American Journal of Emergency Medicine最新文献

{"title":"Effects of coagulopathy and its correction on time to source control and clinical outcomes in patients with sepsis","authors":"Yeonjin Jo MD ,&nbsp;Seung Hyun Kang MD ,&nbsp;Ji Eun Hwang MD, MSc ,&nbsp;You Hwan Jo MD, PhD ,&nbsp;Jae Hyuk Lee MD, PhD ,&nbsp;Young Woo Um MD, MSc","doi":"10.1016/j.ajem.2025.07.048","DOIUrl":"10.1016/j.ajem.2025.07.048","url":null,"abstract":"<div><h3>Objectives</h3><div>Radiological intervention is often required for infection source control in sepsis, and correcting coagulopathy prior to procedures with bleeding risk is recommended. This study aimed to evaluate the impacts of correcting coagulopathy on time to intervention and on 28-day mortality in patients with sepsis undergoing abdominal radiological interventions.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized prospectively collected sepsis registry from the emergency department of a tertiary hospital. Adult patients with sepsis or septic shock who underwent abdominal radiological intervention between January 2011 and December 2020 were included. Coagulopathy was defined as PT-INR &gt; 1.5 or platelet count &lt;50,000/μL. The primary outcome was 28-day mortality, and secondary outcome included major bleeding complications, requiring transfusion, embolization or surgery. Multivariable logistic regression was performed to identify independent associations.</div></div><div><h3>Results</h3><div>Among the 597 patients analyzed, 161 (27.0 %) had coagulopathy. Among these, 55 (34.2 %) underwent correction prior to intervention. Patients who underwent correction had a significantly longer median time to intervention (15.3 vs. 6.0 h, <em>P</em> &lt; 0.001) and higher 28-day mortality (41.8 % vs. 22.6 %, <em>P</em> = 0.02), but no reduction in major bleeding complications was achieved. In multivariable analysis, coagulopathy correction associated independently with a higher 28-day mortality rate (OR, 2.52; 95 % CI, 1.13–5.66, <em>P</em> = 0.03) but not with the incidence of major bleeding complications (OR 1.80; 95 % CI, 0.83–3.90, <em>P</em> = 0.13).</div></div><div><h3>Conclusions</h3><div>In septic patients with coagulopathy undergoing abdominal radiological intervention, coagulopathy correction correlated with delayed source control and increased 28-day mortality, without reducing major bleeding complications.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 140-146"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of a widely available, localizable sepsis early detection model in the emergency department setting","authors":"Danielle Currey BS ,&nbsp;Yasir Tarabichi MD, MSCR","doi":"10.1016/j.ajem.2025.07.056","DOIUrl":"10.1016/j.ajem.2025.07.056","url":null,"abstract":"<div><h3>Study objective</h3><div>Several algorithms have been developed to assist clinicians in predicting the onset of sepsis. One of the most widely used is the Epic Sepsis Model. The first release of the model (V1) was a logistic regression that suffered from variable results in external validation. The second release (V2) leverages a gradient boosted tree model that can be localized to an individual hospital system. While widely available, V2 has yet to be independently externally validated.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study comparing the performance of both models in the emergency department setting. Model discrimination was measured via AUC-ROC for both V1 and V2 at the encounter level, before sepsis-3 criteria were met and before there was evidence of clinical recognition of sepsis (identified by antibiotic, culture, or lactate orders).</div></div><div><h3>Results</h3><div>35,076 encounters were included. 648 (1.8 %) met sepsis-3 criteria. AUC-ROC scores were 0.77 for V1 and 0.90 for V2. When only considering scores before evidence of clinical recognition of sepsis, there is a drop in AUC-ROC to 0.70 for V1 and to 0.85 for V2. At a scoring threshold targeting a 60 % sensitivity, V1 and V2 predictions were earlier than the first clinical recognition of sepsis in only 33.0 and 33.5 % of cases respectively.</div></div><div><h3>Conclusion</h3><div>While V2 achieves superior AUC-ROC's to V1 both before and after clinical recognition of sepsis, both models tended to alert for sepsis after evidence of clinical recognition.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 147-151"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in mental health-related pediatric emergency visits among New York City students","authors":"Juan Echenique PhD ,&nbsp;Amy Ellen Schwartz PhD ,&nbsp;Kevin Konty PhD ,&nbsp;Sophia Day MA ,&nbsp;Argelinda Baroni MD ,&nbsp;Cheryl R. Stein PhD ,&nbsp;Kira Argenio MPH ,&nbsp;Brian Elbel PhD, MPH","doi":"10.1016/j.ajem.2025.07.045","DOIUrl":"10.1016/j.ajem.2025.07.045","url":null,"abstract":"<div><h3>Background and objective</h3><div>Recent studies highlight an increase in pediatric mental health disorders, amplified by COVID-19. This study examines changes in mental health-related emergency department visits among New York City public school students across the pandemic timeline.</div></div><div><h3>Methods</h3><div>We employed logistic regression to examine changes in the probability of a student's emergency department visit being mental health-related, and as a secondary outcome, we analyzed the difference in same-day discharge rates between mental health-related visits and other visits. For this analysis, we used the New York City Student Population Health Registry to link public school students' records to emergency department visit data.</div></div><div><h3>Results</h3><div>No significant linear trends were observed in the average monthly probability of a mental health-related visit before March 2020. From March 2020 through June 2021 there was an increase for all groups except male elementary school students. Female middle and high school students experienced the largest increase (0.031 (CI = [0.027, 0.034])) compared to pre-pandemic (0.103 (CI = [0.103, 0.104])). Post-June 2021, all groups experienced a lower probability except for female middle and high school students, who had a 0.009 (CI = [0.007, 0.011]) higher probability than during the pandemic.</div><div>Compared to the pre-pandemic period and non-mental health-related visits, a 0.043 (CI = [0.029, 0.057]) lower probability of same-day discharge was observed for mental health-related visits during the pandemic period.</div></div><div><h3>Conclusions</h3><div>The COVID-19 pandemic correlated with a significant increase in mental health-related emergency department visits and longer stays, particularly among female middle and high school students.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 152-158"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of APUA, APUA-RO₂, and CURB-65 scores for mortality risk in hospitalized pneumonia patients","authors":"Abdullah Algin ,&nbsp;Serdar Özdemir ,&nbsp;Mustafa Ahmet Afacan ,&nbsp;Kaan Yusufoglu ,&nbsp;Abuzer Özkan","doi":"10.1016/j.ajem.2025.07.054","DOIUrl":"10.1016/j.ajem.2025.07.054","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of patients at high risk of mortality in community-acquired pneumonia (CAP) is critical for clinical decision-making. While the CURB-65 score is widely used, simplified tools such as APUA and APUA-RO₂ have been proposed to improve risk stratification by incorporating fewer and more accessible parameters.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included adult patients (≥18 years) hospitalized with CAP between January 2023 and December 2024. The APUA, APUA-RO₂, and CURB-65 scores were calculated based on admission data. The primary outcome was 30-day in-hospital mortality. The predictive performances of the scores were compared using receiver operating characteristic (ROC) curve analysis, and AUCs were statistically compared using the DeLong test.</div></div><div><h3>Results</h3><div>A total of 348 patients were included; the in-hospital mortality rate was 32.5 %. The area under the curve (AUC) for APUA-RO₂ was 0.716 (95 % CI, 0.657–0.774), for CURB-65 was 0.716 (95 % CI, 0.662–0.770), and for APUA was 0.658 (95 % CI, 0.596–0.719). APUA-RO₂ showed significantly better discriminatory ability than APUA (<em>P</em> &lt; .001). No significant difference was observed between APUA-RO₂ and CURB-65 (<em>P</em> = .976).</div></div><div><h3>Conclusion</h3><div>Both APUA-RO₂ and CURB-65 demonstrated moderate and comparable accuracy in predicting 30-day mortality in hospitalized CAP patients. The APUA-RO₂ score may be a practical alternative to existing tools, offering a balance between simplicity and prognostic utility.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 136-139"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of an influenza vaccine administration program in the emergency department","authors":"Jason J. Bischof MD ,&nbsp;Erin M. Reichert PharmD ,&nbsp;Jillian Maitland MBA, RN ,&nbsp;Jessica M. Queen BS ,&nbsp;Chelsea Cobranchi MTDA ,&nbsp;Mark J. Conroy MD ,&nbsp;Eric Adkins MD ,&nbsp;Daniel R. Martin MD ,&nbsp;Michael S. Lyons MD, MPH","doi":"10.1016/j.ajem.2025.07.038","DOIUrl":"10.1016/j.ajem.2025.07.038","url":null,"abstract":"<div><h3>Background</h3><div>The Emergency Department (ED) offers the opportunity to expand vaccine prevention interventions. However, the processes, outcomes, and sustainability of ED influenza vaccination remain largely uncharacterized. We report the outcomes of a low-intensity, electronic health record (EHR) facilitated, ED influenza vaccination initiative.</div></div><div><h3>Methods</h3><div>This retrospective evaluation of an ED influenza vaccination program used existing EHR records of ED encounters from 2019 to 2023 at two affiliated urban EDs. The ED influenza vaccination program launched September 2020 and continued during annual influenza seasons. Nurses assessed eligibility and administered vaccine by protocol based on passive electronic health record best practice advisories (BPAs). Implementation efforts were limited to BPA programming with email and staff meeting announcements. Descriptive statistics were used to compute the primary outcome of the number of ED influenza vaccine administrations by year.</div></div><div><h3>Results</h3><div>After vaccinating 18 individuals in the year prior to launch, the program vaccinated 271 individuals (225 year 1; 41 year 2; 5 year 3). In the 3-year evaluation period, nurses acknowledged 10,558 (8.9 %) BPAs, of which 116 (1.1 %) were excluded due to contraindications, 10,000 (94.7 %) were documented as “vaccine offer declined”, and 442 (4.2 %) agreed to vaccination.</div></div><div><h3>Conclusion</h3><div>A nursing driven ED influenza vaccination protocol may enable vaccination, but successful ED influenza vaccination was minimal in this experience featuring limited implementation procedures. The passive BPA was most often not acknowledged and when acknowledged resulted in a high refusal rate possibly due to erroneous documentation. A program of research in ED care processes, staff motivation, and health policy is required to leverage EDs as vaccination sites.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 131-135"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent need for reversal agents for xylazine and other imidazolines in illicit fentanyl","authors":"Michael E. Mullins MD ,&nbsp;Donna L. Seger MD","doi":"10.1016/j.ajem.2025.07.042","DOIUrl":"10.1016/j.ajem.2025.07.042","url":null,"abstract":"<div><div>The epidemic of illicit fentanyl use continues in the United States. Xylazine, a veterinary tranquilizer closely related to clonidine, is now a widespread adulterant in illicit fentanyl. More recently medetomidine (racemic version of dexmedetomidine) has appeared with increasing frequency in the fentanyl supply. Specific reversal agents for xylazine and medetomidine such as atipamezole and tolazoline have decades of approved use in animals and favorable experimental use in humans. However, an expert panel in 2024 opined that research into human use of alpha-adrenergic agonist was neither “necessary nor worthwhile”. We disagree. We outline the unmet need for reversal agents for xylazine and medetomidine, discuss their human evidence of effectiveness, and suggest the path forward as the fentanyl epidemic continues to evolve.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 129-130"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When is brain MRI indicated for children with the first unprovoked seizure presenting to the pediatric emergency department? A retrospective cohort study","authors":"Jeeho Han M.D ,&nbsp;Dahyun Kim M.D ,&nbsp;Min Kyo Chun M.D ,&nbsp;Soo-Young Lim M.D ,&nbsp;Jeong-Yong Lee M.D., PhD ,&nbsp;Seung Jun Choi M.D., PhD ,&nbsp;Jong Seung Lee M.D ,&nbsp;Jun Sung Park M.D","doi":"10.1016/j.ajem.2025.07.044","DOIUrl":"10.1016/j.ajem.2025.07.044","url":null,"abstract":"<div><h3>Background</h3><div>The decision to perform immediate brain magnetic resonance imaging (MRI) in children with their first unprovoked seizure presenting to the emergency department (ED) remains a clinical challenge. We aimed to identify clinical factors associated with the detection of epileptogenic lesions and emergent neuroimaging findings on MRI to determine the imaging necessity and urgency, respectively.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled pediatric patients (age 0–18 years) presenting to a single institution's pediatric ED with new-onset unprovoked seizures between January 2010 and December 2023.</div></div><div><h3>Results</h3><div>Among 222 included children, 84 (37.8 %) demonstrated an epileptogenic lesion, among which 18 (21.4 %) exhibited emergent neuroimaging findings. Multiple seizures at presentation (<em>p</em> &lt; 0.001), prolonged seizures lasting ≥5 min (p &lt; 0.001), and developmental delay (p &lt; 0.001) were significantly associated with epileptogenic lesions. Classification of patients with one or more risk factors as the high-risk group showed a sensitivity of 94.0 % and specificity of 55.1 % for detecting epileptogenic lesions, and a sensitivity of 100 % and specificity of 39.7 % for emergent neuroimaging findings. In patients without any of these risk factors, only 5 of 81 patients (6.3 %) had epileptogenic lesions, and none had emergent neuroimaging findings.</div></div><div><h3>Conclusion</h3><div>Among patients with new-onset unprovoked seizures visiting the pediatric ED, those with one or more risk factors—multiple seizures, prolonged seizure duration, or developmental delay—may benefit from MRI to identify epileptogenic lesions. Our findings suggest that low-risk patients rarely have urgent lesions and emergent MRI might be deferred; however, prospective multicenter validation is needed before implementing this approach<strong>.</strong></div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 116-122"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Age and sex related differences in clinical manifestations and severity of acute cocaine toxicity presentations to European emergency departments\" [American Journal of Emergency Medicine 96 (2025);151-160].","authors":"Òscar Miró, Miguel Galicia, Paul I Dargan, David M Wood, Alison M Dines, Fridtjof Heyerdahl, Knut Erik Hovda, Matthias Liechti, Odd Martin Vallersnes, Florian Eyer, Guillermo Burillo-Putze","doi":"10.1016/j.ajem.2025.07.024","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.07.024","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral perfusion index versus NEWS score in prehospital non-trauma adults: A prospective cohort study","authors":"Veysi Siber MD ,&nbsp;Seyda Gedikaslan Tasdemir MD","doi":"10.1016/j.ajem.2025.07.040","DOIUrl":"10.1016/j.ajem.2025.07.040","url":null,"abstract":"<div><h3>Background</h3><div>The Peripheral Perfusion Index (PPI), derived from pulse oximetry waveforms, is a non-invasive and easily obtainable parameter that reflects peripheral microcirculation. It has gained increasing attention for its potential role in early recognition of circulatory compromise and risk stratification in emergency settings. Despite its growing clinical relevance, studies investigating the prognostic value of PPI in non-traumatic adult patients presenting to the emergency department remain limited. In parallel, although the National Early Warning Score (NEWS) is widely used to predict acute clinical deterioration, its effectiveness in the prehospital setting and in undifferentiated patient populations continues to be debated. This study aimed to evaluate the prognostic value of the PPI in non-traumatic adult patients presenting to the emergency department. Additionally, it sought to compare the predictive performance of PPI with the NEWS in determining clinical outcomes such as discharge, ward admission, intensive care unit (ICU) admission, and 24-h and 30-day mortality.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted at Etlik City Hospital Emergency Department from January 13 to 20, 2025. Adult patients (≥18 years) arriving by ambulance with measurable PPI were included. Exclusions were trauma cases, cardiac arrest, alcohol/sedative use, pregnancy, and incomplete data. Vital signs, laboratory values, PPI (measured with MASIMO RAD-97), and NEWS scores were recorded at admission. Out of 1032 ambulance admissions, 452 patients met inclusion criteria and were analyzed.</div></div><div><h3>Results</h3><div>Between January 13–20, 2025, 452 emergency patients were evaluated for the predictive value of PPI and NEWS regarding patient disposition and mortality. ICU-admitted patients had significantly lower PPI and higher NEWS compared to ward-admitted and discharged groups (<em>p</em> &lt; 0.001). Multivariable analysis identified PPI and NEWS as independent predictors of ICU admission. PPI showed excellent accuracy for predicting discharge (AUC 0.970) and ICU admission (AUC 0.942), outperforming NEWS. Additionally, PPI predicted 24-h mortality with high sensitivity and specificity (AUC 0.927).</div></div><div><h3>Conclusions</h3><div>PPI is a rapid, non-invasive, and reliable parameter that demonstrates superior prognostic performance compared to the NEWS in non-trauma adult patients presenting to the emergency department via ambulance. PPI effectively predicts patient disposition and early as well as late mortality, supporting its use as a valuable tool for early risk stratification and resource allocation. Further multicenter studies are needed to validate these findings and to establish standardized protocols for PPI integration into clinical practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 103-110"},"PeriodicalIF":2.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race, ethnicity, and language association with Undertriage in Pediatric emergency medicine","authors":"Deena Berkowitz MD, MPH ,&nbsp;Nichole L. McCollum MD ,&nbsp;James M. Chamberlain MD","doi":"10.1016/j.ajem.2025.07.039","DOIUrl":"10.1016/j.ajem.2025.07.039","url":null,"abstract":"<div><h3>Importance</h3><div>Undertriage in emergency medicine impacts timeliness to care delivery. Limited research examines disparities in pediatric undertriage.</div></div><div><h3>Objective</h3><div>To assess whether minoritized populations are more likely to experience undertriage.</div></div><div><h3>Design/Setting/Participants</h3><div>This cohort study analyzed pediatric patient visits to a Level 1 Pediatric Trauma center and regional referral center from July 1, 2021, and September 16, 2024.Clinically important undertriage was defined using a modified Delphi approach, as Emergency Severity Index (ESI) scores of 4 or 5 in patients who were admitted or received intravenous medications, nebulized medications, or oxygen. Exposures were patient race, ethnicity and caregiver language preference. The primary outcome was clinically important undertriage.</div></div><div><h3>Results</h3><div>In comparison to NH Black patients, NH White patients were more likely to be undertriaged (odds ratio [OR],2.0; 95 % CI, 1.7–2.3). After multivariable adjustment, this association remained significant (adjusted OR [aOR], 2.1; 95 % CI, 1.8–2.4). Similarly, Hispanic patients had higher odds of undertriage compared to NH Black patients (aOR, 1.7;95 % CI,1.6–1.8). Patients and caregivers preferring Spanish or other non-English languages had increased odds of undertriage; (aOR,1.6;95 % CI,1.5–1.7; and aOR 1.5 (95 % CI [1.1–1.9]), respectively.</div></div><div><h3>Conclusions and relevance</h3><div>These findings contrast with prior studies suggesting NH Black patients are at highest risk for undertriage and highlight the complexity of care disparities. Further research is needed for a more nuanced understanding of the factors driving inequitable care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 111-115"},"PeriodicalIF":2.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}