American Journal of Emergency Medicine最新文献

{"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}

{"title":"Diagnosis and treatment of sexually transmitted infections among emergency department patients","authors":"Michael Gottlieb MD ,&nbsp;Eric Moyer MD ,&nbsp;Kevin G. Buell MBBS, MS ,&nbsp;Melissa Fleegler MD ,&nbsp;Supriya Mehta MHS, PhD ,&nbsp;Kyle J. Popovich MD, MS ,&nbsp;Richard E. Rothman MD, PhD ,&nbsp;Yu-Hsiang Hsieh PhD ,&nbsp;Kyle Bernard MD ,&nbsp;Jason Haukoos MD, MSc","doi":"10.1016/j.ajem.2025.12.037","DOIUrl":"10.1016/j.ajem.2025.12.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Sexually transmitted infections (STIs) remain a major public health concern, with emergency departments (EDs) serving as key sites for evaluation and treatment. Despite their importance, contemporary national-level data describing ED testing and treatment practices for patients presenting with symptoms suggestive of STI are limited.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of ED encounters from 2016 to 2024 using Cosmos, a large geographically diverse electronic health record database. Patients aged ≥15 years with symptoms suggestive of an STI were included. We examined diagnostic testing for <em>Neisseria gonorrhoeae</em>/<em>Chlamydia trachomatis</em> (NG/CT), <em>Trichomonas vaginalis</em>/bacterial vaginosis (TV/BV), syphilis, and HIV. Pregnancy testing was assessed among females aged 15–55 years. Empiric antibiotic treatment patterns were evaluated over time.</div></div><div><h3>Results</h3><div>Among 5,566,966 unique ED encounters, only 37.8 % underwent STI testing. NG/CT was the most frequently ordered test (34.1 %), followed by TV/BV (21.7 %), HIV (4.1 %), and syphilis (3.9 %). Among those tested for NG/CT, co-testing was 56.0 % for TV/BV, 9.3 % for syphilis, and 8.5 % for HIV. Pregnancy testing occurred in 68.5 % of eligible females. Nearly half (46.2 %) of NG/CT-tested patients received empiric treatment. Among TV/BV-tested patients, 13.4 % were empirically treated in the ED and 32.4 % were prescribed outpatient treatment.</div></div><div><h3>Conclusion</h3><div>Most ED patients who presented for conditions suggestive of STI did not undergo STI testing, and co-testing for other STIs was also uncommon. Empiric antibiotic therapy remains very common, occurring in approximately half of patients. These findings highlight opportunities to improve STI detection and treatment in EDs through standardized protocols and expanded use of co-testing.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 124-128"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927291","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 taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation","authors":"Alexander Bracey ,&nbsp;Aaron J. Lacy ,&nbsp;Scott D. Weingart ,&nbsp;Ashar Ata ,&nbsp;Alexander S. Giuliano ,&nbsp;John C. Lewis ,&nbsp;James Mantas ,&nbsp;Benjamin Bayly ,&nbsp;Michael Doyle ,&nbsp;Ryan N. Barnicle","doi":"10.1016/j.ajem.2025.12.041","DOIUrl":"10.1016/j.ajem.2025.12.041","url":null,"abstract":"<div><h3>Background</h3><div>Video laryngoscopy (VL) is now ubiquitous in emergency airway management. Hyperangulated video laryngoscopy (HAVL) differs from standard geometry VL (SGVL) in blade design, technique, and required microskills, yet the two are often regarded similarly. Despite widespread use, no comprehensive taxonomy of HAVL-specific performance errors exists.</div></div><div><h3>Methods</h3><div>We conducted an observational study of video-recorded endotracheal intubations (ETIs) performed in an urban academic emergency department (2020–2024). Fifty HAVL videos were first analyzed to derive 20 performance errors, followed by 100 additional recordings to confirm findings and assess incidence. Two independent emergency physicians evaluated each recording for performance errors. Interrater reliability and correlations among errors, procedure duration, and intubation success were assessed using Cohen's κ, Gwet's AC, and Pearson's correlation.</div></div><div><h3>Results</h3><div>We identified 20 discrete performance errors associated with HAVL. All 100 recordings contained at least one performance error (pooled κ = 0.53, 95 % CI 0.48–0.58). The most common error was failure to engage the midline vallecula (56 %), and the least common was bougie delivery issues (1 %). Each additional performance error added approximately 3 s to intubation duration. Strong correlations were observed among several errors.</div></div><div><h3>Conclusions</h3><div>Performance errors during HAVL are common and interrelated. This novel taxonomy provides a framework for structured feedback, targeted training, and future investigation of HAVL technique and clinical outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 152-158"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954026","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":"Adult scarlet fever: Case report and epidemiology","authors":"Nina Prieto MD,&nbsp;Mai Tantawy MD,&nbsp;Swathi Bhuma MD, MS,&nbsp;Siu Fai Li MD","doi":"10.1016/j.ajem.2025.12.040","DOIUrl":"10.1016/j.ajem.2025.12.040","url":null,"abstract":"<div><div>A 30-year-old woman presented to the ED with a generalized rash, fever, and tachycardia. A detailed review of systems and physical examination revealed symptoms and signs of streptococcal pharyngitis. PCR testing confirmed the diagnosis of streptococcal infection and scarlet fever. Scarlet fever is generally a disease of children, but episodic outbreaks are associated with the disease in adults, sometimes with significant complications. It is important for Emergency Medicine clinicians to be aware of this childhood illness presenting in adults.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 121-123"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927295","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 CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study","authors":"Tingting Zhao MD ,&nbsp;Dong Li PhD ,&nbsp;Mengshan Wu MD ,&nbsp;Chenyuan Zhang MD ,&nbsp;Xiaoyuan Qu MD ,&nbsp;Xin Tian MD ,&nbsp;Yixi Zhang MD ,&nbsp;Chunlin Song MD ,&nbsp;Xiaoran Wang PhD ,&nbsp;Xianghong Meng PhD ,&nbsp;Zhi Wang MD","doi":"10.1016/j.ajem.2025.12.038","DOIUrl":"10.1016/j.ajem.2025.12.038","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to develop a multimodal predictive model that integrates clinical variables, radiomic features (RFs), and deep learning–based features (DLFs) to improve prognostic accuracy in patients with blunt chest trauma (BCT).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 337 patients with BCT from three medical centers. Clinical and CT imaging data, including emergency and follow-up scans, were obtained. Features including radiomic (RF) and deep learning-based (DLF) descriptors along with delta features representing temporal changes were extracted. After sequential feature selection, the least absolute shrinkage and selection operator (LASSO) regression was applied to identify optimal features. Model development included clinical-only, imaging-only, and fused models, with performance evaluated using AUC, calibration curves, and decision curve analysis.</div></div><div><h3>Results</h3><div>Rib fracture count, multiple injuries, and hemopneumothorax-to-lung ratio (HPR) were identified as independent prognostic factors. The fusion model, particularly the delta-clinical-DLR model, achieved AUCs of 0.85 (95 % CI: 0.80–0.90) and 0.86 (95 % CI: 0.77–0.95) in the training and test sets, respectively. Significant improvements in net reclassification (NRI up to 0.76) and integrated discrimination (IDI up to 0.26) were observed compared to the clinical models alone.</div></div><div><h3>Conclusions</h3><div>Integrating multi-timepoint CT imaging with clinical variables through a multimodal fusion model significantly enhances the prognostic performance of BCT, providing a robust tool for individualized risk prediction and clinical decision-making.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 71-77"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038940","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}