American Journal of Emergency Medicine最新文献

英文中文

Comparison of the efficacy of oxymetazoline, tranexamic acid, and epinephrine-lidocaine combination in the treatment of epistaxis

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-23 DOI: 10.1016/j.ajem.2025.02.036

Tuna Çelik , Mustafa Altun , Emre Kudu , Mehmet Birkan Korgan , Oğuzhan Demir , Sinan Karacabey , Arzu Denizbasi , Erkman Sanri

Objective

This study aims to evaluate the efficacy of local oxymetazoline, tranexamic acid, and epinephrine-lidocaine combination in the treatment of acute epistaxis and to compare the advantages of these treatments in controlling bleeding.

Methods

This prospective, single-center, observational, cohort trial was conducted in the emergency department of a tertiary hospital between February 2022 and May 2024. Patients were first treated with direct pressure to the nasal alae for 15 min. If bleeding persisted, one of the three medications was applied locally according to the physician's clinical preference. Hemostasis was assessed at five-minute intervals.

Results

A total of 378 patients over 18 years of age presenting with non-traumatic epistaxis were included, and five patients were excluded because they left the emergency department before their treatment was completed. Of the 373 patients, 89 (23.8 %) achieved hemostasis with pressure therapy. Among the 284 patients who did not benefit from pressure therapy, oxymetazoline achieved hemostasis in 71 % (69/97) of patients, tranexamic acid in 55 % (53/96), and epinephrine-lidocaine in 49 % (45/91). Significant differences were found among the three drug groups regarding hemostasis success, with oxymetazoline showing superior efficacy (p = 0.007).

Conclusion

Oxymetazoline is superior to tranexamic acid and epinephrine-lidocaine in achieving rapid hemostasis and reducing recurrence in epistaxis. Its widespread use, easy accessibility, and rapid effect support its consideration as a practical and effective option in emergency departments. Further multicenter randomized controlled trials are needed to confirm these findings.

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引用次数: 0

Trends in substance use-related emergency department visits by youth, 2018–2023 2018-2023 年青少年药物使用相关急诊就诊趋势

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-22 DOI: 10.1016/j.ajem.2025.02.035

Madeline H. Renny , Yago Stecher , Carmen Vargas-Torres , Alexis M. Zebrowski , Roland C. Merchant

Background

We aimed to examine trends in substance use-related emergency department (ED) visits for youth from 2018 to 2023, compare the patient characteristics, types of substance involved, and ED disposition for these visits, and calculate revisit frequency.

Methods

Retrospective review of electronic health records (EHRs) from six EDs in an urban healthcare system to identify 12–21-year-old patients with substance use-related ED visits from 2018 to 2023. Visits were identified by International Classification of Diseases, 10th Revision Clinical Modification codes for substance use. Proportions of substance use-related visits each year were compared by age group (12-14y, 15-17y, 18-21y), sex, race/ethnicity, and substance type. Logistic regression was used to assess characteristics associated with substance use-related visits, hospital admissions, and ED revisits.

Results

Of 151,764 ED visits for 12–21-year-olds, 3.0 % were for substance use. From 2018 to 2023, substance use-related ED visits increased from 2.8 % to 3.4 % of all ED visits (p < 0.001) and were most often by 18–21-year-olds (79.4 %), yet there were significant increases in visits by 12–14-year-olds and 15–17-year-olds. Visits for females increased from 43.4 % to 52.4 % from 2018 to 2023 (p < 0.001). Although visits for alcohol were most frequent (53.4 %), cannabis visits increased from 17.9 % to 35.3 %, with increases across all age groups (p < 0.001). Nineteen percent of visits involved patients that had an ED revisit for a substance use-related diagnosis within one year.

Conclusion

Substance use-related ED visits increased from 2018 to 2023, with an increase in visits for cannabis over time. These findings can inform targeted ED-based interventions for substance use in youth.

{"title":"Trends in substance use-related emergency department visits by youth, 2018–2023","authors":"Madeline H. Renny , Yago Stecher , Carmen Vargas-Torres , Alexis M. Zebrowski , Roland C. Merchant","doi":"10.1016/j.ajem.2025.02.035","DOIUrl":"10.1016/j.ajem.2025.02.035","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to examine trends in substance use-related emergency department (ED) visits for youth from 2018 to 2023, compare the patient characteristics, types of substance involved, and ED disposition for these visits, and calculate revisit frequency.</div></div><div><h3>Methods</h3><div>Retrospective review of electronic health records (EHRs) from six EDs in an urban healthcare system to identify 12–21-year-old patients with substance use-related ED visits from 2018 to 2023. Visits were identified by International Classification of Diseases, 10th Revision Clinical Modification codes for substance use. Proportions of substance use-related visits each year were compared by age group (12-14y, 15-17y, 18-21y), sex, race/ethnicity, and substance type. Logistic regression was used to assess characteristics associated with substance use-related visits, hospital admissions, and ED revisits.</div></div><div><h3>Results</h3><div>Of 151,764 ED visits for 12–21-year-olds, 3.0 % were for substance use. From 2018 to 2023, substance use-related ED visits increased from 2.8 % to 3.4 % of all ED visits (<em>p</em> < 0.001) and were most often by 18–21-year-olds (79.4 %), yet there were significant increases in visits by 12–14-year-olds and 15–17-year-olds. Visits for females increased from 43.4 % to 52.4 % from 2018 to 2023 (<em>p</em> < 0.001). Although visits for alcohol were most frequent (53.4 %), cannabis visits increased from 17.9 % to 35.3 %, with increases across all age groups (<em>p</em> < 0.001). Nineteen percent of visits involved patients that had an ED revisit for a substance use-related diagnosis within one year.</div></div><div><h3>Conclusion</h3><div>Substance use-related ED visits increased from 2018 to 2023, with an increase in visits for cannabis over time. These findings can inform targeted ED-based interventions for substance use in youth.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 1-9"},"PeriodicalIF":2.7,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552693","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

Research progress of cervicocerebral artery dissection, from mechanism to clinic: A scoping review

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-22 DOI: 10.1016/j.ajem.2025.02.028

Hui Cheng , Bingcheng Pan , Huanjie Li , Li Xiaofeng , Dayuan Zhong , Jianfeng He

Cervicocerebral artery dissection (CAD) commonly occurs in young individuals, and its clinical manifestations lack specificity. It can present as either ischemic or hemorrhagic events. Due to variations in the location, timing of formation, and severity of the lesion in CAD, clinical presentations vary widely, making imaging crucial for accurate diagnosis. Currently, the primary treatment for CAD focuses on anti-thrombotic therapy, and evidence supporting venous thrombolysis is still inconclusive. With advancements in scientific technology, the concepts of the etiology and surgical treatment of CAD continue to evolve over time. As of now, the literature on CAD has experienced an exponential growth in the number of articles. However, there is still a lack of comprehensive discussion on the latest perspectives regarding the pathogenic mechanisms and treatment approaches for CAD. This study combines discussions on the etiology, pathogenesis, clinical characteristics, auxiliary examinations, and treatment of CAD, aiming to provide readers with a comprehensive understanding of CAD.

{"title":"Research progress of cervicocerebral artery dissection, from mechanism to clinic: A scoping review","authors":"Hui Cheng , Bingcheng Pan , Huanjie Li , Li Xiaofeng , Dayuan Zhong , Jianfeng He","doi":"10.1016/j.ajem.2025.02.028","DOIUrl":"10.1016/j.ajem.2025.02.028","url":null,"abstract":"<div><div>Cervicocerebral artery dissection (CAD) commonly occurs in young individuals, and its clinical manifestations lack specificity. It can present as either ischemic or hemorrhagic events. Due to variations in the location, timing of formation, and severity of the lesion in CAD, clinical presentations vary widely, making imaging crucial for accurate diagnosis. Currently, the primary treatment for CAD focuses on anti-thrombotic therapy, and evidence supporting venous thrombolysis is still inconclusive. With advancements in scientific technology, the concepts of the etiology and surgical treatment of CAD continue to evolve over time. As of now, the literature on CAD has experienced an exponential growth in the number of articles. However, there is still a lack of comprehensive discussion on the latest perspectives regarding the pathogenic mechanisms and treatment approaches for CAD. This study combines discussions on the etiology, pathogenesis, clinical characteristics, auxiliary examinations, and treatment of CAD, aiming to provide readers with a comprehensive understanding of CAD.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 74-87"},"PeriodicalIF":2.7,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510100","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

DECAF score and procalcitonin in patients with COPD exacerbation: Clinical insights for use in the emergency department.

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-21 DOI: 10.1016/j.ajem.2025.02.031

Nurettin Özgür Doğan

引用次数: 0

DECAF score and procalcitonin.

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-21 DOI: 10.1016/j.ajem.2025.02.032

Gökhan Eyüpoğlu

引用次数: 0

Non-interventional outcomes of adult foreign body ingestions

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-21 DOI: 10.1016/j.ajem.2025.02.022

Melanie M. Randall MD , Moses Lee DO , Ruben Marchosky DO , Kevin Dales DO , Timothy Nesper MD , Andrew Pachon MD , Bishoy L. Zakhary MPH , Thomas Minahan DO , Michael K. Mesisca DO

Introduction

Foreign body ingestions are a common problem in the emergency department. Patients often undergo invasive interventions that require significant resources. Current recommendations based on limited studies, are to attempt endoscopic removal of objects that are sharp or greater than 2.5 cm at or above the proximal duodenum. We hypothesized that many small and sharp objects will pass spontaneously without complication.

Methods

We performed a retrospective study of all foreign bodies ingested by adults that were not removed initially by endoscopy over five years. We recorded foreign body size, shape and location, radiographic results, interventions performed, and demographic data. Regression analysis was used to determine any significant associations with the outcome of late intervention.

Results

117 patients with 171 encounters met inclusion criteria with an average age of 33 years. 74 % of patients had a known psychiatric history. The most common foreign body was a razorblade. Fifteen patients had late intervention with twelve endoscopies and three exploratory laparotomies. 87 % of these late interventions were for failure to progress determined by the treatment team. There were no small bowel obstructions. One patient had a recto-sigmoid perforation from a pencil. Analysis indicates that size and sharpness were not significant risk factors for later intervention.

Conclusion

Our study indicates that small objects, even sharp foreign bodies including razorblades, can pass spontaneously without intervention. If larger, future studies show the same conclusion, there should be a reconsideration of current guidelines.

{"title":"Non-interventional outcomes of adult foreign body ingestions","authors":"Melanie M. Randall MD , Moses Lee DO , Ruben Marchosky DO , Kevin Dales DO , Timothy Nesper MD , Andrew Pachon MD , Bishoy L. Zakhary MPH , Thomas Minahan DO , Michael K. Mesisca DO","doi":"10.1016/j.ajem.2025.02.022","DOIUrl":"10.1016/j.ajem.2025.02.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Foreign body ingestions are a common problem in the emergency department. Patients often undergo invasive interventions that require significant resources. Current recommendations based on limited studies, are to attempt endoscopic removal of objects that are sharp or greater than 2.5 cm at or above the proximal duodenum. We hypothesized that many small and sharp objects will pass spontaneously without complication.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of all foreign bodies ingested by adults that were not removed initially by endoscopy over five years. We recorded foreign body size, shape and location, radiographic results, interventions performed, and demographic data. Regression analysis was used to determine any significant associations with the outcome of late intervention.</div></div><div><h3>Results</h3><div>117 patients with 171 encounters met inclusion criteria with an average age of 33 years. 74 % of patients had a known psychiatric history. The most common foreign body was a razorblade. Fifteen patients had late intervention with twelve endoscopies and three exploratory laparotomies. 87 % of these late interventions were for failure to progress determined by the treatment team. There were no small bowel obstructions. One patient had a recto-sigmoid perforation from a pencil. Analysis indicates that size and sharpness were not significant risk factors for later intervention.</div></div><div><h3>Conclusion</h3><div>Our study indicates that small objects, even sharp foreign bodies including razorblades, can pass spontaneously without intervention. If larger, future studies show the same conclusion, there should be a reconsideration of current guidelines.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 88-92"},"PeriodicalIF":2.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510067","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}

引用次数: 0

Inflammatory indexes in emergency patients with hypertensive pulmonary Oedema: A critical insight

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-20 DOI: 10.1016/j.ajem.2025.02.025

Tutku Duman Şahan MD, Zeynep Karakaya MD, Ejder Saylav Bora MD, Mehmet Göktuğ Efgan MD, Fatih Esad Topal MD

Background

Heart failure (HF) is a prevalent and severe condition with high hospitalization and mortality rates, especially in developing countries. Inflammation plays a crucial role in its aetiology. Hypertensive pulmonary oedema, a severe form of acute decompensated heart failure (ADHF), lacks a definitive scoring system for predicting hospital admission outcomes. This study aims to evaluate the prognostic value of systemic inflammatory indexes (SII), systemic inflammation response index (SIRI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and multi-inflammatory indexes (MII-1, MII-2, MII-3) in patients with hypertensive pulmonary oedema.

Materials and methods

We conducted a retrospective observational study at Izmir Atatürk Training and Research Hospital from March 1, 2023, to March 1, 2024. We included 150 patients aged ≥18 with hypertensive pulmonary oedema, excluding those with incomplete data or conditions affecting inflammation. Various inflammatory indices were calculated from blood parameters. We used ROC curve analysis to analyse their correlation with hospital outcomes, including discharge and mortality.

Results

Among the 150 patients (mean age 70.14 ± 11.47 years), 25 (16.7 %) experienced in-hospital mortality. Significant differences between discharged and deceased patients were found in systolic blood pressure, neutrophil count, and inflammatory indices. ROC curve analysis showed NLR, SIRI, MII-1, MII-2, and MII-3 as significant predictors of in-hospital mortality, with MII-1 having the highest AUC (0.697) and sensitivity (60.00 %).

Conclusion

SIRI, NLR, MII-1, MII-2, and MII-3 may help predict in-hospital mortality in hypertensive pulmonary oedema. Further research is needed to validate these markers and explore their utility in clinical practice.

{"title":"Inflammatory indexes in emergency patients with hypertensive pulmonary Oedema: A critical insight","authors":"Tutku Duman Şahan MD, Zeynep Karakaya MD, Ejder Saylav Bora MD, Mehmet Göktuğ Efgan MD, Fatih Esad Topal MD","doi":"10.1016/j.ajem.2025.02.025","DOIUrl":"10.1016/j.ajem.2025.02.025","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) is a prevalent and severe condition with high hospitalization and mortality rates, especially in developing countries. Inflammation plays a crucial role in its aetiology. Hypertensive pulmonary oedema, a severe form of acute decompensated heart failure (ADHF), lacks a definitive scoring system for predicting hospital admission outcomes. This study aims to evaluate the prognostic value of systemic inflammatory indexes (SII), systemic inflammation response index (SIRI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and multi-inflammatory indexes (MII-1, MII-2, MII-3) in patients with hypertensive pulmonary oedema.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective observational study at Izmir Atatürk Training and Research Hospital from March 1, 2023, to March 1, 2024. We included 150 patients aged ≥18 with hypertensive pulmonary oedema, excluding those with incomplete data or conditions affecting inflammation. Various inflammatory indices were calculated from blood parameters. We used ROC curve analysis to analyse their correlation with hospital outcomes, including discharge and mortality.</div></div><div><h3>Results</h3><div>Among the 150 patients (mean age 70.14 ± 11.47 years), 25 (16.7 %) experienced in-hospital mortality. Significant differences between discharged and deceased patients were found in systolic blood pressure, neutrophil count, and inflammatory indices. ROC curve analysis showed NLR, SIRI, MII-1, MII-2, and MII-3 as significant predictors of in-hospital mortality, with MII-1 having the highest AUC (0.697) and sensitivity (60.00 %).</div></div><div><h3>Conclusion</h3><div>SIRI, NLR, MII-1, MII-2, and MII-3 may help predict in-hospital mortality in hypertensive pulmonary oedema. Further research is needed to validate these markers and explore their utility in clinical practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 93-99"},"PeriodicalIF":2.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510099","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

The role of the HINTS exam, TriAGe+ score, and ABCD2 score in predicting stroke in acute vertigo patients in the ED

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-20 DOI: 10.1016/j.ajem.2025.02.027

Ayse Cagla Ozmert Toplu MD , Isıl Kalyoncu Aslan MD , Ebru Unal Akoglu MD , Tuba Cimilli Ozturk MD

Objective

Posterior circulation stroke can mimic benign causes of vertigo, presenting with no obvious neurologic signs. Differentiating central from peripheral causes remains a challenge. We aimed to compare the diagnostic accuracy of three bedside screening tools for cerebrovascular causes of vertigo: HINTS examination, ABCD2 score, and TriAGe+ score.

Method

We conducted a single-center, prospective, observational study. Our primary outcome was to determine the diagnostic accuracy of the HINTS exam, ABCD2 score, and TriAGe+ score for predicting stroke in patients presenting with isolated dizziness or vertigo. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off scores.

Results

357 patients were recruited, of which 58 were diagnosed with stroke. The sensitivity and specificity of the HINTS exam were 100% and 85.9%, respectively. At a cut-off ≥ 10 for the TriAGe+ score, a sensitivity of 46.6% and a specificity of 96.3% was found. The sensitivity and specificity of the ABCD2 score (≥4) were 65.5% and 68.6%. AUC values for HINTS, ABCD2, and TriAGe+ scores were 0.88, 0.71, and 0.88, respectively. The TriAGe+ score and HINTS exam showed the same diagnostic performance. The exclusion power of the HINTS exam was higher due to the negative LR of 0.0, whereas the diagnostic power of the TriAGe+ score was higher due to the positive LR of 12.65.

Conclusion

The diagnostic accuracy of the HINTS exam and the TriAGE+ score was better than the ABCD2 score. In our cohort, the HINTS exam was highly sensitive, whereas the specificity of the TriAGe+ score was better than other tests. Clinical experience and training are essential for a reliable HINTS exam, whereas the TriAGe+ score, with its practical structure, could help clinicians identify stroke in the chaotic ED environment.

{"title":"The role of the HINTS exam, TriAGe+ score, and ABCD2 score in predicting stroke in acute vertigo patients in the ED","authors":"Ayse Cagla Ozmert Toplu MD , Isıl Kalyoncu Aslan MD , Ebru Unal Akoglu MD , Tuba Cimilli Ozturk MD","doi":"10.1016/j.ajem.2025.02.027","DOIUrl":"10.1016/j.ajem.2025.02.027","url":null,"abstract":"<div><h3>Objective</h3><div>Posterior circulation stroke can mimic benign causes of vertigo, presenting with no obvious neurologic signs. Differentiating central from peripheral causes remains a challenge. We aimed to compare the diagnostic accuracy of three bedside screening tools for cerebrovascular causes of vertigo: HINTS examination, ABCD2 score, and TriAGe+ score.</div></div><div><h3>Method</h3><div>We conducted a single-center, prospective, observational study. Our primary outcome was to determine the diagnostic accuracy of the HINTS exam, ABCD2 score, and TriAGe+ score for predicting stroke in patients presenting with isolated dizziness or vertigo. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off scores.</div></div><div><h3>Results</h3><div>357 patients were recruited, of which 58 were diagnosed with stroke. The sensitivity and specificity of the HINTS exam were 100% and 85.9%, respectively. At a cut-off ≥ 10 for the TriAGe+ score, a sensitivity of 46.6% and a specificity of 96.3% was found. The sensitivity and specificity of the ABCD2 score (≥4) were 65.5% and 68.6%. AUC values for HINTS, ABCD2, and TriAGe+ scores were 0.88, 0.71, and 0.88, respectively. The TriAGe+ score and HINTS exam showed the same diagnostic performance. The exclusion power of the HINTS exam was higher due to the negative LR of 0.0, whereas the diagnostic power of the TriAGe+ score was higher due to the positive LR of 12.65.</div></div><div><h3>Conclusion</h3><div>The diagnostic accuracy of the HINTS exam and the TriAGE+ score was better than the ABCD2 score. In our cohort, the HINTS exam was highly sensitive, whereas the specificity of the TriAGe+ score was better than other tests. Clinical experience and training are essential for a reliable HINTS exam, whereas the TriAGe+ score, with its practical structure, could help clinicians identify stroke in the chaotic ED environment.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 110-117"},"PeriodicalIF":2.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519292","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

Treatment of headache reduces blood pressure among most patients with migraine and elevated blood pressure 治疗头痛可降低大多数偏头痛和血压升高患者的血压

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-19 DOI: 10.1016/j.ajem.2025.02.017

Hannah Kareff BS , Shellyann Sharpe MD , Chiraag Gupta MD , Benjamin W. Friedman MD

<div><h3>Background</h3><div>It is unclear whether patients with elevated BP and acute headache require treatment with anti-hypertensive medication, anti-headache medication, or both. We determined the impact of migraine medication on blood pressure and pain scores among emergency department patients with moderate or severe migraine and elevated blood pressure.</div></div><div><h3>Methods</h3><div>This study uses data collected from four emergency department-based migraine clinical trials. Patients were included if they had moderate or severe migraine. Patients received one of the following medications or medication combinations: Metoclopramide + dexamethasone, metoclopramide + methylprednisolone acetate, metoclopramide + diphenhydramine, hydromorphone, or prochlorperazine+ diphenhydramine. Blood pressure and 0–10 pain scores were assessed before medication administration and 1 h later.</div></div><div><h3>Results</h3><div>We collected data from 729 patients. 13.3 % (97/729) had moderately elevated BP or worse. Among these patients, we identified an association between change in mean arterial pressure and change in pain (B <span><math><mtext>coefficient</mtext><mo>=</mo><mn>0.04</mn><mo>,</mo><mi>p</mi><mo>=</mo><mn>0.01</mn><mo>)</mo></math></span> Among 53 study participants with elevated blood pressure but <em>without</em> a diagnosed history of hypertension, mean arterial pressure change was associated with pain score change (B<span><math><mspace></mspace><mtext>coefficient</mtext><mo>=</mo><mn>0.05</mn><mo>,</mo><mi>p</mi><mo>=</mo><mn>0.01</mn><mo>)</mo></math></span>. Among 44 patients with elevated blood pressure and a history of diagnosed hypertension, there was no association with mean arterial pressure (B <span><math><mtext>coefficient</mtext><mo>=</mo><mn>0.03</mn><mo>,</mo><mi>p</mi><mo>=</mo><mn>0.25</mn><mo>)</mo></math></span>. Among the 97 patients with moderately elevated blood pressure or worse, 73.2 % (95 %CI, 64.2–82.2 %) experienced an improvement in diastolic blood pressure and 78.4 % (95 %CI, 70.0–86.7) improved systolic blood pressure.</div></div><div><h3>Conclusion</h3><div>In this analysis of data aggregated from four ED-based migraine studies, improvement in pain and blood pressure was associated among patients with acutely elevated blood pressure but without diagnosed hypertension. Most patients with elevated blood pressure who receive headache medication will experience improvement in their blood pressure over the subsequent hour.</div></div><div><h3>Plain language summary</h3><div>Many patients present to emergency departments with headache and high blood pressure. A majority of these patients experienced blood pressure improvements upon treatment of their headache, and those with acutely elevated blood pressure but not diagnosed hypertension demonstrated an association between pain and blood pressure improvements. Instead of administering unnecessary anti-hypertensive medication, this research suggests that in a ma

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引用次数: 0

The effect of different retraining intervals for immediate life support training: A randomized controlled trial

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-19 DOI: 10.1016/j.ajem.2025.02.026

Ming-Ju Hsieh , Chih-Wei Yang , Hao-Yang Lin , Ying-Chih Ko , Wen-Chu Chiang , Wei-Tien Chang , Matthew Huei-Ming Ma

Background

The optimal retraining intervals for Immediate Life Support (ILS) are unclear. This study aimed to explore the effects of different retraining intervals for simulation-based, short-duration ILS courses.

Methods

In this randomized controlled study, junior residents and nurses were recruited and assigned to three groups. After receiving initial simulation-based ILS training, the groups underwent retraining at different intervals: 3 months, 6 months, and 1 year. Each one-hour retraining session included an 8-min in-situ resuscitation simulation on a high-fidelity manikin, followed by debriefing. One year after the initial training, all participants completed a paper-based test and self-efficacy questionnaires on teamwork performance, in addition to a resuscitation simulation. Blinded evaluators assessed performance by reviewing simulation videos using validated checklists.

Results

Eighty-two out of 89 participants completed the study. They had similar characteristics, including age and years of work experience. The 6-month group had fewer resuscitation experiences in the past year. One year after the initial training, there were significant differences in the median skill performance scores across the groups (3-month vs. 6-month vs. 1-year: 31 vs. 28 vs. 23.5, p < 0.01). The 3-month group outperformed the 6-month group (p = 0.04), and the 6-month group outperformed the 1-year group (p = 0.01). The 3-month group also had significantly higher knowledge scores and performed best in self-evaluated teamwork performance.

Conclusion

Our study shows that a 3-month retraining interval achieved the greatest effect for healthcare professionals with limited resuscitation experience in simulation-based, short-duration ILS retraining courses.

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