Western Journal of Emergency Medicine最新文献

{"title":"Gender Disparities and Burnout Among Emergency Physicians: A Systematic Review by the World Academic Council of Emergency Medicine-Female Leadership Academy for Medical Excellence.","authors":"Suman Thakur, Vivek Chauhan, Sagar Galwankar, Fatimah Lateef, Pia Daniel, Zeynep Cakir, Katia M Lugo, Samjhana Basnet, Busra Bildik, Siham Azahaf, Sevilay Vural, Busra H Difyeli, Lisa Moreno-Walton","doi":"10.5811/westjem.29331","DOIUrl":"10.5811/westjem.29331","url":null,"abstract":"<p><strong>Background: </strong>The Female Leadership Academy for Medical Excellence, members of the World Academic Council of Emergency Medicine, conducted this systematic review, which explores gender disparities in burnout among emergency physicians (EP) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Burnout is a critical issue in healthcare, particularly in emergency medicine where high stress and demanding work environments prevail.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched PubMed and Epistemonikos for studies using MBI-HSS to measure burnout in EPs. Inclusion criteria encompassed peer-reviewed, English-language articles reporting burnout by sex. Data extraction focused on proportions of burnout and its subcomponents, mean scores, and odds ratios, with quality assessed using Joanna Briggs Institute criteria.</p><p><strong>Results: </strong>We included 18 studies spanning 26,939 EPs from 10 countries. While overall burnout rates did not significantly differ between the sexes, the proportion of female EPs with high emotional exhaustion (EE) (69%) and low sense of personal accomplishment (PA) (45%) were significantly higher compared to males with high EE in 57% and low PA in 29%, respectively (<i>P</i> < 0.001 for both). Proportion with high depersonalization (DP) score was 44% in both male and female EPs. Mean scores revealed females experiencing higher mean EE (26.8 ± 15.7) scores vs males (25.4 ± 15.9) <i>P</i> < 0.001. Males had mean DP scores (8.6 ± 8.0) and mean PA scores (26.6 ± 12.7) compared to females with lower mean DP scores (7.4 ± 7.2) and higher PA scores (27.7 ± 11.9), respectively <i>P</i> < 0.001 for both. Odds ratios indicated varying risks, predominantly higher EE odds among females, varying from 0.72 to 2.3.</p><p><strong>Conclusion: </strong>This review underscores gender-specific manifestations of burnout among emergency physicians, with females more susceptible to emotional exhaustion and lower sense of personal accomplishment. Standardized reporting methods are crucial for future meta-analyses to refine gender-specific interventions combating burnout in emergency medicine. Targeted strategies addressing distinct manifestations of burnout are imperative to support the well-being and retention of EPs, fostering sustainable healthcare delivery.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"338-346"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721283","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":"Immune Checkpoint Inhibitor-associated Pneumonitis: A Narrative Review.","authors":"Chang Li, Saadia A Faiz, Megan Boysen-Osborn, Ajay Sheshadri, Monica K Wattana","doi":"10.5811/westjem.20305","DOIUrl":"10.5811/westjem.20305","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICI), such as pembrolizumab, nivolumab, durvalumab and ipilimumab, have significantly enhanced survival rates for multiple cancer types such as non-small cell lung cancer, melanoma, Hodgkin lymphoma, and breast cancer, and they have emerged as an adjunct or primary therapy for malignant disease. Approximately 40% of patients with cancer on ICI therapy experience side effects called immune-related adverse events (irAE). While not the most common, pulmonary toxicities can be rapidly progressive, potentially fatal, and pose a three-fold increased risk for requiring intensive care unit-level of care. Pneumonitis is a focal or diffuse inflammation of the lung parenchyma, and clinical manifestations may be highly variable. While the onset is generally observed 6-12 weeks after the initiation of therapy, drug toxicity can develop rapidly within days after the first infusion or many months into therapy. Pneumonitis symptoms can be subtle or non-specific; therefore, a thorough and systematic evaluation considering other possible etiologies is crucial. Moreover, extrapulmonary findings, such as skin lesions, colitis, or endocrinopathies, should raise suspicion for irAE as drug toxicity can affect multiple organs simultaneously. Due to the significant overlap of clinical features between ICI-associated pneumonitis and respiratory infections, it can be challenging to differentiate the two conditions based on clinical presentation alone. A multidisciplinary approach to management is recommended for the treatment of ICI-associated pneumonitis, and classification of severity helps to guide interventions. Treatment options in more severe cases include systemic immunosuppression. Given the increased use of ICIs and greater probability that patients with ICI-associated pneumonitis will be seen in the emergency department, we aimed to provide a comprehensive framework for the diagnosis and management. In addition, identifying potential challenges in diagnosis and/or other contributors of respiratory symptoms and radiographic manifestations is highlighted.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"210-218"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721354","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":"Combining Immersive Simulation with a Collaborative Procedural Training on Local Anesthetic Systemic Toxicity and Fascia Iliaca Compartment Block: A Pilot Study.","authors":"Katherine B Griesmer, Maxwell Thompson, Briana Miller, Guihua Zhai, Jaron Raper, Andrew Bloom","doi":"10.5811/westjem.25020","DOIUrl":"10.5811/westjem.25020","url":null,"abstract":"<p><strong>Introduction: </strong>Readiness to perform a wide variety of procedures or manage nearly any patient presentation remains an essential aspect of emergency medicine training and practice. Often, simulation is needed to supplement real-life exposure to provide comfort and knowledge, particularly with rarer pathology and procedures. As the scope of practice continues to grow, newer procedures, such as ultrasound (US)-guided nerve blocks (UGNB), are becoming integrated into resident training, building on previously established skills. The fascia iliaca compartment block (FICB) is performed on patients with specific femoral fractures and is a now a component of standard multimodal pain regimens, with US-guidance limiting adverse events. Given the need for high volumes of local anesthetic to perform the block it is imperative for clinicians to understand dosing as well as recognize and treat local anesthetic systemic toxicity (LAST). With sparse literature on sequential immersive and procedural simulation involving intertwined topics, this presents a unique opportunity for learners.</p><p><strong>Methods: </strong>To study the perceived knowledge and comfort with FICB and LAST, a pilot study was developed with two separate but concurrent one-hour simulations completed encompassing one of each topic over one day. We surveyed 19 learners, consisting of residents ranging from postgraduate years 1-3, prior to and immediately following completion, regarding their perceptions. We used the Stuart-Maxwell test to compare survey data.</p><p><strong>Results: </strong>More than half of participants (56%) had not received prior formal training on FICB. There was a positive trend in perceived confidence and knowledge with visualizing relevant anatomy (4.0 [2.0-6.0] vs 9.0 [7.5-10.0], <i>P</i> = 0.10), performing FICB (4.0 [1.0-5.0] vs 9.0 [7.0-10.0, <i>P</i> = 0.08]), and perceived ability to teach their peers (3.0 [1.0-5.0] vs 8.5 [7.0-10.0], <i>P</i> = 0.20). Perceived ability in diagnosing and managing LAST also increased following the simulation (5.0 [3.0-6.0] vs 6.0 [6.0-7.0], <i>P</i> = 0.12 and 3.0 [2.0-6.0] vs 6.0 [6.0-7.0], <i>P</i> = 0.08, respectively).</p><p><strong>Conclusion: </strong>Learners' perceptions of this simulation experience echo the findings of previous studies in which simulation can be used to teach procedures and pathology; of note, however, we presented a novel experience with a combination of immersive and procedural simulation.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"271-278"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721658","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":"Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity.","authors":"Corlin M Jewell, Guangyu Anthony Bai, Dann J Hekman, Adam M Nicholson, Michael R Lasarev, Roxana Alexandridis, Benjamin H Schnapp","doi":"10.5811/westjem.20282","DOIUrl":"10.5811/westjem.20282","url":null,"abstract":"<p><strong>Introduction: </strong>Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency.</p><p><strong>Methods: </strong>We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017-2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU).</p><p><strong>Results: </strong>A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73-12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157-367; P < 0.001) unit increase in average RVUs generated.</p><p><strong>Conclusion: </strong>Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"254-260"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721325","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":"Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of Ejection Fraction in Emergency Department in India.","authors":"Sudhi Manu, Gopinathan Vivek, Asanaru Kunju Sanjan, A Ajay, S Nisarg, Mymbilly Balakrishnan Jayaraj, T R Aishwarya, Mohammad Khalid, S Chetana","doi":"10.5811/westjem.19394","DOIUrl":"10.5811/westjem.19394","url":null,"abstract":"<p><strong>Introduction: </strong>Assessing cardiac function is crucial for managing acute dyspnea. In this study we aimed to evaluate displacement of the aortic root (DAR) as a method for calculating ejection fraction (EF) in patients with undifferentiated dyspnea presenting to the emergency department (ED). The primary objective was to compare EF values obtained through DAR with the modified Simpson method, which is considered the criterion reference, within an Indian academic ED.</p><p><strong>Methods: </strong>We conducted a prospective, cross-sectional study spanning two years (December 2019-December 2021). The study enrolled 110 consecutive ED patients ≥18 years of age, presenting with undifferentiated dyspnea and normal sinus rhythm. Ultrasound-trained investigators measured DAR using M-mode ultrasonography. Experienced echocardiographers, blinded to DAR, determined EF using the modified Simpson method. Statistical analyses included the Shapiro-Wilk test, McNemar test, and the receiver operating characteristic curve.</p><p><strong>Results: </strong>The mean DAR measurement was 0.781 centimeters, with an average calculated EF of 54.4%. The EF calculated using DAR did not differ significantly from EF calculated using the modified Simpson method. Comparative analysis revealed DAR's superior sensitivity (86.21%) compared to mitral annular plane systolic excursion (48.28%) and end-point septal separation (45.45%). The DAR method exhibited high accuracy (area under the curve = 0.958) with a cut-off value 0.706 (sensitivity 88.7%, specificity 93.1%).</p><p><strong>Conclusion: </strong>Evaluating displacement of the aortic root to calculate ejection fraction in undifferentiated dyspnea demonstrated high accuracy, sensitivity, and agreement with the modified Simpson method, which is considered the criterion reference. Its simplicity and non-invasiveness makes it a valuable initial screening tool in emergency settings, with the potential to reshape cardiac assessment approaches and optimize patient care pathways in the ED.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"191-199"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721624","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":"Analysis of the Highest Altmetrics-scored Articles in Emergency Medicine Journals.","authors":"Başak Bayram, Murat Cetin, Önder Limon, Brit Long, Michael Gottlieb","doi":"10.5811/westjem.21201","DOIUrl":"10.5811/westjem.21201","url":null,"abstract":"<p><strong>Introduction: </strong>Alternative metrics (altmetrics) have emerged as invaluable tools for assessing the influence of scholarly articles. In this study we aimed to evaluate correlations between Altmetric Attention Scores (AAS), and sources and actual citations in articles displaying the highest AAS within emergency medicine (EM) journals.</p><p><strong>Methods: </strong>We conducted an analysis of EM journals listed in the Science Citation Index Expanded (SCIE) using the Altmetric Explorer tool. We analyzed the journals that received the highest number of mentions, the sources of AAS, the regions most frequently mentioned, and the geographical distribution of mentions. In the subsequent stage of our analysis, we conducted an examination of the 200 top-ranked articles that had received high AAS and were published in SCIE EM journals from January 1, 2013-January 1, 2023. We sought to determine the correlations between the AAS and the citation counts of articles on Google Scholar and the Web of Science (WOS).</p><p><strong>Results: </strong>Of 40,840 research outputs evaluated, there were 510,047 shares across multiple platforms. The AAS were present for 36,719 articles (89.9%), while 10.1% had no score. In the review of the top 200 articles with the highest AAS, the median score was 382.5 (interquartile range 301.3-510.8). Of the research output evaluated, 38% were observational studies, 13% case reports, and 13% reviews/meta-analyses. The most common research topics were emergency department (ED) management and COVID-19. There was no correlation between AAS and WOS citation numbers (r_s = -0.041, <i>P</i> = 0.563, 95% confidence interval [CI] -0.175-0.087). There was a weak correlation identified between WOS citations and mentions on X, and a moderate correlation observed for WOS citations and blog mentions (r_s = 0.330, <i>P</i> < .001, 95% CI 0.174 to 0.458; r_s ² = 0.109, and r_s = 0.452, <i>P</i> < .001, 95% CI 0.320-0.566; and r_s ² = 0.204, respectively). However, we found a strong positive correlation between WOS citations and the number of Mendeley readers (r_s = 0.873, <i>P</i> < .001, 95% CI 0.82-0.911, r_s ² = 0.762).</p><p><strong>Conclusion: </strong>While most articles in EM journals received an AAS, we found no correlation with traditional citation metrics. However, Mendeley readership numbers showed a strong positive correlation with citation counts, suggesting that academic platform engagement may better predict scholarly impact.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"353-363"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721606","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":"Personality Traits and Burnout in Emergency Medicine Residents.","authors":"Brendan Freeman, Lukasz Cygan, Laura Melville, Theodore Gaeta","doi":"10.5811/westjem.21139","DOIUrl":"10.5811/westjem.21139","url":null,"abstract":"<p><strong>Background: </strong>Burnout is prevalent in medical training, and some data indicates certain personality types are more susceptible. The criterion reference for measurement of burnout is the Maslach Burnout Inventory (MBI), which scores three factors: emotional exhaustion (EE); depersonalization (DP); and personal accomplishment (PA). Emotional exhaustion most closely correlates with burnout. Studies have yet to evaluate a link between burnout markers and certain personality traits in emergency medicine (EM) residents. The personality traits of openness, agreeableness, extraversion, conscientiousness, and neuroticism can be measured with a 50-item International Personality Item Pool (IPIP) Big 5 survey. Our goal in this study was to be the first to examine the relationship between personality traits and burnout among EM residents and guide future research on potential predictors of burnout and targeted interventions for resident well-being.</p><p><strong>Methods: </strong>This was an observational, cross-sectional study conducted in March and April of 2023 in an urban, Level II trauma center, involving all EM residents at a three-year residency program. Two surveys, the IPIP and MBI-Human Services Survey, were distributed to all residents, and their responses were anonymous. We calculated raw/mean scores and standard deviations for each personality trait/burnout measure and compared them by the Pearson correlation coefficient.</p><p><strong>Results: </strong>All 38 residents completed the surveys. A total of 31% of the cohort reported high exhaustion, 13% reported high DP, and 42% reported low PA. Two of 38 (5%) residents reported the combination of high EE, high DP, and low PA. There was a statistically significant negative correlation between conscientiousness and EE (<i>n</i> = 38; Pearson <i>r</i> = -0.40, <i>P</i> < 0.001) and a positive correlation between conscientiousness and PA (<i>n</i> = 38; Pearson <i>r</i> = 0.36, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>In our sample, residents who were more conscientious reported experiencing lower levels of emotional exhaustion and a greater sense of personal accomplishment. Programs may cautiously explore the potential of assessing resident personality traits as part of broader efforts to identify predictors of burnout, but further research with larger, multicenter, longitudinal samples is needed to corroborate these results. The small sample size and single-center design may limit generalizability of these findings, and the use of self-reported measures introduces the risk of response bias.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"241-245"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721486","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":"Virtual Interviews Correlate with Home and In-State Match Rates at One Emergency Medicine Program.","authors":"Christine Motzkus, Casey Frey, Aloysius Humbert","doi":"10.5811/westjem.21292","DOIUrl":"10.5811/westjem.21292","url":null,"abstract":"<p><strong>Introduction: </strong>Incorporating virtual interviews into residency recruitment may help diversify access to residency programs while reducing the cost involved with travel and lodging. Programs may be more likely to rank students they have met in person at an interview when compared to unknown virtual applicants. Our objective was to characterize home institution, in-state, and in-region match rates to emergency medicine (EM) residency programs for fourth-year medical students.</p><p><strong>Methods: </strong>We used National Residency Matching Program data available to the program director to identify medical school and match location of fourth-year medical students who interviewed at a large EM residency program in the Midwest from 2018-2023. Students' medical schools and ultimately matched programs were mapped to Electronic Residency Application Service geographic regions; subgroup analyses evaluated allopathic and osteopathic medical students separately. We used chi-square tests to compare proportions of students matching to home, in-state, or in-region programs across years.</p><p><strong>Results: </strong>There were 1,401 applicants with match information available. The percentage of students matching to a home institution remained stable over the course of the study. The percentage of students matching to an in-state institution increased over the first two years of virtual interviews rising from 23.2% in the 2020 match to 30.8% in-state matches for the 2022 match. Chi-square tests did not reveal any significant differences among groups for all applicants. Allopathic medical students demonstrated a significant increase in matches to home institutions. In-region matches stayed relatively stable over the study time frame regardless of subgroup.</p><p><strong>Conclusion: </strong>Virtual interviews changed the landscape of residency interviews. Home institution and in-state matches may be more likely for applicants from allopathic schools who participated in a virtual interview as both programs and applicants are more familiar with each other; however, our study did not find convincing evidence of this possibility among all applicants. Additional study is needed to determine ongoing effects of the transition to virtual interviews.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"285-289"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721630","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":"Effort During Ethanol Breath Testing Impacts Correlation with Serum Ethanol Concentration.","authors":"Samuel J Stellpflug, William H Menton, Bjorn C Westgard, Ryan D Johnsen, Alexander M Coomes, Robert C LeFevere, Michael D Zwank","doi":"10.5811/westjem.24998","DOIUrl":"10.5811/westjem.24998","url":null,"abstract":"<p><strong>Introduction: </strong>The gold standard for quantifying ethanol intoxication in patients is serum testing. However, breath testing is faster, less expensive, and less invasive. It is unknown whether perceived effort during a breath ethanol test impacts the accuracy of the test and the correlation with serum concentration. In this study we analyzed whether perceived \"poor\" effort during breath ethanol testing would result in worse correlation than perceived \"normal\" breath-testing effort with respect to serum ethanol concentration.</p><p><strong>Methods: </strong>Subjects were identified retrospectively over a 49-month period if they had both a breath ethanol test and a serum ethanol test obtained during the same ED visit within 60 minutes of each other, if they had their effort during the breath test recorded as \"normal\" or \"poor\" by the person administering the test, and had non-zero breath and serum ethanol concentrations. We completed descriptive and correlation analyses.</p><p><strong>Results: </strong>A total of 480 patients were enrolled, 245 with normal and 235 with poor effort. The patients with normal breath-test effort had mean breath and serum concentrations of 0.19 grams per deciliter (g/dL) and 0.23 g/dL, respectively. The patients with poor breath-test effort had mean breath and serum concentrations of 0.19 and 0.29 g/dL, respectively. The correlation coefficient between breath and serum ethanol values was 0.92 (95% confidence interval (CI) 0.84-0.96) for good effort and 0.63 (95% CI 0.53-0.74) for poor effort.</p><p><strong>Conclusion: </strong>The assessment of breath exhalation effort is meaningful in determining how well a patient's breath ethanol level correlates with the serum ethanol concentration. Poor breath effort, when compared to normal breath effort, was associated with higher ethanol levels as well as a larger difference and a greater variability between breath and serum values. If an accurate ethanol level is important for clinical decision-making, a physician should not rely on a poor-effort breathalyzer value.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 2","pages":"364-366"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721661","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":"Images in Black and White: Disparities in Utilization of Computed Tomography and Ultrasound for Older Adults with Abdominal Pain.","authors":"Ijeoma C Unachukwu, Michael N Adjei-Poku, Olivia C Sailors, Rachel Gonzales, Eugenia South, Zach Meisel, Rachel R Kelz, Anne R Cappola, Ari B Friedman","doi":"10.5811/westjem.18087","DOIUrl":"10.5811/westjem.18087","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal pain is the leading emergency department (ED) chief complaint in older (≥65 years of age) adults, accounting for 1.4 million ED visits annually. Ultrasound and computed tomography (CT) are high-yield tests that offer rapid and accurate diagnosis for the most clinically significant causes of abdominal pain. In this study we used nationally representative data to examine racial/ethnic differences in cross-sectional imaging for older adults presenting to the ED with abdominal pain.</p><p><strong>Methods: </strong>We performed a retrospective, cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to assess differences in the rate of imaging between White and Black older adults presenting to the ED for abdominal pain. Our primary outcome was the receipt of abdominal CT and/or ultrasound imaging.</p><p><strong>Results: </strong>Across 1,656 older adult ED visits for abdominal pain, White patients were 26.8% (relatively, 14.2% absolute) more likely to receive abdominal CT and/or ultrasound than Black patients: 802 of 1,197 (67.0%) White patients were 26.8% (relatively, 14.2% absolute) more likely to receive abdominal computed tomography and/ or ultrasound than Black patients (P=0.01).</p><p><strong>Conclusion: </strong>This study revealed that Black older adults presenting to the ED with abdominal pain receive significantly lower levels of cross-sectional imaging (CT/ultrasound) than White patients. Our findings highlight the need for further investigations into causes of disparities while initiating quality improvement processes to assess and address site- and clinician-specific patterns of care.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"26 3","pages":"452-457"},"PeriodicalIF":1.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498136","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}