American Journal of Emergency Medicine最新文献

{"title":"The impact of previous head trauma and history of cranial surgery on clinical findings in acute pediatric head injury","authors":"Salih Karakoyun ,&nbsp;Kudret Selki ,&nbsp;Ali Rıza Karakoyun ,&nbsp;Mustafa Boğan","doi":"10.1016/j.ajem.2026.01.005","DOIUrl":"10.1016/j.ajem.2026.01.005","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to identify independent predictors of intracranial pathology in children presenting with acute blunt head trauma, with a particular focus on patients who had a history of previous head trauma or cranial surgery and did not meet the PECARN (Pediatric Emergency Care Applied Research Network) criteria for cranial computed tomography (CCT). The study further sought to evaluate the impact of these historical factors on acute clinical findings and to inform more objective decision-making for CCT use in this specific subgroup.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, indications for cranial computed tomography (CCT) were determined based on PECARN criteria. Demographic characteristics, trauma mechanism, mode of presentation, symptoms, physical examination findings, scalp hematoma characteristics, Glasgow Coma Scale (GCS) scores, and CCT findings were recorded for all patients. Subgroup analyses were performed based on previous head trauma and cranial surgery history.</div></div><div><h3>Results</h3><div>Among 1495 enrolled patients, intracranial pathology (skull fracture and/or intracranial hemorrhage) was detected in 2.6% (<em>n</em> = 39) on CCT. Lower GCS (≤14), arrival by ambulance, vomiting, and abnormal mental status were significantly associated with intracranial pathology (all <em>p</em> &lt; 0.05). Temporal (OR: 16.35; 95% CI: 3.57–74.76; <em>p</em> &lt; 0.001), parietal (OR: 10.38; p &lt; 0.001), occipital (OR: 6.20; <em>p</em> = 0.008), and frontal (OR: 4.99; p &lt; 0.001) scalp hematomas were independently associated with intracranial pathology. Younger age (OR: 0.83; p &lt; 0.001) and lower GCS (OR: 0.67; <em>p</em> = 0.021) were also identified as independent risk factors for predicting intracranial injury. Among 361 patients (24.1%) with a history of head trauma and 16 patients (1.1%) with a history of cranial surgery, the rate of intracranial pathology was comparable to that of the general population (all <em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>The PECARN clinical decision rule allows clinicians to safely avoid unnecessary cranial CT imaging in low-risk cases owing to its high sensitivity and negative predictive value. Furthermore, previous head trauma or a history of cranial surgery was not found to increase the risk of new-onset acute intracranial injury.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 21-26"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982059","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":"A concise review investigating simulation modalities' effects on team efficiency, provider wellbeing, education & clinical outcomes","authors":"Yusra Othman ,&nbsp;Alexandra Kata B.S ,&nbsp;Keshavkiran Jayagopi B.S ,&nbsp;Sukriti Prashar B.S ,&nbsp;Cameron Nishida B.S ,&nbsp;Logan Samuel Rogers B.S ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.ajem.2026.01.002","DOIUrl":"10.1016/j.ajem.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Simulation is increasingly being used in trauma care to improve provider confidence, teamwork, and leadership skills in trauma situations. Additionally, the use of modern technology has introduced virtual reality simulation. However, simulations impact on trauma education, clinical practice, and cost effectiveness remain unclear. This review aims to synthesize current literature on the impact of simulation in trauma care education and clinical practice.</div></div><div><h3>Methods</h3><div>This concise review was performed utilizing five major databases: Cochrane, ProQuest, Google Scholar, PubMed, and Embase to identify relevant studies regarding the role of simulation modalities on team performance, medical education, patient outcomes, provider wellbeing, and cost-effectiveness.</div></div><div><h3>Results</h3><div>This concise review analyzed 1091 articles; 21 studies met inclusion criteria. Simulations demonstrated improved team performance by decreased communication response times (21 to 15 s) and increased teamwork (4.06/5 to 4.40/5). Leadership behavior significantly improved (11.29 vs. 7.23; d = 0.92). Studies demonstrated virtual reality (VR) was non-inferior to mannequins for trauma scores (163.1 vs. 163.2), higher VR assessment scores (158.4 vs. 134.2), and AI serious games reducing under-triage by ∼18%. VR was 40% cheaper than mannequins and reduced per-participant costs ($296 vs $149). Simulation improved completion times (251 vs. 497 s), success rates (100% vs. 64%), and diagnostic accuracy (<em>P</em> = .01) in education. Indirect patient outcomes included faster secondary surveys (14 min vs 6 min) and CT prep times (23 min vs 16 min).</div></div><div><h3>Conclusion</h3><div>Simulation-based training is an effective tool in improving trauma care as evidence throughout the studies showed vast improvements in leadership, communication, efficiency in care, and provider confidence. The findings from this study demonstrate that the implementation of VR, in particular, showed tremendous educational benefits and can be a viable strategy to conventional simulation modalities due to its cost effectiveness.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 27-33"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982060","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":"Association of pre-intubation bag-valve-mask ventilation with hypoxemia and regurgitation in the ED: A multicenter cohort study","authors":"Jin Takahashi ,&nbsp;Haruka Tsuji ,&nbsp;Hiraku Funakoshi ,&nbsp;Hiroshi Okamoto ,&nbsp;Yusuke Hagiwara ,&nbsp;Hiroko Watase ,&nbsp;Takao Ono ,&nbsp;Sakina Kadomatsu ,&nbsp;Tatsuhiko Hata ,&nbsp;Kohei Hasegawa ,&nbsp;Takashi Shiga ,&nbsp;Tadahiro Goto ,&nbsp;Japanese Emergency Medicine Network Investigators","doi":"10.1016/j.ajem.2026.01.012","DOIUrl":"10.1016/j.ajem.2026.01.012","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness of pre-intubation bag-valve-mask (BVM) ventilation for rapid sequence intubation (RSI) in the emergency department (ED) remains uncertain. In this study, we investigated whether pre-intubation BVM ventilation was associated with a lower risk of peri-intubation hypoxemia.</div></div><div><h3>Methods</h3><div>We analyzed data from a multicenter prospective observational study conducted in 14 EDs across Japan. Adult (≥18 years) patients who underwent RSI between 2020 and 2023 were included. The primary outcome was peri-intubation hypoxemia (SpO₂ &lt;90%), and the secondary outcome was regurgitation. Missing data were imputed using multiple imputations. Propensity scores were estimated using predefined covariates (age, sex, body mass index, COVID-19, modified LEMON score, intubation indication, device, intubator's specialty, preoxygenation method, pre-intubation SpO₂, and participating institutions). Treatment effects were evaluated using stabilized inverse probability of treatment weighting (IPTW) and sensitivity analysis with 1:1 matching.</div></div><div><h3>Results</h3><div>Among the 1481 patients, 589 (40%) received pre-intubation BVM. Overall, 204 patients (14%) experienced peri-intubation hypoxemia. The BVM group had a lower unadjusted risk of hypoxemia than the non-BVM group (10% vs. 16%; <em>p</em> &lt; 0.001). However, after stabilized IPTW, BVM ventilation was not significantly associated with hypoxemia (adjusted risk difference −3.2%; 95% CI, −7.8% to 1.5%). Sensitivity analysis using 1:1 matching yielded consistent results (risk difference 0.9%; 95% CI, −3.8% to 5.6%). There was no significant difference in the incidence of regurgitation between the BVM and non-BVM groups (1% vs. 1%; <em>p</em> = 0.24).</div></div><div><h3>Conclusion</h3><div>In this multicenter study, pre-intubation BVM ventilation during RSI in the ED was not associated with a reduced risk of peri-intubation hypoxemia.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 108-113"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038939","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":"Evaluation of patients admitted to the pediatric emergency departments due to suicide attempts: A multicenter study from Türkiye","authors":"Hande Yigit ,&nbsp;Ahmet Ziya Birbilen ,&nbsp;Burcu Akbaba ,&nbsp;Cansu Demirel ,&nbsp;Alper Çiçek ,&nbsp;Emel Berksoy ,&nbsp;Berke Mutlu ,&nbsp;Göksel Vatansever ,&nbsp;Deniz Tekin ,&nbsp;Sevcan Bilen ,&nbsp;Hayri Levent Yılmaz ,&nbsp;Gamze Gökulu ,&nbsp;Ali Tunç ,&nbsp;İlknur Akansu ,&nbsp;Emel Ulusoy ,&nbsp;Durgül Yılmaz ,&nbsp;Murat Duman ,&nbsp;İlknur Fidancı ,&nbsp;Medine Ayşin Taşar ,&nbsp;Murat Doğan ,&nbsp;Özlem Tekşam","doi":"10.1016/j.ajem.2025.12.044","DOIUrl":"10.1016/j.ajem.2025.12.044","url":null,"abstract":"<div><h3>Background</h3><div>Suicide is a major cause of morbidity and mortality in adolescents and is increasingly recognized among younger children. Pediatric emergency departments (EDs) are critical points for the identification and management of suicide attempts. This study aimed to evaluate the demographic and clinical characteristics, methods, and temporal trends of suicide attempts among children and adolescents presenting to pediatric EDs in Türkiye.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, multicenter study across 29 pediatric EDs from July 1, 2017, to June 30, 2022. Patients aged 8–18 years with a confirmed suicide attempt were included. Data collected included demographics, methods, psychiatric history, prior attempts, medications used in self-poisoning, psychiatric consultations, and outcomes. Statistical analyses included chi-square and Mann–Whitney <em>U</em> tests.</div></div><div><h3>Results</h3><div>During the study period, 6004 suicide attempt presentations were identified among 9,736,825 ED visits (0.5/1000). The median age was 15 years (IQR: 14–16), with 78.8% female (female-to-male ratio 3.7:1). Most patients (92.9%) were aged 13–18 years. Self-poisoning was the predominant method (95.4%), commonly involving NSAIDs, paracetamol, SSRIs, and atypical antipsychotics; 23.5% ingested their own medications, 76.2% of which were psychotropics. A known psychiatric disorder was present in 36.4%, and 16.4% had a prior suicide attempt. Psychiatric consultation was obtained in 73% of cases. Hospitalization occurred in 89.8%, with 15.5% requiring intensive care. Eleven deaths were recorded.</div></div><div><h3>Conclusions</h3><div>Suicide attempts among children and adolescents are a significant and ongoing public health problem in Türkiye, with self-poisoning as the dominant method. The findings underscore the need for targeted prevention strategies, safe medication storage, and strengthened psychiatric services in pediatric EDs to improve outcomes for this high-risk population.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 159-165"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954064","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":"Design and development of a Bayesian risk assessment model for bacterial infection (BRAIN) in patients admitted to hospital from ED","authors":"Sandeep Tripathi MD, MS ,&nbsp;Collins Odhiambo PhD ,&nbsp;Jessica Haas MS2","doi":"10.1016/j.ajem.2026.01.001","DOIUrl":"10.1016/j.ajem.2026.01.001","url":null,"abstract":"<div><h3>Background</h3><div>C-reactive Protein (CRP) and Procalcitonin (PCT) are commonly used in conjunction with clinical judgment to assess the risk of bacterial infection. Traditional frequentist methods do not allow the incorporation of clinical suspicion into risk estimation. This study aimed to describe clinical phenotypes based on CRP and PCT levels and develop a Bayesian model to estimate the posterior probability of bacterial infection in emergency department (ED) patients.</div></div><div><h3>Methods</h3><div>Retrospective study across 15 hospitals (2019–2023), including patients admitted from the ED with CRP, PCT, and bacterial cultures obtained within 24 h. Patients categorized into four groups: both markers normal (A), both abnormal (B), only PCT abnormal (C), and only CRP abnormal (D). Bayesian logistic regression models developed using priors of 0.3, 0.5, and 0.7 to reflect varying levels of clinical suspicion. Predictors included age, CRP, PCT, fever, white blood cell count, ESR, ferritin, and viral positivity.</div></div><div><h3>Results</h3><div>Among 10,397 patients (median age, 65; 909 &lt; 18 years), 27.5% had positive cultures, with an 11.2% mortality rate. Culture positivity and mortality were highest in group B (35%), followed by D (24%). Posterior probabilities of infection under high, moderate, and low suspicion priors were 25%, 17.5%, and 10.6%, respectively. PCT was the strongest predictor, with a one log-unit increase associated with a 45% rise in infection probability. AUROC was 0.64; AUPRC 0.43. A R Shiny calculator (BRAIN) was created for bedside application.</div></div><div><h3>Conclusion</h3><div>A Bayesian model incorporating inflammatory markers and clinical judgment provides individualized estimates of bacterial infection risk at the bedside.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 34-38"},"PeriodicalIF":2.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031743","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":"Vonoprazan-associated hypomagnesemia presenting to the emergency department with altered mental status and a suspected seizure","authors":"Noriyuki Okamoto ,&nbsp;Shinsuke Onishi ,&nbsp;Tatsuo Manabe ,&nbsp;Shota Satoh ,&nbsp;Satoshi Nara","doi":"10.1016/j.ajem.2025.12.034","DOIUrl":"10.1016/j.ajem.2025.12.034","url":null,"abstract":"<div><div>An older woman without seizure history presented to the emergency department (ED) after an unwitnessed loss of consciousness, with persistent altered mental status. Initial tests showed profound hypomagnesemia (0.6 mg/dL) with low ionized calcium; lactate declined rapidly. Urine showed low magnesium with a fractional excretion of magnesium (FEMg) ≤2.8 %. She had been taking long-term vonoprazan, a potassium-competitive acid blocker (P-CAB). Perfusion MRI with arterial spin labeling (ASL) showed right-hemispheric hyperperfusion, while conventional sequences showed only a chronic cerebellar infarct. These findings resulted in hospital admission with a suspected postictal state. Vonoprazan was discontinued on admission, and magnesium and calcium were repleted. During hospitalization, she improved steadily and returned to baseline within one week. The initial inpatient electroencephalogram showed diffuse low-amplitude slowing without definite epileptiform discharges; by Day 5 the background was more organized. On Day 8, single-photon emission computed tomography (SPECT) showed reduced perfusion in the previously hyperperfused region. QTc peaked at 603 ms and shortened as electrolytes normalized. No antiseizure medication was started, and outpatient labs remained stable on alternative acid suppression. This case suggests that hypomagnesemia associated with a P-CAB, similar to proton pump inhibitor–associated cases, can be a reversible cause of seizure-related ED presentations. Supported by prior case reports and the absence of other culprit drugs or non-drug losses, it underscores early magnesium testing, prompt magnesium and calcium repletion, and medication review with withdrawal of the suspected agent and follow-up monitoring.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 131-134"},"PeriodicalIF":2.2,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927294","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 medicine updates: Pediatric brief resolved unexplained event","authors":"Brit Long MD ,&nbsp;Anna M. DePompolo MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.12.036","DOIUrl":"10.1016/j.ajem.2025.12.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Brief resolved unexplained events (BRUEs) can occur in a large number of pediatric patients, with most having a benign etiology. However, in many cases, these can result in unnecessary evaluations and admissions among low-risk patients. Therefore, it is critical for clinicians to be aware of the current evidence regarding BRUE in the emergency department (ED) setting.</div></div><div><h3>Objective</h3><div>This paper evaluates key evidence-based updates concerning pediatric BRUE for the emergency clinician.</div></div><div><h3>Discussion</h3><div>A BRUE is defined as a clinical entity occurring in an infant less than 1 year of age that an observer reports as sudden, brief (&lt; 1 min), and now resolved episode with no explanation and accompanied by at least one of the following: Change in breathing, pallor or cyanosis, change in tone, or altered level of consciousness. BRUEs often cause significant distress for both caregivers and medical professionals. Having an approach to risk-stratification and engaging in shared decision-making with caregivers can help guide clinicians during these encounters. Clearly identifying what qualifies as a low-risk event can minimize unnecessary testing while ensuring that children who do not meet low-risk criteria receive an appropriately focused evaluation</div></div><div><h3>Conclusion</h3><div>An understanding of the current literature concerning BRUE can assist emergency clinicians and improve the care of these patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 141-146"},"PeriodicalIF":2.2,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927364","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":"Deployment of automated external defibrillators by a supermarket chain","authors":"Kenneth A. Scheppke MD ,&nbsp;Paul E. Pepe MD, MPH ,&nbsp;Remle P. Crowe PhD, NREMT ,&nbsp;Junwei Jiang MPH ,&nbsp;Eric K. Scheppke DO ,&nbsp;Steve A. McCoy MS","doi":"10.1016/j.ajem.2025.12.033","DOIUrl":"10.1016/j.ajem.2025.12.033","url":null,"abstract":"<div><h3>Objective</h3><div>Automated external defibrillator (AED) installation has become commonplace in various public locations. However, AED retrievals involving actual shocks may still be very infrequent in many settings despite significant initial/ongoing costs for equipment acquisition, pad/battery expiry replacements and initial/refresher training for designated rescuers. The purpose here was to track frequencies of AED/CPR applications and shocks delivered following AED installations and related employee training throughout a multi-state retail store chain.</div></div><div><h3>Design</h3><div>Prospective 92-month observational study conducted across a large retail chain to document frequencies of AED device retrievals/applications, CPR performance, shocks delivered, and respective patient and scene characteristics.</div></div><div><h3>Setting</h3><div>1358 retail stores and two-dozen warehouses/offices located in multiple states.</div></div><div><h3>Subjects</h3><div>Persons collapsing with possible cardiopulmonary arrest on corporate properties.</div></div><div><h3>Interventions</h3><div>AED installation and on-going training of employees in CPR/AED use.</div></div><div><h3>Results</h3><div>Among 396 reported AED retrievals/applications (&gt;4/month), 75 % occurred inside stores and the remainder in parking lots/sidewalks/other venues. Among these, 294 persons (ages 1–93 years; 74 % men) received basic CPR and/or AED shocks (&gt;3 cases/month), performed most often by store employees. CPR-patient median age was 60 years (IQR:45–70) for men and 58 (IQR:38–68) for women. AEDs delivered 157 shocks during 112 events (&gt;1 case/month); 71 % involved one shock, 20 % two, 9 % three and one involved four shocks. Documented ages for shocked patients (80 % men) ranged 32–90 years with men's median age 62 (IQR:55–70) and women's 61 (IQR:55–65). In one state's retrospective sub-analysis of shockable cases, hospital outcome records were matched to 37 patients with the majority (at least 19 confirmed) surviving to successful hospital discharge.</div></div><div><h3>Conclusions</h3><div>For this multi-state retail chain, AED installation and employee CPR/AED training appeared to be well-justified considering that AEDs were retrieved/applied frequently systemwide, quite often involving defibrillatory shocks that were associated with survival for many patients. Investigators encourage comparable businesses to adopt/study similar employee-based programs nationwide.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 147-151"},"PeriodicalIF":2.2,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927292","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":"Extended thrombolysis in acute ischemic stroke: A Bayesian meta-analysis and umbrella review","authors":"Ravi Garg ,&nbsp;James M. Brophy","doi":"10.1016/j.ajem.2025.12.043","DOIUrl":"10.1016/j.ajem.2025.12.043","url":null,"abstract":"<div><h3>Background</h3><div>For acute ischemic stroke, national practice guidelines recommend thrombolysis within a 4.5-h time window from symptom onset. Randomized trials with advanced neuroimaging have now examined extended thrombolytic time windows, and multiple meta-analyses have provided positive endorsements. However, these previous meta-analyses have not fully exploited the available data, examined quality of life, or reported the probability of clinically meaningful effects. This meta-analysis addresses these potential shortcomings.</div></div><div><h3>Methods</h3><div>We performed a i) systematic literature review up to August 1, 2025, of all randomized controlled trials comparing thrombolysis (alteplase or tenecteplase) with the assistance of advanced neuroimaging to standard, non-thrombolytic therapy in acute ischemic stroke patients with unknown time or beyond 4.5 h since symptom onset and ii) an umbrella review of previous meta-analyses addressing this issue. Our primary outcome was the mean difference in the utility-weighted modified Rankin Scale (uw-mRS) scores. Secondary outcomes were the absolute risk difference (ARD) for minor disability status and mortality. Bayesian random effects meta-analyses were performed assuming a normal-normal hierarchical model with non-informative priors, which permitted probability calculations for benefit, harm, and regions of practical equivalence (ROPE).</div></div><div><h3>Results</h3><div>Six original randomized trials of extended thrombolysis and 7 meta-analyses were identified but none had considered a uw-mRS score or reported direct probability statements regarding benefit or harm. Our primary uw-mRS outcome showed a ROPE probability of 99 % with only a 1 % probability of a clinically beneficial response with extended alteplase. There was also a 72 % probability that mortality increased by at least 1 life / 100 treated with extended thrombolysis.</div></div><div><h3>Conclusions</h3><div>In contrast with previous publications, this meta-analysis and umbrella review highlights the uncertainty of clinical benefits from extended thrombolysis treatment windows and the need for further high-quality research before this treatment is accepted into routine practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 166-172"},"PeriodicalIF":2.2,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967852","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":"Utilizing an ultrasound-guided nerve block for management of sciatica in the ED: A national simulation-based cost savings analysis","authors":"Lachlan Driver ,&nbsp;Carrie D. Walsh ,&nbsp;Caroline Schissel ,&nbsp;David A. Meguerdichian ,&nbsp;Nicole M. Duggan ,&nbsp;Christopher W. Baugh ,&nbsp;Andrew J. Goldsmith","doi":"10.1016/j.ajem.2025.12.045","DOIUrl":"10.1016/j.ajem.2025.12.045","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute sciatica is a frequent cause of emergency department (ED) visits and hospital admissions. We evaluated the potential national cost savings of using ultrasound-guided transgluteal sciatic nerve block (TGSNB) in patients with acute sciatica who would otherwise be admitted.</div></div><div><h3>Methods</h3><div>We performed a Monte Carlo simulation with 10,000 iterations to compare the costs of usual care versus TGSNB targeted to patients who would otherwise require admission. Model inputs included national ED visits for acute sciatica, pre-block admission rates, admission costs, and procedural costs. The primary outcomes were per-patient savings among admitted patients and projected annual national savings.</div></div><div><h3>Results</h3><div>Targeted use of TGSNB in admission-eligible patients yielded mean per-patient savings of $11,974 (95 % UI: $6702–$18,527). Extrapolated nationally, this corresponds to $45.8 M (95 % UI $22.9 M–$74.0 M) in annual savings. Block costs were modest ($0.67 M (95 % UI: $0.46 M–$0.93 M)), and sensitivity analysis identified admission rates and costs as the main drivers of savings.</div></div><div><h3>Conclusions</h3><div>Adoption of TGSNB for severe sciatica in the ED may reduce admissions and generate meaningful healthcare savings. Prospective studies are needed to confirm clinical efficacy and implementation feasibility.</div><div>Capsule Summary:<ul><li><span>1.</span><span><div>What is already known on this topic:</div><div>Ultrasound-guided transgluteal sciatic nerve block (TGSNB) can rapidly relieve radicular pain; ED adoption is limited.</div></span></li><li><span>2.</span><span><div>What question this study addressed:</div><div>What national cost savings could result if EDs target TGSNB to patients with acute sciatica who would otherwise be admitted?</div></span></li><li><span>3.</span><span><div>What this study adds to our knowledge:</div><div>A Monte Carlo model (10,000 iterations) projects $11,974 per-treated-patient savings and $45.8 M annual national savings, with admission rate and admission cost as primary drivers.</div></span></li><li><span>4.</span><span><div>How this is relevant to clinical practice:</div><div>Targeted ED TGSNB could reduce admissions and overall costs while supporting opioid-sparing pain management.</div></span></li></ul></div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 135-140"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927290","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}