Pub Date : 2024-11-20DOI: 10.1016/j.annemergmed.2024.06.009
Kareem Hamadah BS, John Elue MD, Bradley S. Jackson MD, Nima Sarani MD, Kristi Bernath MD
{"title":"Man With Chest Pain and Vomiting","authors":"Kareem Hamadah BS, John Elue MD, Bradley S. Jackson MD, Nima Sarani MD, Kristi Bernath MD","doi":"10.1016/j.annemergmed.2024.06.009","DOIUrl":"10.1016/j.annemergmed.2024.06.009","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 682-683"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-20DOI: 10.1016/j.annemergmed.2024.07.023
American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thrombolytics, Bruce M. Lo MD, MBA, RDMS (Subcommittee Chair), Christopher R. Carpenter MD, MSc, Ken Milne MD, MSc, Peter Panagos MD, Jason S. Haukoos MD, MSc (Methodologist), Deborah B. Diercks MD, MSc (Committee Chair), Members of the American College of Emergency Physicians (ACEP) Clinical Policies Committee (Oversight Committee), Deborah B. Diercks MD, MSc (Chair 2021-2024), John D. Anderson MD, Richard Byyny MD, MSc (Methodologist), Christopher R. Carpenter MD, MSc, Benjamin W. Friedman MD (Methodologist), Seth R. Gemme MD, Charles J. Gerardo MD, MHS, Steven A. Godwin MD, Benjamin W. Hatten MD, MPH, Jason S. Haukoos MD, MSc (Methodologist), Amy Kaji MD, MPH, PhD (Methodologist) , Heemun Kwok MD, MS (Methodologist), Kaeli Vandertulip MSLS, MBA (AHIP (Staff Liaison, Clinical Policies Committee)
This clinical policy from the American College of Emergency Physicians (ACEP) is the revision of a clinical policy approved in 2015 addressing a critical question regarding the use of thrombolytics for the management of acute ischemic stroke. A writing committee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: In adult stroke patients who are a candidate for mechanical thrombectomy, is the use of intravenous
{"title":"Clinical Policy: Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department","authors":"American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thrombolytics, Bruce M. Lo MD, MBA, RDMS (Subcommittee Chair), Christopher R. Carpenter MD, MSc, Ken Milne MD, MSc, Peter Panagos MD, Jason S. Haukoos MD, MSc (Methodologist), Deborah B. Diercks MD, MSc (Committee Chair), Members of the American College of Emergency Physicians (ACEP) Clinical Policies Committee (Oversight Committee), Deborah B. Diercks MD, MSc (Chair 2021-2024), John D. Anderson MD, Richard Byyny MD, MSc (Methodologist), Christopher R. Carpenter MD, MSc, Benjamin W. Friedman MD (Methodologist), Seth R. Gemme MD, Charles J. Gerardo MD, MHS, Steven A. Godwin MD, Benjamin W. Hatten MD, MPH, Jason S. Haukoos MD, MSc (Methodologist), Amy Kaji MD, MPH, PhD (Methodologist) , Heemun Kwok MD, MS (Methodologist), Kaeli Vandertulip MSLS, MBA (AHIP (Staff Liaison, Clinical Policies Committee)","doi":"10.1016/j.annemergmed.2024.07.023","DOIUrl":"10.1016/j.annemergmed.2024.07.023","url":null,"abstract":"<div>This clinical policy from the American College of Emergency Physicians (ACEP) is the revision of a clinical policy approved in 2015 addressing a critical question regarding the use of thrombolytics for the management of acute ischemic stroke. A writing committee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: In adult stroke patients who are a candidate for mechanical thrombectomy, is the use of intravenous</div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages e57-e86"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Maximizing Pain Relief: Pharmacists’ Analysis of the Ceiling Effect in Nonsteroidal Anti-Inflammatory Drug Treatment for Low Back Pain","authors":"Chia Siang Kow BPharm, MPharm, Dinesh Sangarran Ramachandram MSc, Syed Shahzad Hasan PhD, Kaeshaelya Thiruchelvam PhD, MSc (Clin Pharm)","doi":"10.1016/j.annemergmed.2024.07.012","DOIUrl":"10.1016/j.annemergmed.2024.07.012","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 698-699"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Young Man With Paraparesis After Influenza Virus Infection","authors":"Akiyuki Hiraga MD , Masahiro Mori MD , Shinji Aoyama MD","doi":"10.1016/j.annemergmed.2024.07.005","DOIUrl":"10.1016/j.annemergmed.2024.07.005","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"84 6","pages":"Pages 690-691"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.annemergmed.2024.10.014
Jeremiah S Hinson, Scott R Levin, Benjamin D Steinhart, Christopher Chmura, Rohit B Sangal, Arjun K Venkatesh, R Andrew Taylor
{"title":"Enhancing Emergency Department Triage Equity With Artificial Intelligence: Outcomes From a Multisite Implementation.","authors":"Jeremiah S Hinson, Scott R Levin, Benjamin D Steinhart, Christopher Chmura, Rohit B Sangal, Arjun K Venkatesh, R Andrew Taylor","doi":"10.1016/j.annemergmed.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.014","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.annemergmed.2024.10.013
Jenny Koehl, Devin Spolsdoff, Briana Negaard, Alison Lewis, Ruben Santiago, James Krenz, Alyssa Polotti, Ryan Feldman, Giles Slocum, David Zimmerman, Gavin T Howington, Preeyaporn Sarangarm, Alicia E Mattson, Caitlin Brown, Anne Zepeski, Megan A Rech, Brett Faine
Study objective: The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED).
Methods: This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility.
Results: Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval -0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility.
Conclusion: Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.
{"title":"Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study.","authors":"Jenny Koehl, Devin Spolsdoff, Briana Negaard, Alison Lewis, Ruben Santiago, James Krenz, Alyssa Polotti, Ryan Feldman, Giles Slocum, David Zimmerman, Gavin T Howington, Preeyaporn Sarangarm, Alicia E Mattson, Caitlin Brown, Anne Zepeski, Megan A Rech, Brett Faine","doi":"10.1016/j.annemergmed.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.013","url":null,"abstract":"<p><strong>Study objective: </strong>The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED).</p><p><strong>Methods: </strong>This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility.</p><p><strong>Results: </strong>Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval -0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility.</p><p><strong>Conclusion: </strong>Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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