American Journal of Emergency Medicine最新文献

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Comment on "Depression after traumatic brain injury: A systematic review and meta-analysis". 评论 "创伤性脑损伤后的抑郁症：系统回顾和荟萃分析 "发表评论。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-12 DOI: 10.1016/j.ajem.2024.10.018

Akshat Kumar, Muhammed Shabil, Sanjit Sah

引用次数: 0

The importance of comprehensive documentation of snakebite envenoming: Is "the 'devil' in the details" or in their deficiency? 全面记录毒蛇咬伤的重要性：是 "细节决定成败 "还是 "细节决定成败"？

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-12 DOI: 10.1016/j.ajem.2024.10.024

Ahmad Khaldun Ismail, Scott A Weinstein, David A Warrell

引用次数: 0

A clinical prediction model for safe early discharge of patients with an infection at the emergency department 急诊科感染患者安全提前出院的临床预测模型。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-11 DOI: 10.1016/j.ajem.2024.10.014

Merijn C.F. Mulders , Sevilay Vural , Lisanne Boekhoud , Tycho J. Olgers , Jan C. ter Maaten , Hjalmar R. Bouma

Background

Every hospital admission is associated with healthcare costs and a risk of adverse events. The need to identify patients who do not require hospitalization has emerged with the profound increase in hospitalization rates due to infectious diseases during the last decades, especially during the COVID-19 pandemic. This study aimed to identify predictors of safe early discharge (SED) in patients presenting to the emergency department (ED) with a suspected infection meeting the Systemic Inflammatory Response Syndrome (SIRS) criteria.

Methods

We conducted a prospective cohort study on adult non-trauma patients with a suspected infection and at least two SIRS criteria. We defined SED as hospital discharge within 24 h (e.g. direct ED discharge or rapid ward discharge) without disease-related readmission to our hospital or death during the first seven days. A prediction model for SED was developed using multivariate logistic regression analysis and tested with k-fold cross-validation.

Results

We included 1381 patients, of whom 1027 (74.4 %) were hospitalized for longer than 24 h or re-admitted within seven days and 354 (25.6 %) met SED criteria. Parameters associated with SED were relatively young age, absence of comorbidities, living independently, yellow or green triage urgency, lack of ambulance transport or general practitioner referral, normal clinical impression scores, and risk scores (i.e., qSOFA, PIRO, MEDS, NEWS, and SIRS), normal vital sign measurements and absence of kidney and respiratory failure. The model performance metrics showed an area under the curve of 0.824. The validation showed a minimal drop in performance and indicated a good fit.

Conclusion

We developed and validated a model to identify patients with an infection at the ED who can be safely discharged early.

背景：每次住院都会产生医疗费用和不良事件风险。过去几十年间，尤其是在 COVID-19 大流行期间，传染病导致的住院率大幅上升，因此需要识别无需住院治疗的患者。本研究旨在确定急诊科（ED）就诊的疑似感染患者中符合全身炎症反应综合征（SIRS）标准的安全提前出院（SED）预测因素：我们对疑似感染且至少符合两项 SIRS 标准的成年非外伤患者进行了一项前瞻性队列研究。我们将 SED 定义为 24 小时内出院（如直接急诊室出院或快速病房出院），且在头七天内没有因疾病再次入院或死亡。我们利用多变量逻辑回归分析建立了 SED 预测模型，并通过 k 倍交叉验证进行了测试：我们共纳入了 1381 名患者，其中 1027 人（74.4%）住院时间超过 24 小时或在七天内再次入院，354 人（25.6%）符合 SED 标准。与 SED 相关的参数包括：年龄相对较小、无合并症、独立生活、黄色或绿色分诊紧急程度、无救护车转运或全科医生转诊、临床印象评分和风险评分（即 qSOFA、PIRO、MEDS、NEWS 和 SIRS）正常、生命体征测量正常以及无肾衰竭和呼吸衰竭。模型性能指标的曲线下面积为 0.824。验证结果表明，模型的性能下降很小，拟合效果良好：我们开发并验证了一个模型，用于识别可安全提前出院的急诊室感染患者。

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引用次数: 0

External evaluation of Brain Injury Guideline (BIG) low risk criteria for traumatic brain injury 对《脑损伤指南》（BIG）创伤性脑损伤低风险标准进行外部评估

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-11 DOI: 10.1016/j.ajem.2024.10.013

Elena A. Puccio BS , Joshua B. Brown MD MSc , Clifton W. Callaway MD PhD , Adam N. Frisch MD , David O. Okonkwo MD PhD , David J. Barton MD

Background

Fewer than 20 % of traumatic brain injury (TBI) cases with traumatic intracranial hemorrhage (ICH) result in clinical deterioration. The Brain Injury Guideline (BIG) criteria were published in 2014 and categorize patients with TBI into three risk groups (BIG 1, 2, and 3) based on CT scan findings, neurological examination, anti-coagulant/platelet medications, and intoxication. Early data is promising, suggesting no instances of neurosurgical intervention or death in the low-risk BIG1 category within 30 days. We sought to externally validate the BIG criteria and identify patients with TBI at low risk of clinical deterioration. We hypothesized that patients meeting the BIG1 low risk criteria have less than a 1 % risk of death or neurosurgical intervention.

Methods

We performed a retrospective cohort study of a level 1 trauma center's trauma registry records from 2011 to 2022 to identify patients with head trauma. We abstracted demographics, injury characteristics, clinical course, CT imaging results, and outcomes, and we categorized patients according to the BIG criteria. The Clopper-Pearson Exact method was used to estimate outcome frequency with confidence intervals. The primary outcome was death or neurosurgical intervention within 30 days. Secondary outcomes included progression on repeat head CT (RHCT), ICU admission with neurocritical care intervention, and TBI-related hospital readmission within 30 days.

Results

A total of 1714 patients with TBI with ICH were identified from the trauma registry. 325 patients were excluded due to missing data, pregnancy, incarceration, polytrauma, or GCS < 13, leaving 1389 for analysis. 193 patients (13.9 %) were classified as BIG1. No patients classified as BIG1 experienced the primary outcome measures of death or neurosurgical intervention (95 % confidence interval [CI]: 0 %–1.9 %). The number of patients who experienced the secondary outcome measures of progression on RHCT, ICU admission with neurocritical care intervention, or TBI-related hospital readmission within 30 days were 9 (4.7 %, 95 % CI: 2.2 %–8.7 %), 1 (0.5 %, 95 % CI: 0 %–2.9 %), and 4 (2.1 %, 95 % CI: 0.6 %–5.2 %), respectively.

Conclusion

BIG1 criteria identified a low-risk subset of patients with TBI with ICH. However, an upper 95 % CI of 1.9 % does not exclude the risk of neurologic deterioration being <1 %. Validation of these criteria in larger cohorts is warranted.

背景在创伤性脑损伤（TBI）病例中，只有不到 20% 的创伤性颅内出血（ICH）会导致临床病情恶化。脑损伤指南（BIG）标准于 2014 年发布，根据 CT 扫描结果、神经系统检查、抗凝血剂/血小板药物和中毒情况将 TBI 患者分为三个风险组（BIG 1、2 和 3）。早期数据显示，低风险 BIG1 组在 30 天内没有神经外科干预或死亡病例。我们试图从外部验证 BIG 标准，并确定临床恶化风险较低的创伤性脑损伤患者。我们假设符合 BIG1 低风险标准的患者的死亡或神经外科干预风险低于 1%。方法我们对一级创伤中心 2011 年至 2022 年的创伤登记记录进行了回顾性队列研究，以确定头部创伤患者。我们摘录了人口统计学特征、损伤特征、临床过程、CT成像结果和预后，并根据BIG标准对患者进行了分类。我们采用 Clopper-Pearson 精确法来估计结果频率和置信区间。主要结果是 30 天内死亡或神经外科干预。次要结果包括重复头部 CT（RHCT）的进展、入住 ICU 并接受神经重症监护干预以及 30 天内与 TBI 相关的再入院治疗。由于数据缺失、怀孕、监禁、多发性创伤或 GCS < 13 等原因，325 名患者被排除在外，剩下 1389 名患者用于分析。193名患者（13.9%）被归类为BIG1。没有归类为 BIG1 的患者出现死亡或神经外科干预（95% 置信区间 [CI]：0 %-1.9 %）这一主要结果指标。30天内出现RHCT进展、入住ICU并接受神经重症监护干预或TBI相关再入院等次要结局指标的患者人数分别为9人（4.7%，95% CI：2.2%-8.7%）、1人（0.5%，95% CI：0%-2.9%）和4人（2.1%，95% CI：0.6%-5.2%）。然而，1.9%的95% CI上限并不能排除神经功能恶化的风险。有必要在更大的群体中验证这些标准。

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引用次数: 0

Regarding 'Development of prognostic models for predicting 90-day neurological function and mortality after cardiac arrest'. 关于 "开发预测心脏骤停后 90 天神经功能和死亡率的预后模型"。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-10 DOI: 10.1016/j.ajem.2024.10.005

Tingting Jin, Yan Shen

引用次数: 0

The author replies-sample size issue and overfitting. 作者回答说--样本大小问题和过度拟合问题。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-10 DOI: 10.1016/j.ajem.2024.10.012

Guangqian Ding, Yi Chen

引用次数: 0

Antiseizure medication practices in the adult traumatic brain injury patient population 成年脑外伤患者的抗癫痫药物治疗方法。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-09 DOI: 10.1016/j.ajem.2024.10.009

Aubree J. Houston PharmD , Charles S. Wilson Jr PharmD, BCCCP , Brian W. Gilbert PharmD, MBA, BCCCP, FCCM, FNCS

Background

Antiseizure medication (ASM) use in traumatic brain injuries (TBI) reduces the risk of early post-traumatic seizure (PTS). Agent selection and dosing strategies remain inconsistent among trauma centers in the United States.

Objective

The purpose of this study was to identify and characterize the most common PTS prophylaxis regimens among adult trauma centers in brain injured patients throughout the United States.

Methods

A survey assessing PTS prophylaxis practices of trauma centers was created and distributed in March 2023. Data was then evaluated based on practice site demographics and various sub-group analyses including academic vs. non-academic centers, trauma center designation, geographic practice location, and total number of TBI activations annually.

Results

A total of 84 different trauma centers responded of which, 82 (97.6 %) respondents reporting levetiracetam (LEV) as their ASM of choice for PTS prophylaxis. The most reported dosing regimen included an initial dose of 1000 mg (n = 24, 46.2 %) followed by a maintenance dose of 500 mg BID (n = 39, 48.8 %). There were no statistically significant differences in practice between sub-group analyses evaluated.

Conclusion and relevance

This multicenter, survey study, identified variances in practice for PTS prophylaxis for brain injured patients throughout the U.S. Interestingly, the overwhelming majority of trauma centers do not conform to the Brain Trauma Foundation guidelines and utilize LEV as their agent of choice. Further studies should evaluate ideal patient selection for PTS prophylaxis, optimal agent, and dosing schemes within this cohort.

背景：在创伤性脑损伤（TBI）中使用抗癫痫药物（ASM）可降低早期创伤后癫痫发作（PTS）的风险。美国各创伤中心的药剂选择和剂量策略仍不一致：本研究旨在确定和描述美国各地成人创伤中心对脑损伤患者最常用的 PTS 预防方案：方法： 2023 年 3 月，我们制作并分发了一份调查表，评估创伤中心的 PTS 预防方法。然后根据实践地点的人口统计学特征和各种分组分析（包括学术中心与非学术中心、创伤中心的指定、实践地点的地理位置和每年 TBI 激活的总次数）对数据进行评估：共有 84 个不同的创伤中心做出了回复，其中 82 个（97.6%）回复者称左乙拉西坦（LEV）是其预防创伤后应激障碍的首选 ASM。报告最多的给药方案包括初始剂量 1000 毫克（24 人，占 46.2%），然后是维持剂量 500 毫克，每日两次（39 人，占 48.8%）。在所评估的分组分析中，各组之间的做法没有明显的统计学差异：有趣的是，绝大多数创伤中心并不遵守脑外伤基金会的指导方针，而是将 LEV 作为首选药物。进一步的研究应评估 PTS 预防的理想患者选择、最佳药剂和剂量方案。

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引用次数: 0

Basic resuscitation training for prison inmates in Khon Kaen Province, Thailand. 为泰国孔敬府的监狱囚犯提供基本复苏培训。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-09 DOI: 10.1016/j.ajem.2024.10.011

Supaluck Chaleepad, Nutsara Wanla, Tawatchai Impool, Shinji Nakahara

引用次数: 0

Corrigendum to "Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine", [The American Journal of Emergency Medicine, Volume 85, November 2024, Pages 130-139]. Tranq Dope：美国急诊医学杂志》，第 85 卷，2024 年 11 月，第 130-139 页。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-08 DOI: 10.1016/j.ajem.2024.10.006

Kory London, Yutong Li, Jennifer L Kahoud, Davis Cho, Jamus Mulholland, Sebastian Roque, Logan Stugart, Jeffrey Gillingham, Elias Borne, Benjamin Slovis

引用次数: 0

Diverticulitis evaluation and management among United States emergency departments over an eight-year period 八年间美国急诊科对憩室炎的评估和处理。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-10-05 DOI: 10.1016/j.ajem.2024.10.002

Michael Gottlieb MD , Emily Wusterbarth MD , Eric Moyer MD , Kyle Bernard MD

Introduction

Diverticulitis is a common reason for presentation to the Emergency Department (ED). However, as imaging options, risk stratification tools, and antibiotic options have expanded, there is a need for current data on the changes in incidence, computed tomography (CT) performance, antibiotic usage, and disposition over time.

Methods

This was a cross-sectional study of ED patients with a diagnosis of diverticulitis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, all ED visits for acute diverticulitis were identified using ICD-10 codes. Outcomes included total ED presentations for diverticulitis, admission rates, CTs performed, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients.

Results

There were 186,138,130 total ED encounters, with diverticulitis representing 927,326 (0.50 %). The rate of diverticulitis diagnosis increased from 0.40 % to 0.56 % over time. The admission rate declined over time from 33.6 % to 27.7 %, while the CT rate rose from 83.0 % to 92.6 %. Among those discharged, 90.4 % received an antibiotic, which remained consistent over time. Metronidazole (55.1 %) and ciprofloxacin (40.8 %) were the most commonly prescribed antibiotics, followed by amoxicillin-clavulanate (36.1 %). Among those admitted, most received either metronidazole (62.0 %), a fluoroquinolone (40.4 %), a third-generation cephalosporin (18.9 %), or a penicillin-based agent (38.1 %). Among both discharged and admitted patients, there was a marked shift to penicillin-based agents as the primary antibiotic regimen.

Conclusion

Diverticulitis remains a common ED presentation, with a gradually rising incidence over time. Admission rates have decreased, while CT imaging has become more common. Most patients receive antibiotics, though the specific antibiotic has shifted in favor of penicillin-based agents. These findings can provide key benchmarking data and inform future initiatives to guide imaging and antibiotic use.

简介憩室炎是急诊科（ED）的常见病因。然而，随着影像学选择、风险分层工具和抗生素选择的增加，需要有关发病率、计算机断层扫描（CT）表现、抗生素使用和处置随时间变化的最新数据：这是一项横断面研究，研究对象是 2016 年 1 月 1 日至 2023 年 12 月 31 日期间诊断为憩室炎的急诊室患者。利用 Epic Cosmos 数据库，使用 ICD-10 编码识别了所有急性憩室炎急诊就诊患者。结果包括急诊室憩室炎就诊总人数、入院率、CT检查、门诊抗生素处方以及急诊室对入院患者使用的抗生素：结果：急诊室就诊总人数为 186 138 130 人次，其中憩室炎就诊人数为 927 326 人次（0.50%）。随着时间的推移，憩室炎的诊断率从 0.40% 上升到 0.56%。入院率从 33.6% 下降到 27.7%，而 CT 诊断率从 83.0% 上升到 92.6%。在出院患者中，90.4% 的人使用了抗生素，这一比例在一段时间内保持不变。甲硝唑（55.1%）和环丙沙星（40.8%）是最常用的抗生素，其次是阿莫西林-克拉维酸（36.1%）。在入院患者中，大多数人使用甲硝唑（62.0%）、氟喹诺酮类（40.4%）、第三代头孢菌素（18.9%）或青霉素类药物（38.1%）。在出院和入院患者中，青霉素类药物作为主要抗生素治疗方案的趋势明显：结论：憩室炎仍然是急诊科的常见病，随着时间的推移，发病率逐渐上升。入院率有所下降，而 CT 成像检查变得更加常见。大多数患者会接受抗生素治疗，但具体的抗生素已转向青霉素类药物。这些发现可以提供关键的基准数据，并为未来指导成像和抗生素使用的措施提供参考。

{"title":"Diverticulitis evaluation and management among United States emergency departments over an eight-year period","authors":"Michael Gottlieb MD , Emily Wusterbarth MD , Eric Moyer MD , Kyle Bernard MD","doi":"10.1016/j.ajem.2024.10.002","DOIUrl":"10.1016/j.ajem.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Diverticulitis is a common reason for presentation to the Emergency Department (ED). However, as imaging options, risk stratification tools, and antibiotic options have expanded, there is a need for current data on the changes in incidence, computed tomography (CT) performance, antibiotic usage, and disposition over time.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study of ED patients with a diagnosis of diverticulitis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, all ED visits for acute diverticulitis were identified using ICD-10 codes. Outcomes included total ED presentations for diverticulitis, admission rates, CTs performed, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients.</div></div><div><h3>Results</h3><div>There were 186,138,130 total ED encounters, with diverticulitis representing 927,326 (0.50 %). The rate of diverticulitis diagnosis increased from 0.40 % to 0.56 % over time. The admission rate declined over time from 33.6 % to 27.7 %, while the CT rate rose from 83.0 % to 92.6 %. Among those discharged, 90.4 % received an antibiotic, which remained consistent over time. Metronidazole (55.1 %) and ciprofloxacin (40.8 %) were the most commonly prescribed antibiotics, followed by amoxicillin-clavulanate (36.1 %). Among those admitted, most received either metronidazole (62.0 %), a fluoroquinolone (40.4 %), a third-generation cephalosporin (18.9 %), or a penicillin-based agent (38.1 %). Among both discharged and admitted patients, there was a marked shift to penicillin-based agents as the primary antibiotic regimen.</div></div><div><h3>Conclusion</h3><div>Diverticulitis remains a common ED presentation, with a gradually rising incidence over time. Admission rates have decreased, while CT imaging has become more common. Most patients receive antibiotics, though the specific antibiotic has shifted in favor of penicillin-based agents. These findings can provide key benchmarking data and inform future initiatives to guide imaging and antibiotic use.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"86 ","pages":"Pages 83-86"},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402088","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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