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Policy Statements
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-19 DOI: 10.1016/j.annemergmed.2024.12.019
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引用次数: 0
Global Research Highlights
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-19 DOI: 10.1016/j.annemergmed.2025.01.006
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引用次数: 0
Effectiveness of a Web-Based Training Intervention in Teaching Emergency Physicians First-Trimester Point-of-Care Ultrasound Image Interpretation.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-19 DOI: 10.1016/j.annemergmed.2025.01.005
Lori Stolz, Gillian Sheppard, Jeremy Boyd, Jessica Baez, Patrick Minges, Martin Pusic, Mathew Swarm, Megan Hilbert, Marisa O'Brien, Katie Harris, Catherine Varner, Constance LeBlanc, Kathy Boutis

Study objective: To examine the effectiveness of an education intervention on emergency physician accuracy in identifying pregnancy-related findings from first-trimester point-of-care ultrasound. Case features associated with the odds of a correct response were also determined.

Methods: This was a multicenter prospective cross-sectional study in a convenience sample of emergency physicians in the United States and Canada. The unsupervised web-based education intervention included first-trimester point-of-care ultrasound cases acquired through the transabdominal (n=200 cases) or transvaginal (n=200 cases) approach. Physicians deliberately practiced identifying pregnancy-related imaging findings until they achieved a mastery standard.

Results: In 204 participants, there were learning gains in accuracy (15.2%; 95% confidence interval [CI] 14.6 to 15.8), sensitivity (15.1%; 95% CI 14.3 to 15.9), and specificity (14.3%; 95% CI 13.7 to 15.0). Of these, 132 (64.7%) achieved the mastery standard in a median of 60 cases (interquartile range 58 to 83). Case features associated with an increased odds of a correct intrauterine pregnancy "present" diagnosis were transvaginal versus transabdominal-acquired images (odds ratio [OR]=1.5; 95% CI 1.3 to 1.8) and fetal heartbeat (OR=4.3; 95% CI 3.4 to 5.5). A decreased odds was associated with an eccentrically located intrauterine pregnancy (OR=0.2; 95% CI 0.1 to 0.2), subchorionic hemorrhage (OR=0.5; 95% CI 0.4 to 0.6), adnexal mass (OR=0.7; 95% CI 0.6 to 0.9), and endometrial collection (OR=0.1; 95% CI 0.09 to 0.2).

Conclusions: This study's intervention was effective in teaching first-trimester point-of-care ultrasound image interpretation and identified the specific variables that posed the greatest diagnostic challenges. The methods and results from this work can serve to expand learning opportunities for this critical skill in emergency medicine.

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引用次数: 0
Man With Acute Abdominal Pain
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-19 DOI: 10.1016/j.annemergmed.2024.09.015
Christina Y. Liao MD, Christopher W. Allen MD, Christy Hill RDMS, Enoch A. Obeng MD, Daniel Rebagliati MD, Timothy J. Batchelor MD
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引用次数: 0
A Man With Abdominal Pain and Vomiting
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-19 DOI: 10.1016/j.annemergmed.2024.10.008
Chen-Wei Lee MD , Tou-Yuan Tsai MD , Cheng-Han Chiang MD
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引用次数: 0
Prehospital Management of Adults With Traumatic Out-of-Hospital Circulatory Arrest—A Joint Position Statement 成人创伤性院外循环骤停患者的院前管理--联合立场声明
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-19 DOI: 10.1016/j.annemergmed.2024.12.015
Amelia M. Breyre , Nicholas George , Alexander R. Nelson , Charles J. Ingram , Thomas Lardaro , Wayne Vanderkolk , John W. Lyng
<div><div>The National Association of Emergency Medical Services Physicians (NAEMSP), American College of Surgeons Committee on Trauma (ACS-COT), and American College of Emergency Physicians (ACEP) believe that evidence-based, pragmatic, and collaborative protocols addressing the care of patients with traumatic out-of-hospital circulatory arrest (TOHCA) are needed to optimize patient outcomes and clinician safety. When the etiology of arrest is unclear, particularly without clear signs of life-threatening trauma, standard basic and advanced cardiac life support (BCLS/ACLS) treatments for medical cardiac arrest are appropriate. Traumatic circulatory arrest may result from massive hemorrhage, airway obstruction, obstructive shock, respiratory disturbances, cardiogenic causes, or massive head trauma. While resuscitation and/or transport is appropriate for some populations, it is appropriate to withhold or discontinue resuscitation attempts for TOHCA patients for whom these efforts are nonbeneficial. This position statement and resource document were written as an update to the 2013 joint position statements.</div><div>NAEMSP, ACEP, and ACS-COT recommend:<ul><li><span>●</span><span><div>Emergency medical services (EMS) resuscitation of adults with TOHCA should:<ul><li><span>O</span><span><div>Prioritize prompt identification of patients who may benefit from transport to definitive care at trauma centers when safe and appropriate.</div></span></li><li><span>O</span><span><div>Emphasize the identification of reversible causes of traumatic circulatory arrest and timely use of clinically indicated life-saving interventions (LSIs) within the EMS clinician’s scope of practice. These include:<ul><li><span>■</span><span><div>External hemorrhage control with direct pressure, wound packing, and tourniquets.</div></span></li><li><span>■</span><span><div>Airway management using the least-invasive approach necessary to achieve and maintain airway patency, oxygenation, and adequate ventilation.</div></span></li><li><span>■</span><span><div>Chest decompression if there is clinical concern for a tension pneumothorax. Empiric bilateral decompression, however, is not indicated in the absence of suspected chest trauma.</div></span></li><li><span>■</span><span><div>External chest compressions may be considered but only secondary to other LSIs.</div></span></li><li><span>■</span><span><div>Epinephrine should not be routinely used, and if used should not be administered before other LSIs.</div></span></li></ul></div></span></li><li><span>O</span><span><div>If point-of-care ultrasound (POCUS) demonstrates no evidence of cardiac motion, this may have utility in TOHCA management for prognostication.</div></span></li><li><span>O</span><span><div>Emphasize that placement of cardiac monitors and/or use of POCUS should occur after indicated LSIs have been appropriately performed.</div></span></li><li><span></span><span><div>Conditions where resuscitation attempts should be withh
{"title":"Prehospital Management of Adults With Traumatic Out-of-Hospital Circulatory Arrest—A Joint Position Statement","authors":"Amelia M. Breyre ,&nbsp;Nicholas George ,&nbsp;Alexander R. Nelson ,&nbsp;Charles J. Ingram ,&nbsp;Thomas Lardaro ,&nbsp;Wayne Vanderkolk ,&nbsp;John W. Lyng","doi":"10.1016/j.annemergmed.2024.12.015","DOIUrl":"10.1016/j.annemergmed.2024.12.015","url":null,"abstract":"&lt;div&gt;&lt;div&gt;The National Association of Emergency Medical Services Physicians (NAEMSP), American College of Surgeons Committee on Trauma (ACS-COT), and American College of Emergency Physicians (ACEP) believe that evidence-based, pragmatic, and collaborative protocols addressing the care of patients with traumatic out-of-hospital circulatory arrest (TOHCA) are needed to optimize patient outcomes and clinician safety. When the etiology of arrest is unclear, particularly without clear signs of life-threatening trauma, standard basic and advanced cardiac life support (BCLS/ACLS) treatments for medical cardiac arrest are appropriate. Traumatic circulatory arrest may result from massive hemorrhage, airway obstruction, obstructive shock, respiratory disturbances, cardiogenic causes, or massive head trauma. While resuscitation and/or transport is appropriate for some populations, it is appropriate to withhold or discontinue resuscitation attempts for TOHCA patients for whom these efforts are nonbeneficial. This position statement and resource document were written as an update to the 2013 joint position statements.&lt;/div&gt;&lt;div&gt;NAEMSP, ACEP, and ACS-COT recommend:&lt;ul&gt;&lt;li&gt;&lt;span&gt;●&lt;/span&gt;&lt;span&gt;&lt;div&gt;Emergency medical services (EMS) resuscitation of adults with TOHCA should:&lt;ul&gt;&lt;li&gt;&lt;span&gt;O&lt;/span&gt;&lt;span&gt;&lt;div&gt;Prioritize prompt identification of patients who may benefit from transport to definitive care at trauma centers when safe and appropriate.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;O&lt;/span&gt;&lt;span&gt;&lt;div&gt;Emphasize the identification of reversible causes of traumatic circulatory arrest and timely use of clinically indicated life-saving interventions (LSIs) within the EMS clinician’s scope of practice. These include:&lt;ul&gt;&lt;li&gt;&lt;span&gt;■&lt;/span&gt;&lt;span&gt;&lt;div&gt;External hemorrhage control with direct pressure, wound packing, and tourniquets.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;■&lt;/span&gt;&lt;span&gt;&lt;div&gt;Airway management using the least-invasive approach necessary to achieve and maintain airway patency, oxygenation, and adequate ventilation.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;■&lt;/span&gt;&lt;span&gt;&lt;div&gt;Chest decompression if there is clinical concern for a tension pneumothorax. Empiric bilateral decompression, however, is not indicated in the absence of suspected chest trauma.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;■&lt;/span&gt;&lt;span&gt;&lt;div&gt;External chest compressions may be considered but only secondary to other LSIs.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;■&lt;/span&gt;&lt;span&gt;&lt;div&gt;Epinephrine should not be routinely used, and if used should not be administered before other LSIs.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;O&lt;/span&gt;&lt;span&gt;&lt;div&gt;If point-of-care ultrasound (POCUS) demonstrates no evidence of cardiac motion, this may have utility in TOHCA management for prognostication.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;O&lt;/span&gt;&lt;span&gt;&lt;div&gt;Emphasize that placement of cardiac monitors and/or use of POCUS should occur after indicated LSIs have been appropriately performed.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;&lt;/span&gt;&lt;span&gt;&lt;div&gt;Conditions where resuscitation attempts should be withh","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 3","pages":"Pages e25-e39"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436728","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}
引用次数: 0
Cannabinoid Hyperemesis Syndrome Is Associated With High Disease Burden: An Internet-Based Survey.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-18 DOI: 10.1016/j.annemergmed.2025.01.008
Andrew C Meltzer, Callen Morrison, Aditya Loganathan, Soroush Shahamatdar, Alice Moon, Ryan Heidish, Michael Makutonin, Yan Ma, Runjia Li, Ziva D Cooper

Cannabinoid hyperemesis syndrome is an underrecognized condition associated with recurrent vomiting and abdominal pain in individuals with prolonged cannabis use. This study used an internet-based survey targeting individuals with self-reported cannabinoid hyperemesis syndrome to assess the burden of disease and to examine associations between heavy cannabis use, early initiation of cannabis use, and cannabinoid hyperemesis syndrome episode frequency. A total of 1,052 participants were included, with the majority reporting frequent cannabis use and significant health care utilization, including emergency department visits and hospitalizations. This study highlights the substantial disease burden associated with cannabinoid hyperemesis syndrome in an online support group cohort and underscores the possible risks of heavy daily cannabis use and of use starting in adolescence. Future studies on heavy cannabis users are necessary to further elucidate cannabinoid hyperemesis syndrome and its link to daily cannabis use and the dangers of heavy use in adolescence.

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引用次数: 0
Emergency Department Interventions for Youth With Assault-Related Injuries: A Scoping Review.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-16 DOI: 10.1016/j.annemergmed.2025.01.013
Samaa Kemal, Jethel Hernandez, Katie Donnelly, Denise Nunes, Michael N Levas, Karen M Sheehan, Joel A Fein

Assault-related injuries in youth are associated with poor outcomes related to physical and mental health. These youth often seek acute injury-related care in the emergency department (ED), making this an important location for violence prevention and intervention efforts. This scoping review sought to describe ED-initiated and ED-based interventions for youth with assault-related injury. We searched 6 databases from their inception to October 2023: Ovid MEDLINE, Cochrane Library, Embase, Web of Science, PsycInfo, and CINAHL. We included original research on interventions for youth (0 to 18 years) presenting to the ED with assault-related injury (including firearm-related injury). We excluded non-English studies, conference proceedings, and editorials. Two independent reviewers performed title and abstract screening, full text review, and data abstraction and synthesis. We found 5,021 unique articles and excluded 4,955 after the title and abstract screening. The remaining 66 articles underwent full text review, and 25 were included. The primary types of ED interventions identified were case management, behavioral and psychosocial interventions, and mentorship. Although all interventions were initiated in the ED, the majority primarily occurred following discharge, required high levels of resources, and were often performed by hospital-based personnel in partnership with community-based organizations. Most studies described outcomes related to injury recidivism, criminal justice involvement, violence-related risk factors, health care usage, and mortality. Few described strengths-based and other quality-of-life outcomes. Although many studies demonstrated improved outcomes with interventions, they were often limited by sample size, study attrition, and short-term follow-up. Overall, our findings indicate that current research on ED interventions for youth with assault-related injuries is skewed toward resource-intensive services such as hospital-based violence intervention programs. Further work is needed to develop, implement, and rigorously evaluate community-informed ED-based interventions that could complement these resource-intensive interventions. Future studies should also examine strengths-based and patient-centered outcomes.

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引用次数: 0
PEAChY-O: Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-14 DOI: 10.1016/j.annemergmed.2025.01.007
Elyssia M Bourke, Amit Kochar, Deborah Shellshear, Meredith L Borland, Shefali Jani, Shane George, Doris Tham, Michael Gordon, Kate Klein, Catherine L Wilson, Chidambaram Prakash, Natalie Phillips, Gaby Nieva, Chris J Selman, Katherine J Lee, Andrew Davidson, Jonathan C Knott, Simon S Craig, Franz E Babl

Study objective: To determine whether oral olanzapine or oral diazepam was more effective at achieving behavioral containment for young people presenting to the emergency department with acute severe behavioral disturbance.

Methods: We conducted an open-label, multicenter, randomized controlled trial from October 22, 2021, to November 6, 2023. We enrolled young people aged between 9 and 17 years with acute severe behavioral disturbance deemed to require oral medication across 9 Australian emergency departments. We randomly assigned participants to a single weight-based oral dose of olanzapine or diazepam. The primary outcome was successful sedation (Sedation Assessment Tool score less than or equal to 0) without the need for additional sedatives one hour postrandomization. Secondary outcomes included adverse events; length of stay; aggression toward staff, participants, or parent/guardians; disposition; and satisfaction with care.

Results: We recruited 348 participants, with 176 assigned to olanzapine and 172 to diazepam. Successful sedation without the requirement for additional sedatives occurred in 103/168 (61%) in the olanzapine group and 90/158 (57%) in the diazepam group (adjusted risk difference 3.6%, 95% confidence interval -6.7% to 14.0%). No serious adverse events were reported in either group.

Conclusions: There was no evidence that oral olanzapine resulted in a greater proportion of participants with acute severe behavioral disturbance achieving successful sedation at one hour postrandomization than oral diazepam. Neither medication resulted in any serious adverse events; however, approximately 40% of participants in each group did not achieve successful sedation.

{"title":"PEAChY-O: Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication.","authors":"Elyssia M Bourke, Amit Kochar, Deborah Shellshear, Meredith L Borland, Shefali Jani, Shane George, Doris Tham, Michael Gordon, Kate Klein, Catherine L Wilson, Chidambaram Prakash, Natalie Phillips, Gaby Nieva, Chris J Selman, Katherine J Lee, Andrew Davidson, Jonathan C Knott, Simon S Craig, Franz E Babl","doi":"10.1016/j.annemergmed.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.01.007","url":null,"abstract":"<p><strong>Study objective: </strong>To determine whether oral olanzapine or oral diazepam was more effective at achieving behavioral containment for young people presenting to the emergency department with acute severe behavioral disturbance.</p><p><strong>Methods: </strong>We conducted an open-label, multicenter, randomized controlled trial from October 22, 2021, to November 6, 2023. We enrolled young people aged between 9 and 17 years with acute severe behavioral disturbance deemed to require oral medication across 9 Australian emergency departments. We randomly assigned participants to a single weight-based oral dose of olanzapine or diazepam. The primary outcome was successful sedation (Sedation Assessment Tool score less than or equal to 0) without the need for additional sedatives one hour postrandomization. Secondary outcomes included adverse events; length of stay; aggression toward staff, participants, or parent/guardians; disposition; and satisfaction with care.</p><p><strong>Results: </strong>We recruited 348 participants, with 176 assigned to olanzapine and 172 to diazepam. Successful sedation without the requirement for additional sedatives occurred in 103/168 (61%) in the olanzapine group and 90/158 (57%) in the diazepam group (adjusted risk difference 3.6%, 95% confidence interval -6.7% to 14.0%). No serious adverse events were reported in either group.</p><p><strong>Conclusions: </strong>There was no evidence that oral olanzapine resulted in a greater proportion of participants with acute severe behavioral disturbance achieving successful sedation at one hour postrandomization than oral diazepam. Neither medication resulted in any serious adverse events; however, approximately 40% of participants in each group did not achieve successful sedation.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424714","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}
引用次数: 0
ChatGPT Versus Human Authors: Assessing Efficacy in Title and Abstract Creation in Pediatric Emergency Medicine Research.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-12 DOI: 10.1016/j.annemergmed.2025.01.004
Graham Aufricht, Matt Wilkinson, Jesse Pines, Sriram Ramgopal, Tim Ruttan
{"title":"ChatGPT Versus Human Authors: Assessing Efficacy in Title and Abstract Creation in Pediatric Emergency Medicine Research.","authors":"Graham Aufricht, Matt Wilkinson, Jesse Pines, Sriram Ramgopal, Tim Ruttan","doi":"10.1016/j.annemergmed.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.01.004","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405038","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}
引用次数: 0
期刊
Annals of emergency medicine
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