Journal of Emergency Medicine最新文献

{"title":"Comment on “Evaluation of the Efficacy of Low-Dose Ketamine and Dexmedetomidine Compared to Morphine for Control of Traumatic Limb Pain in the Emergency Department: A Randomized Clinical Trial”","authors":"Anju Gupta MD , Amiya Kumar Barik DM , Chitta Ranjan Mohanty MD , Rakesh Vadakkethil Radhakrishnan MSN , Subhasree Das MD","doi":"10.1016/j.jemermed.2025.05.029","DOIUrl":"10.1016/j.jemermed.2025.05.029","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 161-162"},"PeriodicalIF":1.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858340","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":"Adenosine Versus Fixed-Dose Intravenous Bolus Diltiazem on Reversing Supraventricular Tachycardia in The Emergency Department: A Multi-Center Cohort Study","authors":"Christian A. Lee MD ,&nbsp;Benjamin Morrissey MD ,&nbsp;Kevin Chao MD ,&nbsp;Jack Healy MD ,&nbsp;Kevin Ku MD ,&nbsp;Maha Khan MD ,&nbsp;Ebrima Kinteh MD ,&nbsp;Andrew Shedd MD ,&nbsp;John Garrett MD ,&nbsp;Eric H. Chou MD","doi":"10.1016/j.jemermed.2025.05.020","DOIUrl":"10.1016/j.jemermed.2025.05.020","url":null,"abstract":"<div><h3>Background</h3><div>Supraventricular tachycardia (SVT) is a common and therapeutically challenging cardiac dysrhythmia in the emergency department (ED). Adenosine and diltiazem are the most used pharmacological agents for SVT management, but few comparative studies exist.</div></div><div><h3>Objective</h3><div>To compare the efficacy of bolus intravenous (IV) adenosine versus diltiazem in the termination of spontaneous SVT.</div></div><div><h3>Methods</h3><div>This was a multicenter, retrospective, cohort study conducted in EDs in North Texas. Eligible subjects were adult patients presenting with stable SVT who received either a bolus of IV adenosine or diltiazem as the initial treatment. The primary outcome was the rate of successful conversion, which was defined as a sustained sinus rhythm within 30 min of the initial treatment. Secondary outcomes included time to conversion and response doses.</div></div><div><h3>Results</h3><div>A total of 344 cases were incorporated into the final analysis, 310 in the adenosine-first group and 34 in the diltiazem-first group. The rate of successful conversion trended higher for diltiazem; however, the difference was not significantly different (66.8% adenosine, 82.4% diltiazem, <em>p</em> = 0.08). The median time to conversion was significantly shorter for the adenosine group (3.0 min) to the diltiazem group (6.0 min, <em>p</em> = 0.02), with median response dosages of 12 mg and 15 mg, respectively. Of the cases that failed adenosine monotherapy, 18 (35%) were successfully rescued by diltiazem. Diltiazem also successfully controlled 77% of conversions to atrial fibrillation (AF) or flutter without hypotensive events.</div></div><div><h3>Conclusion</h3><div>This study showed that diltiazem and adenosine had similar conversion rates. In addition, diltiazem effectively rescued cases not responsive to adenosine.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 55-64"},"PeriodicalIF":1.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563595","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 in Electronic Cigarette Use Among Emergency Department Patients at a University Health System Between 2018 and 2023","authors":"Michelle Leigh St. Romain MD,&nbsp;Hryniewicki Adam MD,&nbsp;Brennan Jesse MA,&nbsp;Castillo Edward MPH, PhD,&nbsp;Vilke Gary MD,&nbsp;Alfaraj Dunya N MD ,&nbsp;Vega Edgar MD ,&nbsp;Coyne Christopher MD, MPH","doi":"10.1016/j.jemermed.2025.05.011","DOIUrl":"10.1016/j.jemermed.2025.05.011","url":null,"abstract":"<div><h3>Background</h3><div>E-cigarette use and its health impacts remain understudied in medicine and public health.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the prevalence, demographics, and self-reported health effects of e-cigarette use among emergency department (ED) patients.</div></div><div><h3>Methods</h3><div>This is a cross-sectional survey study of patients age ≥18 years from 2 urban academic EDs between February 2018 and November 2023. The primary outcome was frequent e-cigarette use (defined as ≥3 times/wk); secondary outcomes included self-reported symptoms, perceptions of health risks, and persistence of use despite adverse symptoms. Predictors of frequent use were examined with multivariable logistic regression, including variables with univariate <em>p</em> &lt; 0.20 or clinical relevance. Results are reported as odds ratios (95% CI) with α = 0.05. Analyses were performed in SPSS.</div></div><div><h3>Results</h3><div>Among 3,656 respondents, 147 (4.0%) met our definition of frequent vaping. Of these frequent users, 84 (57%) were male and the greatest proportion fell in the 18–24-year age group. In multivariable analysis, male sex, and younger age independently predicted frequent use: females had roughly half the odds of frequent vaping (OR: 0.50, 95% CI: 0.35–0.72), while odds declined with increasing age (25–34 years OR: 0.46; 35–44 years OR: 0.40; ≥45 years OR: 0.10; <em>p</em> &lt; 0.001). Among frequent users, 48% worried about additive safety and 54% reported coughing.</div></div><div><h3>Conclusions</h3><div>Frequent vaping was most common among younger males in this study. Many of these users report continued vaping despite concerns about potential health risks. EDs are strategically positioned to screen adult patients for frequent e-cigarette use and deliver brief, targeted cessation counseling.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 158-167"},"PeriodicalIF":1.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605821","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":"Association Between the Number of Emergency Medical Services and the Chest Compression Quality in Out-of-Hospital Cardiac Arrest","authors":"Sang A. Yoon EMT ,&nbsp;Ki Hong Kim MD, PhD ,&nbsp;Jeong Ho Park MD, PhD ,&nbsp;Tae Han Kim MD ,&nbsp;Stephen Gyung Won Lee MD ,&nbsp;Ki Jeong Hong MD, PhD ,&nbsp;Young Sun Ro MD, DrPH ,&nbsp;Kyoung Jun Song MD, PhD ,&nbsp;Sang Do Shin MD, PhD","doi":"10.1016/j.jemermed.2025.05.021","DOIUrl":"10.1016/j.jemermed.2025.05.021","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) is a critical public health issue worldwide, and the quality of cardiopulmonary resuscitation (CPR) is essential for patient outcomes.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the association between the number of emergency medical services (EMS) personnel and the quality of CPR in OHCA patients.</div></div><div><h3>Methods</h3><div>This retrospective study utilized data from a metropolitan EMS cardiac arrest registry. Adult cardiac arrest patients who visited emergency departments (EDs) from December 2020 to October 2022 were included. The primary outcome was the proportion of cardiac compressions that achieved an adequate rate (100–120 beats/min) and depth (5–6 cm) for more than 40% of the CPR duration, and flow time for more than 80%. The number of EMS personnel in the first-arrived ambulance was categorized into two- or three-member groups. Multivariate logistic regression was used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>In total, 2777 patients were included. Compared with two-member EMS groups, three-member EMS personnel groups had a higher probability of achieving an adequate chest compression rate: AOR 1.43, 95% CI 1.15–1.77. There was no significant association with achieving an adequate chest compression depth, or chest compression flow time: AOR 1.00, 95% CI 0.80–1.24 and AOR 1.12, 95% CI 0.92–1.35, respectively.</div></div><div><h3>Conclusion</h3><div>Compared with a two-member EMS group, a three-member EMS group in the first-arrived ambulance was more likely to provide adequate chest compression rates. There were no significant differences in adequate chest compression depth or flow time.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 89-98"},"PeriodicalIF":1.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571478","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":"Comparison of Initial Lactate Levels and Their Prognostic Utility in Obese and Nonobese Patients with Sepsis","authors":"Manoj Arra MD, PhD,&nbsp;Sasha Mozelewski-Hill MD,&nbsp;Taylor Kaser MPH,&nbsp;Rachel Ancona PhD,&nbsp;Philip Asaro MD,&nbsp;Christopher Holthaus MD","doi":"10.1016/j.jemermed.2025.05.023","DOIUrl":"10.1016/j.jemermed.2025.05.023","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is a high morbidity and mortality disease that is highly prevalent in emergency departments (EDs). Lactate is often utilized as a biomarker for sepsis, though its performance among subgroups such as obese patients is not well characterized. Given existing data on differences in lactate metabolism at baseline between obese and nonobese patients, this may be clinically relevant in sepsis identification and prognostication.</div></div><div><h3>Study Objective</h3><div>We sought to compare differences in initial lactate measurements and lactate utility in predicting 30-day mortality between obese and nonobese body mass index (BMI) patients with vasopressor-dependent and non-vasopressor-dependent sepsis.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of obese and nonobese patients presenting to an adult hospital ED with sepsis with organ dysfunction. Patients were separated into vasopressor-dependent or non-vasopressor-dependent groups. The primary outcomes were differences in initial lactate and utility of initial lactate in predicting 30-day all-cause mortality by employing receiver operator characteristic curves.</div></div><div><h3>Results</h3><div>Obese patients had lower initial lactate (2.2 mmol/L) compared with nonobese patients (2.4 mmol/L) in the non-vasopressor-dependent cohort. Lactate performed poorly-to-moderately well as a biomarker for 30-day mortality between obese and nonobese patients with sepsis, with no differences between BMI groups.</div></div><div><h3>Conclusion</h3><div>Initial lactate levels are lower in obese patients compared with nonobese patients, but are unlikely to be clinically significant. We found no difference in lactate’s utility as a biomarker for prediction of 30-day all-cause mortality between obese and nonobese patients. Lactate overall maintains some utility as a predictor of sepsis mortality, though factors that contribute to lactate levels remain unclear.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 79-88"},"PeriodicalIF":1.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571479","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":"Influence of the Timing of Antibiotic Administration and Control of Infectious Foci on the Prognosis of Adult Patients with Critical Surgical Sepsis","authors":"Pedro M. Garrido Benedicto ,&nbsp;Pitter F. Cueto Quintana ,&nbsp;Juan Antonio Brito Piris ,&nbsp;Elisabet Garcia Mañosa ,&nbsp;Karla Malpica Basurto ,&nbsp;Raquel Enriquez Sanchez ,&nbsp;Immaculada Vallverdú Perapoch ,&nbsp;Jordi Camps Andreu","doi":"10.1016/j.jemermed.2025.05.019","DOIUrl":"10.1016/j.jemermed.2025.05.019","url":null,"abstract":"<div><h3>Background</h3><div>Delay in administration of antibiotics and surgical control of the infection source are linked to increased mortality in septic patients.</div></div><div><h3>Objective</h3><div>The primary objective was to assess the impact of delays in administering the first antibiotic dose and the timing of surgical control of the infection source on in-hospital mortality.</div></div><div><h3>Method</h3><div>This single-center, retrospective observational study included 155 critically ill septic patients admitted to hospital emergency department (ED). All patients underwent surgical control of the infection source before admission to the intensive care unit (ICU).</div></div><div><h3>Results</h3><div>The median time to the first antibiotic dose was 5.6 hours (IQR: 2.5–10.8) and the median time to surgery was 11.3 hours (IQR: 6.7–21.8). Only 28% of patients received antibiotic therapy within the first 3 hours, and 23.2% underwent surgery within the first 6 hours after ED arrival. Mortality rates did not differ significantly between patients who received antibiotics within 3 hours vs. later (25.0% vs. 15.3%, <em>p</em> = 0.158), those with or without septic shock (50.0% vs. 43.3%, <em>p</em> = 0.519), or based on surgical timing (<em>p</em> = 0.085). Older patients exhibited higher mortality (<em>p</em> = 0.036). Multivariate analysis revealed that only patient age, chronic kidney disease (CKD), and a time to surgery of less than 6 hours from hospital arrival were independently associated with mortality. A strong correlation was found between delays in administering the first antibiotic dose and delays in surgery (<em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>In our series, septic patients requiring control of the infectious focus did not benefit from the combination of early antibiotic administration and faster surgical intervention. Older age was associated with higher mortality. Additionally, delays in antibiotic administration were strongly correlated with delays in surgical intervention, highlighting the need for streamlined sepsis management protocols.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 137-149"},"PeriodicalIF":1.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605801","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":"Evaluating the Impact of a Novel Referral Pathway for Suspected Cancer Cases in Emergency Department Patients","authors":"Nicholas R. Pettit DO, PhD, MPH ,&nbsp;Eli Martinez MD ,&nbsp;Marissa Vander-Missen MD ,&nbsp;Ahmad Al-Hader MD","doi":"10.1016/j.jemermed.2025.05.015","DOIUrl":"10.1016/j.jemermed.2025.05.015","url":null,"abstract":"<div><h3>Background</h3><div>The emergency department (ED) is crucial for identifying acute cancer diagnoses, but the management and outcomes of post-ED cancer care remain unclear due to the absence of standardized protocols.</div></div><div><h3>Objectives</h3><div>We assess the efficacy and outcomes of a newly introduced referral pathway, specifically tailored for ED patients whose ED evaluation is concerning for undiagnosed cancer.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted at a single center, involving 161 patients evaluated in our ED. These patients were referred to our institution's Oncology Department through an ambulatory e-referral placed at the time of their ED discharge. The referral pathway, established in 2021, facilitated virtual coordination of care by an oncologist for ED patients suspected of having cancer.</div></div><div><h3>Results</h3><div>Out of the 161 patients referred to the cancer pathway, 84 (52.2%) were subsequently diagnosed with biopsy or surgically confirmed cancer. All patients received evaluation by an oncologist within 1 business day. Among the diagnosed cases, 60 (75.0%) had available cancer staging information, with a majority presenting at advanced stages, including stage III (n = 12, 20.0%) or stage IV (n = 39, 65.0%). No patients died within 30 days of follow-up. The prevalent cancer types identified included lung (n = 26, 31.0%), renal cell carcinoma (n = 17, 20.2%), pancreatic (n = 6, 7.1%), head and neck (n = 6, 7.1%), and prostate (n = 6, 7.1%).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the capacity of emergency physicians to recognize potential cases of undiagnosed cancer among ED patients. Utilizing an innovative care coordination pathway, these patients can be safely discharged with reliable follow-up mechanisms in place. Future endeavors should prioritize assessing the impact of this referral pathway on critical metrics such as time to biopsy, time to treatment initiation, and overall mortality rates.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 47-54"},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534877","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":"Prothrombin Complex Concentrate in Direct Oral Anticoagulant Reversal: A Systematic Scoping Review","authors":"Nazedah Ain Ibrahim PhD ,&nbsp;Jiaa Yinn Tang BPharm ,&nbsp;Hayati Alwani Yahaya MPharm ,&nbsp;Sin Yee Tan MPharm ,&nbsp;Szu Lynn Tay MPharm ,&nbsp;Jivanraj Nagarajah MPharm","doi":"10.1016/j.jemermed.2025.05.013","DOIUrl":"10.1016/j.jemermed.2025.05.013","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOAC) have emerged as an alternative to warfarin for treating venous thromboembolism and stroke prevention in atrial fibrillation. Reversal agents such as idarucizumab and andexanet alfa are not widely and readily available in Malaysia. In their absence, international guidelines recommend the administration of prothrombin complex concentrates (PCC) in life-threatening bleeding caused by DOAC.</div></div><div><h3>Objective</h3><div>To describe the reported PCC effectiveness and safety in reversing the anticoagulant effects of DOAC and provide better insight into its current practice in Malaysia.</div></div><div><h3>Methods</h3><div>This scoping review was conducted using the following databases: PubMed, Wiley Online Library, Sage Journals, and Google Scholar from 2016 until 2020. Clinical studies focusing on the utilization of PCC in the reversal of DOAC and fulfills the PRISMA extension for Scoping Reviews checklist were included. This review was registered with the National Medical Research Register, Malaysia (NMRR ID-22–01355-DC3).</div></div><div><h3>Results</h3><div>The systematic search retrieved 599 studies, 20 of which met the inclusion criteria. All studies described the use of PCC as a reversal agent for DOAC, with doses ranging between 25 and 50 u/kg. Hemostatic effectiveness was reported in 15 studies, 12 of which used the International Society on Thrombosis and Haemostasis (ISTH) criteria. All 20 studies assessed the safety of PCC in terms of overall risk of thrombotic events and mortality.</div></div><div><h3>Conclusions</h3><div>Further high-quality studies are essential to deepen understanding regarding PCC effectiveness and safety in achieving clinical hemostasis. However, this review provides the information regarding PCC as an option when DOAC-specific reversal agents are unavailable, or the type of DOAC is unknown.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 24-46"},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534876","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":"Emergency Department Observation for Back Pain: Patient Characteristics and Factors Associated with Hospital Admission or 90-day Return Visit","authors":"Caroline Ferazani,&nbsp;Gregory Garra DO,&nbsp;Sanjey Gupta MD","doi":"10.1016/j.jemermed.2025.05.010","DOIUrl":"10.1016/j.jemermed.2025.05.010","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) observation for extended work-up or intensive treatment of intractable back pain (BP) is an alternative to hospital admission. Patient characteristics and outcomes are largely unknown.</div></div><div><h3>Objectives</h3><div>To describe the characteristics of patients placed on ED observation for intractable BP; to determine the hospital admission rate from the ED observation unit (EDOU) and any associated factors; and to determine the 90-day recidivism rate for BP-related return visits and any associated factors.</div></div><div><h3>Methods</h3><div>This was a retrospective, quality improvement initiative of patients placed on ED observation from June 1, 2022, to May 31, 2023, for intractable BP. Data was abstracted from the electronic medical record by a single, trained data abstractor. Variables extracted from the medical record included age, sex, analgesic medications administered during EDOU (type and amount), pain management consultation, pain medicine procedure, EDOU discharge disposition, EDOU length of stay (LOS), 90-day return visits for any reason, and 90-day return visit for BP.</div></div><div><h3>Results</h3><div>Two hundred twenty-five patients were admitted to the EDOU for BP, median age 66 years, 63% female. Median EDOU LOS was 20.8 h. Hospital admission occurred in 25% and a 90-day return visit occurred in 15%. Oral opioid administration was significantly associated with hospital admission. Physical therapy consultation was significantly associated with 90-day return visit.</div></div><div><h3>Conclusion</h3><div>ED observation is an alternative to hospital admission for patients with intractable BP. Hospital admission from observation is consistent with national ED benchmarking for observation admission and the 90-day recidivism rate for BP is low.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 106-111"},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579721","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":"Association of Combined Community Income and Race/Ethnicity to Antidysrhythmic Administration for Out-of-Hospital Cardiac Arrest","authors":"Ryan Huebinger MD ,&nbsp;Anastasia Papin MS ,&nbsp;Ryan A. Coute DO ,&nbsp;Anna Maria Johnson BA ,&nbsp;Larissa Myaskovsky PhD ,&nbsp;Keith E. Kocher MD, MPH ,&nbsp;N. Clay Mann PhD, MS ,&nbsp;Janet Page-Reeves PhD","doi":"10.1016/j.jemermed.2025.05.016","DOIUrl":"10.1016/j.jemermed.2025.05.016","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about antidysrhythmic administration disparities for out-of-hospital cardiac arrest (OHCA).</div></div><div><h3>Objectives</h3><div>We evaluated the association between combined lower-income and minoritized communities with antidysrhythmic administration for OHCA.</div></div><div><h3>Methods</h3><div>We studied the 2018–2021 National Emergency Medical Services Information System encounters, linked to census data. We included adult OHCAs with a shockable rhythm. We used encounter ZIP Code data to calculate household income quartiles (Q1–highest to Q4–lowest). We created combined income and race/ethnicity strata, yielding 6 cohorts and 2 ordered groups (1–4a [Black] and 1–4b [Hispanic] with 1 and 2 shared between them): 1) Q1 income/&gt;70% White, 2) Q2 income/50%–70% White, 3a) Q3 Income/50%–70% Black, 4a) Q4 Income/&gt;70% Black, 3b) Q3 Income/50%–70% Hispanic, and 4b) Q4 income/&gt;70% Hispanic. We evaluated the association of combined income and race/ethnicity groups to administration of an antidysrhythmic, with cohort 1 as the reference.</div></div><div><h3>Results</h3><div>We included 61,437 OHCAs. Compared to Q1 income/&gt;70% White (33.5%), Q2 income/50–70% White had higher odds of antidysrhythmic administration (36.0%, aOR 1.15 [1.1–1.2]). However, all other groups had lower odds of antidysrhythmic administration (Q3 income/50–70% Black – 28.1%, aOR 0.8 [0.7–0.9]; Q4 income/&gt;70% Black – 29.6%, aOR 0.9 [0.8–0.95]; Q3 income/50–70% Hispanic – 31.1%, aOR 0.9 [0.8–0.99]; Q4 income/&gt;70% Hispanic – 23.0%, aOR 0.6 [0.6–0.7]). Using ordinal regression, decreasing income and increasing Black race (aOR 0.95[0.9–0.97]) as well as decreasing income and increasing Hispanic ethnicity (aOR 0.9 [0.9–0.95]) in a community were associated with decreased odds of antidysrhythmic administration</div></div><div><h3>Conclusion</h3><div>Decreasing household income and increasing minoritized race/ethnicity were associated with decreased odds of antidysrhythmic administration.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"75 ","pages":"Pages 112-117"},"PeriodicalIF":1.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596990","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}