Western Journal of Emergency Medicine最新文献

{"title":"Rapid Turnaround Time for Toxic Alcohol Testing Is Associated with Shorter Hospital Length of Stay.","authors":"Steven Chen, Jacob Yudiono, Varun Vohra, Rebecca Lipscomb, Rahul Mhaskar, Justin K Arnold, Diana Dean","doi":"10.5811/westjem.56974","DOIUrl":"10.5811/westjem.56974","url":null,"abstract":"<p><strong>Introduction: </strong>Toxic alcohol poisoning (methanol or ethylene glycol) can cause severe metabolic disturbances, end-organ damage, and death. Timely diagnosis is paramount and predicated on history, lab markers, and confirmatory laboratory testing, which inform antidote use and/or hemodialysis. Confirmatory toxic alcohol testing capabilities and turnaround times vary by geographic region. Our objective in this study was to evaluate how differences in toxic alcohol testing turnaround times impact our primary outcome of hospital length of stay and secondary outcomes of antidote (fomepizole) administration and medical outcomes (including death, major, moderate, and minor effects) among patients with suspected toxic alcohol poisoning.</p><p><strong>Methods: </strong>This is a retrospective cohort study of toxic alcohol poisoning cases reported to two U.S. poison centers, Michigan Poison and Drug Information Center (MiPDC) and Florida's Poison Information Network (FPIN), from 2018-2022. Based on investigator experience with each center's practice patterns, MiPDC had a toxic alcohol testing turnaround time of 12-24 hours, while FPIN had turnaround times averaging 5-7 days. We queried poison center databases for cases where fomepizole was recommended and/or administered. Medical outcomes were categorized using National Poison Database System definitions: minor effects (minimally bothersome symptoms); moderate effects (pronounced symptoms requiring treatment); major effects (life-threatening or significant disability); and death. We excluded cases if there was no concern for toxic alcohol poisoning or if fomepizole was administered for acetaminophen poisoning.</p><p><strong>Results: </strong>A total of 963 cases met inclusion criteria: (MiPDC, n = 590; and FPIN, n = 373). Patients reported to FPIN had a longer median hospital length of stay compared to MiPDC (65.0 versus 48.0 hours, P < .001). FPIN patients received more doses of fomepizole (2.0 versus 1.0 doses, P < .001). FPIN patients had 4.1 times the odds of major effect (95% CI, 1.3-13.3) (P = .02) and 4.7 times the odds of minor effect (95% CI, 1.4-15.8) (P = .01), without significant association for moderate effects or death.</p><p><strong>Conclusion: </strong>Access to rapid confirmatory toxic alcohol testing was associated with shorter hospital length of stay, reduced antidote use, and improved medical outcomes in suspected toxic alcohol poisonings. Future studies are warranted to comprehensively characterize the variation in region-specific care and inform efforts to standardize confirmatory testing capabilities.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1002-1010"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674315","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":"Social Deprivation Index Is Associated with 90-Day Emergency Department Revisits, but Not Admission, for Acute Heart Failure.","authors":"Robert R Ehrman, Nicholas E Harrison, Brian D Haber, Steven J Korzeniewski, Mark J Favot, Lyudmila Khait, Phillip D Levy","doi":"10.5811/westjem.61392","DOIUrl":"10.5811/westjem.61392","url":null,"abstract":"<p><strong>Background: </strong>Prevalence of heart failure is increasing, with an associated rise in emergency department (ED)-related care. Social determinants of health (SDoH) are associated with adverse health outcomes, but the extent to which they influence ED use for heart failure care is poorly understood. We sought to describe the relationship between community-level social vulnerability and ED revisits and hospital admissions for heart failure within a single health system.</p><p><strong>Methods: </strong>We conducted a retrospective review of Social Deprivation Index (SDI) scores (higher score = more deprivation) by ZIP code paired with administrative clinical data. Zero-hurdle regression was used to model the relationship between SDI and ED revisits within 90 days of a prior ED visit for heart failure (logistic model for > 0 revisits; Poisson model for count of revisits). We used a mixed-effects logistic model-accounting for repeat visits-to test the association of SDI with hospital admission at any given ED visit.</p><p><strong>Results: </strong>From January 2022-December 2023, there were 3,569 ED visits from 2,406 patients. Each standard deviation increase in SDI (30.3) was associated with increased odds of at least one 90-day revisit (OR, 1.53; 95% CI, 1.08-2.16). Higher SDI was also associated with more 90-day revisits, with varying magnitude by hospital. After adjusting for characteristics of prior ED visit, SDI was not associated with hospital admission.</p><p><strong>Conclusion: </strong>Our results suggest that area-level social vulnerability influences the decision to seek heart failure-related care in the ED. Patients from more deprived areas may not have more severe clinical presentations, however, as evidenced by lack of association of SDI with hospital admission.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1082-1089"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674361","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 Impact of Urinalysis Turnaround Times on Patient Disposition in the Emergency Department.","authors":"DaMarcus E Baymon, Patricia Hernández, Paul Chen, Leon D Sanchez, Dana Im, Alice Bukhman, Joshua W Joseph","doi":"10.5811/westjem.53952","DOIUrl":"10.5811/westjem.53952","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnostic efficiency in the emergency department (ED) is crucial for workflow. Among these, urinalysis (UA) is a key test for abdominopelvic complaints. Prolonged UA turnaround times can extend patient length of stay and reduce patient satisfaction, highlighting the need for improvement. In this study qw sought to measure the correlation between UA turnaround times and time to disposition.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of discharged ED patients with abdominopelvic complaints who had a UA ordered between January-August 2022. Electronic health records data included UA order-to-result time, urine human chorionic gonadotropin (hCG), time to disposition, and complete blood count (CBC) turnaround time as a venipuncture comparator. Spearman correlation coefficients assessed associations between lab processing times and time to disposition.</p><p><strong>Results: </strong>Among 6,708 discharged patients included in the study, 3,795 presented with abdominopelvic complaints. In this subgroup, 3,688 UAs, 1,285 urine hCG tests, and 2,966 CBCs were obtained. Median times from UA order-to-specimen receipt and result were 65 (IQR 29-138) and 92 (53-168) minutes, respectively. A modest positive correlation was observed between UA order-to-result time and time to disposition (ρ = 0.46), relative to CBC order-to-result time (ρ = 0.29). The relationship was slightly weaker for urine hCG (ρ = 0.35). Laboratory turnaround times showed minimal correlation with ED time to disposition (UA ρ = 0.04; urine hCG ρ = 0.03; CBC ρ = 0.09).</p><p><strong>Conclusion: </strong>Urinalysis acquisition and processing times are modestly correlated with time to disposition in patients with abdominopelvic complaints. Reducing collection time for UA and urine hCG tests may improve throughput for this patient cohort.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"895-898"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674292","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":"Point-of-care Ultrasound for Detecting Methamphetamine-associated Heart Failure in the Emergency Department.","authors":"Madison Nashu, Jordan Lam, Zarak Khan, Soheil Saadat, Roy Almog, Ron Goubert, Joshua Wasmund, Heesun Choi, Shadi Lahham, Edmund Hsu, Megan Guy, John C Fox","doi":"10.5811/westjem.53982","DOIUrl":"10.5811/westjem.53982","url":null,"abstract":"<p><strong>Introduction: </strong>Methamphetamine-associated heart failure with reduced ejection fraction is a serious consequence of methamphetamine use often underrecognized in the emergency department (ED). Point-of-care ultrasound (POCUS) offers rapid, non-invasive cardiac screening for high-risk populations. This study evaluated the diagnostic yield of POCUS for detecting methamphetamine-associated heart failure with reduced ejection fraction in ED patients who use methamphetamine.</p><p><strong>Methods: </strong>We conducted this prospective cohort study between December 2020-February 2024 at an urban Level I trauma center ED. The primary outcome was diagnostic yield of cardiac POCUS for abnormal left ventricular ejection fraction (LVEF) and abnormal sex-specific left ventricular end-diastolic diameter in patients with methamphetamine use, with secondary analyses assessing associations with use duration and frequency. Diagnostic yield was calculated as the proportion of completed POCUS examinations identifying abnormalities. We used E-point septal separation to calculate LVEF; < 40% was abnormal. Left ventricular end-diastolic diameter abnormality (> 5.8 cm males, > 5.2 cm females) was categorized as mild, moderate, or severe (mild, 5.9-6.3/5.3-5.6; moderate, 6.4-6.8/5.7-6.1; severe, > 6.8/> 6.1 cm males/females). Physician-performed POCUS assessed LVEF and left ventricular end-diastolic diameter in patients with a methamphetamine use history and a comparison group of non-users.</p><p><strong>Results: </strong>Of the 136 enrolled patients, 84 (61.8%) reported methamphetamine use. Among methamphetamine users, diagnostic yield of cardiac POCUS was as follows: reduced LVEF in 22 of 70 with measurable LVEF (31.4% [20.9-43.6%]); any sex-specific left ventricular end-diastolic diameter abnormality in 30 of 84 (35.7% [25.6-46.9%]); and severe sex-specific left ventricular end-diastolic diameter abnormality in 15 of 84 (17.9% [10.4-27.7%]). Corresponding values in non-users were 3 of 52 (5.8% [1.2-16.0%]; P < .001), 10 of 52 (19.2% [9.6-32.5%]; P = .05), and 3 of 52 (5.8% [1.2 - 16.0%]; P = .07), respectively. Longer duration (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46-25.10) and higher frequency (OR 5.93, 95% CI, 1.52-23.06) of methamphetamine use were associated with reduced LVEF.</p><p><strong>Conclusion: </strong>Cardiac point-of-care ultrasound demonstrated a clinically significant diagnostic yield in detecting methamphetamine-associated heart failure with reduced ejection fraction among methamphetamine users in the ED, suggesting POCUS could aid early detection in this population, potentially streamlining management before disease progression.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"994-1001"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674373","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":"Initial Specimen Diversion Devices for Emergency Department Blood Cultures May Reduce Contamination Rates and Costs: Structured Literature Review.","authors":"Makayla D Ayres, Maria C Johnson, Megan E Andersen, Alyson P Lewis, Lucas S Farrow, Amelia M Vopat, Kathleen M Spears","doi":"10.5811/westjem.50723","DOIUrl":"10.5811/westjem.50723","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments (ED) are a primary site of blood culture collection in the United States. High rates of blood culture contamination, commonly seen in EDs, are associated with diagnostic inaccuracy, unnecessary antibiotic use, and increased costs. In this structured literature review, we evaluated the effectiveness of initial specimen diversion devices (ISSDs), which are attached to the needle tip and discard the initial 0.15-1.5 mL of blood. We paid particular attention to their applicability in reducing blood culture contamination in adult ED patients in rural healthcare settings. The average cost of an ISDD is $15-$30, and this upfront cost creates a significant barrier in rural EDs, which face resource scarcity.</p><p><strong>Methods: </strong>In this review of primary literature from 2021-2025, we evaluated the efficacy of ISDD in lowering blood culture contamination rates in adult patients in the ED. Our primary outcome was the change in contamination rates after introduction of the ISDD. Secondary outcomes included changes in vancomycin duration of therapy, hospital length of stay, and total hospital costs.</p><p><strong>Results: </strong>We screened 460 records across PubMed, EBSCO, and Embase. Eight papers were selected for full review, from 10 hospital systems. All studies demonstrated a decrease in the rates of blood culture contamination with the ISDD. Contamination rates were reduced by an average of 2.89% across all 10 study locations. Only three of 10 hospitals (30%) achieved a blood culture contamination rate below 1%. One rural community hospital saw an absolute reduction of BCCs from 3.94% to 1.05%. Another study reported a decrease in total yearly hospital costs from $1,120,000 to $383,690, and another reported a 31.4% reduction in mean duration of vancomycin therapy.</p><p><strong>Conclusion: </strong>This review shows the clinical value of ISDDs to reduce blood culture contamination, and highlights the need for further research into scalable implementation strategies, especially in resource-constrained systems, like rural hospitals.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"913-919"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674289","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":"Autologous Fat Transfer Procedure Complications in Four Emergency Departments in Miami, Florida.","authors":"Mary Bridget Lee, Joshua Goldstein, Daniel Hercz, Matthew Pyle","doi":"10.5811/westjem.54037","DOIUrl":"10.5811/westjem.54037","url":null,"abstract":"<p><strong>Introduction: </strong>Our study objective was to share the experiences of four public emergency departments (ED) caring for patients with complications of gluteal autologous fat transfer (AFT), colloquially known as Brazilian butt lifts, to provide emergency physicians with a better understanding of these patients and potential complications associated with the procedure.</p><p><strong>Methods: </strong>Jackson Health System in Miami, Florida, undertook an institutional initiative to prospectively collect data on patients presenting to any of the system's EDs with gluteal AFT complications from October 2020-May 2023. We abstracted patient charts for demographics, disposition, lab values, diagnoses, and care-related charges to generate descriptive statistics. Our primary outcome measure was diagnostic code and diagnostic category. Secondary outcome measures were hemoglobin on presentation, units of blood transfused, admission level of care, hospital charge, length of stay, and mortality.</p><p><strong>Results: </strong>Of 234 potentially relevant patient charts identified by our hospital protocol, 157 patients met our criteria. All were female, with an average age of 33. A total of 123 patients were from out of state, and one was international. The most common diagnoses were anemia/bleeding (81 patients), followed by pain (65), cardiac (36) and hypovolemia/dehydration (32). Our analysis revealed that 86 patients presenting to the ED required admission (54.8%), with 12 patients requiring intensive care unit care (7.6%). There was one death (0.6%). Total hospital charges for this cohort equaled $2,822,540, averaging $17,977 per patient.</p><p><strong>Conclusion: </strong>Gluteal AFT procedures are associated with a wide range of complications, morbidity, and mortality. These patients have a high admission rate and the potential to be critically ill. Patients travel from around the country to have these procedures performed, and it is crucial that EDs nationally are prepared to care for them.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"861-868"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673819","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":"Cultivating Environmentally Sustainable Emergency Departments with GreenED.","authors":"Jennifer L Wood, Alexander Robertson, Tim Spruell, Zoe Steley","doi":"10.5811/westjem.61385","DOIUrl":"10.5811/westjem.61385","url":null,"abstract":"<p><strong>Introduction: </strong>Collective leadership within healthcare is critical if we are to deliver on net zero targets and provide high-value, low-carbon care to our patients. However, driving change in systems under considerable strain from crowding, limited resources, and increasingly complex caseloads can be a daunting task and often feels out of reach. In July 2023, the Royal College of Emergency Medicine (RCEM) launched a sustainability initiative to support environmentally sustainable healthcare within emergency departments (ED). This 12-month support and accreditation scheme centers around a framework of 36 actions and has been designed to make sustainability interventions accessible to staff, enabling individuals, groups, and networks to become leaders within their own spheres of influence and elicit measurable changes. The objective of this study was to evaluate the impact of the accreditation scheme over a 2-year period.</p><p><strong>Methods: </strong>The primary outcome measures were the financial and carbon savings made by participating sites. Secondary outcome measures were derived from a thematic analysis of written submissions, undertaken to identify co-benefits and generate qualitative insights into both barriers to, and enablers of, environmental sustainability interventions within EDs.</p><p><strong>Results: </strong>Five sites were successfully accredited for Bronze and Silver awards in 2024, and 10 sites for Bronze, Silver and Gold awards in 2025, with combined projected annual savings of £351,366 and 157,724 kg of carbon dioxide equivalent.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first time that a collaborative, structured, dynamic, and scalable approach to sustainable healthcare in emergency medicine has been used worldwide.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1105-1112"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674016","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":"Reply: Regarding Racial Disparities in Door-to Clinician Time for Cardiac Chest Pain.","authors":"Emad Awad","doi":"10.5811/westjem.63979","DOIUrl":"10.5811/westjem.63979","url":null,"abstract":"","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1115"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674358","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-initiated Naltrexone for Alcohol Use Disorder: Association with Recidivism.","authors":"Otis Warren, Jeremiah Gress, Timmy Lin, Melanie Lippmann, Gary Bubly","doi":"10.5811/westjem.52971","DOIUrl":"10.5811/westjem.52971","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol use disorder (AUD) contributes to significant healthcare costs, disease, emergency department (ED) crowding, and recidivism. Naltrexone is a treatment for AUD that has been approved by the U.S. Food and Drug Administration and holds promise as a pharmacologic intervention for ED patients with AUD. We hypothesized that subjects who received naltrexone in the ED would have associated reduced recidivism in the 30 days after treatment.</p><p><strong>Methods: </strong>This was a retrospective chart review of an AUD quality program comparing ED visits in the 30 days before with 30 days after initiation of naltrexone in the ED. We performed this study at two academic hospitals (one a Level I trauma center) and one community hospital.</p><p><strong>Results: </strong>A total of 297 subjects (median age 43 years, 69.5% male) made 331 naltrexone index visits during the study period. There was no difference in the number of ED visits before versus after the index visit among all subjects (0 median visits before [interquartile range 0-1] versus 0 median after [0-1]). Subjects who were frequent ED users (defined as ≥ 4 ED visits in the 90 days preceding (N=56 [16.9%]) had a significant reduction in ED visits after administration of naltrexone (median of 5 visits [3-8] before versus 3 [2,6] after), with 36 of these subjects (64.3%) having reduced ED visits in the 30 days after naltrexone administration.</p><p><strong>Conclusion: </strong>Naltrexone administered in the emergency department had no associated change on the study population's rates of recidivism for alcohol use disorder, but it was associated with reduced ED recidivism in subjects with high ED use.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"869-874"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673998","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 Management of Distal Radius and Ulna Fractures: Narrative Review.","authors":"Tyler Kirchberg, Robert Nolan, Spencer Tomberg","doi":"10.5811/westjem.52930","DOIUrl":"10.5811/westjem.52930","url":null,"abstract":"<p><strong>Importance: </strong>Distal radius fractures and distal ulna fractures are common orthopedic injuries treated in emergency departments (ED). Our goal in this narrative review was to present emergency physicians with a single source that covers the evaluation and treatment of distal radius fractures and distal ulna fractures across the lifetime of our patients. There are differences in the treatment algorithms for distal radius fractures between pediatric, young adult, and geriatric patients.</p><p><strong>Observations: </strong>Pediatric distal radius fractures are defined by their relation to the growth plate and are influenced by the gradual calcification of the developing bone. Some pediatric distal radius fractures can heal through significant displacement, while others require anatomical reduction to limit the risk of growth arrest. For adult patients with a distal radius fracture, there are established guidelines for both appropriate reduction goals and for when operative treatment is indicated. For geriatric patients, management strategies have evolved over the last decade after multiple studies demonstrated no functional difference between operative and nonoperative management. Given this, most geriatric distal radius fractures are managed nonsurgically, which makes effective reduction in the ED important to optimize long-term wrist function.</p><p><strong>Conclusion and relevance: </strong>Emergency physicians need to be well versed at both identifying fracture patterns and be knowledgeable about radiographic fracture-reduction goals. This emergency medicine-focused and illustrated narrative review will assist physicians, nurse practitioners, and physician assistants in meeting those goals. We also summarize pain management, splint molding, possible complications and follow-up considerations for emergency physicians treating patients with distal radius fractures.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1090-1104"},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674231","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}