Western Journal of Emergency Medicine最新文献

{"title":"Modeling Hourly Productivity of Advanced Practice Clinicians in the Emergency Department.","authors":"Bryan A Stenson, Peter S Antkowiak, David T Chiu, Leon D Sanchez, Joshua W Joseph","doi":"10.5811/westjem.21298","DOIUrl":"10.5811/westjem.21298","url":null,"abstract":"<p><strong>Introduction: </strong>Advance practice clinicians (APC) play significant roles in academic and community emergency departments (ED). In attendings and residents, prior research demonstrated that productivity is dynamic and changes throughout a shift in a predictable way. However, this has not been studied in APCs. The primary outcome of this study was to model productivity for APCs in community EDs to determine whether it changes during a shift similar to the way it does for attendings and residents.</p><p><strong>Methods: </strong>This was a retrospective, observational analysis of 10-hour APC shifts at two suburban hospitals, worked by 14 total individuals. We examined the number of patients seen per hour of the shift by experienced APCs who see all acuity and staff all patients with an attending. We used a generalized estimating equation to construct the model of hour-by-hour productivity change.</p><p><strong>Results: </strong>We analyzed 862 shifts over one year across two sites, with three shift start times. Site 1 10 am-8 pm saw an average of 13.31 (95% confidence interval [CI] 13.02-13.63) patients per shift; Site 2 8 am-6 pm saw an average of 12.64 (95% CI 12.32-13.06) patients per shift; Site 2 4 pm-2 am saw an average of 12.53 (95% CI 12.04-12.82) patients per shift. Across all sites and shifts, hour 1 saw the highest number of patients. Each subsequent hour was associated with a small, statistically significant decrease over the previous hours. This was most pronounced in the shift's last two hours.</p><p><strong>Conclusion: </strong>The productivity of APCs demonstrates a similar pattern of hourly declines observed in both resident and attending physicians. This corroborates prior findings that patients per hour is a dynamic variable, decreasing throughout a shift. This provides further external validity to prior research to include both APCs and community EDs. These departments must take this phenomenon into account, as it has scheduling and operational consequences.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"295-300"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721481","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":"Productivity and Efficiency Growth During Emergency Medicine Residency Training.","authors":"Matthew T Singh, David M Austin, Stephanie C Mullennix, Joshua C Reynolds, J Adam Oostema","doi":"10.5811/westjem.21227","DOIUrl":"10.5811/westjem.21227","url":null,"abstract":"<p><strong>Introduction: </strong>Throughout training, an emergency medicine (EM) resident is required to increase efficiency and productivity to ensure safe practice after graduation. Multitasking is one of the 22 Accreditation Council for Graduate Medical Education (ACGME) EM milestones and is often measured through evaluations and observation. Providing quantitative data to both residents and residency administration on patients seen per hour (PPH) and efficiency could improve a resident experience and training in many ways. Our study was designed to analyze various throughput metrics and productivity trends using applied mathematics and a robust dataset. Our goals were to define the curve of resident PPH over time, adjust for relevant confounders, and analyze additional efficiency metrics related to throughput such as door-to-decision time (DTDT).</p><p><strong>Methods: </strong>We used a retrospective, observational design in a single, tertiary-care center emergency department (ED) that sees approximately 110,000 adult patients per year; our study spanned the period July 1, 2019-December 31, 2021. A total of 42 residents from an ACGME-accredited three-year residency were included in the analysis. We excluded patients <18 years of age. Data was collected using a secure data vendor, and we created an exponential regression model to assess resident PPH data. Additional models were created accounting for patient covariates.</p><p><strong>Results: </strong>We analyzed a total of 79,232 patients over 30 months. Using an exponential equation and adjusting for patient covariates, median PPH started at 0.898 and ended at 1.425 PPH. The median PPH by postgraduate (PGY) year were 1.13 for PGY 1; 1.38 for PGY 2; and 1.38 for PGY 3. Median DTDT in minutes was as follows: 185 minutes for PGY 1; 171 for PGY 2; and 166 for PGY 3.</p><p><strong>Conclusion: </strong>Productivity and efficiency metrics such as PPH and DTDT data are an essential part of working in an ED. Our study shows that residents improve with number of patients seen per hour over three years but tend to plateau in their second year. Door-to-decision time continued to improve throughout their three years of training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"246-253"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Reliable, Valid Procedural Checklist for Assessment of Emergency Medicine Resident Performance of Emergency Cricothyrotomy.","authors":"Dana E Loke, Andrew M Rogers, Morgan L McCarthy, Maren K Leibowitz, Elizabeth T Stulpin, David H Salzman","doi":"10.5811/westjem.20365","DOIUrl":"10.5811/westjem.20365","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency cricothyrotomy is a rare but potentially life-saving procedure performed by emergency physicians. A comprehensive, dichotomous procedural checklist for emergency cricothyrotomy for emergency medicine (EM) resident education does not exist.</p><p><strong>Objectives: </strong>We aimed to develop a checklist containing the critical steps for performing an open emergency cricothyrotomy, to assess performance of EM residents performing an open emergency cricothyrotomy using the checklist on a simulator, and to evaluate the reliability and validity of the checklist for performing the procedure.</p><p><strong>Curricular design: </strong>We developed a preliminary checklist based on literature review and sent it to experts in EM and trauma surgery. A modified Delphi approach was used to revise the checklist and reach consensus on a final version of the checklist. To assess usability of the checklist, we assessed EM residents using a cricothyrotomy task trainer. Scores were determined by the number of correctly performed items. We calculated inter-rater reliability using the Cohen kappa coefficient. Validity was assessed using the Welch <i>t</i>-test to compare the performance of residents who had and had not performed an open emergency cricothyrotomy, and we used analysis of variance to compare performance of postgraduate year (PGY) cohorts.</p><p><strong>Impact/effectiveness: </strong>The final 27-item checklist was developed after three rounds of revisions. Inter-rater reliability was strong overall (κ = 0.812) with individual checklist items ranging from slight to nearly perfect agreement. A total of 56 residents participated, with an average score of 14.3 (52.9%). Performance varied significantly among PGY groups (<i>P</i> < 0.001). Residents who had performed an emergency cricothyrotomy previously performed significantly better than those who had not <i>(P</i> = 0.005). The developed checklist, which can be used in procedural training for open emergency cricothyrotomy, suggests that improved training approaches to teaching and assessing emergency cricothyrotomy are needed given the overall poor performance of this cohort.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"279-284"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721660","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":"Procedural Sedation in the Emergency Department - An Observational Study: Does Nil Per Os Status Matter?","authors":"Brendan Peterson, Amy S Nowacki, Alexander Ulintz, Sharon E Mace","doi":"10.5811/westjem.18561","DOIUrl":"10.5811/westjem.18561","url":null,"abstract":"<p><strong>Introduction: </strong>Procedural sedation (PS) is commonly performed in the emergency department (ED). Nil per os (nothing by mouth) (NPO) guidelines extrapolated from standards for patients undergoing elective procedures in the operating room have been applied to ED PS patients. There has been no large study of ED PS patients comparing differences in adverse events and PS success rates based on NPO status.</p><p><strong>Methods: </strong>From a cohort of consecutive ED PS patients of all ages in the 20 EDs of one hospital system-one quaternary ED, four tertiary EDs, six community hospital EDs, one rural ED, two pediatric EDs, and six freestanding EDs in two states in the Midwest and South-we conducted a retrospective analysis on a prospective database over 183 months from April 2000-June 2015. Primary outcome was the incidence of side effects and complications, which comprised the adverse effects. The side effects were nausea, vomiting, itching/rash, emergence reaction, myoclonus, paradoxical reaction, cough, and hiccups. Complications were oxygen desaturation <90%, respiratory depression (respiratory rate <8), apnea, tachypnea, hypotension, hypertension, bradycardia, and tachycardia. Normal vital signs were age dependent. Secondary outcome was successful sedation defined as completion of the procedure. We examined the association between adverse events and successful sedation with NPO status.</p><p><strong>Results: </strong>Of 3,274 visits, exact NPO status was known in 2,643 visits. Comparison of NPO <8 hours in 1,388 patients vs ≥ 8 hours in 1,255 patients revealed side effects 5.5% vs 4.5% (<i>P</i> = 0.28); complications 11.9% vs 17.7% (<i>P</i> < 0.001); adverse events 16.3% vs 21.5% (<i>P</i> < 0.001), interventions 4.1% vs 4.4% (<i>P</i> = 0.73), and procedural completions 94.3% vs 89.7% (<i>P</i> < 0.001). After adjustment for age, sex, transfer status, American Society of Anesthesiology physical status classification, race, primary sedative, multiple sedatives, sedative plus analgesic, and primary analgesic, we found no association between NPO status and side effects (<i>P</i> = 0.68), complications (<i>P</i> = 0.48), or adverse effects (<i>P</i> = 0.26); however, procedural completion rate remained significantly higher for NPO < 8 hours (<i>P</i> = 0.007).</p><p><strong>Conclusion: </strong>A nil per os status ≥8 hours may have similar or worse outcomes than NPO <8 hours, which is contrary to many suggested guidelines. Strict adherence to NPO guidelines in ED procedural sedation patients may not be necessary.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"200-209"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721487","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 and Outcomes of Sugammadex for Neurological Examination after Neuromuscular Blockade in the Emergency Department.","authors":"Stephen D Hallisey, Christiana K Prucnal, Annette M Ilg, Raghu R Seethala, Paul S Jansson","doi":"10.5811/westjem.29328","DOIUrl":"10.5811/westjem.29328","url":null,"abstract":"<p><strong>Introduction: </strong>Non-depolarizing agents such as rocuronium and vecuronium are frequently used in the emergency department (ED) to facilitate intubation but may lead to delay in neurologic examination and intervention. Sugammadex is used for reversal of neuromuscular blockade by non-depolarizing agents but its role in the reversal of neuromuscular blockade for neurologic examination in the ED is poorly defined.</p><p><strong>Methods: </strong>This was a multicenter cohort study using retrospective chart review. We reviewed all ED encounters from June 21, 2016-February 9, 2024 of the electronic health record of Mass General Brigham, a large multistate health system, and abstracted all ED administrations of sugammadex to facilitate neurologic examination. We calculated descriptive statistics and assessed outcomes.</p><p><strong>Results: </strong>In 3,080,338 ED visits during the study period, 48 patients received sugammadex to facilitate neurologic examination. Of those patients, 23 (47.9%) underwent a procedure within 24 hours. Three (6.3%) had bradycardia, and one (2.1%) had hypotension following sugammadex administration. A total of 23 patients (47.9%) ultimately died during their admission, and 24 (50%) died within 30 days.</p><p><strong>Conclusion: </strong>Patients who received sugammadex in the ED to facilitate neurologic examination during the study period had rare associated adverse effects, high rates of procedures within 24 hours of administration, and significant in-hospital mortality. Prospective data is needed to assess the impact of sugammadex on decision-making.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"347-352"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721625","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":"Cardiac Computed Tomography Measurements in Pulmonary Embolism Associated with Clinical Deterioration.","authors":"Anthony J Weekes, Angela M Pikus, Parker L Hambright, Kelly L Goonan, Nathaniel O'Connell","doi":"10.5811/westjem.20763","DOIUrl":"10.5811/westjem.20763","url":null,"abstract":"<p><strong>Introduction: </strong>Most pulmonary embolism response teams (PERT) use a radiologist-determined right ventricle to left ventricle ratio (RV:LV) cut-off of 1.0 to risk-stratify pulmonary embolism (PE) patients. Continuous measurements from computed tomography pulmonary angiograms (CTPAs) may improve risk stratification. We assessed associations of CTPA cardiac measurements with acute clinical deterioration and use of advanced PE interventions.</p><p><strong>Methods: </strong>This was a retrospective study of a PE registry used by eight affiliated emergency departments. We used an artificial intelligence (AI) algorithm to measure RV:LV on anonymized CTPAs from registry patients for whom the PERT was activated (2018-2023) by institutional guidelines. Primary outcome was in-hospital PE-related clinical deterioration defined as cardiac arrest, vasoactive medication use for hypotension, or rescue respiratory interventions. Secondary outcome was advanced intervention use. We used bivariable and multivariable analyses. For the latter, we used least absolute shrinkage and selection operator (LASSO) and random forest (RF) to determine associations of all candidate variables with the primary outcome (clinical deterioration), and the Youden index to determine RV:LV optimal cut-offs for primary outcome.</p><p><strong>Results: </strong>Artificial intelligence analyzed 1,467 CTPAs, with 88% agreement on RV:LV categorization with radiologist reports (kappa 0.36, 95% confidence interval [CI] 0.28-0.43). Of 1,639 patients, 190 (11.6%) had PE-related clinical deterioration, and 314 (19.2%) had advanced interventions. Mean RV:LV were 1.50 (0.39) vs 1.30 (0.32) for those with and without clinical deterioration and 1.62 (0.33) vs 1.35 (0.32) for those with and without advanced intervention use. The RV:LV cut-off of 1.0 by AI and radiologists had 0.02 and 0.53 <i>P</i>-values for clinical deterioration, respectively. With adjusted LASSO, top clinical deterioration predictors were cardiac arrest at presentation, lowest systolic blood pressure, and intensive care unit admission. The RV:LV measurement was a top 10 predictor of clinical deterioration by RF. Optimal cut-off for RV:LV was 1.54 with odds ratio of 2.50 (1.85, 3.45) and area under the curve 0.6 (0.66, 0.70).</p><p><strong>Conclusion: </strong>Artifical intelligence-derived RV:LV measurements ≥1.5 on initial CTPA had strong associations with in-hospital clinical deterioration and advanced interventions in a large PERT database. This study points to the potential of capitalizing on immediately available CTPA RV:LV measurements for gauging PE severity and risk stratification.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"219-232"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721656","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":"Injuries and Outcomes of Ground-level Falls Among Older Patients: A Retrospective Cohort Study.","authors":"Vincent Kan, Wilson Huang, Gretta Steigauf-Regan, Jill Anderson, Ivy Dang, Chad Darling","doi":"10.5811/westjem.35281","DOIUrl":"10.5811/westjem.35281","url":null,"abstract":"<p><strong>Study objective: </strong>We sought to determine the overall rates of traumatic injuries and whether the rates of traumatic injuries and various clinical outcomes differed among older patients presenting to a tertiary-care emergency department (ED) after a ground-level fall (GLF) and who underwent whole-body computed tomography.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients ≥65 years of age who presented to the ED with a GLF and received a whole-body CT from January 1-December 31, 2021. Age was stratified into age groups: 65-74; 75-84; and 85+. We presented a descriptive analysis of traumatic injuries, intensive care unit (ICU) admissions, and all-cause mortality rates. We used multivariable logistic regression to determine the association between increasing age, traumatic injuries, and clinical outcomes.</p><p><strong>Results: </strong>Of 638 patients in the cohort, 120 (18.9%) sustained thoracic injuries and 80 (12.5%) sustained intracranial hemorrhages. Only five (0.8%) patients sustained an intra-abdominal injury, while 134 (21.0%) were admitted to the ICU, and 31 (4.8%) died during their index hospitalization. Head injuries (odds ratio [OR] 6.21, 95% CI 3.65-10.6, <i>P</i> < 0.001) and thoracic injuries (OR 5.25, 95% CI 3.30-8.36, <i>P</i> < 0.001) were associated with increased odds of ICU admission, whereas head injuries (OR 3.21, 95% CI 1.41-7.31, <i>P</i> < 0.01) and cervical injuries (OR 3.37, 95% CI 1.08-10.5, <i>P</i> < 0.05) were associated with increased odds of in-hospital, all-cause mortality. There were no statistically significant differences in the rates of injuries sustained between the respective age groups. There was no association between increasing age and ICU admissions or in-hospital, all-cause mortality rates.</p><p><strong>Conclusion: </strong>Among patients aged ≥65 years of age who presented to the ED after a ground-level fall and underwent whole-body CT, thoracic injuries and intracranial hemorrhages were associated with increased odds of ICU admissions. We found no significant differences in injury rates or outcomes across age groups, indicating that age alone should not guide ICU admission decisions. These findings suggest that the use of whole-body CT in this population should be selective and guided by clinical judgment rather than applied universally.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"301-306"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721427","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":"Critical Time Intervals in Door-to-Balloon Time Linked to One-Year Mortality in ST-Elevation Myocardial Infarction.","authors":"Shin-Ho Tsai, Yu-Ting Hsiao, Ya-Ni Yeh, Jih-Chun Lin, Shi-Quan Zhang, Ming-Jen Tsai","doi":"10.5811/westjem.20779","DOIUrl":"10.5811/westjem.20779","url":null,"abstract":"<p><strong>Background: </strong>Timely activation of primary percutaneous coronary intervention (PCI) is crucial for patients with ST-segment elevation myocardial infarction (STEMI). Door-to-balloon (DTB) time, representing the duration from patient arrival to balloon inflation, is critical for prognosis. However, the specific time segment within the DTB that is most associated with long-term mortality remains unclear. In this study we aimed to identify the target time segment within the DTB that is most associated with one-year mortality in STEMI patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a tertiary teaching hospital. All patients diagnosed with STEMI and activated for primary PCI from the emergency department were identified between January 2013-December 2021. Patient demographics, medical history, triage information, electrocardiogram, troponin-I levels, and coronary angiography reports were obtained. We divided the DTB time into door-to-electrocardiogram (ECG), ECG-to-cardiac catheterization laboratory (cath lab) activation, activation-to-cath lab arrival, and cath lab arrival-to-balloon time. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazards models to determine the independent effects of these time intervals on the risk of one-year mortality.</p><p><strong>Results: </strong>A total of 732 STEMI patients were included. Kaplan-Meier analysis revealed that delayed door-to-ECG time (>10 min) and cath lab arrival-to-balloon time (>30 min) were associated with a higher risk of one-year mortality (log-rank test, <i>P</i> < .001 and <i>P</i> = 0.01, respectively). In the multivariable Cox models, door-to-ECG time was a significant predictor for one-year mortality, whether it was analyzed as a dichotomized (>10 min vs ≤10 min) or a continuous variable. The corresponding adjusted hazard ratios (aHR) were 2.81 (95% confidence interval [CI] 1.42-5.55) for the dichotomized analysis, and 1.03 (95% CI 1.00-1.06) per minute increase, respectively. Cath lab arrival-to-balloon time also showed an independent effect on one-year mortality when analyzed as a continuous variable, with an aHR of 1.02 (95% CI 1.00-1.04) per minute increase. However, ECG-to-cath lab activation and activation-to-cath lab arrival times did not show a significant association with the risk of one-year mortality.</p><p><strong>Conclusion: </strong>Within the door-to-balloon interval, the time from door-to-ECG completion is particularly crucial for one-year survival after STEMI, while cath lab arrival-to-balloon inflation may also be relevant.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"180-190"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721659","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":"Food and Housing Insecurity, Resource Allocation, and Follow-up in a Pediatric Emergency Department.","authors":"Raymen R Assaf, Chloe Knudsen-Robbins, Theodore Heyming, Kellie Bacon, Shelby K Shelton, Bharath Chakravarthy, Soheil Saadat, Jason A Douglas, Victor Cisneros","doi":"10.5811/westjem.19435","DOIUrl":"10.5811/westjem.19435","url":null,"abstract":"<p><strong>Introduction: </strong>Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efficient screening tools or most effective interventions for ED use.</p><p><strong>Objective: </strong>In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED.</p><p><strong>Methods: </strong>During the study period (March 1-December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children's hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic, food and housing insecurity, caregiver/patient health status, and healthcare utilization questions. Caregivers who screened positive for food and/or housing insecurity received printed materials with food and/or housing resources. We analyzed data using descriptive statistics, one-way analysis of variance, and the Pearson chi-squared test.</p><p><strong>Results: </strong>A total of 1,908 caregivers were surveyed: 416 (21.8%) screened positive for food and/or housing insecurity. Of those who screened positive, 147/416 completed follow-up surveys. On follow-up, 44 (30.0%) no longer screened positive for food and/or housing insecurity, while 15 (10.2%) reported using at least one resource referral. The most frequently reported referral utilization barrier was loss or reported non-receipt of the referral.</p><p><strong>Conclusion: </strong>This study demonstrates high food- and housing-insecurity rates among families presenting to a pediatric ED, emphasizing the urgency and necessity of screening and intervening in this environment. The food and housing insecurity change between baseline and follow-up reported here and the overall low resource uptake highlights challenges with ED-based screening and intervention efficacy.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"326-337"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721662","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 Individual and Neighborhood Factors with Disparities in COVID-19 Incidence and Outcomes.","authors":"Margaret E Samuels-Kalow, Rebecca E Cash, Kori S Zachrison, Auriole Corel Rodney Fassinou, Norman Harris, Carlos A Camargo","doi":"10.5811/westjem.18526","DOIUrl":"10.5811/westjem.18526","url":null,"abstract":"<p><strong>Introduction: </strong>The disproportionate impact of coronavirus 2019 (COVID-19) on Black and Hispanic communities has been widely reported. Many studies have used neighborhood racial/ethnic composition to study such disparities, but less is known about the interplay between individual race/ethnicity and neighborhood racial composition. Therefore, our goal in this study was to assess the relative contributions of individual and neighborhood risk to disparities in COVID-19 incidence and outcomes.</p><p><strong>Methods: </strong>We performed a cross-sectional study of patients with emergency department (ED) and inpatient visits to an academic health system (12 hospitals; February 1-July 15, 2020). The primary independent variable was race/ethnicity; covariates included individual age, sex, comorbidity, insurance and neighborhood density, poverty, racial/ethnic composition, education and occupation. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity; secondary outcomes included admission and death after COVID-19. We used generalized estimating equations to assess whether race/ethnicity remained significantly associated with COVID-19 after adjustment for individual and neighborhood factors.</p><p><strong>Results: </strong>There were 144,982 patients; 5,633 (4%) were SARS-CoV-2 positive. Of those, 2,961 (53%) were admitted and 601(11%) died. Diagnosis of COVID-19, admission, and death were more common among non-Hispanic Black, Hispanic, Spanish-speaking patients, and those with public insurance. In the base model (adjusting for race/ethnicity, age, sex, and comorbidities), race/ethnicity was strongly associated with COVID-19 (non-Hispanic Black odds ratio [OR] 4.64 [95% confidence interval (CI) 4.18-5.14], and Hispanic OR 6.99 [CI 6.21-7.86]), which was slightly attenuated but remained significant after adjustment for neighborhood factors. Among patients with COVID-19, there was no significant association between race/ethnicity and hospital admission, other than for patients with unknown race.</p><p><strong>Conclusion: </strong>This data demonstrates a persistent association between race/ethnicity and COVID-19 incidence, with Black and Hispanic patients at significantly higher risk, which was not explained by measured individual or neighborhood factors. This suggests that using existing neighborhood factors in studies examining health equity may be insufficient, and more work is needed to quantify and address structural factors and social determinants of health to improve equity.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"315-325"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721636","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}