Tranexamic acid (TXA) can be used after trauma to prevent bleeding. Our goal was to examine the influence of TXA on morbidity and mortality for children with severe traumatic brain injury (TBI).
Methods
We identified children aged <18 years with a severe TBI (Glasgow Coma Scale score less than 8) presenting to 1 of the 291 hospitals contributing to the Japanese Trauma Data Bank between 2019 and 2023. The primary outcome was inhospital death, and the secondary outcome was poor neurologic outcome defined with Glasgow Outcome Scale (GOS) score of 1 to 3 at hospital discharge. Our primary exposure was any TXA administered in the hospital. Using propensity score-based inverse probability weighting, we used logistic regression to measure the association between TXA administration and death as well as poor neurologic outcome.
Results
Of the 342 included patients, 30 (14%) died, and 102/225 (45%) had a GOS score less than 4 at discharge. After inverse propensity weighting, TXA administration was not associated with either mortality (adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.61 to 2.54) or poor neurologic outcome (aOR 0.86, 95% CI 0.47 to 1.56).
Conclusions
TXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.
{"title":"Tranexamic Acid in Pediatric Traumatic Brain Injury: A Multicenter Retrospective Observational Study","authors":"Shu Utsumi MD , Shingo Ohki MD, PhD , Shunsuke Amagasa MD, PhD , Shinichiro Ohshimo MD, PhD , Nobuaki Shime MD, PhD","doi":"10.1016/j.annemergmed.2024.07.014","DOIUrl":"10.1016/j.annemergmed.2024.07.014","url":null,"abstract":"<div><h3>Study objective</h3><div>Tranexamic acid (TXA) can be used after trauma to prevent bleeding. Our goal was to examine the influence of TXA on morbidity and mortality for children with severe traumatic brain injury (TBI).</div></div><div><h3>Methods</h3><div>We identified children aged <18 years with a severe TBI (Glasgow Coma Scale score less than 8) presenting to 1 of the 291 hospitals contributing to the Japanese Trauma Data Bank between 2019 and 2023. The primary outcome was inhospital death, and the secondary outcome was poor neurologic outcome defined with Glasgow Outcome Scale (GOS) score of 1 to 3 at hospital discharge. Our primary exposure was any TXA administered in the hospital. Using propensity score-based inverse probability weighting, we used logistic regression to measure the association between TXA administration and death as well as poor neurologic outcome.</div></div><div><h3>Results</h3><div>Of the 342 included patients, 30 (14%) died, and 102/225 (45%) had a GOS score less than 4 at discharge. After inverse propensity weighting, TXA administration was not associated with either mortality (adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.61 to 2.54) or poor neurologic outcome (aOR 0.86, 95% CI 0.47 to 1.56).</div></div><div><h3>Conclusions</h3><div>TXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 101-108"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370836","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.08.004
Felipe Teran MD, MSCE , Clark G. Owyang MD , Trenton C. Wray MD , John E. Hipskind MD , Justine Lessard MD , William Bédard Michel MD , Chantal Lanthier , Peiman Nazerian MD , Eleonora de Villa MD , Jonathan Nogueira DO , Daniel Doynow DO, MPH , Michelle Clinton MD , Frank Myslik MD , Ross Prager MD , Robert Arntfield MD , Pedro D. Salinas MD , Vladyslav Dieiev MD , Michael Y. Woo MD , Rajiv Thavanathan MD , Graeme Puskas BSc , Benjamin S. Abella MD, MPhil
Study objective
To 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.
Methods
We 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.
Results
A 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.
Conclusions
A 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。
{"title":"Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography","authors":"Felipe Teran MD, MSCE , Clark G. Owyang MD , Trenton C. Wray MD , John E. Hipskind MD , Justine Lessard MD , William Bédard Michel MD , Chantal Lanthier , Peiman Nazerian MD , Eleonora de Villa MD , Jonathan Nogueira DO , Daniel Doynow DO, MPH , Michelle Clinton MD , Frank Myslik MD , Ross Prager MD , Robert Arntfield MD , Pedro D. Salinas MD , Vladyslav Dieiev MD , Michael Y. Woo MD , Rajiv Thavanathan MD , Graeme Puskas BSc , Benjamin S. Abella MD, MPhil","doi":"10.1016/j.annemergmed.2024.08.004","DOIUrl":"10.1016/j.annemergmed.2024.08.004","url":null,"abstract":"<div><h3>Study objective</h3><div>To 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.</div></div><div><h3>Methods</h3><div>We 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.</div></div><div><h3>Results</h3><div>A 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.</div></div><div><h3>Conclusions</h3><div>A 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.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 147-162"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443766","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.08.508
Sriram Ramgopal MD , Oluwakemi Badaki-Makun MD, PhD , Mohamed Eltorki MBChB, MSc , Pradip Chaudhari MD , Timothy T. Phamduy DO , Daniel Shapiro MD, MPH , Chris A. Rees MD, MPH , Kelly R. Bergmann DO , Mark I. Neuman MD, MPH , Douglas Lorenz PhD , Kenneth A. Michelson MD, MPH
Study objective
To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.
Methods
We 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).
Results
We 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.
Conclusion
Respiratory 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.
{"title":"Trends in Respiratory Viral Testing in Pediatric Emergency Departments Following the COVID-19 Pandemic","authors":"Sriram Ramgopal MD , Oluwakemi Badaki-Makun MD, PhD , Mohamed Eltorki MBChB, MSc , Pradip Chaudhari MD , Timothy T. Phamduy DO , Daniel Shapiro MD, MPH , Chris A. Rees MD, MPH , Kelly R. Bergmann DO , Mark I. Neuman MD, MPH , Douglas Lorenz PhD , Kenneth A. Michelson MD, MPH","doi":"10.1016/j.annemergmed.2024.08.508","DOIUrl":"10.1016/j.annemergmed.2024.08.508","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We 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).</div></div><div><h3>Results</h3><div>We 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.</div></div><div><h3>Conclusion</h3><div>Respiratory 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.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 111-121"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451860","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.09.012
Steven Walton MD (EBEM Commentators), Michael Gottlieb MD (EBEM Commentators), Brit Long MD (EBEM Commentators)
{"title":"In Adult Patients With Spontaneous Cervical Artery Dissection, Is Anticoagulation Associated With Reduced Risk of Ischemic Stroke When Compared With Antiplatelet Therapy?","authors":"Steven Walton MD (EBEM Commentators), Michael Gottlieb MD (EBEM Commentators), Brit Long MD (EBEM Commentators)","doi":"10.1016/j.annemergmed.2024.09.012","DOIUrl":"10.1016/j.annemergmed.2024.09.012","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 144-146"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490550","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.08.002
Matthew Lynberg BS , Jacob Isserman MD , Jonathan E. Davis MD
{"title":"Elderly Man With Abdominal Pain","authors":"Matthew Lynberg BS , Jacob Isserman MD , Jonathan E. Davis MD","doi":"10.1016/j.annemergmed.2024.08.002","DOIUrl":"10.1016/j.annemergmed.2024.08.002","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 183-184"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021972","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.12.006
Frederick L. Gmora DO (Guest Contributor) , Allyson M. Hynes MD (Guest Contributor)
{"title":"Modeling the Mottled Child: Evaluating a Pediatric Septic Shock Predictive Modeling Screening Tool","authors":"Frederick L. Gmora DO (Guest Contributor) , Allyson M. Hynes MD (Guest Contributor)","doi":"10.1016/j.annemergmed.2024.12.006","DOIUrl":"10.1016/j.annemergmed.2024.12.006","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 193-195"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021978","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.07.025
Jason T. Kolb MD
{"title":"Grace on the Other Side of the Gown","authors":"Jason T. Kolb MD","doi":"10.1016/j.annemergmed.2024.07.025","DOIUrl":"10.1016/j.annemergmed.2024.07.025","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 191-192"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021975","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 : 2025-02-01DOI: 10.1016/j.annemergmed.2024.09.014
Nathan Kuppermann MD, MPH , Daniel K. Nishijima MD, MAS
{"title":"Tranexamic Acid for Children With Traumatic Brain Injuries: Progress Made and Important Evidence Gaps","authors":"Nathan Kuppermann MD, MPH , Daniel K. Nishijima MD, MAS","doi":"10.1016/j.annemergmed.2024.09.014","DOIUrl":"10.1016/j.annemergmed.2024.09.014","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 2","pages":"Pages 109-110"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543350","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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