American Journal of Emergency Medicine最新文献_第9页

Diagnosis and treatment of sexually transmitted infections among emergency department patients 急诊科患者性传播感染的诊断与治疗

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.037

Michael Gottlieb MD , Eric Moyer MD , Kevin G. Buell MBBS, MS , Melissa Fleegler MD , Supriya Mehta MHS, PhD , Kyle J. Popovich MD, MS , Richard E. Rothman MD, PhD , Yu-Hsiang Hsieh PhD , Kyle Bernard MD , Jason Haukoos MD, MSc

Introduction

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.

Methods

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 Neisseria gonorrhoeae/Chlamydia trachomatis (NG/CT), Trichomonas vaginalis/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.

Results

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.

Conclusion

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.

性传播感染（STIs）仍然是一个主要的公共卫生问题，急诊科（ed）是评估和治疗的关键场所。尽管它们很重要，但目前国家层面的数据描述ED检测和对出现提示性传播感染症状的患者的治疗实践是有限的。方法：我们使用Cosmos（一个大型地理上多样化的电子健康记录数据库）对2016年至2024年ED就诊进行回顾性队列研究。年龄≥15岁且伴有性传播感染症状的患者被纳入研究。我们检查了淋病奈瑟菌/沙眼衣原体（NG/CT）、阴道毛滴虫/细菌性阴道病（TV/BV）、梅毒和HIV的诊断检测。对年龄在15-55岁的女性进行妊娠检测。经验性抗生素治疗模式随时间进行评估。结果在5,566,966例独特的ED就诊中，只有37.8%的患者接受了性传播感染检测。NG/CT是最常见的检查（34.1%），其次是TV/BV（21.7%）、HIV（4.1%）和梅毒（3.9%）。在接受NG/CT检测的人群中，TV/BV联合检测为56.0%，梅毒为9.3%，HIV为8.5%。68.5%符合条件的女性进行了妊娠检测。近一半（46.2%）的NG/ ct检测患者接受了经验性治疗。在接受TV/ bv检测的患者中，13.4%的患者在急诊科接受了经验治疗，32.4%的患者接受了门诊治疗。结论大多数表现为性传播感染的ED患者未接受性传播感染检测，其他性传播感染的联合检测也不常见。经验性抗生素治疗仍然非常普遍，约有一半的患者使用抗生素治疗。这些发现强调了通过标准化方案和扩大联合检测的使用来改善急诊科STI检测和治疗的机会。

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引用次数: 0

A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation 与急诊插管高角度视频喉镜相关的关键表现错误的分类。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.041

Alexander Bracey , Aaron J. Lacy , Scott D. Weingart , Ashar Ata , Alexander S. Giuliano , John C. Lewis , James Mantas , Benjamin Bayly , Michael Doyle , Ryan N. Barnicle

Background

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.

Methods

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.

Results

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.

Conclusions

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.

背景：视频喉镜检查（VL）目前在紧急气道管理中无处不在。超角度视频喉镜（HAVL）与标准几何VL （SGVL）在叶片设计、技术和所需的微技能方面有所不同，但两者通常被认为是相似的。尽管广泛使用，但没有针对特定于havel的性能错误的综合分类。方法：我们对2020-2024年在城市学术急诊科进行的视频气管插管（ETIs）进行了观察性研究。首先分析了50个HAVL视频，得出了20个表现错误，然后进行了100个额外的记录，以确认发现并评估发生率。两名独立的急诊医生评估每一份记录的表现错误。使用Cohen’s κ、Gwet’s AC和Pearson’s相关来评估错误率、手术时间和插管成功之间的可靠性和相关性。结果：我们确定了20个与HAVL相关的离散性能错误。所有100个记录包含至少一个性能错误（pooled κ = 0.53, 95% CI 0.48-0.58）。最常见的错误是未能接合中线小瓣膜（56%），最不常见的是肿胀分娩问题（1%）。每个额外的性能错误使插管持续时间增加约3秒。在几个误差之间观察到很强的相关性。结论：hafl期间的表现错误是常见且相互关联的。这种新颖的分类法为有组织的反馈、有针对性的培训以及未来对HAVL技术和临床结果的研究提供了一个框架。

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引用次数: 0

Adult scarlet fever: Case report and epidemiology 成人猩红热：病例报告和流行病学

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.040

Nina Prieto MD, Mai Tantawy MD, Swathi Bhuma MD, MS, Siu Fai Li MD

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.

一名30岁女性以全身皮疹、发热和心动过速就诊。详细的系统检查和体格检查显示了链球菌性咽炎的症状和体征。PCR检测证实了链球菌感染和猩红热的诊断。猩红热通常是一种儿童疾病，但成人也会出现偶发性暴发，有时伴有明显的并发症。重要的是急诊医学临床医生要意识到这种儿童疾病出现在成人。

引用次数: 0

A CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study 基于ct的多模式融合模型预测钝性胸外伤的预后：一项多中心研究

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.038

Tingting Zhao MD , Dong Li PhD , Mengshan Wu MD , Chenyuan Zhang MD , Xiaoyuan Qu MD , Xin Tian MD , Yixi Zhang MD , Chunlin Song MD , Xiaoran Wang PhD , Xianghong Meng PhD , Zhi Wang MD

Background

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).

Methods

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.

Results

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.

Conclusions

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.

本研究旨在建立一种综合临床变量、放射学特征（RFs）和基于深度学习的特征（DLFs）的多模式预测模型，以提高钝性胸外伤（BCT）患者的预后准确性。方法回顾性分析来自3个医疗中心的337例BCT患者。获得临床和CT成像数据，包括急诊和随访扫描。提取的特征包括放射学（RF）和基于深度学习（DLF）的描述符以及表示时间变化的delta特征。在序列特征选择之后，采用最小绝对收缩和选择算子（LASSO）回归来识别最优特征。模型开发包括仅临床模型、仅成像模型和融合模型，并使用AUC、校准曲线和决策曲线分析来评估性能。结果肋骨骨折计数、多发伤、血气胸肺比（HPR）是独立的预后因素。融合模型，特别是delta-clinical-DLR模型，在训练集和测试集的auc分别为0.85 （95% CI: 0.80-0.90）和0.86 （95% CI: 0.77-0.95）。与单独的临床模型相比，观察到净重分类（NRI高达0.76）和综合区分（IDI高达0.26）的显著改善。结论通过多模态融合模型将多时间点CT图像与临床变量相结合，可显著提高BCT的预后表现，为个体化风险预测和临床决策提供了强有力的工具。

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引用次数: 0

Maggot infestation leading to Ignatzschineria larvae bacteremia and bladder outlet obstruction 蛆感染导致伊格纳茨氏幼虫菌血症和膀胱出口阻塞

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.035

Stephen Gamboa MD, MPH , Christopher Parsons MD , Christina Shenvi MD, PhD, MBA

We report a case of a 61-year-old man with a history of alcoholic cirrhosis and impaired mobility who presented to the Emergency Department (ED) with hepatic encephalopathy, cellulitis, sepsis, and extensive maggot infestation (myiasis). Maggots were recovered from the patient's skin, urethra, and rectum, and the burden of maggots in the urethra had led to bladder outlet obstruction. Blood cultures revealed polymicrobial bacteremia, including Ignatzschineria larvae.

Ignatzschineria larvae is a commensal bacterium that resides in the digestive tract of maggots. The organism is rarely pathogenic to humans, and case reports of Ignatzschineria larvae bacteremia are rare. This case demonstrates two uncommon complications of wound myiasis: bacteremia and bladder infestation, causing outlet obstruction and urinary retention. Patients who present to the Emergency Department with myiasis are at risk for bacteremia from both typical skin pathogens related to their wounds and pathogens associated with the maggots themselves.

我们报告一例61岁男性，有酒精性肝硬化和活动能力受损史，以肝性脑病、蜂窝织炎、败血症和广泛的蛆感染（蝇蛆病）就诊于急诊科。患者皮肤、尿道、直肠均有蛆恢复，尿道中蛆的负担导致膀胱出口梗阻。血液培养显示多种微生物菌血症，包括伊格纳茨氏幼虫。伊格纳茨氏幼虫是寄生在蛆消化道中的一种共生细菌。这种生物很少对人类致病，伊格纳茨氏杆菌幼虫菌血症的病例报告也很罕见。本病例显示两种不常见的伤口蝇蛆病并发症：菌血症和膀胱感染，引起出口阻塞和尿潴留。到急诊科就诊的蝇蛆病患者有感染细菌血症的风险，细菌血症来自与伤口相关的典型皮肤病原体和与蛆本身相关的病原体。

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引用次数: 0

Acute solar and atmospheric shifts preceding emergency department presentations for intentional drug overdose 急性太阳和大气变化前急诊科报告故意药物过量

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.ajem.2025.12.042

Yalcin Golcuk MD (Assoc. Prof.) , Fulden Cantaş Türkiş PhD (Assoc. Prof.) , Meltem Derya Şahin MD (Assoc. Prof.) , Ömer Yasir Boz MD , Sevilay Yerlikaya Boz MD

Background

Intentional drug overdose (IDO) is a major cause of emergency department (ED) presentations. While psychiatric and psychosocial factors are established contributors, many events occur without identifiable triggers. Emerging evidence suggests that rapid environmental changes may act as acute behavioral stressors influencing self-harm risk. This study investigates whether short-term increases in solar insolation and related atmospheric conditions are associated with IDO presentations, using a 15-day harmonic mean (HM15) model to detect individualized environmental deviations.

Methods

This retrospective cohort study included adults presenting with IDO to a tertiary ED in Muğla, Türkiye between July 1, 2019 and July 1, 2024. Environmental data—including solar insolation, temperature at 2 m (T2M), ultraviolet (UV) radiation, and humidity—were obtained from the NASA POWER database. For each case, index-day values were compared to the individual's preceding HM15 baseline.

Results

Among 515 IDO patients, solar insolation, T2M, and UV radiation on the index day were significantly higher than HM15 baselines (all P < 0.001). These deviations were most pronounced in spring and early summer, aligning with established peaks in suicide risk. In spring, a 15.6 % surge in solar insolation was observed, alongside significant increases in T2M and UV exposure. Similar abrupt shifts were noted in summer, while autumn and winter demonstrated mixed environmental patterns.

Conclusions

Acute rises in solar insolation, temperature, and UV radiation are temporally associated with increased IDO risk. The HM15 model may support real-time, meteorologically informed, AI-enhanced risk stratification in ED-based suicide prevention and merits evaluation for integration into clinical decision support systems.

背景：故意药物过量（IDO）是急诊科（ED）报告的主要原因。虽然精神病学和社会心理因素是确定的诱因，但许多事件的发生没有可识别的诱因。新出现的证据表明，快速的环境变化可能是影响自残风险的急性行为压力源。本研究使用15天调和平均（HM15）模型来检测个性化的环境偏差，研究了太阳日照和相关大气条件的短期增加是否与IDO表现有关。方法：本回顾性队列研究纳入了2019年7月1日至2024年7月1日期间在日本Muğla、出现IDO至三级ED的成年人。环境数据包括太阳日照、2米温度、紫外线辐射和湿度，这些数据都是从NASA POWER数据库中获得的。对于每个病例，将指标值与个体之前的HM15基线进行比较。结果515例IDO患者指标日日晒、T2M、UV辐射均显著高于HM15基线（P < 0.001）。这些偏差在春季和初夏最为明显，与自杀风险的既定峰值一致。在春季，观测到太阳日晒量激增15.6%，同时T2M和UV暴露量显著增加。夏季也出现了类似的突变，而秋季和冬季则表现出混合的环境模式。结论日晒、温度和紫外线辐射的急剧升高与IDO风险的增加有暂时的相关性。HM15模型可以支持实时、气象信息、人工智能增强的基于ed的自杀预防风险分层和价值评估，以整合到临床决策支持系统中。

{"title":"Acute solar and atmospheric shifts preceding emergency department presentations for intentional drug overdose","authors":"Yalcin Golcuk MD (Assoc. Prof.) , Fulden Cantaş Türkiş PhD (Assoc. Prof.) , Meltem Derya Şahin MD (Assoc. Prof.) , Ömer Yasir Boz MD , Sevilay Yerlikaya Boz MD","doi":"10.1016/j.ajem.2025.12.042","DOIUrl":"10.1016/j.ajem.2025.12.042","url":null,"abstract":"<div><h3>Background</h3><div>Intentional drug overdose (IDO) is a major cause of emergency department (ED) presentations. While psychiatric and psychosocial factors are established contributors, many events occur without identifiable triggers. Emerging evidence suggests that rapid environmental changes may act as acute behavioral stressors influencing self-harm risk. This study investigates whether short-term increases in solar insolation and related atmospheric conditions are associated with IDO presentations, using a 15-day harmonic mean (HM15) model to detect individualized environmental deviations.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults presenting with IDO to a tertiary ED in Muğla, Türkiye between July 1, 2019 and July 1, 2024. Environmental data—including solar insolation, temperature at 2 m (T2M), ultraviolet (UV) radiation, and humidity—were obtained from the NASA POWER database. For each case, index-day values were compared to the individual's preceding HM15 baseline.</div></div><div><h3>Results</h3><div>Among 515 IDO patients, solar insolation, T2M, and UV radiation on the index day were significantly higher than HM15 baselines (all <em>P</em> < 0.001). These deviations were most pronounced in spring and early summer, aligning with established peaks in suicide risk. In spring, a 15.6 % surge in solar insolation was observed, alongside significant increases in T2M and UV exposure. Similar abrupt shifts were noted in summer, while autumn and winter demonstrated mixed environmental patterns.</div></div><div><h3>Conclusions</h3><div>Acute rises in solar insolation, temperature, and UV radiation are temporally associated with increased IDO risk. The HM15 model may support real-time, meteorologically informed, AI-enhanced risk stratification in ED-based suicide prevention and merits evaluation for integration into clinical decision support systems.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 114-120"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surviving ventricular fibrillation: A documented Lazarus phenomenon 幸存的心室颤动：记载的拉撒路现象。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-12-31 DOI: 10.1016/j.ajem.2025.12.024

Oscar Thabouillot MD, PhD student , Emmanuel Rozenberg MD , Simon-Pierre Corcostegui MD , Clément Derkenne PhD

Case presentation

A 94-year-old woman with no major medical history developed chest pain and experienced ventricular fibrillation at home. In accordance with written advance directives specifying refusal of “unreasonable or futile treatment,” no resuscitation was performed. After approximately ten minutes of asystole, spontaneous circulation resumed. Forty minutes later, the patient regained consciousness with complete neurologic recovery. Coronary angiography revealed significant coronary lesions that were successfully treated with two drug-eluting stents. The patient was discharged neurologically intact and remains well.

Discussion

This case documents a Lazarus phenomenon in the absence of any resuscitative maneuver—an event not previously described in the literature. Physiologic hypotheses may include delayed venous return, spontaneous myocardial reperfusion, or electrical recovery following ventricular fibrillation. The ethical implications are substantial, as the patient's interpretation of her advance directives differed markedly from the medical team's understanding. This case underscores both the physiological mystery of spontaneous circulation recovery and the ethical need for precise, individualized advance directives. It also highlights the importance of adaptability and clinical judgment when unexpected reversals of presumed death occur.

病例介绍：一名94岁女性，无重大病史，在家中出现胸痛和心室颤动。根据书面的预先指示，明确拒绝“不合理或无效的治疗”，没有进行复苏。大约停搏10分钟后，自然循环恢复。40分钟后，患者意识恢复，神经功能完全恢复。冠状动脉造影显示明显的冠状动脉病变，成功治疗两个药物洗脱支架。患者出院时神经系统完好，目前状况良好。讨论：这个病例记录了一个拉撒路现象，在没有任何复苏操作的情况下，这是一个以前没有在文献中描述的事件。生理假说可能包括静脉回流延迟、自发心肌再灌注或心室颤动后的电恢复。伦理影响是实质性的，因为患者对她的预先指示的解释与医疗团队的理解明显不同。这个病例强调了自发循环恢复的生理奥秘和精确的、个性化的预先指示的伦理需要。它还强调了在假定死亡发生意外逆转时适应性和临床判断的重要性。

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引用次数: 0

Beyond survival: Early markers of poor outcome in pediatric trauma 超越生存：儿童创伤预后不良的早期标志。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-12-30 DOI: 10.1016/j.ajem.2025.12.028

Kubra Boydag Guvenc , Ebru Guney Sahin , Idris Abdullah Yılmaz , Refik Ozturk , Ceyhan Sahin , Fatih Varol , Cansu Durak

Background

This study aimed to evaluate the prognostic value of clinical scoring systems and admission-based laboratory biomarkers in predicting mortality and morbidity among pediatric trauma patients.

Methods

We conducted a retrospective analysis of 88 pediatric trauma patients admitted to a tertiary-level pediatric intensive care unit between August 2024 and July 2025. Patients who died within the first 24 h were excluded. PRISM III, PELOD-2, SIPA, GCS, and VIS scores were calculated on the day of admission. Laboratory parameters including lactate, procalcitonin, and albumin levels were recorded. Morbidity was defined as persistent organ-specific dysfunction at discharge. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance.

Results

The overall mortality rate was 5.7 %, while 13.6 % of patients developed sequelae. Non-survivors had significantly higher PRISM III, PELOD-2, lactate, lactate/albumin ratio, and procalcitonin levels, along with longer PICU stay and greater need for mechanical ventilation and inotropic support. The lactate/albumin ratio showed the highest predictive value for mortality (AUC = 0.828). Patients with sequelae had significantly higher illness severity scores and elevated lactate-related markers. Transfusion needs were also more common in this group. Lactate/albumin ratio demonstrated strong negative predictive value (NPV = 95.6 %) for morbidity.

Conclusion

Both clinical severity scores and lactate-related biomarkers were associated with mortality and morbidity in pediatric trauma patients. In particular, the lactate/albumin ratio emerged as a useful early indicator of poor outcomes. These findings support the incorporation of combined scoring and biomarker strategies into early risk stratification protocols in pediatric trauma care.

背景：本研究旨在评估临床评分系统和基于入院的实验室生物标志物在预测儿科创伤患者死亡率和发病率方面的预后价值。方法：回顾性分析2024年8月至2025年7月在某三级儿科重症监护病房收治的88例儿科创伤患者。在最初24小时内死亡的患者被排除在外。入院当天计算PRISM III、PELOD-2、SIPA、GCS、VIS评分。记录实验室参数，包括乳酸、降钙素原和白蛋白水平。发病定义为出院时持续的器官特异性功能障碍。采用受试者工作特征（ROC）分析评价预测效果。结果：总死亡率为5.7%，有13.6%的患者出现后遗症。非幸存者的PRISM III、PELOD-2、乳酸、乳酸/白蛋白比和降钙素原水平显著升高，PICU停留时间更长，对机械通气和肌力支持的需求更大。乳酸/白蛋白比值对死亡率的预测价值最高（AUC = 0.828）。后遗症患者的疾病严重程度评分明显升高，乳酸相关标志物升高。输血需求在这一组中也更为常见。乳酸/白蛋白比值对发病率有很强的阴性预测价值（NPV = 95.6%）。结论：临床严重程度评分和乳酸相关生物标志物与儿童创伤患者的死亡率和发病率相关。特别是，乳酸/白蛋白比率成为不良预后的有用早期指标。这些发现支持将联合评分和生物标志物策略纳入儿科创伤护理的早期风险分层方案。

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引用次数: 0

Corrigendum to ‘Hereditary angioedema-induced laryngeal edema: A diagnostic and therapeutic race against time’ [American Journal of Emergency Medicine 93 (2025) 238.e5–238.e8] “遗传性血管性水肿性喉水肿：与时间赛跑的诊断和治疗”[美国急诊医学杂志93 (2025)238.e5-238.e8]。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-12-30 DOI: 10.1016/j.ajem.2025.12.032

Hao Song , Tingting Mu , Dan Wang , Qiang Zhang , Xicheng Song

引用次数: 0

Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial 单剂量静脉注射常规胰岛素与Lispro胰岛素在急诊科治疗高钾血症的比较：SIR-LISPRO试验

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-12-26 DOI: 10.1016/j.ajem.2025.12.031

Christian Kroll , Mahnoor Khan , Jiayi Sun , Priyanka Vakkalanka , Kasheng Lee , Marianne Said , Joseph Halfpap

Introduction

Hyperkalemia is a potentially life-threatening electrolyte disturbance that is present in 2 % to 3 % of emergency department (ED) patient admissions. These patients are commonly treated with intravenous (IV) insulin. Standard of care consists of administering IV insulin regular, but other insulin formulations might be safer and/or more effective, however this has yet to be explored.

Objective

To evaluate the safety and effectiveness of insulin lispro and insulin regular administered intravenously for the treatment of hyperkalemia in ED patients.

Methods

This was a retrospective cohort study that investigated adults that were admitted to the ED of two academic centers and treated for hyperkalemia with 5 units of IV insulin therapy from January 1, 2022, through January 1, 2023. The primary outcome was the change in serum potassium within 6 h following IV insulin regular compared to IV insulin lispro. The primary safety outcome was the proportion of patients who had a hypoglycemic event (blood glucose <70 mg/dl) or required supplemental dextrose administration within 6 h post-insulin administration. Demographic, clinical characteristics, clinical management, and the outcome of change in potassium were associated using linear regression. Dichotomous outcomes pertaining to hypoglycemia were estimated using logistic regression.

Results

Among the 237 patients who met inclusion criteria, 129 received insulin regular, and 108 patients received insulin lispro. We observed a larger decrease in potassium in those that received insulin lispro compared to those that received insulin regular (uMD: -0.24; 95 %CI: −0.42, −0.06). The odds of hypoglycemia were greater among those who received insulin lispro (16 %) compared to insulin regular (7 %) (uOR: 2.49; 95 %CI: 1.08, 6.09).

Conclusions

Intravenous insulin lispro resulted in a statistically significant reduction of serum potassium but resulted in a higher likelihood of hypoglycemia compared to IV insulin regular. Further prospective, controlled studies are needed to assess the clinical significance of the differences between insulin formulations.

高钾血症是一种潜在危及生命的电解质紊乱，在急诊科（ED）住院患者中有2%至3%的患者存在高钾血症。这些患者通常用静脉注射胰岛素治疗。标准护理包括定期静脉注射胰岛素，但其他胰岛素制剂可能更安全和/或更有效，但这还有待探索。目的评价胰岛素利斯普罗与胰岛素常规静脉注射治疗ED患者高钾血症的安全性和有效性。方法：这是一项回顾性队列研究，调查了2022年1月1日至2023年1月1日期间，在两个学术中心的急诊科接受5单位静脉胰岛素治疗的高钾血症的成年人。主要观察指标为常规胰岛素注射后6小时内血清钾的变化。主要安全性指标是在胰岛素给药后6小时内发生低血糖事件（血糖≤70 mg/dl）或需要补充葡萄糖给药的患者比例。使用线性回归将人口统计学、临床特征、临床管理和钾变化的结果联系起来。与低血糖有关的二分类结果使用逻辑回归进行估计。结果237例符合纳入标准的患者中，常规胰岛素治疗129例，利斯普罗胰岛素治疗108例。我们观察到，与接受常规胰岛素治疗的患者相比，接受lispro胰岛素治疗的患者钾含量下降幅度更大（uMD: -0.24; 95% CI: - 0.42, - 0.06）。与常规胰岛素组（7%）相比，接受利斯普罗胰岛素组（16%）发生低血糖的几率更高（or: 2.49; 95% CI: 1.08, 6.09）。结论静脉注射胰岛素利斯普罗可显著降低血钾，但低血糖发生率高于静脉注射胰岛素常规组。需要进一步的前瞻性对照研究来评估胰岛素配方差异的临床意义。

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引用次数: 0