American Journal of Emergency Medicine最新文献

英文中文

A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation 与急诊插管高角度视频喉镜相关的关键表现错误的分类。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.041

Alexander Bracey , Aaron J. Lacy , Scott D. Weingart , Ashar Ata , Alexander S. Giuliano , John C. Lewis , James Mantas , Benjamin Bayly , Michael Doyle , Ryan N. Barnicle

Background

Video laryngoscopy (VL) is now ubiquitous in emergency airway management. Hyperangulated video laryngoscopy (HAVL) differs from standard geometry VL (SGVL) in blade design, technique, and required microskills, yet the two are often regarded similarly. Despite widespread use, no comprehensive taxonomy of HAVL-specific performance errors exists.

Methods

We conducted an observational study of video-recorded endotracheal intubations (ETIs) performed in an urban academic emergency department (2020–2024). Fifty HAVL videos were first analyzed to derive 20 performance errors, followed by 100 additional recordings to confirm findings and assess incidence. Two independent emergency physicians evaluated each recording for performance errors. Interrater reliability and correlations among errors, procedure duration, and intubation success were assessed using Cohen's κ, Gwet's AC, and Pearson's correlation.

Results

We identified 20 discrete performance errors associated with HAVL. All 100 recordings contained at least one performance error (pooled κ = 0.53, 95 % CI 0.48–0.58). The most common error was failure to engage the midline vallecula (56 %), and the least common was bougie delivery issues (1 %). Each additional performance error added approximately 3 s to intubation duration. Strong correlations were observed among several errors.

Conclusions

Performance errors during HAVL are common and interrelated. This novel taxonomy provides a framework for structured feedback, targeted training, and future investigation of HAVL technique and clinical outcomes.

背景：视频喉镜检查（VL）目前在紧急气道管理中无处不在。超角度视频喉镜（HAVL）与标准几何VL （SGVL）在叶片设计、技术和所需的微技能方面有所不同，但两者通常被认为是相似的。尽管广泛使用，但没有针对特定于havel的性能错误的综合分类。方法：我们对2020-2024年在城市学术急诊科进行的视频气管插管（ETIs）进行了观察性研究。首先分析了50个HAVL视频，得出了20个表现错误，然后进行了100个额外的记录，以确认发现并评估发生率。两名独立的急诊医生评估每一份记录的表现错误。使用Cohen’s κ、Gwet’s AC和Pearson’s相关来评估错误率、手术时间和插管成功之间的可靠性和相关性。结果：我们确定了20个与HAVL相关的离散性能错误。所有100个记录包含至少一个性能错误（pooled κ = 0.53, 95% CI 0.48-0.58）。最常见的错误是未能接合中线小瓣膜（56%），最不常见的是肿胀分娩问题（1%）。每个额外的性能错误使插管持续时间增加约3秒。在几个误差之间观察到很强的相关性。结论：hafl期间的表现错误是常见且相互关联的。这种新颖的分类法为有组织的反馈、有针对性的培训以及未来对HAVL技术和临床结果的研究提供了一个框架。

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引用次数: 0

Adult scarlet fever: Case report and epidemiology 成人猩红热：病例报告和流行病学

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.040

Nina Prieto MD, Mai Tantawy MD, Swathi Bhuma MD, MS, Siu Fai Li MD

A 30-year-old woman presented to the ED with a generalized rash, fever, and tachycardia. A detailed review of systems and physical examination revealed symptoms and signs of streptococcal pharyngitis. PCR testing confirmed the diagnosis of streptococcal infection and scarlet fever. Scarlet fever is generally a disease of children, but episodic outbreaks are associated with the disease in adults, sometimes with significant complications. It is important for Emergency Medicine clinicians to be aware of this childhood illness presenting in adults.

一名30岁女性以全身皮疹、发热和心动过速就诊。详细的系统检查和体格检查显示了链球菌性咽炎的症状和体征。PCR检测证实了链球菌感染和猩红热的诊断。猩红热通常是一种儿童疾病，但成人也会出现偶发性暴发，有时伴有明显的并发症。重要的是急诊医学临床医生要意识到这种儿童疾病出现在成人。

引用次数: 0

A CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study 基于ct的多模式融合模型预测钝性胸外伤的预后：一项多中心研究

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.038

Tingting Zhao MD , Dong Li PhD , Mengshan Wu MD , Chenyuan Zhang MD , Xiaoyuan Qu MD , Xin Tian MD , Yixi Zhang MD , Chunlin Song MD , Xiaoran Wang PhD , Xianghong Meng PhD , Zhi Wang MD

Background

This study aimed to develop a multimodal predictive model that integrates clinical variables, radiomic features (RFs), and deep learning–based features (DLFs) to improve prognostic accuracy in patients with blunt chest trauma (BCT).

Methods

We retrospectively analyzed 337 patients with BCT from three medical centers. Clinical and CT imaging data, including emergency and follow-up scans, were obtained. Features including radiomic (RF) and deep learning-based (DLF) descriptors along with delta features representing temporal changes were extracted. After sequential feature selection, the least absolute shrinkage and selection operator (LASSO) regression was applied to identify optimal features. Model development included clinical-only, imaging-only, and fused models, with performance evaluated using AUC, calibration curves, and decision curve analysis.

Results

Rib fracture count, multiple injuries, and hemopneumothorax-to-lung ratio (HPR) were identified as independent prognostic factors. The fusion model, particularly the delta-clinical-DLR model, achieved AUCs of 0.85 (95 % CI: 0.80–0.90) and 0.86 (95 % CI: 0.77–0.95) in the training and test sets, respectively. Significant improvements in net reclassification (NRI up to 0.76) and integrated discrimination (IDI up to 0.26) were observed compared to the clinical models alone.

Conclusions

Integrating multi-timepoint CT imaging with clinical variables through a multimodal fusion model significantly enhances the prognostic performance of BCT, providing a robust tool for individualized risk prediction and clinical decision-making.

本研究旨在建立一种综合临床变量、放射学特征（RFs）和基于深度学习的特征（DLFs）的多模式预测模型，以提高钝性胸外伤（BCT）患者的预后准确性。方法回顾性分析来自3个医疗中心的337例BCT患者。获得临床和CT成像数据，包括急诊和随访扫描。提取的特征包括放射学（RF）和基于深度学习（DLF）的描述符以及表示时间变化的delta特征。在序列特征选择之后，采用最小绝对收缩和选择算子（LASSO）回归来识别最优特征。模型开发包括仅临床模型、仅成像模型和融合模型，并使用AUC、校准曲线和决策曲线分析来评估性能。结果肋骨骨折计数、多发伤、血气胸肺比（HPR）是独立的预后因素。融合模型，特别是delta-clinical-DLR模型，在训练集和测试集的auc分别为0.85 （95% CI: 0.80-0.90）和0.86 （95% CI: 0.77-0.95）。与单独的临床模型相比，观察到净重分类（NRI高达0.76）和综合区分（IDI高达0.26）的显著改善。结论通过多模态融合模型将多时间点CT图像与临床变量相结合，可显著提高BCT的预后表现，为个体化风险预测和临床决策提供了强有力的工具。

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引用次数: 0

Maggot infestation leading to Ignatzschineria larvae bacteremia and bladder outlet obstruction 蛆感染导致伊格纳茨氏幼虫菌血症和膀胱出口阻塞

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.035

Stephen Gamboa MD, MPH , Christopher Parsons MD , Christina Shenvi MD, PhD, MBA

We report a case of a 61-year-old man with a history of alcoholic cirrhosis and impaired mobility who presented to the Emergency Department (ED) with hepatic encephalopathy, cellulitis, sepsis, and extensive maggot infestation (myiasis). Maggots were recovered from the patient's skin, urethra, and rectum, and the burden of maggots in the urethra had led to bladder outlet obstruction. Blood cultures revealed polymicrobial bacteremia, including Ignatzschineria larvae.

Ignatzschineria larvae is a commensal bacterium that resides in the digestive tract of maggots. The organism is rarely pathogenic to humans, and case reports of Ignatzschineria larvae bacteremia are rare. This case demonstrates two uncommon complications of wound myiasis: bacteremia and bladder infestation, causing outlet obstruction and urinary retention. Patients who present to the Emergency Department with myiasis are at risk for bacteremia from both typical skin pathogens related to their wounds and pathogens associated with the maggots themselves.

我们报告一例61岁男性，有酒精性肝硬化和活动能力受损史，以肝性脑病、蜂窝织炎、败血症和广泛的蛆感染（蝇蛆病）就诊于急诊科。患者皮肤、尿道、直肠均有蛆恢复，尿道中蛆的负担导致膀胱出口梗阻。血液培养显示多种微生物菌血症，包括伊格纳茨氏幼虫。伊格纳茨氏幼虫是寄生在蛆消化道中的一种共生细菌。这种生物很少对人类致病，伊格纳茨氏杆菌幼虫菌血症的病例报告也很罕见。本病例显示两种不常见的伤口蝇蛆病并发症：菌血症和膀胱感染，引起出口阻塞和尿潴留。到急诊科就诊的蝇蛆病患者有感染细菌血症的风险，细菌血症来自与伤口相关的典型皮肤病原体和与蛆本身相关的病原体。

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引用次数: 0

Acute solar and atmospheric shifts preceding emergency department presentations for intentional drug overdose 急性太阳和大气变化前急诊科报告故意药物过量

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.042

Yalcin Golcuk MD (Assoc. Prof.) , Fulden Cantaş Türkiş PhD (Assoc. Prof.) , Meltem Derya Şahin MD (Assoc. Prof.) , Ömer Yasir Boz MD , Sevilay Yerlikaya Boz MD

Background

Intentional drug overdose (IDO) is a major cause of emergency department (ED) presentations. While psychiatric and psychosocial factors are established contributors, many events occur without identifiable triggers. Emerging evidence suggests that rapid environmental changes may act as acute behavioral stressors influencing self-harm risk. This study investigates whether short-term increases in solar insolation and related atmospheric conditions are associated with IDO presentations, using a 15-day harmonic mean (HM15) model to detect individualized environmental deviations.

Methods

This retrospective cohort study included adults presenting with IDO to a tertiary ED in Muğla, Türkiye between July 1, 2019 and July 1, 2024. Environmental data—including solar insolation, temperature at 2 m (T2M), ultraviolet (UV) radiation, and humidity—were obtained from the NASA POWER database. For each case, index-day values were compared to the individual's preceding HM15 baseline.

Results

Among 515 IDO patients, solar insolation, T2M, and UV radiation on the index day were significantly higher than HM15 baselines (all P < 0.001). These deviations were most pronounced in spring and early summer, aligning with established peaks in suicide risk. In spring, a 15.6 % surge in solar insolation was observed, alongside significant increases in T2M and UV exposure. Similar abrupt shifts were noted in summer, while autumn and winter demonstrated mixed environmental patterns.

Conclusions

Acute rises in solar insolation, temperature, and UV radiation are temporally associated with increased IDO risk. The HM15 model may support real-time, meteorologically informed, AI-enhanced risk stratification in ED-based suicide prevention and merits evaluation for integration into clinical decision support systems.

背景：故意药物过量（IDO）是急诊科（ED）报告的主要原因。虽然精神病学和社会心理因素是确定的诱因，但许多事件的发生没有可识别的诱因。新出现的证据表明，快速的环境变化可能是影响自残风险的急性行为压力源。本研究使用15天调和平均（HM15）模型来检测个性化的环境偏差，研究了太阳日照和相关大气条件的短期增加是否与IDO表现有关。方法：本回顾性队列研究纳入了2019年7月1日至2024年7月1日期间在日本Muğla、出现IDO至三级ED的成年人。环境数据包括太阳日照、2米温度、紫外线辐射和湿度，这些数据都是从NASA POWER数据库中获得的。对于每个病例，将指标值与个体之前的HM15基线进行比较。结果515例IDO患者指标日日晒、T2M、UV辐射均显著高于HM15基线（P < 0.001）。这些偏差在春季和初夏最为明显，与自杀风险的既定峰值一致。在春季，观测到太阳日晒量激增15.6%，同时T2M和UV暴露量显著增加。夏季也出现了类似的突变，而秋季和冬季则表现出混合的环境模式。结论日晒、温度和紫外线辐射的急剧升高与IDO风险的增加有暂时的相关性。HM15模型可以支持实时、气象信息、人工智能增强的基于ed的自杀预防风险分层和价值评估，以整合到临床决策支持系统中。

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-01

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-01

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-01

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-01

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-01

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American Journal of Emergency Medicine

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