Western Journal of Emergency Medicine最新文献

{"title":"Emergency Medicine Clerkship Grading Scheme, Grade, and Rank-List Distribution as Reported on Standardized Letters of Evaluation.","authors":"Alexandra Mannix, Thomas Beardsley, Thomas Alcorn, Morgan Sweere, Michael Gottlieb","doi":"10.5811/westjem.18687","DOIUrl":"10.5811/westjem.18687","url":null,"abstract":"<p><strong>Background: </strong>The Standardized Letter of Evaluation (SLOE) is a crucial component of the emergency medicine (EM) application process. Given the critical role of the SLOE, we attempted to better understand the grading scales used, as well as the distribution of grades and rank-list positions.</p><p><strong>Objectives: </strong>Our primary objective in this study was to determine the distribution of grading formats, grades given, and rank-list positions across EM clerkships using the SLOE.</p><p><strong>Methods: </strong>We performed a cross-sectional study of the grading formats, grades given, and ranking distributions as reported on the SLOE during the 2022-23 application cycle. We obtained data on SLOEs from EM residency programs accredited by the Accreditation Council for Graduate Medical Education by reviewing all applicants who applied to either of two EM residency programs in geographically different regions. Trained abstractors recorded the following data: number of students rotating in the prior year; grading format used; and grade and rank distribution among students.</p><p><strong>Results: </strong>We included 264 programs in our final analysis, after 13 programs met exclusion criteria. The majority of programs (72.2%) use an Honors/High Pass/Pass/Fail grading scheme. We determined the mean percent of each grade: Honors/A 27.6%; High Pass/B 31.1%; Pass/C 40.8%; Low Pass/D 0.2%; and Fail/F 0.3%. Finally, we determined the mean percent for each rank-list position: top 10% was 17.6%; top third 36.5%; mid third 34.1%; and low third 11.8%.</p><p><strong>Conclusion: </strong>We determined the grading schemes and grade and rank-list distributions for EM programs during the 2022-2023 academic year. Most programs used a Honors/High Pass/Pass/Fail grading scheme, with the majority of students receiving Honors or High Pass, while 0.3% failed their rotation. Both grades and rank list demonstrated evidence of a skewed distribution toward higher grades and rank-list position.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"66-69"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366109","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":"Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis.","authors":"William Bonadio, Connor Welsh, Brad Pradarelli, Yunfai Ng","doi":"10.5811/westjem.18555","DOIUrl":"10.5811/westjem.18555","url":null,"abstract":"<p><strong>Objective: </strong>Our goal was to characterize a large group of children presenting to the emergency department (ED) with acute anaphylaxis, treated with intramuscular epinephrine (IM EPI) and a corticosteroid (CS), and to determine the impact of pharmacologic intervention on the rate and timing of biphasic reactions (BPR).</p><p><strong>Methods: </strong>We reviewed consecutive children diagnosed with acute anaphylaxis managed in three EDs during a six-year period. All received IM EPI and CS, followed by monitoring for 4-6 hours post-treatment. We analyzed the rate and timing of BPR, comparing the intervals of 0-4 vs 4-48 hours after initiating therapy.</p><p><strong>Results: </strong>During the study period, there were 371 cases of anaphylaxis, of which 357 (94%) received both IM EPI and CS. Of these, 49 (14%) manifested BPR [84% had received prehospital IM EPI] requiring at least one additional dose of IM EPI [14% required ≥2 additional doses]. All BPR episodes occurred within the 0-4 hour interval after initiating therapy, whereas no patient manifested a BPR requiring an additional dose of IM EPI during the 4-48 hours after initiating therapy (<i>P</i> = <0.001, 95% CI 0-1.3%). No patient returned to the ED with recurrence of anaphylaxis symptoms within 48 hours after discharge.</p><p><strong>Conclusion: </strong>Approximately 1 in 7 children with anaphylaxis experience a biphasic reaction after receiving intramuscular epinephrine. Children with anaphylaxis who exhibit symptomatic resolution four hours following initiation of therapy have a low risk for subsequently developing BPR. Most BPR cases required only one additional dose of IM EPI to effect resolution. The rate of BPR in those receiving IM EPI and a corticosteroid is significantly lower >4 hours vs <4 hours after initiating therapy.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"171-175"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366120","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 Hospital Boarding on Emergency Medicine Residency Productivity.","authors":"Peter Moffett, Al Best, Nathan Lewis, Stephen Miller, Grace Hickam, Hannah Kissel-Smith, Laura Barrera, Scott Huang, Joel Moll","doi":"10.5811/westjem.31064","DOIUrl":"10.5811/westjem.31064","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department boarding has escalated to a crisis, impacting patient care, hospital finances, and physician burnout, and contributing to error. No prior studies have examined the effects of boarding hours on resident productivity. If boarding reduces productivity, it may have negative educational impacts. We investigated the effect of boarding on resident productivity as measured by patients per hour and hypothesized that increased boarding leads to decreased productivity.</p><p><strong>Methods: </strong>This was a retrospective study at a quaternary, urban, academic Level I trauma center from 2017-2021 with a three-year emergency medicine residency of 10-12 residents per year and annual volumes of 80,000-101,000. Boarding was defined as the time between an admission order and the patient leaving the ED. We created a multivariable mixed model with fixed covariates for year, month, day of week, resident experience, shift duration, total daily ED patients, and with residents as repeated measures. The effect of boarding was estimated after covarying out all other factors.</p><p><strong>Results: </strong>All variables included in the model were significantly associated with changes in productivity. Resident experience has the largest effect such that for each month of residency experience, a resident adds 0.012 patients per hour (95% confidence interval [CI] 0.010-0.014). Isolating the effect of boarding demonstrated that for every additional 100 hours of boarding, a resident's productivity decreased by 0.022 patients per hour (95% CI 0.016-0.028). In the study, the median daily boarding was 261 hours; if this were eliminated (assuming a resident completes 100 10-hour shifts annually), a resident could be expected to see 56.9 more patients per year (95% CI 40.7-73.1).</p><p><strong>Conclusion: </strong>Hospital boarding significantly reduces resident productivity as measured by patients per hour. Further studies are warranted to determine the educational impact.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"53-61"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366156","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":"#emergencymedicine: A TikTok Content Analysis of Emergency Medicine-related Content.","authors":"Madison Stolly, Erika Wilt, Nathan Gembreska, Mohamad Nawras, Emily Moore, Kelly Walker, Rhonda Hercher, Mohamad Moussa","doi":"10.5811/westjem.19466","DOIUrl":"10.5811/westjem.19466","url":null,"abstract":"<p><strong>Background: </strong>TikTok has rapidly become one of the most extensively downloaded and used social media platforms worldwide. Our focus on emergency medicine (EM)-related content on TikTok is to identify what specific video characteristics result in higher degrees of audience engagement, defined in this study as a total of video likes, comments, and shares.</p><p><strong>Methods: </strong>Five second-year medical students using newly created TikTok accounts independently downloaded the first 100 videos to appear using the hashtag #emergencymedicine. The videos were reviewed for 52 variables. We performed a multiple linear regression analysis to examine the relationship between the variables and video engagement.</p><p><strong>Results: </strong>Of the examined videos, 45.8% (222/484) were produced by physicians (MD or DO). Approximately half, 50.0% (242/484), had an educational component, while 55.4% (268/484) of videos were judged to have an entertainment component. Preliminary findings indicate that among TikTok videos featuring #emergencymedicine, a statistically significant positive correlation exists between video engagement and the presence of a healthcare identifier, (ie, individuals wearing white coats or scrubs). No significant correlation was observed between video engagement and video creators' self-identification as a healthcare professional, use of entertainment, or use of education. A notable negative correlation was identified between video engagement and the inclusion of music.</p><p><strong>Conclusion: </strong>We identified qualities associated with negative and positive correlation with video engagement. For the 100 videos, only healthcare attire, such as wearing a white coat or scrubs, showed a significant positive correlation with engagement, while those with background music showed a negative correlation. Our study offers insight into how EM professionals can effectively use characteristics associated with higher engagement rates to relay information to a wider audience on TikTok.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"155-160"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365520","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":"A Machine Learning Algorithm to Predict Medical Device Recall by the Food and Drug Administration.","authors":"Victor Barbosa Slivinskis, Isabela Agi Maluli, Joshua Seth Broder","doi":"10.5811/westjem.21238","DOIUrl":"10.5811/westjem.21238","url":null,"abstract":"<p><strong>Introduction: </strong>Medical device recalls are important to the practice of emergency medicine, as unsafe devices include many ubiquitous items in emergency care, such as vascular access devices, ventilators, infusion pumps, video laryngoscopes, pulse oximetry sensors, and implantable cardioverter defibrillators. Identification of dangerous medical devices as early as possible is necessary to minimize patient harms while avoiding false positives to prevent removal of safe devices from use. While the United States Food and Drug Administration (FDA) employs an adverse event reporting program (MedWatch) and database (MAUDE), other data sources and methods might have utility to identify potentially dangerous medical devices. Our objective was to evaluate the sensitivity, specificity, and accuracy of a machine learning (ML) algorithm using publicly available data to predict medical device recalls by the FDA.</p><p><strong>Methods: </strong>We identified recalled medical devices (RMD) and non-recalled medical devices (NRMD) using the FDA's website and online database. We constructed an ML algorithm (random forest regressor) that automatically searched Google Trends and PubMed for the RMDs and NRMDs. The algorithm was trained using 400 randomly selected devices and then tested using 100 unique random devices. The algorithm output a continuous value (0-1) for recall probability for each device, which were rounded for dichotomous analysis. We determined sensitivity, specificity, and accuracy for each of three time periods prior to recall (T-3, 6, or 12 months), using FDA recall status as the reference standard. The study adhered to relevant items of the Standards for Reporting Diagnostic accuracy studies (STARD) guidelines.</p><p><strong>Results: </strong>Using a rounding threshold of 0.5, sensitivities for T-3, T-6, and T-12 were 89% (95% confidence interval [CI] 69-97), 90% (95% CI 70-97), and 75% (95% CI 53-89). Specificity was 100% (95% CI 95-100) for all three time periods. Accuracy was 98% (95% CI 93-99) for T-3 and T-6, and 95% (95% CI 89-99) for T-12. Using tailored thresholds yielded similar results.</p><p><strong>Conclusion: </strong>An ML algorithm accurately predicted medical device recall status by the FDA with lead times as great as 12 months. Future research could incorporate longer lead times and data sources including FDA reports and prospectively test the ability of ML algorithms to predict FDA recall.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"161-170"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365521","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":"Beirut Port Blast: Use of Electronic Health Record System During a Mass Casualty Event.","authors":"Eveline Hitti, Dima Hadid, Miriam Saliba, Zouhair Sadek, Rima Jabbour, Rula Antoun, Mazen El Sayed","doi":"10.5811/westjem.20942","DOIUrl":"10.5811/westjem.20942","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments (ED) play a central role in defining the effectiveness and quality of the overall hospital's mass casualty incident (MCI) response. The use of electronic health records (EHR) in hospital settings has been rapidly growing globally. There is, however, a paucity of literature on the use and performance of EHR during MCIs.</p><p><strong>Methods: </strong>In this study we aimed to describe EHR use, as well as the challenges and lessons learnt in response to the 2020 explosion in the Port of Beirut, Lebanon, during which the hospital received over 360 casualties.</p><p><strong>Results: </strong>Information technology support, reducing EHR system restrictions, cross-function training, focus on registration and patient identification, patient flow and tracking, mobility and bedside access, and alternate sites of care are all important areas to focus on during emergency/disaster response planning.</p><p><strong>Conclusion: </strong>Innovative solutions that help address logistical challenges for different aspects of the disaster response are needed.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"20-29"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365877","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 Provider-Perceived Alzheimer's Disease and Related Dementias in the Prehospital Setting.","authors":"Esmeralda Melgoza, Valeria Cardenas, Hiram Beltrán-Sánchez","doi":"10.5811/westjem.18593","DOIUrl":"10.5811/westjem.18593","url":null,"abstract":"<p><strong>Objective: </strong>Our goal was to assess emergency medical services (EMS) provider-perceived Alzheimer's disease and related dementias (ADRD) by patient sociodemographic characteristics and ZIP code tabulation areas (ZCTA) in the prehospital setting.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive analysis of EMS calls with patient contact for adults ≥ 65 years of age who were provided prehospital care between February 1, 2020 and January 31, 2022, using data from the San Francisco Department of Emergency Management and the 2021 American Community Survey. Logistic regression models assessed the associated between EMS provider-perceived ADRD and patient sociodemographic characteristics, including age, race/ethnicity, incident location, and ZCTA-level socioeconomic status.</p><p><strong>Results: </strong>A total of 55,129 patient encounters were recorded, with EMS provider-perceived ADRD recorded in 4,112 (7.5%). Among cases with EMS provider-perceived ADRD, the most common primary impressions were mental disorders (17.1%), weakness (17.0%), injury (15.7%), and pain (13.1%). Increasing age was associated with higher odds of EMS provider-perceived ADRD among both sexes. Among females, EMS provider-perceived ADRD was higher among Hispanics (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.11-1.52), Blacks (OR 1.20, 95% CI 1.03-1.40), Asians (OR 1.18, 95% CI 1.06-1.31), and Native Hawaiian and Pacific Islanders (OR 1.48, 95% CI 1.05-2.08]), while among males, only Asians (OR 87, 95% CI .76-.99) had lower odds, all compared to Whites. Females in low- and medium-income ZCTAs had lower odds of EMS provider-perceived ADRD relative to high-income ZCTAs, with no significant findings in males.</p><p><strong>Conclusion: </strong>Our findings suggest a higher prevalence of EMS provider-perceived Alzheimer's disease and related dementias among minoritized and socioeconomically disadvantaged populations, including the oldest adults, and racial and ethnic minority communities. Future research and more precise data collection is needed to ensure equity for older adults who access emergency care in the prehospital setting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"86-95"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Fentanyl Use and Post-Intubation Mean Arterial Pressure During Rapid Sequence Intubation: Prospective Observational Study.","authors":"Abdullah Bakhsh, Ahmad Bakhribah, Raghad Alshehri, Nada Alghazzawi, Jehan Alsubhi, Ebtesam Redwan, Yasmin Nour, Ahmed Nashar, Elmoiz Babekir, Mohamed Azzam","doi":"10.5811/westjem.18435","DOIUrl":"10.5811/westjem.18435","url":null,"abstract":"<p><strong>Introduction: </strong>The choice of medications used in rapid sequence intubation (RSI) can result in the difference between an acceptable outcome and a lethal one. When executed properly, RSI is a lifesaving intervention. Nonetheless, RSI may result in fatal complications such as peri-intubation cardiac arrest. The risk of peri-intubation cardiac arrest reportedly increases in patients who are profoundly hypoxic or hypotensive prior to endotracheal intubation. Medication choice for RSI may either optimize or deoptimize hemodynamic parameters, thereby impacting patient outcomes. Therefore, our study aimed to examine the association of change in mean arterial pressure (MAP) with and without the use of a predetermined dose of 50 micrograms (μg) intravenous fentanyl as a pretreatment agent during RSI.</p><p><strong>Methods: </strong>This prospective observational study included patients undergoing RSI at an academic emergency department (ED) over a three-year period between January 1, 2018-January 1, 2021. Average hemodynamic parameters were measured at the time of induction (prior to medication administration) and 10 minutes after induction. We categorized patients into fentanyl and non-fentanyl groups for analysis, and we compared data using chi-square and <i>t</i>-test as appropriate. Logistic regression analysis was conducted to account for potential confounding factors.</p><p><strong>Results: </strong>A total of 278 patients were included in the analysis, of whom 160 received fentanyl and 118 did not. The majority of the patients underwent RSI by trainees 95.0% of the time. The first-pass success rate was 77.7% in our sample and did not differ significantly between the two groups (<i>P</i> = 0.84). Unadjusted analysis showed a larger decrease in hemodynamic parameters in the fentanyl group compared to the non-fentanyl group; systolic blood pressure decreased by 11.2% vs 1.6%, diastolic blood pressure decreased by 13.7% vs 3.8%, and MAP decreased by 12.7% vs 3.2%. After adjusting for potential confounders, fentanyl was 2.14 times more likely to lower MAP by 10%.</p><p><strong>Conclusion: </strong>The use of 50 μg fentanyl for rapid sequence intubation in an ED is associated with higher odds of decreasing mean arterial pressure by at least 10% at 10 minutes from the time of induction. Therefore, it should be carefully dosed, and its use in clinical practice should be justified to avoid unnecessary complications.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"10-19"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365834","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":"Self-Reported COVID-19 Vaccine Status and Barriers for Pediatric Emergency Patients and Caregivers.","authors":"Amanda M Szarzanowicz, Kendra Fabian, Maya Alexandri, Carly A Robinson, Sonia Singh, Michael Wallace, Michelle D Penque, Nan Nan, Changxing Ma, Bradford Z Reynolds, Bethany W Harvey, Heidi Suffoletto, E Brooke Lerner","doi":"10.5811/westjem.18417","DOIUrl":"10.5811/westjem.18417","url":null,"abstract":"<p><strong>Objective: </strong>This study determined if the caregivers of children in the emergency department (ED) have the same COVID-19 vaccination status as the child, the reasons they chose to not vaccinate the child, and self-identified barriers to vaccination to determine if the ED is appropriate for vaccination intervention.</p><p><strong>Methods: </strong>A survey was administered to caregivers of pediatric ED patients at four Children's Hospitals in: Augusta, GA, Buffalo, NY, Madison, WI, and Sacramento, CA. Participants were asked about their and the child's demographics, vaccination status, and barriers to vaccination. We used descriptive statistics, Cohen's kappa, and logistic regression to analyze responses.</p><p><strong>Results: </strong>941 caregivers were considered for enrollment, and 800 consented to participation. Participants were 75% women with a mean age of 40.9 ± 8.9 years. 51% (409) of the pediatric ED patients were COVID-19 vaccinated, as were 74% (591) of the caregivers. There was variation across sites, but overall, 15% of caregivers of unvaccinated children wanted the child tobe vaccinated with the most common barriers to vaccination identified as safety data (25%), time availability (20%), and ability to obtain an appointment (13%). The most common reason for not wanting the child COVID-19 vaccinated was concern the vaccine didn't work or had too many side effects.</p><p><strong>Conclusion: </strong>A small but clinically important group of pediatric ED patients are not COVID-19 vaccinated but their caregivers want them to be vaccinated, indicating that consideration should be given to offering vaccination in the ED. Reasons for avoiding COVID-19 vaccination were primarily concerns with efficacy and side effects.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"96-102"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366150","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":"Electroencephalography Correlation of Ketamine-induced Clinical Excitatory Movements: A Systematic Review.","authors":"Emine M Tunc, Neil Uspal, Lindsey Morgan, Sue L Groshong, Julie C Brown","doi":"10.5811/westjem.18611","DOIUrl":"10.5811/westjem.18611","url":null,"abstract":"<p><strong>Background: </strong>This is a systematic review investigating the correlation between seizures identifiable on electroencephalogram (EEG), clinical excitatory movements (CEM), and ketamine administration for procedural sedation.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science in April 2021. Search terms included variations for ketamine, myoclonus, seizures, status epilepticus, and electroencephalography. Two independent reviewers assessed papers based on eligibility criteria, which included human studies where EEG recordings were obtained during ketamine administration.</p><p><strong>Results: </strong>Eight papers were eligible for inclusion with 141 subjects (24 children). Seven studies (133 subjects) reported epilepsy history; 70% (94/133) of these subjects had a pre-existing epilepsy diagnosis. No (0/39) subjects without epilepsy and 28% (26/94) of subjects with epilepsy had electrographic seizures after ketamine administration. In four studies where pediatric and adult subjects could be separated, children with epilepsy had electrographic seizures in 60% (3/5) of cases compared to 28% (6/33) of cases of adults with epilepsy. Of the subjects with epilepsy, 14% (10/74) had CEMs vs 5% (1/21) in subjects without epilepsy. Most CEMs (9/11) were temporally correlated with electrographic seizures.</p><p><strong>Conclusions: </strong>Our findings indicate that in subjects with epilepsy, electrographic seizures were frequently seen with ketamine administration and were correlated with CEMs. No seizure activity after ketamine was seen in subjects without epilepsy. While the clinical significance of these findings needs further investigation, clinicians may want to consider patients' seizure history when providing counseling on the risks and benefits of ketamine sedation.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"147-154"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366049","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}