American Journal of Emergency Medicine最新文献_第4页

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。

{"title":"Clinical differences between metformin-associated lactic acidosis and metformin-unrelated lactic acidosis: A descriptive study","authors":"Yuji Okazaki MD , Fumiya Inoue MD , Toshihisa Ichiba MD , Akira Namera PhD","doi":"10.1016/j.ajem.2026.01.027","DOIUrl":"10.1016/j.ajem.2026.01.027","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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]).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"103 ","pages":"Pages 9-13"},"PeriodicalIF":2.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081746","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

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。

{"title":"Diagnostic and prognostic value of the risk factor-weighted clinical likelihood model in acute chest pain and negative troponin","authors":"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","doi":"10.1016/j.ajem.2026.01.033","DOIUrl":"10.1016/j.ajem.2026.01.033","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>Retrospective, single-center study including 3097 patients without prior CAD evaluated in a dedicated chest pain unit in Spain (2011−2021).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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%).</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 141-147"},"PeriodicalIF":2.2,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079836","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

TOC TOC

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

Using artificial intelligence for automated assessment of point-of-care ultrasound (POCUS) skills in emergency medicine. 在急诊医学中使用人工智能自动评估护理点超声（POCUS）技能。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.ajem.2026.01.039

Nicole M Duggan, Roger D Dias, Rayan Harari, Paulo Borges, Robson J Verly, Madeline Schwid, Chanel E Fischetti, Lao-Tzu Allan-Blitz, Daniel Heron, Calvin K Huang, Andrew J Goldsmith

Background: This study aimed to demonstrate the feasibility of using computer vision (CV) to unobtrusively extract body motion metrics from videos of emergency medicine (EM) clinicians, and gather validity evidence of these metrics to differentiate POCUS skills between novice and experts, as well as to capture skills gained over time.

Methods: Prospective cohort study including novice and expert EM clinicians performing echocardiogram (ECHO) and focused assessment with sonography for trauma (FAST) exams on a live simulated patient. Expert observers provided objective structured clinical examination (OSCE) scores (numerical ratings on a scale from 1 to 100), and sonographers' hands and head motion metrics (path length, speed, acceleration, jerk, and smoothness) were extracted via CV using 2-dimensional videos. Data points were captured at baseline, and for novices at baseline and after 12-15 months of residency training.

Results: CV achieved high detection rates (99.52% ECHO, 98.70% FAST). At baseline, experts demonstrated superior OSCE scores (ECHO: 98.6 ± 2.1 vs 63.4 ± 17.0; FAST: 99.2 ± 1.5 vs 68.9 ± 17.7, p < 0.001) and faster task completion (101.8 ± 44.7 vs 240.3 ± 84.1 s, p < 0.001). Experts exhibited smoother hand movements (left hand smoothness: -129.3 ± 47.6 vs -241.3 ± 64.6, p < 0.001) and reduced total path lengths. After 12-15 months of training, novices showed significant improvements in OSCE scores (ECHO: 85.3 ± 10.3; FAST: 84.8 ± 6.5) and task efficiency (134.0 ± 35.6 s), with improvements in motion smoothness and reduced path lengths (p < 0.001). Motion metrics strongly correlated with OSCE scores (r = 0.455-0.783) and task completion time (r = 0.491-0.951).

Conclusions: CV successfully extracted objective motion metrics that differentiated POCUS skill levels between novices and experts and captured skill development over time. This approach offers a scalable, unobtrusive method for objective POCUS assessment, while supporting competency-based medical education frameworks.

背景：本研究旨在证明使用计算机视觉（CV）从急诊医学（EM）临床医生的视频中不引人注目地提取身体运动指标的可行性，并收集这些指标的有效性证据，以区分新手和专家的POCUS技能，并捕获随时间推移获得的技能。方法：前瞻性队列研究，包括新手和专家EM临床医生对模拟患者进行超声心动图（ECHO）和创伤超声检查（FAST）集中评估。专家观察员提供客观的结构化临床检查（OSCE）评分（从1到100的数值评分），超声医师的手和头的运动指标（路径长度、速度、加速度、震动和平稳性）通过使用二维视频通过CV提取。数据点在基线、基线和12-15个月住院医师培训后被捕获。结果：CV检出率高，ECHO为99.52%，FAST为98.70%。在基线时，专家表现出卓越的OSCE得分（ECHO: 98.6±2.1 vs 63.4±17.0;FAST: 99.2±1.5 vs 68.9±17.7,p）。结论：CV成功提取了区分新手和专家之间POCUS技能水平的客观运动指标，并捕获了随时间的技能发展。这种方法为客观POCUS评估提供了一种可扩展的、不显眼的方法，同时支持基于能力的医学教育框架。

{"title":"Using artificial intelligence for automated assessment of point-of-care ultrasound (POCUS) skills in emergency medicine.","authors":"Nicole M Duggan, Roger D Dias, Rayan Harari, Paulo Borges, Robson J Verly, Madeline Schwid, Chanel E Fischetti, Lao-Tzu Allan-Blitz, Daniel Heron, Calvin K Huang, Andrew J Goldsmith","doi":"10.1016/j.ajem.2026.01.039","DOIUrl":"https://doi.org/10.1016/j.ajem.2026.01.039","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to demonstrate the feasibility of using computer vision (CV) to unobtrusively extract body motion metrics from videos of emergency medicine (EM) clinicians, and gather validity evidence of these metrics to differentiate POCUS skills between novice and experts, as well as to capture skills gained over time.</p><p><strong>Methods: </strong>Prospective cohort study including novice and expert EM clinicians performing echocardiogram (ECHO) and focused assessment with sonography for trauma (FAST) exams on a live simulated patient. Expert observers provided objective structured clinical examination (OSCE) scores (numerical ratings on a scale from 1 to 100), and sonographers' hands and head motion metrics (path length, speed, acceleration, jerk, and smoothness) were extracted via CV using 2-dimensional videos. Data points were captured at baseline, and for novices at baseline and after 12-15 months of residency training.</p><p><strong>Results: </strong>CV achieved high detection rates (99.52% ECHO, 98.70% FAST). At baseline, experts demonstrated superior OSCE scores (ECHO: 98.6 ± 2.1 vs 63.4 ± 17.0; FAST: 99.2 ± 1.5 vs 68.9 ± 17.7, p < 0.001) and faster task completion (101.8 ± 44.7 vs 240.3 ± 84.1 s, p < 0.001). Experts exhibited smoother hand movements (left hand smoothness: -129.3 ± 47.6 vs -241.3 ± 64.6, p < 0.001) and reduced total path lengths. After 12-15 months of training, novices showed significant improvements in OSCE scores (ECHO: 85.3 ± 10.3; FAST: 84.8 ± 6.5) and task efficiency (134.0 ± 35.6 s), with improvements in motion smoothness and reduced path lengths (p < 0.001). Motion metrics strongly correlated with OSCE scores (r = 0.455-0.783) and task completion time (r = 0.491-0.951).</p><p><strong>Conclusions: </strong>CV successfully extracted objective motion metrics that differentiated POCUS skill levels between novices and experts and captured skill development over time. This approach offers a scalable, unobtrusive method for objective POCUS assessment, while supporting competency-based medical education frameworks.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"103 ","pages":"57-64"},"PeriodicalIF":2.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138184","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

Early inotropic support in pediatric shock: evidence and challenges in prehospital setting and interfacility transport 儿童休克的早期肌力支持：院前环境和设施间运输的证据和挑战

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.ajem.2026.01.035

Laura Cannavò , Leonardo Capitanio , Virginia Beretta , Vincenzo Raitano , Serafina Perrone

Background & aim

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.

Methods

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.

Results

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.

Conclusions

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.

背景：小儿休克需要快速识别和及时干预。在院前和设施间运输环境中，由于血管通道有限、监测能力有限以及在动态、资源受限的环境中需要快速决策，这一挑战进一步复杂化。本综述的目的是总结关于血管活性药物在儿童休克中的应用的现有文献，为循证决策提供指导，并确定未来研究的关键空白。方法利用PubMed、Medline等电子数据库进行文献检索。只选择发表在同行评议期刊上的、以英文撰写的、专注于儿科人群血管活性药物使用的文章，使选择的文章总数达到63篇，其中21篇是原始研究（随机或观察性）。两名独立的审稿人提取了数据，然后在考虑研究异质性的情况下，以叙事综合的方式按主题组织数据。结果：本综述对目前关于院前和运输环境下儿童休克血管活性支持的证据进行了全面总结。虽然液体给药是治疗的第一步，但有越来越多的趋势倾向于早期开始使用肌力/血管活性药物。总的来说，肾上腺素和去甲肾上腺素仍然是治疗小儿液体难治性休克的首选药物。抗扩张剂可能对心肌功能障碍患者有潜在的益处。关于辅助治疗的证据，如抗利尿激素、特利加压素和儿茶酚胺保留剂，仍然有限。现有证据支持通过外周和骨内途径使用稀释血管活性药物及时提供血管活性支持的可行性和安全性。结论在院前和转运环境下，中心静脉置管不再是先决条件，早期开始肌力/血管活性治疗可能改善危重患儿的预后，不同临床情况下的文献越来越多地建议尽早开始肌力/血管活性治疗。

{"title":"Early inotropic support in pediatric shock: evidence and challenges in prehospital setting and interfacility transport","authors":"Laura Cannavò , Leonardo Capitanio , Virginia Beretta , Vincenzo Raitano , Serafina Perrone","doi":"10.1016/j.ajem.2026.01.035","DOIUrl":"10.1016/j.ajem.2026.01.035","url":null,"abstract":"<div><h3>Background & 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":"2026-01-21","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}

引用次数: 0

Lidocaine for diphenhydramine-induced ventricular tachycardia: A case report 利多卡因治疗苯海拉明致室性心动过速1例

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.ajem.2026.01.040

Seth Carroll, Mallory McGee, Megan Audette, Merritt Tuttle, Justin Corcoran, Matthew Stanton, Ryan Feldman

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.

苯海拉明过量可通过钠通道阻断引起危及生命的室性心律失常，类似于三环抗抑郁药（TCA）的毒性。目前的管理指南建议将碳酸氢钠作为一线治疗，在难治性病例中考虑使用Ib类抗心律失常药物，如利多卡因，尽管这一建议主要是根据TCA数据推断出来的。描述利多卡因用于苯海拉明毒性的临床报告仍然非常罕见。我们报告了一个16岁的女性谁摄入了大约315片苯海拉明和发展无脉性室性心动过速急诊科复苏。碳酸氢钠、胺碘酮和除颤后可恢复自发循环，但此后不久复发性宽复性心动过速。她接受利多卡因丸和持续输注治疗，导致QRS进行性变窄和节律稳定。毒理学试验证实接触苯海拉明。停用利多卡因，患者出院，无心律失常。实验数据表明苯海拉明优先结合开放的钠通道并缓慢解离，提示利多卡因治疗效果的机制基础。本病例提供了额外的临床证据，支持使用利多卡因辅助治疗苯海拉明引起的钠通道阻断引起的难治性室性心律失常，并强调了在严重抗组胺毒性中早期识别和咨询中毒中心的重要性。

{"title":"Lidocaine for diphenhydramine-induced ventricular tachycardia: A case report","authors":"Seth Carroll, Mallory McGee, Megan Audette, Merritt Tuttle, Justin Corcoran, Matthew Stanton, 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":"2026-01-21","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}

引用次数: 0

Point-of-care ultrasound for hip effusion in children: A systematic review and meta-analysis 儿童髋关节积液的即时超声诊断：系统回顾和荟萃分析

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.ajem.2026.01.034

Cynthia A. Gravel MD, RDMS , Jeffrey T. Neal MD , Joshua Dodderer MD, MPH , Wendy Kim MD , Paul A. Bain PhD, MLIS , Sonal N. Shah MD, MPH

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

患有髋部疼痛、跛行和不能负重的儿童通常是诊断的临床挑战。超声检查是评估积液的理想一线成像方式，最近的文献表明，急诊人员进行的即时超声（POCUS）可以在床边安全准确地进行。本系统综述和荟萃分析旨在总结POCUS对儿童髋关节积液的诊断准确性。方法检索medline、Embase、Web of Science、CINAHL和Cochrane Central数据库至2025年7月，没有日期限制，使用预先定义的标准来评估POCUS对儿童髋关节积液的诊断准确性。使用QUADAS-2工具提取数据并进行质量评估。采用双变量混合效应模型进行meta分析。结果4项研究共扫描了526个髋关节，符合我们的纳入标准。所有纳入研究的参考标准均为影像学超声检查。POCUS的总敏感性为88% (95% CI, 82%-92%)，特异性为97% (95% CI, 93%-99%)，阳性似然比为35 (95% CI, 12.0-100.8)，阴性似然比为0.13（0.08-0.19）。结论spocus对儿童髋关节积液具有高特异性和中等敏感性，是一种有价值的一线诊断工具，可用于评估儿童髋关节疼痛、跛行和不能负重的急诊和急性护理环境。

{"title":"Point-of-care ultrasound for hip effusion in children: A systematic review and meta-analysis","authors":"Cynthia A. Gravel MD, RDMS , Jeffrey T. Neal MD , Joshua Dodderer MD, MPH , Wendy Kim MD , Paul A. Bain PhD, MLIS , 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":"2026-01-21","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}

引用次数: 0

Info for authors 作者信息

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)00810-1

引用次数: 0

Artificial intelligence in emergency medicine: a narrative review 急诊医学中的人工智能：述评

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.ajem.2026.01.028

Angelica Rego , Juan Pablo Arango-Ibanez , R. Andrew Taylor , Moira E. Smith , Derick D. Jones , Jessica Pelletier , James E. Colletti , Michael Gottlieb , Brit Long

Introduction

Artificial intelligence (AI) is increasingly embedded in healthcare, with expanding applications in emergency medicine (EM).

Objective

This focused narrative review provides an overview of key applications, limitations, and future directions of AI that are most relevant for emergency clinicians.

Discussion

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.

Conclusions

AI demonstrates promise across multiple domains for enhancing the practice of EM. Clinicians should understand its potential uses and limitations.

人工智能（AI）越来越多地嵌入到医疗保健中，在急诊医学（EM）中的应用也在不断扩大。本综述综述了与急诊临床医生最相关的人工智能的关键应用、局限性和未来发展方向。人工智能泛指能够执行通常需要人类智能的任务的计算系统，包括模式识别、预测和语言理解。在EM中，人工智能正在整个护理连续体中部署。院前用途包括分诊、调度、病人评估、协议遵守和决策支持。人工智能在放射学中有多种用途，包括诊断、提高效率、安全性和教育。人工智能可用于辅助护理点超声，包括成像指示、采集、解释和医疗决策。人工智能可用于改善急诊科的患者登记、重定向、分诊、等待时间和数据输入，以及诊断支持。在儿科EM中使用人工智能可以改善分诊、临床决策和诊断支持、记录、预测以及管理患者处置和床位可用性。人工智能对创伤的影响包括改进分诊、决策、管理和预测。预测和预测分析的用途包括预测建模、操作和系统级预测、优化分类、数据完整性和综合。人工智能有望加强临床教育，特别是在帮助个性化学习过程方面。潜在的限制包括数据质量和偏差、报告标准、可解释性和透明度、外部验证和推广、临床工作流程集成以及人为因素。结论ai在多个领域展示了增强EM实践的前景，临床医生应了解其潜在用途和局限性。

{"title":"Artificial intelligence in emergency medicine: a narrative review","authors":"Angelica Rego , Juan Pablo Arango-Ibanez , R. Andrew Taylor , Moira E. Smith , Derick D. Jones , Jessica Pelletier , James E. Colletti , Michael Gottlieb , 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":"2026-01-20","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}

引用次数: 0

A global perspective on the accuracy of pediatric weight estimation methods in emergency care: A systematic review 全球视角下儿科体重估算方法在急诊护理中的准确性：一项系统综述

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.ajem.2026.01.030

Irrintzi Fernández-Aedo PhD, RN , Sendoa Ballesteros-Peña PhD, RN , Sandra Tobar-Cabrera RN , Gorka Vallejo-De la Hoz PhD, RN , Julia Fernandez-Alonso PhD

Introduction

In pediatric emergency services, it is essential to know the patient's weight, for which there are numerous estimation tools. However, these instruments present biases in calculating the patient's weight. Therefore, the objective of this study was to evaluate the validity of pediatric weight estimation methods available worldwide, comparing their accuracy and applicability in medical practice.

Methods

A systematic review was conducted following the PRISMA recommendations (PROSPERO Registration Number CRD420251174686). Observational and validation studies with original data published from 2010 to July 2025 were included. Articles were searched for in ProQuest, Web of Science, PubMed/Medline, and Scopus. The inclusion criteria were: patients aged 0 to 18 years, weight estimation methods, and quantitative reports of accuracy.

Results

Thirty-one studies from all continents were selected. Two-dimensional methods were generally more accurate than those based solely on age or one-dimensional formulas, especially in populations with a high prevalence of overweight or obesity. Parental estimation also performed well. Heterogeneity was observed in age ranges, acceptable error and validation criteria between studies.

Conclusions

Within the limitations of the uneven global evidence base, the tools that appear most reliable for estimating pediatric weight in emergency departments are those that incorporate more than one anthropometric variable or are supported by local validation. Given the scarcity of data from various regions and specific populations, each emergency system must determine the approach that best suits its local demographic profile, invest in staff training, and apply standardized validation criteria before adopting changes in routine practice.

在儿科急诊服务中，了解患者的体重是至关重要的，为此有许多估计工具。然而，这些仪器在计算患者体重时存在偏差。因此，本研究的目的是评估世界上现有的儿童体重估计方法的有效性，比较它们在医疗实践中的准确性和适用性。方法按照PRISMA建议（PROSPERO注册号CRD420251174686）进行系统评价。纳入了2010年至2025年7月发表的原始数据的观察性和验证性研究。文章在ProQuest、Web of Science、PubMed/Medline和Scopus中搜索。纳入标准为：患者年龄0 ~ 18岁，体重估计方法，准确性定量报告。结果从各大洲选取31项研究。二维方法通常比仅基于年龄或一维公式的方法更准确，特别是在超重或肥胖高发的人群中。父母估计也表现良好。研究之间的年龄范围、可接受误差和验证标准存在异质性。结论：在全球证据基础不均衡的限制下，估计急诊科儿童体重最可靠的工具是那些包含多个人体测量变量或得到当地验证支持的工具。鉴于来自不同地区和特定人群的数据稀缺，每个应急系统必须确定最适合其当地人口概况的方法，投资于人员培训，并在采用常规做法的变化之前应用标准化的验证标准。

{"title":"A global perspective on the accuracy of pediatric weight estimation methods in emergency care: A systematic review","authors":"Irrintzi Fernández-Aedo PhD, RN , Sendoa Ballesteros-Peña PhD, RN , Sandra Tobar-Cabrera RN , Gorka Vallejo-De la Hoz PhD, RN , Julia Fernandez-Alonso PhD","doi":"10.1016/j.ajem.2026.01.030","DOIUrl":"10.1016/j.ajem.2026.01.030","url":null,"abstract":"<div><h3>Introduction</h3><div>In pediatric emergency services, it is essential to know the patient's weight, for which there are numerous estimation tools. However, these instruments present biases in calculating the patient's weight. Therefore, the objective of this study was to evaluate the validity of pediatric weight estimation methods available worldwide, comparing their accuracy and applicability in medical practice.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following the PRISMA recommendations (PROSPERO Registration Number CRD420251174686). Observational and validation studies with original data published from 2010 to July 2025 were included. Articles were searched for in ProQuest, Web of Science, PubMed/Medline, and Scopus. The inclusion criteria were: patients aged 0 to 18 years, weight estimation methods, and quantitative reports of accuracy.</div></div><div><h3>Results</h3><div>Thirty-one studies from all continents were selected. Two-dimensional methods were generally more accurate than those based solely on age or one-dimensional formulas, especially in populations with a high prevalence of overweight or obesity. Parental estimation also performed well. Heterogeneity was observed in age ranges, acceptable error and validation criteria between studies.</div></div><div><h3>Conclusions</h3><div>Within the limitations of the uneven global evidence base, the tools that appear most reliable for estimating pediatric weight in emergency departments are those that incorporate more than one anthropometric variable or are supported by local validation. Given the scarcity of data from various regions and specific populations, each emergency system must determine the approach that best suits its local demographic profile, invest in staff training, and apply standardized validation criteria before adopting changes in routine practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 81-89"},"PeriodicalIF":2.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039441","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