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.
{"title":"A CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study","authors":"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","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}
Pub Date : 2026-01-02DOI: 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.
{"title":"Maggot infestation leading to Ignatzschineria larvae bacteremia and bladder outlet obstruction","authors":"Stephen Gamboa MD, MPH , Christopher Parsons MD , Christina Shenvi MD, PhD, MBA","doi":"10.1016/j.ajem.2025.12.035","DOIUrl":"10.1016/j.ajem.2025.12.035","url":null,"abstract":"<div><div>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 <em>Ignatzschineria larvae</em>.</div><div><em>Ignatzschineria larvae</em> is a commensal bacterium that resides in the digestive tract of maggots. The organism is rarely pathogenic to humans, and case reports of <em>Ignatzschineria larvae</em> 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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 129-130"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 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.
{"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}
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.
{"title":"Surviving ventricular fibrillation: A documented Lazarus phenomenon","authors":"Oscar Thabouillot MD, PhD student , Emmanuel Rozenberg MD , Simon-Pierre Corcostegui MD , Clément Derkenne PhD","doi":"10.1016/j.ajem.2025.12.024","DOIUrl":"10.1016/j.ajem.2025.12.024","url":null,"abstract":"<div><h3>Case presentation</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 110-113"},"PeriodicalIF":2.2,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919366","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}
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.
{"title":"Beyond survival: Early markers of poor outcome in pediatric trauma","authors":"Kubra Boydag Guvenc , Ebru Guney Sahin , Idris Abdullah Yılmaz , Refik Ozturk , Ceyhan Sahin , Fatih Varol , Cansu Durak","doi":"10.1016/j.ajem.2025.12.028","DOIUrl":"10.1016/j.ajem.2025.12.028","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 103-109"},"PeriodicalIF":2.2,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.ajem.2025.12.032
Hao Song , Tingting Mu , Dan Wang , Qiang Zhang , Xicheng Song
{"title":"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]","authors":"Hao Song , Tingting Mu , Dan Wang , Qiang Zhang , Xicheng Song","doi":"10.1016/j.ajem.2025.12.032","DOIUrl":"10.1016/j.ajem.2025.12.032","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"100 ","pages":"Page 230"},"PeriodicalIF":2.2,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-26DOI: 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.
{"title":"Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial","authors":"Christian Kroll , Mahnoor Khan , Jiayi Sun , Priyanka Vakkalanka , Kasheng Lee , Marianne Said , Joseph Halfpap","doi":"10.1016/j.ajem.2025.12.031","DOIUrl":"10.1016/j.ajem.2025.12.031","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Objective</h3><div>To evaluate the safety and effectiveness of insulin lispro and insulin regular administered intravenously for the treatment of hyperkalemia in ED patients.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 92-98"},"PeriodicalIF":2.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-25DOI: 10.1016/j.ajem.2025.12.030
Hany A. Zaki , Hussam Elmelliti , Amira Shaban , Ahmed Shaban , Ali Elkandow , Mohamed Gafar Abdelrahim , Wadah Musaed , Eman E. Shaban
Background
Fluid resuscitation is a key element for the management of critical care patients. However, it is uncertain whether balanced crystalloids may be preferred over normal saline (NS) in trauma patients. Therefore, the current meta-analysis compared the efficacy and safety of balanced crystalloids with NS in trauma resuscitation.
Methods
The online search for articles relevant to our study objective was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus. This search was limited to randomized controlled trials (RCTs) available in English language. The primary outcome of our study was all-cause mortality, and secondary outcomes were incidence of acute kidney injury (AKI), length of intensive care unit (ICU) stay, ventilator-free days, need for renal replacement therapy (RRT), and base deficit. The statistical analyses were performed using RevMan 5.4.1, and bias assessment was performed using the Cochrane risk of bias tool (ROB-2).
Results
Six distinct RCTs involving 1950 trauma patients were included. The pooled analyses revealed that NS was associated with decreased mortality in traumatic brain injury (TBI) patients (OR: 1.35; 95 % CI: 1.06 to 1.72; p = 0.02), but not in trauma patients without TBI (OR: 1.17; 95 % CI: 0.47 to 2.90; p = 0.74). Similarly, more ventilator-free days were observed in the NS group than in the balanced crystalloids group among TBI patients (MD: −0.67 days; 95 % CI: −0.86 to −0.48; p < 0.00001), but not in trauma patients without TBI (MD: 3.0 days; 95 % CI: −3.36 to 9.36; p = 0.36). On the other hand, no significant difference was observed in total volume of study fluid administered, AKI incidence and length of ICU stay among patients with or without TBI.
Conclusions
In trauma patients with TBI, NS was associated with lower mortality and more ventilator-free days than balanced crystalloids, whereas no significant difference was noted in trauma populations without TBI. Moreover, there was no significant difference between NS and balanced crystalloids in terms of AKI incidence, need for RRT, and ICU stay, suggesting that balanced crystalloids remain a safe and reasonable option for trauma resuscitation.
背景：液体复苏是重症监护患者管理的关键因素。然而，在创伤患者中，平衡晶体是否优于生理盐水（NS）尚不确定。因此，本荟萃分析比较了平衡晶体与NS在创伤复苏中的有效性和安全性。方法：在PubMed、Cochrane Central Register of Controlled Trials （Central）、Web of Science和Scopus中在线检索与我们研究目标相关的文章。本研究限于随机对照试验（RCTs）中可用的英语。本研究的主要结局是全因死亡率，次要结局是急性肾损伤（AKI）发生率、重症监护病房（ICU）住院时间、无呼吸机天数、肾脏替代治疗（RRT）需求和基础缺陷。采用RevMan 5.4.1软件进行统计分析，采用Cochrane风险偏倚工具（rob2）进行偏倚评估。结果：纳入6个不同的随机对照试验，涉及1950例创伤患者。合并分析显示，NS与创伤性脑损伤（TBI）患者的死亡率降低相关（OR: 1.35; 95% CI: 1.06至1.72;p = 0.02），但与无TBI的创伤患者无关（OR: 1.17; 95% CI: 0.47至2.90;p = 0.74）。同样，在TBI患者中，NS组比平衡晶体组观察到更多的无呼吸机天数（MD: -0.67天；95% CI: -0.86至-0.48;p）。结论：在创伤性TBI患者中，NS比平衡晶体组与更低的死亡率和更多的无呼吸机天数相关，而在没有TBI的创伤人群中没有显著差异。此外，NS和平衡晶体在AKI发生率、RRT需求和ICU住院时间方面无显著差异，表明平衡晶体仍然是创伤复苏的安全合理选择。
{"title":"Balanced crystalloids versus normal saline for trauma resuscitation: A systematic review and meta-analysis","authors":"Hany A. Zaki , Hussam Elmelliti , Amira Shaban , Ahmed Shaban , Ali Elkandow , Mohamed Gafar Abdelrahim , Wadah Musaed , Eman E. Shaban","doi":"10.1016/j.ajem.2025.12.030","DOIUrl":"10.1016/j.ajem.2025.12.030","url":null,"abstract":"<div><h3>Background</h3><div>Fluid resuscitation is a key element for the management of critical care patients. However, it is uncertain whether balanced crystalloids may be preferred over normal saline (NS) in trauma patients. Therefore, the current meta-analysis compared the efficacy and safety of balanced crystalloids with NS in trauma resuscitation.</div></div><div><h3>Methods</h3><div>The online search for articles relevant to our study objective was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus. This search was limited to randomized controlled trials (RCTs) available in English language. The primary outcome of our study was all-cause mortality, and secondary outcomes were incidence of acute kidney injury (AKI), length of intensive care unit (ICU) stay, ventilator-free days, need for renal replacement therapy (RRT), and base deficit. The statistical analyses were performed using RevMan 5.4.1, and bias assessment was performed using the Cochrane risk of bias tool (ROB-2).</div></div><div><h3>Results</h3><div>Six distinct RCTs involving 1950 trauma patients were included. The pooled analyses revealed that NS was associated with decreased mortality in traumatic brain injury (TBI) patients (OR: 1.35; 95 % CI: 1.06 to 1.72; <em>p</em> = 0.02), but not in trauma patients without TBI (OR: 1.17; 95 % CI: 0.47 to 2.90; <em>p</em> = 0.74). Similarly, more ventilator-free days were observed in the NS group than in the balanced crystalloids group among TBI patients (MD: −0.67 days; 95 % CI: −0.86 to −0.48; <em>p</em> < 0.00001), but not in trauma patients without TBI (MD: 3.0 days; 95 % CI: −3.36 to 9.36; <em>p</em> = 0.36). On the other hand, no significant difference was observed in total volume of study fluid administered, AKI incidence and length of ICU stay among patients with or without TBI.</div></div><div><h3>Conclusions</h3><div>In trauma patients with TBI, NS was associated with lower mortality and more ventilator-free days than balanced crystalloids, whereas no significant difference was noted in trauma populations without TBI. Moreover, there was no significant difference between NS and balanced crystalloids in terms of AKI incidence, need for RRT, and ICU stay, suggesting that balanced crystalloids remain a safe and reasonable option for trauma resuscitation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 84-91"},"PeriodicalIF":2.2,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-25DOI: 10.1016/j.ajem.2025.12.029
Jessica Zola MD , Sarah Petelinsek , Patrick G. Hughes DO
Pelvic pain is a common chief complaint in the acute care setting. As intrauterine devices continue to grow in prevalence, incidence of complications will naturally increase. While the care of malpositioned IUDs is well described in obstetrics/gynecologic and radiologic literature, there is limited information regarding it in the emergency department. In this case series we identified four cases of symptomatic, malpositioned IUDs with removal in the emergency department and documented symptomatic improvement. Removal in all cases was uncomplicated. These cases suggest that malpositioned IUDs are a potential source of acute pelvic pain and vaginal bleeding and that removal has been safe and effective. While these findings align with prior literature that removal of malpositioned IUDs is safe, their broader clinical implications are limited by the small sample size and safeguards inherent in a tertiary care center. Further research specific to the acute care setting and the emergency provider is needed.
{"title":"Clinical outcomes after removal of malpositioned intrauterine devices in the emergency department","authors":"Jessica Zola MD , Sarah Petelinsek , Patrick G. Hughes DO","doi":"10.1016/j.ajem.2025.12.029","DOIUrl":"10.1016/j.ajem.2025.12.029","url":null,"abstract":"<div><div>Pelvic pain is a common chief complaint in the acute care setting. As intrauterine devices continue to grow in prevalence, incidence of complications will naturally increase. While the care of malpositioned IUDs is well described in obstetrics/gynecologic and radiologic literature, there is limited information regarding it in the emergency department. In this case series we identified four cases of symptomatic, malpositioned IUDs with removal in the emergency department and documented symptomatic improvement. Removal in all cases was uncomplicated. These cases suggest that malpositioned IUDs are a potential source of acute pelvic pain and vaginal bleeding and that removal has been safe and effective. While these findings align with prior literature that removal of malpositioned IUDs is safe, their broader clinical implications are limited by the small sample size and safeguards inherent in a tertiary care center. Further research specific to the acute care setting and the emergency provider is needed.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 79-83"},"PeriodicalIF":2.2,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-25DOI: 10.1016/j.ajem.2025.12.023
Michael Scott, Shani Italiya, K Tom Xu, Michael Brodeur, Peter Richman
{"title":"Positive serial blood cultures after negative initial cultures in the ED for patients with sepsis.","authors":"Michael Scott, Shani Italiya, K Tom Xu, Michael Brodeur, Peter Richman","doi":"10.1016/j.ajem.2025.12.023","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.12.023","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866652","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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