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Does Andexanet Alpha Improve Outcomes Compared With Four-Factor Prothrombin Complex Concentrate for Reversal of Direct Oral Anticoagulants? 与用于逆转直接口服抗凝剂的四因子凝血酶原复合物浓缩物相比,Andexanet Alpha 是否能改善疗效?
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-16 DOI: 10.1016/j.annemergmed.2024.09.001
Kyle Smiley,Joshua Lowe,Brit Long
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引用次数: 0
Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic. COVID-19 大流行后儿科急诊室呼吸道病毒检测的趋势。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-16 DOI: 10.1016/j.annemergmed.2024.08.508
Sriram Ramgopal,Oluwakemi Badaki-Makun,Mohamed Eltorki,Pradip Chaudhari,Timothy T Phamduy,Daniel Shapiro,Chris A Rees,Kelly R Bergmann,Mark I Neuman,Douglas Lorenz,Kenneth A Michelson
STUDY OBJECTIVETo evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.METHODSWe performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024).RESULTSWe included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (-17.80%; 95% CI -17.90 to -17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic.CONCLUSIONRespiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing.
研究目的评估 COVID-19 大流行是否会增加儿科急诊室(ED)呼吸道病毒检测的使用和成本。方法我们使用儿科健康信息系统进行了一项横断面研究。研究对象为 2016 年 10 月至 2024 年 3 月期间从儿科急诊室出院并纳入儿科健康信息系统的儿童(90 天至 18 岁)。为了评估呼吸道病毒检测频率和成本的变化,我们在 3 个研究期间进行了间断时间序列分析:大流行前期(2016 年 10 月 1 日至 2020 年 3 月 14 日)、大流行早期(2020 年 3 月 15 日至 2023 年 12 月 31 日)和大流行后期(2023 年 1 月 1 日至 2024 年 3 月 31 日)。在 7,311,177 例大流行前就诊者中,有 460,826 例(6.3%)进行了至少一次病毒性呼吸道测试;在 5,100,796 例大流行早期就诊者中,有 1,240,807 例(24.3%)进行了至少一次病毒性呼吸道测试;在 2,849,966 例大流行后期就诊者中,有 545,696 例(19.1%)进行了至少一次病毒性呼吸道测试。大流行前的病毒检测呈正斜率(0.17% 次/月;95% CI 0.17 至 0.18)。大流行早期的转变率为 4.98%(95% CI 为 4.90 至 5.07),斜率为正(0.54% 次/月;95% CI 为 0.54 至 0.55)。大流行后期与负变化(-17.80%;95% CI -17.90至-17.70)和正斜率(0.42%人次/月;95% CI 0.41至0.42)有关。在大流行早期,检测成本的斜率从 5,000 美元/月(95% CI 4,200 美元至 5,700 美元)增加到 33,000 美元/月(95% CI 32,000 美元至 34,000 美元)。这些发现突出表明,有必要进一步明确急诊室病毒检测的适应症,并努力减少低价值的检测。
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引用次数: 0
Sugammadex Should Not be Used to Routinely Reverse Rocuronium for Patients in the Emergency Department. 急诊科患者不应常规使用舒格马定逆转罗库溴铵。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-16 DOI: 10.1016/j.annemergmed.2024.08.513
Kyle M DeWitt,Alicia E Mattson
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引用次数: 0
Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography. 开发和实施以复苏为重点的经食道超声心动图多中心登记系统。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-15 DOI: 10.1016/j.annemergmed.2024.08.004
Felipe Teran,Clark G Owyang,Trenton C Wray,John E Hipskind,Justine Lessard,William Bédard Michel,Chantal Lanthier,Peiman Nazerian,Eleonora de Villa,Jonathan Nogueira,Daniel Doynow,Michelle Clinton,Frank Myslik,Ross Prager,Robert Arntfield,Pedro D Salinas,Vladyslav Dieiev,Michael Y Woo,Rajiv Thavanathan,Graeme Puskas,Karan Singh,Priyanka Bhat,Jackson Horn,Brian M Buchanan,Nadia Baig,Katharine M Burns,Kelsey Kennedy,Lawrence Haines,Leily Naraghi,Harpriya Singh,Michael Secko,Daniel Singer,Maria Taylor,John M Joyce,Stephanie DeMasi,Zan M Jafry,Tammy Phan,Natalie Truong,Evan Robinson,Korbin H Haycock,Allyson Hansen,Charlotte Derr,Frances M West,Mangala Narasimhan,James Horowitz,Asad Usman,Kenton L Anderson,Yifan Peng,Philippe Rola,Phillip Andrus,Junaid Razzak,Hugh C Hemmings,Rohan Panchamia,Joanna Palasz,Aarthi Kaviyarasu,Nathaniel A Sands,Robert M Sutton,Benjamin S Abella,
STUDY OBJECTIVETo evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs.METHODSWe established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images.RESULTSA total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare.CONCLUSIONSA prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.
研究目的评估聚焦经食道超声心动图 (TEE) 在评估急诊科 (ED) 和重症监护室重症患者时的临床效果、安全性和临床结局。方法我们建立了一个前瞻性、多中心、观察性登记处,涉及在急诊科、重症监护室或手术室环境中进行聚焦经食道超声心动图检查以评估院外心脏骤停 (OHCA)、院内心脏骤停、未分化休克评估、血流动力学监测和/或程序指导的成年重症患者。本次调查的主要目的是评估重症患者集中式床旁 TEE 的临床影响和安全性。结果从 28 家医院的 916 名患者中共收集到 1045 次聚焦 TEE 研究,其中包括 585 例(64%)骤停中和骤停后 OHCA 以及院内心脏骤停患者、267 例(29%)未分化休克初步评估患者、101 例(11%)程序指导患者以及 92 例(10%)血液动力学监测患者。TEE 改变了 85% 未分化休克患者、71% 院内心脏骤停患者和 62% OHCA 患者的治疗方案。没有食管穿孔或口咽损伤的报告,其他程序并发症也很少发生。结论成功实施了前瞻性、多中心和多学科 TEE 注册,并证明了聚焦 TEE 在多种重症监护应用中是安全和具有临床影响力的。该研究网络的进一步研究将加速急诊和重症监护环境中使用 TEE 的成果导向型研究和知识转化的发展。
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引用次数: 0
SUGAMMADEX SHOULD BE USED TO REVERSE ROCURONIUM IN EMERGENCY DEPARTMENT PATIENTS WITH NEUROLOGIC INJURIES. 神经系统损伤的急诊科患者应使用苏加麦角来逆转罗库溴铵。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-15 DOI: 10.1016/j.annemergmed.2024.04.015
Megan A Rech,Michael Gottlieb
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引用次数: 0
Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials. 神经肌肉阻滞剂与紧急气管插管结果之间的关系:随机试验的二次分析。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-08 DOI: 10.1016/j.annemergmed.2024.08.509
Stephanie C DeMasi,Wesley H Self,Neil R Aggarawal,Michael D April,Luke Andrea,Christopher R Barnes,Jason Brainard,Veronika Blinder,Alon Dagan,Brian Driver,Kevin C Doerschug,Ivor Douglas,Matthew Exline,Daniel G Fein,John P Gaillard,Sheetal Gandotra,Kevin W Gibbs,Adit A Ginde,Stephen J Halliday,Jin H Han,Taylor Herbert,Kevin High,Christopher G Hughes,Akram Khan,Andrew J Latimer,Amelia W Maiga,Steven H Mitchell,Amelia L Muhs,Amira Mohamed,Ari Moskowitz,David B Page,Jessica A Palakshappa,Matthew E Prekker,Edward T Qian,Dan Resnick-Ault,Todd W Rice,Derek W Russel,Steven G Schauer,Kevin P Seitz,Nathan I Shapiro,Lane M Smith,Peter Sottile,Susan Stempek,Stacy A Trent,Derek J Vonderhaar,James E Walker,Li Wang,Micah R Whitson,Jonathan D Casey,Matthew W Semler,
STUDY OBJECTIVETo examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.METHODSWe performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).RESULTSAmong the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26).CONCLUSIONAmong critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.
研究目的:研究在急诊科(ED)或重症监护室对重症成人进行气管插管时,所使用的神经肌肉阻断剂(琥珀胆碱与罗库溴铵)与首次插管成功率和严重并发症发生率之间的关系。方法:我们对在急诊科或重症监护室对重症成人进行气管插管的两项多中心随机试验的数据进行了二次分析。我们使用带有预设基线协变量的广义线性混合效应模型,研究了所使用的神经肌肉阻断剂(琥珀胆碱与罗库溴铵)与首次尝试成功插管的发生率(主要结果)和气管插管期间严重并发症的发生率(次要结果)之间的关系。结果在试验数据集中的 2,440 名患者中,2,339 名(95.9%)纳入了本次分析;475 名患者(20.3%)接受了琥珀胆碱治疗,1,864 名患者(79.7%)接受了罗库溴铵治疗。375名接受琥珀胆碱治疗的患者(78.9%)和1,510名接受罗库溴铵治疗的患者(81.0%)首次尝试就成功插管(调整后的几率比为0.87;95% CI为0.65至1.15)。结论在接受气管插管的重症成人患者中,接受琥珀胆碱的患者和接受罗库洛宁的患者在首次插管成功率和严重并发症的发生率上没有显著差异。
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引用次数: 0
Picture This: Text-to-Image Models Transforming Pediatric Emergency Medicine 想象一下:从文字到图像的模式改变了儿科急诊医学。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-10-02 DOI: 10.1016/j.annemergmed.2024.07.019
Niharika Goparaju MD, MPH
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引用次数: 0
38 Finger-to-Nose Test to Improve EMS Pre-Hospital Recognition of Posterior Stroke 38 指到鼻测试提高急救服务对后发中风的院前识别能力
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-09-25 DOI: 10.1016/j.annemergmed.2024.08.045
Z. Langston, T. Nagy, D. Schwerin, L. Fowler, S. Fabiano
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引用次数: 0
50 Time to Provider for Patients With Non-English Language Preferences in the Emergency Department 50 急诊科非英语语言偏好患者向医护人员求助的时间
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-09-25 DOI: 10.1016/j.annemergmed.2024.08.057
A. Rimawi, A. Sung, E. Lin, M. Pike, D. Haidar, C.-M. Chen, R. Medlin, M. Perry, C. Fung
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引用次数: 0
89EMF The Utility of High Dose Buprenorphine in Producing Prolonged Suppression of Opioid Withdrawal 89EMF 大剂量丁丙诺啡在长期抑制阿片类药物戒断方面的效用
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-09-25 DOI: 10.1016/j.annemergmed.2024.08.094
R. McCormack, M. Gazzola, S.-M. Shin, I. Wittman, R. Gulati, K. Jahnes, K. Rahnemoon, A. Chitnis, S. Olafsson, A. Herring
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引用次数: 0
期刊
Annals of emergency medicine
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