首页期刊导航|The American journal of emergency medicine
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The American journal of emergency medicine
Centrum Philadelphia]
The American journal of emergency medicine

Centrum Philadelphia]

0735-6757

The American journal of emergency medicine/Journal The American journal of emergency medicine
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    Validation of a simplified comorbidity evaluation predicting clinical outcomes among patients with coronavirus disease 2019 – A multicenter retrospective observation study

    Bryant D.P.Shaikh S.Schrader C.D.Wang H....
    6页
    查看更多>>摘要：? 2022Objectives: We compared and validated the performance accuracy of simplified comorbidity evaluation compared to the Charlson Comorbidity Index (CCI) predicting COVID-19 severity. In addition, we also determined whether risk prediction of COVID-19 severity changed during different COVID-19 pandemic outbreaks. Methods: We enrolled all patients whose SARS-CoV-2 PCR tests were performed at six different hospital Emergency Departments in 2020. Patients were divided into three groups based on the various COVID-19 outbreaks in the US (first wave: March–May 2020, second wave: June–September 2020, and third wave: October–December 2020). A simplified comorbidity evaluation was used as an independent risk factor to predict clinical outcomes using multivariate logistic regressions. Results: A total of 22,248 patients were included, for which 7023 (32%) patients tested COVID-19 positive. Higher percentages of COVID-19 patients with more than three chronic conditions had worse clinical outcomes (i.e., hospital and intensive care unit admissions, receiving invasive mechanical ventilations, and in-hospital mortality) during all three COVID-19 outbreak waves. Conclusions: This simplified comorbidity evaluation was validated to be associated with COVID clinical outcomes. Such evaluation did not perform worse when compared with CCI to predict in-hospital mortality.
      原文链接:
    • NSTL
    • Elsevier

    Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic

    Lurie T.Bonnin N.Rea J.Tuteja G....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic. Methods: We conducted a pre-post study of adult patients who were discharged from 13 EDs and one urgent care within our academic medical system between 01/01/2019 and 09/30/2020 using an interrupted time series (ITS) approach. Patient characteristics and prescription data were extracted from the single unified electronic medical record across all study sites. Prescriptions of opioids were converted into morphine equivalent dose (MED). We compared the “Covid-19 Pandemic” period (C19, 03/29/2020–9/30/2020) and the “Pre-Pandemic” period (PP, 1/19/2020–03/28/2020). We used a multivariate logistic regression to assess clinical factors associated with opioid prescriptions. Results: We analyzed 361,794 ED visits by adult patients, including 259,242 (72%) PP and 102,552 (28%) C19 visits. Demographic information and percentages of patients receiving opioid prescriptions were similar in both groups. The median [IQR] MED per prescription was higher for C19 patients (70 [56–90]) than for PP patients (60 [60–90], P < 0.001). ITS demonstrated a significant trend toward higher MED prescription per ED visit during the pandemic (coefficient 0.11, 95% CI 0.05–0.16, P = 0.002). A few factors, that were associated with lower likelihood of opioid prescriptions before the pandemic, became non-significant during the pandemic. Conclusion: Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.
      原文链接:
    • NSTL
    • Elsevier

    Utility of non-invasive synchronized intermittent mandatory ventilation in acute cardiogenic pulmonary edema

    Cekmen B.Bildik B.Bozan O.Atis S.E....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Backgrounds: Acute cardiogenic pulmonary edema (ACPE), one of the outcomes of acute heart failure (AHF), is a common reason in a critical condition with respiratory distress. Non-invasive synchronized intermittent mandatory ventilation(nSIMV) mode, which includes inspiratory pressure in addition to positive end expiratory pressure with/without pressure support provided in the non-invasive continuous positive airway pressure plus/pressure support(nCPAP/PS) mode can be effective in hypercarbia and the associated changes in consciousness. This study aimed to demonstrate the efficacy of nSIMV in ACPE. Methods: Patients who presented with clinical acute respiratory failure and were admitted to the critical care unit of the emergency department with the diagnosis of ACPE were included. Patients were placed on non-invasive mechanical ventilators with an oronasal mask under the nCPAP/PS and nSIMV modes. Pulse and respiratory rate, systolic and diastolic blood pressure and Glasgow Coma Scores(GCS), HACOR(heart rate, acidosis, consciousness, oxygenation and respiratory rate) scores, pH, PaCO2, PaO2/FiO2 and lactate at the time of admission and at 30 and 60 min were evaluated. Results: Twenty-two patients were recruited, nCPAP/PS mode was 10 and nSIMV mode was 12. Although there was no statistically significant difference between the two groups in terms of the change in the relevant parameters from admission to 60 min, the decreases in PaCO2 and lactate levels (31.4% vs. 21.2%, p = 0.383; 68.8% vs. 47.1%, p = 0.224; respectively) and the increase in PaO2 and PaO2/FiO2 values (34% vs. 14.2%, p = 0.710 and 132.1% vs. 52.7%, p = 0.073; respectively) were higher in the nSIMV group. Conclusion: The nSIMV mode is as effective as the nCPAP/PS mode in the treatment of patients with ACPE. We believe that the nSIMV mode can be preferable, particularly in patients with hypercarbia who have relatively lower GCS and oxygenation.
      原文链接:
    • NSTL
    • Elsevier

    Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians

    Rouleau S.G.Brady W.J.Koyfman A.Long B....
    10页
    查看更多>>摘要：? 2022Introduction: Aortic valve stenosis (AS) is present in up to 10% of individuals over age 80 years. Transcatheter aortic valve replacement (TAVR) has become the most common method to replace the aortic valve in patients with AS. TAVR-related complications may occur. Objective: This narrative review evaluates the emergency department (ED) assessment and management of patients with TAVR complications. Discussion: Post-TAVR complications can be conceptualized as occurring peri-procedurally and after the peri-procedural period. Peri-procedural complications include device landing zone rupture, coronary artery obstruction, acute myocardial infarction, cardiac tamponade, and valve embolization. Complications beyond the peri-procedural window include vascular access/bleeding, mechanical valve issues, electrical conduction complications, and end-organ damage. Conclusions: Emergency clinicians are more likely to encounter TAVR complications after the initial procedural hospitalization and must be prepared to diagnose and manage these complications.
      原文链接:
    • NSTL
    • Elsevier

    Comparison of supine and upright face-to-face cadaver intubation

    Julliard D.Vassiliadis J.Bowra J.Gillett M....
    5页
    查看更多>>摘要：? 2022 Elsevier Inc.Introduction: Optimal patient positioning during intubation improves laryngeal view and first pass success, as well as reducing incidence of hypoxia. In certain pre-hospital situations, it may be impractical or impossible for the operator to stand behind the patient. Objective: We compared intubation in the supine and upright face-to-face positions, with regards to time to intubate and the view of the vocal cords obtained. Methods: This was a pilot comparison study. One investigator intubated 25 cadavers with the use of a bougie in the supine and upright face-to-face positions. Each attempt was recorded on a video laryngoscope. Recordings of each attempt were reviewed by five blinded emergency physicians, who allocated both a percentage of glottic opening (POGO) score and Cormack-Lehane (CL) grade. Time to insertion of the endotracheal tube (ETT) through the vocal cords was measured from the video. Results: The median intubation time was 1 s longer for upright cadavers than for supine cadavers, with greater variation in intubation times for upright cadavers compared with supine cadavers (IQR 9.0 vs 3.5 excluding the outlier case). The mean POGO score (averaged across raters) was 4.7% lower for upright intubation attempts (excluding the outlier case) with a moderate-to-good degree of inter-rater reliability, however this difference was not statistically significant. The median CL grade (averaged across raters) was 0.2 higher for upright intubation attempts (excluding the outlier case) with a poor-to-moderate degree of inter-rater reliability, and this difference was also not statistically significant. Conclusions: This pilot study suggests that upright, face-to-face intubation may be clinically similar to supine intubation in terms of time to intubation and difficulty. Further studies utilising a larger number of operators and cadaver types are indicated.
      原文链接:
    • NSTL
    • Elsevier

    Analgesic efficacy of nitrous oxide in adults in the emergency department: A meta-analysis of randomized controlled trials

    Xing Y.Zhou L.Yu J.Wang Z....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Nitrous oxide (N2O) has a rapidly analgesic effect, but evidence regarding its role in managing pain in adults in the emergency department (ED) is conflicting. The purpose of this meta-analysis is to investigate the analgesic efficacy and safety of N2O in adults in ED. Methods: We systematically searched PubMed, the Cochrane Library, Embase, Web of science, China National Knowledge Infrastrusture (CNKI) and Wanfang Database up to August 10th, 2021. Randomized controlled trials (RCTs) were included if they compared N2O/O2 to placebo or other analgesic methods for management of pain in adults in ED or prehospital. The primary outcome was the analgesic efficacy of N2O. Secondary outcomes included adverse events, satisfaction of patients and the duration of procedure. Results: 14 RCTs with 1751 patients were included. Pooled analysis suggested that N2O had better analgesia than placebo in the pain score (WMD = ?3.00, 95% CI = ?3.99 to ?2.02, P < 0.00001, I2 = 91%) and the number of patients with pain relief (OR = 6.18, 95% CI = 3.22 to 11.85, P < 0.00001, I2 = 0%), while there were no significant difference in the pain score (WMD = 0.93, 95% CI = ?1.09 to 2.95, P = 0.37, I2 = 97%) or the number of patients with pain relief (OR = 0.07, 95% CI = 0.00 to 3.47, P = 0.18, I2 = 86%) between the N2O group and the other analgesic method group. Although N2O did not increase nausea (OR = 1.52, 95% CI = 0.44 to 5.21, P = 0.50, I2 = 54%) or satisfaction of patients (OR = 1.06, 95% CI = 0.16 to 7.18, P = 0.96, I2 = 81%), it was associated with higher tendency of vomiting (OR = 6.50, 95% CI = 2.07 to 20.42, P = 0.001, I2 = 29%) and dizziness (OR = 4.54, 95% CI = 2.27 to 9.09, P < 0.0001, I2 = 26%), and shorter procedure time (WMD = ?5.73 min, 95% CI = ?10.14 min to ?1.32 min, P = 0.01, I2 = 98%). Conclusions: The present meta-analysis suggested that N2O could provide better analgesia than placebo and similar analgesia to other methods with more vomiting and dizziness in adults in ED.
      原文链接:
    • NSTL
    • Elsevier

    Limited accessibility of free online resuscitation education for people with disabilities

    Birkun A.Kosova Y.
    4页
      原文链接:
    • NSTL
    • Elsevier

    Low peripheral perfusion index values may indicate the need for antivenom in the early phase of scorpion envenomation

    Ozluer Y.E.Karaman K.Kayaoz D.Avcil M....
    3页
    查看更多>>摘要：? 2022Background: Scorpion envenomation may cause local symptoms as well as life-threatening situations including shock, and death. Antivenom administration is the cornerstone of therapy, meticulous patient selection is needed because of the possible side effects of the antivenom including anaphylaxis. Peripheral perfusion index (PPI) is a simple, non-invasive test that is widely used for the detection of peripheral hypoperfusion. We aimed to investigate the value of using PPI to predict the need for antivenom administration for scorpion envenomation. Methods: This prospective observational study was conducted in the ED of a tertiary care center. We consecutively enrolled patients with scorpion envenomation on the extremities who are over 18 years old without pregnancy and a peripheral arterial disease between March 1, 2021, to October 31, 2021. Demographics included age, sex, sting zone, the time between sting and the ED admission, and vital parameters, we blindly measured PPI both on affected and contralateral extremities before any therapeutic intervention. We compared PPI levels, vital parameters, and the outcome including discharge from the ED, admission to ward or ICU, and death between patients who received antivenom and those who did not. Results: Twenty-nine male (58.0%) and 21 (42.0%) female patients with scorpion envenomation were enrolled in the study. The median age was 46.5 [IQR 33.3]. Thirty-eight (76.0%) patients had Class I, 12 (24.0%) patients had Class II and III envenomation. The median duration of the ED admission after the sting was 90 [IQR 120] minutes. Antivenom was administered in 13 (26.0%) patients. PPI was significantly lower both on the affected and the contralateral extremities (p = 0.043 and p = 0.045, respectively) in patients who required antivenom. With a cut-off value of 2.4, PPI can predict the need for antivenom with a sensitivity of 61.54%, a specificity of 86.5%, a positive likelihood ratio of 4.55, a negative likelihood ratio of 0.44, a positive predictive value of 61.54%, a negative predictive value of 86.49%, and an accuracy of 80% (AUC 0.691, p < 0.05). Conclusion: PPI can better reflect the ongoing systemic inflammation and the need for antivenom compared to other vital parameters. Therefore, we suggest this noninvasive and objective test may have a significant role in detecting patients who need antivenom in the early phase of scorpion envenomation. However, more studies are needed to elucidate the role of PPI in scorpion envenomation.
      原文链接:
    • NSTL
    • Elsevier

    Assessment of novel ICT-EMS systems to improve emergency patient transportation during the COVID-19 pandemic

    Lee J.Kong S.Y.Kim B.W.Kim S.-Y....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objectives: This study aimed to examine the usability, feasibility, acceptability, and appropriateness of the information and communication technology for emergency medical services (ICT-EMS) systems to improve the transportation of emergency patients during the COVID-19 pandemic. Methods: Emergency medical technicians (EMTs) (n = 229) employed at 7 fire stations operated by the North Chungcheong Fire Service Headquarters, South Korea were trained to use ICT-EMS devices prior to a 1-month implementation period. System Usability Scale (SUS), Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM) questionnaires were conducted in the 4th week of the 1-month implementation period to assess the perceived usability, feasibility, acceptability, and appropriateness of the ICT-EMS systems. Results: Among a total of 229 EMTs, 187 EMTs (81.7%) completed the survey. The overall SUS score was significantly low (score of 35.6) indicating an overall negative perception of the ICT-EMS systems. With regard to the feasibility, acceptability, and intervention appropriateness of ICT-EMS, roughly 50 (26.7%) participants agreed that ICT-EMS implementation was possible, appealing, and suitable. Conclusion: Many potential areas of improvement were identified within the ICT-EMS systems. System alterations regarding usability, feasibility, acceptability, and appropriateness may be necessary to successfully implement the ICT-EMS systems.
      原文链接:
    • NSTL
    • Elsevier

    Triage travel screening in the pediatric emergency department: A cross-sectional analysis to evaluate current use and effectiveness in identifying travel related illness

    Greenky D.Linam M.Yaffee A.Costello B....
    4页
    查看更多>>摘要：? 2022 Elsevier Inc.Objectives: In 2014 the Center for Disease Control and Prevention recommended emergency departments (EDs) implement triage travel screening to identify persons at risk for Ebola Virus Disease (EVD). EVD remains rare in the United States, and in practice the triage travel screen serves as a de facto screen for all travel-related illnesses. This study seeks to determine the current use and effectiveness of the triage travel screen to detect travel-related illness in the pediatric ED. Methods: This was a retrospective, cross-sectional study of visits across three pediatrics EDs in 2019 in Atlanta, GA. Prevalences of travel-related illnesses were compared between patients with positive and negative travel screens. Patient charts with diagnoses of travel-related illness were then reviewed. Results: Out of 244,841 patient encounters during the study period, 13 patients with travel-related illness were identified. 5/13 cases of travel-related illness were not diagnosed at the initial ED visit. Of these 5 cases, 2 had correctly negative travel screens (as travel was not within the specified timeframe) and 3 had correctly positive travel screens, but none had a clinician-documented travel history in the ED clinical notes. Of the 8/13 cases that were diagnosed at the initial ED visit, 7/8 had a clinician-documented travel history in the ED note. Conclusions: This study highlights the limitations of the current pediatric ED triage travel screen to detect travel-related illness and reinforces the importance of a provider-taken travel history. Strategies to increase provider-administered travel history documentation and revisions to increase triage travel-screen efficacy should be considered.
      原文链接:
    • NSTL
    • Elsevier