American Journal of Emergency Medicine最新文献_第5页

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IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

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

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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。

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引用次数: 0

Empowering front-line physicians with AI: Evaluating large language models in everyday ENT care 用人工智能赋予一线医生力量：评估日常耳鼻喉科护理中的大型语言模型

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-19 DOI: 10.1016/j.ajem.2026.01.029

Sholem Hack , Habib G. Zalzal , Rebecca Attal , Armin Farzad , Lilia Ann Crew , Idit Tessler , Talya Frankel , Ben Gvili , Shaked Shivatzki , Amit Wolfovitz , Noa Rozendorn

Purpose

Artificial intelligence systems known as large language models are being evaluated for clinical decision support, yet their role in emergency and primary care remains limited. Physicians in these settings often encounter ear, nose, and throat conditions where diagnostic uncertainty, unnecessary testing, and inappropriate referrals contribute to patient risk and healthcare inefficiency. This study compared the performance of advanced large language models with physicians in diagnosis, management, and referral across common and high-acuity otolaryngologic scenarios.

Methods

Twelve clinical vignettes representing routine and urgent presentations were developed and validated by otolaryngologists. One hundred practicing physicians in family medicine and emergency medicine, including residents and attending physicians, completed all vignettes by providing a diagnosis, management plan, and referral decision. Four large language models (Gemini-2.0, ChatGPT-4.0, ChatGPT-5, and OpenEvidence) were tested using identical prompts. Model outputs were anonymized, randomized, and rated by a blinded expert panel using the Quality Analysis of Medical Artificial Intelligence tool, which assesses accuracy, clarity, completeness, sourcing, relevance, and usefulness.

Results

Physicians achieved mean diagnostic accuracy of 91.6% and management accuracy of 87.9%. In non-urgent cases, 30.4% of responses represented inappropriate referral. Only half recognized the need for urgent referral in a cerebrospinal fluid leak scenario. Large language models demonstrated comparable diagnostic and management accuracy with higher referral appropriateness.

Conclusions

Large language models showed consistent, guideline-concordant reasoning in simulated emergency and primary-care otolaryngology cases. Their potential lies in supporting, not replacing, clinical judgment through responsible integration and real-world validation.

被称为大型语言模型的人工智能系统正在被评估用于临床决策支持，但它们在急诊和初级保健中的作用仍然有限。在这些环境中，医生经常遇到耳、鼻和咽喉疾病，其中诊断不确定、不必要的测试和不适当的转诊导致患者风险和医疗效率低下。本研究比较了先进的大型语言模型与医生在普通和高敏度耳鼻喉科的诊断、管理和转诊方面的表现。方法由耳鼻喉科医师制作并验证了12份代表常规和紧急表现的临床小短文。包括住院医师和主治医师在内的100名家庭医学和急诊医学执业医师通过提供诊断、管理计划和转诊决定完成了所有小插曲。使用相同的提示测试了四种大型语言模型（Gemini-2.0、ChatGPT-4.0、ChatGPT-5和OpenEvidence）。模型输出是匿名的、随机的，并由盲法专家小组使用医疗人工智能工具的质量分析进行评分，该工具评估准确性、清晰度、完整性、来源、相关性和有用性。结果医师平均诊断准确率为91.6%，管理准确率为87.9%。在非紧急情况下，30.4%的答复代表不适当的转诊。只有一半的人认识到在脑脊液泄漏的情况下需要紧急转诊。大型语言模型显示出可比较的诊断和管理准确性和更高的转诊适当性。结论在模拟急诊和初级保健耳鼻喉科病例中，大型语言模型显示出一致的、与指南一致的推理。它们的潜力在于通过负责任的整合和真实世界的验证来支持而不是取代临床判断。

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引用次数: 0

Impact of the coronavirus pandemic on bystander CPR, dispatcher-assisted CPR, EMS response time, and survival outcomes in China 冠状病毒大流行对中国旁观者CPR、调度员辅助CPR、EMS响应时间和生存结果的影响

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-19 DOI: 10.1016/j.ajem.2026.01.024

Yaping Hou MPH , Wentao Sang PhD , Ying Deng PhD , Jiaqi Zheng PhD , Zhepei Yuan PhD , Dong Xia MB , Xue Zhao MD , Wen Zheng PhD , Mingjie Wang MPH , Peiwu Li PhD , Feng Xu PhD , Yuguo Chen PhD

Aim

This study aimed to evaluate whether the COVID-19 pandemic affected out-of-hospital cardiac arrest (OHCA) care and outcomes across multiple regions in China, despite the country's strict containment measures.

Methods

Data from the BASeline Investigation of Out-of-hospital Cardiac Arrest (BASIC-OHCA) Utstein Registry between 2019 and 2020 were analyzed. OHCA cases from 18 Emergency Medical Services (EMS) agencies were included. The primary outcome was survival to hospital discharge or 30 days, while secondary outcomes included return of spontaneous circulation (ROSC), and favorable neurologic outcome (Cerebral Performance Category [CPC] score 1–2). Three periods were compared: pre-COVID-19, outbreak, and regular prevention and control. Multilevel logistic regression adjusted for Utstein variables and center-level clustering was used.

Results

A total of 16,595 patients received CPR (pre-COVID-19 n = 3890; outbreak n = 5939; regular prevention and control n = 6766). Survival to hospital discharge or 30 days did not differ significantly across periods. ROSC was lower during the outbreak (5.3% vs. 3.6%, AOR 0.80, P = 0.045) and regular prevention and control periods (5.3% vs. 3.5%, AOR 0.80, P = 0.045). Bystander CPR and dispatcher-assisted CPR were significantly less frequent during the regular prevention and control period. EMS response time was longer in the regular prevention and control period (median 12 min vs. 11 min; AOR 1.25, P = 0.006).

Conclusion

The COVID-19 pandemic impacted the EMS system in China, reducing bystander CPR, dispatcher-assisted CPR, and ROSC, and increasing EMS response times. However, survival and neurological outcomes did not deteriorate significantly.

目的本研究旨在评估COVID-19大流行是否影响了中国多个地区的院外心脏骤停（OHCA）护理和结果，尽管中国采取了严格的遏制措施。方法分析2019 - 2020年院外心脏骤停基线调查（BASIC-OHCA） Utstein Registry的数据。包括来自18个紧急医疗服务机构的OHCA病例。主要结局是存活至出院或30天，次要结局包括自发循环恢复（ROSC）和良好的神经系统结局（脑功能分类[CPC]评分1-2）。比较前期、疫情和常规防控三个阶段。采用经Utstein变量调整的多水平logistic回归和中心水平聚类。结果接受心肺复苏术的患者共16595例（新冠肺炎前3890例，爆发5939例，常规防控6766例）。到出院或30天的生存率在不同时期没有显著差异。ROSC在疫情期间（5.3%比3.6%,AOR 0.80, P = 0.045）和常规防控期间（5.3%比3.5%,AOR 0.80, P = 0.045）均较低。在常规预防和控制期间，旁观者CPR和调度员辅助CPR的频率显著降低。常规防控期EMS反应时间较长（中位12 min vs. 11 min; AOR 1.25, P = 0.006）。结论2019冠状病毒病大流行对中国EMS系统造成影响，减少了旁观者CPR、调度员辅助CPR和ROSC，增加了EMS响应时间。然而，生存和神经预后没有明显恶化。

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引用次数: 0

Test results and follow-up care stemming from an ED-based cervical cancer intervention 基于ed的宫颈癌干预的检测结果和后续护理

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-19 DOI: 10.1016/j.ajem.2026.01.031

Beau Abar, Nancy Wood, Joely Merriman, David Adler

Background

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.

Objective

The current study describes test results and subsequent care observed among patients who received documented cervical cancer screening following an ED-based intervention.

Methods

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.

Results

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, p < 0.001). High-risk HPV infection was observed in 15% among those tested, elevated from an estimated nationwide prevalence of 11% (Z = 1.63, p = 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.

Conclusion

ED-based cervical cancer screening interventions have meaningful positive impact on subsequent testing and care.

背景在美国，每年有超过4300人死于宫颈癌。当发现癌前病变并采取适当措施时，生存率接近100%。一项随机对照试验表明，两种基于急诊科（ED）的宫颈癌筛查干预措施表明，每种情况下的患者接受筛查的比率远高于未治疗的历史对照组。虽然筛查是预防宫颈癌发病率和死亡率的必要第一步，但缺乏后续临床护理的数据限制了对基于ed的筛查工作的评价。目的：本研究描述了在以ed为基础的干预后接受记录的宫颈癌筛查的患者的检测结果和随后的护理。方法收集电子健康记录中记录的21-65岁妇女的HPV感染、巴氏试验结果和宫颈癌诊断信息，这些妇女(a)参加了上述试验，(b)在入组后365天内接受了宫颈癌筛查。结果181名妇女接受了筛查。在做过巴氏试验的人中，有12%的人发现了异常。与全国3.8%的发病率相比，观察到明显升高的风险（Z = 5.55, p < 0.001）。在接受检测的人群中，高危HPV感染率为15%，高于全国估计的11% （Z = 1.63, p = 0.052）。值得注意的是，近一半继续进行阴道镜检查和宫颈活检的患者没有常规的女性健康提供者。结论基于ed的宫颈癌筛查干预措施对后续检测和护理有显著的积极影响。

{"title":"Test results and follow-up care stemming from an ED-based cervical cancer intervention","authors":"Beau Abar, Nancy Wood, Joely Merriman, 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> < 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":"2026-01-19","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}

引用次数: 0

Reader comment regarding effect of hyperangulated videolaryngoscopy on first-attempt success in tracheal intubations: A systematic review and meta-analysis. 关于气管插管首次尝试成功的高角度视屏喉镜的影响的读者评论：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 : 2026-01-19 DOI: 10.1016/j.ajem.2026.01.017

Samuel I Garcia, Maria Lorraine G Bugayong, Aidan F Mullan, Alexander S Niven

引用次数: 0

Radiopaque pediatric oxygen absorber ingestion and the hidden risks of active packaging 不透光儿童吸氧剂摄入及活性包装的隐患

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-19 DOI: 10.1016/j.ajem.2026.01.004

Mehmet Yorgun , Ruhi Cüre

We report the case of a 5-year-old girl who presented to the emergency department after accidental ingestion of the contents of an oxygen absorber sachet found in packaged food. Abdominal radiography demonstrated multiple fine, diffusely distributed radiopaque granules throughout the stomach and small bowel, producing a distinctive sandstorm-like appearance. The ingested material was confirmed to be iron powder mixed with sodium chloride, a compound commonly used in active food packaging with low gastrointestinal bioavailability. The patient exhibited no symptoms during the observation period and no specific intervention was required. This case demonstrates an unusual but recognisable radiographic pattern associated with oxygen absorber ingestion. It also emphasises the importance of differentiating this condition from other radiopaque foreign bodies to support appropriate clinical management.

我们报告的情况下，一个5岁的女孩谁提出了急诊室后意外摄入的内容在包装食品中的吸氧袋。腹部x线片示胃和小肠内多发弥漫性不透射线的细小颗粒，呈沙暴样。经证实，摄入的物质是混合了氯化钠的铁粉，氯化钠是一种常用于活性食品包装的化合物，其胃肠道生物利用度较低。患者在观察期间未出现任何症状，无需进行特异性干预。本病例表现出与吸氧剂摄入有关的不寻常但可识别的x线图像。它还强调了将这种情况与其他不透射线的异物区分开来的重要性，以支持适当的临床管理。

引用次数: 0

Performance of the ESC 0/1 h hs-cTnI algorithm in suspected NSTEMI patients with normal versus abnormal electrocardiograms ESC 0/1 h hs-cTnI算法在心电图正常与异常的疑似NSTEMI患者中的表现

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-19 DOI: 10.1016/j.ajem.2026.01.026

Zi-qiu Feng , Fen Xu , Ye-nan Fu , Fang-fang Yang , Yang Li , Bing-hua Yang , Yan Liang , Zhou Zhou , Ya-hui Lin

Objective

To evaluate the diagnostic and prognostic performance of the ESC 0/1-h high-sensitivity cardiac troponin I(hs-cTnI) algorithm in emergency department patients with suspected non-ST-segment elevation myocardial infarction(NSTEMI), stratified by by initial electrocardiogram (ECG) findings.

Methods

This retrospective analysis included 1535 patients with suspected ACS. Based on initial ECG, patients were categorized into normal (n = 888) or abnormal (n = 647) groups,with the abnormal group further stratified into ischemic (n = 464) and non-ischemic (n = 183).The ESC 0/1 h hs-cTnI algorithm was applied for risk stratification. Diagnostic performance (sensitivity, specificity, NPV, PPV) was evaluated against clinical diagnosis. Prognostic value for 30-day and 180-day all-cause mortality and major adverse cardiovascular events (MACE) was assessed.

Results

Sensitivity and NPV in the abnormal ECG group were both 100%, compared to 98.8% and 99.5% in the normal ECG group. Specificity was significantly lower in patients with ischemic ECG changes (81.2%) than in the normal ECG group (91.6%, P < 0.001). Subgroup analysis showed slightly lower sensitivity in women (95.5%), patients with pain onset ≤3 h (97.9%), and those aged ≤65 years (98.1%) within the normal ECG group. The algorithm effectively stratified mortality risk in both groups but showed limited discrimination for MACE in the abnormal ECG group.

Conclusion

The ESC 0/1-h hs-cTnI algorithm provides excellent rule-out safety across all ECG presentations. Crucially, a lower specificity—driven primarily by the ischemic ECG phenotype—suggests a higher risk of false-positive rule-in in this subgroup. Clinicians should integrate ischemic ECG patterns with clinical history to interpret algorithm results. Additionally, vigilance for potential under-detection in specific normal-ECG subgroups (women, younger patients, early presenters) remains warranted.

目的：评价ESC 0/1-h高灵敏度心肌肌钙蛋白I（hs-cTnI）算法在急诊疑似非st段抬高型心肌梗死（NSTEMI）患者中的诊断和预后表现，并对其进行初始心电图（ECG）分层。方法：回顾性分析1535例疑似ACS患者。根据初始心电图将患者分为正常组（n = 888）和异常组（n = 647），异常组进一步分为缺血组（n = 464）和非缺血组（n = 183）。采用ESC 0/1 h hs-cTnI算法进行风险分层。根据临床诊断评估诊断性能（敏感性、特异性、NPV、PPV）。评估30天和180天全因死亡率和主要不良心血管事件（MACE）的预后价值。结果：异常心电图组的敏感性和NPV均为100%，而正常心电图组的敏感性和NPV分别为98.8%和99.5%。缺血性心电图改变患者的特异性（81.2%）明显低于正常心电图组（91.6%），P结论：ESC 0/1-h hs-cTnI算法在所有心电图表现中都提供了出色的排除安全性。至关重要的是，较低的特异性（主要由缺血性ECG表型驱动）表明该亚组中假阳性规则的风险较高。临床医生应结合缺血性心电图模式和临床病史来解释算法结果。此外，对特定正常心电图亚组（女性、年轻患者、早期呈现者）可能未被发现的情况保持警惕是有必要的。

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引用次数: 0

Mixed reality simulation outperforms video for peripheral venous catheter placement training. 混合现实模拟优于视频外周静脉导管放置训练。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.ajem.2026.01.025

Jarom Morris, Sarah Petelinsek, Holden Wagstaff, Brian Merritt, Rowan Kelner, Robert Levine, Patrick G Hughes

引用次数: 0