Academic Emergency Medicine最新文献

Background: Syncope places a significant burden on emergency departments (EDs), often prompting extensive testing to exclude life-threatening conditions. However, the diagnostic utility of troponin, B-type natriuretic peptide (BNP), transthoracic echocardiography (TTE), and outpatient cardiac monitoring remains unclear.

Methods: This systematic review assessed the diagnostic accuracy of these tests in adults presenting with syncope. The research question was: In ED patients with syncope, does TTE, cardiac biomarkers (troponin, BNP), or outpatient arrhythmia monitoring, compared with no testing, improve outcomes within 30 days? Primary outcomes included adverse events (death, arrhythmias, structural/ischemic heart disease, and select non-cardiac causes such as pulmonary embolism or aortic dissection) for biomarkers and diagnostic yield for TTE and monitoring. Sensitivity, specificity, and likelihood ratios (LR+ and LR-) were calculated for biomarkers, while diagnostic yield with 95% CI was reported for TTE and monitoring. Risk of bias was assessed using JBI and QUADAS-2.

Results: The database searches identified 1759 citations. After applying inclusion and exclusion criteria, 41 studies (21,557 patients) were included. Significant heterogeneity among the included trials (all with I² > 90%) precluded meta-analysis. For BNP, LR+ ranged 1.4-47 and LR- 0.06-0.4; for troponin, LR+ 1.9-11.2 and LR- 0.2-0.9. TTE diagnostic yield was 0%-29% overall and 8%-28% in high-risk groups. Outpatient monitoring yielded 1%-59% overall and 12%-42% in high-risk patients.

Conclusion: In ED patients with syncope, the diagnostic accuracy and yield of cardiac biomarkers, TTE, and outpatient monitoring show substantial variability, largely due to differences in patient populations, outcome measures, and study methodologies. Based on the existing evidence, these modalities in isolation cannot be recommended for routine use in syncope evaluation. Among these tests, the diagnostic yield of TTE and outpatient monitoring is greater in patients with cardiac risk factors and could potentially contribute to a more accurate diagnosis.

Background: Community consultation (CC) is crucial for exception from informed consent (EFIC) trials. Digital marketing platforms offer a novel and efficient way to gather community input through surveys. This study aimed to determine if the demographics of digital CC survey respondents align with those of their targeted communities.

Methods: We deployed an EFIC CC digital survey for Pedi-PART, a multicenter study on paramedic airway management in critically ill children. A seven-item survey, developed to gauge community perspectives on emergency care research and the trial, was disseminated through a digital marketing platform (Qualtrics Inc.). The survey targeted adults aged 18-65 residing within the geographic service areas of 10 participating EMS agencies. We determined community demographic data from the 2022 American Community Survey (ACS) for the dominant county in each service area. We compared survey respondent demographics (age, sex, race, ethnicity, household income, education) with those of the corresponding communities.

Results: We received 6630 completed surveys (528 to 913 per community). The proportion of individuals over 35 years old was similar between survey and community populations (67.1% vs. 66.5%). Survey respondents were more likely to be female (60.0% vs. 50.9%) and report household incomes < $100,000 (77.5% vs. 60.2%). Survey respondents were less likely to be Black, American Indian, Pacific Islander, or other race (33.9% vs. 52.1%), Hispanic ethnicity (15.3% vs. 34.9%), or have at least a high school education (23.2% vs. 34.9%). Demographic differences between survey respondents and communities varied across the 10 communities.

Conclusions: Demographic differences may exist between digital survey respondents and their targeted communities. Study teams should account for these factors when utilizing such platforms for EFIC CC.

Background: Sepsis is a common, critical, time-sensitive medical emergency, with mortality rates of up to 56%. Early antibiotic administration is a cornerstone of sepsis management, yet prehospital antibiotic administration remains uncommon in the United States.

Methods: This prospective observational study evaluated the implementation of a prehospital sepsis protocol in an urban EMS system. Patients were eligible for prehospital antibiotic administration if they were ≥18 years old, hypotensive (SBP < 90 mm Hg), and febrile or hypothermic (<96.8°F or >100.4°F). Paramedics drew blood cultures and administered piperacillin/tazobactam or ceftriaxone. A report was generated to prospectively identify patients eligible for the study by hemodynamic data and/or if they were administered prehospital antibiotics. Demographic, operational, and clinical data were abstracted from patient care records and electronic health records. Outcomes were reported descriptively.

Results: A sample of 147 patients was included for encounters from December 1, 2019, to December 1, 2024 (mean age 72.8 years, 31.3% female). Antibiotics were administered to 132 patients (89.8%). Of encounters with antibiotic administrations, 127/132 (96.2%) complied with the clinical protocol, and five (3.8%) were protocol violations. Additionally, six patients (4.1%) were inappropriately not administered antibiotics, and nine patients (6.1%) had contraindications to the protocol, so antibiotics were withheld. Of 356 blood culture bottles that underwent laboratory analysis, nine (2.5%) were contaminated. The mean (±SD) time from patient contact to antibiotics was 32.7 (±8.2) min.

Conclusions: Prehospital clinicians can reliably and safely administer antibiotics for sepsis with hypotension and severe sepsis, observing high protocol adherence and low contamination rates while expediting time from recognition of sepsis to first antibiotics. These findings support the integration of prehospital antibiotics into broader sepsis care pathways. Expanding such protocols could improve compliance with sepsis care quality measures and enhance patient outcomes, particularly in resource-constrained environments.