Pub Date : 2024-10-15DOI: 10.1016/j.ajem.2024.10.020
Fatma Tortum , Erdal Tekin , Bugra Kerget , Alperen Aksakal , Orhan Enes Tuncez
Introduction
This study investigated the feasibility of using the Roth score in the emergency setting to make hospitalization or discharge decisions for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
Materials and methods
This study was conducted prospectively between March 1, 2023 and January 1, 2024 and included 101 patients with Group E chronic obstructive pulmonary disease who were treated in the emergency department of a tertiary hospital. The patients were categorized into two groups: those who were hospitalized and those who were discharged. The Roth score, determined by measuring patients' breath-holding times after forced inspiration and counting rhythmically, was measured in seconds and counted. Changes in Roth scores, arterial blood gas parameters, and transcutaneous oxygen saturation levels measured during AECOPD presentation and after appropriate treatment were examined.
Results
The study included 101 patients (57 males, 44 females) with a mean age of 61.4 years. After AECOPD treatment, the area under the curve for the Roth score was 0.937 s for the duration and 0.969 for the count. At a cut-off value of 9.5 s, the Roth score in seconds had a sensitivity of 92 % and a specificity of 75 %. At a cut-off value of 10.5, the Roth score had a sensitivity of 97 % and a specificity of 70 %.
Conclusion
The Roth score (only counts) increased in discharged patients after AECOPD treatment. It appears to be a viable method for predicting hospitalization or discharge decisions in patients with AECOPD who present to the emergency department.
{"title":"The use of the Roth score in emergency department for patients with acute exacerbation of chronic obstructive pulmonary disease","authors":"Fatma Tortum , Erdal Tekin , Bugra Kerget , Alperen Aksakal , Orhan Enes Tuncez","doi":"10.1016/j.ajem.2024.10.020","DOIUrl":"10.1016/j.ajem.2024.10.020","url":null,"abstract":"<div><h3>Introduction</h3><div>This study investigated the feasibility of using the Roth score in the emergency setting to make hospitalization or discharge decisions for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).</div></div><div><h3>Materials and methods</h3><div>This study was conducted prospectively between March 1, 2023 and January 1, 2024 and included 101 patients with Group E chronic obstructive pulmonary disease who were treated in the emergency department of a tertiary hospital. The patients were categorized into two groups: those who were hospitalized and those who were discharged. The Roth score, determined by measuring patients' breath-holding times after forced inspiration and counting rhythmically, was measured in seconds and counted. Changes in Roth scores, arterial blood gas parameters, and transcutaneous oxygen saturation levels measured during AECOPD presentation and after appropriate treatment were examined.</div></div><div><h3>Results</h3><div>The study included 101 patients (57 males, 44 females) with a mean age of 61.4 years. After AECOPD treatment, the area under the curve for the Roth score was 0.937 s for the duration and 0.969 for the count. At a cut-off value of 9.5 s, the Roth score in seconds had a sensitivity of 92 % and a specificity of 75 %. At a cut-off value of 10.5, the Roth score had a sensitivity of 97 % and a specificity of 70 %.</div></div><div><h3>Conclusion</h3><div>The Roth score (only counts) increased in discharged patients after AECOPD treatment. It appears to be a viable method for predicting hospitalization or discharge decisions in patients with AECOPD who present to the emergency department.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"86 ","pages":"Pages 135-140"},"PeriodicalIF":2.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481695","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}
Pub Date : 2024-10-15DOI: 10.1016/j.ajem.2024.10.019
Michael Gottlieb MD, Evelyn Schraft MD, James O'Brien MD, Daven Patel MD, MPH
Introduction
Cardiac point-of-care ultrasound (POCUS) can evaluate for systolic and diastolic dysfunction to inform care in the Emergency Department (ED). However, accurate assessment can be limited by user experience. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of cardiac POCUS. However, there is limited evidence of the accuracy of AI in the clinical environment. The objective of this study was to determine the diagnostic accuracy of AI for identifying systolic and diastolic dysfunction compared with expert reviewers.
Methods
This was a prospective, observational study of adult ED patients aged ≥45 years with risk factors for systolic and diastolic dysfunction. Ultrasound fellowship-trained physicians used an ultrasound machine with existing AI software and obtained parasternal long axis, parasternal short axis, and apical 4-chamber views of the heart. Systolic dysfunction was defined as ejection fraction (EF) < 50 % in at least two views using visual assessment or E-point septal separation >10 mm. Diastolic dysfunction was defined as an E:A < 0.8, or ≥ 2 of the following: septal e' < 7 cm/s or lateral e' < 10 cm/s, E:e' > 14, or left atrial volume > 34 mL/m2. AI was subsequently used to measure EF, E, A, septal e', and lateral e' velocities. The gold standard was systolic or diastolic dysfunction as assessed by two independent physicians with discordance resolved via consensus. We performed descriptive statistics (mean ± standard deviation) and calculated the sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of the AI in determining systolic and diastolic dysfunction with 95 % confidence interval (CI). Subgroup analyses were performed by body mass index (BMI).
Results
We enrolled 220 patients, with 11 being excluded due to inadequate images, resulting in 209 patients being included in the study. Mean age was 60 ± 9 years, 51.7 % were women, and the mean BMI was 31 ± 8.1 mg/kg2. For assessing systolic dysfunction, AI was 85.7 % (95 %CI 57.2 % to 98.2 %) sensitive and 94.8 % (95 %CI 90.6 % to 97.5 %) specific with a LR+ of 16.4 (95 %CI 8.6 to 31.1) and LR- of 0.15 (95 % CI 0.04 to 0.54). For assessing diastolic dysfunction, AI was 91.9 % (95 %CI 85.6 % to 96.0 %) sensitive and 94.2 % (95 %CI 87.0 % to 98.1 %) specific with a LR+ of 15.8 (95 %CI 6.7 to 37.1) and a LR- of 0.09 (0.05 to 0.16). When analyzed by BMI, results were similar except for lower sensitivity in the BMI ≥ 30 vs BMI < 30 (100 % vs 80 %).
Conclusion
When compared with expert assessment, AI had high sensitivity and specificity for diagnosing both systolic and diastolic dysfunction.
{"title":"Diagnostic accuracy of artificial intelligence for identifying systolic and diastolic cardiac dysfunction in the emergency department","authors":"Michael Gottlieb MD, Evelyn Schraft MD, James O'Brien MD, Daven Patel MD, MPH","doi":"10.1016/j.ajem.2024.10.019","DOIUrl":"10.1016/j.ajem.2024.10.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac point-of-care ultrasound (POCUS) can evaluate for systolic and diastolic dysfunction to inform care in the Emergency Department (ED). However, accurate assessment can be limited by user experience. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of cardiac POCUS. However, there is limited evidence of the accuracy of AI in the clinical environment. The objective of this study was to determine the diagnostic accuracy of AI for identifying systolic and diastolic dysfunction compared with expert reviewers.</div></div><div><h3>Methods</h3><div>This was a prospective, observational study of adult ED patients aged ≥45 years with risk factors for systolic and diastolic dysfunction. Ultrasound fellowship-trained physicians used an ultrasound machine with existing AI software and obtained parasternal long axis, parasternal short axis, and apical 4-chamber views of the heart. Systolic dysfunction was defined as ejection fraction (EF) < 50 % in at least two views using visual assessment or E-point septal separation >10 mm. Diastolic dysfunction was defined as an E:A < 0.8, or ≥ 2 of the following: septal e' < 7 cm/s or lateral e' < 10 cm/s, E:e' > 14, or left atrial volume > 34 mL/m<sup>2</sup>. AI was subsequently used to measure EF, E, A, septal e', and lateral e' velocities. The gold standard was systolic or diastolic dysfunction as assessed by two independent physicians with discordance resolved via consensus. We performed descriptive statistics (mean ± standard deviation) and calculated the sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of the AI in determining systolic and diastolic dysfunction with 95 % confidence interval (CI). Subgroup analyses were performed by body mass index (BMI).</div></div><div><h3>Results</h3><div>We enrolled 220 patients, with 11 being excluded due to inadequate images, resulting in 209 patients being included in the study. Mean age was 60 ± 9 years, 51.7 % were women, and the mean BMI was 31 ± 8.1 mg/kg<sup>2</sup>. For assessing systolic dysfunction, AI was 85.7 % (95 %CI 57.2 % to 98.2 %) sensitive and 94.8 % (95 %CI 90.6 % to 97.5 %) specific with a LR+ of 16.4 (95 %CI 8.6 to 31.1) and LR- of 0.15 (95 % CI 0.04 to 0.54). For assessing diastolic dysfunction, AI was 91.9 % (95 %CI 85.6 % to 96.0 %) sensitive and 94.2 % (95 %CI 87.0 % to 98.1 %) specific with a LR+ of 15.8 (95 %CI 6.7 to 37.1) and a LR- of 0.09 (0.05 to 0.16). When analyzed by BMI, results were similar except for lower sensitivity in the BMI ≥ 30 vs BMI < 30 (100 % vs 80 %).</div></div><div><h3>Conclusion</h3><div>When compared with expert assessment, AI had high sensitivity and specificity for diagnosing both systolic and diastolic dysfunction.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"86 ","pages":"Pages 115-119"},"PeriodicalIF":2.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481693","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}
Pub Date : 2024-10-14DOI: 10.1016/j.ajem.2024.10.021
Sofia Portuondo Quirch, Veronica Abello, Olga Chamberlain, Nicole Lynn Warren, Michael Shalaby
Background: Patients who present to the emergency department (ED) with incarcerated or strangulated ventral hernias are often in significant pain. Furthermore, even with procedural sedation, reduction itself also causes substantial pain. Hernias that cannot be reduced at the bedside with intravenous opioids or procedural sedation will require emergent surgery, which contributes to morbidity and mortality, especially in high-risk populations.
Case report: We present the case of a 94-year-old man with an incarcerated ventral hernia that was reduced in the ED with the aid of a rectus sheath block, ultimately avoiding the need for emergent surgical intervention.
Implications: Ultrasound can visualize and diagnose an incarcerated hernia, and a bilateral rectus sheath block can be performed in the ED to anesthetize the peritoneal wall, paralyze abdominal musculature, and achieve nearly painless hernia reduction.
{"title":"Rectus sheath nerve block for analgesia & incarcerated hernia reduction in the emergency department.","authors":"Sofia Portuondo Quirch, Veronica Abello, Olga Chamberlain, Nicole Lynn Warren, Michael Shalaby","doi":"10.1016/j.ajem.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.021","url":null,"abstract":"<p><strong>Background: </strong>Patients who present to the emergency department (ED) with incarcerated or strangulated ventral hernias are often in significant pain. Furthermore, even with procedural sedation, reduction itself also causes substantial pain. Hernias that cannot be reduced at the bedside with intravenous opioids or procedural sedation will require emergent surgery, which contributes to morbidity and mortality, especially in high-risk populations.</p><p><strong>Case report: </strong>We present the case of a 94-year-old man with an incarcerated ventral hernia that was reduced in the ED with the aid of a rectus sheath block, ultimately avoiding the need for emergent surgical intervention.</p><p><strong>Implications: </strong>Ultrasound can visualize and diagnose an incarcerated hernia, and a bilateral rectus sheath block can be performed in the ED to anesthetize the peritoneal wall, paralyze abdominal musculature, and achieve nearly painless hernia reduction.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481688","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}
Pub Date : 2024-10-13DOI: 10.1016/j.ajem.2024.10.028
Mohamed Eltorki MBChB, MSc , Matt Hall PhD , Sriram Ramgopal MD , Pradip P. Chaudhari MD , Oluwakemi Badaki-Makun MD, PhD , Chris A. Rees MD, MPH , Kelly R. Bergmann DO , Daniel J. Shapiro MD , Frank Gonzalez MD , Timothy Phamduy DO , Mark I. Neuman MD, MPH
<div><div>This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids.</div></div><div><h3>Background</h3><div>Vaso-occlusive episodes (VOEs) are a hallmark of sickle cell disease (SCD), leading to frequent emergency department (ED) visits. Effective pain management is crucial, with guidelines recommending routine use of non-steroidal anti-inflammatory drugs (NSAIDs) with opioids, and emerging evidence supporting ketamine use. However, these recommendations are based on low-certainty evidence, and the impact of these guidelines on analgesia use over time remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to analyze trends in analgesia use over an 11-year period in pediatric SCD patients presenting to U.S. EDs with VOE and assess variations in treatment across hospitals.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using data from the Pediatric Health Information System covering 34 U.S. children's hospitals from January 1, 2013, to December 31, 2023. The primary outcomes were the proportions of visits where opioids, NSAIDs, acetaminophen, and/or ketamine were administered on the first calendar day of the initial visit. Secondary outcomes included the co-administration of NSAIDs with opioids. Logistic and linear regression models were used to assess trends and hospital-level variations.</div></div><div><h3>Results</h3><div>A total of 86,111 ED visits for VOE were analyzed. Opioids were administered in 82 % of encounters, NSAIDs in 72 %, acetaminophen in 17 %, and ketamine in 1 %. Co-administration of NSAIDs with opioids occurred in 59 % of the visits. Among discharged patients, there was a positive trend for NSAID use (slope: 1.68 %/year, 95 % CI: 0.91 %, 2.45 %) and NSAID-opioid co-administration (slope: 1.03 %/year, 95 % CI: 0.37 %, 1.69 %) over time. Acetaminophen use also increased over the study period (slope: 0.99 %/year, 95 % CI: 0.80 %, 1.17 %). In hospitalized patients, there was a significant upward trend for acetaminophen (slope: 1.29 %/year, 95 % CI: 0.69 %, 1.89 %) and ketamine (slope: 0.36 %/year, 95 % CI: 0.27 %, 0.45 %), while opioid use remained unchanged. Significant hospital-level variations were observed, with larger hospitals more likely to administer opioids but less likely to co-administer NSAIDs with opioids compared to medium-volume hospitals.</div></div><div><h3>Conclusion</h3><div>Over the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals unders
{"title":"Trends and hospital practice variation for analgesia for children with sickle cell disease with vaso-occlusive pain episodes: An 11-year analysis","authors":"Mohamed Eltorki MBChB, MSc , Matt Hall PhD , Sriram Ramgopal MD , Pradip P. Chaudhari MD , Oluwakemi Badaki-Makun MD, PhD , Chris A. Rees MD, MPH , Kelly R. Bergmann DO , Daniel J. Shapiro MD , Frank Gonzalez MD , Timothy Phamduy DO , Mark I. Neuman MD, MPH","doi":"10.1016/j.ajem.2024.10.028","DOIUrl":"10.1016/j.ajem.2024.10.028","url":null,"abstract":"<div><div>This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids.</div></div><div><h3>Background</h3><div>Vaso-occlusive episodes (VOEs) are a hallmark of sickle cell disease (SCD), leading to frequent emergency department (ED) visits. Effective pain management is crucial, with guidelines recommending routine use of non-steroidal anti-inflammatory drugs (NSAIDs) with opioids, and emerging evidence supporting ketamine use. However, these recommendations are based on low-certainty evidence, and the impact of these guidelines on analgesia use over time remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to analyze trends in analgesia use over an 11-year period in pediatric SCD patients presenting to U.S. EDs with VOE and assess variations in treatment across hospitals.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using data from the Pediatric Health Information System covering 34 U.S. children's hospitals from January 1, 2013, to December 31, 2023. The primary outcomes were the proportions of visits where opioids, NSAIDs, acetaminophen, and/or ketamine were administered on the first calendar day of the initial visit. Secondary outcomes included the co-administration of NSAIDs with opioids. Logistic and linear regression models were used to assess trends and hospital-level variations.</div></div><div><h3>Results</h3><div>A total of 86,111 ED visits for VOE were analyzed. Opioids were administered in 82 % of encounters, NSAIDs in 72 %, acetaminophen in 17 %, and ketamine in 1 %. Co-administration of NSAIDs with opioids occurred in 59 % of the visits. Among discharged patients, there was a positive trend for NSAID use (slope: 1.68 %/year, 95 % CI: 0.91 %, 2.45 %) and NSAID-opioid co-administration (slope: 1.03 %/year, 95 % CI: 0.37 %, 1.69 %) over time. Acetaminophen use also increased over the study period (slope: 0.99 %/year, 95 % CI: 0.80 %, 1.17 %). In hospitalized patients, there was a significant upward trend for acetaminophen (slope: 1.29 %/year, 95 % CI: 0.69 %, 1.89 %) and ketamine (slope: 0.36 %/year, 95 % CI: 0.27 %, 0.45 %), while opioid use remained unchanged. Significant hospital-level variations were observed, with larger hospitals more likely to administer opioids but less likely to co-administer NSAIDs with opioids compared to medium-volume hospitals.</div></div><div><h3>Conclusion</h3><div>Over the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals unders","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"86 ","pages":"Pages 129-134"},"PeriodicalIF":2.7,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481696","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}
Pub Date : 2024-10-13DOI: 10.1016/j.ajem.2024.10.025
Abid Rizvi, Almadhoun Yousuf
{"title":"Critical methodological considerations for opioid use disorder research in emergency departments.","authors":"Abid Rizvi, Almadhoun Yousuf","doi":"10.1016/j.ajem.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.025","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481684","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}
Pub Date : 2024-10-13DOI: 10.1016/j.ajem.2024.10.022
Samer Metri, Carlos Gonzalez-Cobos, Gabriel Rose
Background: Shoulder pain is a common presentation to the Emergency Department (ED). Despite an increasing volume of ED visits for shoulder pain, achieving adequate pain control can be challenging. Ultrasound-guided nerve blocks, such as the interscalene nerve block (ISB), are effective but can cause hemidiaphragmatic paresis and motor dysfunction. The interfascial plane block (IPB) is a simple and new regional anesthesia technique that spares the diaphragm, and most upper extremity motor function.
Case report: Three patients presented to the ED with acute shoulder pain refractory to oral analgesics and were treated successfully with an ultrasound-guided IPB in the ED.
Conclusion: The ultrasound-guided IPB is a simple, safe, and effective alternative approach to treating shoulder pain in the ED, especially in patients who may not tolerate ISB.
{"title":"Treatment of shoulder pain with ultrasound-guided interfascial plane block: A case series.","authors":"Samer Metri, Carlos Gonzalez-Cobos, Gabriel Rose","doi":"10.1016/j.ajem.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.022","url":null,"abstract":"<p><strong>Background: </strong>Shoulder pain is a common presentation to the Emergency Department (ED). Despite an increasing volume of ED visits for shoulder pain, achieving adequate pain control can be challenging. Ultrasound-guided nerve blocks, such as the interscalene nerve block (ISB), are effective but can cause hemidiaphragmatic paresis and motor dysfunction. The interfascial plane block (IPB) is a simple and new regional anesthesia technique that spares the diaphragm, and most upper extremity motor function.</p><p><strong>Case report: </strong>Three patients presented to the ED with acute shoulder pain refractory to oral analgesics and were treated successfully with an ultrasound-guided IPB in the ED.</p><p><strong>Conclusion: </strong>The ultrasound-guided IPB is a simple, safe, and effective alternative approach to treating shoulder pain in the ED, especially in patients who may not tolerate ISB.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481691","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}
Pub Date : 2024-10-12DOI: 10.1016/j.ajem.2024.10.026
Sangil Lee, Leon Sun, J Priyanka Vakkalanka
{"title":"The authors respond: Data units, population estimates, and comorbidities.","authors":"Sangil Lee, Leon Sun, J Priyanka Vakkalanka","doi":"10.1016/j.ajem.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.026","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481690","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}
Pub Date : 2024-10-12DOI: 10.1016/j.ajem.2024.10.017
Uğur Durmuş
{"title":"Comments on \"The effect of intravenous ondansetron on QT interval in the emergency department\".","authors":"Uğur Durmuş","doi":"10.1016/j.ajem.2024.10.017","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.017","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481683","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}
Pub Date : 2024-10-12DOI: 10.1016/j.ajem.2024.10.015
Alexander D. Ginsburg M.D. , Heather A. Heaton M.D., M.S. , Aeryana Beaudrie-Nunn Pharm.D., R.Ph. , Lucas Oliveira J. e Silva M.D., Ph.D. , Elizabeth Canterbury Pharm.D., R.Ph. , Caitlin S. Brown Pharm.D., R.Ph. , Allyson K. Palmer M.D., Ph.D. , Kristin C. Cole M.S. , Erin D. Wieruszewski Pharm.D., R.Ph. , Fernanda Bellolio M.D., M.Sc.
Background and objectives
Ketamine is increasingly being utilized in the management of acute pain in the emergency department (ED), including for older adults, a population at increased risk of adverse effects from medications. We aimed to compare the safety and analgesic effects of high-dose (≥0.3 mg/kg) to low-dose (<0.3 mg/kg) intravenous (IV) ketamine among older ED patients.
Methods
Multi-center, retrospective cohort study of adults ≥60 years who received IV ketamine for pain between 2018 and 2021. The primary outcome was pain improvement as measured by the Numerical Rating Scale (NRS) pain score within 60 min after administration. Secondary outcomes included adverse effects (early discontinuation, nausea, rescue benzodiazepines and intubation) and the need for rescue analgesia. Linear regression was used to assess the association between the change in NRS pain scores and dose after adjusting for baseline pain, requiring an additional dose of ketamine, and receiving an opioid.
Results
A total of 130 older adults received ketamine as an analgesic (37 high-dose, 93 low-dose). Median age was 69.2 years, 52 % were women, 40 % had a history of substance use disorder. Prior to ketamine, 76 % received alternate analgesics and 23 % antiemetics. Baseline mean pain score was lower in the high-dose group (6.7 vs. 8.3, difference −1.7 [95 % CI −2.6 to −0.7], p = 0.013). Change in NRS pain scores were similar between the high-dose and low-dose groups (−2.4 [95 % CI −3.6 to −1.3] vs −1.6 [95 % CI −2.2 to −0.9], p = 0.27). After adjustment for baseline pain score, the high-dose group had a larger reduction in pain scores (−1.3 [95 % CI −2.6 to −0.1], p = 0.042) and percent change of pain (−23.8 % [95 % CI −42.1 % to −5.4 %], p = 0.012). There was no significant difference in rates of rescue analgesia (35.1 % vs. 44.1 %, p = 0.35) or early discontinuation (29.7 % vs. 32.3 %, p = 0.78). Rates of adverse effects were similar.
Conclusion
High-dose and low-dose ketamine reduced pain scores in older adults. High-dose ketamine led to a greater reduction in pain scores, and there was no observed difference in adverse effects or the need for rescue analgesia. One-third needed discontinuation of ketamine in both groups.
背景和目的：氯胺酮正越来越多地被用于急诊科（ED）急性疼痛的治疗，包括老年人，因为老年人因药物不良反应而增加的风险更大。我们的目的是比较大剂量（≥0.3 毫克/千克）和小剂量（方法：多中心回顾性研究）氯胺酮的安全性和镇痛效果：多中心、回顾性队列研究，对象为 2018 年至 2021 年间接受静脉注射氯胺酮治疗疼痛的≥60 岁成人。主要结果为用药后 60 分钟内通过数字评分量表（NRS）疼痛评分衡量的疼痛改善情况。次要结果包括不良反应（提前停药、恶心、苯二氮卓类药物抢救和插管）以及对抢救性镇痛的需求。在对基线疼痛、需要额外剂量氯胺酮和接受阿片类药物进行调整后，采用线性回归评估 NRS 疼痛评分变化与剂量之间的关系：共有 130 名老年人接受了氯胺酮镇痛（37 名高剂量，93 名低剂量）。中位年龄为 69.2 岁，52% 为女性，40% 有药物使用障碍史。在使用氯胺酮之前，76%的患者接受了替代镇痛药，23%的患者接受了止吐药。大剂量组的基线平均疼痛评分较低（6.7 对 8.3，差异-1.7 [95 % CI -2.6 to -0.7]，P = 0.013）。高剂量组和低剂量组的 NRS 疼痛评分变化相似（-2.4 [95 % CI -3.6 to -1.3] vs -1.6 [95 % CI -2.2 to -0.9]，p = 0.27）。对基线疼痛评分进行调整后，大剂量组的疼痛评分（-1.3 [95 % CI -2.6 to -0.1]，p = 0.042）和疼痛变化百分比（-23.8 % [95 % CI -42.1 % to -5.4%]，p = 0.012）降低幅度更大。抢救性镇痛率（35.1% 对 44.1%，p = 0.35）和提前停药率（29.7% 对 32.3%，p = 0.78）没有明显差异。不良反应发生率相似：结论：大剂量和小剂量氯胺酮都能降低老年人的疼痛评分。大剂量氯胺酮能更大程度地降低疼痛评分，而在不良反应或镇痛抢救需求方面没有观察到差异。两组中都有三分之一的人需要停用氯胺酮。
{"title":"High- versus low-dose ketamine for analgesia in older adults in the emergency department","authors":"Alexander D. Ginsburg M.D. , Heather A. Heaton M.D., M.S. , Aeryana Beaudrie-Nunn Pharm.D., R.Ph. , Lucas Oliveira J. e Silva M.D., Ph.D. , Elizabeth Canterbury Pharm.D., R.Ph. , Caitlin S. Brown Pharm.D., R.Ph. , Allyson K. Palmer M.D., Ph.D. , Kristin C. Cole M.S. , Erin D. Wieruszewski Pharm.D., R.Ph. , Fernanda Bellolio M.D., M.Sc.","doi":"10.1016/j.ajem.2024.10.015","DOIUrl":"10.1016/j.ajem.2024.10.015","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Ketamine is increasingly being utilized in the management of acute pain in the emergency department (ED), including for older adults, a population at increased risk of adverse effects from medications. We aimed to compare the safety and analgesic effects of high-dose (≥0.3<!--> <!-->mg/kg) to low-dose (<0.3<!--> <!-->mg/kg) intravenous (IV) ketamine among older ED patients.</div></div><div><h3>Methods</h3><div>Multi-center, retrospective cohort study of adults ≥60<!--> <!-->years who received IV ketamine for pain between 2018 and 2021. The primary outcome was pain improvement as measured by the Numerical Rating Scale (NRS) pain score within 60<!--> <!-->min after administration. Secondary outcomes included adverse effects (early discontinuation, nausea, rescue benzodiazepines and intubation) and the need for rescue analgesia. Linear regression was used to assess the association between the change in NRS pain scores and dose after adjusting for baseline pain, requiring an additional dose of ketamine, and receiving an opioid.</div></div><div><h3>Results</h3><div>A total of 130 older adults received ketamine as an analgesic (37 high-dose, 93 low-dose). Median age was 69.2<!--> <!-->years, 52 % were women, 40 % had a history of substance use disorder. Prior to ketamine, 76 % received alternate analgesics and 23 % antiemetics. Baseline mean pain score was lower in the high-dose group (6.7 vs. 8.3, difference −1.7 [95 % CI −2.6 to −0.7], <em>p</em> = 0.013). Change in NRS pain scores were similar between the high-dose and low-dose groups (−2.4 [95 % CI −3.6 to −1.3] vs −1.6 [95 % CI −2.2 to −0.9], <em>p</em> = 0.27). After adjustment for baseline pain score, the high-dose group had a larger reduction in pain scores (−1.3 [95 % CI −2.6 to −0.1], <em>p</em> = 0.042) and percent change of pain (−23.8 % [95 % CI −42.1 % to −5.4 %], <em>p</em> = 0.012). There was no significant difference in rates of rescue analgesia (35.1 % vs. 44.1 %, <em>p</em> = 0.35) or early discontinuation (29.7 % vs. 32.3 %, <em>p</em> = 0.78). Rates of adverse effects were similar.</div></div><div><h3>Conclusion</h3><div>High-dose and low-dose ketamine reduced pain scores in older adults. High-dose ketamine led to a greater reduction in pain scores, and there was no observed difference in adverse effects or the need for rescue analgesia. One-third needed discontinuation of ketamine in both groups.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"86 ","pages":"Pages 120-124"},"PeriodicalIF":2.7,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481694","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}
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