Western Journal of Emergency Medicine最新文献

{"title":"Integrating Disaster Response Tools for Clinical Leadership.","authors":"Kenneth V Iserson","doi":"10.5811/westjem.35390","DOIUrl":"10.5811/westjem.35390","url":null,"abstract":"<p><strong>Background: </strong>Disastrous situations in the emergency department (ED) or community can overwhelm even the best-prepared teams due to their complexity and dynamic nature. In this paper we propose an integrated approach to disaster management, combining six theoretical and practical frameworks to enhance decision-making and operational effectiveness.</p><p><strong>Discussion: </strong>The approach begins with \"sensemaking,\" an instinctive process that helps leaders quickly gain situational awareness, a crucial foundation for the recognition-primed decision process (RPD). RPD enables swift, experience-based decisions without exhaustive analysis, aligning them with the appropriate domain in the Cynefin framework to guide subsequent interventions. In chaotic situations, rapid action is necessary, and the edge-of-chaos theory guides leaders to balance order and chaos for optimal adaptability. Complexity theory aids in managing the unpredictable elements of a crisis, highlighting the need for flexible responses. Finally, the Incident Command System ensures effective implementation by providing a standardized approach to command, control, and coordination. This cohesive strategy equips emergency physicians and incident commanders to manage both internal ED crises and broader community disasters effectively, with an emphasis on the importance of training in these frameworks to enhance the resilience of emergency medical services.</p><p><strong>Conclusion: </strong>This multifaceted approach should improve disaster management by better preparing responders for the unpredictable nature of emergencies, enabling effective evaluation and management of complex scenarios, and leading to a more rapid restoration of order.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"30-39"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366121","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":"Practice Patterns of Graduates of a Rural Emergency Medicine Training Program.","authors":"Dylan S Kellogg, Miriam S Teixeira, Michael Witt","doi":"10.5811/westjem.18661","DOIUrl":"10.5811/westjem.18661","url":null,"abstract":"<p><strong>Introduction: </strong>Rural communities continue to face a shortage of emergency physicians despite the growing number of emergency medicine (EM) residencies. In rural areas, emergency physicians tend to be older, male, and White, and are less likely to have completed EM residency training or have board certification. There is also currently a higher rate of rural physicians leaving clinical practice than in urban emergency departments (ED). In this cross-sectional study we sought to identify the work environments of graduates of a rural EM residency program, and the strengths and weaknesses of such a program.</p><p><strong>Methods: </strong>We conducted a survey among 29 graduates of a community-based EM program to evaluate the effectiveness of a residency program in training physicians who will work in rural areas. The survey assessed the graduates' perceptions of their level of preparedness, further training, and practice location after completing the program. Results are reported using descriptive statistics.</p><p><strong>Results: </strong>Twenty respondents completed the survey (69%). Most of them identified as male (60%), White (70%), and non-Hispanic or -Latino (80%). Seventy-five percent of the graduates work in counties with fewer than 1,000,000 inhabitants, and 70% work in community hospitals and EDs caring for fewer than 100,000 patients/year. Four (20%) declared to work in critical access hospitals. Overall, respondents felt confident in their residency training.</p><p><strong>Conclusion: </strong>A community-based EM training program may be an effective strategy for producing emergency physicians who go on to work in rural and smaller communities.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"40-46"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366142","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":"Associations of the Need for Surgery in Emergency Department Patients with Small Bowel Obstructions.","authors":"Daniel J Berman, Alexander W Mahler, Ryan C Burke, Andrew E Bennett, Nathan I Shapiro, Leslie A Bilello","doi":"10.5811/westjem.18455","DOIUrl":"10.5811/westjem.18455","url":null,"abstract":"<p><strong>Objectives: </strong>Management strategies for small bowel obstruction (SBO) vary from conservative approaches to surgical intervention. A known complication of surgery is the subsequent adhesions that can cause recurrent SBOs, longer hospital stays, and higher treatment costs. Our primary outcome was to identify independent risk factors that are associated with the decision for surgical intervention, and our secondary outcome was to describe characteristics of visits associated with complications.</p><p><strong>Methods: </strong>This study was a single-center, retrospective chart review from a large, urban university hospital. We included adult patients admitted to the emergency department (ED) with the International Classification of Diseases, 10th Rev, codes for small bowel obstruction from June 1, 2017- May 30, 2019. Eligible covariates were demographics, radiological findings, clinical presentation, past medical history, and results of radiologic testing. We identified univariate associations of outcome and then performed a multivariate logistic regression to identify independent associations of each outcome. Finally, a backwards selection was used to determine the final model. We calculated odds ratios (OR) and 95% confidence intervals (CI) along with the area under the curve (AUC), as appropriate.</p><p><strong>Results: </strong>A total of 530 patients met the study criteria; 148 (27.9%) underwent surgery of whom 35 (6.6%) had complications. We identified seven independent associations for the decision of surgery: abdominal distension (OR 0.27, 95% CI 0.10-0.62); gastrografin (OR 0.41, 95% CI 0.20-0.81); previous SBO (OR 0.42, 95% CI 0.26-0.66); higher Charlson Comorbidity Index score (OR 0.87, 95% CI 0.80-0.95); nasogastric decompression (OR 2.04, 95% CI 1.25-3.39), initial systolic blood pressure <100 mm Hg (OR 2.65, 95% CI 1.05-6.53); free fluid or volvulus/closed-loop obstruction on computed tomography (OR 7.95, 95% CI 4.25-15.39), with the AUC for the predictive model equaling 0.73.</p><p><strong>Conclusion: </strong>We identified seven independent associations present in the ED associated with the decision for surgery. These associations are a step toward building better prediction models and improving decision-making in the ED, allowing for a more adequate treatment plan.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"135-141"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365838","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 Physicians' and Nurses' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany.","authors":"Torben Brod, Carsten Stoetzer, Christoph Schroeder, Stephanie Stiel, Kambiz Afshar","doi":"10.5811/westjem.20919","DOIUrl":"10.5811/westjem.20919","url":null,"abstract":"<p><strong>Introduction: </strong>Providing appropriate healthcare for transgender, intersexual and non-binary (TIN) individuals remains a significant challenge, as this group experiences higher rates of health inequalities, discrimination, and barriers to accessing care. Emergency physicians (EP) often lack formal training and knowledge about caring for TIN patients, while comparatively less evidence is available for other healthcare professionals, including emergency nurses (EN). Therefore, our goal in this study was to explore the experiences, knowledge, and attitudes as well as education/training needs of both ENs and EPs in Germany regarding the care of TIN patients.</p><p><strong>Methods: </strong>In February 2023, we electronically surveyed EPs and ENs from emergency departments (ED) across Germany. The survey, developed through literature review and collaboration with experts and members of the TIN community, consisted of 15 closed-ended items divided into three sections: experiences and knowledge; attitudes; and education/training needs. We used standard descriptive statistics and tested for group differences using the chi-square test.</p><p><strong>Results: </strong>Of the approximately 1,665 EPs and ENs contacted, 502 completed the survey and were eligible for further analysis (30% response rate). Of the respondents, 233 (46%) were EPs and 269 (54%) were ENs, with ENs being significantly younger and with fewer years in practice. More than half reported experience caring for TIN patients (71% of ENs vs 61% of EPs; <i>P</i> = 0.002), but there were significant gaps in medical and non-medical knowledge. Attitudes toward TIN patients were generally positive, but differences in communication approaches were noted, with ENs significantly more likely than EPs to limit their communication with TIN patients to what was necessary (25% of ENs vs 17% of EPs; <i>P</i> = 0.006). Most respondents (55% of ENs and 58% of EPs) had no training in the management of TIN patients, with only 8% of EPs and 17% of ENs having received such training during their medical/nursing school education (<i>P</i> = 0.01). Both groups agreed that there is an urgent need to increase awareness of emergency medical care for TIN patients among ED staff.</p><p><strong>Conclusion: </strong>Both emergency physicians and nurses in Germany demonstrated deficits in knowledge of and clinical preparedness to care for patients in the ED who identify as transgender, intersexual and non-binary, indicating a clear need for enhanced education, training, and institutional support to improve emergency care for this vulnerable patient population.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"111-119"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366113","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":"Pediatric Emergency Department-based Food Insecurity Screening During the COVID-19 Pandemic.","authors":"Stephanie Ruest, Lana Nguyen, Celeste Corcoran, Susan Duffy","doi":"10.5811/westjem.19488","DOIUrl":"10.5811/westjem.19488","url":null,"abstract":"<p><strong>Introduction: </strong>The emergency department (ED) is a safety net, caring for families who lack adequate access to food and other basic needs. The COVID-19 pandemic caused a dramatic rise in food insecurity (FI) nationally; however, little is known about the prevalence of FI among families seen in pediatric EDs (PED). In this study we aimed to determine the prevalence of FI, as well as awareness and utilization of supplemental food services, among families seen in an urban PED during the COVID-19 pandemic using an electronic screening survey.</p><p><strong>Methods: </strong>This was a cross-sectional survey of families screened for FI in an urban PED. An electronic survey was advertised to all families via posters placed in patient rooms and other locations in the PED between February-October 2022. Surveys in English and Spanish were accessed on personal electronic devices via QR codes. Six validated US Department of Agriculture household food security questions and sociodemographic questions were included. We calculated respondents' food security and performed descriptive and bivariate analyses of patient sociodemographics and responses to FI questions.</p><p><strong>Results: </strong>Of 42,697 PED visits, 612 surveys were completed and analyzed (1.4%). Nearly 50% of respondents identified as White and non-Hispanic, with approximately 80% female. Thirty percent had a household income of <$25,000 and 32% between $25,000-<50,000. Among survey respondents, 56.7% demonstrated FI: 25% with low food security, and 31.7% with very low food security. We identified statistically significant differences in awareness and use of supplemental food services by FI status, household income, and primary language spoken.</p><p><strong>Conclusions: </strong>Nearly 60% of survey participants in an urban pediatric ED during the COVID-19 pandemic experienced food insecurity, substantially higher than previous reports. These results support the ED's contributory role in FI screening, particularly during times of a public health crisis, and highlights the need for targeted outreach in this setting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"120-128"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366129","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":"Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department.","authors":"Frank-Peter Stephan, Florian N Riede, Luca Ünlü, Gioele Capoferri, Tito Bosia, Axel Regeniter, Roland Bingisser, Christian H Nickel","doi":"10.5811/westjem.35286","DOIUrl":"10.5811/westjem.35286","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperkalemia, a potentially life-threatening electrolyte disturbance, is commonly encountered in the Emergency Department (ED). However, the frequency of factitious hyperkalemia, an artificially elevated potassium level in hyperkalemic ED patients, is unknown. This study aims to detect the rate of factitious hyperkalemia among patients with a potassium concentration of ≥5.0 mmol/l in an all-comer ED population.</p><p><strong>Methods: </strong>This retrospective, monocentric chart review analyzed data of 2,440 ED patients who presented with a potassium concentration of ≥5.0 mmol/L in their initial whole blood or plasma sample, who also underwent a repeat potassium measurement on the same day. Two groups were established based on potassium levels in the initial and repeat blood tests: 1) True hyperkalemia, characterized by consistently elevated potassium levels in both the initial and repeat samples; and 2) Factitious hyperkalemia, defined by an elevated initial potassium level while the repeat blood test showed a normal potassium level. A subset of factitious hyperkalemia was spurious hyperkalemia. In spurious hyperkalemia, the initial blood sample showed an elevated potassium level with evidence of hemolysis, but a repeat test revealed a normal potassium level without evidence of hemolysis.</p><p><strong>Results: </strong>Of the 2,440 patients, 1,576 (65%) had true hyperkalemia and 864 (35%) factitious hyperkalemia. Among the 864 patients with factitious hyperkalemia, 597 (69%) displayed hemolysis in their initial blood sample, indicating spurious hyperkalemia due to in-vitro hemolysis.</p><p><strong>Conclusion: </strong>These data show that about one third of all hyperkalemic blood samples drawn in the ED were due to factitious hyperkalemia. The leading cause of factitious hyperkalemia was spurious hyperkalemia due to in-vitro hemolysis.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"176-179"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366116","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":"Effectiveness of a Collaborative, Virtual Outreach Curriculum for 4th-Year EM-bound Students at a Medical School Affiliated with a Historically Black College and University.","authors":"Cortlyn Brown, Richard Carter, Nicholas Hartman, Aaryn Hammond, Emily MacNeill, Lynne Holden, Ava Pierce, Linelle Campbell, Marquita Norman","doi":"10.5811/westjem.18748","DOIUrl":"10.5811/westjem.18748","url":null,"abstract":"<p><strong>Background: </strong>Diversity within the physician workforce is associated with improved clinical outcomes and patient satisfaction. Despite this, the US physician workforce, particularly in emergency medicine (EM), remains relatively homogeneous. Of all Black medical school students in the US, 14% attend the four Historically Black Colleges and Universities (HBCU) that have a medical school. Unfortunately, none of these schools are affiliated with an academic EM program. Because of this, there is less professional mentorship focused on obtaining a career in EM and potentially less formal curricula for senior medical students doing their home sub-internship in EM.</p><p><strong>Objectives: </strong>Our objective was to fill the gap left by the absence of an academic EM department at Howard University College of Medicine (HUCOM) by creating a collaborative educational experience for fourth-year medical students during their home EM sub-internship. The curricular objectives were to teach core principles of EM, build relationships with students, and prepare them for pursuing EM residency training.</p><p><strong>Curricular design: </strong>Four EM academic departments collaborated to create and implement a virtual curriculum using the six-step approach to curricular development.</p><p><strong>Impact/effectiveness: </strong>After completion of the course, five students (100%) reported strongly agreeing with the following statements. These sessions 1) helped me learn the approach to core EM topics more than I would have been able to do on my own; 2) helped me learn key skills for excelling in an EM rotation more than I would have been able to do on my own; and 3) allowed me to connect with faculty and resident mentors to learn more about the field of EM. Of these five students, 80% and 20% reported strongly agreeing and agreeing, respectively, that these sessions helped them learn about the process of applying to and selecting an EM residency program.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"129-134"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366044","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":"Substantial Variation Exists in Clinical Exposure to Chief Complaints Among Residents Within an Emergency Medicine Training Program.","authors":"Corlin M Jewell, Amy T Hummel, Dann J Hekman, Benjamin H Schnapp","doi":"10.5811/westjem.20281","DOIUrl":"10.5811/westjem.20281","url":null,"abstract":"<p><strong>Introduction: </strong>While many aspects of emergency medicine (EM) residency training are standardized among residents within a single residency program, there is no standard for the distribution of chief complaints (CC) that residents should see over the course of residency. This could result in substantial variability in each resident's clinical exposure. Our objective in this study was to explore EM residents' clinical exposure to CCs to determine whether substantial variation exists. If such variation exists, this could suggest the need for curricular reform to address gaps in resident clinical exposure during training.</p><p><strong>Methods: </strong>This was a retrospective observational study of EM residents who graduated in the years 2016-2021 at a single, university-affiliated emergency department (ED) in the midwestern United States. All patient encounters where a CC was logged were included and categorized into 1 of 20 clinical domains based on the 2016 American Board of Emergency Medicine Model of Clinical Practice. We calculated descriptive statistics for the top 10 most encountered domains for comparison among residents.</p><p><strong>Results: </strong>We included a total of 228,916 patient encounters from 69 residents in the analysis. Residents were involved in an average of 3,323 distinct patient encounters during the study period. The overall interquartile range for patient encounters was 523. The three CC domains with the broadest interquartile variation were abdominal and gastrointestinal disorders (116), musculoskeletal disorders (nontraumatic) (93), and traumatic disorders (86).</p><p><strong>Conclusion: </strong>Within a single, three-year academic EM program, substantial variation existed among residents with regard to the variety of patient CCs seen during their residency training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 1","pages":"47-52"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366152","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":"Palliative Care Boot Camp Offers Skill Building for Emergency Medicine Residents.","authors":"Julie Cooper, Jenna Fredette","doi":"10.5811/westjem.18381","DOIUrl":"10.5811/westjem.18381","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"913-916"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772582","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":"Buprenorphine-Naloxone for Opioid Use Disorder: Reduction in Mortality and Increased Remission.","authors":"Krishna K Paul, Christian G Frey, Stanley Troung, Laura Vita Q Paglicawan, Kathryn A Cunningham, T Preston Hill, Lauren G Bothwell, Georgiy Golovko, Yeoshina Pillay, Dietrich Jehle","doi":"10.5811/westjem.18569","DOIUrl":"10.5811/westjem.18569","url":null,"abstract":"<p><strong>Introduction: </strong>As fentanyl has become more readily available, opioid-related morbidity and mortality in the United States has increased dramatically. Preliminary studies suggest that high-affinity, partial mu-opioid receptor agonists such as the combination product buprenorphine-naloxone may reduce mortality from overdose and promote remission. With the escalating prevalence of opioid use disorder (OUD), it is essential to evaluate the effectiveness of opioid agonists like buprenorphine-naloxone. This study examines mortality and remission rates for OUD patients prescribed buprenorphine-naloxone to determine the efficacy of this treatment toward these outcomes.</p><p><strong>Methods: </strong>We carried out a retrospective analysis using the US Collaborative Network database in TriNetX, examining de-identified medical records from nearly 92 million patients across 56 healthcare organizations. The study spanned the years from January 1, 2017-May 13, 2022. Cohort 1 included OUD patients who began buprenorphine-naloxone treatment within one-year post-diagnosis, while Cohort 2, the control group, consisted of OUD patients who were not administered buprenorphine. The study measured mortality and remission rates within a year of the index event, incorporating propensity score matching for age, gender, and race/ethnicity.</p><p><strong>Results: </strong>Prior to propensity matching, we identified a total of 221,967 patients with OUD. Following exclusions, 61,656 patients treated with buprenorphine-naloxone showed 34% fewer deaths within one year of diagnosis compared to 159,061 patients who did not receive buprenorphine (2.6% vs 4.0%; relative risk [RR] 0.661; 95% confidence interval [CI] 0.627-0.698; <i>P</i> < 0.001). The remission rate was approximately 1.9 times higher in the buprenorphine-naloxone group compared to the control group (18.8% vs 10.1%; RR 1.862; 95% CI 1.812-1.914; <i>P</i> < 0.001). After propensity matching, the effect on mortality decreased but remained statistically significant (2.6% vs 3.0%; RR 0.868; 95% CI 0.813-0.927; <i>P</i> < 0.001) and the remission rate remained consistent (18.8% vs 10.4%; RR 1.812; 95% CI 1.750-1.876; <i>P</i> < 0.001). Number needed to treat for benefit was 249 for death and 12 for remission.</p><p><strong>Conclusion: </strong>Buprenorphine-naloxone was associated with significantly reduced mortality and increased remission rates for patients with opioid use disorder and should be used as a primary treatment. The recognition and implementation of treatment options like buprenorphine-naloxone is vital in alleviating the impact of OUD.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"869-874"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772829","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}