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Tranexamic Acid in Pediatric Traumatic Brain Injury: A Multicenter Retrospective Observational Study 氨甲环酸治疗小儿创伤性脑损伤:一项多中心回顾性观察研究。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.07.014
Shu Utsumi MD , Shingo Ohki MD, PhD , Shunsuke Amagasa MD, PhD , Shinichiro Ohshimo MD, PhD , Nobuaki Shime MD, PhD

Study objective

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.
研究目的氨甲环酸(TXA)可在创伤后用于预防出血。我们的目标是研究氨甲环酸对严重创伤性脑损伤(TBI)儿童发病率和死亡率的影响:方法:我们确定了年龄为在纳入的 342 名患者中,30 人(14%)死亡,102 人(45%)出院时 GCS 评分低于 8 分。经过反倾向加权后,使用 TXA 与死亡率(调整赔率[aOR]1.25,95% 置信区间[CI]0.61 至 2.54)或不良神经功能预后(aOR 0.86,95% CI 0.47 至 1.56)均无关联:结论:使用TXA与死亡或不良神经功能预后无关。需要对严重创伤性脑损伤儿童使用 TXA 进行前瞻性临床试验。
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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 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 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。
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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 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 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.
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
In Adult Patients With Spontaneous Cervical Artery Dissection, Is Anticoagulation Associated With Reduced Risk of Ischemic Stroke When Compared With Antiplatelet Therapy? 与抗血小板疗法相比,抗凝疗法是否能降低自发性颈动脉夹层成人患者的缺血性卒中风险?
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.012
Steven Walton MD (EBEM Commentators), Michael Gottlieb MD (EBEM Commentators), Brit Long MD (EBEM Commentators)
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引用次数: 0
Elderly Man With Abdominal Pain
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.08.002
Matthew Lynberg BS , Jacob Isserman MD , Jonathan E. Davis MD
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引用次数: 0
Modeling the Mottled Child: Evaluating a Pediatric Septic Shock Predictive Modeling Screening Tool
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.12.006
Frederick L. Gmora DO (Guest Contributor) , Allyson M. Hynes MD (Guest Contributor)
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引用次数: 0
Adolescent Girl With Lower Abdominal Pain
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.08.003
Ashley Booth BS , Rosemary Thomas-Mohtat MD
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引用次数: 0
Cybersecurity in Virtual Observation Units
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.08.568
Fredrik Granholm MD, Derrick Tin MBBS, Gregory Ciottone MD
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引用次数: 0
Grace on the Other Side of the Gown
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.07.025
Jason T. Kolb MD
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引用次数: 0
Tranexamic Acid for Children With Traumatic Brain Injuries: Progress Made and Important Evidence Gaps 氨甲环酸治疗脑外伤儿童:取得的进展和重要的证据差距。
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.014
Nathan Kuppermann MD, MPH , Daniel K. Nishijima MD, MAS
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引用次数: 0
期刊
Annals of emergency medicine
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