HCT 测量的 GWR 值在根据 HIBI 严重程度预测神经系统预后方面存在差异。此外，中度组的 GWR 与不良的神经系统预后有关。

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引用次数: 0

Incidental Renal Cysts Found by Point-of-Care Ultrasound: A Retrospective Chart Review 超声在急诊医学中的应用--床旁超声发现的肾囊肿：病历回顾

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.020

Background

Incidental findings are unrelated to a patient's complaint, found on diagnostic imaging, such as point-of-care ultrasound (POCUS). Incidental findings represent potential harms to patients and may lead to increased patient anxiety and health care costs related to downstream testing and surveillance.

Study Objectives

In this study, we aimed to calculate the rate of incidental renal cysts found by POCUS. Further, we hoped to describe how emergency physicians relay the findings to patients. Lastly, we hoped to examine if patients suffered harms in the 12 months following identification of an incidental renal cyst.

Methods

From our single-center, academic emergency department (ED), we reviewed renal POCUS images from 1000 consecutive adult ED patients to determine if there was a renal cyst. Next, we performed manual chart review to determine if patients were informed of the incidental renal cyst or suffered any patient harms.

Results

We found the prevalence of renal cysts to be 6.5% (95% confidence interval: 4.9%–8.4%). Those with cysts were more likely to be older compared to those without (63 ± 14 vs. 49 ± 15 years of age). Only 8% of patients had evidence that they were informed of their incidental renal cyst. No patients received a biopsy or were diagnosed with renal cell carcinoma or polycystic kidney disease.

Conclusion

Incidental renal cysts are common and are more likely to be found in older adults. In our study, physicians infrequently informed patients of their incidental finding.

研究背景偶然发现是指在诊断成像（如床旁超声检查（POCUS））中发现的与患者主诉无关的结果。意外发现对患者造成了潜在的伤害，并可能导致患者焦虑增加以及与下游检测和监控相关的医疗费用增加。研究目的在这项研究中，我们旨在计算 POCUS 意外发现肾囊肿的比率。此外，我们还希望描述急诊医生如何向患者转达检查结果。最后，我们希望研究患者在发现偶发肾囊肿后的 12 个月内是否受到了伤害。方法在我们的单中心学术急诊科（ED）中，我们查看了 1000 名连续的 ED 成人患者的肾脏 POCUS 图像，以确定是否存在肾囊肿。接下来，我们进行了人工病历审查，以确定患者是否被告知偶发肾囊肿或是否受到任何患者伤害。结果我们发现肾囊肿的发病率为 6.5%（95% 置信区间：4.9%-8.4%）。与无囊肿的患者相比，有囊肿的患者年龄更大（63 ± 14 岁对 49 ± 15 岁）。只有8%的患者有证据表明，他们被告知自己患有偶发性肾囊肿。没有患者接受活组织检查或被诊断为肾细胞癌或多囊肾。在我们的研究中，医生很少告知患者其偶然发现。

{"title":"Incidental Renal Cysts Found by Point-of-Care Ultrasound: A Retrospective Chart Review","authors":"","doi":"10.1016/j.jemermed.2024.03.020","DOIUrl":"10.1016/j.jemermed.2024.03.020","url":null,"abstract":"<div><h3>Background</h3><p>Incidental findings are unrelated to a patient's complaint, found on diagnostic imaging, such as point-of-care ultrasound (POCUS). Incidental findings represent potential harms to patients and may lead to increased patient anxiety and health care costs related to downstream testing and surveillance.</p></div><div><h3>Study Objectives</h3><p>In this study, we aimed to calculate the rate of incidental renal cysts found by POCUS. Further, we hoped to describe how emergency physicians relay the findings to patients. Lastly, we hoped to examine if patients suffered harms in the 12 months following identification of an incidental renal cyst.</p></div><div><h3>Methods</h3><p>From our single-center, academic emergency department (ED), we reviewed renal POCUS images from 1000 consecutive adult ED patients to determine if there was a renal cyst. Next, we performed manual chart review to determine if patients were informed of the incidental renal cyst or suffered any patient harms.</p></div><div><h3>Results</h3><p>We found the prevalence of renal cysts to be 6.5% (95% confidence interval: 4.9%–8.4%). Those with cysts were more likely to be older compared to those without (63 ± 14 vs. 49 ± 15 years of age). Only 8% of patients had evidence that they were informed of their incidental renal cyst. No patients received a biopsy or were diagnosed with renal cell carcinoma or polycystic kidney disease.</p></div><div><h3>Conclusion</h3><p>Incidental renal cysts are common and are more likely to be found in older adults. In our study, physicians infrequently informed patients of their incidental finding.</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":"140277773","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

The Shock Index among Children Presenting to the Emergency Department: Analysis of Nationally Representative Sample 急诊科就诊儿童的休克指数：全国代表性样本分析

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.022

Background

The Shock Index (SI) is emerging as a potentially useful measure among children with injury or suspected sepsis.

Objective

The aim of this study was to evaluate the distribution of the SI and evaluate its association with clinical outcomes among all children presenting to the emergency department (ED).

Methods

A complex survey of nonfederal U.S. ED encounters from 2016 through 2021 was analyzed. Among children, the Pediatric Age-Adjusted Shock Index (SIPA), Pediatric Shock Index (PSI), and the Temperature- and Age-Adjusted Shock Index (TAMSI) were analyzed. The association of these criteria with disposition, acuity, medication administration, diagnoses and procedures was analyzed.

Results

A survey-weighted 81.5 million ED visits were included for children aged 4–16 years and 117.2 million visits were included for children aged 1–12 years. SI could be calculated for 78.6% of patients aged 4–16 years and 57.9% of patients aged 1–12 years. An abnormal SI was present in 15.9%, 11.1%, and 31.7% when using the SIPA, PSI, and TAMSI, respectively. With all criteria, an elevated SI was associated with greater hospitalization. The SIPA and PSI were associated with triage acuity. All criteria were associated with medical interventions, including provision of IV fluids and acquisition of blood cultures.

Conclusions

An elevated SI is indicative of greater resource utilization needs among children in the ED. When using any criteria, an elevated SI was associated with clinically important outcomes. Further research is required to evaluate the distribution of the SI in children and to investigate its potential role within existing triage algorithms for children in the ED.

背景休克指数（SI）正在成为受伤或疑似败血症儿童的一种潜在有用的测量指标。本研究旨在评估所有急诊科（ED）就诊儿童的休克指数分布情况，并评估其与临床结果的关联。在儿童中，分析了儿科年龄调整休克指数 (SIPA)、儿科休克指数 (PSI) 以及温度和年龄调整休克指数 (TAMSI)。结果经调查加权后，4-16 岁儿童的急诊就诊人次为 8,150 万，1-12 岁儿童的急诊就诊人次为 1.172 亿。78.6%的 4-16 岁患者和 57.9% 的 1-12 岁患者可以计算出 SI。在使用 SIPA、PSI 和 TAMSI 时，分别有 15.9%、11.1% 和 31.7% 的患者出现 SI 异常。在所有标准中，SI 升高与住院率增加有关。SIPA 和 PSI 与分诊严重程度相关。所有标准都与医疗干预有关，包括提供静脉输液和采集血液培养。在使用任何标准时，SI 升高都与临床重要结果相关。需要进一步研究来评估 SI 在儿童中的分布情况，并调查其在急诊室儿童现有分诊算法中的潜在作用。

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引用次数: 0

Traumatic Pseudoaneurysm of the Temporal Artery 颞动脉外伤性假性动脉瘤。

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.035

引用次数: 0

The Effect of Contrast Rationing on the Development of Acute Kidney Injury During the Global Contrast Shortage 全球造影剂短缺期间造影剂配给对发生 AKI 的影响

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.04.009

Background

In April of 2022, the COVID-19 pandemic resulted in a global shortage of intravenous contrast media (ICM), which led our health care system to implement rationing measures.

Study Objectives

We set out to determine if the reduction in ICM use was associated with a change in the incidence of acute kidney injury (AKI).

Methods

We conducted a multicenter retrospective cohort analysis to compare the incidence of AKI in patients who presented before and after ICM rationing. Adult patients who had a CT of the abdomen performed who had at least 2 creatinine measurements, at least 24 h apart, were included. The maximum increase in creatinine was determined by subtracting the maximal creatinine obtained within 7 days with the initial creatinine. The primary outcome was the development of AKI.

Results

A total of 2168 patients met inclusion criteria (1082 before; 1086 after). There was no significant difference in age, gender, comorbid conditions, disposition, or initial estimated glomerular filtration rate between groups. In the prerationing group, 87.7% of patients received ICM compared to 42.7% after. There was no significant difference in the development of AKI between groups (11.1% vs. 11.0%), including when stratified by baseline renal function and adjusted for age, sex, race, comorbid conditions, and emergency severity index.

Conclusions

The dramatic reduction in ICM use that resulted from the global shortage was not associated with a change in the incidence of AKI. This reinforces the results of previous studies which have failed to find evidence of a relationship between ICM administration and AKI.

背景2022 年 4 月，COVID-19 大流行导致全球静脉注射造影剂 (ICM) 短缺，我们的医疗保健系统因此采取了配给措施。研究目的我们试图确定 ICM 使用量的减少是否与急性肾损伤 (AKI) 发病率的变化有关。纳入的成年患者均接受过腹部 CT 检查，并至少在 24 小时内测量过两次血肌酐。将 7 天内获得的最大肌酐值减去初始肌酐值，即可确定肌酐的最大增幅。结果共有 2168 名患者符合纳入标准（纳入前 1082 人；纳入后 1086 人）。两组患者在年龄、性别、合并症、体质或初始估计肾小球滤过率方面无明显差异。在配药前组，87.7% 的患者接受了 ICM 治疗，而配药后为 42.7%。根据基线肾功能进行分层，并根据年龄、性别、种族、合并症和急诊严重程度指数进行调整后，各组之间的 AKI 发生率无明显差异（11.1% 对 11.0%）。这进一步证实了之前的研究结果，即没有证据表明 ICM 的使用与 AKI 之间存在关系。

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引用次数: 0

Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study 提高急诊室患者的肺癌筛查率：一项试点研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.034

Background

Lung cancer is the leading cause of cancer death in the United States. Lung cancer screening (LCS) decreases lung cancer mortality. Emergency department (ED) patients are at disproportionately high risk for lung cancer. The ED, therefore, is an optimal environment for interventions to promote LCS.

Objectives

Demonstrate the operational feasibility of identifying ED patients in need of LCS, referring them to LCS services, deploying a text message intervention to promote LCS, and conducting follow-up to determine LCS uptake.

Methods

We conducted a randomized clinical trial to determine the feasibility and provide estimates of the preliminary efficacies of 1) basic referral for LCS and 2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of LCS among ED patients. Participants aged 50 to 80, identified as eligible for LCS, were randomized to study arms and followed up at 150 days to assess interval LCS uptake (primary outcome), barriers to screening, and perceptions of the study interventions.

Results

A total of 303 patients were surveyed, with 198 identified as eligible for LCS and subsequently randomized. Results indicated that 24% of participants with follow-up data received LCS (11% of the total randomized sample). Rates of screening at follow-up were similar across study arms. The intervention significantly improved normative perceptions of LCS (p = 0.015; Cohen's d = 0.45).

Conclusion

This pilot study demonstrates the feasibility of ED-based interventions to increase uptake of LCS among ED patients. A scalable ED-based intervention that increases LCS uptake could reduce lung cancer mortality.

背景肺癌是美国癌症死亡的主要原因。肺癌筛查（LCS）可降低肺癌死亡率。急诊科（ED）患者罹患肺癌的风险极高。因此，急诊室是采取干预措施促进肺癌筛查的最佳环境。目标展示识别需要肺癌筛查的急诊室患者、将他们转介到肺癌筛查服务机构、部署短信干预措施促进肺癌筛查以及进行随访以确定肺癌筛查接受率的操作可行性。方法我们进行了一项随机临床试验，以确定以下两种方法的可行性，并对其初步疗效进行估算：1）基本转诊以接受 LCS 服务；2）基本转诊加短信干预（以行为改变理论为基础），以促进急诊室患者接受 LCS 服务。年龄在 50 至 80 岁之间、被确定为符合 LCS 条件的参与者被随机分配到研究组，并在 150 天后进行随访，以评估 LCS 的接受间隔（主要结果）、筛查障碍以及对研究干预措施的看法。结果共调查了 303 名患者，其中 198 人被确定为符合 LCS 条件，随后被随机分配。结果显示，有随访数据的参与者中有 24% 接受了 LCS（占随机样本总数的 11%）。各研究机构的随访筛查率相似。该干预措施极大地改善了患者对 LCS 的标准认知（p = 0.015；Cohen's d = 0.45）。以急诊室为基础的可扩展干预措施可提高肺癌患者对肺癌筛查的接受率，从而降低肺癌死亡率。

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引用次数: 0

Assessing the Predictive Value of Combining Risk Scoring Systems and Ultrasonography for Short-Term Adverse Outcomes in Syncope: A Prospective Observational Study 评估结合风险评分系统和超声波检查对晕厥短期不良后果的预测价值：前瞻性观察研究

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine

Pub Date : 2024-08-01 DOI: 10.1016/j.jemermed.2024.03.016

Background

In the emergency department (ED), the role of ultrasonography (USG) in risk stratification and predicting adverse events in syncope patients is a current research area. However, it is still unclear how ultrasound can be combined with existing risk scores.

Objectives

In this study, it was aimed to examine the contribution of the use of bedside USG to current risk scores in the evaluation of patients presenting to the ED with syncope. The predictive values of the combined use of USG and risk scores for adverse outcomes at 7 and 30 days were examined.

Methods

The Canadian Syncope Risk Score (CSRS), San Francisco syncope rules (SFSR), USG findings of carotid and deep venous structures, and echocardiography results were recorded for patients presenting with syncope. Parameters showing significance in the 7-day and 30-day adverse outcome groups were utilized to create new scores termed CSRS-USG and SFSR-USG. Predictive values were evaluated using receiver operating characteristic (ROC) analysis. The difference between the predictive values was evaluated with the DeLong test.

Results

The study was carried out with 137 participants. Adverse outcomes were observed in 45 participants (32.8%) within 30 days. 32 (71.7%) of the adverse outcomes were in the first 7 days. For 30-day adverse outcomes, the SFSR-USG (p = 0.001) and CSRS-USG (p = 0.038) scores had better predictive accuracy compared to SFSR and CSRS, respectively. However, there was no significant improvement in sensitivity and specificity values.

Conclusion

The use of USG in the evaluation of syncope patients did not result in significant improvement in sensitivity and specificity values for predicting adverse events. However, larger sample-sized studies are needed to understand its potential contributions better.

背景在急诊科（ED）中，超声波检查（USG）在晕厥患者的风险分层和不良事件预测中的作用是当前的一个研究领域。本研究旨在探讨在评估因晕厥而到急诊科就诊的患者时，床旁 USG 的使用对现有风险评分的贡献。方法记录晕厥患者的加拿大晕厥风险评分（CSRS）、旧金山晕厥规则（SFSR）、颈动脉和深静脉结构的 USG 结果以及超声心动图结果。在 7 天和 30 天不良后果组中显示出显著性的参数被用来创建新的评分，称为 CSRS-USG 和 SFSR-USG。预测值采用接收器操作特征（ROC）分析法进行评估。预测值之间的差异通过 DeLong 检验进行评估。45 名参与者（32.8%）在 30 天内出现了不良后果。32例（71.7%）的不良反应发生在前7天。与 SFSR 和 CSRS 相比，SFSR-USG（p = 0.001）和 CSRS-USG（p = 0.038）评分对 30 天内不良后果的预测准确性分别更高。结论在评估晕厥患者时使用 USG 并未显著提高预测不良事件的灵敏度和特异性。然而，要想更好地了解 USG 的潜在贡献，还需要进行更大样本量的研究。

{"title":"Assessing the Predictive Value of Combining Risk Scoring Systems and Ultrasonography for Short-Term Adverse Outcomes in Syncope: A Prospective Observational Study","authors":"","doi":"10.1016/j.jemermed.2024.03.016","DOIUrl":"10.1016/j.jemermed.2024.03.016","url":null,"abstract":"<div><h3>Background</h3><p><span>In the emergency department (ED), the role of </span>ultrasonography<span><span> (USG) in risk stratification and predicting </span>adverse events in syncope patients is a current research area. However, it is still unclear how ultrasound can be combined with existing risk scores.</span></p></div><div><h3>Objectives</h3><p>In this study, it was aimed to examine the contribution of the use of bedside USG to current risk scores in the evaluation of patients presenting to the ED with syncope. The predictive values of the combined use of USG and risk scores for adverse outcomes at 7 and 30 days were examined.</p></div><div><h3>Methods</h3><p>The Canadian Syncope Risk Score (CSRS), San Francisco syncope rules (SFSR), USG findings of carotid and deep venous structures, and echocardiography results were recorded for patients presenting with syncope. Parameters showing significance in the 7-day and 30-day adverse outcome groups were utilized to create new scores termed CSRS-USG and SFSR-USG. Predictive values were evaluated using receiver operating characteristic (ROC) analysis. The difference between the predictive values was evaluated with the DeLong test.</p></div><div><h3>Results</h3><p><span>The study was carried out with 137 participants. Adverse outcomes were observed in 45 participants (32.8%) within 30 days. 32 (71.7%) of the adverse outcomes were in the first 7 days. For 30-day adverse outcomes, the SFSR-USG (</span><em>p</em> = 0.001) and CSRS-USG (<em>p</em> = 0.038) scores had better predictive accuracy compared to SFSR and CSRS, respectively. However, there was no significant improvement in sensitivity and specificity values.</p></div><div><h3>Conclusion</h3><p>The use of USG in the evaluation of syncope patients did not result in significant improvement in sensitivity and specificity values for predicting adverse events. However, larger sample-sized studies are needed to understand its potential contributions better.</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":"140280483","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}

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