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1.
Robert J. McLoughlin Jonathan Green Pradeep P. Nazarey Michael P. Hirsh Muriel Cleary Jeremy T. Aidlen 《The American journal of emergency medicine》2019,37(3):439-443
Purpose
In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment.Methods
A retrospective analysis was performed of 10–17?year old patients with snow-sport related injuries at a Level-1 trauma center from 2005 to 2015. Participants were divided into groups, 10–13 (middle-school, MS) and 14–17?years (high-school, HS) and compared using chi-square, Student's t-tests, and multivariable logistic regression.Results
We identified 235 patients. The HS group had a higher proportion of females than MS (17.5% vs. 7.4%, p?=?0.03) but groups were otherwise similar. Helmet use was significantly lower in the HS group (51.6% vs. 76.5%, p?<?0.01). MS students were more likely to suffer any head injury (aOR 4.66, 95% CI: 1.70–12.8), closed head injury (aOR 3.69 95% CI: 1.37–9.99), or loss of consciousness (aOR 5.56 95% CI 1.76–17.6) after 4?pm. HS students engaging in jumps or tricks had 2.79 times the risk of any head injury (aOR 2.79 95% CI: 1.18–6.57) compared to peers that did not. HS students had increased risk of solid organ injury when helmeted (aOR 4.86 95% CI: 1.30–18.2).Conclusions
Injured high-school snow sports participants were less likely to wear helmets and more likely to have solid organ injuries when helmeted than middle-schoolers. Additionally, high-schoolers with head injuries were more like to sustain these injures while engaging in jumps or tricks. Injury prevention in this vulnerable population deserves further study.Level of evidence
Level III (Retrospective Comparative Study). 相似文献2.
Nathaniel L. Scott Lauren R. Klein Ellen Cales Brian E. Driver 《The American journal of emergency medicine》2019,37(2):209-213
Introduction
Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication.Methods
Adult ED patients (≥18?years old) with hyperkalemia (>5.3?mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.Results
1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose <70?mg/dL) occurred in 68/409 (17%) of patients given insulin, compared to 4% of patients who did not receive insulin. Lower glucose prior to insulin (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.85 to 0.96), higher doses of insulin (aOR 1.07; 95% CI 1.01 to 1.15) and lower doses of D50 (aOR 0.98; 95% CI 0.97 to 0.99) were independently associated with hypoglycemia in the multivariate analysis. Age, history of diabetes, and history renal failure were not independently associated.Conclusion
Hypoglycemia is a frequent complication of treatment with IV insulin in the ED. Interventions such as standardized protocols to assist with the ED management of hyperkalemia should be developed; their efficacy and safety should be compared. 相似文献3.
Chrysovalantis Stafylis Claire C Bristow Lauren J Natoli Katheryn R Salow Emma Davidson Yancy Granados Mark McGrath Jeffrey D Klausner 《Diagnostic microbiology and infectious disease》2019,93(4):325-328
Introduction
Dual human immunodeficiency virus/syphilis rapid diagnostic devices can play an important role in prevention efforts. The field performance of the INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test (Multiplex) was evaluated.Methods
Fingerstick whole blood was tested using the rapid test. A fourth-generation HIV laboratory assay and treponemal-specific laboratory assays were used as reference. Rapid plasma reagin (RPR) was used to stratify treponemal results. Sensitivity and specificity were calculated.Results
Overall, 274 patients participated. Sensitivity of the Multiplex for detection of HIV was 98.8% (95% CI, 93.4–100%), and specificity was 100% (95% CI, 98.1–100%). Sensitivity for detection of syphilis antibodies was 56.8% (95% CI, 44.7–68.2%), and specificity was 98.5% (95% CI, 95.7–99.7%). Sensitivity for treponemal antibodies improved with increasing RPR and was 100% (95% CI, 78.2–100%) among samples with RPR titers ≥1:8.Conclusions
The Multiplex showed excellent performance for detection of HIV antibodies and increasing sensitivity for detection of treponemal antibody with increasing RPR titer. 相似文献4.
Sameer Sharif Michelle Eventov Clive Kearon Sameer Parpia Meirui Li River Jiang Paula Sneath Carmen Otero Fuentes Christopher Marriott Kerstin de Wit 《The American journal of emergency medicine》2019,37(5):845-850
Background
Diagnosing pulmonary embolism (PE) in the emergency department (ED) can be challenging because its signs and symptoms are non-specific.Objective
We compared the efficacy and safety of using age-adjusted D-dimer interpretation, clinical probability-adjusted D-dimer interpretation and standard D-dimer approach to exclude PE in ED patients.Design/methods
We performed a health records review at two emergency departments over a two-year period. We reviewed all cases where patients had a D-dimer ordered to test for PE or underwent CT or VQ scanning for PE. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30?days. We applied the three D-dimer approaches to the low and moderate probability patients. The primary outcome was exclusion of PE with each rule. Secondary objective was to estimate the negative predictive value (NPV) for each rule.Results
1163 emergency patients were tested for PE and 1075 patients were eligible for inclusion in our analysis. PE was excluded in 70.4% (95% CI 67.6–73.0%), 80.3% (95% CI 77.9–82.6%) and 68.9%; (95% CI 65.7–71.3%) with the age-adjusted, clinical probability-adjusted and standard D-dimer approach. The NPVs were 99.7% (95% CI 99.0–99.9%), 99.1% (95% CI 98.3–99.5%) and 100% (95% CI 99.4–100.0%) respectively.Conclusion
The clinical probability-adjusted rule appears to exclude PE in a greater proportion of patients, with a very small reduction in the negative predictive value. 相似文献5.
Shinya Iwase Taka-aki Nakada Noriyuki Hattori Waka Takahashi Nozomi Takahashi Tuerxun Aizimu Masahiro Yoshida Toshio Morizane Shigeto Oda 《The American journal of emergency medicine》2019,37(2):260-265
Background
The ability of blood levels of interleukin (IL)-6 to differentiate between infection and non-infection in critically ill patients with suspected infection is unclear. We assessed the diagnostic accuracy of serum IL-6 levels for the diagnosis of infection in critically ill patients.Methods
We systematically searched the PubMed, MEDLINE, Cochrane Resister of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, and Igaku Chuo Zasshi databases for studies published from 1986 to August 2016 that evaluated the accuracy of IL-6 levels for the diagnosis of infection. We constructed 2?×?2 tables and calculated summary estimates of sensitivity and specificity using a bivariate random-effects model.Results
The literature search identified 775 articles, six of which with a total of 527 patients were included according to the predefined criteria. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.73 (95% confidence interval [CI], 0.61–0.82), 0.76 (95% CI, 0.61–0.87), and 2.31 (95% CI, 1.20–3.48), respectively. The area under the curve (AUC) of the summary receiver operator characteristic (SROC) curve was 0.81 (95% CI, 0.78–0.85). In the secondary analysis of two studies with a total of 263 adult critically ill patients with organ dysfunction, the pooled sensitivity, specificity, and diagnostic odds ratio were 0.81 (95% CI, 0.75–0.86), 0.77 (95% CI, 0.67–0.84), and 2.87 (95% CI 2.15–3.60), respectively.Conclusions
Blood levels of IL-6 have a moderate diagnostic value and a potential clinical utility to differentiate infection in critically ill patients with suspected infection. 相似文献6.
Cody McIlvain Galadima Hadiza Theodore J. Tzavaras Gregory S. Weingart 《The American journal of emergency medicine》2019,37(3):472-477
Introduction
Hoverboards have become popular since they became available in 2015. We seek to provide an estimate of the number of injuries in the United States for 2015 and 2016, and to evaluate differences between adult and pediatric injury complexes.Methods
We performed a retrospective analysis of the National Electronic Injury Surveillance System (NEISS) from January 1, 2015 to December 31, 2016. Using the weighted design of the NEISS, a nationally representative sample could be determined.Results
During the 2?year period, there were 24,650 hoverboard related injuries (95% confidence interval [Cl], 17,635–31,664) in the US. The average age was 20.9?years old. There were 15,134 pediatric injuries (95%CI 9980–20,287) and 9515 adult injuries (95%CI 7185–11,845). Female patients compromised 51.2% of the sample. The upper extremity was the most common region injured [13,080 (95% CI 8848–17,311)] and fracture was the most common type of injury [10,074 (95% CI 6934–13,213)]. Hoverboard injuries increased from 2416 (95% CL 575–4245) in 2015 to 22,234 (95% CI 16,446–28,020) in 2016. Pediatric patients were more likely to be injured in the upper and lower extremity when compared to their adult cohort (p?=?0.0031). Six percent of the cohort [1575 (95% CI 665–2485)] sustained critical injuries with pediatric patients being at 1.46 times higher risk for life threatening injuries.Conclusion
Emergency department (ED) visits for hoverboard related injuries appear to be increasing. Pediatric patients are more at risk for hoverboard related injuries than adults and almost 6% of ED visits involved critical injuries, highlighting that hoverboards may be more dangerous than previously recognized. 相似文献7.
Patrick M. Ryan Andrew J. Kienstra Peter Cosgrove Robert Vezzetti Matthew Wilkinson 《The American journal of emergency medicine》2019,37(2):237-240
Objective
To examine the safety and effectiveness of intranasal midazolam and fentanyl used in combination for laceration repair in the pediatric emergency department.Methods
We performed a retrospective chart review of a random sample of 546 children less than 18?years of age who received both intranasal midazolam and fentanyl for laceration repair in the pediatric emergency department at a large, urban children's hospital. Records were reviewed from April 1, 2012 to June 31, 2015. The primary outcome measures were adverse events and failed laceration repair.Results
Of the 546 subjects analyzed, 5.1% had multiple lacerations. Facial lacerations were the most common site representing 70.3%, followed by lacerations to the hand (9.9%) and leg (7.0%). The median length of lacerations was 1.5?cm [1.0–2.5]. The median dose of fentanyl was 2.0?μg/kg [1.9–2.0] and midazolam was 0.2?mg/kg [0.19–0.20].There were no serious adverse events reported. The rate of minor side effects was 0.7% (95% CI 0.2% to 1.9%); 0.5% (95% CI 0.1% to 1.6%) experienced anxiety and 0.2% (95% CI 0.0% to 1.0%) vomited. No patients developed hypotension or hypoxia. Of the 546 patients, 2.4% (95% CI 1.3% to 4.0%) experienced a treatment failure. 2.0% (95% CI 1.3% to 4.0%) required IV sedation and 0.4% (95% CI 0.0% to 1.3%) were repaired in the operating room.Conclusions
Our results suggest that the combination of INM and INF may be a safe and effective strategy for procedural sedation in young children undergoing simple laceration repair. 相似文献8.
Aloysius Niroshan Siriwardena Zahid Asghar Bill Lord Helen Pocock Viet-Hai Phung Theresa Foster Julia Williams Helen Snooks 《The American journal of emergency medicine》2019,37(2):266-271
Objective
We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation.Methods
We used a cross-sectional design with a 7-day retrospective sample of adults aged 18?years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0–10 numerical verbal pain score [NVPS]).Results
We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff.Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p?<?0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75).Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P?<?0.01), attending patients aged 51 to 64?years (OR 2.04, 95% CI 1.21 to 3.45, p?=?0.01), in moderate to severe (NVPS 4–10) compared with lower levels of pain for any clinical condition group compared with the reference condition.Conclusion
There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction. 相似文献9.
Chenliang Sun Hongsheng Zhao Yang Lu Zhiwei Wang Wanjiang Xue Shu Lu Haoliang Shen Yiping Wang Qingyun Peng Lili Huang 《The American journal of emergency medicine》2019,37(2):254-259
Background
We evaluated factors associated with mortality in patients with moderate/severe generalized tetanus.Methods
This retrospective study included patients with moderate/severe generalized tetanus admitted to the Affiliated Hospital of Nantong University (China) between January 2005 and January 2017. Clinical data were extracted from medical records. Patients were divided into two groups based on outcome (survival or death). Factors associated with mortality were analyzed using univariate and multivariate logistic regression.Results
Seventy-five patients were included (57.3% male; age, 57.9?±?18.4?years; APACHE II score, 10.6?±?3.4; severe tetanus, 49.3%; mortality, 25.3%). Multivariate analysis identified severe tetanus (odds ratio [OR], 30.364; 95% confidence interval [CI], 2.459–374.896) and APACHE II score (OR, 1.536; 95%CI, 1.051–2.243) as positively associated with mortality, whereas high-calorie nutrition (OR, 0.027; 95%CI, 0.002–0.359) and dexmedetomidine use (OR, 0.035; 95%CI, 0.003–0.467) were negatively associated with mortality (all P?<?0.05).Conclusion
Tetanus severity and APACHE II score were associated with mortality in patients with generalized tetanus, whereas high-calorie nutrition and dexmedetomidine use reduced the odds of death. High-calorie nutrition and dexmedetomidine administration may improve prognosis in adult patients with moderate/severe generalized tetanus. 相似文献10.
Ayman El-Menyar Brijesh Sathian Bianca M. Wahlen Hassan Al-Thani 《The American journal of emergency medicine》2019,37(1):133-142
Objective
The association between brain injury and elevated serum cardiac troponin (cTn) remains poorly understood. We conducted a systematic review and meta-analysis to evaluate whether elevated cTn increases the risk of mortality in patients with traumatic (TBI) or non-traumatic brain injury (NT-BI).Methods
Cochrane Library, MEDLINE, PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, and Google scholar databases, and clinicaltrials.gov were searched for a retrospective, prospective and randomized clinical trials (RCT) or quasi-RCT studies that assessed the effect of elevated cTn (conventional or high sensitive assay) on the outcomes of brain injury patients. The main outcome of interest was mortality. Two authors independently abstracted the data using a data collection form. Results from different studies were pooled for analysis, whenever appropriate. The total number of patients pooled was 2435, of which 916 had elevated cTn and 1519 were in control group.Results
Out of 691 references identified through the search, 8 analytical studies met inclusion criteria. Among both types of brain injuries, an elevated cTn was associated with a higher mortality with an overall pooled odd ratio (OR) of 3.37 (95% CI 2.13–5.36). The pooled OR for mortality was 3.31 (95% CI 1.99–5.53) among patients with TBI and 3.36 (95% CI 1.32–8.6) among patients with NT-BI.Conclusions
Pooled analysis indicates that elevated cTn is significantly associated with a high mortality in patients with TBI and NT-BI. Prospective clinical trials are needed to support these findings and to inform a biomarker risk stratification regardless of the mechanism of injury. 相似文献11.
Christine M. Ulbricht Jacob N. Hunnicutt Giovanni Gambassi Anne L. Hume Kate L. Lapane 《Journal of pain and symptom management》2019,57(3):535-544.e1
Context
Despite many nursing home residents experiencing pain, research about the multidimensional nature of nonmalignant pain in these residents is scant.Objectives
To identify and describe pain symptom subgroups and to evaluate whether subgroups differed by sex.Methods
Using Minimum Data Set 3.0 data (2011-2012), we identified newly admitted nursing home residents reporting pain (n = 119,379). A latent class analysis included 13 indicators: markers for pain (i.e., severity, frequency, impacts sleep, and function) and depressive symptoms. Sex was evaluated as a grouping variable. Multinomial logistic models identified the association between latent class membership and covariates, including age and cognitive impairment.Results
Four latent subgroups were identified: severe (15.2%), moderate frequent (26.4%), moderate occasional with depressive symptoms (26.4%), and moderate occasional without depressive symptoms (32.0%). Measurement invariance by sex was ruled out. Depressed mood, sleep disturbances, and fatigue distinguished subgroups. Age ≥75 years was inversely associated with belonging to the severe, moderate frequent, or moderate occasional with depressive symptoms subgroups. Residents with severe cognitive impairment had reduced odds of membership in the severe pain subgroup (adjusted odds ratio [aOR]: 0.84; 95% confidence interval [CI]: 0.78-0.90) and moderate frequent pain subgroup (aOR: 0.60; 95% CI: 0.56-0.64) but increased odds in the moderate occasional pain with depressive symptoms subgroup (aOR: 1.12; 95% CI: 1.06-1.18).Conclusion
Identifying subgroups of residents with different patterns of pain and depressive symptoms highlights the need to consider physical and psychological components of pain. Expanding knowledge about pain symptom subgroups may provide a promising avenue to improve pain management in nursing home residents. 相似文献12.
Troy Madsen Rocky Jedick Troy Teeples Margaret Carlson Jacob Steenblik 《The American journal of emergency medicine》2019,37(2):281-285
Background
The Pulmonary Embolism Rule-out Criteria (PERC) defines hypoxia as an oxygen saturation (O2 sat)?<?95%. Utilizing this threshold for hypoxia at a significant elevation above sea level may lead to an inflated number of PERC-positive patients and unnecessary testing. The aim of this study was to determine the effect of an altitude-adjusted O2 sat on PERC's sensitivity and the potential impact on testing rates.Methods
At the University of Utah Emergency Department (ED) (elevation: 4980?ft/1518?m), we prospectively enrolled a convenience sample of patients presenting with chest pain and/or shortness of breath. We calculated PERC utilizing triage vital signs and baseline clinical variables and noted the diagnosis of acute PE during the ED visit. We adjusted the PERC O2 sat threshold to <90% to account for altitude to determine the potential impact on outcomes and decision tool performance.Results
Of 3024 study patients, 1.9% received the diagnosis of an acute PE in the ED, resulting in a sensitivity of 96.6% for the traditional PERC (95% CI: 88.1%–99.6%). Utilizing a definition of hypoxia of <90%, the sensitivity of the altitude-adjusted PERC rule was 94.8% (95% CI: 85.6%–98.9%). Assuming that imaging would not have been pursued for PERC-negative patients, the altitude-adjusted PERC rule would have reduced the overall rate of advanced imaging by 2.7% (95% CI: 1.8%–4.1%).Conclusion
Adjusting the PERC O2 sat threshold for altitude may result in decreased rates of advanced imaging for PE without a substantial change in the sensitivity of the PERC rule. 相似文献13.
Catherine A. Marco Robert P. Wahl James D. Thomas Ramon W. Johnson O. John Ma Anne L. Harvey Earl J. Reisdorff 《The American journal of emergency medicine》2019,37(5):859-863
Objective
The ABEM ConCert Examination is a summative examination that ABEM-certified physicians are required to pass once in every 10-year cycle to maintain certification. This study was undertaken to identify practice settings of emergency physicians, and to determine if there was a difference in performance on the 2017 ConCert between physicians of differing practice types and settings.Methods
This was a mixed methods cross sectional-study, using a post-examination survey and test performance data. All physicians taking the 2017 ConCert Examination who completed three survey questions pertaining to practice type, practice locations, and teaching were included. These three questions address different aspects of academia: self-identification, an academic setting, and whether the physician teaches.Results
Among 2796 test administrations of the 2017 ConCert Examination, 2693 (96.3%) completed the three survey questions about practice environment. The majority (N?=?2054; 76.3%) self-identified as primarily being a community physician, 528 (19.6%) as academic, and 111 (4.1%) as other. The average ConCert Examination score for community physicians was 83.5 (95% CI, 83.3–83.8); the academic group was 84.8 (95% CI, 84.3–85.3); and the other group was 82.3 (95% CI, 81.1–83.6). After controlling for initial ability as measured by the Qualifying Examination score, there was no significant difference in performance between academic and community physicians (p?=?.10).Conclusions
Academic emergency physicians and community emergency physicians scored similarly on the ConCert. Working at a community teaching hospital was associated with higher examination performance. Teaching medical learners, especially non-emergency medicine residents, was also associated with better examination performance. 相似文献14.
Namkyung Jeong Kyung Su Kim Yoon Sun Jung Taegyun Kim So Mi Shin 《The American journal of emergency medicine》2019,37(2):277-280
Objectives
To determine the association between delayed (>24?h) endoscopy and hospital mortality in patients with upper gastrointestinal hemorrhage (UGIH).Methods
We retrospectively analyzed all adult patients with UGIH who underwent endoscopy in a single emergency room for 2?years. The primary exposure was defined as >24?h from the ED visit to the first endoscopy. The primary outcome was defined as all cause hospital mortality. Secondary outcomes were intensive care unit admission rate, ED length of stay, and hospital length of stay.Results
Among 1101 patients enrolled, 898 received endoscopy within 24?h (early group) and 203 received endoscopy after 24?h (delayed group). The hospital mortality of early and delayed group was 2.8% and 6.4%, respectively (unadjusted relative risk [RR] 2.30: 95% CI, 1.20–4.42, p?=?0.012). This was significant after adjusting covariates including AIMS65 and Glasgow-Blatchford score (adjusted RR 2.23: 95% CI, 1.18–4.20, p?=?0.013). Intensive care unit admission rate was not different between two groups. ED and hospital length of stay were significantly longer in delayed group.Conclusions
Endoscopy performed after 24?h was associated with increased hospital mortality in UGIH. Patients in the delayed group stayed longer in the ED and in the hospital. 相似文献15.
Hiroyuki Inoue Shuji Uemura Keisuke Harada Hirotoshi Mizuno Naofumi Bunya Kazuhito Nomura Ryuichiro Kakizaki Eichi Narimatsu 《The American journal of emergency medicine》2019,37(2):189-193
Background
Pancreatic damage is commonly observed as a consequence of accidental hypothermia (core body temperature below 35?°C). We aimed to investigate the risk factors for pancreatic damage and the causal relationship in patients with accidental hypothermia.Methods
This retrospective, single-center, observational case-control study was conducted in the emergency department of a tertiary care medical center. We investigated patients who were admitted for accidental hypothermia over a course of ten years (January 2008 to December 2017).Results
Of the 138 enrolled patients, 70 had elevated serum amylase levels (51%). We observed a correlation between initial core body temperature and serum amylase level (Spearman's rank correlation coefficient ?0.302, p?<?0.001). Patients who developed acute pancreatitis had a significantly lower initial core body temperature than those who did not develop it (odds ratio?=?0.76; 95% confidence interval [CI]?=?0.61–0.94; p?=?0.011). Receiver operating characteristic analysis showed that a body temperature lower than 28.5?°C at the time of visit was predictive of acute pancreatitis (area under the curve?=?0.71, 95% CI?=?0.54–0.88, sensitivity?=?0.67, specificity?=?0.69, p?=?0.017).Conclusions
We concluded that an initial core body temperature lower than 28.5?°C was a risk factor for acute pancreatitis in accidental hypothermia cases. In such situations, careful follow-up is necessary. 相似文献16.
David C. Mackenzie Aftab M. Azad Vicki E. Noble Andrew S. Liteplo 《The American journal of emergency medicine》2019,37(1):123-126
Objective
We sought to determine test performance characteristics of emergency physician ultrasound for the identification of gastric contents.Methods
Subjects were randomized to fast for at least 10?h or to consume food and water. A sonologist blinded to the patient's status performed an ultrasound of the stomach 10?min after randomization and oral intake, if applicable. The sonologist recorded their interpretation of the study using three sonographic windows. Subsequently 2 emergency physicians reviewed images of each study and provided an interpretation of the examination. Test performance characteristics and inter-rater agreement were calculated.Results
45 gastric ultrasounds were performed. The sonologist had excellent sensitivity (92%; 95% CI 73%–99%) and specificity (85%; 95% CI 62%–92%). Expert review demonstrated excellent sensitivity but lower specificity. Inter-rater agreement was very good (κ?=?0.64, 95%CI 0.5–0.78).Conclusion
Emergency physician sonologists were sensitive but less specific at detecting stomach contents using gastric ultrasound. 相似文献17.
Leonardo Jönck Staub Roberta Rodolfo Mazzali Biscaro Erikson Kaszubowski Rosemeri Maurici 《The Journal of emergency medicine》2019,56(1):53-69
Background
Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms.Objective
Systematically review the accuracy of lung ultrasonography (LUS) for emergency diagnosis of pneumonia, acute heart failure, and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma in adults.Methods
PubMed, Embase, Scopus, Web of Science, and LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde; until 2016) were searched for prospective diagnostic accuracy studies. Rutter-Gatsonis hierarchical summary receiver operating characteristic method was used to measure the overall accuracy of LUS and Reitsma bivariate model to measure the accuracy of the different sonographic signs. This review was previously registered in PROSPERO (Centre for Reviews and Dissemination, University of York, York, UK; CRD42016048085).Results
Twenty-five studies were included: 14 assessing pneumonia, 14 assessing acute heart failure, and four assessing exacerbations of COPD/asthma. The area under the summary receiver operating characteristic curve of LUS was 0.948 for pneumonia, 0.914 for acute heart failure, and 0.906 for exacerbations of COPD/asthma. In patients suspected to have pneumonia, consolidation had sensitivity of 0.82 (95% confidence interval [CI] 0.74–0.88) and specificity of 0.94 (95% CI 0.85–0.98) for this disease. In acutely dyspneic patients, modified diffuse interstitial syndrome had sensitivity of 0.90 (95% CI 0.87–0.93) and specificity of 0.93 (95% CI 0.91–0.95) for acute heart failure, whereas B-profile had sensitivity of 0.93 (95% CI 0.72–0.98) and specificity of 0.92 (95% CI 0.79–0.97) for this disease in patients with respiratory failure. In patients with acute dyspnea or respiratory failure, the A-profile without PLAPS (posterior-lateral alveolar pleural syndrome) had sensitivity of 0.78 (95% CI 0.67–0.86) and specificity of 0.94 (95% CI 0.89–0.97) for exacerbations of COPD/asthma.Conclusion
Lung ultrasound is an accurate tool for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of COPD/asthma. 相似文献18.
C. Tomich J.S. Liegey S. Sagnier S. Olindo M. Poli S. Debruxelles F. Rouanet P. Renou I. Sibon 《The American journal of emergency medicine》2019,37(2):194-198
Background
Optimization of the detection of atrial fibrillation following stroke is mandatory. Unfortunately, access to long-term cardiac monitoring is limited in many centers. The aim of this study was to assess the potential usefulness of three routine biological markers, troponin, D-dimers and BNP, measured in acute stroke phase in the selection of patients at risk of cardio-embolic stroke.Methods
Troponin, D-Dimers and BNP were measured within 48?h after admission for ischemic stroke in 634 patients. Stroke mechanism was defined at the 3?months follow-up visit using ASCOD classification using a standardized work-up. Association between clinical, radiological and biological markers and stroke mechanism was evaluated using logistic regression analyses.Results
159 patients (25.1% of total study population) had a cardiac mechanism. On multivariate analysis, admission initial stroke severity (OR 1.04, 95 CI% 1.004–1.07, p?<?0.05) history of heart failure (OR 3.03, 95% CI 1.19–7.73, p?<?0.05), ECG abnormalities and high BNP value (OR 4.34, 95% CI 2.59–7.29, p?<?0.05) were associated with pure cardiac stroke mechanism.Conclusion
High BNP value measured within 48?h after stroke admission is an independent predictor of cardiac stroke mechanism. Its measurement might be used to improve the selection of patients for whom further cardiologic investigations such as continuous long term ECG monitoring would be the most useful. BNP should be added to the standard admission-work-up for stroke patients. 相似文献19.
Alexander D. Bode Mallika Singh James R. Andrews Amado A. Baez 《The American journal of emergency medicine》2019,37(1):53-55
Background
Barriers to EMS care can result in suboptimal outcomes and preventable morbidity and mortality. Large EMS databases such as the National Emergency Medical Services Information System (NEMSIS) dataset provide valuable data on the relative incidence of such barriers to care.Methods
A retrospective cross-sectional analysis was performed using the NEMSIS database. Cases of violent trauma were collected based on gender and racial group. Each group was analyzed for the ratio of cases that involved an EMS barrier to care. Chi-square testing was used to assess associations, and the relative risk was used as the measure of strength of association. For all tests, statistical significance was set at the 0.05 level.Results
719,812 cases of violent trauma were analyzed using the NEMSIS dataset. EMS encountered barriers to care for white and non-white patients was found to be 4.9% and 4.0% respectively. The difference between groups was found to be 0.9% (95% CI [0.7%, 1.1%] p?<?0.0001). RR was 1.23 for white patients (95% CI [1.19, 1.26]), and 0.82 (95% CI [0.79, 0.84]) for non-white. EMS barriers to care for male and female patients was found to be 6.03% and 3.34%, respectively. The difference between groups was found to be 2.7% (95% CI [2.6%, 2.8%] p?<?0.0001). RR for male patients was 1.80 (95% Cl [1.76, 1.84]) while RR for female patients was 0.55 (95% CI [0.54, 0.57]).Conclusions
Racially white patients and male patients have a statistically significant higher risk of encountering an EMS barrier to care in cases of violent trauma. 相似文献20.
Lauren R. Klein Brian E. Driver Gabriella Horton Sarah Scharber Marc L. Martel Jon B. Cole 《The Journal of emergency medicine》2019,56(5):484-490