Quarterly EJEM research roundup

by Nicolas Segal

Welcome to the quarterly EJEM research round-up, where we present our top picks from the last three months of EJEM editions.

The first four picks are not peer review articles but a series of 4 documents in the February issue of the EJEM about Emergency Medicine training requirements in Europe, workplace-based assessments, and The European Board Certification. Those important topics show the professionalization of our specialty on a European scale in recent years. McNamara (1) emphasizes the importance of on-the-job training to acquire specific skills that books cannot teach. In recent years, simulation has emerged as an additional tool for assessing and developing technical and nontechnical skills. While in the workplace learning includes technical skills, clinical skills, and, beyond those classical skills, the acquisition of interpersonal and leadership skills. To achieve this, the authors emphasize that training programs must be structured and staffed by adequate faculty members. Govender and Kiren (2) report the perspective of the Young Emergency Medicine Doctors (YEMD) section of EuSEM. They show that the involvement of our youngest colleagues in various committees has been instrumental in the recent development of the specialty. Brown (3) continues by presenting the requirements for our specialty training. From the first curriculum in 2002 to the most refreshed pedagogical approach of April 2024, this document demonstrates the evolution of emergency medicine and the high standard it aims to achieve. The new curriculum's focus on professional skills, including leadership, academic, educational, and improvement skills, builds on the increasing recognition that the emergency specialist is the leader of an emergency care system rather than the clinician in charge of a single patient. It also recognized that clinical practice had changed specifically around some skills (e.g. point-of-care ultrasound) and new diagnostic approaches. Finally, the end of each training should be sanctioned by an exam; Innocenti presents the structure, content, and some results from the European Board Examination (4).

Ylä-Mattila et al published the result of an investigation about factors associated with hospital revisitation within 7 days among patients discharged at triage. (5) The goal was to increase the ability of triage to ensure that patients receive the level of care appropriate to their clinical needs and to enhance future triage performance. The study evaluated factors associated with unplanned hospital revisits within 7 days and with revisits within 7 days that lead to hospitalization among a group of patients initially directly discharged or redirected by the triage team. In this case-control study, they included 92 406 ED visits, a whole calendar year of ED visitation at the Tampere University Hospital. The cases comprised unplanned hospital revisits within 7 days of being discharged or redirected by triage, while the controls were discharged or redirected but did not revisit. Of the 92 406 ED visits, 7216 (7.8%) were discharged or redirected by triage, and 6.5% (n = 467) of all these patients revisited. Of the patients revisiting, 25% (n = 117) were hospitalized. The authors found in multivariable analysis, that higher age was associated with both revisitation [odds ratio (OR): 1.01, 95% confidence interval (CI): 1.00–1.02] and hospitalization (OR: 1.02, 95% CI: 1.00–1.04).  Furthermore, abdominal pain (OR: 3.70, 95% CI: 2.24–6.11), neurological or vision symptoms (OR: 2.90, 95% CI: 1.46–5.74), and mental health or substance abuse problems (OR: 5.10, 95% CI: 2.15–12.1) were associated with a higher revisitation probability. The authors concluded that regardless of the triage system in use, there might be patient groups that should be evaluated more cautiously if a triage-based discharge or redirection strategy is to be considered.

Finally, Marjanovic et al performed a review of the literature and meta-analysis about high-flow nasal cannula oxygen therapy versus noninvasive ventilation (NIV) in acute respiratory failure related to suspected or confirmed acute heart failure. (6) Primary outcome included treatment failure, as a composite outcome including early termination to the allocated treatment, need for in-hospital intubation or mortality, or the definition used in the study for treatment failure if adequate. Six of the 802 identified studies were selected for final analysis, including 572 patients (221 assigned to high flow and 351 to NIV). Overall, the treatment failure rate was 24% (54 of 221) and 13% (46 of 351) of patients in the high-flow oxygen and NIV groups, respectively. Tracheal intubation was required in 10% (19 of 197) and 6% (11 of 185) of patients in the high-flow oxygen and NIV groups, respectively. Mortality was known in 554 (97%) out of the 572 patients. Overall, 13% (28 of 210) and 9% (30 of 344) of patients died in the high-flow oxygen and NIV groups, respectively. In this systematic review, the authors found that in patients managed for acute respiratory failure related to suspected or confirmed acute heart failure, high-flow oxygen use was not associated with a higher risk of treatment failure than noninvasive ventilation.

(1)    Life beyond exams: the role of workplace-based assessments and observation in emergency medicine training. McNamara, Rosa; on behalf of the Emergency Medicine Examination Reference Group for Europe (EMERGE). European Journal of Emergency Medicine. 32(1):3-4, February 2025.

(2)    Emergency medicine training in Europe: the Young Emergency Medicine Doctors perspective. Govender, Kiren; on behalf of Emergency Medicine Reference Group for Europe (EMERGE); on behalf of Young Emergency Medicine Doctors (YEMD); More European Journal of Emergency Medicine. 32(1):5-7, February 2025.

(3)    The new European Training Requirements for emergency medicine: rationale and implementation. Brown, Ruth; Prosen, Gregor; Dryver, Eric. European Journal of Emergency Medicine. 32(1):8-9, February 2025.

(4)    A decade of European Board Examination in Emergency Medicine: achievements and future perspectives. Innocenti, Francesca; on behalf of EMERGE. European Journal of Emergency Medicine. 32(1):10-11, February 2025.

(5)    Factors associated with hospital revisitation within 7 days among patients discharged at triage: a case–control study Ylä-Mattila, Jari; Koivistoinen, Teemu; Siippainen, Henna; More. European Journal of Emergency Medicine. 32(1):22-28, February 2025.

(6)    High-flow nasal cannula oxygen therapy versus noninvasive ventilation in acute respiratory failure related to suspected or confirmed acute heart failure: a systematic review with meta-analysis. Marjanovic, Nicolas; Couvreur, Raphael; Lamarre, Jennifer; More. European Journal of Emergency Medicine. 31(6):388-397, December 2024.