Western Journal of Emergency Medicine最新文献

{"title":"Retention Challenges in Opioid Use Disorder Treatment: The Role of Comorbid Psychological Conditions.","authors":"David C Seaberg, Jamie McKinnon, Lyn Haselton, Patrick Palmieri, Jason Kolb, Suman Vellanki, Mary Moran, J Chika Morah, Nicholas Jouriles","doi":"10.5811/westjem.38089","DOIUrl":"10.5811/westjem.38089","url":null,"abstract":"<p><strong>Introduction: </strong>Comorbid psychological conditions have an impact on opioid use disorder (OUD). We measured multiple psychological tests in OUD patients who entered an emergency department (ED)-based medication for opioid use disorder (MOUD) program to determine whether any test correlated with six-month retention in the MOUD treatment program.</p><p><strong>Methods: </strong>Patients with OUD who were enrolled in an ED-based MOUD program over a 12-month period were eligible to participate. We surveyed enrollees using nine validated tools to assess depression, anxiety, and traumatic stress within 24 hours of their ED presentation and then at one and six months. The primary outcome was program retention rates at one and six months. Secondary outcomes were levels of clinical symptoms, substance use, and quality of life.</p><p><strong>Results: </strong>Of 143 patients enrolled in the MOUD program, 64 (44.8%) participated during the 12-month study. The mean age was 33 years, with 65% male and 35% female. Baseline surveys indicated moderate symptom severity for depression and anxiety. The Post-Traumatic Stress Disorder Checklist (PCL-5) scores showed significant traumatic stress. Retention rates were 47% at one month and 25% at six months. General well-being improved from 40% at baseline to 56% at six months. Average income correlated (0.51) with six-month retention, suggesting that those with financial means were more likely to remain in treatment. The Life Events Checklist (LEC-5) correlated (0.41) with six-month retention. This indicates that the more trauma an individual experienced, the less likely the person would remain in treatment.</p><p><strong>Conclusion: </strong>Higher income and lower post-traumatic stress disorder scores had higher retention rates in a medication-based opioid use disorder program. Psychological surveys of patients entering a MOUD program may help predict treatment retention. There will likely be challenges in keeping patients with extensive trauma histories retained in treatment.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"897-904"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Medicine at the Frontline of Climate Change: The Role of Geographic Information Systems.","authors":"Tushara Surapaneni, Anna Patrikakou, Antigoni Faka, Liz Grant, Andrew Ulrich, Dimitrios Tsiftsis, Eleanor Reid","doi":"10.5811/westjem.47035","DOIUrl":"10.5811/westjem.47035","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"990-993"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Acceptance of Rapid HIV Testing During Targeted Screening in the Emergency Department.","authors":"Brianna N McMonagle, Robert Braun, Jude Luke, Anita Goel, Caroline Freiermuth","doi":"10.5811/westjem.48500","DOIUrl":"10.5811/westjem.48500","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1124-1126"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-Facility Emergency Department Transfers for Non-Contracted Insurance Status: Disproportionate Impact Upon Minority Patients.","authors":"Andrew Holzman, Malik Aaron, Krish Nayar, William Rankin, Melissa Tapia, Douglas Rappaport","doi":"10.5811/westjem.48502","DOIUrl":"10.5811/westjem.48502","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1127-1128"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed-Methods Investigation of Rural Emergency Medical Services ST-Elevation Myocardial Infarction Time to Percutaneous Coronary Intervention: High- vs Low-Performing Agencies.","authors":"Michael Supples, McKenna E Gallagher, Nicklaus P Ashburn, Anna C Snavely, Ashley E Strahley, Chadwick D Miller, Simon A Mahler, Jason P Stopyra","doi":"10.5811/westjem.43536","DOIUrl":"10.5811/westjem.43536","url":null,"abstract":"<p><strong>Background: </strong>Patients with ST-elevation myocardial infarction (STEMI) cared for by rural emergency medical services (EMS) agencies commonly do not have first medical contact-to-percutaneous coronary intervention (PCI) time within the recommended goal of 90 minutes. In this study we identify factors associated with performance variation among rural EMS agencies in first medical contact-to-PCI time.</p><p><strong>Methods: </strong>In this explanatory, sequential, mixed-methods study, we ranked eight rural county EMS agencies by continuous first medical contact-to-PCI time, accounting for loaded mileage, using data from a regional STEMI registry (2016-2019). A qualitative researcher conducted 28, one-hour, semi-structured interviews from January- March 2021 with the EMS director, training officer, medical director, and four paramedics at the top two high- and bottom two low-performing rural EMS agencies. Key informants were blinded to agency STEMI performance. Interviews were structured to identify positive deviance by exploring agencies' clinical approach to patients with chest pain, their organizational culture, structure, and quality improvement (QI) activities regarding STEMI care, and recommendations for improving STEMI performance. Interviews were digitally recorded and transcribed verbatim by a professional transcription service. We established a codebook and performed a thematic analysis using an inductive approach. We summarized and compared data across agencies to identify commonalities and differences between high- and low-performing agencies. Findings were reviewed and validated by an expert panel.</p><p><strong>Results: </strong>The top two highest-performing EMS agencies had a median first medical contact-to-PCI time of 79 minutes (interquartile range [IQR] 65-91) minutes vs 98 minutes (IQR 82-120) among the bottom two lowest-performing agencies, P<.001. Both high- and low-performing agencies identified issues with electrocardiogram (ECG) transmitting technology and cumbersome hospital activation communications. However, top-performing agencies shared a culture that encourages early EMS activation of the cardiac catheterization lab after STEMI recognition. Top-performing agencies also placed a higher value on QI and training. These agencies prioritized mission and chain of command over staff relationships/interpersonal bonds; have stable, strong leadership; provide opportunities for career advancement; and collaborate with community leaders.</p><p><strong>Conclusion: </strong>Top-performing rural EMS agencies for STEMI care promote early activation, have a strong chain of command, are mission focused, and have a greater focus on quality improvement and training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"924-935"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Incidence of Stroke Mimics in the Emergency Department of a Tertiary-care Center in Lebanon.","authors":"Hind Anan, Maya Bizri, Mustapha Jomaa, Nour Ibrahim, Afif Mufarrij","doi":"10.5811/westjem.39718","DOIUrl":"10.5811/westjem.39718","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke mimics comprise a significant proportion of cases presenting with neurological deficits and can be difficult to differentiate from true stroke cases. Our aim in this study was to assess the frequency and etiologies of stroke mimics presenting to our emergency department (ED).</p><p><strong>Methods: </strong>We conducted a retrospective review of the charts of patients presenting to the ED of a tertiary-care center between November 2018-August 2023 and on whom the stroke code was activated. The cases were categorized into real strokes or stroke mimics based on patients' discharge diagnoses.</p><p><strong>Results: </strong>Stroke code activation was implemented on 584 patients during the study period. These patients received full service and a final discharge diagnosis. Of these, 349 (59.8%) received a diagnosis of a true stroke, whether ischemic, hemorrhagic, or transient ischemic attack. The remaining 235 (40.2%) were classified as stroke mimics, with functional (12.8%) and medical (87.2%) etiologies. Medical stroke mimics were further categorized into non-cerebrovascular neurologic (59.5%), infection or allergic reaction (17.1%), cardiovascular (11.7%), metabolic or drug-induced (8.3%), and other (3.4%). Factors found to favor stroke mimics were history of neurological (adjusted odds ratio [aOR] 4.98; 95% confidence interval [CI] 2.89 - 8.57) or psychiatric disorders (aOR 2.88; 95% CI 1.29 - 6.41) and patients presenting with altered mental status (aOR 1.70; 95% CI 1.04 - 2.80) or generalized weakness (aOR 2.38; 95% CI1.12 - 5.03). Conversely, factors that favored true strokes (with OR <1 for mimics), were patients aged >65 years (aOR 0.61; 95% CI 0.38-0.96), history of hypertension (aOR 0.61; 95% CI 0.38 - 0.97) or atrial fibrillation (aOR 0.39; 95% CI 0.21 - 0.72), and presenting with speech disturbance (aOR 0.56; 95% CI 0.37-0.83) or extremity weakness (aOR: 0.22; 95% CI 0.15-0.38).</p><p><strong>Conclusion: </strong>Approximately 40% of cases presenting to our ED with stroke code activation were found to be mimics. The high ratio warrants the establishment and adoption of a more specific triaging algorithm for stroke code activation to minimize the pressure on an already overburdened healthcare sector.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"943-950"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Outcomes of Patients with Self-directed Violence Presenting to Trauma Centers in the United States.","authors":"Gregory Jasani, Garrett Cavaliere, Rana Bachir, Sarah Van Remmen, Mazen El Sayed","doi":"10.5811/westjem.42022","DOIUrl":"10.5811/westjem.42022","url":null,"abstract":"<p><strong>Introduction: </strong>Psychiatric conditions are common presentations to the emergency department, and their prevalence has been steadily increasing. Part of this spectrum of presentations is self-directed violence. Self-directed violence involves suicidal acts and non-suicidal self-injuries that can result in serious morbidity and mortality. This study examines characteristics and outcomes of patients who presented to US trauma centers with self-inflicted injuries and identifies factors associated with survival to hospital discharge in this patient population.</p><p><strong>Methods: </strong>We extracted data in a retrospective, observational manner from the 2020 National Trauma Data Bank (NTDB) 2020. The NTDB includes data from over 900 trauma centers (900/2,294 total trauma centers in the United States, 39.2%). We performed a descriptive analysis of characteristics, injury patterns and outcomes. All variables were tabulated by outcome (died: yes/no). We then conducted a multivariable logistic regression using a stepwise technique to identify factors associated with the patients' survival to hospital discharge.</p><p><strong>Results: </strong>A total of 12,824 patients with self-inflicted injuries were included in this analysis. Their median age was 35 years (interquartile range 25-50), and they were mostly males (74.7%) and White (69.6%). Patients were mostly transported by ground ambulance (78.9%) to Level I (60.6%) and Level II (33.5%) trauma centers. Most patients had a pre-existing condition (70.2%). These included mental/personality disorder (48.2%), alcohol use disorder (11.5%), and substance use disorder (17.7%). The most common mechanism of injury was penetrating trauma (71.6%), followed by blunt trauma (18.0%) and burns (1%). Cutting/piercing was the most common penetrating mechanism (60%) compared with firearm-related trauma (40%). Severe injury (Injury Severity Score ≥ 16) was present in 32.8% of patients. A positive alcohol screen and/or a positive drug screen were reported in 30.2% and 31.2% of patients, respectively. Most patients were admitted to hospital (86%). Overall mortality rate at hospital discharge was 21.7%. We identified Important factors associated with survival to hospital discharge in this patient population.</p><p><strong>Conclusion: </strong>Patients with self-inflicted injuries treated at US trauma centers have high rates of injury severity and a high mortality rate. This study sheds light on the complex and resource-intensive care needed for this vulnerable patient population.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1008-1020"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Content Analysis of Hospitals' Community Health Needs Assessments in the Most Violent Cities: 2023 Update.","authors":"Ai Alexa Tarui, Robert D Flint, Benoit Stryckman, William Wical, Henry D M Schwimmer, Kyle Fischer","doi":"10.5811/westjem.48501","DOIUrl":"10.5811/westjem.48501","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1130-1131"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Water Fluoridation Rates and Atraumatic Dental Visits to Emergency Departments in the U.S.: An Epidemiological Study.","authors":"Jenna LaColla, Melissa Nelson-Perron","doi":"10.5811/westjem.48503","DOIUrl":"10.5811/westjem.48503","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1132"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Mental Health Disorders and Social Determinants of Health with Frequent Emergency Department Use.","authors":"Derick D Jones, Luis Santos Molina, Aidan Mullan, Ronna L Campbell","doi":"10.5811/westjem.35599","DOIUrl":"10.5811/westjem.35599","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who frequently use the emergency department (ED) make up 8% of ED patients annually but account for up to 28% of all ED visits. Frequent ED utilization has been associated with mental health disorders. However, the association between social determinants of health (SDoH) and frequent ED use is not as well understood. Our objective was to identify associations between frequent ED use and mental health disorders and SDoH among patients visiting 19 Upper Midwest EDs in an integrated health system.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of adult patients presenting to the 19 EDs from July 1, 2020-June 30, 2021. Using odds ratios (OR) and 95% confidence intervals obtained from multivariable logistic regression models, we characterized associations between mental health disorders (based on ICD-10 groupings) and 10 SDoH with frequent ED utilization (defined as ≥6 ED visits per year).</p><p><strong>Results: </strong>A total of 228,814 visits among 134,452 patients were eligible for inclusion. After accounting for clinical features and mental health risk factors, the following had the strongest association with frequent ED use: unmet transportation needs (OR 1.73); high risk for financial resources (OR 1.52); food insecurity (OR 1.58); smoking tobacco (OR 1.31); and physical inactivity (OR 1.23). The top mental health risk factors for frequent ED utilization were adult personality and behavioral disorders (OR 4.0) and anxiety, stress and non-psychotic disorders (OR 3.35).</p><p><strong>Conclusion: </strong>We found strong associations between mental illness and SDoH and frequent ED use. The strongest SDoH risk factors included unmet transportation needs, financial resource risk, and food insecurity. The top two mental health risk factors were adult personality and behavioral disorders as well as anxiety and stress disorders, with differences that persisted when analyzed independently as well as when adjusting for other mental health risk factors. By understanding the interaction between social determinants of health and mental health disorders researchers can better address root causes and improve health outcomes among this vulnerable population.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"905-917"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}