Journal of Emergency Medicine最新文献

{"title":"","authors":"Edward J. Otten MD, FACMT, FAWM","doi":"10.1016/j.jemermed.2024.11.011","DOIUrl":"10.1016/j.jemermed.2024.11.011","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 142-143"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912793","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":"Relationship Between Gender Identity and Underrepresented-In-Medicine Identity on Emergency Medicine Resident Feedback","authors":"Ryan F. Coughlin MD ,&nbsp;Jessica Bod MD ,&nbsp;Shacelles Bonner MD ,&nbsp;Katarzyna Gore MD ,&nbsp;Alina Tsyrulnik MD ,&nbsp;Dylan Devlin MD ,&nbsp;Nickolas Srica MD ,&nbsp;David Della-Giustina MD ,&nbsp;Manali Phadke MS ,&nbsp;James Dziura PhD ,&nbsp;Katja Goldflam MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.jemermed.2024.11.019","DOIUrl":"10.1016/j.jemermed.2024.11.019","url":null,"abstract":"<div><h3>Background</h3><div>Effective delivery of feedback is critical to enhancing learning, clinical performance, and professional growth among residents. However, disparities may exist in how feedback is given to different learner groups.</div></div><div><h3>Objective</h3><div>To determine if resident gender or underrepresented–in medicine (UiM) identity influenced the likelihood of receiving feedback.</div></div><div><h3>Methods</h3><div>This was a retrospective study of feedback delivery at an academic, 4-year, emergency medicine residency over a 28-month period. Generalized estimating equation models were performed to assess the odds of receiving feedback, feedback delivery, feedback content, or use of deliberate practice with respect to resident and assessor gender identity and UiM identity, or resident-assessor gender identity or UiM identity concordance.</div></div><div><h3>Results</h3><div>Resident gender identity (OR 0.96; 95% CI 0.84–1.11) and UiM identity (OR 1.02; 95% CI 0.81–1.27) were not associated with differences in receiving written feedback. Analysis among those who received face-to-face feedback revealed no significant differences in feedback delivery method by gender (OR 1.13; 95% CI 0.83–1.52) or UiM identity (OR 1.40; 95% CI 0.97–2.02). There were no significant differences in the use of deliberate practice (gender OR 0.94; 95% CI 0.81–1.09 and UiM OR 1.009; 95% CI 0.77–1.33). Neither faculty-resident gender concordance (OR 0.95; 95% CI 0.83–1.08) nor faculty-resident UiM concordance (OR 1.07; 95% CI 0.92–1.24) were significantly associated with receiving written feedback.</div></div><div><h3>Conclusion</h3><div>In this single-center, retrospective study, there were no significant differences in the odds of receiving feedback, feedback delivery, self-reported feedback content, or use of deliberate practice with respect to resident gender identity and resident UiM identity, or resident-faculty gender or UiM concordance. Further research with larger, multisite datasets is needed to draw more definitive conclusions regarding disparities in these areas on a larger scale.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 97-103"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912787","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":"Continuous QTc Monitoring for Patients Intoxicated with QTc Prolonging Medication in the Emergency Department: A Proof of Principle Study","authors":"Marit Bot MSC ,&nbsp;Raymond J. van Wijk MSC ,&nbsp;Hermie J. Hermens PHD ,&nbsp;David N. van der Kooi BSC ,&nbsp;Thomas Luttmer BSC ,&nbsp;Eva M. Boetje BSC ,&nbsp;Jan C. ter Maaten MD, PHD ,&nbsp;Hjalmar R. Bouma MD, PHD ,&nbsp;Ewoud ter Avest MD, PHD","doi":"10.1016/j.jemermed.2024.11.007","DOIUrl":"10.1016/j.jemermed.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>It can be challenging to determine when patients presenting with an overdose of QT interval prolonging drugs can be discharged safely, especially when the moment of intoxication or the substance ingested is unknown.</div></div><div><h3>Objective</h3><div>In a proof of principle study, we aimed to determine whether continuous corrected QT interval (QTc) analysis can be used to establish optimal observation duration of patients intoxicated with QTc prolonging medication.</div></div><div><h3>Methods</h3><div>For patients presenting with an intoxication with QT interval prolonging drugs in the emergency department, electrocardiography signals sampled at 500 Hz were preprocessed and the mean heart rate QTc per 5 min was calculated and plotted against time. A third order polynomial was fitted to visualize when the QTc would be highest (i.e., electrophysiological time to maximum concentration [T_max]). This point in time was compared with the estimated T_max based on pharmacokinetic properties of the ingested substance.</div></div><div><h3>Results</h3><div>In a retrospective biobank-based study, a total of 22 emergency department visits (of 15 patients) were analyzed. An electrophysiological T_max could be calculated for 17 of 22 visits. The remaining 5 patients presented either long after the electrophysiological T_max (n = 4) or were admitted to the ward before reaching the T_max (n = 1). The mean (SD) difference between the estimated T_max based on drug properties and the calculated electrophysiological T_max was 18 (133) min (range –158 to 296 min). Despite the wide range, there was a significant correlation between recorded electrophysiological T_max and estimated T_max (<em>r</em> = 0.67, <em>p</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>Continuous electrophysiological monitoring can be used as an adjunct to determine the toxicokinetic T_max for patients presenting with an intoxication, especially when the time of ingestion or the substance ingested is unknown.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 46-55"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753059","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":"What is the Utility of Point-of-Care Ultrasound for Diagnosis of Soft Tissue Abscess vs. Cellulitis?","authors":"Kristine Jeffers MD ,&nbsp;Samuel M. Keim MD, MS ,&nbsp;Brit Long MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Srikar R. Adhikari MD, MS","doi":"10.1016/j.jemermed.2024.11.012","DOIUrl":"10.1016/j.jemermed.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Skin and soft tissue infections (SSTIs) including cellulitis and abscess are common conditions managed in the emergency department, but differentiating these on history and physical examination alone can be challenging. Point-of-care ultrasound (POCUS) has been proposed as a tool to distinguish abscess from cellulitis.</div></div><div><h3>Clinical Question</h3><div>What is the utility of POCUS for diagnosing soft tissue abscess vs. cellulitis?</div></div><div><h3>Evidence Review</h3><div>Studies retrieved included four systematic reviews and meta-analyses evaluating the use of POCUS for diagnosing abscess. These studies provide estimates of the potential utility of POCUS in differentiating abscess and cellulitis.</div></div><div><h3>Conclusion</h3><div>Based upon the available literature, POCUS can reliably differentiate abscess and cellulitis and assist with management of SSTIs.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 121-128"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912789","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)00166-0","DOIUrl":"10.1016/S0736-4679(25)00166-0","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 144-145"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912794","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":"Receiver Operating Characteristic Curve Analysis of the Value of Exertional Heat Stroke Score in Predicting the Prognosis of Exertional Heat Stroke Patients","authors":"Heliang Ke MM ,&nbsp;Dong Li MM ,&nbsp;Yi Lin MM","doi":"10.1016/j.jemermed.2024.11.023","DOIUrl":"10.1016/j.jemermed.2024.11.023","url":null,"abstract":"<div><h3>Background</h3><div>Exertional heat stroke (EHS) frequently affects individuals participating in high-intensity physical labor under conditions of elevated temperature and humidity. Therefore, it is essential to investigate the prognosis of EHS.</div></div><div><h3>Objective</h3><div>This study aims to evaluate the utility of the Exertional Heat Stroke Score (EHSS) system in predicting the prognosis of EHS patients by employing the receiver operating characteristic (ROC) curve.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center analysis of 178 patients with EHS who were hospitalized between March 2020 and June 2023. These patients were categorized into two groups: those with poor prognosis and those with good prognosis, based on their prognostic outcomes. We compared the clinical data of both groups, including Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and EHSS scores. Additionally, we analyzed the predictive value of the EHSS system for the prognosis of EHS patients by constructing an ROC curve.</div></div><div><h3>Results</h3><div>Significant differences were observed between the poor prognosis group and the good prognosis group concerning several clinical parameters, including platelet count, urine creatinine, pH value, body temperature, lactate concentration, troponin I (TNL), prothrombin time, total bilirubin, fibrinogen, aspartate aminotransferase, and Glasgow Coma Scale. Additionally, the APACHE II and EHSS scores were notably higher in the poor prognosis group compared to the good prognosis group. The area under the curve (AUC) for the EHSS score in predicting the prognosis of EHS patients was 0.972, significantly surpassing the AUC of 0.872 for the APACHE II score.</div></div><div><h3>Conclusion</h3><div>The EHSS system accurately predicts the prognosis of EHS patients and has potential of clinical promotion to predict patient outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 1-8"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912242","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 Physician Age and Imaging Utilization in Emergency Department Abdominal Pain Evaluation","authors":"Lauren B. Querin MD, MEd ,&nbsp;Alyssa McGary MS ,&nbsp;Nicole R. Hodgson MD ,&nbsp;Ryan Allen BA ,&nbsp;Wayne A. Martini MD","doi":"10.1016/j.jemermed.2024.11.016","DOIUrl":"10.1016/j.jemermed.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) workup of abdominal pain commonly utilizes substantial healthcare resources including laboratory tests and advanced imaging. Although studies have explored various characteristics that influence resource utilization, the relationship between physician age and use of imaging modalities is unclear.</div></div><div><h3>Objectives</h3><div>Determine the correlation between physician age and ordering of abdominal imaging in the ED.</div></div><div><h3>Methods</h3><div>We extracted data from 5 years of patient visits across multiple EDs. The primary outcome was use of abdominal imaging, with secondary outcomes of hospital admission, ED length of stay (LOS), and 72-h revisits. Multivariable logistic regression was used to assess binary outcomes, and multivariable linear regression was used for LOS. Physician age was categorized into cohorts of &lt;36, 36-44, 45-54, ≥55 years.</div></div><div><h3>Results</h3><div>Evaluation of 91,922 unique encounters revealed that the most senior physicians had lower odds of ordering imaging than younger physicians of any group and had lower odds of 72-h revisits with no difference in admission or ED LOS when compared to physicians &lt;36 years. The middle groups (36–44 and 45–54 years) had higher odds of hospital admission than the youngest. The 2 most senior groups had lower odds of 72-h ED revisits than physicians &lt;36 years.</div></div><div><h3>Conclusion</h3><div>For patients presenting to the ED with abdominal pain, more senior physicians utilize fewer imaging resources, have fewer 72-h revisits, while maintaining equivalent hospital admissions and ED LOS as the youngest cohort of physicians. Further research is needed to discern what specific features of senior physicians contribute to the associations highlighted in this study.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 9-16"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912246","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":"The Airway Lead and the Creation of a Comprehensive Emergency Airway Quality Program","authors":"Scott D. Weingart MD ,&nbsp;Ryan N Barnicle MD ,&nbsp;Somair Malik MD ,&nbsp;Matthew Tanzi MD ,&nbsp;Brian Wright MD ,&nbsp;Pete McKenna MD ,&nbsp;Mike Frost MD ,&nbsp;Christina Lu MD ,&nbsp;Candice King NP ,&nbsp;Adam Singer MD ,&nbsp;Alexander Bracey MD","doi":"10.1016/j.jemermed.2024.11.010","DOIUrl":"10.1016/j.jemermed.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Department (ED) Intubation is one of the most critical times during a patient's hospital course. Ideal performance requires training, equipment, and mindset to overcome the barriers of anatomy, physiology, and human factors.</div></div><div><h3>Objectives</h3><div>We believe that EDs should use the same model of quality improvement and leadership for intubation as other critical procedures such as ED ultrasound.</div></div><div><h3>Discussion</h3><div>This paper delineates one program's creation of a comprehensive airway quality improvement (QI) program and will hopefully serve as a roadmap for other centers.</div></div><div><h3>Conclusions</h3><div>The creation of an airway QI program headed by a designated airway lead has the potential to improve patient care and procedural success in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 104-111"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912788","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":"Determinants of Early Mortality Among Deaths at Adult Emergency Departments in Southern Ethiopia","authors":"Amnuay Kleebayoon PhD ,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.jemermed.2024.11.008","DOIUrl":"10.1016/j.jemermed.2024.11.008","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 137-138"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912791","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":"Effect of a HEART Score Best Practice Alert on Discharge Decisions and Outcomes of Patients Presenting to an Emergency Department with Chest Pain","authors":"Adrianna Vaskas BS ,&nbsp;Kyle Marshall MD ,&nbsp;Ria Garg MD ,&nbsp;Ciaran Fisher BS ,&nbsp;Cindi L. Bower-Stout BSN, RN ,&nbsp;Muzna Hussain MD ,&nbsp;Martin E. Matsumura MD","doi":"10.1016/j.jemermed.2024.11.022","DOIUrl":"10.1016/j.jemermed.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary evaluation of chest pain (CP) utilizes a high-sensitivity troponin (hsTn) accelerated diagnostic protocol (ADP). Whether the addition of a bioclinical risk score such as the HEART score improves performance of a hsTn ADP is not clear.</div></div><div><h3>Objectives</h3><div>To determine the effect of an automated best practice alert (BPA) that guided capture of the HEART score on emergency department (ED) discharge decision-making and outcomes when added to a hsTn ADP.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients evaluated for CP in a 6 month period before and 10-month period following launch of a HEART score BPA in May 2022. Discharge percentages and 30-day major adverse cardiac event (MACE) rates were determined for the pre- vs. post-BPA cohort and stratified by both peak hsTnT value and HEART score.</div></div><div><h3>Results</h3><div>Compared to the pre-BPA cohort (<em>n</em> = 4438), post-BPA (<em>n</em> = 6794) with a completed HEART score had a higher rate of ED discharge (5.5% vs. 3.6%, <em>p</em> &lt; 0.001). Patients with low (≤3) risk HEART scores had significantly lower (1.6% vs. 0.6%, <em>p</em> = 0.001) and patients with high-risk scores had significantly higher (1.6% vs. 6.6%, <em>p</em> &lt; 0.001) rates of 30-day MACE vs. pre-BPA. The relationship of HEART score to MACE had the most discriminatory power in patients with peak hsTnT 12/51 ng/dL (3.9% vs. 6.7%, <em>p</em> &lt; 0.028).</div></div><div><h3>Conclusion</h3><div>The addition of a HEART score BPA to a hsTnT ADP was associated with a higher rate of discharge and improved risk stratification of 30-day MACE among patients for whom a discharge disposition was made, particularly among patients with moderate elevations (12–51 ng/dL) of hsTnT.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 17-24"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912848","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}