American Journal of Emergency Medicine最新文献

Background: Approximately 20 % of emergency department (ED) visits involve cardiovascular symptoms. While ECGs are crucial for diagnosing serious conditions, interpretation accuracy varies among emergency physicians. Artificial intelligence (AI), such as ChatGPT, could assist in ECG interpretation by enhancing diagnostic precision.

Methods: This single-center, retrospective observational study, conducted at Merano Hospital's ED, assessed ChatGPT's agreement with cardiologists in interpreting ECGs. The primary outcome was agreement level between ChatGPT and cardiologists. Secondary outcomes included ChatGPT's ability to identify patients at risk for Major Adverse Cardiac Events (MACE).

Results: Of the 128 patients enrolled, ChatGPT showed good agreement with cardiologists on most ECG segments, excluding T wave (kappa = 0.048) and ST segment (kappa = 0.267). Significant discrepancies arose in the assessment of critical cases, as ChatGPT classified more patients as at risk for MACE than were identified by physicians.

Conclusions: ChatGPT demonstrates moderate accuracy in ECG interpretation, yet its current limitations, especially in assessing critical cases, restrict its clinical utility in ED settings. Future research and technological advancements could enhance AI's reliability, potentially positioning it as a valuable support tool for emergency physicians.

Objectives: Testicular torsion (TT) is an emergency requiring timely surgery to prevent testicular loss. There is a lack of reports on the clinical significance of the time of admission (on-hours vs. off-hours) on the long-term surgical outcome of TT.

Methods: We retrospectively reviewed all consecutive patients <18 years who were admitted to the hospital and treated for TT during the ten years. Patients were classified according to their admission time: weekday (on-hours), outside working hours, and weekends (off-hours). They were also classified based on their testicular outcome: salvaged and non-salvaged testis.

Results: Seventy-two patients were included. Their median age was 14.2 years. Thirty-three patients (46 %) were admitted during on-hours, whereas 39 patients (54 %) were admitted during off-hours. Forty-three patients (59.7 %) required orchidopexy and, out of those, during the long-term follow-up, only 27 (37.5 %) had definitive testicular salvage. Forty-five patients (62.5 %) were with no testicular salvage. On-hours vs. off-hours admission had no impact on the clinical outcome (p = 0.25). However, significant differences in the duration of symptoms (DoS) between the orchidopexy and orchidectomy groups were observed (p < 0.001).

Conclusion: Testicular torsion is a time-dependent diagnosis, and any delay in treatment could cause testicular loss. Our data suggest that the DoS before admission, rather than the admission time, influences the testicular outcome. The efficient management of emergencies regardless of the time of day is a key factor for the reduced probability that admission timing affects outcomes.

Background: Each year, increasing numbers of Americans travel abroad to undergo bariatric surgery. When postoperative complications arise, these patients often present to domestic emergency departments for care.

Case reports: We present three patients who experienced severe postoperative complications after bariatric surgery in Mexico and subsequently sought emergency medical care at an under-resourced, rural community hospital in Southern California, just north of the US-Mexico border.

Significance: The presentation of patients with complications from bariatric surgery abroad at emergency departments, particularly those located near ports of entry, is likely to become more frequent. Emergency physicians should familiarize themselves with the clinical and operational challenges they may face when caring for this population.

Background: Abdominal pain remains a top chief complaint for patients presenting to the emergency department (ED). Benign or emergent etiologies can present similarly. A thorough history and physical examination are critical for emergency physicians, especially for post-operative patients with concerns for a possible bowel perforation. Hysteroscopies with myomectomies are a minimally invasive surgical technique to remove fibroids. Gynecologic procedures historically have a low incidence of bowel perforation, however, in patients with post-operative pain presenting to the ED, distinguishing between a normal post-operative course and a post-operative complication can be challenging.

Case: A 33-year-old female with a history of obesity, colitis, type II diabetes, and hypertension presented to the freestanding ED with complaints of severe lower abdominal following a hysteroscopy with myomectomy earlier that day. The initial differential diagnosis had concern for a surgical complication, although her computed tomography of the abdomen and pelvis revealed mildly dilated loops of small bowel, suggestive of a low-grade small bowel obstruction (SBO) or enteritis. On reassessment, she noted pre-operative diarrhea after taking antibiotics. After admission, a transvaginal ultrasound revealed a collection of fluid in her pelvis prompting a diagnostic laparoscopy. Two enterotomies in her ileum with two uterine defects were successfully repaired, and she recovered several days later with minimal complications.

Discussion: This patient initially presented with abdominal pain associated with nausea and vomiting following a hysteroscopy with myomectomy, where initial testing led to a possible diagnosis of enteritis. Due to her continued abdominal pain, the ED physician admitted the patient, and it was found that she had two ileum perforations from suspected uterine perforations.

Central retinal artery occlusion (CRAO) is an ophthalmic emergency characterized by sudden loss of vision with a low chance of spontaneous recovery. This case report presents a 49-year-old female with sudden right eye visual loss, diagnosed as non-arteritic CRAO. Fundoscopic examination revealed retinal pallor, and optical coherence tomography demonstrated edema of the inner retinal layer, consistent with CRAO. Brain magnetic resonance imaging (MRI) showed an acute ischemic lesion in the right occipital subcortex. The patient received intravenous recombinant tissue plasminogen activator (IV rt-PA) at a lower-than-standard dose of 0.6 mg/kg within 4 h and 17 min of symptom onset, resulting in significant visual improvement. Extensive etiological investigation, including transesophageal echocardiography, uncovered a large, high-risk patent foramen ovale (PFO), leading to the diagnosis of PFO-associated CRAO and concomitant embolic stroke. This case suggests the effectiveness of low-dose IV rt-PA in treating CRAO, which might offer comparable efficacy to the standard dose while potentially minimizing bleeding risks. It also emphasizes the importance of considering cardiac comorbidities, particularly PFO, in younger CRAO patients, and underscores the need for a multidisciplinary approach and comprehensive stroke-etiology workups in CRAO management. This report contributes to the limited evidence on CRAO treatment in Japan, particularly in the context of lower tPA dosing and associated cardiac abnormalities. It underscores the importance of early diagnosis, treatment, and thorough etiological investigation in improving outcomes for CRAO patients.