American Journal of Emergency Medicine最新文献

{"title":"Protocolized trauma team activations improve trauma patient outcomes and decrease decision-making intervals","authors":"Yau-Ren Chang ,&nbsp;Hu-Lin Christina Wang ,&nbsp;Chien Wu ,&nbsp;Po-Cheng Chen ,&nbsp;Keng-Li Lin ,&nbsp;Chih-Yuan Fu ,&nbsp;Heng-Fu Lin","doi":"10.1016/j.ajem.2026.01.011","DOIUrl":"10.1016/j.ajem.2026.01.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma team activation (TTA) is widely recognized to improve outcomes in trauma care; however, few studies have examined its long-term maturation and the effects of protocolized implementation. This study aimed to evaluate the impact of a comprehensive trauma team protocol introduced in 2012 in a single institution and to identify factors associated with patient outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of trauma patients who underwent TTA between 2006 and 2023 at a single medical center in Taiwan. The generalized protocol was implemented in 2012 for trauma patients who fulfilled the TTA criteria. Patients &lt;18 years old, who were dead or had unknown vital signs on arrival at the emergency department (ED) or had been transferred from other institutions were excluded. The primary outcomes were the patient clinical outcomes; the time intervals to critical decision-making points after TTA were evaluated as secondary outcomes. Logistic regression was performed to identify independent risk factors.</div></div><div><h3>Results</h3><div>The study included 3002 patients. Compared with patients in the pre-protocolized stage (<em>n</em> = 518), patients in the protocolized stage (<em>n</em> = 2484) had a higher survival rate (90.5% vs. 79.7%, <em>p</em> &lt; 0.001), lower morbidity (0.8% vs. 10.6%, p &lt; 0.001), a higher success rate of nonoperative management (NOM) (39.0% vs. 27.2%, p &lt; 0.001), and shorter ED-to-computed tomography (CT) times (39.0 vs. 52.6 min, <em>p</em> = 0.001). Multivariate analysis identified age, Trauma Score and Injury Severity Score (TRISS), Glasgow Coma Scale (GCS) score, and treatment stage as independent predictors of survival. In addition, timely ED-to-CT (≤60 min) was more frequent in the protocolized stage.</div></div><div><h3>Conclusion</h3><div>Implementing a protocolized TTA system is feasible and can enhance the quality of trauma care, both in processes and outcomes. The treatment stage itself, independent of patient condition, serves as a determinant of clinical results. Tertiary trauma centers should consider adopting a standardized TTA protocol to improve patient outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963138","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}

{"title":"Achieved blood pressure during the first 12 h and clinical outcomes in patients with out-of-hospital cardiac arrest","authors":"Chen-Hsi Chang M.D. ,&nbsp;Shih-Neng Lin M.D. ,&nbsp;Hao-Wei Lee M.D. ,&nbsp;Ming-Jen Kuo M.D. ,&nbsp;Pai-Feng Hsu M.D., Ph.D. ,&nbsp;I-Hsin Lee M.D. ,&nbsp;Teh-Fu Hsu M.D. ,&nbsp;Chorng-Kuang How M.D. ,&nbsp;Yenn-Jiang Lin M.D., Ph.D. ,&nbsp;Chin-Chou Huang M.D., Ph.D.","doi":"10.1016/j.ajem.2026.01.009","DOIUrl":"10.1016/j.ajem.2026.01.009","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt; 80 mmHg, 80 ≤ MAP &lt;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 &lt; 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, <em>P</em> = 0.013) and worse neurological outcomes (HR = 1.560, 95% CI = 1.060–2.300, <em>P</em> = 0.023).</div></div><div><h3>Conclusion</h3><div>MAP &lt;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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 13-20"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963139","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}

{"title":"Test results and follow-up care stemming from an ED-based cervical cancer intervention","authors":"Beau Abar,&nbsp;Nancy Wood,&nbsp;Joely Merriman,&nbsp;David Adler","doi":"10.1016/j.ajem.2026.01.031","DOIUrl":"10.1016/j.ajem.2026.01.031","url":null,"abstract":"<div><h3>Background</h3><div>More than 4300 lives are lost to cervical cancer in the US annually. The survival rate is nearly 100% when precancerous lesions are identified and acted upon appropriately. A randomized controlled trial of two Emergency Department-based (ED) cervical cancer screening interventions demonstrated that patients in each condition received screening at rates far above an untreated historical control group. While screening represents a necessary first step in preventing cervical cancer morbidity and mortality, a lack of data on subsequent clinical care limits appreciation of ED-based screening efforts.</div></div><div><h3>Objective</h3><div>The current study describes test results and subsequent care observed among patients who received documented cervical cancer screening following an ED-based intervention.</div></div><div><h3>Methods</h3><div>Information on HPV infections, Pap test results, and cervical cancer diagnoses documented in the electronic health record were collected from women ages 21–65 who were (a) enrolled into the above-mentioned trial and (b) received cervical cancer screening over the 365-days post enrollment.</div></div><div><h3>Results</h3><div>181 women received screening. Of those who had a Pap test, 12% had abnormal findings. Compared to a national rate of 3.8%, significantly elevated risk was observed (Z = 5.55, <em>p</em> &lt; 0.001). High-risk HPV infection was observed in 15% among those tested, elevated from an estimated nationwide prevalence of 11% (<em>Z</em> = 1.63, <em>p</em> = 0.052). Notably, nearly half of patients who went on to have colposcopy and cervical biopsy did not have a routine women's health provider.</div></div><div><h3>Conclusion</h3><div>ED-based cervical cancer screening interventions have meaningful positive impact on subsequent testing and care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 78-80"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038938","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}

{"title":"Artificial intelligence in emergency medicine: a narrative review","authors":"Angelica Rego ,&nbsp;Juan Pablo Arango-Ibanez ,&nbsp;R. Andrew Taylor ,&nbsp;Moira E. Smith ,&nbsp;Derick D. Jones ,&nbsp;Jessica Pelletier ,&nbsp;James E. Colletti ,&nbsp;Michael Gottlieb ,&nbsp;Brit Long","doi":"10.1016/j.ajem.2026.01.028","DOIUrl":"10.1016/j.ajem.2026.01.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence (AI) is increasingly embedded in healthcare, with expanding applications in emergency medicine (EM).</div></div><div><h3>Objective</h3><div>This focused narrative review provides an overview of key applications, limitations, and future directions of AI that are most relevant for emergency clinicians.</div></div><div><h3>Discussion</h3><div>AI refers broadly to computational systems capable of performing tasks that typically require human intelligence, including pattern recognition, prediction, and language understanding. Within EM, AI is being deployed across the care continuum. Prehospital uses include triage, dispatch, patient assessment, protocol adherence, and decision support. There are several uses of AI in radiology, including diagnosis as well as improving efficiency, safety, and education. AI can be used to assist with point-of-care ultrasound, including imaging indication, acquisition, interpretation, and medical decision-making. AI may be used to improve emergency department patient registration, redirection, triage, waiting time, and data entry, as well as diagnostic support. Use of AI in pediatric EM may improve triage, clinical decision-making and diagnostic support, documentation, prognostication, and managing patient disposition and bed availability. AI implications in trauma include improved triage, decision-making, management, and prognostication. Prognosis and predictive analysis uses include prognostic modeling, operational, and system-level prediction, optimizing triage, and data integrity and synthesis. AI shows promise for enhancing clinical education, particularly in helping to individualize the learning process. Potential limitations include data quality and bias, reporting standards, interpretability and transparency, external validation and generalizability, clinical workflow integration, and human factors.</div></div><div><h3>Conclusions</h3><div>AI demonstrates promise across multiple domains for enhancing the practice of EM. Clinicians should understand its potential uses and limitations.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 155-165"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079835","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}

{"title":"Early inotropic support in pediatric shock: evidence and challenges in prehospital setting and interfacility transport","authors":"Laura Cannavò ,&nbsp;Leonardo Capitanio ,&nbsp;Virginia Beretta ,&nbsp;Vincenzo Raitano ,&nbsp;Serafina Perrone","doi":"10.1016/j.ajem.2026.01.035","DOIUrl":"10.1016/j.ajem.2026.01.035","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Pediatric shock requires rapid recognition and timely intervention. In the prehospital and interfacility transport setting, the challenge is further compounded by limited vascular access, limited monitoring capabilities, and the need for rapid decision-making in dynamic, resource-constrained environments. The aim of this review is to summarize the available literature on the use of vasoactive agents in pediatric shock, provide guidance for evidence-based decision-making, and identify key gaps for future research.</div></div><div><h3>Methods</h3><div>A literature search was conducted using electronic databases, including PubMed and Medline. Only articles published in peer-reviewed journals, written in English, and focusing on the use of vasoactive drugs in the pediatric population were selected, bringing the total number of articles selected to 63, of which 21 were original studies (randomized or observational). Two independent reviewers extracted the data, which were then organized thematically in a narrative synthesis given study heterogeneity.</div></div><div><h3>Results</h3><div>This review provides a comprehensive summary of the current evidence regarding vasoactive support in pediatric shock in the prehospital and transport setting. Although fluid administration is the first therapeutic step, there is a growing trend towards early initiation of inotropic/vasoactive agents. Overall, epinephrine and norepinephrine remain the agents of choice for fluid-refractory pediatric shock. Inodilators may offer potential benefit in selected patients with myocardial dysfunction. Evidence regarding adjunctive therapies, such as vasopressin, terlipressin, and catecholamine-sparing agents, remains limited. Available evidence supports the feasibility and safety of timely vasoactive support via peripheral and intraosseous routes with dilute preparations of vasoactive agents.</div></div><div><h3>Conclusions</h3><div>In the context of prehospital and transport settings, central venous catheterization is no longer a prerequisite, and early initiation of inotropic/vasoactive therapy, which is increasingly suggested by literature in different clinical scenarios, may improve outcomes in critically ill children.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 180-189"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079845","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}

{"title":"The impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury","authors":"Salih Karakoyun ,&nbsp;Kudret Selki ,&nbsp;Ali Rıza Karakoyun ,&nbsp;Mustafa Boğan","doi":"10.1016/j.ajem.2026.01.005","DOIUrl":"10.1016/j.ajem.2026.01.005","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (<em>n</em> = 39) on CCT. Lower GCS (≤14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all <em>p</em> &lt; 0.05). Temporal (OR: 16.35; 95% CI: 3.57–74.76; <em>p</em> &lt; 0.001), parietal (OR: 10.38; p &lt; 0.001), occipital (OR: 6.20; <em>p</em> = 0.008), and frontal (OR: 4.99; p &lt; 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p &lt; 0.001) and lower GCS (OR: 0.67; <em>p</em> = 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 <em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 21-26"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982059","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}

{"title":"Lidocaine for diphenhydramine-induced ventricular tachycardia: A case report","authors":"Seth Carroll,&nbsp;Mallory McGee,&nbsp;Megan Audette,&nbsp;Merritt Tuttle,&nbsp;Justin Corcoran,&nbsp;Matthew Stanton,&nbsp;Ryan Feldman","doi":"10.1016/j.ajem.2026.01.040","DOIUrl":"10.1016/j.ajem.2026.01.040","url":null,"abstract":"<div><div>Diphenhydramine overdose can cause life-threatening ventricular dysrhythmias through sodium channel blockade, similar to tricyclic antidepressant (TCA) toxicity. Current management guidelines recommend sodium bicarbonate as first-line therapy, with class Ib antiarrhythmics such as lidocaine considered in refractory cases, though this recommendation is largely extrapolated from TCA data. Clinical reports describing lidocaine use in diphenhydramine toxicity remain exceedingly rare. We report a case where a 16-year-old female who ingested approximately 315 tablets of diphenhydramine and developed pulseless ventricular tachycardia during emergency department resuscitation. Return of spontaneous circulation was achieved after sodium bicarbonate, amiodarone and defibrillation, but recurrent wide-complex tachycardia occurred shortly thereafter. She was treated with a lidocaine bolus and continuous infusion, resulting in progressive QRS narrowing and rhythm stabilization. Diphenhydramine exposure was confirmed with toxicology testing. The lidocaine infusion was weaned, and patient was discharged home without further dysrhythmias. Experimental data demonstrates that diphenhydramine binds preferentially to open sodium channels and dissociates slowly, suggesting a mechanistic basis for lidocaine's therapeutic effect. This case provides additional clinical evidence supporting the use of lidocaine as an adjunct for refractory ventricular dysrhythmias in diphenhydramine induced sodium channel blockade and highlights the important of early recognition and consultation with a poison center in severe antihistamine toxicity.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 131-134"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079846","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}

{"title":"Point-of-care ultrasound for hip effusion in children: A systematic review and meta-analysis","authors":"Cynthia A. Gravel MD, RDMS ,&nbsp;Jeffrey T. Neal MD ,&nbsp;Joshua Dodderer MD, MPH ,&nbsp;Wendy Kim MD ,&nbsp;Paul A. Bain PhD, MLIS ,&nbsp;Sonal N. Shah MD, MPH","doi":"10.1016/j.ajem.2026.01.034","DOIUrl":"10.1016/j.ajem.2026.01.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Children with hip pain, limp and inability to bear weight often present a diagnostic clinical challenge. Sonography is an ideal first-line imaging modality to assess for effusion, and recent literature suggests that point-of-care ultrasound (POCUS) performed by emergency providers can be safely and accurately performed at the bedside. This systematic review and meta-analysis aims to summarize the diagnostic accuracy of POCUS for pediatric hip effusion.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central databases were searched through July 2025, with no date limits, using pre-defined criteria for articles assessing the diagnostic accuracy of POCUS for pediatric hip effusion. Data were extracted and quality assessment was performed using the QUADAS-2 tool. Test characteristics were pooled using a bivariate mixed effects model for meta-analysis.</div></div><div><h3>Results</h3><div>Four studies, with a total of 526 hips scanned, met our inclusion criteria. The reference standard for all included studies was radiology-performed ultrasonography. POCUS demonstrated a pooled sensitivity of 88% (95% CI, 82%–92%), specificity of 97% (95% CI, 93%–99%), positive likelihood ratio of 35 (95% CI, 12.0–100.8), and negative likelihood ratio of 0.13 (0.08–0.19).</div></div><div><h3>Conclusions</h3><div>POCUS has high specificity and moderate sensitivity for hip effusion in children and is a valuable first-line diagnostic tool for evaluating children with hip pain, limp and inability to bear weight in emergency and acute care settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 148-154"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079869","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}

{"title":"Prospective evaluation of flexible bronchoscopy in the emergency department: Indications, findings, and complications. A cohort study","authors":"Lorenzo Pelagatti ,&nbsp;Simone Vanni ,&nbsp;Lorenzo Corbetta ,&nbsp;Peiman Nazerian","doi":"10.1016/j.ajem.2026.01.036","DOIUrl":"10.1016/j.ajem.2026.01.036","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%.</div><div>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.</div></div><div><h3>Conclusion</h3><div>Flexible bronchoscopy performed by trained emergency physicians appears safe and feasible.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 190-197"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079958","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}

{"title":"A CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study","authors":"Tingting Zhao MD ,&nbsp;Dong Li PhD ,&nbsp;Mengshan Wu MD ,&nbsp;Chenyuan Zhang MD ,&nbsp;Xiaoyuan Qu MD ,&nbsp;Xin Tian MD ,&nbsp;Yixi Zhang MD ,&nbsp;Chunlin Song MD ,&nbsp;Xiaoran Wang PhD ,&nbsp;Xianghong Meng PhD ,&nbsp;Zhi Wang MD","doi":"10.1016/j.ajem.2025.12.038","DOIUrl":"10.1016/j.ajem.2025.12.038","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 71-77"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038940","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}