Western Journal of Emergency Medicine最新文献

{"title":"Real-time Ultrasound-guided Lumbar Puncture: A Comparison of Two Techniques Using Simulation.","authors":"Kara Samsel, David Wasiak, Elaine Situ-LaCasse, Srikar Adhikari, Josie Acuña","doi":"10.5811/westjem.21163","DOIUrl":"10.5811/westjem.21163","url":null,"abstract":"<p><strong>Introduction: </strong>The current literature on the use of real-time ultrasound-guidance for lumbar punctures (LP) is limited. Two techniques have been described: the paramedian sagittal oblique (PSO); and the transverse interlaminar (TL) approach. Our objectives in this study were to compare the procedure outcomes between these two techniques and assess the ability of emergency physicians to perform ultrasound-guided LPs.</p><p><strong>Methods: </strong>This was a prospective study whose participants included emergency physicians. Participants were randomized into either Group P (PSO technique) or Group T (TL technique). After a didactic session, participants then performed an ultrasound-guided LP on a training manikin, during which we collected procedure data. A survey was administered after completion of the procedure.</p><p><strong>Results: </strong>A total of 31 participants were included, 16 in Group P and 15 in Group T. Most participants (90.3%) successfully performed the procedure, without a statistical difference between Group P and Group T (15/16 vs 13/15, P = 0.95). Group T required a longer average time to complete the procedure (176.7 ± 140.4 seconds [s] vs 311.2 ± 202.3 s, P = 0.04). There was no statistically significant difference between Group P and Group T with regard to average time needed to obtain the required ultrasound view (18.3 ± 14.6 s vs 35.1 ± 32.9 s, P = 0.09); number of needle redirections; total number of needle passes; first puncture success; number of participants who advanced the needle without visualization of the tip (13/16 vs 14/15, P = 0.64); penetration of the anterior dura; and needle contact with bone. The Likert-style questionnaire responses (reported on a 1-10 scale) revealed no difference between Group P and Group T as to perceived difficulty of finding the required ultrasound view (3 [interquartile range (IQR) 2-5) vs 5 (IQR 3-6.5), P = 0.10), perceived difficulty of needle tracking, or rating of the needle view when entering the intrathecal space. However, Group T reported a higher overall perceived level of difficulty (4 [IQR 3-5] vs 6 (IQR 5.5-7.5), P= 0.01).</p><p><strong>Conclusion: </strong>This study suggests emergency physicians can be trained to use ultrasound-guidance for lumbar puncture in the simulation setting without significantly prohibitive training. Both techniques were performed with high success rates. There may be a preference for implementing the paramedian sagittal oblique approach over the transverse interlaminar.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"737-742"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498147","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":"Coronary Artery Bypass Grafting Is Rarely Done in the Acute Care of ST-elevation Myocardial Infarction Patients Treated by Emergency Medical Services.","authors":"Jake Toy, Caroline Lauer, Amy H Kaji, Joseph L Thomas, Nichelle Megowan, Nichole Bosson, Marianne Gausche-Hill, Puneet Dhawan, Robert A Kloner, Sara Rasnake, William French, Shira Schlesinger","doi":"10.5811/westjem.35271","DOIUrl":"10.5811/westjem.35271","url":null,"abstract":"<p><strong>Introduction: </strong>The use of coronary artery bypass grafting (CABG) for primary revascularization during the acute care of ST-elevation myocardial infarction (STEMI) patients has declined significantly in the past decade; but there is little data to determine whether there has been a change in the use of CABG for STEMI patients treated by emergency medical services (EMS). In this study we described the incidence of urgent or emergent CABG for STEMI patients treated in a large, regionalized cardiac care system.</p><p><strong>Methods: </strong>We obtained data obtained for patients transported by EMS between January 2011-December 2022 who were diagnosed with acute STEMI on prehospital or emergency department (ED) electrocardiogram and taken for primary diagnostic catheterization. All STEMI patients were transported by EMS to one of 34 STEMI receiving centers (SRC) in a regionalized cardiac care system, all of which are required to maintain onsite cardiac surgery as a condition of their SRC designation. Patients were considered to have undergone urgent or emergent CABG if it was performed within 72 hours of the primary diagnostic cardiac catheterization. We excluded patients if no diagnostic catheterization was performed or if CABG was performed >72 hours after diagnostic catheterization. The primary outcome was the incidence of urgent or emergent CABG. Patients were further stratified by time between diagnostic catheterization and CABG (<24 hours, 24-48 hours, 48-72 hours).</p><p><strong>Results: </strong>A total of 28,349 patients were transported by EMS and diagnosed with an acute STEMI during the study period. Only 384 (1.35%) patients underwent CABG within 72 hours of diagnostic catheterization: 268 (0.95%) underwent CABG in <24 hours; 71 (0.25%) in 24-48 hours, and 45 (0.16%) in 48-72 hours. The median age of patients undergoing CABG was 64 years (interquartile range 58-72). Twenty-eight (7.3%) experienced prehospital cardiac arrest, and eight (2.1%) required vasopressors. Prior to undergoing CABG, 137 patients (36%) underwent primary percutaneous coronary intervention. The proportion of patients undergoing CABG within 72 hours remained relatively stable between 2011-2022 at 1.19% and 1.96%, respectively.</p><p><strong>Conclusion: </strong>Urgent or emergent CABG remained infrequently performed for acute STEMI patients after primary diagnostic catheterization. There was little change in the percentage of STEMI patients who received CABG within 72 hours of diagnostic catheterization over the past decade. These findings suggest that regional or local policies requiring on-site cardiac surgery at SRCs may be reconsidered.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"729-736"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498160","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":"Validation of a Methodology to Investigate Care Inequities for Transgender Patients.","authors":"Kellyn Engstrom, Fernanda Bellolio, Molly Moore Jeffery, Sara C Sutherland, Kayla P Carpenter, Gia Jackson, Kristin Cole, Victor Chedid, Caroline J Davidge-Pitts, Kharmene L Sunga, Cesar Gonzalez, Caitlin S Brown","doi":"10.5811/westjem.21279","DOIUrl":"10.5811/westjem.21279","url":null,"abstract":"<p><strong>Introduction: </strong>Pain is a common chief complaint in the emergency department (ED), and there are known disparities in the management of pain among racial/ethnic minorities, women, and older adults. Transgender and gender diverse (TGD) individuals comprise another under-represented patient population in emergency medicine and are also at risk of disparities in care. To measure and evaluate the magnitude of care inequities among TGD individuals, first we need to be able to accurately identify the right cohort and comparison groups. The primary objective of this study was to establish an accurate and generalizable process for identifying TGD patients through the electronic health record (EHR). Secondary objectives included creating and validating a method for matching and comparing of TGD patients to cisgender patients.</p><p><strong>Methods: </strong>This was a retrospective, observational cohort study that included patients presenting to Mayo Clinic EDs with a chief complaint of abdominal pain across four states (MN, WI, AZ, FL) between July 1, 2018-November 15, 2022. Patients ≥12 years of age were included. Patients' sex assigned at birth and gender identity was extracted from the EHR via patient-provided registration fields. Two independent investigators independently reviewed each medical record of the identified TGD patient to validate the accuracy of pulled gender identity. Discrepancies were resolved by a third reviewer. Each transgender patient was matched to cisgender GBQ males (gay, bisexual, queer), cisgender LBQ (lesbian, bisexual, queer) females, cisgender heterosexual males, and cisgender heterosexual females using propensity score (PS) matching. We calculated the PS values using a multivariable logistic regression model where being transgender was the outcome, and covariates in the model included age, site, mental health history, and gastrointestinal history.</p><p><strong>Results: </strong>We initially identified 300 patients as TGD based on electronic data pull. An additional 1,000 patients were also included in the cohort for matching purposes. The agreement between electronic and manual review was 99.9%, and the kappa was 0.998 (95% confidence interval 0.994-1.000). We were able to match patients except for GBQ males due to low numbers. There is a significant difference in age between groups (P <0.001) with GBQ males being older than other groups.</p><p><strong>Conclusion: </strong>The methodology for identifying transgender and gender diverse patients in the EHR was accurate compared to manual review of gender identity. The TGD patients were able to be well matched, except to GBQ males. This provides a validated method to identify TGD patients in the EHR and further study disparities they may receive in care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"425-430"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Heat Index and Patient Presentation Rate at a Stadium.","authors":"Jennifer Wolin, Daniel Wolf, John Su, Eric Quinn, David Eng, Humaira Ali, David Lobel, Matt Friedman","doi":"10.5811/westjem.21222","DOIUrl":"10.5811/westjem.21222","url":null,"abstract":"<p><strong>Introduction: </strong>A mass gathering is defined as an event that has the potential to strain the resources of the local health system. An onsite physician for mass gatherings can mitigate the strain on the local health infrastructure. One factor affecting onsite medical usage and patient presentation rates is the heat index, which is a calculated value of perceived heat exposure that combines air temperature and relative humidity. In this study we asked whether there was a positive association between heat index and patient presentation rates for onsite medical care at a bounded (large event in an enclosed location) professional stadium sporting event. We hypothesized that a positive correlation exists between these two variables and assess whether it might surpass current onsite resources.</p><p><strong>Methods: </strong>We performed a prospective observational study with patients seeking medical care at a baseball stadium in a large northeastern city in the United States. The onsite physician collected information on patients who presented during games held at the stadium. Data on game attendance, temperature in degrees Fahrenheit (F), humidity, and heat index were collected using government and professional organization websites. We assessed the correlation between heat index and patient presentation rate with the Pearson product-moment correlation (PPMC) per 100,000 attendees at the game.</p><p><strong>Results: </strong>A total of 81 baseball games occurred at the studied stadium from April-September 2023, with eight games excluded due to incomplete data. The heat index ranged from 46°F to 91°F, with a mean (± SD) of 70.8°F (± 10.4°F). The number of patients varied from 0-5 per game, with a mean of 1.92 (± 1.13), and stadium attendance ranged from 25,007 to 47,295, with a mean of 40,824. The patient presentation rate per 100,000 in attendance was 5.04 (± 2.13). The PPMC was calculated to be 0.37 (P < .01), indicating a positive correlation between heat index and patient presentation rates. The most common reasons for seeking medical care were lightheadedness and musculoskeletal complaints.</p><p><strong>Conclusion: </strong>In this study we found that the heat index was moderately associated with higher patient presentation rates at bounded mass gathering baseball events. No additional resources were needed, but this correlation could aid future event medical planning efforts as the climate continues to evolve.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"667-673"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498153","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":"Civil Monetary Penalties from Violations of the Emergency Medical Treatment and Labor Act for Patients Arriving or Leaving with Law Enforcement.","authors":"Sameer Ahmed, Zach Reichert, Genevieve Santillanes, Carmen Toomer, Sandra Tyler-Mills, Neha Vontela, Jasmine Hsia, Sarah Axeen, Saman Kashani, Joe Nakagawa, Michael Menchine, Sophie Terp","doi":"10.5811/westjem.39677","DOIUrl":"10.5811/westjem.39677","url":null,"abstract":"<p><strong>Introduction: </strong>The Emergency Medical Treatment and Labor Act (EMTALA), a federal law enacted in 1986, is intended to prevent inadequate, delayed, or denied treatment of emergency medical or emergency psychiatric conditions by Medicare-participating hospitals when individuals present to dedicated emergency departments (EDs). EMTALA requires all patients seeking evaluation for an emergency medical condition (EMC) at a dedicated ED to have an appropriate medical screening exam (MSE), stabilization of identified EMCs, and an appropriate transfer if specialized services are needed for stabilization.</p><p><strong>Methods: </strong>We obtained summaries of all EMTALA-related civil monetary penalties (CMPs) between 2002-2023 from the Office of the Inspector General (OIG) and reviewed them for instances where patients arrived or departed with law enforcement officers (LEOs). In this article, we describe the characteristics of these CMPs.</p><p><strong>Results: </strong>Of 260 EMTALA-related CMPs, 15 (5.8%) were identified as having involved patients arriving to or departing from an ED with LEOs. Among these, nine (60%) involved patients arriving to the ED with LEOs, of whom five (55.6%) were transported to alternate facilities by LEOs at the direction of ED staff without receipt of an appropriate MSE. Overall, eight (88.9%) of nine patients arriving with LEOs involved psychiatric concerns. Four cases were identified as having involved patients discharged from but not arriving to the ED with LEOs. Of these, two involved patients brought to the ED for evaluation of psychiatric conditions and discharged to jail without appropriate MSE after becoming disruptive. Two involved patients with psychiatric issues sent to jail without appropriate MSE/stabilization, some due to hospital policies pertaining to alcohol intoxication. Two involved patients without noted psychiatric concerns escorted from the ED with the assistance of LEOs after reported to be \"resistant\" or \"aggressive.\" One returned to the ED in cardiac arrest, and another was subsequently diagnosed with bacterial meningitis.</p><p><strong>Conclusion: </strong>Overall, 5.8% of EMTALA-related CMPs involved patients arriving to or departing from the ED with LEOs; most of these involved patients with psychiatric emergencies. In many cases, LEOs were advised to either transport patients to an alternate medical facility without an appropriate MSE, or disruptive or intoxicated patients with noted psychiatric concerns were discharged to jail without adequate MSE or stabilization. Findings indicate a need for education surrounding EMTALA requirements to provide MSEs and, if needed, stabilizing treatment prior to discharge or transfer for all patients presenting to the ED, regardless of LEO involvement.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"712-719"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498158","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":"Evaluation of Point-of-Care Ultrasound Use in Emergency Medicine Residents: An Observational Study.","authors":"Michael Fareri, Matthew VandeHei, Benjamin Schnapp, Corlin Jewell, Michael R Lasarev, Roxana Alexandridis, Dana Resop, Sara Damewood, Hani I Kuttab","doi":"10.5811/westjem.21200","DOIUrl":"10.5811/westjem.21200","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) is integral to emergency medicine (EM) training. It is unclear how EM residents use POCUS and how these skills are maintained as they progress in residency training. The purpose of this study was to evaluate resident use of POCUS at various timepoints in EM training.</p><p><strong>Methods: </strong>This was a retrospective cohort study of EM residents at a single, three-year training program between July 1, 2014-June 30, 2022. Residents were included if they had completed three consecutive years of training and an ultrasound rotation in their postgraduate year (PGY)-1. The following time points were assessed: PGY-1 rotation and 3-, 6-, 12-, 18-, and 24-months post-rotation. Number of scans, accuracy of interpretation, acceptability for credit, and percentage of technically limited studies (TLS) were collected at each point. We analyzed performance characteristics using mixed-effects binomial logistic regression with time as a fixed effect and resident as a random effect. Models were fit separately for each performance characteristic and likelihood ratio tests were performed to determine whether performance varied over time.</p><p><strong>Results: </strong>A total of 65 residents were included with a total of 13,229 exams performed during the study period. Cardiac and focused assessment with sonography in trauma examinations were performed most commonly. Overall accuracy of all exams during the examination period was 97.1% (95% confidence interval [CI] 96.2-98.0%), TLS was 14.5% (95% CI 9.7-20.6%), and acceptability was 82.9% (95% CI 76.3-88.2%). Trend over time (3, 6, 12, 18, and 24 months) found no differences in accuracy (P = 0.84), TLS (P = 0.20), or acceptability (P = 0.28). Further analyses by individual exam types also showed no significant differences in accuracy, acceptability, nor TLS.</p><p><strong>Conclusion: </strong>Accuracy, acceptability, and percentage of technically limited scans did not significantly vary over time, suggesting that POCUS skills are maintained from PGY-1 rotation to each time point evaluated in this study.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"478-485"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498131","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":"Patient Sociodemographic Factors Are Associated with Receiving Point-of-care Ultrasound in the Emergency Department.","authors":"Brandon M Wubben, Devin Spolsdoff, Karisa K Harland, Marina Del Rios","doi":"10.5811/westjem.21297","DOIUrl":"10.5811/westjem.21297","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is widely used in emergency medicine (EM) and increasingly throughout healthcare. Prior studies have revealed disparities in the use of imaging in the emergency department (ED) based on sociodemographic factors; however, the association between these factors and POCUS use is unknown. Our aim was to compare the odds of receiving POCUS in the ED based on patient race and ethnicity, language, sex, and type of insurance.</p><p><strong>Methods: </strong>We reviewed electronic health records (EHR) matched to a departmental POCUS database from November 2021-June 2023 at an academic Level I trauma center. We included ED patients diagnosed with an International Classification of Diseases code mapped to chest or flank pain, who had a cardiac troponin obtained, or had been evaluated as a trauma activation or alert. Our primary outcome was whether a patient received transthoracic echocardiography (cardiac), renal, or focused assessment with sonography in trauma. Predictor variables were race/ethnicity group (non-Hispanic [NH] White, NH Black, Hispanic, other), patient language, sex assigned at birth, and insurance type as recorded in the EHR. We performed descriptive analyses and logistic regression (adjusted odds ratio [aOR], 95% confidence interval [CI]) controlling for body mass index, age, comorbidities, and triage hypotension or tachycardia.</p><p><strong>Results: </strong>Of the 25,389 ED patients meeting inclusion criteria, 79.5% were NH White, 95.3% listed English as their primary language, 51.5% were female, and 33.4% had private payor insurance. After adjusting for confounding, patients had lower odds of receiving POCUS if they were \"other\" race/ethnicity as compared to NH White (aOR 0.65, CI 0.42-0.99, P = .04), female as compared to male (aOR 0.81, CI 0.69-0.94, P = .007), or if they had Medicare (aOR 0.67, CI 0.54-0.84, P <.001) or Medicaid (aOR 0.66, CI 0.52-0.83, P = .001) as compared to private payors.</p><p><strong>Conclusion: </strong>Overall, patients of female sex and patients with Medicaid or Medicare had lower odds of receiving point-of-care ultrasound in the ED. Although we did not find a difference in POCUS use among non-Hispanic White, NH Black, and Hispanic patients, patients belonging to other race/ethnicity categories had lower odds of receiving POCUS compared to NH White patients.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"486-490"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498142","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":"Age-stratified Association Between Plasma Adiponectin Levels and Mortality in Septic Patients.","authors":"Hui Wang, Ming Ma, Jingfeng Dong, Jun Duan","doi":"10.5811/westjem.35607","DOIUrl":"10.5811/westjem.35607","url":null,"abstract":"<p><strong>Background: </strong>Plasma adiponectin (APN) levels might be affected by age. In this study we aimed to study the association between plasma APN levels and age and the effects of APN levels on mortality in age-stratified septic patients.</p><p><strong>Methods: </strong>We conducted this single-center, retrospective study with 173 patients with sepsis and 57 controls. Physical and demographic characteristics were recorded, and blood samples were collected to measure plasma APN levels. Using this data, we determined the association between plasma APN levels and age, and the effect of plasma APN levels on mortality in age-stratified septic patients.</p><p><strong>Results: </strong>We stratified patients into three age groups: < 60 years (middle age); 60-80 years (advanced age); and elderly (≥ 80 years). Plasma APN levels increased with increasing age in both the control group and the sepsis group. Mortality also increased with age: 12.3% in the < 60 group; 24.6% in those 60-80 years of age; and 36.2% in elderly patients >80 years (P<0.001). In middle-aged and advanced-age patients, APN levels were found to be associated with 28-day mortality based on the receiver operating characteristic curve analysis. Furthermore, APN levels remained independently associated with 28-day mortality in patients < 80 years. However, in elderly patients the APN levels showed no significant association with 28-day mortality.</p><p><strong>Conclusion: </strong>We found a positive association between plasma adiponectin levels and age in septic patients. Low circulating levels of APN were associated with 28-day mortality in septic patients < 80 years of age. We found no significant association between APN and mortality in sepsis patients who were > 80 years of age.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"609-616"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Medical Service Responders' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany.","authors":"Torben Brod, Kambiz Afshar, Christoph Schroeder, Carsten Stoetzer, Stephanie Stiel","doi":"10.5811/westjem.39705","DOIUrl":"10.5811/westjem.39705","url":null,"abstract":"<p><strong>Introduction: </strong>Gender minorities, including transgender, intersexual and non-binary (TIN) individuals, are at risk of receiving suboptimal care in emergency departments due to clinicians' limited knowledge and formal training in TIN-specific needs. Little evidence is available regarding emergency medical service (EMS) responders, including paramedics (EMT-P), emergency medical technicians (EMT) ,and prehospital emergency physicians (EP). Therefore, in this study we aimed to explore the experiences and knowledge, attitudes, and education/training needs of EMS professionals in Germany regarding the care of TIN patients.</p><p><strong>Methods: </strong>In April 2023, we electronically surveyed EMTs, EMT-Ps and prehospital EPs from ambulance stations across Germany. Participants completed a questionnaire consisting of 15 closed-ended items assessing their experience and knowledge, attitudes, and education/training needs regarding the care of TIN patients. We used standard descriptive statistics and tested for group differences using the chi-square test.</p><p><strong>Results: </strong>Of the 2,925 potential respondents, 906 completed the survey and were eligible for further analysis (response rate: 31%). Of these, 218 (24%) were prehospital EPs and 688 (76%) were EMTs and EMT-Ps, the latter two being significantly younger and less experienced. Almost half of the respondents reported having experience in caring for TIN patients as EMS responders (45% of EMTs/EMT-Ps vs 40% of prehospital EPs) but demonstrated significant gaps in non-medical and medical knowledge. Attitudes toward TIN patients were generally positive, but there were discrepancies between perceived comfort and actual communication behavior, with up to 25% of respondents overall avoiding questions they would ask non-TIN patients. Most respondents had no formal training in the appropriate management of TIN patients: only 7% of EMTs/EMT-Ps and 5% of prehospital EPs indicated having received such training during their professional or medical training. Our survey showed that 63% of EMTs/EMT-Ps and 62% of prehospital EPs agreed that there is an urgent need to increase awareness for TIN patients among EMS responders.</p><p><strong>Conclusion: </strong>Despite generally positive attitudes toward transexual, intersexual and non-binary patients, EMS responders in Germany demonstrated deficits in knowledge and clinical preparedness to care for this vulnerable patient population, indicating that the care of TIN patients has not yet become routine in EMS and highlighting a strong need for improved education and training.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"458-464"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498175","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":"Descriptive Analysis of Resources Used to Learn About Residency Programs Since Transition to Virtual Interviews.","authors":"Richard Bounds, John Priester, Benjamin Lewis, Roz King, Skyler Lentz","doi":"10.5811/westjem.33574","DOIUrl":"10.5811/westjem.33574","url":null,"abstract":"<p><strong>Introduction: </strong>The transition to virtual interviews over the past four years has been associated with changes to the ways that applicants collect information on residency programs.</p><p><strong>Methods: </strong>Our program collected free-response data from questionnaires completed by applicants prior to their virtual interview days over the course of four recruitment cycles. We performed a descriptive analysis of these responses to identify the frequency with which students have been accessing various resources to learn about programs, and to learn how that has changed over time.</p><p><strong>Results: </strong>Our findings over four years and 322 applicants (of 391 surveyed, response rate 82%) indicated that the three most common sources of information were individual program websites, the Emergency Medicine Resident's Association (EMRA) Match website, and Instagram. These sources were reported more frequently than personal experience, word of mouth, and advice from mentors. Other online resources were rarely used.</p><p><strong>Conclusion: </strong>These findings may help program leaders to direct their limited time and attention towards marketing their programs through online resources most commonly used by applicants.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"569-572"},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498162","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}