Western Journal of Emergency Medicine最新文献

{"title":"A Decade Later: Trends in Fellowship Training and Secondary Board Certification Among Emergency Medicine Residency Leaders.","authors":"Danielle Langan, Lindsay Shogan, Shorok E Hassan, William Caputo, Abbas Husain, Jerel Chacko, Amin Mohamadi, Josh Greenstein, Barry Hahn","doi":"10.5811/westjem.54378","DOIUrl":"https://doi.org/10.5811/westjem.54378","url":null,"abstract":"<p><strong>Introduction: </strong>Residency program leaders shape the academic pipeline in emergency medicine (EM). We assessed current demographics and postgraduate training among EM residency leadership in the United States.</p><p><strong>Methods: </strong>We conducted a national, cross-sectional survey of all Accreditation Council for Graduate Medical Education-accredited EM residency program leadership via an online, confidential questionnaire. Primary outcomes were the prevalence of any postgraduate fellowship training and any secondary board certification (ie, additional board certification beyond EM) as a complementary marker of advanced credentialing distinct from fellowship training. Programs were grouped by National Resident Matching Program (NRMP) region.</p><p><strong>Results: </strong>We received 103 program responses (35.9%). Any fellowship training was reported by 25.5% of program directors (PD), 40.0% of associate program directors (APD), and 42.8% of assistant PDs. Compared with the 2014-2015 national survey, fellowship training increased from approximately 20-25% to 40-43% among APD and assistant PDs, while remaining similar among PDs (~25% previously vs 26% currently). Any secondary board certification was reported by 8.8% of PDs, 5.0% of APDs, and 8.2% of assistant PDs. Medical education was the most common fellowship (n = 54), followed by ultrasound (n = 24), toxicology (n = 16), simulation (n = 15), pediatric EM (n = 11), critical care (n = 7), emergency medical services (n = 5), and administration (n = 3). Programs in the western United States reported the highest proportions of leaders with either fellowship or secondary certification across roles.</p><p><strong>Conclusion: </strong>Postgraduate fellowship and secondary board certification remain uncommon overall among EM residency leaders, but fellowship completion is more prevalent among junior leaders compared with a decade earlier. These data provide an updated, role-specific snapshot to inform leadership development and workforce planning.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1243-1249"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Ultrasound-Guided Peripheral Intravenous Training on Central Line Placement in the Emergency Department.","authors":"Matthew Berniard, Richard Slama, Gavin Rogers, Elena Garrett, Chandler Davis, John Alex","doi":"10.5811/westjem.58319","DOIUrl":"https://doi.org/10.5811/westjem.58319","url":null,"abstract":"<p><strong>Introduction: </strong>Central venous catheters are placed in the emergency department (ED) when difficult peripheral access limits care or when critical medications require central access because of their sclerotic nature or incompatibility with other drugs. Ultrasound-guided peripheral intravenous (IV) access offers a less invasive alternative. We evaluated whether implementation of a structured ultrasound-guided peripheral intravenous training program for ED nurses and technicians was associated with changes in ED central venous catheter use.</p><p><strong>Methods: </strong>We performed a retrospective chart review at our 50-bed academic community ED, which holds a Level II trauma designation. This center has an ED census of 80,000 patients per year, a 4:1 nursing to patient ratio with an admission rate of 20-25% with expected monthly variation. A structured ultrasound-guided peripheral IV curriculum for nurses and technicians launched in November 2023. The primary endpoint was annual ED central venous catheter placement count, identified through procedure documentation in the electronic health record. Training that was conducted for nurses and clinical technicians consisted of three hours of didactic and hands-on training, followed by a period of procedural supervision. We compared the baseline year 2022 with the first two full post-implementation years, 2024 and 2025. The analysis was descriptive.</p><p><strong>Results: </strong>Central venous catheter placements in the ED decreased from 387 in 2022 to 275 in 2024 and 218 in 2025, corresponding to absolute reductions of 112 placements (28.9%) and 169 placements (43.7%), respectively. By the end of 2025, 33 nurses and ED technicians had completed training and competency sign-off.</p><p><strong>Conclusion: </strong>Implementation of a structured ultrasound-guided peripheral IV training program for nurses and technicians was associated with fewer ED central venous catheter placements at our institution. These findings support further multicenter evaluation using patient-level outcomes and visit-adjusted rates.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1447-1451"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial.","authors":"Yu-Chi Lu, Sung-Chun Tang, Li-Kai Tsai, Jiann-Shing Jeng, Yu-Ching Lee, Ming-Ju Hsieh","doi":"10.5811/westjem.61934","DOIUrl":"https://doi.org/10.5811/westjem.61934","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital triage challenges often lead to suboptimal choices and delayed treatment for stroke patients. The objective of the study was to evaluate whether a decision-support interface to assist in stroke triage to an appropriate hospital could reduce emergency medical technicians' (EMT) mental workload.</p><p><strong>Methods: </strong>This randomized crossover study was conducted between February and March 2025. Each participant completed two 12-minute simulated trials in randomized order: current dispatch orders without decision support and a decision-support interface. We assessed mental workload-the mental effort required to make hospital transport decisions under time pressure during prehospital stroke triage-using heart rate variability (HRV) metrics and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). System usability was assessed using the System Usability Scale. The primary outcome was the root mean square of successive differences for each participant after completing the two trials. The secondary outcomes included the differences of NASA-TLX, System Usability Scale, and other heart rate variability parameters, including mean R-R interval (meanRR), mean heart rate, percentage of successive R-R intervals that differ by more than 50 milliseconds, low-frequency power (LF), high-frequency (HF) power, and the LF/HF ratio. Subgroup analyses examined differences by sex, education, age, and years of service.</p><p><strong>Results: </strong>A total of 35 emergency medical technician (EMT)-intermediate participants (mean age, 27.5 [5.3] years) completed the study. For the primary outcome, the root mean square of successive differences increased significantly (28.1 [13.0] vs 32.4 [13.6] milliseconds; mean difference, 4.3 milliseconds [95% CI, 1.57-6.99]; P < .01), indicating reduced mental workload when the participants used the decision-support interface. For the secondary outcomes, mean heart rate (77.5 [8.6] vs 73.8 [10.6], P < .01) decreased, mean R (784.2 [89.5] vs 808.9 [87.3], P < .01) increased, and HF power (370.1 [291.7] versus 482.6 [433.9], P = .02) increased, suggesting reduced mental workload when the participants used the decision-support interface. The mental demand scores in NASA-TLX decreased from 62.5 (14.6) to 35.5 (17.0). Emergency medical technicians with 1.0-1.5 years of service reported higher System Usability Scale scores than those with 1.5-3.0 years (84.4 versus 71.3, P = .02), and 82.9% of participants rated the system as acceptable (System Usability Scale score ≥ 70).</p><p><strong>Conclusion: </strong>This study demonstrated that integrating a web-based decision-support interface effectively reduces mental workload and psychological stress among EMTs in stroke triage.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1428-1435"},"PeriodicalIF":2.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Immersion Using Body Bags for Exertional Hyperthermia: A Randomized Crossover Study.","authors":"Diane Zashin, Xiujing Zhao, Luzita Vela, Elizabeth Parke, Ramon Ylanan, Brendon P McDermott","doi":"10.5811/westjem.62965","DOIUrl":"https://doi.org/10.5811/westjem.62965","url":null,"abstract":"<p><strong>Introduction: </strong>Recent recommendations suggest emergency medical personnel should consider rapid whole-body cooling for heat stroke patients. Cold-water immersion maximizes cooling rate and subsequent outcomes following heat stroke. Body bags filled with ice and water may provide portable, accessible partial cold-water immersion for this setting. The purpose of this study was to determine whole-body cooling rates when using body bags to facilitate partial cold-water immersion to treat exertional hyperthermia.</p><p><strong>Methods: </strong>A total of 9 healthy participants (8 male; mean [SD] age, 24 [4] years; height, 175 [7] cm; body mass, 83.6 [21.6] kg) completed our randomized-crossover field study. Following hydration verification, participants completed a self-paced 400 warm-up run, 1,609 m run, and 10-m sprints until rectal temperature (T-_rec) reached 39.2 °C or volitional exhaustion. Following exercise, participants were cooled for a maximum of 30 minutes lying supine in the shade (control; CON) or in body bags filled with 20 gallons of ice water (5.2 [1.6] °C). Following cooling, participants sat upright for a 15-minute recovery. T-_rec and heart rate (HR) were taken throughout exercise, every minute of cooling, and every 5 minutes of recovery. Participants completed both trials separated by 1 week in random order.</p><p><strong>Results: </strong>Wet bulb globe temperature between trials was not significantly different (grand mean, 28.43 [1.03] °C; P = .73). There was no difference in participant maximum T-_rec (body bag, 38.98 [.23] °C; CON, 38.93 [.39] °C; P = .45); HR (body bag, 183 [14] beats per minute [bpm]; CON, 189 [13] bpm; P = .21); rating of perceived exertion (P >.99); thirst (P = .62); or thermal sensation (P = .73) during exercise. Fluid consumed (P = .40), body mass change (P = .90), 400 m run times (P = .19) and 1,609 m run times (P = .17) were no different between trials. Whole-body cooling rate for body bag was .102 (.04) °C/min, whereas CON produced a cooling rate of .040 (.04) °C/min (95% CI, .030-.095; P = .002). Total cooling time was significantly faster (13.2 (5.8) min) with BB compared to CON (27.6 (4.2) min; 95% CI, 9.2-19.5; P = .002).</p><p><strong>Conclusion: </strong>In clinical settings where full-body cold-water immersion is not feasible, or during emergency transport, partial immersion via body bags offers acceptable cooling rates for hyperthermic patients. Emergency medical personnel could apply these data for support in updating heat stroke protocols to include partial immersion via body bag during transport, or immediately upon emergency department arrival.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1160-1166"},"PeriodicalIF":2.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-Urban Parity and Socioeconomic Gaps in Traumatic Brain Injury Outcomes.","authors":"Minahil Cheema, Aamna Cheema, Anastasia Ternovskaia, Raneem Hamada Megahed, Patrick McGinnis, Japneet Sarai, Taylor Kowansky, Shriya Jaddu, Emily Esposito, Jessica V Downing, Quincy K Tran","doi":"10.5811/westjem.62017","DOIUrl":"https://doi.org/10.5811/westjem.62017","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Rural residence and low community income are independently associated with poorer health outcomes, mediated by variations in injury mechanism and healthcare access. We evaluated the impact of geographic location on injury patterns and acute-care metrics in adults with TBI treated at Maryland's statewide Level I trauma center.</p><p><strong>Methods: </strong>Adults (≥18 years of age) with radiographically confirmed TBI admitted between 2017 and 2021 were identified retrospectively from the institutional trauma registry. Rural residence was defined using Rural-Urban Commuting Area codes. This single-center study included only patients surviving to hospital admission. Primary outcomes included hospital length of stay (LOS) and discharge to hospice or death. Secondary outcomes included intensive care unit (ICU) and ventilator days and discharge disposition.</p><p><strong>Results: </strong>Of 2,812 patients diagnosed with TBI during the study period, 267 (9.5%) resided in rural areas. Compared with nonrural patients, rural patients were older (median age 67 vs 60 years, P < .001) and lived in lower income communities. However, after adjustment for demographic and clinical covariates, rural residence was not associated with higher hospital LOS quartile category (adjusted odds ratio [aOR] 1.18; 95% CI, 0.91-1.53; P = .20), discharge to hospice or death (aOR 1.67; 95% CI, 0.95-2.94), or discharge to a nonhome setting (aOR 0.93; 95% CI, 0.66-1.31). Groups showed no significant differences in critical care use, including ICU and ventilator durations. Worse outcomes were associated primarily with injury severity, including lower Glasgow Coma Scale scores and higher Injury Severity Scores.</p><p><strong>Conclusion: </strong>In a well-established regional trauma network, we found that among patients admitted with traumatic brain injury, residing in a rural area was not independently associated with worse in-hospital outcomes compared to patients who resided in nonrural (urban and suburban) communities. These findings suggest that a coordinated statewide trauma triage and access to tertiary neurotrauma care may help other systems similarly reduce rural disparities after severe head injury.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1271-1279"},"PeriodicalIF":2.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations.","authors":"Seung-Yup Lee, Reid M Eagleson, Larry R Hearld, Madeline J Gibson, Allyson G Hall, Michael J Mugavero, Greer Burkholder, Kimberly L Payne, William M Brown, Lauren M Epp, Laurie Hunter, Corey T Spraberry, Kristine R Hearld","doi":"10.5811/westjem.53190","DOIUrl":"https://doi.org/10.5811/westjem.53190","url":null,"abstract":"<p><strong>Introduction: </strong>Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments.</p><p><strong>Methods: </strong>This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models.</p><p><strong>Results: </strong>Among 2,698 appointments analyzed (mean age 51.5 years; 49.7% female), patients who attended their AICC appointment had a lower absolute ED visit rate compared with those who missed it (250/2,389 [10.5%] vs 47/309 [15.2%]; risk difference, 4.75%; 95% CI, 0.56-8.93%; P = .03). Missing an AICC appointment was significantly associated with greater odds of an ED visit (OR, 1.54; 95% CI, 1.07-2.21; P = .02). Hospitalization rates were 47.3% versus 53.4% (P = .04), although missing an AICC appointment was not significantly associated with increased hospitalizations (OR, 1.28; 95% CI, 1.00-1.64; P = .05). Findings were consistent across robustness analyses.</p><p><strong>Conclusion: </strong>The ambulatory intermediate care clinic model was associated with fewer ED visits but not reduced hospitalizations, suggesting that intermediate care can improve timely access and address acute care needs but may be insufficient to influence more complex drivers of inpatient admissions. Future research should explore strategies to enhance coordination and optimize the role of intermediate care within broader health system workflows.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1199-1207"},"PeriodicalIF":2.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency of Early Warning Scores in Adult Emergency Department and Inpatient Populations: Overview of Reviews.","authors":"Michal Pospíšil, Tereza Friessová, Tamara Skříšovská, Andrea Pokorná, Jan Maláska, Jana Rozmarinová, Alena Langaufová","doi":"10.5811/westjem.62022","DOIUrl":"https://doi.org/10.5811/westjem.62022","url":null,"abstract":"<p><strong>Introduction: </strong>Early Warning Scores (EWS) are used to support decisions regarding triage and early intervention of patient deterioration in emergency departments (ED) and other clinical environments. We synthesized evidence from systematic reviews on the predictive performance and clinical impact of EWS and their modifications in adult in-hospital populations.</p><p><strong>Methods: </strong>We conducted and reported an overview of reviews following the Joanna Briggs Institute (JBI) methodology, PRIOR statement, and our predefined protocol. A systematic search of MEDLINE (Ovid) and Epistemonikos was performed in May 2025. Two reviewers independently screened studies, extracted data, and critically appraised systematic reviews. We included systematic reviews of adult in-hospital populations evaluating EWS as either prognostic tools for deterioration or mortality, or as interventions implemented within track-and-trigger or rapid response systems. Primary study overlap was quantified using the corrected covered area (CCA). We synthesized evidence narratively and tabularly, emphasizing ED-related data.</p><p><strong>Results: </strong>From 502 records identified, 21 systematic reviews comprising 343 primary studies were included. We identified ED-relevant evidence in 12 reviews. In ED populations, EWS demonstrated moderate-to-good discrimination for mortality and clinical deterioration (National EWS area under the receiver operating characteristic curve (AUROC) values: 0.88 for 24-hour mortality, 0.86 for 48-hour mortality). Across ED and mixed acute-care cohorts, Early Warning Scores also showed fair performance for predicting ICU admission and composite adverse outcomes (AUROC ~0.70-0.75). In sepsis-focused analyses relevant to ED populations, quick Sequential Organ Failure Assessment (qSOFA) demonstrated low sensitivity but high specificity for 28/30-day mortality (sensitivity 0.41, 95% CI, 0.24-0.62; specificity 0.88, 95% CI, 0.81-0.92). The SOFA score showed high sensitivity and moderate specificity for in-hospital mortality (sensitivity 0.89, 95% CI, 0.88-0.90; specificity 0.69, 95% CI, 0.68-0.69). Evidence on the clinical impact of EWS implementation in ED and other emergency settings was limited and heterogeneous.</p><p><strong>Conclusion: </strong>In EDs, Early Warning Scores support early risk stratification and identification of patients at risk of deterioration, particularly for short-term mortality and escalation of care. Their impact on patient-important outcomes remains uncertain. Early Warning Scores should complement clinical judgment, triage systems, and structured escalation protocols. They should not be a standalone tool. Future research should prioritize standardized thresholds, transparent reporting, and rigorous comparative and implementation studies defining the role of EWS in emergency care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1222-1234"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Residency-Run Emergency Medicine Podcast Summary on Learning Retention and Engagement.","authors":"Christopher Reilly, Bobbie Ann Adair White, Katherine Pattee, Hannah Blakely, Reuben Strayer, Sergey Motov, Antonios Likourezos, Rukhsana Hossain, Sarah Kabariti, Jefferson Drapkin","doi":"10.5811/westjem.52913","DOIUrl":"https://doi.org/10.5811/westjem.52913","url":null,"abstract":"<p><strong>Introduction: </strong>Podcasts have become a widely used educational tool in emergency medicine. In this study, a podcast was used as the intervention. This podcast consisted of a brief audio summary of weekly in-person conference content produced by residents and faculty. We assessed whether a resident-led, curriculum-based podcast summary improved knowledge retention and learner engagement compared to a standard written summary format.</p><p><strong>Methods: </strong>This mixed-methods prospective cohort study conducted at a single urban academic hospital included 54 emergency medicine residents and approximately 66 attending physicians. The study unfolded in three phases: eight weeks of standard written conference summaries (control); followed by eight weeks of written plus podcast conference summaries (intervention); and a four-week post-intervention period with surveys. The primary outcome was knowledge retention, measured by weekly postconference quiz scores comparing the written-summary phase (control) with the podcast phase. Secondary outcomes included learner satisfaction, podcast usage patterns (downloads and self-reported listening), and self-reported impact on clinical application of conference content. Data included quiz scores, survey responses, and podcast analytics. Statistical comparisons of quiz performance were made using paired t-tests. Thematic analysis of open-ended responses was performed using Braun and Clarke's framework.</p><p><strong>Results: </strong>Mean quiz scores were 73.1% (standard deviation [SD] 6.6) during the written phase and 73.7% (SD 14.4) during the podcast phase with no statistically significant difference in weekly quiz performance between conditions (paired t-test, P = .92). An exploratory linear trend analysis suggested a steeper week-to-week improvement during the podcast phase, but this post-hoc finding should be interpreted cautiously. Although the podcast did not improve knowledge retention compared with the existing written summary, learners reported high satisfaction, perceived reinforcement of key concepts, and convenient asynchronous access.</p><p><strong>Conclusion: </strong>In this mixed-methods study, a residency-run podcast summary did not improve quiz-based knowledge retention compared with an existing written conference summary. However, learners reported high satisfaction, perceived reinforcement of key concepts, and convenient asynchronous access.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1250-1257"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Extremity Amputations in Children: Causes and Outcomes Based on a Regional Experience.","authors":"Joyce J L H McRae, Joseph Whitaker, Rebecca Dolman, Rosemary Vannix, Liang Ji, Andrei Radulescu, Donald Moores","doi":"10.5811/westjem.65072","DOIUrl":"https://doi.org/10.5811/westjem.65072","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric traumatic extremity or digit amputations are preventable causes of morbidity. The object of this study was to evaluate the etiology and outcomes of these injuries in our region. We used the Childhood Opportunity Index to explore the role of social determinants of health.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at an academic children's hospital on all pediatric patients younger than 18 years who presented with a traumatic digit or extremity amputation between January 1, 2014, to July 31, 2024. Metrics such as patient demographics, injury severity, prehospital course, hospital events and follow-up were abstracted. The Childhood Opportunity Index assigns a 0-100 composite score of region-based childhood opportunity determined from home ZIP codes. Our primary outcome measure was mechanism of injury. Secondary outcomes included length of stay, need for initial surgical intervention, subsequent operations, or unplanned readmissions.</p><p><strong>Results: </strong>A total of 73 patients presented with a traumatic amputation of a digit or extremity. The median age was 12.7. The top three causes of amputations were all-terrain vehicle (ATV) crashes, fireworks, and entrapment in an object. All-terrain vehicle crashes were the most common cause in all age groups from 5-17, while caught in an object was the most common for ages 0-4. The median Injury Severity Score was 5 (IQR 7). The three most common sites of amputation were right index finger (21), right long finger (17), and left long finger (15). Thirty-three children (45.2%) had more than one amputation. The highest number of amputations in a single patient was 10. All patients underwent a surgical intervention, and there were no mortalities. The median Childhood Opportunity Index score of the cohort was low at 19 (IQR 33), with 73% (n = 53) of the cohort originating from a very low (n = 37) or low (n = 16) index region. A rising index score was weakly associated with a decrease in total number of amputations (ρ = -0.25 [CI, -0.45 to -0.02, P = .04]).</p><p><strong>Conclusion: </strong>A. total of 73 children in our region suffered a traumatic digit or extremity amputation, mostly due to ATV crashes and fireworks. Most patients originated from a neighborhood of very low or low Childhood Opportunity Index scores. Increased public awareness regarding the danger of ATVs in regions with lower index scores may prevent these injuries. Clear, targeted policies toward ATV usage in childhood are needed.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1290-1297"},"PeriodicalIF":2.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency and Humanism: The Impact of the Humanistic Charting Tool on Patient Experience in the Emergency Department.","authors":"Namrata Garg, Omid Boozarpour, Jose Alaras, Ivy Tran, Christopher R Peabody, Nicholas Stark","doi":"10.5811/westjem.62128","DOIUrl":"https://doi.org/10.5811/westjem.62128","url":null,"abstract":"<p><strong>Introduction: </strong>Emphasis on documentation challenges clinicians to strike a balance between efficiency and individualized care, often leading to the depersonalization of patient interactions. The Humanistic Charting Tool (HCT) addresses this by integrating the patient's voice into the electronic medical record (EHR). The objective of this study was to examine whether use of the HCT during emergency department (ED) visits is feasible and improves key patient experience metrics.</p><p><strong>Methods: </strong>The study took place in an urban, academic hospital. Patients in the ED completed the HCT while waiting to see a clinician. The patient's responses were condensed into a two-page summary and uploaded into their EHR. Clinicians were asked whether they used the HCT for each patient at the end of the encounter, and patients completed precare and postcare surveys assessing key experience metrics. Our primary outcome measure was changes in patient experience metrics, including key Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) metrics. Our secondary outcome measure was subgroup analyses among patients facing barriers to care.</p><p><strong>Results: </strong>Approximately 2.8% of the total ED patients were enrolled during the study period. Overall, 129 patients filled out the HCT, and 97 (74%) patients had complete survey data. A total of 65 clinicians participated in the study including 32 attending physicians, 23 resident physicians, and 10 advanced practice practitioners (APP). Clinicians used the HCT for 51 (53%) of these patients. Patients demonstrated significant improvements in feeling that clinicians listened carefully (79% to 92%; P < .001), took their preferences into account (61% to 74%; P = .01), treated them with courtesy and respect (85% to 94%; P < .001), and knew important information about them (43% to 52%; P = .01). Patients who did not have a regular clinician (n = 25 [26%]) had a significantly greater increase in feeling involved in their treatment discussion (36% to 60% vs 59% to 66%; P = .05). Patients who endorsed at least one social need (n = 15 [16%]) had a significantly greater increase in being listened to carefully (53% to 73% vs 84% to 95%; P = .01). No statistical significance was found between patients whose clinicians used the HCT versus not.</p><p><strong>Conclusion: </strong>The Humanisticc Charting Tool demonstrated feasibility and was associated with improvements in patient experience within the ED. This tool has the potential for patients to share their narratives and enrich their own healthcare experience, which is invaluable in a high-stakes, time-sensitive environment. The results also highlight a novel finding that the HCT may help mitigate disparities in communication, trust, and engagement that disproportionately affect vulnerable populations. This study supports the further development of humanism-centered tools within healthcare systems.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 5","pages":"1499-1505"},"PeriodicalIF":2.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}