American Journal of Emergency Medicine最新文献

{"title":"Authors response to AJEM correspondence manuscript AJEM37729","authors":"Christopher Thom MD RDMS","doi":"10.1016/j.ajem.2025.01.034","DOIUrl":"10.1016/j.ajem.2025.01.034","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"89 ","pages":"Page 295"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257482","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":"Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury","authors":"Yu-Long Chen ,&nbsp;Tsung-Hsien Wu ,&nbsp;Chi-Yuan Liu ,&nbsp;Chien-Hsing Wang ,&nbsp;Chia-Hung Tsai ,&nbsp;Jui-Yuan Chung ,&nbsp;Giou-Teng Yiang ,&nbsp;Meng-Yu Wu","doi":"10.1016/j.ajem.2025.02.041","DOIUrl":"10.1016/j.ajem.2025.02.041","url":null,"abstract":"<div><h3>Objectives</h3><div>The shock index (SI) is widely used to screen for patients in shock, and the dSI is created by utilizing prehospital SI and emergency department SI to enhance predictive accuracy. However, few have compared dSI with prehospital SI and SI at ED, and even fewer have explored the directional changes in dSI. This study aims to evaluate the prediction accuracy of prehospital SI, SI at ED, and delta SI in trauma patients, proposing that the delta scoring systems provide a more precise tool for field triage.</div></div><div><h3>Patients and methods</h3><div>This study conducted a cohort analysis involving 48,524 patients from the trauma registry data at Tzu Chi Hospital. The three primary outcomes assessed were in-hospital mortality, intensive care unit (ICU) admission, and prolonged total length of hospital stay (≥ 30 days). The area under the receiver operating characteristic curve (AUROC) for these scores was calculated and compared using the DeLong test. The delta SI was calculated as the difference between prehospital SI and SI at the emergency department (ED). The dSI was categorized into five groups: dSI &lt; −0.5, −0.5 ≤ dSI &lt; −0.1, −0.1 ≤ dSI &lt; 0.1, 0.1 ≤ dSI &lt; 0.5, and 0.5 ≤ dSI.</div></div><div><h3>Results</h3><div>Prehospital SI, SI at ED, and dSI were significant predictors of in-hospital mortality, ICU admission, and prolonged length of stay (LOS) of ≥30 days. Compared to prehospital SI and SI at ED, dSI demonstrated significantly higher AUROC values in discriminating major injury, prolonged ICU stay, and in-hospital mortality. The groups with dSI &lt; −0.5 and dSI ≥ 0.5 exhibited a significantly higher risk of in-hospital mortality compared to other dSI group with adjusted odds ratio (aOR) of 2.170 and 2.976. A J-shaped relationship in aOR values was observed across different dSI ranges for in-hospital mortality. The dSI ≥ 0.5 group had an increased risk of in-hospital mortality among elderly patients, those with major or minor injuries, and both TBI and non-TBI groups. The dSI ≥ 0.1 demonstrated accuracies of 80.94 % for predicting ISS ≥ 16, 72.91 % for ICU admission, 87.14 % for prolonged LOS ≥ 30 days, and 89.33 % for predicting mortality.</div></div><div><h3>Conclusions</h3><div>The dSI demonstrated significantly better discriminative ability for major injury, prolonged ICU stay, and in-hospital mortality. A potential J-shaped relationship has been identified between dSI and mortality, indicating that both the dSI &lt; −0.5 and dSI ≥ 0.5 groups have a significantly higher risk of in-hospital mortality. It is anticipated that dSI will be integrated into clinical practice for the field triage of trauma patients in the future.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 10-17"},"PeriodicalIF":2.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552694","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":"Comparative analysis of accident mechanisms and injury patterns of e-moped, and e-scooter operators","authors":"Adi Brenner ,&nbsp;Dana Niry ,&nbsp;Itay Blum ,&nbsp;Genady Shendler ,&nbsp;Aviad Rabinowich ,&nbsp;Dana Stav ,&nbsp;Yuval Ran ,&nbsp;Ahuva Weiss-Meilik ,&nbsp;Omer J. Ungar","doi":"10.1016/j.ajem.2025.02.045","DOIUrl":"10.1016/j.ajem.2025.02.045","url":null,"abstract":"<div><h3>Objective</h3><div>To compare accident-related injuries and degree of risk for operators/riders of e-mopeds and e-scooters.</div></div><div><h3>Methods</h3><div>A retrospective medical charts review in a tertiary medical center was performed. All individuals aged 13 years and older who were referred to a single tertiary referral center after 2 wheels vehicle injury were enrolled. Demographics, injury type, imaging, surgeries, hospital and intensive care unit lengths of stay, mortality, helmet use and hour and day of injury were recorded and analyzed.</div></div><div><h3>Results</h3><div>A total of 2429 patients were enrolled (1095 e-moped and 1334 e-scooter operators/riders). The mean (±standard deviation) age for operators/riders was 31.5 (±11.7) years. There was a male preponderance in both groups (70.8 % and 60.3 % in the e-moped and e-scooter operators/riders, respectively). Helmet use was poor, with an overall usage rate of 39.7 % among all riders. <em>E</em>-moped operators/riders were more commonly hospitalized in the intensive care unit (1.5 %) than e-scooter operator/riders (0.6 %), <em>p</em> = 0.039. <em>E</em>-moped operators/riders had significantly fewer injuries (35.7 %) compared to e-scooter operators/riders (42.4 %), <em>p</em> &lt; 0.001. <em>E</em>-Scooters were associated with significantly more face and upper extremity injuries compared to e-moped (<em>9.0 % and 23.9 % compared to 5.8 % and 19.4 %,</em> respectively, <em>p</em> = 0.003 and 0.008, respectively). Chest and abdomen injuries were more common in the e-moped operators/riders compared to the e-scooters operators/riders (4.4 % and 1.1 % compared to 2.1 % and 0.3 %, respectively, <em>p</em> = 0.002 and 0.021, respectively).</div></div><div><h3>Conclusion</h3><div>The data in this analysis indicated that e-Scooters are involved in a higher number of accidental injuries that tend to be less severe and result in fewer fatalities than those sustained by e-moped use. In contrast, e-mopeds were linked to more complex injuries, as reflected by higher hospitalization rates, ICU admissions and multi-level injuries among e-moped operators/riders. This finding also corresponded to a higher demand for imaging studies in the emergency department (ED). Additionally, our analysis of a relatively smaller cohort of helmeted versus non-helmeted patients reinforces the critical role of helmets in mitigating head and face injuries.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 32-36"},"PeriodicalIF":2.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back-to-Back Climate shocks and the mental health crisis: A Texas-sized surge in depression and anxiety ER visits","authors":"Omolola E. Adepoju PhD ,&nbsp;Lulu Xu MS ,&nbsp;Summer Chavez DO, MPH ,&nbsp;Patrick Dang BS ,&nbsp;Mary Tipton MPH ,&nbsp;Maria Perez Arguelles PhD ,&nbsp;Gail J. Buttorff PhD ,&nbsp;Man Chiu Wong PhD","doi":"10.1016/j.ajem.2025.02.038","DOIUrl":"10.1016/j.ajem.2025.02.038","url":null,"abstract":"<div><div>Climate change is intensifying the frequency and severity of climate-related disasters, posing significant challenges to public mental health. This study explores the relationship between successive climate events and emergency department (ED) visits for depression and anxiety in the Greater Houston area from 2019 to 2023. Combining monthly data from the Texas Syndromic Surveillance System, the National Weather Service, and the Agency for Healthcare Research and Quality, we conducted a time-series analysis to assess the impact of successive weather events on ED visits for anxiety and depression. Our random forest models reveal significant associations between weather variables and mental health-related ED visits. Specifically, time series decomposition uncovered distinct seasonal patterns, with specific periods consistently showing higher demand for mental health services. Additionally, the analysis indicates that severe weather events that restrict mobility, such as hurricanes and tropical storms, initially lead to a decrease in ED visits, followed by a surge in the following months, whereas events that do not impede travel, such as heatwaves and droughts, correlate with immediate increases in visits. Feature importance analysis indicated social factors, such as the number of households and children ≤17, along with weather variables like average temperature and total precipitation, were significant predictors of ED visits for both anxiety and depression. Access to healthcare services, including proximity to healthcare clinics and treatment centers, also played a crucial role. These observed patterns underscore the significant influence of seasonal and weather-related factors on mental health and underscore the need for targeted public health interventions that consider the timing and nature of climate events, as well as strategies to enhance community resilience and strengthen mental health support systems.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 123-131"},"PeriodicalIF":2.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The utility of initial lactate for the quick sequential organ failure assessment (LqSOFA) for emergency septic patients","authors":"Saqer M. Althunayyan MBBS SBEM ,&nbsp;Ahmed Abdullah Aledeny MBBS ,&nbsp;Mohammed A. Malabarey MBBS ,&nbsp;Ali Ibrahim Alshaqaqiq MBBS ,&nbsp;Eyman Okbah Haj-Ali MBBS ,&nbsp;Mhd Walid Alhomsi MBBS ,&nbsp;Hagar Khaled Elgazar MBBS ,&nbsp;Tamim S.M. Alrefaei MBBS ,&nbsp;Saad Ali AlAsiri MBBS","doi":"10.1016/j.ajem.2025.02.042","DOIUrl":"10.1016/j.ajem.2025.02.042","url":null,"abstract":"<div><h3>Background</h3><div>The Lactate-enhanced Quick Sequential Organ Failure Assessment (LqSOFA) has been identified as a tool for predicting sepsis outcomes. We evaluated the predictive power of the LqSOFA for adult patients suspected of having sepsis in the Emergency Department (ED). It was assessed as an indicator for Intensive Care Unit (ICU) admission, the necessity for vasopressors, and mortality within 72 h. This was then compared with the Quick Sequential Organ Failure Assessment (qSOFA).</div></div><div><h3>Methods</h3><div>We conducted a retrospective, cohort observational study of suspected sepsis patients from four branches of Dr. Sulaiman Al-Habib Medical Group (HMG) in Riyadh, Saudi Arabia, from 1 May 2022 to 30 April 2023. We calculated the initial LqSOFA and qSOFA for all patients. The sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve were evaluated for both LqSOFA and qSOFA scores (with ≥2 criteria) for each targeted outcome.</div></div><div><h3>Results</h3><div>The study included a total of 1274 patients, the majority of whom were males (754 (59.2 %)), with a mean age of 68.80 ± 17.9 years. LqSOFA demonstrated higher sensitivity for ICU admission, vasopressor requirement, and mortality (48 %, 68 %, and 76 % respectively) in comparison to qSOFA (30 %, 50 %, and 71 % respectively). However, the specificities of the LqSOFA score for ICU admission, vasopressor requirements, and mortality were lower (81 %, 71 %, and 67 % respectively) than those of the qSOFA score (89 %, 83 %, and 80 % respectively). The AUC of LqSOFA was greater than that of qSOFA for each outcome of interest but the difference was only statistically significant for mortality outcome (<em>p</em>-value &lt;0.05).</div></div><div><h3>Conclusion</h3><div>LqSOFA exhibits strong predictive reliability compared to qSOFA. Prospective multiregional studies need to be conducted to validate LqSOFA's performance.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 118-122"},"PeriodicalIF":2.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pyogenic flexor tenosynovitis resulting from a fingerstick glucose test.","authors":"Peter J Sobraske, Grant Gerstner, Brit Long","doi":"10.1016/j.ajem.2025.02.040","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.040","url":null,"abstract":"<p><p>Pyogenic flexor tenosynovitis (FTS) is a rapidly progressing infection of the flexor tendon sheath synovial fluid. Bacterial seeding most often occurs from trauma overlying the sheath followed by swift proximal propagation. FTS is an uncommon but high morbidity disease that emergency physicians must identify early to prevent devastating complications such as tendon rupture, digit necrosis, and sepsis. Here, we report a case of FTS that occurred in an immunocompetent 82-year-old female approximately 48 h after a fingerstick glucose test.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558600","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":"Factors contributing to paramedic attrition in Connecticut: An analysis of workforce stability.","authors":"Elina Kurkurina, Eliza Little, Richard Feinn, Kevin Ferrarotti","doi":"10.1016/j.ajem.2025.02.039","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.039","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538131","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":"Emergency and disaster preparedness of schools in the United States: A national survey of school nurses.","authors":"Robert P Olympia, Neha Gupta, Marcus Erdman, Paige Chardavoyne, Susan J Boehmer","doi":"10.1016/j.ajem.2025.02.034","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.034","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532224","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":"Spontaneous hemorrhage arising from a proximal descending branch of the suprascapular artery.","authors":"Kevin J Boluyt, Armando L Ugarte, Jennifer A Bach, Nathan D DeBruine","doi":"10.1016/j.ajem.2025.02.037","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.037","url":null,"abstract":"<p><p>Suprascapular arterial hemorrhage is exceedingly uncommon. This case presents a 71-year-old male with a spontaneous suprascapular artery hemorrhage without a clear cause. He initially presented to the emergency department (ED) with an expanding soft tissue mass overlying his left neck, shoulder, and back. Computed tomography angiography (CTA) revealed active contrast extravasation from a branch of the left suprascapular artery, controlled by embolization. There are no prior case reports of spontaneous suprascapular artery hemorrhage, though rupture secondary to an inciting traumatic event has been described. This case highlights the importance of maintaining a high index of suspicion for vascular injury in patients with an enlarging soft tissue mass, as early diagnosis and intervention are crucial for achieving a favorable outcome.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538132","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":"Intravenous vs intraosseous administration of drugs for out of hospital cardiac arrest: A systematic review and meta-analysis","authors":"Muhammad Saad ,&nbsp;Muhammad Umer Sohail ,&nbsp;Saad Ahmed Waqas ,&nbsp;Ifrah Ansari ,&nbsp;Ashish Gupta ,&nbsp;Hritvik Jain ,&nbsp;Raheel Ahmed","doi":"10.1016/j.ajem.2025.02.029","DOIUrl":"10.1016/j.ajem.2025.02.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Timely drug administration via vascular access is critical, with intravenous (IV) and intraosseous (IO) routes being the primary options. Current guidelines prefer IV access but recommend IO when IV access is delayed. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the clinical effectiveness of IO compared to IV access in adults with OHCA.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Scopus, and Cochrane databases through November 2024 identified RCTs comparing IO and IV drug administration in OHCA patients aged ≥18 years. Outcomes included 30-day survival, sustained return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with favorable neurological outcomes. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using a random-effects model.</div></div><div><h3>Results</h3><div>Three RCTs comprising 9293 patients were included. No significant differences were found between IO and IV routes for 30-day survival (OR: 1.00, 95 % CI: 0.76–1.34, <em>p</em> = 0.98), sustained ROSC (OR: 1.08, 95 % CI: 0.97–1.21, <em>p</em> = 0.18), survival to hospital discharge (OR: 1.03, 95 % CI: 0.84–1.25, <em>p</em> = 0.80), or favorable neurological outcomes (OR: 0.93, 95 % CI: 0.77–1.13, <em>p</em> = 0.49).</div></div><div><h3>Conclusion</h3><div>IV and IO access routes demonstrated comparable outcomes for survival and neurological function in OHCA. These findings support the flexibility to prioritize the most practical route in emergency settings, particularly when IV access is delayed or challenging. Further research should explore patient-level outcomes and health economic implications.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 100-103"},"PeriodicalIF":2.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}