Western Journal of Emergency Medicine最新文献

{"title":"Food and Housing Insecurity, Resource Allocation, and Follow-up in a Pediatric Emergency Department.","authors":"Raymen R Assaf, Chloe Knudsen-Robbins, Theodore Heyming, Kellie Bacon, Shelby K Shelton, Bharath Chakravarthy, Soheil Saadat, Jason A Douglas, Victor Cisneros","doi":"10.5811/westjem.19435","DOIUrl":"10.5811/westjem.19435","url":null,"abstract":"<p><strong>Introduction: </strong>Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efficient screening tools or most effective interventions for ED use.</p><p><strong>Objective: </strong>In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED.</p><p><strong>Methods: </strong>During the study period (March 1-December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children's hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic, food and housing insecurity, caregiver/patient health status, and healthcare utilization questions. Caregivers who screened positive for food and/or housing insecurity received printed materials with food and/or housing resources. We analyzed data using descriptive statistics, one-way analysis of variance, and the Pearson chi-squared test.</p><p><strong>Results: </strong>A total of 1,908 caregivers were surveyed: 416 (21.8%) screened positive for food and/or housing insecurity. Of those who screened positive, 147/416 completed follow-up surveys. On follow-up, 44 (30.0%) no longer screened positive for food and/or housing insecurity, while 15 (10.2%) reported using at least one resource referral. The most frequently reported referral utilization barrier was loss or reported non-receipt of the referral.</p><p><strong>Conclusion: </strong>This study demonstrates high food- and housing-insecurity rates among families presenting to a pediatric ED, emphasizing the urgency and necessity of screening and intervening in this environment. The food and housing insecurity change between baseline and follow-up reported here and the overall low resource uptake highlights challenges with ED-based screening and intervention efficacy.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"326-337"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721662","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":"Injuries and Outcomes of Ground-level Falls Among Older Patients: A Retrospective Cohort Study.","authors":"Vincent Kan, Wilson Huang, Gretta Steigauf-Regan, Jill Anderson, Ivy Dang, Chad Darling","doi":"10.5811/westjem.35281","DOIUrl":"10.5811/westjem.35281","url":null,"abstract":"<p><strong>Study objective: </strong>We sought to determine the overall rates of traumatic injuries and whether the rates of traumatic injuries and various clinical outcomes differed among older patients presenting to a tertiary-care emergency department (ED) after a ground-level fall (GLF) and who underwent whole-body computed tomography.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients ≥65 years of age who presented to the ED with a GLF and received a whole-body CT from January 1-December 31, 2021. Age was stratified into age groups: 65-74; 75-84; and 85+. We presented a descriptive analysis of traumatic injuries, intensive care unit (ICU) admissions, and all-cause mortality rates. We used multivariable logistic regression to determine the association between increasing age, traumatic injuries, and clinical outcomes.</p><p><strong>Results: </strong>Of 638 patients in the cohort, 120 (18.9%) sustained thoracic injuries and 80 (12.5%) sustained intracranial hemorrhages. Only five (0.8%) patients sustained an intra-abdominal injury, while 134 (21.0%) were admitted to the ICU, and 31 (4.8%) died during their index hospitalization. Head injuries (odds ratio [OR] 6.21, 95% CI 3.65-10.6, <i>P</i> < 0.001) and thoracic injuries (OR 5.25, 95% CI 3.30-8.36, <i>P</i> < 0.001) were associated with increased odds of ICU admission, whereas head injuries (OR 3.21, 95% CI 1.41-7.31, <i>P</i> < 0.01) and cervical injuries (OR 3.37, 95% CI 1.08-10.5, <i>P</i> < 0.05) were associated with increased odds of in-hospital, all-cause mortality. There were no statistically significant differences in the rates of injuries sustained between the respective age groups. There was no association between increasing age and ICU admissions or in-hospital, all-cause mortality rates.</p><p><strong>Conclusion: </strong>Among patients aged ≥65 years of age who presented to the ED after a ground-level fall and underwent whole-body CT, thoracic injuries and intracranial hemorrhages were associated with increased odds of ICU admissions. We found no significant differences in injury rates or outcomes across age groups, indicating that age alone should not guide ICU admission decisions. These findings suggest that the use of whole-body CT in this population should be selective and guided by clinical judgment rather than applied universally.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"301-306"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721427","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":"Associations of Individual and Neighborhood Factors with Disparities in COVID-19 Incidence and Outcomes.","authors":"Margaret E Samuels-Kalow, Rebecca E Cash, Kori S Zachrison, Auriole Corel Rodney Fassinou, Norman Harris, Carlos A Camargo","doi":"10.5811/westjem.18526","DOIUrl":"10.5811/westjem.18526","url":null,"abstract":"<p><strong>Introduction: </strong>The disproportionate impact of coronavirus 2019 (COVID-19) on Black and Hispanic communities has been widely reported. Many studies have used neighborhood racial/ethnic composition to study such disparities, but less is known about the interplay between individual race/ethnicity and neighborhood racial composition. Therefore, our goal in this study was to assess the relative contributions of individual and neighborhood risk to disparities in COVID-19 incidence and outcomes.</p><p><strong>Methods: </strong>We performed a cross-sectional study of patients with emergency department (ED) and inpatient visits to an academic health system (12 hospitals; February 1-July 15, 2020). The primary independent variable was race/ethnicity; covariates included individual age, sex, comorbidity, insurance and neighborhood density, poverty, racial/ethnic composition, education and occupation. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity; secondary outcomes included admission and death after COVID-19. We used generalized estimating equations to assess whether race/ethnicity remained significantly associated with COVID-19 after adjustment for individual and neighborhood factors.</p><p><strong>Results: </strong>There were 144,982 patients; 5,633 (4%) were SARS-CoV-2 positive. Of those, 2,961 (53%) were admitted and 601(11%) died. Diagnosis of COVID-19, admission, and death were more common among non-Hispanic Black, Hispanic, Spanish-speaking patients, and those with public insurance. In the base model (adjusting for race/ethnicity, age, sex, and comorbidities), race/ethnicity was strongly associated with COVID-19 (non-Hispanic Black odds ratio [OR] 4.64 [95% confidence interval (CI) 4.18-5.14], and Hispanic OR 6.99 [CI 6.21-7.86]), which was slightly attenuated but remained significant after adjustment for neighborhood factors. Among patients with COVID-19, there was no significant association between race/ethnicity and hospital admission, other than for patients with unknown race.</p><p><strong>Conclusion: </strong>This data demonstrates a persistent association between race/ethnicity and COVID-19 incidence, with Black and Hispanic patients at significantly higher risk, which was not explained by measured individual or neighborhood factors. This suggests that using existing neighborhood factors in studies examining health equity may be insufficient, and more work is needed to quantify and address structural factors and social determinants of health to improve equity.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"315-325"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721636","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":"Cardiac Computed Tomography Measurements in Pulmonary Embolism Associated with Clinical Deterioration.","authors":"Anthony J Weekes, Angela M Pikus, Parker L Hambright, Kelly L Goonan, Nathaniel O'Connell","doi":"10.5811/westjem.20763","DOIUrl":"10.5811/westjem.20763","url":null,"abstract":"<p><strong>Introduction: </strong>Most pulmonary embolism response teams (PERT) use a radiologist-determined right ventricle to left ventricle ratio (RV:LV) cut-off of 1.0 to risk-stratify pulmonary embolism (PE) patients. Continuous measurements from computed tomography pulmonary angiograms (CTPAs) may improve risk stratification. We assessed associations of CTPA cardiac measurements with acute clinical deterioration and use of advanced PE interventions.</p><p><strong>Methods: </strong>This was a retrospective study of a PE registry used by eight affiliated emergency departments. We used an artificial intelligence (AI) algorithm to measure RV:LV on anonymized CTPAs from registry patients for whom the PERT was activated (2018-2023) by institutional guidelines. Primary outcome was in-hospital PE-related clinical deterioration defined as cardiac arrest, vasoactive medication use for hypotension, or rescue respiratory interventions. Secondary outcome was advanced intervention use. We used bivariable and multivariable analyses. For the latter, we used least absolute shrinkage and selection operator (LASSO) and random forest (RF) to determine associations of all candidate variables with the primary outcome (clinical deterioration), and the Youden index to determine RV:LV optimal cut-offs for primary outcome.</p><p><strong>Results: </strong>Artificial intelligence analyzed 1,467 CTPAs, with 88% agreement on RV:LV categorization with radiologist reports (kappa 0.36, 95% confidence interval [CI] 0.28-0.43). Of 1,639 patients, 190 (11.6%) had PE-related clinical deterioration, and 314 (19.2%) had advanced interventions. Mean RV:LV were 1.50 (0.39) vs 1.30 (0.32) for those with and without clinical deterioration and 1.62 (0.33) vs 1.35 (0.32) for those with and without advanced intervention use. The RV:LV cut-off of 1.0 by AI and radiologists had 0.02 and 0.53 <i>P</i>-values for clinical deterioration, respectively. With adjusted LASSO, top clinical deterioration predictors were cardiac arrest at presentation, lowest systolic blood pressure, and intensive care unit admission. The RV:LV measurement was a top 10 predictor of clinical deterioration by RF. Optimal cut-off for RV:LV was 1.54 with odds ratio of 2.50 (1.85, 3.45) and area under the curve 0.6 (0.66, 0.70).</p><p><strong>Conclusion: </strong>Artifical intelligence-derived RV:LV measurements ≥1.5 on initial CTPA had strong associations with in-hospital clinical deterioration and advanced interventions in a large PERT database. This study points to the potential of capitalizing on immediately available CTPA RV:LV measurements for gauging PE severity and risk stratification.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"219-232"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721656","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":"Critical Time Intervals in Door-to-Balloon Time Linked to One-Year Mortality in ST-Elevation Myocardial Infarction.","authors":"Shin-Ho Tsai, Yu-Ting Hsiao, Ya-Ni Yeh, Jih-Chun Lin, Shi-Quan Zhang, Ming-Jen Tsai","doi":"10.5811/westjem.20779","DOIUrl":"10.5811/westjem.20779","url":null,"abstract":"<p><strong>Background: </strong>Timely activation of primary percutaneous coronary intervention (PCI) is crucial for patients with ST-segment elevation myocardial infarction (STEMI). Door-to-balloon (DTB) time, representing the duration from patient arrival to balloon inflation, is critical for prognosis. However, the specific time segment within the DTB that is most associated with long-term mortality remains unclear. In this study we aimed to identify the target time segment within the DTB that is most associated with one-year mortality in STEMI patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a tertiary teaching hospital. All patients diagnosed with STEMI and activated for primary PCI from the emergency department were identified between January 2013-December 2021. Patient demographics, medical history, triage information, electrocardiogram, troponin-I levels, and coronary angiography reports were obtained. We divided the DTB time into door-to-electrocardiogram (ECG), ECG-to-cardiac catheterization laboratory (cath lab) activation, activation-to-cath lab arrival, and cath lab arrival-to-balloon time. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazards models to determine the independent effects of these time intervals on the risk of one-year mortality.</p><p><strong>Results: </strong>A total of 732 STEMI patients were included. Kaplan-Meier analysis revealed that delayed door-to-ECG time (>10 min) and cath lab arrival-to-balloon time (>30 min) were associated with a higher risk of one-year mortality (log-rank test, <i>P</i> < .001 and <i>P</i> = 0.01, respectively). In the multivariable Cox models, door-to-ECG time was a significant predictor for one-year mortality, whether it was analyzed as a dichotomized (>10 min vs ≤10 min) or a continuous variable. The corresponding adjusted hazard ratios (aHR) were 2.81 (95% confidence interval [CI] 1.42-5.55) for the dichotomized analysis, and 1.03 (95% CI 1.00-1.06) per minute increase, respectively. Cath lab arrival-to-balloon time also showed an independent effect on one-year mortality when analyzed as a continuous variable, with an aHR of 1.02 (95% CI 1.00-1.04) per minute increase. However, ECG-to-cath lab activation and activation-to-cath lab arrival times did not show a significant association with the risk of one-year mortality.</p><p><strong>Conclusion: </strong>Within the door-to-balloon interval, the time from door-to-ECG completion is particularly crucial for one-year survival after STEMI, while cath lab arrival-to-balloon inflation may also be relevant.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"180-190"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721659","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":"Gender Disparities and Burnout Among Emergency Physicians: A Systematic Review by the World Academic Council of Emergency Medicine-Female Leadership Academy for Medical Excellence.","authors":"Suman Thakur, Vivek Chauhan, Sagar Galwankar, Fatimah Lateef, Pia Daniel, Zeynep Cakir, Katia M Lugo, Samjhana Basnet, Busra Bildik, Siham Azahaf, Sevilay Vural, Busra H Difyeli, Lisa Moreno-Walton","doi":"10.5811/westjem.29331","DOIUrl":"10.5811/westjem.29331","url":null,"abstract":"<p><strong>Background: </strong>The Female Leadership Academy for Medical Excellence, members of the World Academic Council of Emergency Medicine, conducted this systematic review, which explores gender disparities in burnout among emergency physicians (EP) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Burnout is a critical issue in healthcare, particularly in emergency medicine where high stress and demanding work environments prevail.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched PubMed and Epistemonikos for studies using MBI-HSS to measure burnout in EPs. Inclusion criteria encompassed peer-reviewed, English-language articles reporting burnout by sex. Data extraction focused on proportions of burnout and its subcomponents, mean scores, and odds ratios, with quality assessed using Joanna Briggs Institute criteria.</p><p><strong>Results: </strong>We included 18 studies spanning 26,939 EPs from 10 countries. While overall burnout rates did not significantly differ between the sexes, the proportion of female EPs with high emotional exhaustion (EE) (69%) and low sense of personal accomplishment (PA) (45%) were significantly higher compared to males with high EE in 57% and low PA in 29%, respectively (<i>P</i> < 0.001 for both). Proportion with high depersonalization (DP) score was 44% in both male and female EPs. Mean scores revealed females experiencing higher mean EE (26.8 ± 15.7) scores vs males (25.4 ± 15.9) <i>P</i> < 0.001. Males had mean DP scores (8.6 ± 8.0) and mean PA scores (26.6 ± 12.7) compared to females with lower mean DP scores (7.4 ± 7.2) and higher PA scores (27.7 ± 11.9), respectively <i>P</i> < 0.001 for both. Odds ratios indicated varying risks, predominantly higher EE odds among females, varying from 0.72 to 2.3.</p><p><strong>Conclusion: </strong>This review underscores gender-specific manifestations of burnout among emergency physicians, with females more susceptible to emotional exhaustion and lower sense of personal accomplishment. Standardized reporting methods are crucial for future meta-analyses to refine gender-specific interventions combating burnout in emergency medicine. Targeted strategies addressing distinct manifestations of burnout are imperative to support the well-being and retention of EPs, fostering sustainable healthcare delivery.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"338-346"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721283","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":"Immune Checkpoint Inhibitor-associated Pneumonitis: A Narrative Review.","authors":"Chang Li, Saadia A Faiz, Megan Boysen-Osborn, Ajay Sheshadri, Monica K Wattana","doi":"10.5811/westjem.20305","DOIUrl":"10.5811/westjem.20305","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICI), such as pembrolizumab, nivolumab, durvalumab and ipilimumab, have significantly enhanced survival rates for multiple cancer types such as non-small cell lung cancer, melanoma, Hodgkin lymphoma, and breast cancer, and they have emerged as an adjunct or primary therapy for malignant disease. Approximately 40% of patients with cancer on ICI therapy experience side effects called immune-related adverse events (irAE). While not the most common, pulmonary toxicities can be rapidly progressive, potentially fatal, and pose a three-fold increased risk for requiring intensive care unit-level of care. Pneumonitis is a focal or diffuse inflammation of the lung parenchyma, and clinical manifestations may be highly variable. While the onset is generally observed 6-12 weeks after the initiation of therapy, drug toxicity can develop rapidly within days after the first infusion or many months into therapy. Pneumonitis symptoms can be subtle or non-specific; therefore, a thorough and systematic evaluation considering other possible etiologies is crucial. Moreover, extrapulmonary findings, such as skin lesions, colitis, or endocrinopathies, should raise suspicion for irAE as drug toxicity can affect multiple organs simultaneously. Due to the significant overlap of clinical features between ICI-associated pneumonitis and respiratory infections, it can be challenging to differentiate the two conditions based on clinical presentation alone. A multidisciplinary approach to management is recommended for the treatment of ICI-associated pneumonitis, and classification of severity helps to guide interventions. Treatment options in more severe cases include systemic immunosuppression. Given the increased use of ICIs and greater probability that patients with ICI-associated pneumonitis will be seen in the emergency department, we aimed to provide a comprehensive framework for the diagnosis and management. In addition, identifying potential challenges in diagnosis and/or other contributors of respiratory symptoms and radiographic manifestations is highlighted.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"210-218"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721354","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":"Combining Immersive Simulation with a Collaborative Procedural Training on Local Anesthetic Systemic Toxicity and Fascia Iliaca Compartment Block: A Pilot Study.","authors":"Katherine B Griesmer, Maxwell Thompson, Briana Miller, Guihua Zhai, Jaron Raper, Andrew Bloom","doi":"10.5811/westjem.25020","DOIUrl":"10.5811/westjem.25020","url":null,"abstract":"<p><strong>Introduction: </strong>Readiness to perform a wide variety of procedures or manage nearly any patient presentation remains an essential aspect of emergency medicine training and practice. Often, simulation is needed to supplement real-life exposure to provide comfort and knowledge, particularly with rarer pathology and procedures. As the scope of practice continues to grow, newer procedures, such as ultrasound (US)-guided nerve blocks (UGNB), are becoming integrated into resident training, building on previously established skills. The fascia iliaca compartment block (FICB) is performed on patients with specific femoral fractures and is a now a component of standard multimodal pain regimens, with US-guidance limiting adverse events. Given the need for high volumes of local anesthetic to perform the block it is imperative for clinicians to understand dosing as well as recognize and treat local anesthetic systemic toxicity (LAST). With sparse literature on sequential immersive and procedural simulation involving intertwined topics, this presents a unique opportunity for learners.</p><p><strong>Methods: </strong>To study the perceived knowledge and comfort with FICB and LAST, a pilot study was developed with two separate but concurrent one-hour simulations completed encompassing one of each topic over one day. We surveyed 19 learners, consisting of residents ranging from postgraduate years 1-3, prior to and immediately following completion, regarding their perceptions. We used the Stuart-Maxwell test to compare survey data.</p><p><strong>Results: </strong>More than half of participants (56%) had not received prior formal training on FICB. There was a positive trend in perceived confidence and knowledge with visualizing relevant anatomy (4.0 [2.0-6.0] vs 9.0 [7.5-10.0], <i>P</i> = 0.10), performing FICB (4.0 [1.0-5.0] vs 9.0 [7.0-10.0, <i>P</i> = 0.08]), and perceived ability to teach their peers (3.0 [1.0-5.0] vs 8.5 [7.0-10.0], <i>P</i> = 0.20). Perceived ability in diagnosing and managing LAST also increased following the simulation (5.0 [3.0-6.0] vs 6.0 [6.0-7.0], <i>P</i> = 0.12 and 3.0 [2.0-6.0] vs 6.0 [6.0-7.0], <i>P</i> = 0.08, respectively).</p><p><strong>Conclusion: </strong>Learners' perceptions of this simulation experience echo the findings of previous studies in which simulation can be used to teach procedures and pathology; of note, however, we presented a novel experience with a combination of immersive and procedural simulation.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"271-278"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721658","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":"Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity.","authors":"Corlin M Jewell, Guangyu Anthony Bai, Dann J Hekman, Adam M Nicholson, Michael R Lasarev, Roxana Alexandridis, Benjamin H Schnapp","doi":"10.5811/westjem.20282","DOIUrl":"10.5811/westjem.20282","url":null,"abstract":"<p><strong>Introduction: </strong>Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency.</p><p><strong>Methods: </strong>We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017-2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU).</p><p><strong>Results: </strong>A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73-12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157-367; P < 0.001) unit increase in average RVUs generated.</p><p><strong>Conclusion: </strong>Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"254-260"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721325","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":"Personality Traits and Burnout in Emergency Medicine Residents.","authors":"Brendan Freeman, Lukasz Cygan, Laura Melville, Theodore Gaeta","doi":"10.5811/westjem.21139","DOIUrl":"10.5811/westjem.21139","url":null,"abstract":"<p><strong>Background: </strong>Burnout is prevalent in medical training, and some data indicates certain personality types are more susceptible. The criterion reference for measurement of burnout is the Maslach Burnout Inventory (MBI), which scores three factors: emotional exhaustion (EE); depersonalization (DP); and personal accomplishment (PA). Emotional exhaustion most closely correlates with burnout. Studies have yet to evaluate a link between burnout markers and certain personality traits in emergency medicine (EM) residents. The personality traits of openness, agreeableness, extraversion, conscientiousness, and neuroticism can be measured with a 50-item International Personality Item Pool (IPIP) Big 5 survey. Our goal in this study was to be the first to examine the relationship between personality traits and burnout among EM residents and guide future research on potential predictors of burnout and targeted interventions for resident well-being.</p><p><strong>Methods: </strong>This was an observational, cross-sectional study conducted in March and April of 2023 in an urban, Level II trauma center, involving all EM residents at a three-year residency program. Two surveys, the IPIP and MBI-Human Services Survey, were distributed to all residents, and their responses were anonymous. We calculated raw/mean scores and standard deviations for each personality trait/burnout measure and compared them by the Pearson correlation coefficient.</p><p><strong>Results: </strong>All 38 residents completed the surveys. A total of 31% of the cohort reported high exhaustion, 13% reported high DP, and 42% reported low PA. Two of 38 (5%) residents reported the combination of high EE, high DP, and low PA. There was a statistically significant negative correlation between conscientiousness and EE (<i>n</i> = 38; Pearson <i>r</i> = -0.40, <i>P</i> < 0.001) and a positive correlation between conscientiousness and PA (<i>n</i> = 38; Pearson <i>r</i> = 0.36, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>In our sample, residents who were more conscientious reported experiencing lower levels of emotional exhaustion and a greater sense of personal accomplishment. Programs may cautiously explore the potential of assessing resident personality traits as part of broader efforts to identify predictors of burnout, but further research with larger, multicenter, longitudinal samples is needed to corroborate these results. The small sample size and single-center design may limit generalizability of these findings, and the use of self-reported measures introduces the risk of response bias.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"241-245"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721486","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}