Western Journal of Emergency Medicine最新文献

{"title":"An Assessment of the Presence of <i>Clostridium tetani</i> in the Soil and on Other Surfaces.","authors":"Michael Shalaby, Alessandro Catenazzi, Melissa F Smith, Robert A Farrow Ii, David Farcy, Oren Mechanic, Tony Zitek","doi":"10.5811/westjem.18702","DOIUrl":"10.5811/westjem.18702","url":null,"abstract":"<p><strong>Introduction: </strong>Standard emergency medicine practice includes tetanus vaccine administration as part of wound care management for patients who are not fully immunized. Since there have been no available studies in the United States reaffirming the prevalence of <i>Clostridium tetani (C tetani)</i> since 1926, we sought to identify its prevalence in a major urban county in the US.</p><p><strong>Methods: </strong>We sampled soil, rusted metal, concrete, and dog feces to determine the prevalence of <i>C tetani</i> in a single metropolitan county in the United States. Soil samples and swabs were collected from four locations: the soil of a public park and an elementary school; dog feces from a single public dog park; and rusted surfaces (metal and concrete) in common student areas of a university campus. The presence of <i>C tetani</i> in each sample was determined using a quantitative polymerase chain reaction.</p><p><strong>Results: </strong>In total, 200 samples were collected, of which 37 (18.5%) tested positive for <i>C tetani</i> DNA. Among the 140 samples taken from the soil, just one (0.7%) tested positive for <i>C tetani</i> DNA. Of the 40 samples of rusted metal and concrete surfaces, 30 (75%) tested positive for <i>C tetani</i>, and six (30%) of the 20 samples from dog feces tested positive for <i>C tetani</i>.</p><p><strong>Conclusion: </strong>We found that <i>C tetani</i> is frequently present on rusted metal and concrete surfaces but rarely in soil samples. Minor wounds contaminated with soil may be considered low risk for tetanus. However, future studies should assess the burden of <i>C tetani</i> in other similar urban, suburban, and rural environments to help determine the threat of <i>C tetani</i> more exactly.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"890-893"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772812","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":"Comments on \"Bicarbonate and Serum Lab Markers as Predictors of Mortality in the Trauma Patient\".","authors":"Patrick McGinnis, Samantha Camp, Minahil Cheema, Shriya Jaddu, Quincy Tran, Jessica Downing","doi":"10.5811/westjem.31021","DOIUrl":"10.5811/westjem.31021","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"1025-1026"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772833","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 Patient Satisfaction Scores Are Lower for Patients Who Arrive During the Night Shift.","authors":"Tony Zitek, Luke Weber, Tatiana Nuñez, Luis Puron, Adam Roitman, Claudia Corbea, Dana Sherman, Michael Shalaby, Frayda Kresch, David A Farcy","doi":"10.5811/westjem.20326","DOIUrl":"10.5811/westjem.20326","url":null,"abstract":"<p><strong>Background: </strong>Increasingly, patient satisfaction scores are being used to assess emergency physicians. We sought to determine whether the patient satisfaction scores collected by our hospital system are lower for patients who are treated in the emergency department (ED) on night shifts as compared to those treated on day shifts.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of patient satisfaction scores from three EDs in Florida. We obtained satisfaction data from NRC Health (the company that provides our surveys) using a random sample of 1,000 completed surveys from patients treated in 2022; we also performed manual chart review to obtain clinical data. The satisfaction surveys asked patients how likely they would be to recommend the facility (from 0-10). Patients who provided a score of 9 or 10 were considered \"promoters.\" For our primary analysis, we compared the percentage of promoters for the day shift encounters (7 AM to 7 PM) to the night shift encounters (7 PM to 7 AM). We also performed a multivariable logistic regression analysis using several demographic and clinical variables to further assess the association between night shift arrival and satisfaction scores.</p><p><strong>Results: </strong>Of the 1,000 surveys analyzed, 66.3% of patients arrived during the day shift, and 33.7% arrived during the night shift. Of those who arrived during the day shift, 525 (79.2%) were promoters compared to 228 (67.7%) of those who arrived during the night shift, a difference of 11.5% (95% confidence interval [CI] 5.7-17.4%), <i>P</i> < 0.001. On multivariable analysis, night shift arrival was associated with a lower chance of a patient being a promoter, with adjusted odds ratio 0.60 (95% CI 0.43-0.84), <i>P</i> = 0.003.</p><p><strong>Conclusion: </strong>Patients who presented to the ED during the night shift were less likely to be promoters than patients who arrived during the day shift. Assessments of patient satisfaction data should account for time of visit and other facility-related and operational characteristics.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"929-937"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772888","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":"Perceptions and Use of Automated Hospital Outcome Data by EMS Providers: A Pilot Study.","authors":"Michael Kaduce, Antonio Fernandez, Scott Bourn, Dustin Calhoun, Jefferson Williams, Mallory DeLuca, Heidi Abraham, Kevin Uhl, Brian Bregenzer, Baxter Larmon, Remle P Crowe, Alison Treichel, J Brent Myers","doi":"10.5811/westjem.21175","DOIUrl":"10.5811/westjem.21175","url":null,"abstract":"<p><strong>Background: </strong>Our primary objective evaluated the perception of emergency medical service (EMS) providers' review of automated hospital outcome data. Secondarily, we assessed participation in outcome review as a means of microlearning to obtain continuing education (CE).</p><p><strong>Methods: </strong>From October-December 2023, three high-volume EMS systems participated in a three-part intervention with results evaluated using a mixed-methods approach. First, EMS providers (emergency medical technicians and paramedics) were invited, via their electronic health record (EHR), to complete a presurvey evaluating their perceptions of reviewing outcomes. Then, EMS providers were notified about the opportunity to earn CE via a microlearning intervention, offering Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE)-approved CE hours for completion of outcome reviews and associated learning modules. Finally, EMS providers were invited to complete a post-survey mirroring the pre-survey. Qualitative analyses identified themes among open-ended responses. Quantitative analyses examined perceptions between pre- and post- surveys.</p><p><strong>Results: </strong>Of 843 providers contacted, 217 responded to the pre-survey (25.7%). The most endorsed rationale for reviewing outcomes included improving clinical knowledge (95%), improving patient care (94%), and knowing whether care made a difference (93%). Nearly all (91%) reported being more likely to review outcomes if CE were awarded. Among the 67 who completed the open-ended items, the three dominant themes included enhance personal confidence and competence (43%); acquire personal knowledge (39%); and operations (21%). Of 211 providers who participated in the intervention, 56 (27%) were awarded CE. A total of 152 providers responded to the post-survey, and the percentage who agreed that reviewing outcomes improves job satisfaction rose from 89% to 95% between pre- and post-surveys (<i>P</i> = 0.05).</p><p><strong>Conclusion: </strong>EMS providers supported the personal and professional development and patient care improvement of reviewing patients' outcomes with associated CE. Further study is warranted to evaluate the generalizability of these findings and the best user experience.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"949-957"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772657","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":"Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers.","authors":"Sierra Lane, Jeffry Nahmias, Michael Lekawa, John Christian Fox, Carrie Chandwani, Shahram Lotfipour, Areg Grigorian","doi":"10.5811/westjem.20523","DOIUrl":"10.5811/westjem.20523","url":null,"abstract":"<p><strong>Introduction: </strong>The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers.</p><p><strong>Methods: </strong>We queried the 2017-2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition.</p><p><strong>Results: </strong>Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all <i>P</i> < 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], <i>P</i> < 0.001), discharged home (286 vs 160 min, <i>P</i> < 0.001), non-ICU admissions (234 vs 164 min, <i>P</i> < 0.001), and those requiring surgery (126 vs 101 min, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients' final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"938-945"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772854","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 COVID-19 Pandemic on Emergency Department Visits for Opioid Use Disorder Across University of California Health Centers.","authors":"Matthew Heshmatipour, Ding Quan Ng, Emily Yi-Wen Truong, Jianwei Zheng, Alexandre Chan, Yun Wang","doi":"10.5811/westjem.18468","DOIUrl":"10.5811/westjem.18468","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Coronavirus 2019 (COVID-19) has had a devastating impact on mental health and access to addiction treatment in the United States, including in California, which resulted in the highest rates of emergency department visits (ED) for opioid poisoning in 2020. As California slowly returns to pre-pandemic normalcy, it remains uncertain whether the rates of opioid-related events have slowed down over time. We hypothesized that the number of opioid-related ED visits were exacerbated after the period of the COVID-19 pandemic and continue at a high rate in the present.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this analysis we searched the University of California (UC) Health Data Warehouse-a database of electronic health records from six academic medical centers-for opioid related ED visits, identifiying using the following International Classification of Diseases, 10&lt;sup&gt;th&lt;/sup&gt; Ed, Clinical Modification codes: F11 codes, and T40.0*, T40.1*, T40.2*, T40.3*, T40.4*, T40.6*. Opioid overdose-associated visits were classified by types of opioids involved: heroin (T40.1*); prescription opioids (T40.2* or T40.3*); and synthetic opioids (T40.4*). We performed interrupted time analysis to estimate the immediate (level) change and change-in-time trend (trend change), from before (January 2018-October 2019) and during the pandemic (April 2020-December 2022). Monthly visit rates were evaluated with negative binomial regression adjusted for first-order autoregression and using all-cause ED counts as the offset. We present effect sizes as rate ratios (RR) and 95% confidence intervals (CI), tested at α = .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We observed a decrease in overall ED visits from 28,426 to 25,121 visits in December 2019 and June 2021, respectively across all six UC Health Centers. Before COVID-19, we found that ED visit rates steadily increased for all outcomes (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) except synthetic opioids. Total opioid-related ED visit rates increased by 15% (RR 1.15, 95% CI 1.02-1.29, &lt;i&gt;P&lt;/i&gt; = 0.20) immediately after March 2020 before decreasing by 0.5% every month, albeit without statistical significance (RR .995, 95% CI .991-1.00, &lt;i&gt;P&lt;/i&gt; = 0.06). Opioid-related events across the six academic medical centers increase from 232 in December 2019, representing a single month's total, and peaked at 315 in June 2021. Similar trends were observed with prescription opioid overdoses, with a step increase of 44% (RR 1.44, 95% CI 1.10-1.89, &lt;i&gt;P&lt;/i&gt; = .008) before plateauing after March 2020 (RR 1.01, 95% CI .998-1.02, &lt;i&gt;P&lt;/i&gt; = 0.12). Specifically, the total number of prescription opioid-related ED visits more than doubled between December 2019 (22 visits) and June 2021 (49 visits). After March 2020, ED visit rates for synthetic opioid overdoses were increasing steadily by 4% every month (RR 1.04, 95% CI 1.02-1.06, &lt;i&gt;P&lt;/i&gt; = .001), unlike with heroin, which was observed with an 8% monthly reduction (RR .92, 95% CI .90-.93, &lt;i&gt;P&lt;/i&gt; &lt; ","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"883-889"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772898","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":"Opioid Treatment Is Associated with Recurrent Healthcare Visits, Increased Side Effects, and Pain.","authors":"Caroline E Freiermuth, Jenny A Foster, Pratik Manandhar, Evangeline Arulraja, Alaattin Erkanli, Charles V Pollack, Stephanie A Eucker","doi":"10.5811/westjem.18380","DOIUrl":"10.5811/westjem.18380","url":null,"abstract":"<p><strong>Introduction: </strong>Pain is a major driver of visits to the emergency department (ED). Clinicians must consider not only the efficacy of treatment options but also subsequent healthcare utilization and patient-centered outcomes such as side effects from prescribed medications. Our goal in this study was to determine whether there was an association between acute pain treatment regimen (opioids, intranasal non-steroidal anti-inflammatory drugs [NSAIDs], or both) and unscheduled healthcare visits following ED discharge.</p><p><strong>Methods: </strong>This study was a secondary analysis of the Acute Management of Pain from the Emergency Department (AMPED) prospective, observational cohort study. We used Cox proportional hazards analysis to assess the relationship between treatment regimen and time to first unscheduled healthcare visit. Repeated measures logistic regression analyses were used to determine the relationship between treatment regimen and any unscheduled visits, and to evaluate whether this relationship was mediated by pain severity and/or medication side effects.</p><p><strong>Results: </strong>Of 831 total enrolled participants, 141 (16.9%) experienced an unplanned healthcare visit within five days of ED discharge. A majority of these visits happened one day after the ED visit. Those who were treated with intranasal NSAIDs only were less likely to have an unscheduled healthcare visit compared to those who received opioids only, with an adjusted odds ratio (AOR) of 0.63. The higher odds of unscheduled healthcare visits with opioids were mediated by both the presence of side effects and higher pain levels, with AORs of 2.24 and 1.33, respectively.</p><p><strong>Conclusion: </strong>Opioid treatment for acute pain is associated with increased unscheduled healthcare visits compared to those treated with intranasal ketorolac. This difference can be explained by higher levels of ongoing pain and greater medication side effects.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"875-882"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772537","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 California Managed Care Organization Tax and Medi-Cal Patients in the Emergency Department.","authors":"Lauren Murphy, Gita Golonzka, Ellen Shank, Jorge Fernandez","doi":"10.5811/westjem.35257","DOIUrl":"10.5811/westjem.35257","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"1000-1002"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772669","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":"Use of Parenteral Antibiotics in Emergency Departments: Practice Patterns and Class Concordance.","authors":"Megan Elli, Timothy Molinarolo, Aidan Mullan, Laura Walker","doi":"10.5811/westjem.17998","DOIUrl":"10.5811/westjem.17998","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess antibiotic stewardship by quantifying the use of first-dose intravenous (IV) vs oral-only antibiotics and the frequency with which antibiotic class was changed for discharged patients. Secondary aims included the following: evaluation of the relative length of stay (LOS); differences in prescribing patterns between clinician types; differences between academic and community settings; assessment of prescribing patterns among emergency department (ED) diagnoses; and frequency of return visits for patients in each group.</p><p><strong>Methods: </strong>This was a retrospective cohort study including patients presenting to EDs with infections who were discharged from our Midwest healthcare system consisting of 17 community hospitals and one academic center. We included infection type, antibiotic class and route of administration, type of infection, LOS, return visit within two weeks, clinician type, and demographics. Data were collected between June 1, 2018-December 31, 2021 and analyzed using descriptive statistics.</p><p><strong>Results: </strong>We had 77,204 ED visits for patients with infections during the study period, of whom 3,812 received IV antibiotics during their visit. There were more women (62.4%) than men included. Of the 3,812 patients who received IV antibiotics, 1,026 (34.3%) were discharged on a different class of antibiotics than they received. The most common changes were from IV cephalosporin to oral quinolone or penicillin. Patients treated with IV antibiotics prior to discharge had a longer LOS in the ED (median difference of 102 minutes longer for those who received IV antibiotics). There was not a significant difference in the use of IV antibiotics between the academic center and community sites included in the study.</p><p><strong>Conclusion: </strong>Administering IV antibiotics as a first dose prior to oral prescriptions upon discharge is common, as is shifting classes from the IV dose to the oral prescription. This offers an opportunity for intervention to improve antibiotic stewardship for ED patients as well as reduce cost and length of stay.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"966-974"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772670","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":"Recent Interventions for Acute Suicidality Delivered in the Emergency Department: A Scoping Review.","authors":"Alex P Hood, Lauren M Tibbits, Juan I Laporta, Jennifer Carrillo, Lacee R Adams, Stacey Young-McCaughan, Alan L Peterson, Robert A De Lorenzo","doi":"10.5811/westjem.18640","DOIUrl":"10.5811/westjem.18640","url":null,"abstract":"<p><strong>Introduction: </strong>Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients.</p><p><strong>Methods: </strong>We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013-2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy.</p><p><strong>Results: </strong>Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings.</p><p><strong>Conclusion: </strong>This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"858-868"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772661","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}