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IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.12.007

引用次数: 0

Development and Evaluation of a Novel Resuscitation Teamwork Model for Out-of-Hospital Cardiac Arrest in the Emergency Department 开发和评估针对急诊科院外心脏骤停的新型复苏团队合作模式。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.008

Kah Meng Chong MD , Eric Hao-Chang Chou MD , Wen-Chu Chiang MD, PhD , Hui-Chih Wang MD , Yeh-Ping Liu MD, LLM , Patrick Chow-In Ko MD, MsC , Edward Pei-Chuan Huang MD, MsC , Ming-Ju Hsieh MD, PhD , Hao-Yang Lin MD , Wan-Ching Lien MD, PhD , Chien-Hua Huang MD, PhD , Cheng-Chung Fang MD , Shyr-Chyr Chen MD, EMBA , Farhan Bhanji MD, MsC , Chih-Wei Yang MD, PhD , Matthew Huei-Ming Ma MD, PhD

Study objective

Cardiopulmonary resuscitation (CPR) is critical for out-of-hospital cardiac arrest patients but is prone to rapid changes and errors. Effective teamwork and leadership are essential for high-quality CPR. We aimed to introduce the Airway-Circulation-Leadership-Support (A-C-L-S) teamwork model in the emergency department (ED) to address these challenges.

Methods

The study comprised 2 phases. The development phase involved reviewing CPR videos, categorizing problems, and formulating strategies using the Systems Engineering Initiative for Patient Safety model. Resuscitation tasks were organized into A-C-L-S domains using hierarchical task analysis. Equipment and environmental deficits were optimized ergonomically with a pit-crew style arrangement. Mnemonics enhanced teamwork and leadership. The evaluation phase assessed postimplementation ED resuscitation team performance, focusing on adherence, timeliness, and quality of A-C-L-S tasks.

Results

The development phase produced a structured teamwork model, assigning tasks, tools, mnemonics, and positions based on A-C-L-S domains. The A-team manages the airway and optimizes end-tidal CO₂ levels; the C-team focuses on high-quality chest compressions and defibrillation. Leadership coordinates resuscitation efforts using goal-directed mnemonics (DABCD²E³), whereas the S-team handles medications, timekeeping, and recording. The evaluation phase showed improvements in adherence and timeliness of A-C-L-S tasks, with sustained increases in chest compression fraction before mechanical CPR, from 67.2% preimplementation to 83.0% postimplementation, 89.1% after 1 year, and 86.1% after 2 years. Overall, chest compression fraction also improved from 81.7% to 88.6%, peaking at 92.2% after 1 year and maintaining 90.8% after 2 years.

Conclusion

The A-C-L-S teamwork model is feasible, applicable, and effective. Further research is needed to assess its influence on patient outcomes.

研究目的：心肺复苏术（CPR）对院外心脏骤停患者至关重要，但容易出现快速变化和错误。有效的团队合作和领导力是高质量心肺复苏术的关键。我们旨在将气道-循环-领导-支持（A-C-L-S）团队合作模式引入急诊科（ED），以应对这些挑战：研究分为两个阶段。开发阶段包括回顾心肺复苏视频、对问题进行分类，并使用 "患者安全系统工程倡议 "模型制定策略。使用分层任务分析法将复苏任务划分为 A-C-L-S 领域。设备和环境方面的缺陷通过维修组式的安排进行了人体工程学优化。记忆法增强了团队合作和领导力。评估阶段对实施后急诊室复苏团队的表现进行了评估，重点关注A-C-L-S任务的坚持性、及时性和质量：结果：开发阶段产生了一个结构化团队合作模型，根据 A-C-L-S 领域分配任务、工具、记忆法和职位。A 组负责管理气道并优化潮气末二氧化碳水平；C 组侧重于高质量的胸外按压和除颤。领导层使用目标引导记忆法（DABCD2E3）协调复苏工作，而 S 组则负责药物、计时和记录。评估阶段的结果表明，A-C-L-S 任务的坚持率和及时性都有所提高，机械心肺复苏前的胸外按压率持续上升，从实施前的 67.2% 提高到实施后的 83.0%，1 年后提高到 89.1%，2 年后提高到 86.1%。总体而言，胸外按压率也从 81.7% 提高到 88.6%，1 年后达到 92.2%，2 年后维持在 90.8%：结论：A-C-L-S 团队合作模式是可行、适用和有效的。结论：A-C-L-S 团队合作模式可行、适用且有效，需要进一步研究以评估其对患者预后的影响。

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引用次数: 0

Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department 开发临床风险评分，对急诊科就诊患者的严重眩晕病因进行风险分层。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.06.003

Robert Ohle MSc, MBBCh , David W. Savage MD, PhD , Danielle Roy BSc , Sarah McIsaac Med, MBBCh , Ravinder Singh MD , Daniel Lelli MD , Darren Tse MD , Peter Johns MD , Krishan Yadav MSc, MD , Jeffrey J. Perry MSc, MD

Study objective

Identify high-risk clinical characteristics for a serious cause of vertigo in patients presenting to the emergency department (ED).

Methods

Multicentre prospective cohort study over 3 years at three university-affiliated tertiary care EDs. Participants were patients presenting with vertigo, dizziness or imbalance. Main outcome measurement was an adjudicated serious diagnosis defined as stroke, transient ischemic attack, vertebral artery dissection or brain tumour.

Results

A total of 2,078 of 2,618 potentially eligible patients (79.4%) were enrolled (mean age 77.1 years; 59% women). Serious events occurred in 111 (5.3%) patients. We used logistic regression to create a 7-item prediction model: male, age over 65, hypertension, diabetes, motor/sensory deficits, cerebellar signs/symptoms and benign paroxysmal positional vertigo diagnosis (C-statistic 0.96, 95% confidence interval [CI] 0.92 to 0.98). The risk of a serious diagnosis ranged from 0% for a score of <5, 2.1% for a score of 5 to 8, and 41% for a score >8. Sensitivity for a serious diagnosis was 100% (95% CI, 97.1% to 100%) and specificity 72.1% (95% CI, 70.1% to 74%) for a score <5.

Conclusion

The Sudbury Vertigo Risk Score identifies the risk of a serious diagnosis as a cause of a patient’s vertigo and if validated could assist physicians in guiding further investigation, consultation, and treatment decisions, improving resource utilization and reducing missed diagnoses.

研究目的确定急诊科（ED）就诊患者严重眩晕病因的高危临床特征：多中心前瞻性队列研究：在三所大学附属三级医疗机构的急诊科进行，为期三年。参与者为出现眩晕、头晕或失衡的患者。主要结果测量指标是经裁定的严重诊断，即中风、短暂性脑缺血发作、椎动脉夹层或脑肿瘤：在 2618 名可能符合条件的患者中，共有 2078 人（79.4%）入选（平均年龄 77.1 岁；59% 为女性）。111名患者（5.3%）发生了严重事件。我们使用逻辑回归建立了一个 7 项预测模型：男性、65 岁以上、高血压、糖尿病、运动/感觉障碍、小脑体征/症状和良性阵发性位置性眩晕诊断（C 统计量为 0.96，95% 置信区间 [CI] 为 0.92 至 0.98）。对严重诊断的敏感性为 100%（95% CI，97.1% 至 100%），特异性为 72.1%（95% CI，70.1% 至 74%）：萨德伯里眩晕症风险评分可确定导致患者眩晕的严重诊断风险，如果得到验证，可帮助医生指导进一步的调查、咨询和治疗决策，提高资源利用率并减少漏诊。

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引用次数: 0

Door-In-Door-Out Times at Referring Hospitals and Outcomes of Hemorrhagic Stroke 转诊医院的门进门出时间与出血性脑卒中的预后。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.002

Regina Royan MD, MPH , Iyanuoluwa Ayodele MS , Brian Stamm MD , Brooke Alhanti PhD , Kevin N. Sheth MD , Peter Pruitt MD, MS , Brian C. Mac Grory MB BCh , William J. Meurer MD, MS , Shyam Prabhakaran MD, MS

Study objective

Interhospital transfer is often required in the care of patients with hemorrhagic stroke. Guidelines recommend a door-in-door-out (DIDO) time of ≤120 minutes at the transferring emergency department (ED); however, it is unknown whether DIDO times are related to clinical outcomes of hemorrhagic stroke.

Methods

Retrospective, observational cohort study using US registry data from Get With The Guidelines–Stroke participating hospitals. Patients include those aged ≥18 years with intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) who were transferred from the ED to a Get With The Guidelines participating receiving hospital from January 1, 2019, to July 31, 2022. The primary outcome was ordinal discharge modified Rankin scale (mRS) score and secondary outcomes included dichotomous discharge mRS, ability to ambulate independently at discharge, and inhospital mortality at the receiving hospital.

Results

In all, 19,708 ICH and 7,757 patients with SAH were included. For patients with ICH, an increasing DIDO time was associated with greater odds of mRS 0 to 3 versus 4 to 6 at discharge in the unadjusted analyses (DIDO 91 to 180 minutes, odds ratio [OR] 1.15 [1.04 to 1.27]; DIDO 181 to 270 minutes, OR 1.51 [1.33, 1.71]; DIDO >270 minutes, OR 1.83 [1.58, 2.11]; versus DIDO ≤90 minutes). In the adjusted analyses, no associations were observed. Similar results were seen for mRS at discharge in patients with SAH. In both patients with ICH and SAH, longer DIDO times were associated with greater odds of independent ambulation at discharge and lower odds of inhospital mortality in the unadjusted analyses. After adjustment, the effect sizes of these associations were reduced, with some of the results based on quartiles becoming statistically nonsignificant.

Conclusion

These findings suggest that EDs currently expedite the transfer of the sickest patients; however, prospective studies and more granular data are needed to understand the impact of early treatment and timing of transfer for patients with hemorrhagic stroke.

研究目的出血性脑卒中患者通常需要院间转运。指南建议转院急诊科（ED）的门进门出（DIDO）时间应≤120 分钟；然而，DIDO 时间是否与出血性卒中的临床预后有关尚不清楚：方法：使用《指南》-卒中参与医院的美国登记数据进行回顾性观察队列研究。患者包括从2019年1月1日至2022年7月31日期间从急诊室转入Get With The Guidelines参与医院的年龄≥18岁的脑内出血（ICH）或蛛网膜下腔出血（SAH）患者。主要结果是出院时修改后兰金量表（mRS）的顺序评分，次要结果包括出院时mRS的二分法、出院时独立行走的能力以及接收医院的院内死亡率：共纳入 19708 名 ICH 患者和 7757 名 SAH 患者。在未经调整的分析中，DIDO时间越长，ICH患者出院时mRS 0至3与4至6的几率越大（DIDO 91至180分钟，几率比[OR] 1.15 [1.04至1.27]；DIDO 181至270分钟，OR 1.51 [1.33至1.71]；DIDO >270分钟，OR 1.83 [1.58至2.11]；DIDO≤90分钟）。在调整后的分析中，未观察到相关性。SAH患者出院时的mRS也有类似结果。在未经调整的分析中，对于 ICH 和 SAH 患者，较长的 DIDO 时间与较高的出院时独立行走几率和较低的院内死亡率几率相关。经过调整后，这些关联的效应大小减小，一些基于四分位数的结果在统计学上变得不显著：这些研究结果表明，急诊室目前正在加快转运病情最严重的患者；然而，要了解早期治疗和转运时机对出血性卒中患者的影响，还需要前瞻性研究和更详细的数据。

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IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.010

Emily M. Hayden MD, MHPE, Beth G. Grabowski MBA, MPH, Ekta B. Kishen MPH, Kori S. Zachrison MD, MSc, Benjamin A. White MD

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The Osmolal Gap Has a Limited Role in the Evaluation of Possible Toxic Alcohol Poisoning

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.07.024

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IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.013

Jia Liu MD, Cheng Tan MD

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Dyspnea in a Patient With Clear Lungs

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.08.510

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IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/S0196-0644(24)01281-2

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The Osmolal Gap: A Valuable Test for Identifying Toxic Alcohol-Induced Anion Gap Metabolic Acidosis

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.annemergmed.2024.09.011

James D. Whitledge MD, Emily Guy MD, Christopher James Watson MD

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