Western Journal of Emergency Medicine最新文献

{"title":"Effects of the COVID-19 Pandemic on Anxiety and Depression among Medical Interns.","authors":"Tugay Usta, Serap Biberoğlu, Afşin İpekci, İbrahim İkizceli, Fatih Çakmak, Yonca S Akdeniz, Gülçin Baktıroğlu, Seda Özkan","doi":"10.5811/westjem.38455","DOIUrl":"10.5811/westjem.38455","url":null,"abstract":"<p><strong>Introduction: </strong>The demanding nature of emergency medicine (EM), requiring immediate responses to emergencies, and presents significant challenges, particularly for new trainess specialty. Our goal was to evaluate levels of anxiety and depression among EM intern doctors, with focus on the impact of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We conducted this study at Istanbul University-Cerrahpasa, Department of Emergency Medicine, from December 29, 2019-May 2, 2021. In Türkiye, the six year medical education program has the first three years preclinical, the fourth and fifth years comprised of clerkships, and the sixth year is internship training. In this final year, these intern doctors rotate through various departments, including an 8-week EM internship. A total of 203 medical interns participated in the study, 50.2% male. We assessed participants using the State-Trait Anxiety Inventory (STAI 1-2) and the Beck Depression Inventory, both prior to starting their EM internship and upon completion. Intern doctors were divided into two groups: 51 who completed their internship before the COVID-19 pandemic (December 29, 2019-March 11, 2020) and 152 during the pandemic (March 11, 2020-May 2, 2021). We compared pre- and post-internship scores within each group and between the two cohorts.</p><p><strong>Results: </strong>Anxiety scores (STAI-1) increased significantly in both groups during the internship. In the pre-COVID-19 group, median STAI-1 scores rose from 47 (IQR: 38-53) to 51 (IQR: 45-56) (p<0.001), and in the COVID-19 group, from 41 (IQR: 35-48) to 47 (IQR: 42-52) (p<0.001). However, depression scores (BDI) showed a significant increase only in the pre-COVID-19 group: from 9 (IQR: 2-14) to 26 (IQR: 15-32) (p<0.001). In contrast, the COVID-19 group's depression scores remained relatively stable, increasing only from 7 (IQR: 2-13) to 8 (IQR: 3-16) (p=0.345).There were no significant differences between the groups in trait anxiety (STAI-2) scores (p=0.221) or pre-internship BDI scores (p=0.408). However, post-internship BDI scores were significantly lower in the COVID-19 group compared to the pre-COVID-19 group (median: 8 vs. 26; p<0.001).</p><p><strong>Conclusion: </strong>The EM internship was associated with an increase in anxiety levels among intern doctors. Depression scores did not show a significant increase in the COVID-19 group, whereas depression scores significantly increased in the pre-COVID-19 group by the end of the internship. These findings suggest that, while anxiety increased across both groups, depression levels were more stable in the COVID-19 group, with lower post-internship scores compared to those in the pre-COVID-19 group.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"795-803"},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837921","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":"Evaluation of an Emergency Department Sexually Transmitted Infection Empiric Treatment and Linkage-to-care Program.","authors":"Victoria R Bortner, Emily Holbrook, Heather Henderson, Jason W Wilson","doi":"10.5811/westjem.18583","DOIUrl":"10.5811/westjem.18583","url":null,"abstract":"<p><strong>Introduction: </strong>Rates of sexually transmitted infections (STI), remain high in Hillsborough County, FL. As the emergency department (ED) is frequently used for STI diagnosis and treatment, a local hospital ED implemented a linkage-to-care program using a callback system to ensure that patients with chlamydia, gonorrhea, and/or syphilis received treatment. Our primary aim in this paper was to evaluate implementation of an ED-based STI treatment program by describing empiric, follow-up, and overall treatment rates in STI-positive patients by disease and sex. A secondary aim was to evaluate reasons for undertreatment during the acute-care encounter.</p><p><strong>Methods: </strong>We conducted this quality assurance project, including a retrospective chart review of electronic health records from 2019-2022, at an urban ED in Hillsborough County, Florida. During this period, we reviewed all records reflecting positive results for chlamydia, gonorrhea and/or syphilis to determine whether empiric treatment was administered in the ED or the patient required coordination for follow-up care. Patients who received empiric treatment or successful follow-up treatment were classified as treated, while those who did not receive successful follow-up treatment were classified as untreated.</p><p><strong>Results: </strong>A total of 1,170 patients were diagnosed with an STI at an urban, quaternary-care hospital in the county. Of these, 689 (58.9%) had chlamydia, 324 (27.7%) had gonorrhea, 133 (11.4%) had dual gonorrhea-chlamydia, and 24 (2.1%) had syphilis. Rates of STI empiric, follow-up, and overall treatment were 47.1%, 86.1%, and 92.6%, respectively. Empiric and overall treatment rates were highest for male patients (72.3% male, 33.4% female) and patients presenting with gonorrhea (67.6% gonorrhea, 63.9% chlamydia). Follow-up treatment rates were highest for female patients (87.1%) and patients presenting with gonorrhea (87.6%).</p><p><strong>Conclusion: </strong>Our findings emphasize both the successes and opportunities for improvement of a linkage-to-care protocol to provide treatment access for patients in the ED who test positive for sexually transmitted infections. Given the significant strain on the public health infrastructure in the United States and on our local Department of Health, ED-based linkage programs fill an important gap in healthcare delivery. Going forward, improving overall treatment rates in females and patients with chlamydia or syphilis is warranted.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"863-868"},"PeriodicalIF":2.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837968","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":"Utility of Emergent Spine MRI in the Emergency Department.","authors":"Farid Hajibonabi, Dan Cohen-Addad, Francisco Delgado, Po-Han Chen, Bing Fang Wang, Shamie Das, Tarek N Hanna","doi":"10.5811/westjem.32802","DOIUrl":"10.5811/westjem.32802","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged emergency department (ED) waiting times for STAT spine magnetic resonance imaging (MRI) in the ED can expose patients to hospital-acquired infections and increase the workload in the ED, further impacting healthcare quality. In this study we aimed to characterize emergent spine MRI frequency and positivity in the ED, and its impact on ED length of stay (LOS), admission rates, and the necessity for surgical interventions.</p><p><strong>Methods: </strong>We performed a retrospective chart review of a consecutive group of patients who had emergent spine MRI (cervical, thoracic, lumbar) ordered from the EDs at four hospitals from January 1, 2017-December 31,2022 were included for traumatic and atraumatic patients. We recorded patient demographics, time metrics, discharge status, and surgical interventions within seven days (for those who were hospitalized during the ED encounter). Spine MRI reports were reviewed and categorized, with positive cases defined as severe spinal canal stenosis regardless of cause and/or fracture. We used descriptive statistics to assess the positivity rate for emergent spine MRIs as well as the LOS, rate of surgery, and rate of admission for patients getting emergent spine MRIs.</p><p><strong>Results: </strong>A total of 689 spine MRI of 889,527 ED visits (0.1%) were included. Patients' mean age was 51.3 ±17.1 years, and 59.5% were female. Discharge rate was 93.9%, 3.3% were admitted, 1.7% left against medical advice, and 1.0% were transferred to other facilities. The overall spine MRI positivity rate was 18.9% (130). Moreover, the median (IQR) time from imaging order placement to imaging completion was 2.6 (1.8 - 3.7) hours, while the time from imaging completion to final report availability was 1.5 (0.4 - 13.9) hours. The median ED LOS was 7.4 (5.7 - 9.5) hours. Of 23 hospitalized patients, 17 (73.9%) required surgical intervention. Positive cases had significantly higher ED LOS compared to negative cases (8.1 vs 7.2, respectively; P < .001).</p><p><strong>Conclusion: </strong>The positivity rate for ED spine MRI in this study was 18.9%. Of the positive cases, 17.7% underwent hospitalization, with 13.1% requiring emergent surgery. Considering high costs in both time and resource utilization, further research is needed to optimize the triage process for patients requiring emergent spine MRI.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"936-942"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837997","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 Medical Services Calls for Service at Adult Detention Centers: A Descriptive Study.","authors":"Jeffrey N Wood, Aaron B Klassen, Matthew D Sztajnkrycer","doi":"10.5811/westjem.33613","DOIUrl":"10.5811/westjem.33613","url":null,"abstract":"<p><strong>Introduction: </strong>Incarcerated individuals represent a vulnerable sector of society, with a disproportionate burden of substance use, mental health problems, and chronic illness. The purpe of this study was to perform a descriptive analysis of emergency medical services (EMS) response to detention facilities.</p><p><strong>Methods: </strong>We conducted a retrospective review of Mayo Clinic Ambulance Service ground EMS emergency (9-1-1) calls for service to nine detention centers within the service area occurring between January 1, 2002-December 31,2021. We excluded calls to a 10^th detention center, the Federal Medical Center - Rochester, due to the unique nature of this facility. Additional exclusion criteria included non-emergency calls and lack of patient care narratives within the patient care report. We analyzed data using descriptive statistics, chi-square, and the Student t-test. This study was reviewed and approved by the Mayo Clinic Institutional Review Board.</p><p><strong>Results: </strong>During the study period, 3,114/1,231,853 (0.25%) service requests to detention facilities occurred. After accounting for exclusion criteria, the final sample size consisted of 2,034 patients. Average patient age was 40.2 ± 13.3 years of age, compared with 54.0 ± 25.9 years of age for non-detention center calls (P < 0.001). The majority (80.8%) of patients were male. Mean scene time was 14:13 ± 7:49 minutes, compared with 12:04 ± 12:27 minutes (P < 0.01) for non-detention center calls. The most common complaints were medical, behavioral emergencies, cardiac, and trauma. Obstetrics requests accounted for 5.8% of calls for female patients. Most calls (91.3%) to detention centers involved incarcerated individuals, with the remainder representing facility staff (1.5%), visitors (0.5%), and undetermined (6.7%). Nearly 4% of patients refused treatment; 48.9% of these patients were still transported. Consent for treatment/transport by the patient was documented in 6.1% of charts.</p><p><strong>Conclusion: </strong>Recognizing the retrospective, single-agency nature of this study, we found that calls to detention facilities within our 9-1-1 service area predominantly involved incarcerated individuals. Consent for treatment/transport was not documented in most EMS encounters. Further study is needed to better understand the healthcare needs of these patients, including ability to consent.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"918-923"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837965","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":"Extended-release Injectable Buprenorphine Initiation in the Emergency Department.","authors":"Brittany Cesar, Jessica Moore, Raluca Isenberg, Jessica Heil, Rachel Rafeq, Rachel Haroz, Matthew Salzman, Alice V Ely","doi":"10.5811/westjem.21299","DOIUrl":"10.5811/westjem.21299","url":null,"abstract":"<p><strong>Introduction: </strong>Extended-release buprenorphine (XR-BUP) is a long-acting injectable medication used for the treatment of opioid use disorder (OUD). It is currently approved for use in patients who have been administered at least seven days of sublingual buprenorphine (SL-BUP). For patients with OUD who are unstable (ie, not at treatment goal, with active opioid use) or not yet on medication for OUD (MOUD) such as SL-BUP, the emergency department (ED) setting is an essential location for access to treatment. There is, as yet, no research on the utility of on-demand XR-BUP administration in the ED.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of individuals with OUD who received XR-BUP in the ED through our novel reallocation pathway. We reviewed charts from an addiction medicine specialty outpatient clinic to determine retention in treatment, continuation on XR-BUP, and reported quantitative analysis. Our primary outcome was retention in treatment, measured by subsequent XR-BUP injection after initial ED XR-BUP administration. The secondary outcome was the reason for ED administration of XR-BUP (as opposed to administration in the clinic setting).</p><p><strong>Results: </strong>Our study population included 69 patients (68.2% male). Our primary outcome showed that 51 (73.9%) patients who had their first injection in the ED received a second XR-BUP injection and 40 (58%) received their third XR-BUP injection. Our secondary outcome showed that 7.2% had barriers with access to treatment; however, most of the patients received the injection due to instability of the treatment of the OUD (69.6%). These patients were either unable to adhere to MOUD, reported issues with the prescription, or were still using substances while on MOUD. For 52 (75%) patients, the index ED injection was their first ever XR-BUP injection. Logistical regression analyses demonstrated that clinical and demographic factors did not lead to increased attrition, while patients with other co-occurring substance use disorders were more likely to present for follow-up treatment.</p><p><strong>Conclusion: </strong>In our retrospective study, patients who received ED-initiated extended-release buprenorphine had a strong retention rate compared to previous studies evaluating ED-initiated sublingual BUP (retention rates ranging from 16.7-60%). The ED provided a convenient healthcare access point for XR-BUP initiation. The XR-BUP is a helpful tool for achieving induction after failed SL-BUP initiation and may have further implications in minimizing treatment gaps after discharge and improving OUD treatment retention.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"888-896"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837970","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":"Biological Variation of Corrected QT and QRS Electrocardiogram Intervals: Interpreting Results of Drug-induced Prolongation.","authors":"Alan Wu, Kayla Kendric, Caitlin Roake, Emily Kelly","doi":"10.5811/westjem.33602","DOIUrl":"10.5811/westjem.33602","url":null,"abstract":"<p><strong>Introduction: </strong>Toxicologists use a universal threshold to determine QRS and QTc prolongation in poisoned patients. Further understanding of the biologic variance of these intervals may allow for a more personalized approach to assessing the clinical significance of electrocardiogram (ECG) changes in these patients.</p><p><strong>Methods: </strong>We recruited six male and six female healthy subjects. Standard 12-lead ECGs were performed in duplicate once per week for four consecutive weeks. We calculated the mean and standard deviation, the coefficient of variance (CV) for replicate readings (CV_A), and within (CV_I) and between individuals (CV_G) using analysis of variance for all subjects and separately for males and females. From these measured parameters, we determined the index of individuality (II), the reference change value (RCV), and number of readings needed to maintain a homeostatic setpoint.</p><p><strong>Results: </strong>The median QRS interval for healthy males (103.4 milliseconds [ms]) was statistically higher than that for females (88.6 ms) in our study (P < .05). The CV_A and CV_I for the QRS interval for the total cohort were relatively low at 3.0 and 2.2, respectively. The CV_G for the QRS interval was relatively high at 12.9. There was no difference in the QTcorrected (QTc) interval between gender (404 vs 415 msec, respectively). The II was 0.29 for QRS and 0.74 for QTc in pooled subjects. The RCV was 10.3 and 7.1 msec, respectively, for QRS and QTc for all subjects. The number of samples needed to establish a homeostatic set point was 1 for all analyses at a closeness of 10% with a 95% probability (P = .05).</p><p><strong>Conclusion: </strong>We demonstrated a significant difference in QRS duration between healthy males and females as well as a low II, particularly for the QRS interval, indicating that the CV_G is greater than the CV_I among these ECG intervals. In this study we also determined that one ECG is needed to establish a homeostatic set point for patients. If a baseline ECG is available, medical toxicologists would benefit from using the baseline tracing as an internal reference for determining QRS and QTc prolongation in the individual patient rather than a predetermined universal threshold for managing poisoned patients.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"978-983"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837957","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":"Physician Orders for Waiting Room Patients: Ethical Considerations.","authors":"Nicholas Kluesner, Jennifer Chapman, Monisha Dilip, James H Paxton, Karen Jubanyik, Paul Bissmeyer","doi":"10.5811/westjem.33481","DOIUrl":"10.5811/westjem.33481","url":null,"abstract":"<p><p>With increasing emergency department (ED) boarding and crowding, EDs have introduced several novel care-delivery initiatives including split-flow models (e.g., fast tracks), non-linear patient flow models (e.g., protocol bays), nursing triage order sets, physician-in-triage, and the use of non-traditional care areas (e.g., ED hallways). One such emerging practice is the placement of orders for patients in the waiting room (WR) by physicians prior to in-person physician evaluation (e.g., based on triage documentation and the patient's medical record). This paper describes key ethical obligations to WR patients that support this practice, as well as other considerations that must be balanced against these obligations, including potential risks.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"1025-1029"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837987","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":"Developing Interprofessional Immigrant Health Education for Emergency Physicians.","authors":"Leonardo Garcia Heglund, Katrin Jaradeh, Carolina Ornelas-Dorian, Nicholas Stark, Theresa Cheng, Christopher R Peabody","doi":"10.5811/westjem.33576","DOIUrl":"10.5811/westjem.33576","url":null,"abstract":"<p><strong>Background: </strong>As of 2021, there were 47 million immigrants in the United States. Immigrant populations are uninsured at higher rates than US citizens, leading many to rely on emergency departments (ED) for their healthcare needs. However, emergency physicians (EP) often lack training on the unique challenges faced by this population, necessitating educational interventions.</p><p><strong>Methods: </strong>We implemented educational interventions for an urban emergency medicine residency program using Kern's six-step approach for curriculum development to inform EPs of existing immigration-specific patient resources; teach social-medical-legal best practices with regard to asking, documenting, and sharing immigration-specific health information; and increase awareness of ED-relevant local policies. We developed three educational interventions.in collaboration with legal organizations, and community experts. To evaluate the success of these interventions we administered a pre- and post-survey to 64 EPs (36% of 178 targeted learners) RESULTS: We found a significant increase in confidence and knowledge, with an average 5-point Likert scale score improvement of 1.47 (P < .001) in all responses and 1.40 (P < .001) in paired responses, and an improvement in test scores on the three knowledge-based questions of 30.66% (P < .001) in all responses and 33% (P = .02) in paired responses.</p><p><strong>Conclusion: </strong>This study highlights a model for interprofessional collaboration in curriculum development and the importance of a multipronged educational approach to improve the care of immigrants in the ED. The curriculum offers a framework for other EDs aiming to address healthcare inequities for this population. Future research can explore long-term knowledge retention, detailed educational tool utilization, and the impact on patients.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"781-785"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837919","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":"Surgical Disease Burden, Outcomes, and Roles of Non-Physician Clinicians in Ugandan Emergency Departments.","authors":"Stacey Chamberlain, Pearl Ugwu-Dike, Ronald Mbiine, Thomas Sims, Brian T Rice","doi":"10.5811/westjem.24989","DOIUrl":"10.5811/westjem.24989","url":null,"abstract":"<p><strong>Background: </strong>Delivery of emergency surgical care remains a challenge in much of Sub-Saharan Africa, with physician shortages in Uganda resulting in only one surgeon per 100,000 people. Emergency units in Uganda receive emergency surgical patients, but it is unknown how great of a burden these emergency surgical patients represent in terms of total number, care required, or outcomes.</p><p><strong>Methods: </strong>We performed a retrospective review of a quality assurance database for all patients treated at two emergency units in Uganda from 2009-2019. Patients were defined as \"surgical\" if they were admitted directly to the operating theatre, received a surgical diagnosis, or received an emergency surgical procedure as identified by the Disease Control Priorities 3 (DCP3) group. We generated descriptive statistics.</p><p><strong>Results: </strong>Of the 109,999 total patients seen, 24,745 (22.5%) were emergency surgical patients. Surgical patients were predominantly male (71.7%) with a mean age of 34.9 years. Most surgical patients (57.0%) were admitted to the hospital, while 38.9% were discharged, and only 1.7% were sent directly to the operating theatre. In total, 12.1% of all patients seen in the emergency unit received a surgical procedure from a non-physician clinician while in the unit. Of the surgical procedures, the most common were suturing of lacerations (51.8%), urinary catheterization (24.5%), fracture management (16.5%), and incision and drainage of abscesses (6.0%). Among surgical patients, the most common surgical diagnoses were for fractures (30.9%), lacerations (29.6%), and abscesses (8.8%). The overall three-day mortality for emergency surgical patients was 2.8%.</p><p><strong>Conclusion: </strong>Emergency surgical patients are common in Ugandan emergency units, where emergent surgical procedures are commonly performed by non-physician clinicians. Strengthening system capacity for emergency surgical patients should also consider emergency unit resources.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"994-1001"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838010","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 Effect of Pain on the Relationship Between Triage Acuity and Emergency Department Hospitalization Rate and Length of Stay.","authors":"Yan-He Lin, Nai-Wen Ku, Chia-Hsin Ko, Eric H Chou, Chih-Hung Wang, Tsung-Chien Lu, Chien-Hua Huang, Chu-Lin Tsai","doi":"10.5811/westjem.33600","DOIUrl":"10.5811/westjem.33600","url":null,"abstract":"<p><strong>Objectives: </strong>Little is known about the effect of pain on the relationship between triage and patient outcomes in United States emergency departments (ED). In this study we aimed to describe pain-associated ED visits and to explore how pain modifies the ability of ED triage to predict patient outcomes (hospitalization and ED length of stay [EDLOS)].</p><p><strong>Methods: </strong>We obtained data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2010-2021. Adult ED visits without missing data on pain score or triage level were included. We assessed pain scores at triage using a numeric rating scale (NRS) of 0-10. We further categorized the NRS scores into no (0), mild (1-3), moderate (4-6), and severe (7-10) pain. The five-level Emergency Severity Index was used for ED triage. The primary outcomes were hospital admission during the ED visit and EDLOS. For the analyses we used descriptive statistics and multivariable regression accounting for NHAMCS's complex survey design.</p><p><strong>Results: </strong>Over the 12-year study period, there were 132,308 adult ED visits (representing 773,000,000 ED visits nationwide). Approximately 50% were triaged to level 3, followed by 30% to level 4. Approximately 45% reported severe pain, 21% moderate pain, 9% mild pain, and 25% no pain. Triage level 1 was associated with the highest rate of hospitalization (35%), with a gradual decrease in hospitalization rate from levels 2 to 4. Triage level 2 was associated with the longest mean EDLOS (5.6 hours), with a gradual decrease in EDLOS from levels 3 to 5. When stratified by pain intensity, the pattern of hospitalization altered in the mild and moderate pain groups. In these two pain-intensity groups, triage level 1 was associated with lower-than-expected odds of hospitalization, a 31% reduction suggested by the interaction term (adjusted odds ratio 0.69; 95% confidence interval .51-.92, P = .01). By contrast, the pattern of EDLOS persisted across all pain-intensity groups.</p><p><strong>Conclusion: </strong>Mild and moderate levels of pain intensity appear to negatively impact the ability of triage to predict hospitalization, resulting in overtriage among patients in these two pain-intensity groups. Pain intensity in the ED should be carefully evaluated to avoid overtriage and ensure the appropriate allocation of resources.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 4","pages":"835-842"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838011","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}