Western Journal of Emergency Medicine最新文献

{"title":"Exposure to Community Violence and Adverse Childhood Experiences in the Emergency Department.","authors":"Leslie Cachola, Yanina Guevara, Sobia Ansari","doi":"10.5811/westjem.34857","DOIUrl":"10.5811/westjem.34857","url":null,"abstract":"<p><strong>Introduction: </strong>Adverse childhood experiences (ACEs) and exposure to community violence are public health issues linked to negative mental and physical health outcomes. The emergency department (ED) can play a critical role in the care of patients with a history of trauma exposure. Unfortunately, patients' experiences often go unidentified, leading to missed opportunities to address and prevent further harm.</p><p><strong>Methods: </strong>We administered a 22-question survey of trauma exposure in ED patients to 1) identify the prevalence of exposure to community violence and ACEs and resulting post-traumatic stress disorder (PTSD) symptoms, and 2) determine perceived social service needs. This self-administered survey study was conducted on a convenience sample of 267 adult patients at one academic hospital in Chicago, IL, between July 2018-December 2019. This ED sees approximately 70,000 patients annually. These were fluent English-speaking patients who were non-critically ill or altered and chosen randomly after being assigned to an ED room, typically during regular business hours based on research associate availability. They were not offered compensation for study participation. The survey included demographic information and questions modified from the Adverse Childhood Experiences Study questionnaire, the 54-item Survey of Exposure to Community Violence, and the Primary Care PTSD screen. Participants were also asked to identify resources to address their exposure to trauma.</p><p><strong>Results: </strong>Of 268 surveys, 267 were completed; 88% of participants endorsed exposure to ACEs or community violence (95% confidence interval [CI] 84.1-91.9%, p < 0.001 compared to general US population rate of 61%). A total of 53.6% of respondents endorsed exposure to at least one ACE (95% CI, 47.6-59.6%), and 15.7% were exposed to ≥4 ACE (95% CI, 11.3-20.1%). The most commonly endorsed categories of ACE were \"emotional neglect\" (30.3%, 95% CI 24.8%-35.8%); \"emotional abuse\" (25.8%, 95% CI 20.6%-31.1%); and \"exposure to family substance use\" (21%, 95% CI 16.1%-25.9%). When asked about personal experience with violence in the community, 47.9% said they had been shoved, kicked or punched (95% CI 41.9%-53.9%), 8% had been stabbed (95% CI 4.8%-11.3%), and 6.7% had been shot (95% CI 3.7%-9.7%). Among the survey participants, 26.2% said they had seen someone die from violence either in their home or in their neighborhood (95% CI 20.9%-31.5%). ZIP Code analysis indicates that most patients resided in neighborhoods near our ED and were likely to utilize it for medical care. Of respondents with exposure to trauma 38% asked for resources through their primary care clinic (95% CI 32.2%-43.8%), while 77.4% asked for resources through faith-based organizations (95% CI 72.4%-82.4%).</p><p><strong>Conclusion: </strong>These findings suggest that most respondents in the ED have experienced trauma, and many are interested in community and clinical r","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"406-412"},"PeriodicalIF":1.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498132","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":"Post-Concussion Syndrome Following Blast Injury: A Cross-Sectional Study of Beirut Blast Casualties.","authors":"Hind Anan, Moustafa Al Hariri, Eveline Hitti, Firas Kobeissy, Afif Mufarrij","doi":"10.5811/westjem.21131","DOIUrl":"10.5811/westjem.21131","url":null,"abstract":"<p><strong>Introduction: </strong>The massive 2020 blast in Beirut, Lebanon, caused by improperly stored ammonium nitrate, was one of the most powerful non-nuclear explosions in history, Following the blast, head injuries emerged as a predominant presentation to the emergency department (ED). Blast-induced head injuries can lead to mild traumatic brain injuries (mTBI) mediated via primary blast overpressure without direct head trauma. The recovery process from mTBIs can be prolonged and affected by several factors. If symptoms persist for more than three months, patients should be evaluated for post-concussion syndrome (PCS). While clinical blast-injury studies have focused on repetitive blast exposure, this study evaluates a cohort exposed to a single blast. We hypothesized that a single blast exposure is sufficient to induce PCS symptoms similar to those exposed to repetitive blasts.</p><p><strong>Methods: </strong>This cross-sectional study explores PCS in patients presenting to the ED of a tertiary-care center following the Beirut blast. Patients were identified through medical charts, contacted by phone, and consented to participate at least three months post-blast (beginning in November 2020). We used the Rivermead Post-Concussion Questionnaire (RPQ) to assess for PCS. We analyzed the association of PCS with patients and injury characteristics.</p><p><strong>Results: </strong>Of 370 patients presenting to the ED, 145 (58.5%) completed the study questionnaire. Mean age was 39.8 ± 15.4 years, and 40% were females. Head trauma (46.9%) was the most common presentation. A total of 112 patients (77.2%) met the criteria for PCS, with a median RPQ score of 25 (interquartile range 18.75). After adjusting for injury types and distance from the blast, younger patients (adjusted odds ratio [aOR] 0.972, 95% confidence interval [CI] 0.947-0.998) and females (aOR 2.836, 95% CI 1.114-7.220) were more likely to suffer from PCS.</p><p><strong>Conclusion: </strong>Our study revealed a remarkably high prevalence of PCS among survivors of the Beirut blast, with younger individuals and females disproportionately affected. This highlights the need for age- and sex-specific rehabilitation and support programs. However, the study was limited by incomplete patients records and contact information, leading to the exclusion of a significant number of patients who initially presented to the ED. Ultimately, this study underscores the crucial role of robust public health preparedness and specialized care pathways against future large-scale catastrophes. Further assessment, including neurobiomarker evaluation, will be conducted on these survivors.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"743-750"},"PeriodicalIF":1.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498143","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":"Dispatch Decisions and Emergency Medical Services Response in the Prehospital Care of Status Epilepticus.","authors":"Robert P McInnis, Andrew J Wood, Courtney L Shay, Anna A Haggart, Remle P Crowe, Elan L Guterman","doi":"10.5811/westjem.21266","DOIUrl":"10.5811/westjem.21266","url":null,"abstract":"<p><strong>Objective: </strong>Emergency medical dispatch is intended to ensure that emergency medical services (EMS) allocate appropriate resources for the treatment of patients with status epilepticus (SE). However, it is unclear whether dispatch algorithms accurately identify those patients having a seizure-related medical emergency and how dispatch algorithms influence what prehospital resources are allocated for the encounter.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of prehospital encounters for SE using data from the 2019 ESO Data Collaborative. We included patients who were ≥18 years of age, had an EMS diagnostic impression of SE, and did not have a cardiac arrest. We examined the dispatch-determined complaint designated by the emergency medical dispatch (EMD) code, dispatch-determined level of acuity (A, B, C, D), ambulance response, and training level of the responding prehospital professional.</p><p><strong>Results: </strong>Of the 18,515 patient encounters for SE with an EMD code, 8,279 (44.9%) were women, and the mean age was 40.0 years (SD 19.7). There were 13,829 (75%) encounters that received a dispatch code for seizures/convulsions and 4,686 (25%) with a dispatch code for a non-seizure-related condition. Among encounters for SE identified by dispatch as seizures/convulsions, 6,412 (46.4%) were designated high acuity, 6,626 (63.6%) were designated low acuity, and the majority received emergent ambulance responses (98.1% among those designated high acuity and 81.8% among those designated low acuity) and an Advanced Life Support-trained responder (93.7% among those designated high acuity and 92.7% among those designated low acuity). Median response times were similar for all acuity levels (9.1, 8.8, 9.1, and 8.3 minutes for A-D, respectively).</p><p><strong>Conclusion: </strong>Approximately one-fourth of SE cases were categorized as a non-seizure related condition at dispatch, and fewer than half received the highest acuity determinant code. Despite this, dispatch-assigned acuity did not have a strong relationship with the ambulance response or training level of the EMS responder or response time, suggesting that use of dispatch algorithms might be further optimized and highlighting a potential area to improve quality of EMS care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"549-555"},"PeriodicalIF":1.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Medicine Residency Website Wellness Pages: A Content Analysis.","authors":"Alexandra Sappington, Brian Milman","doi":"10.5811/westjem.34873","DOIUrl":"10.5811/westjem.34873","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic impacted the way medical students seek residency positions. In 2020, the Accreditation Council for Graduate Medical Education advocated for virtual interviews. Most emergency medicine (EM) interviews in 2023 remained virtual, and this format will persist for the foreseeable future. Since students are not evaluating programs in person in most cases, residency websites are crucial for prospective residents. Resident wellness is critical for resident training and important to prospective residents; it follows that programs must be transparent about resident wellness on websites. In this study we aimed to quantify the number of EM programs with wellness pages on their websites and identify themes portrayed on those pages.</p><p><strong>Methods: </strong>We analyzed residency website wellness pages from EM websites based on the 2022 directory of the Electronic Residency Application Service. We independently coded wellness statements through an inductive process. Codes were revised iteratively to consensus and organized into themes.</p><p><strong>Results: </strong>We identified 278 (100%) EM residency websites. Of these websites, 57 (20.5%) had a wellness page, 45 (16.2%) linked to an institutional page that discussed wellness, 169 (60.8%) discussed wellness themes on their website in areas other than a wellness page, and 69 (24.8%) had no direct mention of wellness anywhere on their website. Using this information, we identified themes including community involvement, growth and development, nutrition and health, psychological well-being, social and relaxation activities, wellness culture and environment, wellness curriculum, wellness structure and resources, and work-life integration.</p><p><strong>Conclusion: </strong>Most EM program websites do not include a wellness page. Of the programs that do, we identified important themes. The absence of dedicated wellness pages on most EM websites suggests an opportunity for programs to better communicate their wellness initiatives to applicants, helping them identify programs that align with their values.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"573-579"},"PeriodicalIF":1.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498176","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":"Trends in Studies on Transesophageal Echocardiography in Emergency Medicine: A Scoping Review.","authors":"Bor-Yuan Tseng, Chih-Jui Yang, Jen-Tang Sun, Yiju Teresa Liu, Kabir Yadav, Yu-Lin Hsieh, Sheng-En Chu, Chen-Wei Lee, Yi-Kung Lee, Tou-Yuan Tsai","doi":"10.5811/westjem.24870","DOIUrl":"10.5811/westjem.24870","url":null,"abstract":"<p><strong>Background: </strong>Transesophageal echocardiography (TEE) has been introduced in resuscitative scenarios in recent decades, with a growing number of emergency physicians learning, performing, and studying resuscitative TEE.</p><p><strong>Objective: </strong>Our goal was to characterize publishing trends regarding TEE use in emergency medicine (EM) and to investigate the increasing interest in potential applications of TEE in emergency departments (ED).</p><p><strong>Methods: </strong>We retrieved published research associated with the use of TEE in EM from the Web of Science database from inception to December 31, 2023. We analyzed trends based on the number of articles published annually. To systematically map trends related to TEE in emergency medicine (EM), we extracted data on the number of unique EM TEE practitioners, institutions performing EM TEE, study topics, and other characteristics from research articles and case reports. To better reflect research trends, we exclusively conducted subgroup analysis on the research articles. We used linear regression analysis to analyze trends and conducted checkpoints on the timelines.</p><p><strong>Results: </strong>Of the 964 titles and abstracts screened, we included 99 eligible published articles after careful review. Articles related to EM TEE increased from one article in 1991 to 20 articles in 2023, and the rate of publication has increased rapidly since 2018 (+12.4 publications per year, 95% confidence interval [CI] 9.8-15.0, P<0.001). The number of EM TEE practitioners and EM TEE-performing institutions underwent a rapid expansion with an inflection point between 2018-2020, with a rate of +91.7 practitioners per year and +36.5 institutions per year. Subgroup analysis revealed a similar trend in the published research articles. The most common indications for EM TEE were cardiac arrest (72.7%), shock (13.1%), and procedural guidance (11.1%). The United States published the majority of EM TEE-related articles (51.5%).</p><p><strong>Conclusion: </strong>The present study highlights that TEE-related articles in EM continue to accelerate. Among the indications for TEE, cardiac arrest remains the most frequently discussed. This scoping review provides insights into the expanding interest and applications of TEE in the field of EM.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"469-477"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498171","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":"Development and Evaluation of a Novel Curriculum for Whole Blood Transfusion by Paramedics in the Prehospital Environment.","authors":"Eric Garfinkel, Robby May, Asa Margolis, Eric Cohn, Steven Colburn, Tom Grawey, Matthew Levy","doi":"10.5811/westjem.19438","DOIUrl":"10.5811/westjem.19438","url":null,"abstract":"<p><strong>Introduction: </strong>Resuscitation with low-titer O+ whole blood improves the outcomes of patients with hemorrhagic shock. Recently, some emergency medical services (EMS) agencies have started to carry blood in the field. However, there exists no standardized training program to teach paramedics the fundamentals of blood administration. This study describes one EMS system's experience with implementing a novel, whole blood educational curriculum.</p><p><strong>Methods: </strong>We used Kern's six-step framework to develop a novel curriculum to provide paramedics the requisite knowledge to safely administer blood in the field. The course included an asynchronous component as well as an in-person, skills competency verification. The asynchronous portion was open to any paramedic, but only paramedic supervisors were eligible for the in-person skills check as they are the ones tasked with administering blood in the field. The course was evaluated through survey and performance outcome measurements.</p><p><strong>Results: </strong>Fifty-three (26.5%) of 200 total paramedics at a combined career and volunteer fire department enrolled in the asynchronous course, and 31 (58.5%) completed the pre- and post-course survey. Of participating paramedic supervisors, 20 of 20 (100%) finished both portions of the course. Survey answers were based on a 5-point Likert scale. We reported results as a mean, with 5 corresponding to \"strongly comfortable\" or \"strongly agree.\" There was a statistically significant increase in the number of respondents who felt overall comfortable in administering blood from 3.51 to 4.16 (P = 0.003). Additionally, there was an increase in the number of paramedics who reported feeling comfortable performing the procedure of a blood transfusion from 3.11 to 4.13 (P = <0.001). Nearly all participants (30/31) would recommend the course to someone else. In the first three months of carrying blood in the field, there were 12 units of blood transfused and no protocol deviations or safety events.</p><p><strong>Conclusion: </strong>This study provides a model for the successful creation and implementation of a prehospital blood transfusion educational program using Kern's framework. The curriculum was implemented in a single EMS system with senior paramedics, which may limit generalizability.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"535-540"},"PeriodicalIF":1.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498164","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 Disparities in Emergency Department Admission and Wait Times for Non-English Preferred Patients.","authors":"John Wong-Castillo, Daniel Berger, Juan Carlos Montoy, Riham Alwan","doi":"10.5811/westjem.21242","DOIUrl":"10.5811/westjem.21242","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who prefer to communicate in a language other than English are vulnerable to the consequences of medical communication barriers. Studies of non-English language preferred (NELP) and English language preferred (ELP) patients have shown differences in rates of hospital admission and wait times-factors known to be related to increased costs and lower patient satisfaction. However, few studies include languages other than Spanish or account for patient acuity level.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at an urban, Level I trauma center from January-December 2020. Patients were grouped by language preference, with NELP languages grouped into three categories: Spanish; Chinese (Mandarin, Cantonese, Taishanese, Taiwanese, and Zhongshan-Chinese dialect); and other (all other remaining languages). We extracted age, sex, race, ethnicity, language preference, emergency department (ED) discharge disposition, and Emergency Severity Index Score (ESI) from the electronic health record. The primary outcome was the hospital admission rate. Secondary outcomes were the time from patient arrival to placement in the treatment room and the time from patient arrival to disposition. We analyzed data with chi-square tests, logistic, and linear regressions.</p><p><strong>Results: </strong>Of the 58,079 unique ED encounters, 26.4% (15,307) patients identified as NELP. Within NELP patient encounters, 75.0% preferred Spanish, 13.9% preferred Chinese, and 11.1% preferred another language. After adjusting for age and acuity, Spanish language- and Chinese language-preferred patients were at 16% and 14% higher odds of admission, respectively (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.10-1.23 and OR 1.14, CI 1.02-1.27 respectively), compared to ELP patients. NELP patients waited an average 5.4 minutes longer to be roomed (95% CI 4.46-6.29) and 15.6 minutes longer until disposition (95% CI 12.62-18.54, P<0.05). This discrepancy was greater for patients triaged at lower acuities, with ESI 5 Spanish language- and Chinese language-preferred patients waiting an average of 50.3 and 90.6 minutes longer than ELP patients until disposition (95% CI 17.67-83.57; and 95% CI 24.31-81.57 respectively).</p><p><strong>Conclusion: </strong>After adjusting for acuity level and age, non-English language preferred patients were at higher odds of admission and experienced disparate wait times, especially at lower acuity levels. Further investigation is needed to understand the causes of these differences and mitigate these health inequities.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"415-424"},"PeriodicalIF":1.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498181","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 Department Blood Pressure Management in Type B Aortic Dissection: An Analysis with Machine Learning.","authors":"Nelson Chen, Jessica V Downing, Jacob Epstein, Samira Mudd, Angie Chan, Sneha Kuppireddy, Roya Tehrani, Isha Vashee, Emily Hart, Emily Esposito, Rose Chasm, Quincy K Tran","doi":"10.5811/westjem.25005","DOIUrl":"10.5811/westjem.25005","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissections (AAD) have a high morbidity and mortality rate. Treatment for type B aortic dissection includes strict systolic blood pressure (SBP) and heart rate (HR) control per the American Heart Association (AHA) guidelines. However, predictors of successful emergency department (ED) management of SBP have not been well studied.</p><p><strong>Methods: </strong>We retrospectively analyzed the records of adult patients presenting to any regional ED with type B AAD between 2017-2020 with initial SBP >120 mmHg and HR >60 beats per minute (bpm) and were subsequently transferred to our quaternary center. Primary outcome was SBP <120 mmHg based on both the 2010 and 2022 AHA guidelines and HR <60 bpm (based on the 2010 guideline), or HR <80 (2022 guideline). We used random forest (RF) algorithms, a machine-learning tool that uses clusters of decision trees to predict a categorical outcome, to identify predictors of achieving HR and SBP goals prior to ED departure, defined as the time point at which patients left the referring ED to come to our institution.</p><p><strong>Results: </strong>The analysis included 134 patients. At the time of ED departure, 26 (19%) had SBP <120 mmHg, 96 (67%) received anti-impulse therapy, and 40 (28%) received beta-blocker or vasodilator infusions specifically. The RF algorithm identified higher triage SBP and treatment with intravenous labetalol as the top predictors for SBP >120 mmHg at ED departure, contrary to AHA guidelines. Pain management with higher total morphine equivalent unit, as well as shorter time to computed tomography as predictors for HR <60 bpm and <80 bpm, were in concert with AHA guidelines.</p><p><strong>Conclusion: </strong>Many patients with type B AAD did not achieve hemodynamic parameters in line with 2010 or 2022 AHA guidelines while being in the ED prior to transferring to a quaternary care center for further evaluation and management. Patients with higher heart rate and systolic blood pressure on ED arrival were less likely to achieve goals at the time of departure from the referring EDs. Those receiving more pain medications prior to transfer were more likely to meet certain AHA goals.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"674-684"},"PeriodicalIF":1.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498173","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":"Evaluating the Implementation of a \"COVID-19 Test\" Chief Concern in the Emergency Department.","authors":"Collin Michels, Daniel J Hekman, Rebecca J Schwei, Ryan E Tsuchida, Joshua Gauger, Irene Hurst, Joshua Glazer, Jenna Brink, Ciara Barclay-Buchanan, Manish N Shah, Azita G Hamedani, Michael Pulia","doi":"10.5811/westjem.34850","DOIUrl":"10.5811/westjem.34850","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, rapid, at-home testing for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was inconsistently available. Consequently, for some patients, emergency departments (ED) became the preferred site to access COVID-19 testing. To improve operational efficiency, our ED implemented a \"COVID-19 Test\" chief concern (CC). Our primary objective in this analysis was to broadly assess the utilization of the new \"COVID-19 Test\" CC and associated clinical care.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of ED encounters from an academic ED and an affiliated, community-based ED of all patients after the establishment of a CC of \"COVID-19 Test\" from October 11, 2021-July 31, 2022. The data were extracted from the electronic health record. We calculated descriptive demographic statistics and ran a univariate and multivariate logistic regression with additional diagnostic or therapeutic interventions (binary) as the outcome variable to generate odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of 320 patients were assigned a \"COVID-19 Test\" CC by a triage nurse. This was 0.5% of all ED encounters in this time frame. Of those, 45% were found to be SARS-CoV-2 positive. Admission or repeat ED visit at 72 hours occurred in 5.3% of patients. Nearly half (46.9%) of patients assigned a \"COVID-19 Test\" CC underwent additional ED interventions. Patients on Medicaid and those who self-identified as Black or Hispanic/Latino were disproportionately represented in the \"COVID-19 Test\" CC group as compared to the overall ED population. In multivariate analysis, an Emergency Severity Index of 1, 2 or 3 was associated with significantly higher odds of receiving additional interventions compared to ESI of 4 or 5 (adjusted OR: 46.85; 95% CI 13.28-165.26; P <0.001).</p><p><strong>Conclusion: </strong>Patients assigned a chief concern of \"COVID-19 Test\" had a high COVID-19 positivity rate, often underwent additional ED interventions, and were at low risk of return ED visits or admission. Minoritized and low-income patients were disproportionately represented in the \"COVID-19 Test\" CC group, highlighting potential disparities in access to at-home COVID-19 testing and implementation of this CC.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"507-512"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498180","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":"Harnessing Residents' Practice-based Inquiries to Enhance Research Literacy: The Thoughtful Reading of Evidence into Clinical Settings (T-RECS) Initiative.","authors":"Emmagene Worley, Edward H Suh, Liliya Abrukin, Michael DeFilippo, Jonathan J Kamler, Mahesh Polavarapu, Peter C Wyer","doi":"10.5811/westjem.20921","DOIUrl":"10.5811/westjem.20921","url":null,"abstract":"<p><strong>Introduction: </strong>Research literacy is an important competency for all clinicians, but developing resident enthusiasm for it is difficult. At one academic emergency medicine (EM) residency program, we designed an innovative program to help residents improve literacy skills within a community of practice and use research literature to address clinical problems.</p><p><strong>Methods: </strong>A six-member faculty core team surveyed residents to assess their baseline experience with evidence-based medicine (EBM) and level of engagement with the medical literature. Interested residents joined an iterative curriculum development process that drew on previous EBM pedagogical experience and literacy theory. We developed a semi-structured approach that prioritizes using the reference frame of clinical applicability rather than research methodology. We held 90-120 minute sessions three times a year as part of the regular residency didactic conference; post-session evaluations with quantitative and qualitative elements were used to adjust subsequent didactics to refine the approach.</p><p><strong>Results: </strong>An average of 48 residents were in the EM training program during the nine sessions conducted during the study period. At baseline, residents had a high degree of exposure to EBM during medical school (94% of respondents) but low confidence in reading the medical literature (25%) or applying research to practice (10%). In contrast, they reported the novel program equipped them with skills to interpret literature and led to collective practice improvement. We found engagement was highest when residents led sessions based on inquiries that emerged out of their own training experience. Other positive factors included well-facilitated discussions between residents, relating questions to data-driven review of local practice patterns and addressing findings from free open access medical education (FOAMed) sources. The initial stages required significant team effort to design the pilot sessions, but later sessions were developed following the trajectory of resident inquiries using a minimally structured faculty consensus process and required less than 12 total faculty hours of commitment.</p><p><strong>Conclusion: </strong>An innovative program centered on residents' practice-based queries of research literature appears to enhance learner enthusiasm for development of research literacy. Further development is needed to validate the overall effectiveness and generalizability of this approach.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"564-568"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498135","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}