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

New world screwworm: A focused review for the emergency medicine clinician 新的世界螺旋蝇：急诊医学临床医师的重点综述

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.007

Brit Long MD , Anissa Finley DO , Stephen Y. Liang MD, MPHS , Heather A. Heaton MD

Introduction

New World Screwworm (NWS), or Cochliomyia hominivorax, is a potentially fatal disease due to severe larvae infestation and tissue destruction. A resurgence has been reported.

Objective

This narrative review provides a focused overview of NWS for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease.

Discussion

NWS is endemic to tropical and subtropical America. While previously eradicated in the U.S., several human cases have been recently reported. This insect primarily infests livestock but may also affect humans. Female flies are attracted to mucosal surfaces and wounds and lay hundreds of eggs. Once hatching, larvae burrow into these surfaces and cause extensive damage by ingesting live tissue. Humans at risk include those with significant immunocompromise, open wounds, and those around animals. Infested patients present with severe swelling, bleeding, pain, and open, malodorous wounds. Larvae are usually visible in the wound. Bacterial superinfections may also occur. Suspected cases should be reported to the local or state public health department and the Centers for Disease Control and Prevention. Diagnosis includes morphologic identification of larvae removed from a wound. Larvae should be placed in a leak-proof container with 70% ethanol. Serum laboratory testing may also be needed in patients with evidence of bacterial superinfection and sepsis. Treatment includes removal of all larvae and often extensive debridement. Reevaluation of the wound within 48 h is recommended. Antibiotics are necessary for those with bacterial superinfection.

Conclusion

Emergency clinicians should be aware of the presentation, diagnosis, evaluation, and management of NWS to ensure optimal outcomes.

新世界螺旋虫（new World Screwworm，简称NWS）是一种具有潜在致命性的疾病，其幼虫严重侵染并破坏组织。据报道，这种情况又开始抬头。目的本综述为急诊临床医生提供了NWS的重点概述，包括该病的流行病学、表现、诊断和治疗。nws是热带和亚热带美洲特有的疾病。虽然以前在美国被根除，但最近报告了几例人类病例。这种昆虫主要侵害牲畜，但也可能影响人类。雌性苍蝇被粘膜表面和伤口吸引，产卵数百个。一旦孵化，幼虫就会钻入这些表面，并通过摄入活组织造成广泛的损害。有风险的人包括免疫功能明显低下的人、开放性伤口和动物周围的人。受感染的患者表现为严重的肿胀、出血、疼痛和开放性、有恶臭的伤口。伤口上通常可以看到幼虫。细菌重复感染也可能发生。疑似病例应报告给当地或州公共卫生部门和疾病控制与预防中心。诊断包括从伤口取出的幼虫的形态学鉴定。幼虫应放置在含有70%乙醇的防漏容器中。有细菌重复感染和败血症证据的患者也可能需要进行血清实验室检测。治疗包括清除所有幼虫和通常广泛的清创。建议在48小时内重新评估伤口。抗生素对于细菌重复感染是必需的。结论急诊临床医生应了解NWS的表现、诊断、评估和管理，以确保最佳结果。

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引用次数: 0

Achieved blood pressure during the first 12 h and clinical outcomes in patients with out-of-hospital cardiac arrest 院外心脏骤停患者前12小时的血压及临床结果

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.009

Chen-Hsi Chang M.D. , Shih-Neng Lin M.D. , Hao-Wei Lee M.D. , Ming-Jen Kuo M.D. , Pai-Feng Hsu M.D., Ph.D. , I-Hsin Lee M.D. , Teh-Fu Hsu M.D. , Chorng-Kuang How M.D. , Yenn-Jiang Lin M.D., Ph.D. , Chin-Chou Huang M.D., Ph.D.

Purpose

There is a significant correlation between mean arterial pressure (MAP) levels after the return of spontaneous circulation (ROSC) and the outcomes of out-of-hospital cardiac arrest (OHCA) patients. This study investigates the impact of MAP regulation within 12 h post-ROSC on OHCA outcomes.

Methods

This retrospective, single-center cohort study included non-traumatic OHCA patients who achieved ROSC at a medical center in Taiwan between January 1, 2017, and December 31, 2022. The primary outcomes were 30-day mortality and neurological status assessed by the Cerebral Performance Category (CPC) score.

Results

A total of 231 OHCA survivors were included in the analysis. Patients were stratified into three tertiles based on MAP distribution, with each group consisting of 77 patients, as follows: MAP < 80 mmHg, 80 ≤ MAP <95 mmHg, and MAP ≥ 95 mmHg, based on measurements taken within the first 12 h post-ROSC. No significant differences were observed in mortality or CPC scores between the 80 ≤ MAP < 95 mmHg and ≥ 95 mmHg groups. However, MAP levels below 80 mmHg were correlated with significantly higher 30-day mortality (hazard ratio [HR] = 1.760, 95% confidence interval [CI] = 1.130–2.760, P = 0.013) and worse neurological outcomes (HR = 1.560, 95% CI = 1.060–2.300, P = 0.023).

Conclusion

MAP <80 mmHg within the first 12 h post-ROSC is a strong predictor of poor clinical outcomes in OHCA patients, while a higher MAP target (≥ 95 mmHg) is not associated with additional benefit in the early post-arrest period.

目的探讨院外心脏骤停（OHCA）患者自发循环恢复（ROSC）后平均动脉压（MAP）水平与预后的相关性。本研究探讨rosc后12小时内MAP调节对OHCA结果的影响。方法本研究为回顾性单中心队列研究，纳入2017年1月1日至2022年12月31日在台湾某医疗中心完成ROSC的非创伤性OHCA患者。主要结局是30天死亡率和脑功能分类（CPC）评分评估的神经系统状态。结果共有231例OHCA幸存者纳入分析。根据MAP分布将患者分为三组，每组77例患者，根据rosc后前12小时内的测量结果分为MAP <； 80 mmHg, 80≤MAP <；95 mmHg和MAP≥95 mmHg。80≤MAP <； 95 mmHg组和≥95 mmHg组的死亡率或CPC评分无显著差异。然而，MAP水平低于80 mmHg与较高的30天死亡率（风险比[HR] = 1.760, 95%可信区间[CI] = 1.130-2.760, P = 0.013）和较差的神经预后（HR = 1.560, 95% CI = 1.060-2.300, P = 0.023）相关。结论：rosc后12小时内MAP = 80 mmHg是OHCA患者临床预后不良的有力预测指标，而较高的MAP目标（≥95 mmHg）与骤停后早期的额外获益无关。

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引用次数: 0

The impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury 既往颅脑外伤和颅脑手术史对急性儿童颅脑损伤临床表现的影响

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.005

Salih Karakoyun , Kudret Selki , Ali Rıza Karakoyun , Mustafa Boğan

Background

This study aimed to identify independent predictors of intracranial pathology in children presenting with acute blunt head trauma, with a particular focus on patients who had a history of previous head trauma or cranial surgery and did not meet the PECARN (Pediatric Emergency Care Applied Research Network) criteria for cranial computed tomography (CCT). The study further sought to evaluate the impact of these historical factors on acute clinical findings and to inform more objective decision-making for CCT use in this specific subgroup.

Methods

In this prospective cohort study, indications for cranial computed tomography (CCT) were determined based on PECARN criteria. Demographic characteristics, trauma mechanism, mode of presentation, symptoms, physical examination findings, scalp hematoma characteristics, Glasgow Coma Scale (GCS) scores, and CCT findings were recorded for all patients. Subgroup analyses were performed based on previous head trauma and cranial surgery history.

Results

Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (n = 39) on CCT. Lower GCS (≤14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all p < 0.05). Temporal (OR: 16.35; 95% CI: 3.57–74.76; p < 0.001), parietal (OR: 10.38; p < 0.001), occipital (OR: 6.20; p = 0.008), and frontal (OR: 4.99; p < 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p < 0.001) and lower GCS (OR: 0.67; p = 0.021) were also identified as independent risk factors for predicting intracranial injury. Among 361 patients (24.1%) with a history of head trauma and 16 patients (1.1%) with a history of cranial surgery, the rate of intracranial pathology was comparable to that of the general population (all p > 0.05).

Conclusions

The PECARN clinical decision rule allows clinicians to safely avoid unnecessary cranial CT imaging in low-risk cases owing to its high sensitivity and negative predictive value. Furthermore, previous head trauma or a history of cranial surgery was not found to increase the risk of new-onset acute intracranial injury.

本研究旨在确定急性钝性颅脑外伤患儿颅内病理的独立预测因素，特别关注有颅脑外伤或颅脑手术史且不符合PECARN（儿科急诊应用研究网络）颅脑计算机断层扫描（CCT）标准的患者。该研究进一步试图评估这些历史因素对急性临床表现的影响，并为在这一特定亚组中使用CCT提供更客观的决策。方法在这项前瞻性队列研究中，根据PECARN标准确定颅骨计算机断层扫描（CCT）的适应症。记录所有患者的人口学特征、创伤机制、表现方式、症状、体格检查结果、头皮血肿特征、格拉斯哥昏迷量表（GCS）评分和CCT结果。根据先前的头部创伤和颅脑手术史进行亚组分析。结果在1495例入组患者中，2.6% （n = 39）的CCT检测到颅内病理（颅骨骨折和/或颅内出血）。较低GCS（≤14）、救护车到达、呕吐、精神状态异常与颅内病理有显著相关性（p < 0.05）。颞部（OR: 16.35; 95% CI: 3.57-74.76; p < 0.001）、顶叶（OR: 10.38; p < 0.001）、枕部（OR: 6.20; p = 0.008）和额部（OR: 4.99; p < 0.001）头皮血肿与颅内病理独立相关。年龄较小（OR: 0.83; p < 0.001）和GCS较低（OR: 0.67; p = 0.021）也被认为是预测颅内损伤的独立危险因素。在361例（24.1%）有颅脑外伤史的患者和16例（1.1%）有颅脑手术史的患者中，颅内病理发生率与普通人群相当（p > 0.05）。结论PECARN临床决策规则具有较高的敏感性和阴性预测值，可使临床医生在低危病例中安全地避免不必要的颅脑CT成像。此外，既往头部外伤或颅脑手术史未发现增加新发急性颅内损伤的风险。

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引用次数: 0

A concise review investigating simulation modalities' effects on team efficiency, provider wellbeing, education & clinical outcomes 简明回顾调查模拟模式对团队效率，提供者福利，教育和临床结果的影响

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.002

Yusra Othman , Alexandra Kata B.S , Keshavkiran Jayagopi B.S , Sukriti Prashar B.S , Cameron Nishida B.S , Logan Samuel Rogers B.S , Adel Elkbuli MD, MPH, MBA

Background

Simulation is increasingly being used in trauma care to improve provider confidence, teamwork, and leadership skills in trauma situations. Additionally, the use of modern technology has introduced virtual reality simulation. However, simulations impact on trauma education, clinical practice, and cost effectiveness remain unclear. This review aims to synthesize current literature on the impact of simulation in trauma care education and clinical practice.

Methods

This concise review was performed utilizing five major databases: Cochrane, ProQuest, Google Scholar, PubMed, and Embase to identify relevant studies regarding the role of simulation modalities on team performance, medical education, patient outcomes, provider wellbeing, and cost-effectiveness.

Results

This concise review analyzed 1091 articles; 21 studies met inclusion criteria. Simulations demonstrated improved team performance by decreased communication response times (21 to 15 s) and increased teamwork (4.06/5 to 4.40/5). Leadership behavior significantly improved (11.29 vs. 7.23; d = 0.92). Studies demonstrated virtual reality (VR) was non-inferior to mannequins for trauma scores (163.1 vs. 163.2), higher VR assessment scores (158.4 vs. 134.2), and AI serious games reducing under-triage by ∼18%. VR was 40% cheaper than mannequins and reduced per-participant costs ($296 vs $149). Simulation improved completion times (251 vs. 497 s), success rates (100% vs. 64%), and diagnostic accuracy (P = .01) in education. Indirect patient outcomes included faster secondary surveys (14 min vs 6 min) and CT prep times (23 min vs 16 min).

Conclusion

Simulation-based training is an effective tool in improving trauma care as evidence throughout the studies showed vast improvements in leadership, communication, efficiency in care, and provider confidence. The findings from this study demonstrate that the implementation of VR, in particular, showed tremendous educational benefits and can be a viable strategy to conventional simulation modalities due to its cost effectiveness.

模拟越来越多地用于创伤护理，以提高提供者的信心，团队合作，以及创伤情况下的领导技能。此外，利用现代技术引入了虚拟现实仿真。然而，模拟对创伤教育、临床实践和成本效益的影响仍不清楚。本综述旨在综合目前关于模拟在创伤护理教育和临床实践中的影响的文献。方法采用Cochrane、ProQuest、谷歌Scholar、PubMed和Embase五个主要数据库进行简要回顾，以确定模拟模式在团队绩效、医学教育、患者预后、提供者福利和成本效益方面的作用。结果本综述分析了1091篇文献；21项研究符合纳入标准。模拟显示，通过减少沟通响应时间（21至15秒）和增加团队合作（4.06/5至4.40/5），提高了团队绩效。领导行为显著改善（11.29 vs. 7.23; d = 0.92）。研究表明，虚拟现实（VR）在创伤评分（163.1比163.2）、更高的VR评估评分（158.4比134.2）和AI严肃游戏方面不逊于人体模型，减少了18%的分类不足。VR比人体模型便宜40%，并且降低了每个参与者的成本（296美元对149美元）。模拟提高了教育中的完成时间（251秒对497秒）、成功率（100%对64%）和诊断准确性（P = 0.01）。患者的间接结果包括更快的二次调查（14分钟vs 6分钟）和CT准备时间（23分钟vs 16分钟）。结论基于模拟的培训是改善创伤护理的有效工具，研究证据表明，在领导力、沟通、护理效率和提供者信心方面有很大改善。这项研究的结果表明，特别是VR的实施，显示出巨大的教育效益，并且由于其成本效益，可以成为传统模拟模式的可行策略。

{"title":"A concise review investigating simulation modalities' effects on team efficiency, provider wellbeing, education & clinical outcomes","authors":"Yusra Othman , Alexandra Kata B.S , Keshavkiran Jayagopi B.S , Sukriti Prashar B.S , Cameron Nishida B.S , Logan Samuel Rogers B.S , Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.ajem.2026.01.002","DOIUrl":"10.1016/j.ajem.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Simulation is increasingly being used in trauma care to improve provider confidence, teamwork, and leadership skills in trauma situations. Additionally, the use of modern technology has introduced virtual reality simulation. However, simulations impact on trauma education, clinical practice, and cost effectiveness remain unclear. This review aims to synthesize current literature on the impact of simulation in trauma care education and clinical practice.</div></div><div><h3>Methods</h3><div>This concise review was performed utilizing five major databases: Cochrane, ProQuest, Google Scholar, PubMed, and Embase to identify relevant studies regarding the role of simulation modalities on team performance, medical education, patient outcomes, provider wellbeing, and cost-effectiveness.</div></div><div><h3>Results</h3><div>This concise review analyzed 1091 articles; 21 studies met inclusion criteria. Simulations demonstrated improved team performance by decreased communication response times (21 to 15 s) and increased teamwork (4.06/5 to 4.40/5). Leadership behavior significantly improved (11.29 vs. 7.23; d = 0.92). Studies demonstrated virtual reality (VR) was non-inferior to mannequins for trauma scores (163.1 vs. 163.2), higher VR assessment scores (158.4 vs. 134.2), and AI serious games reducing under-triage by ∼18%. VR was 40% cheaper than mannequins and reduced per-participant costs ($296 vs $149). Simulation improved completion times (251 vs. 497 s), success rates (100% vs. 64%), and diagnostic accuracy (<em>P</em> = .01) in education. Indirect patient outcomes included faster secondary surveys (14 min vs 6 min) and CT prep times (23 min vs 16 min).</div></div><div><h3>Conclusion</h3><div>Simulation-based training is an effective tool in improving trauma care as evidence throughout the studies showed vast improvements in leadership, communication, efficiency in care, and provider confidence. The findings from this study demonstrate that the implementation of VR, in particular, showed tremendous educational benefits and can be a viable strategy to conventional simulation modalities due to its cost effectiveness.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 27-33"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982060","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

Association of pre-intubation bag-valve-mask ventilation with hypoxemia and regurgitation in the ED: A multicenter cohort study 急诊科插管前气囊-瓣膜-面罩通气与低氧血症和返流的关系：一项多中心队列研究

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.012

Jin Takahashi , Haruka Tsuji , Hiraku Funakoshi , Hiroshi Okamoto , Yusuke Hagiwara , Hiroko Watase , Takao Ono , Sakina Kadomatsu , Tatsuhiko Hata , Kohei Hasegawa , Takashi Shiga , Tadahiro Goto , Japanese Emergency Medicine Network Investigators

Background

The effectiveness of pre-intubation bag-valve-mask (BVM) ventilation for rapid sequence intubation (RSI) in the emergency department (ED) remains uncertain. In this study, we investigated whether pre-intubation BVM ventilation was associated with a lower risk of peri-intubation hypoxemia.

Methods

We analyzed data from a multicenter prospective observational study conducted in 14 EDs across Japan. Adult (≥18 years) patients who underwent RSI between 2020 and 2023 were included. The primary outcome was peri-intubation hypoxemia (SpO₂ <90%), and the secondary outcome was regurgitation. Missing data were imputed using multiple imputations. Propensity scores were estimated using predefined covariates (age, sex, body mass index, COVID-19, modified LEMON score, intubation indication, device, intubator's specialty, preoxygenation method, pre-intubation SpO₂, and participating institutions). Treatment effects were evaluated using stabilized inverse probability of treatment weighting (IPTW) and sensitivity analysis with 1:1 matching.

Results

Among the 1481 patients, 589 (40%) received pre-intubation BVM. Overall, 204 patients (14%) experienced peri-intubation hypoxemia. The BVM group had a lower unadjusted risk of hypoxemia than the non-BVM group (10% vs. 16%; p < 0.001). However, after stabilized IPTW, BVM ventilation was not significantly associated with hypoxemia (adjusted risk difference −3.2%; 95% CI, −7.8% to 1.5%). Sensitivity analysis using 1:1 matching yielded consistent results (risk difference 0.9%; 95% CI, −3.8% to 5.6%). There was no significant difference in the incidence of regurgitation between the BVM and non-BVM groups (1% vs. 1%; p = 0.24).

Conclusion

In this multicenter study, pre-intubation BVM ventilation during RSI in the ED was not associated with a reduced risk of peri-intubation hypoxemia.

背景：在急诊科（ED）快速顺序插管（RSI）中，预插管袋-阀-面罩（BVM）通气的有效性仍不确定。在这项研究中，我们调查了插管前BVM通气是否与插管周围低氧血症的风险降低有关。方法：我们分析了来自日本14个ed的多中心前瞻性观察研究的数据。纳入了2020年至2023年间接受RSI的成人（≥18岁）患者。主要结局是插管周围低氧血症（spo2 <90%），次要结局是反流。缺失的数据是通过多重输入输入的。使用预定义协变量（年龄、性别、体重指数、COVID-19、改良LEMON评分、插管指征、设备、插管器专业、预氧方法、插管前SpO2和参与机构）估计倾向得分。采用稳定的处理加权逆概率（IPTW）和1:1匹配的敏感性分析来评估治疗效果。结果1481例患者中589例（40%）接受了插管前BVM。总体而言，204例患者（14%）经历了插管周围低氧血症。BVM组发生低氧血症的风险低于非BVM组（10% vs. 16%; p < 0.001）。然而，IPTW稳定后，BVM通气与低氧血症无显著相关性（调整后的风险差为- 3.2%；95% CI为- 7.8%至1.5%）。使用1:1匹配的敏感性分析得出一致的结果（风险差异0.9%;95% CI, - 3.8%至5.6%）。BVM组和非BVM组的反流发生率无显著差异（1% vs 1%; p = 0.24）。结论：在这项多中心研究中，急诊科RSI患者插管前BVM通气与插管后低氧血症的风险降低无关。

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引用次数: 0

Evaluation of patients admitted to the pediatric emergency departments due to suicide attempts: A multicenter study from Türkiye 对因自杀未遂而进入儿科急诊科的患者的评估：一项来自<s:1> rkiye的多中心研究

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2025.12.044

Hande Yigit , Ahmet Ziya Birbilen , Burcu Akbaba , Cansu Demirel , Alper Çiçek , Emel Berksoy , Berke Mutlu , Göksel Vatansever , Deniz Tekin , Sevcan Bilen , Hayri Levent Yılmaz , Gamze Gökulu , Ali Tunç , İlknur Akansu , Emel Ulusoy , Durgül Yılmaz , Murat Duman , İlknur Fidancı , Medine Ayşin Taşar , Murat Doğan , Özlem Tekşam

Background

Suicide is a major cause of morbidity and mortality in adolescents and is increasingly recognized among younger children. Pediatric emergency departments (EDs) are critical points for the identification and management of suicide attempts. This study aimed to evaluate the demographic and clinical characteristics, methods, and temporal trends of suicide attempts among children and adolescents presenting to pediatric EDs in Türkiye.

Methods

We conducted a retrospective, multicenter study across 29 pediatric EDs from July 1, 2017, to June 30, 2022. Patients aged 8–18 years with a confirmed suicide attempt were included. Data collected included demographics, methods, psychiatric history, prior attempts, medications used in self-poisoning, psychiatric consultations, and outcomes. Statistical analyses included chi-square and Mann–Whitney U tests.

Results

During the study period, 6004 suicide attempt presentations were identified among 9,736,825 ED visits (0.5/1000). The median age was 15 years (IQR: 14–16), with 78.8% female (female-to-male ratio 3.7:1). Most patients (92.9%) were aged 13–18 years. Self-poisoning was the predominant method (95.4%), commonly involving NSAIDs, paracetamol, SSRIs, and atypical antipsychotics; 23.5% ingested their own medications, 76.2% of which were psychotropics. A known psychiatric disorder was present in 36.4%, and 16.4% had a prior suicide attempt. Psychiatric consultation was obtained in 73% of cases. Hospitalization occurred in 89.8%, with 15.5% requiring intensive care. Eleven deaths were recorded.

Conclusions

Suicide attempts among children and adolescents are a significant and ongoing public health problem in Türkiye, with self-poisoning as the dominant method. The findings underscore the need for targeted prevention strategies, safe medication storage, and strengthened psychiatric services in pediatric EDs to improve outcomes for this high-risk population.

背景：自杀是青少年发病和死亡的主要原因，并且越来越多地在低龄儿童中得到认识。儿科急诊科（EDs）是识别和管理自杀企图的关键点。本研究旨在评估日本儿科急诊科儿童和青少年自杀企图的人口学和临床特征、方法和时间趋势。方法：我们在2017年7月1日至2022年6月30日期间对29个儿科急诊科进行了一项回顾性多中心研究。年龄在8-18岁之间且确认有自杀企图的患者被纳入研究对象。收集的数据包括人口统计、方法、精神病史、既往尝试、自我中毒使用的药物、精神病学咨询和结果。统计分析包括卡方检验和Mann-Whitney U检验。结果：在研究期间，9,736,825次ED就诊中发现6004例自杀企图（0.5/1000）。年龄中位数为15岁（IQR: 14-16），女性占78.8%（男女比3.7:1）。患者年龄以13 ~ 18岁为主（92.9%）。自我中毒是主要的方法（95.4%），通常涉及非甾体抗炎药、扑热息痛、SSRIs和非典型抗精神病药物；23.5%服用自己的药物，其中76.2%为精神类药物。36.4%的人存在已知的精神障碍，16.4%的人之前有过自杀企图。73%的病例接受了精神科咨询。住院率为89.8%，其中15.5%需要重症监护。11人死亡。结论：日本儿童和青少年自杀未遂是一个严重且持续存在的公共卫生问题，其中自毒是主要的自杀方式。研究结果强调需要有针对性的预防策略、安全的药物储存和加强儿科急诊科的精神病学服务，以改善这一高危人群的预后。

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引用次数: 0

Design and development of a Bayesian risk assessment model for bacterial infection (BRAIN) in patients admitted to hospital from ED 急诊科住院患者细菌感染（BRAIN）贝叶斯风险评估模型的设计与开发

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-07 DOI: 10.1016/j.ajem.2026.01.001

Sandeep Tripathi MD, MS , Collins Odhiambo PhD , Jessica Haas MS2

Background

C-reactive Protein (CRP) and Procalcitonin (PCT) are commonly used in conjunction with clinical judgment to assess the risk of bacterial infection. Traditional frequentist methods do not allow the incorporation of clinical suspicion into risk estimation. This study aimed to describe clinical phenotypes based on CRP and PCT levels and develop a Bayesian model to estimate the posterior probability of bacterial infection in emergency department (ED) patients.

Methods

Retrospective study across 15 hospitals (2019–2023), including patients admitted from the ED with CRP, PCT, and bacterial cultures obtained within 24 h. Patients categorized into four groups: both markers normal (A), both abnormal (B), only PCT abnormal (C), and only CRP abnormal (D). Bayesian logistic regression models developed using priors of 0.3, 0.5, and 0.7 to reflect varying levels of clinical suspicion. Predictors included age, CRP, PCT, fever, white blood cell count, ESR, ferritin, and viral positivity.

Results

Among 10,397 patients (median age, 65; 909 < 18 years), 27.5% had positive cultures, with an 11.2% mortality rate. Culture positivity and mortality were highest in group B (35%), followed by D (24%). Posterior probabilities of infection under high, moderate, and low suspicion priors were 25%, 17.5%, and 10.6%, respectively. PCT was the strongest predictor, with a one log-unit increase associated with a 45% rise in infection probability. AUROC was 0.64; AUPRC 0.43. A R Shiny calculator (BRAIN) was created for bedside application.

Conclusion

A Bayesian model incorporating inflammatory markers and clinical judgment provides individualized estimates of bacterial infection risk at the bedside.

背景：c反应蛋白（CRP）和降钙素原（PCT）是常用的结合临床判断来评估细菌感染的风险。传统的频率分析方法不允许将临床怀疑纳入风险评估。本研究旨在描述基于CRP和PCT水平的临床表型，并建立贝叶斯模型来估计急诊科（ED）患者细菌感染的后验概率。方法：对15家医院（2019-2023年）的回顾性研究，包括在24 h内获得CRP、PCT和细菌培养的急诊科入院患者。患者分为四组：两种标志物均正常(A)，两种标志物均异常(B)，仅PCT异常(C)，仅CRP异常(D)。贝叶斯逻辑回归模型使用0.3、0.5和0.7的先验来反映不同程度的临床怀疑。预测因素包括年龄、CRP、PCT、发热、白细胞计数、ESR、铁蛋白和病毒阳性。结果：10,397例患者（中位年龄65岁；909岁 ）结论：结合炎症标志物和临床判断的贝叶斯模型提供了床边细菌感染风险的个性化估计。

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引用次数: 0

Vonoprazan-associated hypomagnesemia presenting to the emergency department with altered mental status and a suspected seizure vonoprazan相关的低镁血症出现在急诊科的精神状态改变和疑似癫痫发作

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-05 DOI: 10.1016/j.ajem.2025.12.034

Noriyuki Okamoto , Shinsuke Onishi , Tatsuo Manabe , Shota Satoh , Satoshi Nara

An older woman without seizure history presented to the emergency department (ED) after an unwitnessed loss of consciousness, with persistent altered mental status. Initial tests showed profound hypomagnesemia (0.6 mg/dL) with low ionized calcium; lactate declined rapidly. Urine showed low magnesium with a fractional excretion of magnesium (FEMg) ≤2.8 %. She had been taking long-term vonoprazan, a potassium-competitive acid blocker (P-CAB). Perfusion MRI with arterial spin labeling (ASL) showed right-hemispheric hyperperfusion, while conventional sequences showed only a chronic cerebellar infarct. These findings resulted in hospital admission with a suspected postictal state. Vonoprazan was discontinued on admission, and magnesium and calcium were repleted. During hospitalization, she improved steadily and returned to baseline within one week. The initial inpatient electroencephalogram showed diffuse low-amplitude slowing without definite epileptiform discharges; by Day 5 the background was more organized. On Day 8, single-photon emission computed tomography (SPECT) showed reduced perfusion in the previously hyperperfused region. QTc peaked at 603 ms and shortened as electrolytes normalized. No antiseizure medication was started, and outpatient labs remained stable on alternative acid suppression. This case suggests that hypomagnesemia associated with a P-CAB, similar to proton pump inhibitor–associated cases, can be a reversible cause of seizure-related ED presentations. Supported by prior case reports and the absence of other culprit drugs or non-drug losses, it underscores early magnesium testing, prompt magnesium and calcium repletion, and medication review with withdrawal of the suspected agent and follow-up monitoring.

一位无癫痫发作史的老年妇女在意识丧失后被送到急诊科（ED），并伴有持续的精神状态改变。初步检查显示重度低镁血症（0.6 mg/dL），伴有低离子钙；乳酸迅速下降。尿中镁含量低，部分镁排泄量(FEMg)≤2.8%。她长期服用vonoprazan，一种钾竞争性酸阻滞剂（P-CAB）。动脉自旋标记（ASL）灌注MRI显示右半球过度灌注，而常规序列仅显示慢性小脑梗死。这些发现导致了疑似阳性状态的住院。入院时停用Vonoprazan，补充镁和钙。住院期间，患者病情稳定好转，一周内恢复到基线水平。住院初期脑电图显示弥漫性低幅度减慢，无明确的癫痫样放电；到了第五天，背景更有条理了。第8天，单光子发射计算机断层扫描（SPECT）显示先前高灌注区灌注减少。QTc峰值为603 ms，随着电解质归一化而缩短。没有抗癫痫药物开始，门诊实验室保持稳定的替代酸抑制。本病例提示，与P-CAB相关的低镁血症，类似于质子泵抑制剂相关的病例，可能是癫痫相关ED表现的可逆原因。在既往病例报告的支持下，没有其他元凶药物或非药物损失，它强调早期镁检测，及时补充镁和钙，以及停药后的药物审查和随访监测。

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引用次数: 0

Emergency medicine updates: Pediatric brief resolved unexplained event 急诊医学更新：儿科简短解决不明原因事件

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-03 DOI: 10.1016/j.ajem.2025.12.036

Brit Long MD , Anna M. DePompolo MD , Michael Gottlieb MD

Introduction

Brief resolved unexplained events (BRUEs) can occur in a large number of pediatric patients, with most having a benign etiology. However, in many cases, these can result in unnecessary evaluations and admissions among low-risk patients. Therefore, it is critical for clinicians to be aware of the current evidence regarding BRUE in the emergency department (ED) setting.

Objective

This paper evaluates key evidence-based updates concerning pediatric BRUE for the emergency clinician.

Discussion

A BRUE is defined as a clinical entity occurring in an infant less than 1 year of age that an observer reports as sudden, brief (< 1 min), and now resolved episode with no explanation and accompanied by at least one of the following: Change in breathing, pallor or cyanosis, change in tone, or altered level of consciousness. BRUEs often cause significant distress for both caregivers and medical professionals. Having an approach to risk-stratification and engaging in shared decision-making with caregivers can help guide clinicians during these encounters. Clearly identifying what qualifies as a low-risk event can minimize unnecessary testing while ensuring that children who do not meet low-risk criteria receive an appropriately focused evaluation

Conclusion

An understanding of the current literature concerning BRUE can assist emergency clinicians and improve the care of these patients.

简要解决不明原因事件（brue）可发生在大量儿科患者中，其中大多数具有良性病因。然而，在许多情况下，这可能导致对低风险患者进行不必要的评估和入院。因此，对于临床医生来说，了解急诊部门（ED）中有关BRUE的现有证据是至关重要的。目的评价急诊临床医生对儿科BRUE的关键循证更新。布鲁被定义为一种临床症状，发生在1岁以下的婴儿身上，观察者报告为突然、短暂（1分钟），现在已经消退，没有任何解释，并伴有以下至少一种：呼吸改变、苍白或发绀、音调改变或意识水平改变。布鲁斯通常会给护理人员和医疗专业人员带来巨大的痛苦。采用风险分层方法并与护理人员共同决策可以帮助指导临床医生在这些遭遇中。明确确定什么是低风险事件可以最大限度地减少不必要的检测，同时确保不符合低风险标准的儿童得到适当的重点评估。结论：了解目前关于BRUE的文献可以帮助急诊临床医生改善对这些患者的护理。

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引用次数: 0

Deployment of automated external defibrillators by a supermarket chain 连锁超市部署自动体外除颤器

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-03 DOI: 10.1016/j.ajem.2025.12.033

Kenneth A. Scheppke MD , Paul E. Pepe MD, MPH , Remle P. Crowe PhD, NREMT , Junwei Jiang MPH , Eric K. Scheppke DO , Steve A. McCoy MS

Objective

Automated external defibrillator (AED) installation has become commonplace in various public locations. However, AED retrievals involving actual shocks may still be very infrequent in many settings despite significant initial/ongoing costs for equipment acquisition, pad/battery expiry replacements and initial/refresher training for designated rescuers. The purpose here was to track frequencies of AED/CPR applications and shocks delivered following AED installations and related employee training throughout a multi-state retail store chain.

Design

Prospective 92-month observational study conducted across a large retail chain to document frequencies of AED device retrievals/applications, CPR performance, shocks delivered, and respective patient and scene characteristics.

Setting

1358 retail stores and two-dozen warehouses/offices located in multiple states.

Subjects

Persons collapsing with possible cardiopulmonary arrest on corporate properties.

Interventions

AED installation and on-going training of employees in CPR/AED use.

Results

Among 396 reported AED retrievals/applications (>4/month), 75 % occurred inside stores and the remainder in parking lots/sidewalks/other venues. Among these, 294 persons (ages 1–93 years; 74 % men) received basic CPR and/or AED shocks (>3 cases/month), performed most often by store employees. CPR-patient median age was 60 years (IQR:45–70) for men and 58 (IQR:38–68) for women. AEDs delivered 157 shocks during 112 events (>1 case/month); 71 % involved one shock, 20 % two, 9 % three and one involved four shocks. Documented ages for shocked patients (80 % men) ranged 32–90 years with men's median age 62 (IQR:55–70) and women's 61 (IQR:55–65). In one state's retrospective sub-analysis of shockable cases, hospital outcome records were matched to 37 patients with the majority (at least 19 confirmed) surviving to successful hospital discharge.

Conclusions

For this multi-state retail chain, AED installation and employee CPR/AED training appeared to be well-justified considering that AEDs were retrieved/applied frequently systemwide, quite often involving defibrillatory shocks that were associated with survival for many patients. Investigators encourage comparable businesses to adopt/study similar employee-based programs nationwide.

目的自动体外除颤器（AED）的安装在各种公共场所已经变得司空见惯。然而，在许多情况下，尽管购买设备、更换衬垫/电池以及对指定救援人员进行初始/更新培训的初始/持续成本很高，但涉及实际冲击的AED回收可能仍然很少。本研究的目的是跟踪在多州零售连锁店安装AED和相关员工培训后，AED/CPR应用和电击的频率。设计在一家大型零售连锁店进行了为期92个月的前瞻性观察研究，以记录AED设备检索/应用的频率、心肺复苏的表现、电击的传递以及各自的患者和现场特征。1358家零售店和24个仓库/办公室分布在多个州。实验对象有人晕倒，可能心肺骤停在公司大楼。对员工进行CPR/AED使用的持续培训。结果在396例报告的AED检索/应用（每月4例）中，75%发生在商店内，其余发生在停车场/人行道/其他场所。其中294人（年龄1-93岁，74%男性）接受了基本CPR和/或AED电击（>；3例/月），通常由商店员工执行。男性患者中位年龄为60岁（IQR: 45-70），女性患者中位年龄为58岁（IQR: 38-68）。aed在112次事件中提供157次电击（>；1例/月）；71%是一次电击，20%是两次，9%是三次，还有一个是四次电击。休克患者（80%为男性）的记录年龄为32-90岁，男性中位年龄为62岁（IQR: 55-70），女性为61岁（IQR: 55-65）。在一个州对休克病例的回顾性亚分析中，医院结果记录与37例患者相匹配，其中大多数（至少19例确诊）存活至成功出院。考虑到AED在全系统范围内被频繁使用，而且常常涉及与许多患者生存相关的除颤器电击，对于这家多州零售连锁店来说，安装AED和员工CPR/AED培训似乎是合理的。调查人员鼓励类似的企业在全国范围内采用/研究类似的基于员工的计划。

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引用次数: 0