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"Diagnosis"

Review Article

Neurology

Initial diagnosis and management of acute ischemic stroke: updates and future directions
Sang Hee Ha, Sujin Koo, Seung Min Kim, Jae Young Park, Seung Eun Lee, Bum Joon Kim
Clin Exp Emerg Med 2026;13(1):5-12.   Published online January 14, 2026
DOI: https://doi.org/10.15441/ceem.25.241

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Initial diagnosis and management of acute ischemic stroke: updates and future directions
Clin Exp Emerg Med. 2026;13(1):5-12.   Published online January 14, 2026
DOI: https://doi.org/10.15441/ceem.25.241
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Initial diagnosis and management of acute ischemic stroke: updates and future directions
Clin Exp Emerg Med. 2026;13(1):5-12.   Published online January 14, 2026
DOI: https://doi.org/10.15441/ceem.25.241
Close
Outcomes in acute ischemic stroke (AIS) depend critically on rapid and accurate early diagnosis in the emergency department. Traditional prehospital tools and large vessel occlusion–focused scales facilitate triage but have limited capacity to distinguish ischemic from hemorrhagic stroke, a distinction essential for acute-phase treatment decisions. Recent advances include mobile stroke units equipped with computed tomography (CT), point-of-care laboratories, and telemedicine systems, as well as the emergence of biomarkers that enable field-based diagnosis and faster initiation of therapy. In-hospital imaging strategies incorporating CT, CT perfusion, and magnetic resonance imaging (MRI)-based tissue clocks have expanded eligibility for endovascular thrombectomy to include patients with large-core infarction or unclear-onset wake-up strokes. Prolonged cardiac monitoring and high-resolution vessel wall MRI have improved the detection of embolic sources and high-risk atherosclerotic plaques. Artificial intelligence now supports rapid imaging interpretation, workflow optimization, and treatment selection. Tenecteplase, a novel thrombolytic, provides a practical alternative to alteplase with comparable safety and efficacy, while post-thrombectomy management emphasizes individualized blood pressure control. In patients with minor stroke or high-risk transient ischemic attack, short-term dual antiplatelet therapy reduces early recurrence, and early initiation of lipid-lowering agents after AIS may stabilize vulnerable plaques and enhance vascular outcomes. Collectively, these innovations represent a shift toward integrated, time-sensitive, and precision-based AIS care spanning prehospital assessment, emergency department management, and post-reperfusion management.

Citations

Citations to this article as recorded by  Crossref logo
  • Current status and advances in comprehensive treatment of acute ischemic stroke in China: from evidence-based guidelines to clinical practice
    Ze-Ying Wang, Qin-Bao Zhang, Xiao-Ming Zheng
    Frontiers in Neurology.2026;[Epub]     CrossRef
  • 3,882 View
  • 188 Download
  • 1 Web of Science
  • 1 Crossref

Systematic Review

Use of biomarkers in the early diagnosis of Ischemic Stroke: A Systematic Review
José-Manuel León, Rosa Castillo-Olate, Jeffrey Penny
In Press, Received July 30, 2025  Accepted December 20, 2025  Available online January 14, 2026  
DOI: https://doi.org/10.15441/ceem.25.167    [Accepted]

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Use of biomarkers in the early diagnosis of Ischemic Stroke: A Systematic Review
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Use of biomarkers in the early diagnosis of Ischemic Stroke: A Systematic Review
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Objective
The diagnosis of acute ischemic stroke (AIS) is time-sensitive and reliant on neuroimaging, which is not always immediately accessible. This systematic review aims to identify and evaluate bloodbased biomarkers with potential to support early diagnostic decision-making and facilitate prompt referral for confirmatory imaging and treatment.
Methods
Following the PRISMA guidelines, a systematic search of PubMed, Web of Science, LILACS, Medline, Scopus, Scielo, Epistemonikos and TRIP Data Base was conducted for primary studies published in the last five years. Original studies evaluating blood-based biomarkers collected within 12 hours of symptom onset for early diagnosis of AIS were included. The methodological quality of included studies was assessed using the QUADAS-2 tool.
Results
Ten studies met the inclusion criteria, investigating a range of biomarkers including proteins, non-coding RNAs, and lipids. Most studies were case-control in design, with overall risk of bias rated as low to moderate. Multi-marker panels combining biomarkers with clinical scales (e.g., D-dimer and GFAP with FAST-ED; AUC = 0.95), and lipidomics-based models (AUC = 0.968), demonstrated the highest diagnostic performance. Several individual non-coding RNAs also showed promising accuracy (AUC > 0.85).
Conclusion
Blood-based biomarkers, especially when used in multi-marker panels, demonstrate considerable potential as triage tools for early AIS diagnosis. Their application in point-of-care settings could reduce diagnostic uncertainty and accelerate time to treatment. However, prospective validation in real-world emergency environments is essential prior to clinical implementation.
  • 794 View
  • 75 Download

Review Article

Critical Care

Advances in metabolomics in critically ill patients with sepsis and septic shock
Swarnima Pandey
Clin Exp Emerg Med 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211

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Advances in metabolomics in critically ill patients with sepsis and septic shock
Clin Exp Emerg Med. 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211
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Advances in metabolomics in critically ill patients with sepsis and septic shock
Clin Exp Emerg Med. 2025;12(1):4-15.   Published online July 19, 2024
DOI: https://doi.org/10.15441/ceem.24.211
Close
Sepsis is associated with high morbidity and mortality rates in hospitalized patients. This condition has a complex pathophysiology and can swiftly progress to the severe form of septic shock, which can lead to organ dysfunction, organ failure, and death. Metabolomics has transformed the clinical and research topography of sepsis, with application to prognosis, diagnosis, and risk assessment. Metabolomics involves detecting and analyzing levels of metabolites in blood (plasma, serum, and/or erythrocytes) and urine; when applied in sepsis, this technology can improve our understanding of the pathogenesis of the disease and aid in better disease management by identifying early biomarkers. For this review article, “metabolomics,” “sepsis,” and “septic shock” were keywords used to search records in various databases including PubMed and Scopus from their inception until December 2023. This review article summarizes information regarding metabolic profiling performed in sepsis and septic shock and illustrates how metabolomics is advancing the diagnosis and prognosis of patients with sepsis.

Citations

Citations to this article as recorded by  Crossref logo
  • Impact of Metabolically Healthy and Unhealthy Obesity on Outcomes of Sepsis Complicated by Septic Shock in Elderly Patients
    Giorgi Chilingarashvili, Diksha Sanjana Pasnoor, Shreya Bajjuri, Ritika Parekh, Nirmala Manjappachar, Jyotsna Gummadi, Athmananda Nanjundappa, Rupak Desai
    Journal of Intensive Care Medicine.2026; 41(6): 486.     CrossRef
  • Effect of norepinephrine initiation timing on mortality in septic shock: a multicenter cohort study
    Jung Won Choi, Tae Gun Shin, Seung Jin Maeng, Sung Yeon Hwang, Sang-Min Kim, Won Young Kim, Kyuseok Kim, Sung-Joon Park, Sung-Hyuk Choi, Sejoong Ahn, Woon Yong Kwon, Taeyoung Kong, Sung Phil Chung, Byuk Sung Ko, Tae Ho Lim
    BMC Anesthesiology.2026;[Epub]     CrossRef
  • Identification of Volatile Organic Compounds (Distinct Biomarkers) Emitted by Cancer Cells Using Gas Chromatography-mass Spectrometry – A Review
    Surendar Balu, Ashok K. Sundramoorthy
    Current Analytical Chemistry.2026; 22(1): 35.     CrossRef
  • Integrative multi-omics and machine learning identify mitochondrial biomarkers for pathogen-specific sepsis stratification and translational prioritization
    Chaoyuan Jin, Ruijinlin Hao, Bate Gonggaoang, Qingxia Dai, Xingxing Ren, Jie Shen
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • Age–Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study
    Seung Jin Maeng, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Minha Kim, Sejin Heo, Tae Ho Lim, Sung Phil Chung, Sung-Hyuk Choi, Tae Gun Shin
    Healthcare.2026; 14(6): 722.     CrossRef
  • Artificial intelligence-driven cluster analysis for identifying clinical phenotypes in suspected sepsis patients in the emergency department
    Daun Jeong, Jong Rul Park, Seung Jin Maeng, Jung Won Choi, Gun Tak Lee, Sung Yeon Hwang, Chulhong Kim, Jong Eun Park, Tae Gun Shin
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Early prediction of renal replacement therapy within 24 hours after septic shock recognition in the emergency department using machine learning: a retrospective analysis of a prospectively collected multicenter registry
    Sangun Nah, Tae Ho Lim, Sung Phil Chung, Gil Joon Suh, Sung-Hyuk Choi, Woon Yong Kwon, Won Young Kim, Kyuseok Kim, Sangchun Choi, Je Sung You, Han Sung Choi, Tae Gun Shin, Sangsoo Han
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Early vasopressin administration in septic shock: A systematic review, meta-analysis, and multicenter retrospective observational study
    Chiwon Ahn, Gun Tak Lee, Jae Hwan Kim, Sejoong Ahn, Sung Yeon Hwang, Sang-Min Kim, Won Young Kim, Sung-Joon Park, Sung-Hyuk Choi, Woon Yong Kwon, Taeyoung Kong, Sung Phil Chung, Byuk Sung Ko, Kyung Hun Yoo, Tae Ho Lim, Tae Gun Shin, Kyuseok Kim
    European Journal of Internal Medicine.2026; : 106933.     CrossRef
  • Metabolic footprint of sepsis and septic shock: A narrative review
    Anjali Mishra, Deven Juneja
    World Journal of Critical Care Medicine.2026;[Epub]     CrossRef
  • Neutrophil immunometabolism in ACLF and sepsis: mechanisms, dysfunction, and therapeutic opportunities
    Sonali Mukherjee, Takhellambam Malemnganba, Pragyan Acharya
    Frontiers in Immunology.2026;[Epub]     CrossRef
  • Integrative transcriptomic and bioinformatic analyses predict candidate EMT-related genes in sepsis-associated acute lung injury
    Jun Liu, Yun Chen, Hao Peng, Zheyuan Xu, Yang Wang, Libin Zhang, Han Wang
    Naunyn-Schmiedeberg's Archives of Pharmacology.2026;[Epub]     CrossRef
  • Metabolic reprogramming in sepsis-associated acute kidney injury: insights from lipopolysaccharide-induced oxidative stress and amino acid dysregulation
    Hakan Turk, Ebru Temiz, Ismail Koyuncu
    Molecular Biology Reports.2025;[Epub]     CrossRef
  • Leveraging diverse cell-death patterns in diagnosis of sepsis by integrating bioinformatics and machine learning
    Mi Liu, Xingxing Gao, Hongfa Wang, Yiping Zhang, Xiaojun Li, Renlai Zhu, Yunru Sheng
    PeerJ.2025; 13: e19077.     CrossRef
  • Characterization of metabolism associated with outcomes in severe acute pancreatitis: Insights from serum metabolomic analysis
    Mohd Adnan Siddiqui, Anamika Singh, Swarnima Pandey, Mohammed Haris Siddiqui, Afzal Azim, Neeraj Sinha
    Biophysical Chemistry.2025; 322: 107436.     CrossRef
  • Untargeted lipidomics profiling provides novel insights into pediatric patients with sepsis: an exploratory study
    Reyihangu Awuti, Jiayi Bai, Ye Cheng, Weili Yang, Zimei Cheng, Hetian Zhou, Guoyun Su, Kexin Wang, Yaodong Wang, Tingyan Liu, Ying Liu, Weiming Chen, Hehe Chen, Guoping Lu, Caiyan Zhang
    Metabolomics.2025;[Epub]     CrossRef
  • Multi‐Omics and ‐Organ Insights into Energy Metabolic Adaptations in Early Sepsis Onset
    Lin‐Lin Xu, Zhengyuan Zhou, Sascha Schäuble, Wolfgang Vivas, Karen Dlubatz, Michael Bauer, Sebastian Weis, Mervyn Singer, Roman Lukaszewski, Gianni Panagiotou
    Advanced Science.2025;[Epub]     CrossRef
  • Metabolomics for the Identification of Biomarkers in Rheumatoid Arthritis
    Swarnima Pandey
    Phenomics.2025; 5(3): 343.     CrossRef
  • Understanding metabolic alterations in advanced stage chronic kidney disease patients by NMR-based metabolomics
    Amrita Sahu, Upasna Gupta, Bikash Baishya, Dharmendra Singh Bhadauria, Neeraj Sinha
    Molecular Omics.2025; 21(5): 464.     CrossRef
  • Functional metabolomics: unlocking the role of small molecular metabolites
    Hetao Chen, Jiao Kong, Peipei Du, Qian Wang, Tao Jiang, Xixi Hou, Tingting Feng, Jiajia Duan, Chuanxin Liu
    Frontiers in Molecular Biosciences.2025;[Epub]     CrossRef
  • Recent advances in biomarkers for detection and diagnosis of sepsis and organ dysfunction: a comprehensive review
    Leiyang Chen, Xiuxiu Zhang, Peizhi Shi
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Metabolomics for the identification of biomarkers in endometriosis
    Swarnima Pandey
    Archives of Gynecology and Obstetrics.2024; 310(6): 2823.     CrossRef
  • 10,847 View
  • 200 Download
  • 23 Web of Science
  • 21 Crossref

Original Articles

Emergency Medical Services | Neurology

Uncooperative patients suspected of acute stroke ineligible for prehospital stroke screening test by emergency medical service providers: final hospital diagnoses and characteristics
Sol Han, Sung Wook Song, Hansol Hong, Woo Jeong Kim, Young Joon Kang, Chang Bae Park, Jeong Ho Kang, Ji Hwan Bu, Sung Kgun Lee, Seo Young Ko, Soo Hoon Lee, Chul-Hoo Kang
Clin Exp Emerg Med 2023;10(2):213-223.   Published online February 14, 2023
DOI: https://doi.org/10.15441/ceem.22.372

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Uncooperative patients suspected of acute stroke ineligible for prehospital stroke screening test by emergency medical service providers: final hospital diagnoses and characteristics
Clin Exp Emerg Med. 2023;10(2):213-223.   Published online February 14, 2023
DOI: https://doi.org/10.15441/ceem.22.372
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Uncooperative patients suspected of acute stroke ineligible for prehospital stroke screening test by emergency medical service providers: final hospital diagnoses and characteristics
Clin Exp Emerg Med. 2023;10(2):213-223.   Published online February 14, 2023
DOI: https://doi.org/10.15441/ceem.22.372
Close
Objective
This study investigated the hospital diagnoses and characteristics of uncooperative prehospital patients suspected of acute stroke who could not undergo a prehospital stroke screening test (PHSST).
Methods
This retrospective observational study was conducted at a single academic hospital with a regional stroke center. We analyzed three scenario-based prehospital stroke screening performances using the final hospital diagnoses: (1) a conservative approach only in patients who underwent the PHSST, (2) a real-world approach that considered all uncooperative patients as screening positive, and (3) a contrapositive approach that all uncooperative patients were considered as negative.
Results
Of the 2,836 emergency medical services (EMS)-transported adult patients who met the prehospital criteria for suspicion of acute stroke, 486 (17.1%) were uncooperative, and 570 (20.1%) had a confirmed final diagnosis of acute stroke. The diagnosis in the uncooperative group did not differ from that in the cooperative group (22.0% vs. 19.7%, P=0.246). The diagnostic performances of the PHSST in the conservative approach were as follows: 79.5% sensitivity (95% confidence interval [CI], 75.5%–83.1%), 90.2% specificity (95% CI, 88.8%–91.6%), and 0.849 area under the receiver operating characteristic curve (AUC; 95% CI, 0.829–0.868). The sensitivity and specificity were 83.3% (95% CI, 80.0%–86.3%) and 75.2% (95% CI, 73.3%–76.9%), respectively, in the real-world approach and 64.6% (95% CI, 60.5%–68.5%) and 91.9% (95% CI, 90.7%–93.0%), respectively, in the contrapositive approach. No significant difference was evident in the AUC between the real-world approach and the contrapositive approach (0.792 [95% CI, 0.775–0.810] vs. 0.782 [95% CI, 0.762–0.803], P>0.05).
Conclusion
We found overestimation (false positive) and underestimation (false negative) in the uncooperative group depending on the scenario-based EMS stroke screening policy for uncooperative prehospital patients suspected of acute stroke.

Citations

Citations to this article as recorded by  Crossref logo
  • LncRNA MCM3AP-AS1 protects against cerebral ischemia-reperfusion injury via targeting miR-27b-3p
    Rouli Dai, Wei Li, Bin Han
    Neurological Research.2026; 48(2): 229.     CrossRef
  • Impact of snoring on the risk of stroke in patients with diabetes mellitus
    Eujene Jung, U Chul Ju, Hyun Ho Ryu, Hyun Lee Kim
    Sleep and Breathing.2024; 28(6): 2675.     CrossRef
  • Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Sung Eun Lee, Hyo Jin Kim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S48.     CrossRef
  • 7,583 View
  • 122 Download
  • 3 Web of Science
  • 3 Crossref

Cardiovascular

Analysis of the accuracy of automatic electrocardiogram interpretation in ST-segment elevation myocardial infarction
Seongsoo Kim, Wonhee Kim, Gu Hyun Kang, Yong Soo Jang, Hyun Young Choi, Jae Guk Kim, Yoonje Lee, Dong Geum Shin
Clin Exp Emerg Med 2022;9(1):18-23.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.21.163

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Analysis of the accuracy of automatic electrocardiogram interpretation in ST-segment elevation myocardial infarction
Clin Exp Emerg Med. 2022;9(1):18-23.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.21.163
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Analysis of the accuracy of automatic electrocardiogram interpretation in ST-segment elevation myocardial infarction
Clin Exp Emerg Med. 2022;9(1):18-23.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.21.163
Close
Objective
This study aimed to analyze the association between the culprit artery and the diagnostic accuracy of automatic electrocardiogram (ECG) interpretation in patients with ST-segment elevation myocardial infarction (STEMI).
Methods
This single-centered, retrospective cohort study included adult patients with STEMI who visited the emergency department between January 2017 and December 2020. The primary endpoint was the association between the culprit artery occlusion and the misinterpretation of ECG, evaluated by the chi-square test or Fisher exact test.
Results
The rate of misinterpretation of the automated ECG for patients with STEMI was 26.5% (31/117 patients). There was no significant correlation between the ST segment change in the four involved leads (anteroseptal, lateral, inferior, and aVR) and the misinterpretation of ECG (all P > 0.05). Single culprit artery occlusion significantly affected the misinterpretation of ECG compared with multiple culprit artery occlusion (single vs. multiple, 27/86 [31.3%] vs. 4/31 [12.9%], P = 0.045). There was no association between culprit artery and the misinterpretation of ECG (P = 0.132).
Conclusion
Single culprit artery occlusion might increase misinterpretation of ECG compared with multiple culprit artery occlusions in the automatic interpretation of STEMI.

Citations

Citations to this article as recorded by  Crossref logo
  • Advances in the Interpretation of the Electrocardiogram by Artificial Intelligence
    S. Suave Lobodzinski, Ryszard Piotrowicz
    Diagnostics.2026; 16(14): 2167.     CrossRef
  • Implementation of a Novel Prehospital Clinical Decision Tool and ECG Transmission for STEMI Significantly Reduces Door-to-Balloon Time and Sex-Based Disparities
    Bryan D. Nelson, Conor J. McLaughlin, Orlando E. Rivera, Kashyap Kaul, Andrew J. Ferdock, Zachary M. Matuzsan, Ali R. Yazdanyar, Jay V. Gopal, Ayushi Y. Patel, Rachael M. Chaska, Bruce A. Feldman, Jeanne L. Jacoby
    Prehospital Emergency Care.2025; 29(2): 170.     CrossRef
  • An Overview of Artificial Intelligence in Primary Care and Administrative Medicine
    Vincent Morelli
    Primary Care: Clinics in Office Practice.2025; 52(4): 671.     CrossRef
  • Computer-Interpreted Electrocardiograms: Impact on Cardiology Practice
    Shyla Gupta, Anthony H. Kashou, Robert Herman, Stephen Smith, Adam May, Ana G. Múnera Echeverri, Mildren Del Sueldo, Ana C. Berni, Juan Farina, Sebastian Garcia-Zamora, Adrian Baranchuk
    International Journal of Cardiovascular Sciences.2024;[Epub]     CrossRef
  • 10,226 View
  • 235 Download
  • 3 Web of Science
  • 4 Crossref

Case Report

Imaging

Cat got your artery? Point of care ultrasound in the evaluation of penetrating trauma by a feline: a case report
Campbell Belisle Haley, David Mackenzie
Clin Exp Emerg Med 2022;9(1):63-66.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.20.065

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Cat got your artery? Point of care ultrasound in the evaluation of penetrating trauma by a feline: a case report
Clin Exp Emerg Med. 2022;9(1):63-66.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.20.065
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Cat got your artery? Point of care ultrasound in the evaluation of penetrating trauma by a feline: a case report
Clin Exp Emerg Med. 2022;9(1):63-66.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.20.065
Close
Point of care ultrasound is an important tool for diagnosis of musculoskeletal and vascular pathology in patients presenting to the emergency department. Superficial vascular and soft tissue structures are well-visualized at the bedside using modern ultrasound systems and have image characteristics that can be rapidly identified. This report describes the use of point of care ultrasound to distinguish between rapidly progressive soft tissue infection and vascular injury following penetrating trauma from a cat scratch. Ultrasound allowed the physician to rapidly make accurate decisions about the next necessary steps in the patient’s care. Point of care ultrasound provides immediate diagnostic information to supplement indeterminate physical examination findings. In this case, it allowed the treating physician to make the diagnosis of arterial injury using ultrasound image characteristics. An integrative approach to ultrasonography of superficial musculoskeletal and vascular structures could enhance clinical decision making and improve care of patients with similar complaints.

Citations

Citations to this article as recorded by  Crossref logo
  • Diagnostic technologies for neuroblastoma
    Leena Khelifa, Yubing Hu, Jennifer Tall, Rasha Khelifa, Amina Ali, Evon Poon, Mohamed Zaki Khelifa, Guowei Yang, Catarina Jones, Rosalia Moreddu, Nan Jiang, Savas Tasoglu, Louis Chesler, Ali K. Yetisen
    Lab on a Chip.2025; 25(15): 3630.     CrossRef
  • 6,647 View
  • 175 Download
  • 1 Web of Science
  • 1 Crossref

Review Article

Medical Emergencies

Recent update on the management of anaphylaxis
Quang Luu Quoc, Tra Cao Thi Bich, Jae-Hyuk Jang, Hae-Sim Park
Clin Exp Emerg Med 2021;8(3):160-172.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.21.121

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Recent update on the management of anaphylaxis
Clin Exp Emerg Med. 2021;8(3):160-172.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.21.121
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Recent update on the management of anaphylaxis
Clin Exp Emerg Med. 2021;8(3):160-172.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.21.121
Close
Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.

Citations

Citations to this article as recorded by  Crossref logo
  • Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis
    Caroline A. Jackson, Ryan C. Dillon, L. Montana Fleenor, Emily K. Pauw, Mary M. O'Keefe
    The American Journal of Emergency Medicine.2026; 99: 270.     CrossRef
  • Exploring the anti-anaphylaxis potential of natural products: A Review
    Aya H. Eid, Eman S. Zaki, Miral O. Sabry, Riham A. El-Shiekh, Samar S. Khalaf
    Inflammopharmacology.2025; 33(5): 2589.     CrossRef
  • Identifying patients at risk of anaphylaxis
    George DuToit, Pete Smith, Antonella Muraro, Adam T. Fox, Graham Roberts, Johannes Ring, Margitta Worm
    World Allergy Organization Journal.2024; 17(6): 100904.     CrossRef
  • Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study
    Roy Khalaf, Connor Prosty, Christine McCusker, Adam Bretholz, Mohammed Kaouache, Ann E. Clarke, Judy Morris, Rodrick Lim, Edmond S. Chan, Ran D. Goldman, Andrew O’Keefe, Jennifer Gerdts, Derek K. Chu, Julia Upton, Elana Hochstadter, Jocelyn Moisan, Xun Zh
    International Archives of Allergy and Immunology.2024; : 1.     CrossRef
  • A New and Different Method for Adrenaline Auto-injector Training
    Ahmet KAN, Veysiye Hülya ÜZEL
    Turkish Journal of Pediatric Disease.2022; : 1.     CrossRef
  • 16,164 View
  • 228 Download
  • 7 Web of Science
  • 5 Crossref

Original Articles

Cardiovascular

The predictive value of HEART score for acute coronary syndrome and significant coronary artery stenosis
Changsung Han, Heajin Chung, Youngjoo Lee, Hye Young Jang, Young Shin Cho, Junbum Park, Sang-Il Kim
Clin Exp Emerg Med 2020;7(4):267-274.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.084

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The predictive value of HEART score for acute coronary syndrome and significant coronary artery stenosis
Clin Exp Emerg Med. 2020;7(4):267-274.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.084
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The predictive value of HEART score for acute coronary syndrome and significant coronary artery stenosis
Clin Exp Emerg Med. 2020;7(4):267-274.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.084
Close
Objective
Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS).
Methods
We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis.
Results
Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627–0.776) and 0.737 (95% confidence interval, 0.660–0.804) for SCS.
Conclusion
HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.

Citations

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  • Diagnostic Accuracy Improvement of an Updated HEART Score to Predict Coronary Artery Disease as Detected by Coronary Computed Tomography Angiography
    Michele Della Rocca, Stefano Ferdico, Nicola Cosentino, Alice Bonomi, Andrea Baggiano, Manuela Muratori, Saima Mushtaq, Laura Salvini, Matteo Biroli, Edona Leka, Gianluca Pontone, Marco Grazi, Emilio Assanelli
    Journal of Clinical Medicine.2026; 15(4): 1424.     CrossRef
  • Retrospective analysis of the performance of the PROMISE minimal risk tool for patients presenting with recent onset stable chest pain
    Conor Tuffs, Natasha Khullar, Terry Levy, Vivek Kodoth, Rosie Swallow, Peter O’Kane, Jehangir Din, Chun Shing Kwok, Nick Curzen, Jonathan Hinton
    Open Heart.2026; 13(1): e003837.     CrossRef
  • Predictive Performance of the HEART Score for Acute Coronary Syndrome with Significant Coronary Stenosis in Patients with Non–ST-Elevation Acute Chest Pain
    André Martins, Mónica Amado, Adriana Vazão, Joana Pereira, Luís Santos, Margarida Cabral, Célia Domingues, David Durão, João Morais
    Journal of Cardiovascular Development and Disease.2026; 13(7): 335.     CrossRef
  • A Cross-Sectional Study on the Relationship between the HEART Score and the Severity of CAD using the SYNTAX Score in Patients with NSTEMI Admitted to the Emergency Department: A Study from Turkey
    MS Pepele, I Aktas, O Demiroz, S Derya, E Yildirim, MN Bilen, B Demir
    Nigerian Journal of Clinical Practice.2025; 28(6): 758.     CrossRef
  • Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain
    Tanja Stojkovic, Eva Stojkovic, Dejan Sakac, Aleksandar Redzek, Anastazija Stojsic-Milosavljevic, Lazar Velicki, Biljana Parapid
    Srpski arhiv za celokupno lekarstvo.2022; 150(3-4): 149.     CrossRef
  • 11,147 View
  • 144 Download
  • 6 Web of Science
  • 5 Crossref

Imaging

Diagnostic performance of brain computed tomography to detect facial bone fractures
Duk Ho Kim, Yoon Hee Choi, Seong Jong Yun, Sun Hwa Lee
Clin Exp Emerg Med 2018;5(2):107-112.   Published online June 29, 2018
DOI: https://doi.org/10.15441/ceem.17.223

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Diagnostic performance of brain computed tomography to detect facial bone fractures
Clin Exp Emerg Med. 2018;5(2):107-112.   Published online June 29, 2018
DOI: https://doi.org/10.15441/ceem.17.223
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Diagnostic performance of brain computed tomography to detect facial bone fractures
Clin Exp Emerg Med. 2018;5(2):107-112.   Published online June 29, 2018
DOI: https://doi.org/10.15441/ceem.17.223
Close
Objective
Most patients with head trauma require brain computed tomography (CT) in the emergency department. However, the requirement for facial CT remains controversial. The aim of this study was to evaluate the diagnostic value of brain CT alone for detection of facial fractures and its ability to determine the requirement for additional facial CT.
Methods
This retrospective multicenter study was conducted in two tertiary hospitals in Seoul, Republic of Korea, between January 2014 and December 2015. Data were collected from the medical records of adult patients (aged over 18 years) who had undergone both brain and facial CT on the same day as their presentation to the emergency department with blunt trauma to the head and face. The same radiologist analyzed all brain and facial CT images.
Results
Eight hundred and sixty patients (668 men, 192 women; mean age 48.60±18.2 years) were identified to have had facial fractures. There was a statistically significant predominance of men but not of any particular age group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of brain CT were 83.72%, 98.87%, 97.17%, 92.92%, and 94.08%, respectively.
Conclusion
These findings suggest that brain CT has high diagnostic value for detection of upper facial bone fractures with high accuracy and can aid emergency physicians when determining the requirement for additional facial CT.

Citations

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  • Neuro-ophthalmic sequelae of sports-related injuries: mechanisms, diagnosis, and emerging directions
    Konstantinos A. A. Douglas, Molly K. Pluenneke, Nicholas Panzo, Kyle Sporn, Vivian Paraskevi Douglas, Rahul Kumar, Joshua Ong, Ethan Waisberg, Andrew G. Lee
    Expert Review of Ophthalmology.2026; 21(3): 267.     CrossRef
  • Reduced Receipt of Dedicated Computed Tomography With Implementation of a New Temporal Bone Fracture Protocol
    Aneesh A. Patel, Charles Tandler, Osamu Sakai, Peter C. Weber
    Annals of Otology, Rhinology & Laryngology.2025; 134(10): 763.     CrossRef
  • The Adelaide Facial Bone Rule: A simple prediction model and clinical guideline for the presence of facial fractures using CT brain scans in victims of minor trauma
    Sarah Constantine, Amy Salter, Jennie Louise, Peter J. Anderson
    Injury.2024; 55(5): 111302.     CrossRef
  • Evaluation of Concomitant Facial Fracture in Traumatic Brain Injury Patients—Simplification and External Validation of a Prediction Model
    Jennifer An-Jou Lin, Pei-Hua Li, Chien-Hung Liao, Chi-Hsun Hsieh, Yu-Chi Kuo, Ting-An Hsu, Yu-Ying Chu, Chih-Yuan Fu
    Annals of Plastic Surgery.2024; 92(1S): S27.     CrossRef
  • Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study
    Brittany N Nguyen, Mary J Edwards, Shachi Srivatsa, Derek Wakeman, Thais Calderon, Abdularouf Lamoshi, Kim Wallenstein, Tiffany Fabiano, Brittany Cantor, Kathryn Bass, Ananth Narayan, Ralph Zohn, Mitchell Chess, Richard D Thomas
    Trauma Surgery & Acute Care Open.2022; 7(1): e000899.     CrossRef
  • Individual Anatomical Variability of Mandibular Alveolar Arc in Adulthood
    O. M. Sazonova
    Ukraïnsʹkij žurnal medicini, bìologìï ta sportu.2019; 4(2): 87.     CrossRef
  • 12,438 View
  • 110 Download
  • 5 Web of Science
  • 6 Crossref

Environmental | Clinical Laboratory

Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite
Yong Sung Cha, Kang Hyun Lee, Seok Jeong Lee, Ho Chul Kwon, Jong Wook Lee, Hyung Il Kim, Oh Hyun Kim, Kyoung-Chul Cha, Hyun Kim, Sung Oh Hwang
Clin Exp Emerg Med 2018;5(2):76-83.   Published online June 29, 2018
DOI: https://doi.org/10.15441/ceem.16.195

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Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite
Clin Exp Emerg Med. 2018;5(2):76-83.   Published online June 29, 2018
DOI: https://doi.org/10.15441/ceem.16.195
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Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite
Clin Exp Emerg Med. 2018;5(2):76-83.   Published online June 29, 2018
DOI: https://doi.org/10.15441/ceem.16.195
Close
Objective
Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)—a new indicator for immature granulocytes—for DIC diagnosis.
Methods
This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite.
Results
Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P<0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P<0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI’s receiver operating characteristic curve was 0.724.
Conclusion
DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department.

Citations

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  • Haemotoxicity of snakes: a review of pathogenesis, clinical manifestations, novel diagnostics and challenges in management
    Bhawani Yasassri Alvitigala, Harsha A Dissanayake, Praveen N Weeratunga, P A Chanya D Padmaperuma, Lallindra Viranjan Gooneratne, Christeine Ariaranee Gnanathasan
    Transactions of The Royal Society of Tropical Medicine and Hygiene.2025; 119(3): 283.     CrossRef
  • The association between the neutrophil lymphocyte ratio and local edema after viper snake envenomation in South Korea
    Jeong Mi Moon, B.J. Chun, Y.J. Koo
    Toxicon.2024; 240: 107635.     CrossRef
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    JeongMi Moon, ByeongJo Chun, YoungSoo Cho, KwangHyn Park
    Scientific Reports.2024;[Epub]     CrossRef
  • Clinical features of snake envenomation in South Korea
    Jeong Mi Moon, Byeong Jo Chun, Yong Soo Cho
    Clinical Toxicology.2023; 61(4): 276.     CrossRef
  • Predictors of complications in venomous snakebites
    Kedareshwar P. S. Narvencar, T. T. Favas, Amit Dias
    Indian Journal of Medical Sciences.2022; 74: 86.     CrossRef
  • The effect of myocardial injury on the clinical course of snake envenomation in South Korea
    J. M. Moon, Y. J. Koo, B. J. Chun, K. H. Park, Y. S. Cho, J. C. Kim, S. D. Lee, Y. R. Min, H. S. Park
    Clinical Toxicology.2021; 59(4): 286.     CrossRef
  • Coagulopathy after snake envenomation in South Korea
    J. M. Moon, B. J. Chun, Y. S. Cho, J. C. Kim, Y. J. Koo, K. H. Park, S. D. Lee, J. S. Ahn, D. K. Kim, S. J. Ryu
    Clinical Toxicology.2021; 59(10): 905.     CrossRef
  • Snakebite envenomings in the Republic of Korea from the 1970s to the 2020s: A review
    Yucheol Shin, Yikweon Jang, Amaël Borzée
    Toxicon.2021; 196: 8.     CrossRef
  • The Usefulness of Platelet Distribution Width and Platelet Distribution Width to Lymphocyte Ratio in Predicting Severity and Outcomes in Patients with Snakebite
    Ataman Köse, Aydan Akdeniz, Seyran Bozkurt Babus, Mert Göçmen, Gülhan Orekici Temel
    Wilderness & Environmental Medicine.2021; 32(3): 284.     CrossRef
  • Novel Treatment Strategy for Patients with Venom-Induced Consumptive Coagulopathy from a Pit Viper Bite
    Eun Jung Park, Sangchun Choi, Hyuk-Hoon Kim, Yoon Seok Jung
    Toxins.2020; 12(5): 295.     CrossRef
  • The delta neutrophil index is an early predictive marker of severe acute cholecystitis
    Seok Jeong Lee, Eung Joo Park, Kyong Joo Lee, Yong Sung Cha
    Digestive and Liver Disease.2019; 51(11): 1593.     CrossRef
  • 11,242 View
  • 129 Download
  • 10 Web of Science
  • 11 Crossref

Imaging | Neurology

Predictors of abnormal brain computed tomography findings in patients with acute altered mental status in the emergency department
Somi Shin, Hui Jai Lee, Jongwhan Shin, Sejong Lee
Clin Exp Emerg Med 2018;5(1):1-6.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.16.163

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Predictors of abnormal brain computed tomography findings in patients with acute altered mental status in the emergency department
Clin Exp Emerg Med. 2018;5(1):1-6.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.16.163
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Predictors of abnormal brain computed tomography findings in patients with acute altered mental status in the emergency department
Clin Exp Emerg Med. 2018;5(1):1-6.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.16.163
Close
Objective
Brain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings.
Methods
Patients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of <15 were included in the study.
Results
Among the 367 brain CT results of patients with AMS during the study period, 146 (39.8%) were positive. In a multivariate analysis, the presence of focal neurologic deficit (odds ratio [OR], 132.6; 95% confidence interval [CI], 37.8 to 464.6), C-reactive protein level <2 mg/dL (OR, 3.9; 95% CI, 1.4 to 10.6), and Glasgow Comal Scale score <9 (OR, 2.4; 95% CI, 1.2 to 4.8) were significantly associated with positive brain CT results.
Conclusion
The presence of focal neurologic deficit, initial Glasgow Comal Scale score of <9, and initial C-reactive protein levels of <2 mg/dL can facilitate the selection of brain CT to diagnose patients with acute AMS in the emergency department.

Citations

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  • Diagnosis of delirium, confusion, and altered mental status in the emergency department using head computed tomography: A meta-analysis
    Yiting Xie, Qingyun Wang
    Journal of Radiation Research and Applied Sciences.2026; 19(3): 102540.     CrossRef
  • Brain CT in Patients With Altered Mental Status: Tertiary Care Emergency Department Review
    Maan Jamjoom, Faisal Boker, Abeer Alraiqi, Rahaf Organji, Mohammed Alotaibi, Abdulrahman Alghamdi, Nawaf Alharbi, Waleed Aljehani, Saleh Alqadi, Lara Aljohny, Belal Alturkistani
    Cureus.2025;[Epub]     CrossRef
  • Diagnostic yield of CT head in delirium and altered mental status—A systematic review and meta‐analysis
    Haris Akhtar, Shazia H. Chaudhry, Émilie Bortolussi‐Courval, Ryan Hanula, Anas Akhtar, Bénédicte Nauche, Emily G. McDonald
    Journal of the American Geriatrics Society.2023; 71(3): 946.     CrossRef
  • Head computed tomography findings in geriatric emergency department patients with delirium, altered mental status, and confusion: A systematic review
    Shan W. Liu, Sangil Lee, Jane M. Hayes, Danya Khoujah, Alexander X. Lo, Michelle Doering, Kerstin de Wit
    Academic Emergency Medicine.2023; 30(6): 616.     CrossRef
  • Utility of head computed tomography for older adults with suspected delirium in the emergency department: A retrospective observational study
    Josh D. Butcher, Mckinley C. Smith, Lauren Roberts, Brittany Ellis
    Academic Emergency Medicine.2023; 30(1): 16.     CrossRef
  • Multi-detector computed tomography and 3Tesla magnetic resonance imaging in assessment of COVID-19 intracranial complications
    Ghada Sobhy Ibrahim, Buthaina M. Alkandari, Ahmed Mahmoud Elzeneini, Islam Ahmed Abo Shady, Ahmed Mohamed Housseini, Mohsen Ahmed Abdelmohsen
    Egyptian Journal of Radiology and Nuclear Medicine.2022;[Epub]     CrossRef
  • Head computed tomography for elderly patients with acute altered mental status in the emergency setting: value for decision-making and predictors of abnormal findings
    Camille Gerlier, Mélanie Forster, Audrey Fels, Marc Zins, Gilles Chatellier, Olivier Ganansia
    Clinical and Experimental Emergency Medicine.2022; 9(4): 333.     CrossRef
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    A. Asgari, A.A. Parach, F. Bouzarjomehri, F. Shirani-Takabi, A.H. Mehrparvar, S.J. Mirmohammadi, E. Khaksar
    Radioprotection.2021; 56(1): 25.     CrossRef
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    Alina Uzelac
    Radiologic Clinics of North America.2020; 58(1): 187.     CrossRef
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    A. Radmanesh, E. Raz, E. Zan, A. Derman, M. Kaminetzky
    American Journal of Neuroradiology.2020; 41(7): 1179.     CrossRef
  • Is brain imaging necessary for febrile elderly patients with altered mental status? A retrospective multicenter study
    Sungwoo Choi, Hyun Na, Sangun Nah, Hayeong Kang, Sangsoo Han, Juan Manuel Marquez-Romero
    PLOS ONE.2020; 15(7): e0236763.     CrossRef
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    Olaf Eberhardt, Helge Topka
    NeuroTransmitter.2019; 30(4): 32.     CrossRef
  • Diagnostische Strategien bei akut verwirrten Patienten
    Olaf Eberhardt, Helge Topka Gernhardt
    Geriatrie-Report.2019; 14(4): 38.     CrossRef
  • 13,132 View
  • 138 Download
  • 11 Web of Science
  • 13 Crossref
Diagnostic accuracy and implementation of computed tomography angiography for gastrointestinal hemorrhage according to clinical severity
Yoo Jin Choi, Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon
Clin Exp Emerg Med 2016;3(2):69-74.   Published online June 30, 2016
DOI: https://doi.org/10.15441/ceem.15.066

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Diagnostic accuracy and implementation of computed tomography angiography for gastrointestinal hemorrhage according to clinical severity
Clin Exp Emerg Med. 2016;3(2):69-74.   Published online June 30, 2016
DOI: https://doi.org/10.15441/ceem.15.066
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Diagnostic accuracy and implementation of computed tomography angiography for gastrointestinal hemorrhage according to clinical severity
Clin Exp Emerg Med. 2016;3(2):69-74.   Published online June 30, 2016
DOI: https://doi.org/10.15441/ceem.15.066
Close
Objective
This study compared the diagnostic accuracy of computed tomography (CT) angiography in patients with various severities of gastrointestinal hemorrhage (GIH).
Methods
We retrospectively enrolled adult patients (n=262) with GIH who had undergone CT angiography from January 2012 to December 2013. Age, sex, comorbidities, presenting symptoms, initial vital signs, laboratory results, transfusion volume, emergency department disposition, and hospital mortality were abstracted from patient records. CT angiography findings were reviewed and compared to reference standards consisting of endoscopy, conventional angiography, bleeding scan, capsule endoscopy, and surgery, either alone or in combination. Clinical severity was stratified according to the number of packed red blood cell units transfused during the first two days: the first quartile was categorized as mild severity, while the second and third quartiles were categorized as moderate severity. The fourth quartile was categorized as severe.
Results
Patients were categorized into the mild (n=75, 28.6%), moderate (n=139, 53.1%), and severe (n=48, 18.3%) groups. The mean number of transfused packed red blood cell units was 0, 3, and 9.6 in the mild, moderate, and severe groups, respectively. The overall sensitivity, specificity, positive predictive value, and negative predictive value of CT angiography were 73.8%, 94.0%, 97.3%, and 55.3%, respectively. The area under the receiver operating characteristics curve for the diagnostic performance of CT angiography was 0.780, 0.841, and 0.930 in the mild, moderate, and severe groups, respectively, which significantly differed among groups (P=0.006).
Conclusion
The diagnostic accuracy of CT angiography is better in patients with more severe GIH.

Citations

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  • The Accuracy of Computed Tomography Angiography Compared With Technetium-99m Labelled Red Blood Cell Scintigraphy for the Diagnosis and Localization of Acute Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
    Kaspar L. Yaxley, Ali Mulhem, Sean Godfrey, Jason L. Oke
    Current Problems in Diagnostic Radiology.2023; 52(6): 546.     CrossRef
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    Namkyung Jeong, Kyung Su Kim, Yoon Sun Jung, Taegyun Kim, So Mi Shin
    The American Journal of Emergency Medicine.2019; 37(2): 277.     CrossRef
  • Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding
    Daejin Kim, Sion Jo, Jae Baek Lee, Youngho Jin, Taeoh Jeong, Jaechol Yoon, Boyoung Park
    Clinical and Experimental Emergency Medicine.2018; 5(4): 219.     CrossRef
  • 18,164 View
  • 106 Download
  • 4 Web of Science
  • 3 Crossref

Review Article

Cardiovascular

Diagnosing and managing acute heart failure in the emergency department
Dick C. Kuo, W. Frank Peacock
Clin Exp Emerg Med 2015;2(3):141-149.   Published online September 30, 2015
DOI: https://doi.org/10.15441/ceem.15.007

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Diagnosing and managing acute heart failure in the emergency department
Clin Exp Emerg Med. 2015;2(3):141-149.   Published online September 30, 2015
DOI: https://doi.org/10.15441/ceem.15.007
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Diagnosing and managing acute heart failure in the emergency department
Clin Exp Emerg Med. 2015;2(3):141-149.   Published online September 30, 2015
DOI: https://doi.org/10.15441/ceem.15.007
Close
Heart failure is a clinical syndrome that results from the impairment of ventricular filling or ejection of blood and affects millions of people worldwide. Diagnosis may not be straightforward and at times may be difficult in an undifferentiated patient. However, rapid evaluation and diagnosis is important for the optimal management of acute heart failure. We review the many aspects of diagnosing and treating acute heart failure in the emergency department.

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  • Evaluation of a New Antibody-Based NT-proBNP Assay for Acute Dyspnea in the Emergency Department
    Brandon R Allen, Jessica L Guidi, Gary Headden, Nicole Winden, Dileepa Alahapperuma, Robert H Christenson, W Franklin Peacock, Sean Collins, Elizabeth L Walters, James L Januzzi
    Clinical Chemistry.2026; 72(3): 398.     CrossRef
  • Clinical Performance of an N-Terminal Pro-B-Type Natriuretic Peptide Assay in Acute Heart Failure Diagnosis
    Lori B Daniels, Patience Ajongwen, Robert H Christenson, Carol L Clark, Deborah B Diercks, Gregory J Fermann, Sharon E Mace, Simon A Mahler, Peter S Pang, Zubaid Rafique, Michael S Runyon, James Tauras, Christopher R deFilippi
    The Journal of Applied Laboratory Medicine.2025; 10(2): 325.     CrossRef
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    Piero Tarantini, Francesco Cei, Fabiola Longhi, Aldo Fici, Salvatore Tupputi, Gino Solitro, Lucia Colavolpe, Stefania Marengo, Nicola Mumoli
    Journal of Cardiovascular Development and Disease.2025; 12(10): 379.     CrossRef
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    Mohamad Abu Zaher, Ching Lee, Sumith Abeygunasekar
    Cureus.2025;[Epub]     CrossRef
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    Sunita Pokhrel Bhattarai, Dillon J. Dzikowicz, Mary G. Carey
    Journal of Cardiovascular Nursing.2024; 39(2): 118.     CrossRef
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    Alexandra L. Schick, Josh C. Kaine, Nehal A. Al-Sadhan, Timmy Lin, Janette Baird, Kamil Bahit, Kristin H. Dwyer
    The American Journal of Emergency Medicine.2023; 68: 52.     CrossRef
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    Chan-Ho Park, Hee Yoon, Ik-Joon Jo, Sookyoung Woo, Sejin Heo, Hansol Chang, Guntak Lee, Jong-Eun Park, Taerim Kim, Se-Uk Lee, Sung-Yeon Hwang, Won-Chul Cha, Tae-Gun Shin
    Diagnostics.2023; 13(14): 2412.     CrossRef
  • Cuantificación y tratamiento de la congestión en insuficiencia cardíaca: una visión clínica y fisiopatológica
    Rafael de la Espriella, Enrique Santas, Isabel Zegri Reiriz, José Luis Górriz, Marta Cobo Marcos, Julio Núñez
    Nefrología.2022; 42(2): 145.     CrossRef
  • Quantification and treatment of congestion in heart failure: A clinical and pathophysiological overview
    Rafael de la Espriella, Enrique Santas, Isabel Zegri Reiriz, Jose Luis Górriz, Marta Cobo Marcos, Julio Núñez
    Nefrología (English Edition).2022; 42(2): 145.     CrossRef
  • Acute Heart Failure
    Amber Adams, Courtney L. Olesky, Allison Fisher, Stephanie Baker Justice
    Advanced Emergency Nursing Journal.2022; 44(3): 178.     CrossRef
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    Yeying Sun, Xiaoli Jiang, Yan Lv, Xinyue Liang, Bingrui Zhao, Weihua Bian, Daolai Zhang, Jing Jiang, Chunxiang Zhang
    Biomolecules.2020; 10(2): 187.     CrossRef
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    Nikita Mehta, Maryann Mazer-Amirshahi, Caroline Schulman, Francis O’Connell, Ali Pourmand
    The American Journal of Emergency Medicine.2020; 38(6): 1253.     CrossRef
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    Youngho Seo, Jinhui Paik, Seunglyul Shin, Ahjin Kim, Soo Kang
    Clinical and Experimental Emergency Medicine.2020; 7(3): 213.     CrossRef
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    European Journal of Translational Myology.2020; 30(1): 171.     CrossRef
  • Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
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    Western Journal of Emergency Medicine.2019; 20(6): 875.     CrossRef
  • Drugs’ development in acute heart failure: what went wrong?
    Vincenzo Teneggi, Nithy Sivakumar, Deborah Chen, Alex Matter
    Heart Failure Reviews.2018; 23(5): 667.     CrossRef
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    Brit Long, Alex Koyfman, Michael Gottlieb
    The Journal of Emergency Medicine.2018; 55(5): 635.     CrossRef
  • 65,535 View
  • 619 Download
  • 18 Web of Science
  • 17 Crossref

Original Articles

Neurology

Clinical insights for early detection of acute transverse myelitis in the emergency department
Yo Huh, Eun-Jung Park, Ju-Won Jung, Sungho Oh, Sang-Cheon Choi
Clin Exp Emerg Med 2015;2(1):44-50.   Published online March 31, 2015
DOI: https://doi.org/10.15441/ceem.14.034

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Clinical insights for early detection of acute transverse myelitis in the emergency department
Clin Exp Emerg Med. 2015;2(1):44-50.   Published online March 31, 2015
DOI: https://doi.org/10.15441/ceem.14.034
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Clinical insights for early detection of acute transverse myelitis in the emergency department
Clin Exp Emerg Med. 2015;2(1):44-50.   Published online March 31, 2015
DOI: https://doi.org/10.15441/ceem.14.034
Close
Objective
Acute transverse myelitis (ATM) is characterized by motor weakness, sensory changes, and autonomic dysfunction. However, diagnosis of ATM is based on early-stage clinical features only (and clarification of the cause of disease), which are difficult for emergency department (ED) physicians owing to low incidence rates. We performed retrospective analysis of ATM in order to provide clinical insights for early detection.
Methods
Medical records of patients, who were finally diagnosed with ATM from January 2005 to February 2013, were investigated. Data, including demographics, clinical findings, and radiographic findings, were reviewed.
Results
Forty-six patients were included in the present study, with a mean age of 43.4 years. Sensory changes were identified in 45 patients (97.8%), motor weakness in 33 patients (71.7%), and autonomic dysfunction in 35 patients (76.1%). Thirty patients (65.2%) showed high signal intensity in T2-weighted magnetic resonance imaging (MRI), with lesions most frequently found in the thoracic level of the spinal cord (56.7%). There were discrepancies between sensory changes and levels of MRI lesions. Thirty-five patients (76.1%) were diagnosed with idiopathic ATM. Initial diagnostic impressions in the ED were herniated intervertebral disc (38.7%), stroke (19.4%), Guillain-Barré syndrome (12.9%), cauda equina syndrome (9.7%), ATM (9.7%), and others (9.7%).
Conclusion
When a patient presents with motor weakness, sensory changes, or autonomic dysfunction, ATM should be initially considered as a differential diagnosis, unless the ED physician’s impression after initial evaluation is clear.

Citations

Citations to this article as recorded by  Crossref logo
  • Transverse Myelitis in a 72-Year-Old Male Presenting With Upper Extremity Weakness
    Hannah Cox, Richard Virgilio, Luke Yuhico
    Cureus.2024;[Epub]     CrossRef
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    Debashis Maikap, Prasanta Padhan
    Modern Rheumatology Case Reports.2021; 5(1): 113.     CrossRef
  • Atypical presentation of transverse myelitis in the emergency department
    Clara Pavesi-Krieger, Megan A. Rech, Shannon Lovett
    The American Journal of Emergency Medicine.2021; 50: 813.e5.     CrossRef
  • Transverse myelitis caused by varicella-zoster
    Anjely Pulparampil Sebastian, Arini Basu, Nandini Mitta, Dominic Benjamin
    BMJ Case Reports.2021; 14(8): e238078.     CrossRef
  • Pediatric Spinal Cord Diseases
    Victor M. Lu, Toba N. Niazi
    Pediatrics In Review.2021; 42(9): 486.     CrossRef
  • CLINICAL PROFILE AND ETIOLOGICAL EVALUATION OF NON-TRAUMATIC MYELOPATHIES USING MAGNETIC RESONANCE IMAGING
    BIJAYA KUMAR BEHERA, SUKANTA KUMAR JENA, NISARG BEHERA
    Asian Journal of Pharmaceutical and Clinical Research.2021; : 63.     CrossRef
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    Brian N. Corwell, Natalie L. Davis
    Emergency Medicine Clinics of North America.2020; 38(1): 167.     CrossRef
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    Allen D. DeSena
    Current Physical Medicine and Rehabilitation Reports.2017; 5(3): 134.     CrossRef
  • 16,183 View
  • 209 Download
  • 7 Web of Science
  • 8 Crossref

Imaging | Orthopedics

New, specific ultrasonographic findings for the diagnosis of pulled elbow
Yu Sung Lee, You Dong Sohn, Young Teak Oh
Clin Exp Emerg Med 2014;1(2):109-113.   Published online December 31, 2014
DOI: https://doi.org/10.15441/ceem.14.009

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New, specific ultrasonographic findings for the diagnosis of pulled elbow
Clin Exp Emerg Med. 2014;1(2):109-113.   Published online December 31, 2014
DOI: https://doi.org/10.15441/ceem.14.009
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New, specific ultrasonographic findings for the diagnosis of pulled elbow
Clin Exp Emerg Med. 2014;1(2):109-113.   Published online December 31, 2014
DOI: https://doi.org/10.15441/ceem.14.009
Close
Objective
Among infants and preschool children with complaint of upper extremity immobility, pulled elbow, also known as nursemaid’s elbow or radial head subluxation is the most common cause presenting to pediatric emergency departments. However, proper tools to diagnose pulled elbow remain limited. We conducted a study to determine the feasibility of ultrasonography in diagnosing pulled elbow.
Methods
Infants and preschool children presenting to an urban emergency department with the complaint of upper extremity immobility between April and July 2013 were enrolled. The following ultrasonographic information was recorded: (1) whether there was a change in the shape of the supinator muscle, (2) whether there was an annular ligament in place, and (3) whether there was an enlargement of the synovial fringe. We used the affected arms’ ultrasonographic images as the study group and opposite arms’ ultrasonographic images as the control group.
Results
When we diagnosed pulled elbow using ultrasonographic findings (i.e., the annular ligament was not in place), we found the following results: sensitivity, 64.9% (95% CI, 47.5% to 79.8%); specificity, 100.0% (95% CI, 90.5% to 100.0%); positive predictive value, 100.0% (95% CI, 85.8% to 100.0%); and negative predictive, 74.0% (95% CI, 59.7% to 85.4%).
Conclusion
A pulled elbow can easily be confirmed by ultrasonography when the annular ligament is displaced.

Citations

Citations to this article as recorded by  Crossref logo
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    Chun-Hin Lo, Kai-Yuan Cheng
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    Chia-Che Tsai, Yi-Pin Chiang
    Journal of Pediatric Orthopaedics.2023; 43(6): e440.     CrossRef
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    Batuhan GENCER, İhsaniye SÜER DOĞAN, Nuri Koray ÜLGEN, Mehmet Murat ARSLAN, Özgür DOĞAN
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    Masahiko Kimura
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    Martin Čepelík, Jan Hendrych, Hana Melínová, Petr Havránek, Tomáš Pešl
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    Seminars in Musculoskeletal Radiology.2021; 25(04): 580.     CrossRef
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    Michael Gottlieb, Linda I. Suleiman
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    Faruk Güngör, Taylan Kılıç
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  • 33,163 View
  • 197 Download
  • 15 Web of Science
  • 14 Crossref
Review Article

Environmental

The evaluation and management of thermal injuries: 2014 update
Jimmy Toussaint, Adam J. Singer
Clin Exp Emerg Med 2014;1(1):8-18.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.029

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The evaluation and management of thermal injuries: 2014 update
Clin Exp Emerg Med. 2014;1(1):8-18.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.029
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The evaluation and management of thermal injuries: 2014 update
Clin Exp Emerg Med. 2014;1(1):8-18.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.029
Close

Burns are among the most common injuries presenting to the emergency department. While burns, especially large ones, may be associated with significant morbidity and mortality, most are minor and can be managed by emergency practitioners and discharged home with close follow-up. In contrast, patients with large burns require aggressive management of their airway, breathing and circulation in order to reduce mortality and morbidity. While early endotracheal intubation of patients with actual or impending airway compromise and aggressive fluid resuscitation have been emphasized, it appears that the pendulum may have swung a bit too far towards the extreme. The current review will briefly cover the epidemiology, pathogenesis and diagnosis of burn injuries with greater emphasis on airway and fluid management. We will also discuss the local management of the burn wound, which is all that is required for most burn patients in the emergency department.

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  • 34,123 View
  • 373 Download
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CEEM : Clinical and Experimental Emergency Medicine