European Journal of Emergency Medicine

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ISSN / EISSN : 0969-9546 / 1473-5695
Total articles ≅ 2,914
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, Carine Van de Voorde, Koen Van Den Heede
European Journal of Emergency Medicine; https://doi.org/10.1097/mej.0000000000000947

Abstract:
Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.
Megan Hoffer, Quincy K. Tran, Ryan Hodgson, Matthew Atwater,
European Journal of Emergency Medicine; https://doi.org/10.1097/mej.0000000000000941

Abstract:
Atrial fibrillation with rapid ventricular response (Afib/RVR) is a frequent reason for emergency department (ED) visits and can be treated with a variety of pharmacological agents. Magnesium sulfate has been used to prevent and treat postoperative Afib/RVR. We performed a systematic review and meta-analysis to assess the effectiveness of magnesium for treatment of Afib/RVR in the ED. PubMed and Scopus databases were searched up to June 2021 to identify any relevant randomized trials or observational studies. We used Cochrane’s Risk-of-Bias tools to assess study qualities and random-effects meta-analysis for the difference of heart rate (HR) before and after treatment. Our search identified 395 studies; after reviewing 11 full texts, we included five randomized trials in our analysis. There were 815 patients with Afib/RVR; 487 patients (60%) received magnesium treatment, whereas 328 (40%) patients received control treatment. Magnesium treatment was associated with significant reduction in HR [standardized mean difference (SMD), 0.34; 95% CI, 0.21–0.47; P < 0.001; I2 = 4%), but not associated with higher rates of sinus conversion (OR, 1.46; 95% CI, 0.726–2.94; P = 0.29), nor higher rates of hypotension and bradycardia (OR, 2.2; 95% CI, 0.62–8.09; P = 0.22). Meta-regressions demonstrated that higher maintenance dose (corr. coeff, 0.17; P = 0.01) was positively correlated with HR reductions, respectively. We observed that magnesium infusion can be an effective rate control treatment for patients who presented to the ED with Afib/RVR. Further studies with more standardized forms of control and magnesium dosages are necessary to assess the benefit/risk ratio of magnesium treatment, besides to confirm our observations.
Robert Leach, Davi Kaur, Said Laribi, Christoph Dodt, Wilhelm Behringer, Jim Connolly,
European Journal of Emergency Medicine, Volume 29, pp 156-157; https://doi.org/10.1097/mej.0000000000000936

Wan-Ching Lien, Jia-Yu Chen, Pei-Hsiu Wang, Dean-An Ling, Hsiu-Po Wang
European Journal of Emergency Medicine, Volume 29, pp 236-238; https://doi.org/10.1097/mej.0000000000000888

Noa Galtung, Eva Diehl-Wiesenecker, Dana Lehmann, Natallia Markmann, Wilma H. Bergström, James Wacker, Oliver Liesenfeld, Michael Mayhew, Ljubomir Buturovic, Roland Luethy, et al.
European Journal of Emergency Medicine; https://doi.org/10.1097/mej.0000000000000931

Abstract:
Background and importance mRNA-based host response signatures have been reported to improve sepsis diagnostics. Meanwhile, prognostic markers for the rapid and accurate prediction of severity in patients with suspected acute infections and sepsis remain an unmet need. IMX-SEV-2 is a 29-host-mRNA classifier designed to predict disease severity in patients with acute infection or sepsis. Objective Validation of the host-mRNA infection severity classifier IMX-SEV-2. Design, settings and participants Prospective, observational, convenience cohort of emergency department (ED) patients with suspected acute infections. Outcome measures and analysis Whole blood RNA tubes were analyzed using independently trained and validated composite target genes (IMX-SEV-2). IMX-SEV-2-generated risk scores for severity were compared to the patient outcomes in-hospital mortality and 72-h multiorgan failure. Main results Of the 312 eligible patients, 22 (7.1%) died in hospital and 58 (18.6%) experienced multiorgan failure within 72 h of presentation. For predicting in-hospital mortality, IMX-SEV-2 had a significantly higher area under the receiver operating characteristic(AUROC) of 0.84 [95% confidence intervals (CI), 0.76–0.93] compared to 0.76 (0.64–0.87) for lactate, 0.68 (0.57–0.79) for quick Sequential Organ Failure Assessment (qSOFA) and 0.75 (0.65–0.85) for National Early Warning Score 2 (NEWS2), (P = 0.015, 0.001 and 0.013, respectively). For identifying and predicting 72-h multiorgan failure, the AUROC of IMX-SEV-2 was 0.76 (0.68–0.83), not significantly different from lactate (0.73, 0.65–0.81), qSOFA (0.77, 0.70–0.83) or NEWS2 (0.81, 0.75–0.86). Conclusion The IMX-SEV-2 classifier showed a superior prediction of in-hospital mortality compared to biomarkers and clinical scores among ED patients with suspected infections. No improvement for predicting multiorgan failure was found compared to established scores or biomarkers. Identifying patients with a high risk of mortality or multiorgan failure may improve patient outcomes, resource utilization and guide therapy decision-making.
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