Journal of Emergency Medicine最新文献

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00279-3","DOIUrl":"10.1016/S0736-4679(25)00279-3","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 342-343"},"PeriodicalIF":1.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctors, Drop the Jargon: A Case Against Endorsing Symptoms, Appreciating Disease and Blaming Patients","authors":"Tim Bongartz MD, MS","doi":"10.1016/j.jemermed.2025.07.025","DOIUrl":"10.1016/j.jemermed.2025.07.025","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 7-8"},"PeriodicalIF":1.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00250-1","DOIUrl":"10.1016/S0736-4679(25)00250-1","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"74 ","pages":"Pages 142-143"},"PeriodicalIF":1.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic Variables Associated with Self-Reported Emergency Department Utilization: A Cross-Sectional, Population-Based Analysis","authors":"Umaima Abbas MD(C) ,&nbsp;Thanansayan Dhivagaran MD(C) ,&nbsp;Fahad R. Butt MD(C) ,&nbsp;Christine Wang BHSc(C) ,&nbsp;Ante Cuvalo BHSc(C) ,&nbsp;Varounan Dhivagaran HBSc ,&nbsp;Erfun Hatam MD","doi":"10.1016/j.jemermed.2025.05.028","DOIUrl":"10.1016/j.jemermed.2025.05.028","url":null,"abstract":"<div><h3>Background</h3><div>Current evidence has established disparities in ED utilization across various demographic and socioeconomic groups. However, there is a paucity of recent evidence exploring the interaction of multiple sociodemographic variables and their influence on emergency department (ED) utilization.</div></div><div><h3>Objectives</h3><div>To evaluate the influence and interaction of multiple sociodemographic variables on ED utilization.</div></div><div><h3>Methods</h3><div>Cross-sectional, population-based logistic regression analyses were conducted using the 2023 National Health Interview Survey (NHIS) data.</div></div><div><h3>Results</h3><div>Adjusted odds of ED utilization were significantly higher among female (OR 1.31, 95% CI 1.21–1.41, <em>p</em> &lt; 0.001), Black (OR 1.16, 95% CI 1.03–1.31, <em>p</em> = 0.014) and American Indian/Alaskan (OR 1.37, 95% CI 1.04–1.81, <em>p</em> = 0.026) individuals. Compared to ages 18-25, individuals aged 50-74 (<em>p</em> &lt; 0.05) had lower odds. Compared to participants &gt;5x poverty threshold, those with income 2–5x poverty threshold, 1–2x poverty threshold, and &lt;1x poverty threshold had 19% (<em>p</em> &lt; 0.001), 40% (<em>p</em> &lt; 0.001) and 52% (<em>p</em> &lt; 0.001) increased odds of ED utilization, respectively. Individuals with Medicaid/public insurance (OR 1.43, 95% CI 1.29–1.59, <em>p</em> &lt; 0.001) and high school education (OR 1.12, 95% CI 1.01–1.23, <em>p</em> = 0.025) had higher odds of ED utilization compared to those with private insurance and college education. Those without access to a usual place of care (OR 0.71, 95% CI 0.60–0.82, <em>p</em> &lt; 0.001) had lower odds. Compared to participants in good health, those in fair (OR 2.03, 95% CI 1.84–2.25, <em>p</em> &lt; 0.001) or poor (OR 4.4, 95% CI 3.77–5.24, <em>p</em> &lt; 0.001) health had higher odds of ED visits.</div></div><div><h3>Conclusions</h3><div>Sex, age, race, income, insurance coverage, education, self-reported health status and access to care are significant predictors of ED visits.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 125-136"},"PeriodicalIF":1.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involuntary Psychiatric Holds in Acute Care Settings: Implications for Emergency Department Capacity and Care - A Narrative Review.","authors":"Arika Brown, Cole Ettingoff, Josh Davis, Heather Henderson","doi":"10.1016/j.jemermed.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.05.022","url":null,"abstract":"<p><strong>Background: </strong>Involuntary psychiatric holds, commonly limited to 72 hours, serve as a critical intervention for individuals experiencing acute mental health crises. These holds aim to prevent immediate harm and facilitate crisis stabilization, yet their effectiveness, legal variability, and long-term impact remain inadequately studied. Despite widespread implementation, the 72-hour standard lacks strong empirical justification, and significant inconsistencies exist in its application across jurisdictions.</p><p><strong>Objective: </strong>This narrative review examines the factors leading to the initiation of involuntary psychiatric holds, focusing on legal frameworks, clinical assessment protocols, systemic challenges, and patient outcomes.</p><p><strong>Methods: </strong>A clinically structured literature review was conducted using peer-reviewed journals and official guidance. Studies were included if they analyzed U.S. laws and practices regarding involuntary psychiatric holds, examined clinical assessment criteria, or explored patient outcomes related to psychiatric detentions. Thematic analysis was used to identify patterns, inconsistencies, and areas for future research.</p><p><strong>Discussion: </strong>Suicidality remains the leading cause for psychiatric holds, but assessment criteria vary widely. Emergency departments serve as the primary entry point, yet resource limitations and legal inconsistencies contribute to disparities in care. The historical 72-hour timeframe is not supported by robust evidence, and recidivism rates remain high due to inadequate posthold care.</p><p><strong>Conclusions: </strong>Standardized protocols, expanded crisis intervention training, and improved outpatient services are essential for optimizing involuntary psychiatric holds. Further research is needed to evaluate the efficacy of the 72-hour standard and to develop policies that balance patient rights with public safety.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Factors Affecting High-Dose (≥50 mSv) Computed Tomography Scans in the Emergency Department: A Four-Year Analysis","authors":"Hamid Shokoohi MD, MPH ,&nbsp;Melissa Meeker PhD ,&nbsp;Kristofer Montoya MD ,&nbsp;Maria Mataac B.S. ,&nbsp;Xinhua Li PhD ,&nbsp;Madan M. Rehani PhD","doi":"10.1016/j.jemermed.2025.05.024","DOIUrl":"10.1016/j.jemermed.2025.05.024","url":null,"abstract":"<div><h3>Background</h3><div>Advances in computed tomography (CT) technology have reduced radiation exposure, with head CTs delivering around 2 mSv. However, some examinations still deliver doses of ≥50 mSv, increasing the risk of radiation-induced cancers.</div></div><div><h3>Study Objectives</h3><div>This study examines the incidence of high-dose CT scans (≥50 mSv) in the emergency department (ED) over a four-year period, exploring trends and potential contributing factors.</div></div><div><h3>Methods</h3><div>This retrospective cohort study examined CT scans from the ED of a tertiary care hospital from 2019 to 2022. Adult patients (≥18 years) who received a single CT scan with a dose ≥50 mSv were included. We analyzed the data by age, sex, scan type, scanner model, use of contrast, and examination year using descriptive statistics and Kruskal–Wallis testing to identify significant variations in radiation dose.</div></div><div><h3>Results</h3><div>Out of over 166,000 CT scans performed during the study period, we identified 1357 (0.81% of examinations) examinations with radiation doses ≥ 50 mSv, 58% of which were performed on females and 61% &lt;65 years old. Aorta CTs were most common (62%), followed by chest/abdomen/pelvis (14%). Most of these scans were aorta studies (62%), followed by chest/abdomen/pelvis scans (14%) and trauma-related examinations. The highest doses were seen in extremity CTs (median 67 mSv), aorta scans (median 60 mSv), and chest/abdomen/pelvis studies (median 59 mSv). Use of IV contrast was associated with 89% of high-dose scans. The overall percentage of high-dose CTs increased over time, from 0.50% in 2019 to 0.92% in 2022, with a rise in median dose from 57 mSv to 60 mSv. Dose variations were statistically significant across scan type, patient age, contrast use, and year, but not by gender or scanner model.</div></div><div><h3>Conclusion</h3><div>Although high-dose CT examinations are relatively uncommon, their occurrence in the ED has increased in recent years despite newer CT technology. These scans are most often linked to specific protocols like aortic imaging and multiphase extremity studies. Our findings point to the need for review of CT protocols and better awareness of radiation risks.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 118-124"},"PeriodicalIF":1.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Solutions to Improve Emergency Department Wait Times: Living Systematic Review","authors":"Bahareh Ahmadzadeh MSc ,&nbsp;Christopher Patey MD ,&nbsp;Paul Norman BN ,&nbsp;Alison Farrell MLIS ,&nbsp;John Knight PhD ,&nbsp;Stephen Czarnuch PhD ,&nbsp;Shabnam Asghari MD, PhD","doi":"10.1016/j.jemermed.2025.05.031","DOIUrl":"10.1016/j.jemermed.2025.05.031","url":null,"abstract":"<div><h3>Background</h3><div>Overcrowding and long wait times in emergency departments (EDs) remain global challenges that negatively affect patient outcomes and staff satisfaction. As an emerging technology, artificial intelligence (AI) offers the potential to optimize ED operations and reduce wait times.</div></div><div><h3>Objective</h3><div>Establish a strategy to evaluate AI modeling as it relates to utilizing AI based strategies for ED flow.</div></div><div><h3>Methods</h3><div>We searched Embase, MEDLINE, CINAHL, and Scopus for English-language studies published from January 1, 1946, to August 17, 2023, and we will update our search to ensure currency. The ROBINS-I tool assessed study quality, while PROBAST examined the risk of bias and applicability.</div></div><div><h3>Results</h3><div>Out of 17,569 screened studies, 65 full-text articles were evaluated for eligibility, with 16 quantitative observational studies meeting inclusion criteria. The best-performing algorithms included regression-based methods (n = 2), traditional single-model machine learning (n = 8), neural networks/deep learning (n = 3), natural language processing (n = 1), and ensemble methods (n = 2). None of the studies examined AI’s impact in a real ED setting, though four simulations reported wait-time reductions ranging from 7 to 43.2 minutes.</div></div><div><h3>Conclusions</h3><div>AI integration in ED is still in its infancy. Our review found no real-world ED implementation studies, and most of the existing research lacked involvement from ED experts. This gap highlights the lack of insight into AI’s practical impact. Future reviews and research must clarify these dimensions, guiding AI's effective, collaborative adoption in ED workflows.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 174-187"},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144623751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in Geriatric Emergency Department Patients with Blunt Head Trauma on Preinjury Factor Xa Inhibitors","authors":"Bailey K. Pierce MD, MBA ,&nbsp;Scott M. Alter MD, MBA ,&nbsp;Lisa M. Clayton DO, MBS ,&nbsp;Gabriella Engstrom PHD, RN ,&nbsp;Mike Wells MBBCH, PHD ,&nbsp;Joshua J. Solano MD ,&nbsp;Patrick G. Hughes DO, MEHP ,&nbsp;Richard D. Shih MD","doi":"10.1016/j.jemermed.2025.05.017","DOIUrl":"10.1016/j.jemermed.2025.05.017","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants may increase the risk of intracranial hemorrhage and mortality in patients with blunt head trauma. Previous studies are limited by small sample size or retrospective design.</div></div><div><h3>Objective</h3><div>The objective of this study was to evaluate the association of direct factor Xa inhibitors on intracranial hemorrhage and mortality in older adults with head trauma.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a large cohort study of geriatric emergency department (ED) patients with blunt head trauma. Patients ≥ 65 years presenting to the ED with blunt head trauma were included. Exclusion criteria included use of antiplatelet or anticoagulant medications other than apixaban and rivaroxaban. Intracranial hemorrhage was assessed via head computed tomography and outcomes. Patients were followed up for 30 days via telephone, medical records, and the state death registry. Odds ratios compared intracranial hemorrhage and mortality rates in patients on factor Xa inhibitors with those not anticoagulated.</div></div><div><h3>Results</h3><div>Of 3031 eligible patients, 2294 were not on anticoagulant or antiplatelet agent, 505 were on apixaban, and 232 on rivaroxaban. Among those not on anticoagulation, 162 patients (7.1%) developed intracranial hemorrhage and 46 patients (6.2%) on factor Xa inhibitors experienced intracranial hemorrhage. Factor Xa inhibitors do not seem to increase the risk of intracranial hemorrhage (6.2% vs. 7.1%; <em>p</em> = 0.443) or 30-day mortality (7.9% vs. 6.8%; <em>p</em> = 0.345).</div></div><div><h3>Conclusions</h3><div>Factor Xa inhibitors were not found to be associated with an increased risk of intracranial hemorrhage in geriatric ED patients with blunt head trauma in our study. Additional studies need to be completed to confirm our findings.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 65-73"},"PeriodicalIF":1.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate-Smart Diagnostic Medical Imaging and Point-of-Care Ultrasound: An Evidence-Based Perspective","authors":"Hamid Shokoohi MD, MPH ,&nbsp;Andrew S. Liteplo MD ,&nbsp;Kristofer Montoya MD ,&nbsp;Casey Patnode MD, MPH ,&nbsp;Ainsley B. Hutchinson BA ,&nbsp;Michael E. Zalis MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Ali S. Raja MD ,&nbsp;Jonathan E. Slutzman MD","doi":"10.1016/j.jemermed.2025.05.027","DOIUrl":"10.1016/j.jemermed.2025.05.027","url":null,"abstract":"<div><h3>Background</h3><div>Hospital diagnostic imaging significantly contributes to healthcare's carbon emissions, with modalities such as magnetic resonance imaging (MRI) and computed tomography (CT), accounting for a disproportionate share of energy consumption and greenhouse gas (GHG) emissions. While clinical value remains paramount, sustainability must become part of imaging decision-making.</div></div><div><h3>Objectives</h3><div>Point-of-care ultrasound (POCUS) is known for its portability, cost-effectiveness, and bedside efficiency, but its environmental impact remain underexplored. This review aims to examine GHG emissions across imaging modalities and highlights POCUS as an eco-friendlier alternative within a broader strategy to align diagnostic imaging with global climate goals.</div></div><div><h3>Discussion</h3><div>POCUS consumes less energy, generates minimal standby emissions, and avoids infrastructure-intensive setups. It also reduces indirect energy use from patient transport and prolonged hospital stays. Life-cycle analyses support ultrasound as a low-emission option, with its high portability, compact design, lower disposable waste, battery-powered operation, and lack of need for contrast agents in most applications. Broader integration of POCUS, particularly in selected clinical settings where it can precede or replace more carbon-intensive modalities, offers a practical strategy to reduce healthcare emissions.</div><div>When paired with artificial intelligence (AI) integration, tele-ultrasound, and stewardship frameworks, appropriate POCUS use can minimize unnecessary imaging and support climate-smart practices.</div></div><div><h3>Conclusion</h3><div>With the escalating climate crisis, the environmental impact of medical imaging particularly from MRI and CT can no longer be ignored. Prioritizing ultrasound, a low impact modality, as the first-line option where appropriate, can reduce reliance on high-emission imaging and advance a more sustainable, climate smart approach to diagnostic care.</div></div><div><h3>Presentation</h3><div>The abstract was presented at the SAEM24 Annual Meeting, held in Phoenix, Arizona, in May 2024.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 150-157"},"PeriodicalIF":1.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Near Catastrophe: Antiphospholipid Syndrome and Catastrophic Antiphospholipid Syndrome Complicating Emergency Department Care","authors":"Francis Harrison MD ,&nbsp;Sarah Bella DO ,&nbsp;Kassem Makki DO ,&nbsp;Nessy Dahan MD","doi":"10.1016/j.jemermed.2025.05.012","DOIUrl":"10.1016/j.jemermed.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Antiphospholipid syndrome (APS) is an autoimmune syndrome that often clinically manifests as venous thrombosis, arterial thrombosis, pregnancy morbidity, and thrombocytopenia. While APS is rare and difficult to diagnose, it can lead to devastating complications, most notably catastrophic antiphospholipid syndrome (CAPS). Both APS and CAPS have a strong association with pregnancy, which is often what reveals a new diagnosis of APS. Recurrent spontaneous abortions and pre-eclampsia are the most common pregnancy-related triggers for APS, while Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP) syndrome is less common but more dangerous to the patient’s health.</div></div><div><h3>Case Report</h3><div>This case report identifies a 23-year-old female who presented to the emergency department (ED) 1-week postpartum with significant abdominal pain and nausea with vomiting. The report details an uncommon and life-threatening postpartum condition that was a result of a yet to be diagnosed autoimmune condition.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>APS is potentially life threatening, particularly when the patient’s clinical course is complicated by CAPS, but it is difficult to diagnose. This case report reveals 4 clinical clues found in the ED that pointed toward a new diagnosis of APS and impending CAPS. If a new diagnosis of APS is suspected or a patient with known APS is possibly presenting with CAPS, the emergency physician must be able to consider these diagnoses and appropriately begin therapeutic interventions. If possible, these interventions should be done in close consultation with the admitting team, particularly the intensive care unit and hematology.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 74-78"},"PeriodicalIF":1.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}