Western Journal of Emergency Medicine最新文献

{"title":"Telesimulation Use in Emergency Medicine Residency Programs: National Survey of Residency Simulation Leaders.","authors":"Max Berger, Jack Buckanavage, Jaime Jordan, Steven Lai, Linda Regan","doi":"10.5811/westjem.24863","DOIUrl":"10.5811/westjem.24863","url":null,"abstract":"<p><strong>Introduction: </strong>Coronavirus 2019 (COVID-19) accelerated the need for virtual learning including telesimulation. Many emergency medicine (EM) programs halted in-person simulation and trialed telesimulation, but specifics on its utilization and plans for future use are unknown. Telesimulation has been defined as \"a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location.\" Our objective in this study was to describe the patterns of telesimulation usage in EM residency programs during COVID-19-induced learning restrictions as well as its anticipated future utility.</p><p><strong>Methods: </strong>We identified EM simulation leaders via the EMRA Match website, institutional websites, or personal contact with residency coordinators and directors, and invited them to participate by email. Participants completed a confidential, web-based survey consisting of multiple-choice items and one free-response question, developed by our study team with consideration of survey research best practices and Messick's validity framework. We collected data between January-February 2022. We calculated descriptive statistics for multiple-choice items and examined the free-response answers for common themes.</p><p><strong>Results: </strong>We obtained contact information for simulation leaders at 139 EM residency programs. Survey response rate was 65% (91/139). During in-person restrictions, 62% (56/91) of programs used telesimulation. Assuming all restrictions lifted, 38% (34/90) of respondents planned to continue to use telesimulation, compared to 9% (8/91) using telesimulation before COVID-19. Most respondents planned to use telesimulation for medical knowledge (26/34, 76%) and communication/teamwork-focused cases (23/34, 68%). In response to the free-response question regarding experience with and plans for use, we identified three major themes: 1) telesimulation is a valuable alternative to in-person learning; 2) telesimulation is an option for learners unable to participate in person; and 3) telesimulation is challenging for procedural education.</p><p><strong>Conclusion: </strong>Despite the relatively limited use of telesimulation in EM residencies prior to COVID-19, an increased number of programs have plans to continue incorporating telesimulation into their curricula. This plan for continued use opens opportunities for further innovation and scholarship within simulation education.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"907-912"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772666","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":"Barriers to Adoption of a Child-Abuse Clinical Decision Support System in Emergency Departments.","authors":"Alanna C Peterson, Donald M Yealy, Emily Heineman, Rachel P Berger","doi":"10.5811/westjem.18501","DOIUrl":"10.5811/westjem.18501","url":null,"abstract":"<p><strong>Introduction: </strong>Child abuse is a leading cause of morbidity and mortality in children. The rate of missed child abuse in general emergency departments (ED), where 85% of children are evaluated, is higher than in pediatric EDs. We sought to evaluate the impact of an electronic health record (EHR)-embedded child-abuse clinical decision support system (CA-CDSS) in the identification and evaluation of child maltreatment in a network of EDs three years after implementation.</p><p><strong>Methods: </strong>We anonymously surveyed all 196 ED attending physicians and advanced practice practitioners (APP) in the University of Pittsburgh Medical Center network. The survey evaluated practitioner awareness of, attitudes toward, and changes in clinical practice prompted by the CA-CDSS. We also assessed practitioner recognition and evaluation of sentinel injuries.</p><p><strong>Results: </strong>Of the 71 practitioners (36%) who responded to the survey, 75% felt the tool raised child abuse awareness, and 72% had a face-to-face discussion with the child's nurse after receiving a CA-CDSS alert. Among APPs, 72% consulted with the attending physician after receiving an alert. Many practitioners were unaware of at least one function of the CA-CDSS; 38% did not know who completed the child abuse screen (CAS); 54% were unaware that they could view the results of the CAS in the EHR, and 69% did not recognize the clinical decision support dashboard icon. Slightly over 20% of respondents felt that the CA-CDSS limited autonomy; and 4.5% disagreed with the recommendations in the physical abuse order set, which reflects American Academy of Pediatrics (AAP) guidelines. Greater than 90% of respondents correctly identified an intraoral injury and torso bruise in an infant as sentinel injuries requiring an evaluation for abuse.</p><p><strong>Conclusion: </strong>A child-abuse clinical decision support system embedded in the electronic health record was associated with communication among practitioners and was overall perceived as improving child abuse awareness in our system. Practitioners correctly recognized injuries concerning for abuse. Barriers to improving identification and evaluation of abuse include gaps in knowledge about the CA-CDSS and the presence of practitioners who disagree with the AAP recommendations for physical abuse evaluation and/or felt that clinical decision support in general limited their clinical autonomy.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"1011-1019"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772797","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":"External Validation of the RESCUE-IHCA Score as a Predictor for In-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation.","authors":"Yi-Ju Ho, Pei-I Su, Chien-Yu Chi, Min-Shan Tsai, Yih-Sharng Chen, Chien-Hua Huang","doi":"10.5811/westjem.18601","DOIUrl":"10.5811/westjem.18601","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) improves the prognosis of in-hospital cardiac arrest (IHCA). The six-factor RESCUE-IHCA score (resuscitation using ECPR during IHCA) was developed to predict outcomes of post-IHCA ECPR-treated adult patients. Our goal was to validate the score in an Asian medical center with a high volume and experience of ECPR performance and to compare the differences in patient characteristics between the current study and the original cohort in a 2022 observational study.</p><p><strong>Method: </strong>For this single-center, retrospective cohort study we enrolled 324 ECPR-treated adult IHCA patients. The primary outcome was in-hospital mortality. We used the area under the receiver operating curve (AUROC) to externally validate the RESCUE-IHCA score. The calibration of the model was tested by the decile calibration plot as well as Hosmer-Lemeshow goodness-of-fit with an associated <i>P</i>-value.</p><p><strong>Results: </strong>Of the 324 participants, 231 (71%) died before hospital discharge. The discriminative performance of the RESCUE-IHCA score was comparable with the originally validated cohort, with an AUC of 0.63. A prolonged duration of cardiac arrest was associated with an increased risk of mortality (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03, <i>P</i> = .006). An initial rhythm of ventricular tachycardia (OR 0.14, 95% CI 0.04-0.51, <i>P</i> = .003), ventricular fibrillation (OR 0.11, 95% CI 0.03-0.46, <i>P</i> = .003), and palpable pulse (OR 0.26, 95% CI 0.07-0.92, <i>P</i> = 0.04) were associated with a reduced mortality risk compared to asystole or pulseless electrical activity. In contrast to the original study, age (<i>P</i> = 0.28), resuscitation timing (<i>P</i> = 0.14), disease category (<i>P</i> = 0.18), and pre-existing renal insufficiency (<i>P</i> = 0.12) were not associated with in-hospital death.</p><p><strong>Conclusion: </strong>In external validation, the RESCUE-IHCA score exhibited performance comparable to its original validation within the single-center population. Further investigation on hospital experience, time-of-day effect, and specific disease categories is warranted to improve the selection criteria for ECPR candidates during IHCA.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 6","pages":"894-902"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772818","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":"Interfacility Patient Transfers During COVID-19 Pandemic: Mixed-Methods Study.","authors":"Michael B Henry, Emily Funsten, Marisa A Michealson, Danielle Albright, Cameron S Crandall, David P Sklar, Naomi George, Margaret Greenwood-Ericksen","doi":"10.5811/westjem.20929","DOIUrl":"https://doi.org/10.5811/westjem.20929","url":null,"abstract":"<p><strong>Introduction: </strong>The United States lacks a national interfacility patient transfer coordination system. During the coronavirus 2019 (COVID-19) pandemic, many hospitals were overwhelmed and faced difficulties transferring sick patients, leading some states and cities to form transfer centers intended to assist sending facilities. In this study we aimed to explore clinician experiences with newly implemented transfer coordination centers.</p><p><strong>Methods: </strong>This mixed-methods study used a brief national survey along with in-depth interviews. The American College of Emergency Physicians Emergency Medicine Practice Research Network (EMPRN) administered the national survey in March 2021. From September-December 2021, semi-structured qualitative interviews were conducted with administrators and rural emergency clinicians in Arizona and New Mexico, two states that started transfer centers during COVID-19.</p><p><strong>Results: </strong>Among 141 respondents (of 765, 18.4% response rate) to the national EMPRN survey, only 30% reported implementation or expansion of a transfer coordination center during COVID-19. Those with new transfer centers reported no change in difficulty of patient transfers during COVID-19 while those without had increased difficulty. The 17 qualitative interviews expanded upon this, revealing four major themes: 1) limited resources for facilitating transfers even before COVID-19; 2) increased number of and distance to transfer partners during the COVID-19 pandemic; 3) generally positive impacts of transfer centers on workflow, and 4) the potential for continued use of centers to facilitate transfers.</p><p><strong>Conclusion: </strong>Transfer centers may have offset pandemic-related transfer challenges brought on by the COVID-19 pandemic. Clinicians who frequently need to transfer patients may particularly benefit from ongoing access to such transfer coordination services.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"758-766"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355017","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":"Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System.","authors":"Ramesh Karra, Amber D Rice, Aileen Hardcastle, Justin V Lara, Adrienne Hollen, Melody Glenn, Rachel Munn, Philipp Hannan, Brittany Arcaris, Daniel Derksen, Daniel W Spaite, Joshua B Gaither","doi":"10.5811/westjem.18427","DOIUrl":"https://doi.org/10.5811/westjem.18427","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers.</p><p><strong>Methods: </strong>This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality.</p><p><strong>Results: </strong>The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019-September 10, 2020) and the post-implementation period (September 11, 2020-December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45-2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (<i>P</i> = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as \"good.\"</p><p><strong>Conclusion: </strong>In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as \"good.\"</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"777-783"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nonlinear Relationship Between Temperature and Prognosis in Sepsis-induced Coagulopathy Patients: A Retrospective Cohort Study from MIMIC-IV Database.","authors":"Guojun Chen, Tianen Zhou, Jingtao Xu, Qiaohua Hu, Jun Jiang, Weigan Xu","doi":"10.5811/westjem.18589","DOIUrl":"https://doi.org/10.5811/westjem.18589","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of body temperature in sepsis-induced coagulopathy (SIC) remains unclear. In this study we aimed to investigate the association between temperature and mortality among SIC patients.</p><p><strong>Methods: </strong>We analyzed data for 9,860 SIC patients from an intensive care database. Patients were categorized by maximum temperature in the first 24 hours into the following: ≤36.0°C; 36.0-37.0°C; 37.0-38.0°C; 38.0-39.0°C; and ≥39.0°C. The primary outcome was 28-day mortality. We used multivariate regression to analyze the temperature-mortality association.</p><p><strong>Results: </strong>The 37.0-38.0°C, 38.0-39.0°C and ≥39.0°C groups correlated with lower 28-day mortality (adjusted HR 0.70, 0.76 and 0.72, respectively), while the <36.0°C group correlated with higher mortality compared to the 36.0-37.0°C group (adjusted HR 2.60). A nonlinear relationship was observed between temperature and mortality. Subgroup analysis found no effect modification except in cerebrovascular disease.</p><p><strong>Conclusion: </strong>A body temperature in the range of 37.0-38.0°C was associated with a significantly lower mortality compared to the normal temperature (36.0-37.0°C) group. Additionally, a gradual but statistically insignificant increase in mortality risk was observed when body temperature exceeded 38.0°C. Further research should validate these findings and elucidate involved mechanisms, especially in cerebrovascular disease subgroups.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"697-707"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355033","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":"A Cross-Sectional Review of HIV Screening in High-Acuity Emergency Department Patients: A Missed Opportunity.","authors":"Jacqueline J Mahal, Fernando Gonzalez, Deirdre Kokasko, Ahava Muskat","doi":"10.5811/westjem.18067","DOIUrl":"https://doi.org/10.5811/westjem.18067","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) patients requiring immediate treatment often bypass a triage process that includes HIV screening. In this study we aimed to investigate the potential missed opportunity to screen these patients for HIV.</p><p><strong>Methods: </strong>We conducted this cross-sectional study in a municipal ED over a six-week period between June-August 2019. The patient population in this study arrived in the ED as a pre-notification from prehospital services or designated by the ambulance or walk-in triage nurse as requiring immediate medical attention. Medical student researchers collected demographic data and categorized patients into three clinical groups (trauma, medical, psychiatric). They documented the patient's eligibility for HIV screening as determined by a physician and confirmed that the patient met criteria of clear mental status, controlled pain, stable vital signs, and ability to contribute to a medical history and physical examination. The student researchers did this at initial presentation and then again during the patient's ED stay of up to eight hours. The study outcomes measured the percentage of total patients within each clinical group (trauma, medical, psychiatric) able to engage in the HIV screening process upon arrival and during an eight-hour ED stay.</p><p><strong>Results: </strong>On average, 700 patients per month are announced on arrival via overhead page, indicating that they require immediate medical attention. During the six-week study, 205 patients (approximately 20% of total) were enrolled: 114 trauma; 56 medical; and 35 psychiatric presentations. The average patient age was 53; 60% of patients were male. Niney-eight (48%) patients were eligible for HIV screening within an eight-hour ED stay; 63 (31%) were able to be screened upon initial presentation and 35 (17%) in the first eight hours of their ED visit. Within medical and trauma subgroups, there was no significant difference in the proportion (36%) of patients that could be screened upon presentation. Among the psychiatric presentations, only five (14%) were able to be screened during their hospital stay.</p><p><strong>Conclusion: </strong>Triage protocols for high-acuity medico-surgical patients resulted in a missed opportunity to screen 48% of patients for HIV. Acute psychiatric patients represented a particular missed opportunity. We advocate for universal HIV screening, facilitated through electronic best practice advisories and a modified triage tailored to higher acuity patients. Implementing these changes would ensure that HIV screening is not overlooked in high-acuity ED patients, leading to early detection and timely interventions.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"817-822"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355032","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":"ChatGPT's Role in Improving Education Among Patients Seeking Emergency Medical Treatment.","authors":"Faris F Halaseh, Justin S Yang, Clifford N Danza, Rami Halaseh, Lindsey Spiegelman","doi":"10.5811/westjem.18650","DOIUrl":"https://doi.org/10.5811/westjem.18650","url":null,"abstract":"<p><p>Providing appropriate patient education during a medical encounter remains an important area for improvement across healthcare settings. Personalized resources can offer an impactful way to improve patient understanding and satisfaction during or after a healthcare visit. ChatGPT is a novel chatbot-computer program designed to simulate conversation with humans- that has the potential to assist with care-related questions, clarify discharge instructions, help triage medical problem urgency, and could potentially be used to improve patient-clinician communication. However, due to its training methodology, ChatGPT has inherent limitations, including technical restrictions, risk of misinformation, lack of input standardization, and privacy concerns. Medicolegal liability also remains an open question for physicians interacting with this technology. Nonetheless, careful utilization of ChatGPT in clinical medicine has the potential to supplement patient education in important ways.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"845-855"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355047","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":"Drowning Among Children 1-4 Years of Age in California, 2017-2021.","authors":"Phyllis F Agran, Diane G Winn, Soheil Saadat, Jaya R Bhalla, Van Nguyen Greco, Nakia C Best, Shahram Lotfipour","doi":"10.5811/westjem.20356","DOIUrl":"https://doi.org/10.5811/westjem.20356","url":null,"abstract":"<p><strong>Background and objectives: </strong>Drowning, the leading cause of unintentional injury death among California children less than five years of age, averaged 49 annual fatalities for the years 2010-2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among children 1-4 years of age from 2017-2021.</p><p><strong>Methods: </strong>We identified fatalities, injury hospitalizations, and emergency department (ED) visits from California state vital statistics death data and state hospital and ED discharge data using the EpiCenter California Injury Data Online website.</p><p><strong>Results: </strong>Over the five-year study period, 4,166 drowning incidents were identified: 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (<i>P</i> = 0.88). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases.</p><p><strong>Conclusion: </strong>Drowning remains the leading cause of unintentional, injury-related death among California children 1-4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and non-fatal local, state, and national systematic data collection systems could aid in moving the needle in decreasing pool fatalities among young children.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"838-844"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355050","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 of Long Spinal Board Post-Application of Protocol for Spinal Motion Restriction for Spinal Cord Injury.","authors":"Amber D Rice, Philipp L Hannan, Memu-Iye Kamara, Joshua B Gaither, Robyn Blust, Vatsal Chikani, Franco Castro-Marin, Gail Bradley, Bentley J Bobrow, Rachel Munn, Mary Knotts, Justin Lara","doi":"10.5811/westjem.18342","DOIUrl":"https://doi.org/10.5811/westjem.18342","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, prehospital care of trauma patients has included nearly universal use of a cervical collar (C-collar) and long spine board (LSB). Due to recent evidence demonstrating harm in using LSBs, implementation of new spinal motion restriction (SMR) protocols in the prehospital setting should reduce LSB use, even among patients with spinal cord injury. Our goal in this study was to evaluate the rates of and reasons for LSB use in high-risk patients-those with hospital-diagnosed spinal cord injury (SCI)-after statewide implementation of SMR protocols.</p><p><strong>Methods: </strong>Applying data from a state emergency medical services (EMS) registry to a state hospital discharge database, we identified cases in which a participating EMS agency provided care for a patient later diagnosed in the hospital with a SCI. Cases were then retrospectively reviewed to determine the prevalence of both LSB and C-collar use before and after agency adoption of a SMR protocol. We reviewed cases with LSB use after SMR protocol implementation to determine the motivations driving continued LSB use. We used simple descriptive statistics, odds ratios (OR) with 95% confidence intervals (CI) to describe the results.</p><p><strong>Results: </strong>We identified 52 EMS agencies in the state of Arizona with 417,979 encounters. There were 225 patients with SCI, of whom 74 were excluded. The LSBs were used in 52 pre-SMR (81%) and 49 post-SMR (56%) cases. The odds of LSB use after SMR protocol implementation was 70% lower than it had been before implementation (OR 0.297, 95% CI 0.139-0.643; <i>P</i> = 0.002). Use of a C-collar after SMR implementation was not significantly changed (OR 0.51, 95% CI 0.23-1.143; <i>P</i> = 0.10). In the 49 cases of LSB use after agency SMR implementation, the most common reasons for LSB placement were ease of lifting (63%), placement by non-transporting agency (18%), and extrication (16.3%). High suspicion of SCI was determined as the primary or secondary reason for not removing LSB after assessment in 63% of those with LSB placement, followed by multiple transfers required (20%), and critical illness (10%).</p><p><strong>Conclusion: </strong>Implementation of selective spinal motion restriction protocols was associated with a statistically significant decrease in the utilization of long spine boards among prehospital patients with acute traumatic spinal cord injury.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 5","pages":"793-799"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355034","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}