American Journal of Emergency Medicine最新文献_第3页

An unintended path: Foley catheter-induced biliary obstruction following gastrostomy tube replacement - A case report 意外路径：胃造口管更换后Foley导尿管引起的胆道梗阻1例报告

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.ajem.2026.01.041

Wed H. Jadallah, Osama Muhtaseb, Daniel D. Gold

Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for long-term enteral access. Accidental dislodgement is a relatively common occurrence, and in many settings a Foley catheter is inserted as a temporary measure to preserve tract patency until definitive replacement can be performed. Although this practice is routinely employed, Foley catheters lack an external flange and are therefore susceptible to distal migration and associated complications. We describe a case of a 97-year-old woman with advanced dementia who presented to the emergency department with recurrent vomiting and coffee-ground material in her gastrostomy drainage bag after her PEG tube had been replaced with a Foley catheter at a nursing facility. Laboratory evaluation revealed cholestatic liver enzyme elevation, and imaging demonstrated distal migration of the catheter with balloon compression of the distal common bile duct, resulting in obstructive biliary pathology. Repositioning of the Foley catheter and delayed reinsertion of a dedicated PEG tube led to prompt clinical improvement. This case illustrates an underrecognized complication of temporary gastrostomy substitutes and emphasizes the importance of considering catheter migration in patients presenting with unexplained gastrointestinal or biliary symptoms after recent tube replacement. Preventive strategies including external marking, temporary securement measures, and routine radiologic confirmation of tube position may reduce morbidity and avoid unnecessary diagnostic evaluations.

经皮内镜胃造口术（PEG）管被广泛应用于长期肠内通路。意外移位是相对常见的，在许多情况下，Foley导管被插入作为临时措施，以保持尿道通畅，直到可以进行最终的更换。虽然这种做法是常规的，但Foley导管缺乏外部法兰，因此容易发生远端移位和相关并发症。我们描述了一个97岁晚期痴呆妇女的病例，她在护理机构用Foley导管替换PEG管后，胃造口引流袋中出现反复呕吐和咖啡渣物质。实验室评估显示胆汁淤积性肝酶升高，影像学显示导管远端移位，球囊压迫远端胆总管，导致胆道梗阻性病理。Foley导管重新定位和延迟重新插入专用PEG管可迅速改善临床。本病例说明了临时胃造口代用品的一种未被认识到的并发症，并强调了在近期换管后出现无法解释的胃肠道或胆道症状的患者考虑导管移位的重要性。预防策略包括外部标记、临时安全措施和常规放射学确认管的位置可以减少发病率和避免不必要的诊断评估。

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引用次数: 0

Photic sneeze reflex: When light becomes lethal 光性打喷嚏反射：当光线变得致命时

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.ajem.2026.01.042

Subramanian Senthilkumaran , S.V. Arathisenthil , Sivakumar Girija , Patne Sanjay , Ponniah Thirumalaikolundusubramanian

Background

Photic sneeze reflex (PSR) is an autosomal dominant condition characterized by paroxysmal sneezing in response to bright light exposure. This is also known by the acronym ACHOO (Autosomal Dominant Compelling Helio-Ophthalmic Outburst) syndrome. Even though it has precipitated motor vehicle accidents (MVAs) leading to trauma, it remains yet as an underrecognized entity in emergency settings.

Case presentation

A 26-year-old male delivery boy who drives a scooter presented to ED with left periorbital swelling following an MVA triggered by PSR, while exiting a covered parking into sunlight. This was his third MVA in three months, all linked to photic transitions, with prior episodes causing vehicle damage only. He reported a three-month history of sneezing (10–15 bursts) triggered by sunlight and during tooth brushing, unresponsive to toothpaste changes. Examination revealed a left orbital floor fracture with inferior rectus entrapment, confirmed by CT scan. Allergy evaluation showed low total IgE (5 IU/mL) and negative specific IgE, ruling out allergic etiology. PSR was diagnosed and he underwent surgical repair, and received preventive counseling.

Conclusion

Life-threatening MVAs are likely to occur following PSR. In order to overcome such events, an early diagnosis, occupational counseling and prevention strategies are suggested. Emergency physicians should suspect light-induced sneezing, if vital signs are stable and the allergy workup is negative in such cases.

光性打喷嚏反射（PSR）是一种常染色体显性遗传病，其特征是在强光照射下发生阵发性打喷嚏。这也被称为ACHOO（常染色体显性强迫性日光-眼爆发）综合征。尽管它引发了导致创伤的机动车辆事故，但在紧急情况下，它仍然是一个未被充分认识的实体。病例描述：一名26岁的男性外卖男孩驾驶摩托车，在离开有盖的停车场进入阳光下时，因PSR引发的MVA导致左眶周肿胀而出现ED。这是他三个月内第三次MVA，都与光过渡有关，之前的发作只造成车辆损坏。他报告说，在阳光和刷牙时，他有三个月的打喷嚏史（10-15次），对更换牙膏没有反应。检查发现左眶底骨折伴下直肌夹持，经CT证实。过敏评价显示总IgE低（5 IU/mL），特异性IgE阴性，排除过敏病因。PSR被诊断出来，他接受了手术修复，并接受了预防性咨询。结论PSR术后易发生危及生命的mva。为了克服这些事件，建议早期诊断，职业咨询和预防策略。如果生命体征稳定且过敏检查呈阴性，急诊医生应怀疑是光引起的打喷嚏。

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引用次数: 0

Gaps in syphilis screening for patients receiving sexually transmitted infection testing in the emergency department. 在急诊科接受性传播感染检测的患者中梅毒筛查的差距。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.ajem.2026.01.046

Madelyn Krueger, Mirinda Ann Gormley, Fahad Uddin, Sarah Guess, Prerana Roth, Alain H Litwin, Phillip Moschella

Objectives: To assess gaps in emergency department (ED) syphilis screening in patients receiving testing for other sexually transmitted infections (STI) within a large healthcare system in Upstate South Carolina (SC).

Methods: A retrospective cohort study of patients (aged 13+) tested for STIs (gonorrhea, chlamydia, or trichomonas) across eight EDs from 1/1/2020-12/31/2024 was examined. A missed opportunity (MO) for syphilis screening was defined as absent syphilis screening during any ED encounter where STI testing obtained. Adjusted logistic regression identified characteristics associated with a MO for syphilis screening.

Results: Between 2020 and 2024 syphilis screening increased by 127.1%, occurring in 9.9% of all encounters. Patients were less likely to have a MO if they were aged 13-19 years compared to 30-34 years (aOR = 0.89, 95%CI = 0.77-1.02), attended an ED with an opt-out screening program (aOR = 0.84, 95%CI = 0.78-0.91) or had a history of any STI (aOR = 0.80, 95%CI = 0.71-0.91). Individuals were more likely to have an MO if they were female (aOR = 1.82, 95%CI = 1.65-2.00) uninsured (aOR = 1.17, 95%CI = 1.07-1.28), had one STI screen (aOR = 3.47, 95%CI = 2.95-4.09) or two STI screens (aOR = 1.19, 95%CI = 1.09-1.31) compared to three STI screens, and had no previous history of HIV (aOR = 1.77, 95%CI = 1.26-2.47) or syphilis (aOR = 2.82, 95%CI = 2.13-3.74).

Conclusions: Notable gaps exist in ED syphilis screening within patients receiving testing for other STIs. Adopting ED syphilis screening initiatives is urgently necessary to expand screening in high-risk geographic areas as recommended by the CDC.

目的：评估在南卡罗来纳州北部（SC）的一个大型医疗保健系统内接受其他性传播感染（STI）检测的患者在急诊科（ED）梅毒筛查方面的差距。方法：对2020年1月1日至2024年12月31日期间8个急诊科进行性传播感染（淋病、衣原体或滴虫）检测的患者（13岁以上）进行回顾性队列研究。错失梅毒筛查机会（MO）定义为在获得性病检测的任何急诊科遭遇期间没有进行梅毒筛查。调整后的逻辑回归确定了与梅毒筛查MO相关的特征。结果：2020年至2024年间，梅毒筛查增加了127.1%，占所有接触者的9.9%。与30-34岁的患者相比，13-19岁的患者发生MO的可能性更小（aOR = 0.89, 95%CI = 0.77-1.02），参加ED并选择退出筛查计划（aOR = 0.84, 95%CI = 0.78-0.91）或有任何STI病史（aOR = 0.80, 95%CI = 0.71-0.91）。女性（aOR = 1.82, 95%CI = 1.65-2.00）、无保险（aOR = 1.17, 95%CI = 1.07-1.28）、接受过一次性传播感染筛查（aOR = 3.47, 95%CI = 2.95-4.09）或两次性传播感染筛查（aOR = 1.19, 95%CI = 1.09-1.31）比接受过三次性传播感染筛查、无HIV （aOR = 1.77, 95%CI = 1.26-2.47）或梅毒（aOR = 2.82, 95%CI = 2.13-3.74）史的个体更容易发生MO。结论：在接受其他性传播感染检测的患者中，ED梅毒筛查存在显著差距。采用ED梅毒筛查倡议是迫切需要的，以扩大筛查高危地区的疾病预防控制中心的建议。

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引用次数: 0

The impact of pre-hospital transport process optimization on rescue efficiency and complications in patients with traumatic intracranial hemorrhage. 院前转运流程优化对外伤性颅内出血患者抢救效率及并发症的影响

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.ajem.2026.01.044

Yang Lu, Suling Huang, Hui Li, Bin Qi

Background: The pre-hospital phase is a critical factor affecting the prognosis of patients with traumatic intracranial hemorrhage (TICH). Early recognition, rapid transport, and optimized pre-hospital management can significantly influence patient outcomes.

Objective: To compare the impact of "traditional pre-optimized workflow" versus "post-optimization workflow" pre-hospital transport models on scene-to-CT time, scene-to-surgery time, and complication rates in TICH patients.

Methods: This retrospective cohort study analyzed patients treated by the pre-hospital emergency system between January 2023 and June 2025. Patients were divided into a control group (traditional workflow, January 2023 - February 2024) and an optimization group (post-implementation of standardized triage, direct imaging access, and wireless remote command, March 2024-June 2025). Primary outcomes were scene-to-CT time and scene-to-surgery time. Secondary outcomes included early complications (hypotension, hypoxemia, rebleeding, and transport-related hypothermia). Advanced hypothesis testing analyses included multivariable logistic regression and Cox Proportional Hazards models.

Results: The study included 223 TICH patients. The optimization group showed significantly reduced scene-to-CT time [from 52 (IQR 44-63) to 37 (IQR 31-45) minutes, p < 0.001] and scene-to-surgery time [from 89 (IQR 76-108) to 67 (IQR 56-82) minutes, p < 0.001]. Cox regression analysis indicated that the optimization group had a significantly higher likelihood of receiving definitive treatment (adjusted HR 2.14, 95% CI 1.58-2.90). Treatment-related complications decreased significantly, with hypothermia rates reducing from 21 (18.6%) to 8 (7.3%) and hypoxemia from 17 (15.0%) to 6 (5.5%). Multivariable logistic regression confirmed that workflow optimization was independently associated with reduced odds of complications (adjusted OR 0.44, 95% CI 0.24-0.79).

Conclusion: Pre-hospital workflow optimization, specifically incorporating rapid dispatch protocols, direct transport to neurosurgical-capable facilities, wireless telemedicine consultation, and standardized point-of-care resuscitation, significantly reduced the time from scene to surgery and improved rescue efficiency while decreasing complication rates in TICH patients. These improvements suggest that systematic integration of evidence-based pre-hospital interventions represents a feasible and essential strategy for regional trauma networks.

背景：院前阶段是影响外伤性颅内出血患者预后的关键因素。早期识别、快速运输和优化院前管理可以显著影响患者的预后。目的：比较“传统的预优化工作流程”与“后优化工作流程”院前转运模式对颅脑损伤患者从现场到ct时间、从现场到手术时间及并发症发生率的影响。方法：本回顾性队列研究分析了2023年1月至2025年6月在院前急救系统治疗的患者。患者分为对照组（传统工作流程，2023年1月- 2024年2月）和优化组（实施标准化分诊、直接成像访问和无线远程命令后，2024年3月- 2025年6月）。主要结局是现场到ct的时间和现场到手术的时间。次要结局包括早期并发症（低血压、低氧血症、再出血和运输相关的低体温）。先进的假设检验分析包括多变量logistic回归和Cox比例风险模型。结果：纳入223例TICH患者。优化组显示，从现场到ct的时间从52分钟（IQR 44-63）显著缩短至37分钟（IQR 31-45）。结论：院前工作流程优化，特别是结合快速调度方案、直接运送到神经外科设施、无线远程医疗会诊和标准化的护理点复苏，显著缩短了从现场到手术的时间，提高了抢救效率，同时降低了TICH患者的并发症发生率。这些改进表明，以证据为基础的院前干预措施的系统整合是区域创伤网络的可行和必要策略。

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引用次数: 0

Derivation and validation of a clinical prediction score for ICU utilization at trauma intake 创伤入院时ICU使用率的临床预测评分的推导和验证

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-23 DOI: 10.1016/j.ajem.2026.01.047

Michael Makutonin , Atharva V. Sapre , Thomas R. Hartka , Bruce M. Lo , Michael Lozano Jr. , Moira Smith , Andrew C. Meltzer , R. Andrew Taylor

Background

Delayed admission to the intensive care unit (ICU) after trauma can lead to tripling of in-hospital mortality. Accurate ICU resource prediction at initial trauma assessment can help appropriately target resources and transfers for these patients and improve timeliness of ICU care delivery. Existing models for predicting ICU need in trauma, often have low generalizability or accuracy. This study aims to bridge this gap by deriving and externally validating a sensitive, temporally stable, registry-based prediction model for identifying trauma patients requiring ICU care during emergency department (ED) stabilization.

Methods

Trauma encounters from the U.S. National Trauma Data Bank (NTDB) between 2015 and 2021 were used to predict ICU care at index hospitalization. Predictor variables were derived from clinical, demographic, procedural, and diagnostic data. Exclusion criteria included patients under 17, encounters with missing ED lengths of stay, encounters from non-ACS Level 1 or 2 centers, and transfers with incomplete initial stabilization data. A logistic regression (LR) model was trained on data from 2015 to 2020 with five-fold cross-validation and calibrated for a 99% sensitivity threshold. The model was subsequently tested on 2021 data withheld from initial training and validation. Fairness analysis was conducted to measure model performance across race, sex, and insurance status.

Results

Of 16,877,474 trauma encounters in the NTDB, 14.3% met inclusion criteria. The logistic regression model achieved an AUC of 0.855 and PR-AUC of 0.705 during internal validation, translating to 99.2% sensitivity and 8.6% specificity. When applied to the 2021 test set, the model maintained 99.0% sensitivity and 9.9% specificity. Model discrimination was slightly higher for Medicare patients, White patients, and male patients. However, the model's sensitivity declined to 73% in non-ACS-verified Level I/II centers.

Significance

This study demonstrates that for trauma patients presenting to ACS-verified Level I or II centers, the need for intensive care can be predicted with very high sensitivity using routinely available clinical variables. The model provided a generalizable framework for early ICU triage, reducing unnecessary activations while ensuring an extremely low rate of under-triage. Prospective integration of this model into trauma workflows could significantly improve ICU resource mobilization without compromising patient safety.

背景：创伤后延迟入住重症监护病房（ICU）可导致住院死亡率增加三倍。在创伤初始评估时准确预测ICU资源，有助于对这些患者进行适当的资源定位和转移，提高ICU护理的及时性。现有的预测创伤患者ICU需求的模型通常具有较低的通用性和准确性。本研究旨在通过推导和外部验证一个敏感的、暂时稳定的、基于注册表的预测模型来识别在急诊科（ED）稳定期间需要ICU护理的创伤患者，从而弥合这一差距。方法采用2015年至2021年美国国家创伤数据库（NTDB）的创伤遭遇数据预测指数住院ICU护理情况。预测变量来源于临床、人口学、程序和诊断数据。排除标准包括17岁以下的患者，急诊科住院时间不足的患者，来自非acs 1级或2级中心的患者，以及初始稳定数据不完整的转院患者。对2015年至2020年的数据进行了逻辑回归（LR）模型的训练，并进行了五倍交叉验证，并校准了99%的灵敏度阈值。该模型随后在2021年从初始训练和验证中保留的数据上进行了测试。进行公平性分析以衡量模型在种族、性别和保险状况方面的表现。结果在NTDB的16,877,474例创伤就诊中，14.3%符合纳入标准。在内部验证中，logistic回归模型的AUC为0.855，PR-AUC为0.705，灵敏度为99.2%，特异性为8.6%。当应用于2021测试集时，该模型保持了99.0%的灵敏度和9.9%的特异性。医疗保险患者、白人患者和男性患者的模型歧视略高。然而，在非acs验证的I/II级中心，该模型的敏感性降至73%。意义本研究表明，对于在acs验证的I级或II级中心就诊的创伤患者，可以使用常规可用的临床变量以非常高的灵敏度预测重症监护的需要。该模型为早期ICU分诊提供了一个可推广的框架，减少了不必要的激活，同时确保了极低的分诊不足率。该模型与创伤工作流程的前瞻性整合可以显著改善ICU资源动员，同时不影响患者安全。

{"title":"Derivation and validation of a clinical prediction score for ICU utilization at trauma intake","authors":"Michael Makutonin , Atharva V. Sapre , Thomas R. Hartka , Bruce M. Lo , Michael Lozano Jr. , Moira Smith , Andrew C. Meltzer , R. Andrew Taylor","doi":"10.1016/j.ajem.2026.01.047","DOIUrl":"10.1016/j.ajem.2026.01.047","url":null,"abstract":"<div><h3>Background</h3><div>Delayed admission to the intensive care unit (ICU) after trauma can lead to tripling of in-hospital mortality. Accurate ICU resource prediction at initial trauma assessment can help appropriately target resources and transfers for these patients and improve timeliness of ICU care delivery. Existing models for predicting ICU need in trauma, often have low generalizability or accuracy. This study aims to bridge this gap by deriving and externally validating a sensitive, temporally stable, registry-based prediction model for identifying trauma patients requiring ICU care during emergency department (ED) stabilization.</div></div><div><h3>Methods</h3><div>Trauma encounters from the U.S. National Trauma Data Bank (NTDB) between 2015 and 2021 were used to predict ICU care at index hospitalization. Predictor variables were derived from clinical, demographic, procedural, and diagnostic data. Exclusion criteria included patients under 17, encounters with missing ED lengths of stay, encounters from non-ACS Level 1 or 2 centers, and transfers with incomplete initial stabilization data. A logistic regression (LR) model was trained on data from 2015 to 2020 with five-fold cross-validation and calibrated for a 99% sensitivity threshold. The model was subsequently tested on 2021 data withheld from initial training and validation. Fairness analysis was conducted to measure model performance across race, sex, and insurance status.</div></div><div><h3>Results</h3><div>Of 16,877,474 trauma encounters in the NTDB, 14.3% met inclusion criteria. The logistic regression model achieved an AUC of 0.855 and PR-AUC of 0.705 during internal validation, translating to 99.2% sensitivity and 8.6% specificity. When applied to the 2021 test set, the model maintained 99.0% sensitivity and 9.9% specificity. Model discrimination was slightly higher for Medicare patients, White patients, and male patients. However, the model's sensitivity declined to 73% in non-ACS-verified Level I/II centers.</div></div><div><h3>Significance</h3><div>This study demonstrates that for trauma patients presenting to ACS-verified Level I or II centers, the need for intensive care can be predicted with very high sensitivity using routinely available clinical variables. The model provided a generalizable framework for early ICU triage, reducing unnecessary activations while ensuring an extremely low rate of under-triage. Prospective integration of this model into trauma workflows could significantly improve ICU resource mobilization without compromising patient safety.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 166-169"},"PeriodicalIF":2.2,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Emergency Physician Notification of CT-detected Hepatic Steatosis ct检测肝脏脂肪变性的急诊医师通知

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.ajem.2026.01.038

Mert Erogul MD , Sarah Kabariti MPH , Antonios Likourezos MA MPH , Suzanne Bialeck MD , Aaron Chen MD , Jefferson Drapkin MPH

Background

Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most prevalent chronic liver condition globally and a leading cause of liver-related morbidity. Although often asymptomatic, MASLD is frequently identified incidentally on emergency department (ED) imaging. Timely patient notification is critical, as early intervention may alter disease trajectory.

Objective

To determine the proportion of ED patients with CT evidence of hepatic steatosis who recall being informed of the diagnosis by their ED physician.

Methods

We conducted a retrospective cohort study with prospective follow-up at two ED sites within the Maimonides Health system from March to June 2025. Adult patients (18–80 years) with incidental hepatic steatosis noted on CT imaging were identified. Exclusion criteria included hospital admission, non-English language, known liver disease, alcohol use disorder, or psychiatric conditions precluding interview. Structured telephone interviews assessed patient recall of physician notification. The primary outcome was patient-reported awareness of the diagnosis.

Results

Of 171 eligible patients, 150 completed interviews (mean age 47.2 years; 50% female). Only 17 patients (11.3%) recalled being informed of their diagnosis. Notification rates did not differ significantly by sex (13.3% men vs. 9.3% women; P = .440).

Conclusions

Fewer than one in eight ED patients with CT evidence of hepatic steatosis recalled being notified of their diagnosis. This communication gap represents a missed opportunity for early MASLD intervention and underscores the need for systematic approaches to ensure patient awareness and follow-up.

背景：代谢功能障碍相关脂肪变性肝病（MASLD）是全球最常见的慢性肝病，也是肝脏相关疾病的主要原因。虽然通常无症状，但MASLD经常在急诊科（ED）成像中偶然发现。及时通知患者是至关重要的，因为早期干预可能会改变疾病的发展轨迹。目的确定有CT表现为肝脂肪变性的ED患者回忆其内科医生告知其诊断的比例。方法：我们于2025年3月至6月在Maimonides卫生系统的两个ED站点进行了回顾性队列研究，并进行了前瞻性随访。成人患者（18-80岁）在CT上发现偶发性肝脂肪变性。排除标准包括住院、非英语语言、已知肝脏疾病、酒精使用障碍或妨碍访谈的精神疾病。结构化电话访谈评估了患者对医生通知的回忆。主要结果是患者报告的诊断意识。结果171例符合条件的患者中，150例完成了访谈（平均年龄47.2岁，50%为女性）。只有17名患者（11.3%）回忆被告知他们的诊断。通报率在性别上没有显著差异（男性13.3% vs女性9.3%;P = 0.440）。结论：在有肝脂肪变性CT证据的ED患者中，只有不到八分之一的人回忆起被告知他们的诊断。这种沟通差距意味着错失了早期干预MASLD的机会，并强调需要采取系统的方法来确保患者的认识和随访。

{"title":"Emergency Physician Notification of CT-detected Hepatic Steatosis","authors":"Mert Erogul MD , Sarah Kabariti MPH , Antonios Likourezos MA MPH , Suzanne Bialeck MD , Aaron Chen MD , Jefferson Drapkin MPH","doi":"10.1016/j.ajem.2026.01.038","DOIUrl":"10.1016/j.ajem.2026.01.038","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most prevalent chronic liver condition globally and a leading cause of liver-related morbidity. Although often asymptomatic, MASLD is frequently identified incidentally on emergency department (ED) imaging. Timely patient notification is critical, as early intervention may alter disease trajectory.</div></div><div><h3>Objective</h3><div>To determine the proportion of ED patients with CT evidence of hepatic steatosis who recall being informed of the diagnosis by their ED physician.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study with prospective follow-up at two ED sites within the Maimonides Health system from March to June 2025. Adult patients (18–80 years) with incidental hepatic steatosis noted on CT imaging were identified. Exclusion criteria included hospital admission, non-English language, known liver disease, alcohol use disorder, or psychiatric conditions precluding interview. Structured telephone interviews assessed patient recall of physician notification. The primary outcome was patient-reported awareness of the diagnosis.</div></div><div><h3>Results</h3><div>Of 171 eligible patients, 150 completed interviews (mean age 47.2 years; 50% female). Only 17 patients (11.3%) recalled being informed of their diagnosis. Notification rates did not differ significantly by sex (13.3% men vs. 9.3% women; <em>P</em> = .440).</div></div><div><h3>Conclusions</h3><div>Fewer than one in eight ED patients with CT evidence of hepatic steatosis recalled being notified of their diagnosis. This communication gap represents a missed opportunity for early MASLD intervention and underscores the need for systematic approaches to ensure patient awareness and follow-up.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 176-179"},"PeriodicalIF":2.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Prospective evaluation of flexible bronchoscopy in the emergency department: Indications, findings, and complications. A cohort study 弹性支气管镜在急诊科的前瞻性评价：指征、结果和并发症。队列研究

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.ajem.2026.01.036

Lorenzo Pelagatti , Simone Vanni , Lorenzo Corbetta , Peiman Nazerian

Background

Flexible bronchoscopy (FBS) is a widely used diagnostic and therapeutic tool in intensive care and pulmonary medicine. However, its role in the emergency department (ED) is less well established, especially in emergency physicians' hands.

Objective

The aim of this study was to describe the indications, findings, outcomes, and complications of FBS performed by emergency physicians in the ED following structured training, with a specific focus on its feasibility and safety.

Methods

This was a prospective single-center cohort study at Careggi University Hospital (Florence, Italy), including all patients undergoing FBS in the ED between January 1, 2023, and September 1, 2025. Demographic data, clinical indications, outcomes, and complications were prospectively collected and analyzed.

Results

We prospectively enrolled 431 patients (median age 69 years, 43.4% female), the majority of whom were non-intubated (86.8%). The main indications were pneumonia or respiratory infection (40.4%), hemoptysis (19.3%), and bronchial toilet for secretion clearance (18.3%). Common bronchoscopic findings included purulent secretions (42.2%), mucus plugs (9.9%), and airway bleeding (12.3%). Bronchoalveolar lavage was performed in 46.6% of cases, and bronchial toilet in 18.3%.

A clinical improvement was observed in 24.4% of patients, while 70.8% showed no immediate change. Complications were minor and self-limited, with no major adverse events or procedure-related deaths recorded.

Conclusion

Flexible bronchoscopy performed by trained emergency physicians appears safe and feasible.

柔性支气管镜检查（FBS）是一种广泛应用于重症监护和肺部医学的诊断和治疗工具。然而，它在急诊科（ED）的作用还不太确定，特别是在急诊医生的手中。本研究的目的是描述急诊科急诊医生在接受结构化培训后实施FBS的适应症、发现、结果和并发症，并特别关注其可行性和安全性。方法：这是一项来自Careggi大学医院（Florence, Italy）的前瞻性单中心队列研究，纳入了2023年1月1日至2025年9月1日期间在急诊科接受FBS治疗的所有患者。前瞻性地收集和分析人口统计学资料、临床适应症、结局和并发症。结果前瞻性纳入431例患者（中位年龄69岁，女性43.4%），其中大多数患者（86.8%）未插管。主要指征为肺炎或呼吸道感染（40.4%）、咯血（19.3%）、支气管清扫分泌物（18.3%）。常见的支气管镜检查结果包括化脓性分泌物（42.2%）、粘液塞（9.9%）和气道出血（12.3%）。支气管肺泡灌洗占46.6%，支气管如厕占18.3%。24.4%的患者有临床改善，而70.8%的患者没有立即出现变化。并发症轻微且自限性，无重大不良事件或手术相关死亡记录。结论经培训的急诊医师进行柔性支气管镜检查是安全可行的。

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引用次数: 0

Clinical differences between metformin-associated lactic acidosis and metformin-unrelated lactic acidosis: A descriptive study 二甲双胍相关乳酸酸中毒与二甲双胍无关乳酸酸中毒的临床差异：一项描述性研究

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.ajem.2026.01.027

Yuji Okazaki MD , Fumiya Inoue MD , Toshihisa Ichiba MD , Akira Namera PhD

Background

The extent to which metformin contributes to lactic acidosis in metformin-treated patients presenting to the emergency department (ED) remains unclear, particularly when blood metformin concentrations are unavailable. This study aimed to clarify the clinical differences between metformin-associated lactic acidosis (MALA) and metformin-unrelated lactic acidosis (MULA) on ED admission.

Methods

We conducted a retrospective study at a tertiary care hospital from January 1, 2023 to July 31, 2025. We included adult patients receiving metformin who presented to the ED with lactic acidosis, defined as pH < 7.35 and lactate ≥5 mmol/L. Patients were classified as having MALA if their serum metformin concentration at ED admission was ≥5 mg/L; others were categorized as MULA.

Results

Among 14 patients with available serum metformin concentrations, 3 were classified as MALA and 11 as MULA. MALA patients presented with lower blood pressure at ED admission (median 65/36 versus 130/74 mmHg), more profound acidemia (median pH 7.03 [IQR 6.89–7.06] versus 7.22 [IQR 7.20–7.32]), and higher lactate levels (median 14.8 mmol/L [IQR 14.3–19.0] versus 7.3 mmol/L [IQR 5.7–12.5]). Serum creatinine was also higher in the MALA group (median 2.65 mg/dL [IQR 2.26–6.35]) than in the MULA group (median 1.16 mg/dL [IQR 0.97–1.39]).

Conclusions

Although the sample size was small, three clinical clues for identifying MALA may include severe acidemia with hyperlactatemia, kidney impairment, and hypotension. Clinicians may consider MALA when these findings coexist in the absence of measured blood metformin concentrations. Further large-scale studies are warranted to confirm our findings.

背景：二甲双胍对急诊科（ED）接受二甲双胍治疗的患者乳酸性酸中毒的影响程度尚不清楚，特别是在无法获得血液二甲双胍浓度的情况下。本研究旨在阐明二甲双胍相关乳酸性酸中毒（MALA）和二甲双胍无关乳酸性酸中毒（MULA）在急诊科入院时的临床差异。方法对2023年1月1日至2025年7月31日在某三级医院进行回顾性研究。我们纳入了接受二甲双胍治疗并以乳酸酸中毒（定义为pH <； 7.35，乳酸≥5 mmol/L）向ED就诊的成年患者。如果患者入院时血清二甲双胍浓度≥5mg /L，则归类为MALA；其他被归类为MULA。结果14例患者血清二甲双胍可用浓度中，3例为MALA， 11例为MULA。MALA患者入院时血压较低（中位数65/36对130/74 mmHg），更严重的酸血症（中位数pH为7.03 [IQR 6.89-7.06]对7.22 [IQR 7.20-7.32]），乳酸水平较高（中位数14.8 mmol/L [IQR 14.3-19.0]对7.3 mmol/L [IQR 5.7-12.5]）。MALA组的血清肌酐（中位数2.65 mg/dL [IQR 2.26-6.35]）也高于MULA组（中位数1.16 mg/dL [IQR 0.97-1.39]）。结论虽然样本量较小，但重度酸血症伴高乳酸血症、肾功能损害和低血压可能是诊断MALA的三个临床线索。当没有测量血液二甲双胍浓度时，这些发现共存，临床医生可能会考虑MALA。需要进一步的大规模研究来证实我们的发现。

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引用次数: 0

Diagnostic and prognostic value of the risk factor-weighted clinical likelihood model in acute chest pain and negative troponin 危险因素加权临床似然模型对急性胸痛和肌钙蛋白阴性的诊断及预后价值

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-22 DOI: 10.1016/j.ajem.2026.01.033

Cayetana Barbeito-Caamaño , Alberto Bouzas-Mosquera , Jesús Peteiro-Vázquez , Antonio Fuentes-Vivero , Javier Vilasanchez-Vilar , Domingo López-Vázquez , María Dolores Martínez-Ruíz , Juan Carlos Yañez-Wonenburguer , Miriam Piñeiro-Portela , Rafael Vidal-Pérez , Francisco J. Broullón-Molanes , Ramón Calviño-Santos , José Manuel Vázquez-Rodríguez

Background

Acute chest pain is a common reason for emergency department consultation. In patients with suspected acute coronary syndrome but with non-elevated troponin and non-ischemic electrocardiogram, identifying those who require further testing remains a clinical challenge. The aim of the study was to assess the value of the risk factor–weighted clinical likelihood (RF-CL) model–derived pre-test probability (PTP) of coronary artery disease (CAD) for detecting obstructive CAD or myocardial ischemia, and for predicting major adverse cardiovascular events (MACE).

Methods

Retrospective, single-center study including 3097 patients without prior CAD evaluated in a dedicated chest pain unit in Spain (2011−2021).

Results

The prevalence of obstructive CAD or ischemia ranged from 2.3% in patients with very low PTP to 78.3% in those with high PTP. Each 1% increase in PTP was independently associated with higher odds of obstructive CAD or ischemia (OR 1.11, 95% CI 1.09–1.12) and greater risk of MACE (HR 1.04, 95% CI 1.03–1.05). The model showed strong discrimination for diagnosis (AUC 0.83) and acceptable prognostic performance (C-index 0.71). No patient with PTP ≤5% and non-elevated high-sensitivity troponin experienced adverse events within 30 days.

Conclusions

The PTP of CAD estimated by the RF-CL model was associated with the presence of obstructive CAD, myocardial ischemia and MACE in patients with suspected ACS, non-elevated troponin and non-ischemic electrocardiogram. Additional diagnostic testing may be safely deferred in patients with very low PTP (≤5%).

背景：急性胸痛是急诊科就诊的常见原因。在疑似急性冠状动脉综合征但肌钙蛋白和非缺血性心电图未升高的患者中，确定需要进一步检测的患者仍然是一个临床挑战。该研究的目的是评估危险因素加权临床可能性（RF-CL）模型衍生的冠状动脉疾病（CAD）的预测概率（PTP）在检测阻塞性CAD或心肌缺血以及预测主要不良心血管事件（MACE）方面的价值。方法回顾性、单中心研究，纳入3097例无CAD病史的患者，于2011 - 2021年在西班牙一家专门的胸痛科室进行评估。结果阻塞性CAD或缺血的患病率从极低PTP患者的2.3%到高PTP患者的78.3%不等。PTP每增加1%与阻塞性CAD或缺血的较高几率（or 1.11, 95% CI 1.09-1.12）和MACE的较高风险（HR 1.04, 95% CI 1.03-1.05）独立相关。该模型对诊断（AUC 0.83）和可接受的预后表现（C-index 0.71）有很强的鉴别能力。PTP≤5%且高敏感肌钙蛋白未升高的患者在30天内无不良事件发生。结论RF-CL模型估测的冠心病PTP与疑似ACS患者存在阻塞性冠心病、心肌缺血及MACE、肌钙蛋白未升高及非缺血性心电图相关。对于PTP非常低（≤5%）的患者，可以安全地推迟额外的诊断检测。

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引用次数: 0

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-21 DOI: 10.1016/S0735-6757(25)00809-5

引用次数: 0