American Journal of Emergency Medicine最新文献

{"title":"Invasive blood pressure monitoring does not improve survival in septic critically ill patients","authors":"Rajiv Sonti ,&nbsp;Allan Fong ,&nbsp;Ellie Hummel ,&nbsp;Suzanne Simkovich ,&nbsp;William Weintraub ,&nbsp;Nathan Cobb","doi":"10.1016/j.ajem.2025.04.060","DOIUrl":"10.1016/j.ajem.2025.04.060","url":null,"abstract":"<div><h3>Background</h3><div>Invasive blood pressure (BP) monitoring with arterial catheters is commonly used in the management of septic shock, however its impact on recovery remains unclear. We aimed to determine whether invasive BP monitoring improves survival, impacts length of stay (LOS) or accelerates shock resolution.</div></div><div><h3>Methods</h3><div>We conducted a multicenter case-control study of ICU patients with septic shock from January 2021 to December 2023. Cases received arterial lines for invasive BP monitoring; controls did not. Patients were matched 1: 1 based on exact Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation status, and propensity scores using age, race, and sex. Primary outcomes were all-cause inpatient mortality and ICU LOS.</div></div><div><h3>Results</h3><div>Among 739 eligible patients, 326 were matched. The mean age was 67 ± 14 years, and 57 % were male. Inpatient mortality was similar between cases and controls (41 % vs. 38 %, <em>p</em> = 0.43). Patients with arterial lines had longer ICU LOS (median 5.6 vs. 3.7 days, <em>p</em> &lt; 0.01). Time to vasopressor discontinuation (28.6 vs. 26.5 h, <em>p</em> = 0.82) did not differ significantly. Patients with arterial lines had more daily blood draws (median 9 vs. 7, <em>p</em> = 0.046), lower nadir hemoglobin levels (median 7.0 vs. 7.8 g/dL, <em>p</em> &lt; 0.01), and received more red blood cell transfusions (median 2.2 vs. 1.5 units, <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Invasive BP monitoring with arterial catheters did not improve survival in critically ill patients with septic shock. It was associated with longer lengths of stay, increased blood sampling, and higher transfusion requirements. These findings suggest the need to reassess the routine use of arterial lines in this population.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 173-178"},"PeriodicalIF":2.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890515","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":"Expanding acute care treatment and disposition options: Creating a post-ED rapid clinic follow-up program","authors":"Doug Wallace MD ,&nbsp;Chetan Aher MD ,&nbsp;Patty Wright MD ,&nbsp;Justin Young MBA ,&nbsp;Mitchell Sexton MBA ,&nbsp;C. Blayke Gibson MD MBA ,&nbsp;Stephan Russ MD MPH ,&nbsp;Schiara Gonzalez Parker BSN MBA ,&nbsp;Nathaniel Miller MD MMHC ,&nbsp;H. Gerard Colmer IV MD ,&nbsp;Tyler W. Barrett MD, MSCI","doi":"10.1016/j.ajem.2025.04.054","DOIUrl":"10.1016/j.ajem.2025.04.054","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department (ED) arrivals are surging in hospitals across the United States, with many systems facing significant capacity challenges. Identifying effective and safe alternative dispositions for patients is one solution to the capacity and boarding crises.</div></div><div><h3>Methods</h3><div>Our health system created a rapid post-ED evaluation follow-up process through enterprise-wide collaboration among multiple service lines. This system allowed for real-time payer agnostic scheduling of rapid subspecialty and primary care outpatient follow-up appointments for ED patients as a safe alternative to hospital admission.</div></div><div><h3>Results</h3><div>During the first 12 months of the program, 735 referrals were ordered by the ED physicians with 551 (75 %) of appointments identified to have safely averted a hospital admission on retrospective review by a physician oversight leader.</div><div>Program safety was measured by appointment completion and return ED visits within 1 week. More than 80 % of patients attended their appointments, 74 patients had one or more repeat visits to the ED within seven days with 26 patients (3.5 %) admitted on the subsequent visit. No patients required an escalation of inpatient care to an intensive care or intermediate care unit.</div></div><div><h3>Conclusions</h3><div>The post-ED rapid clinic follow-up program has been successful and provided a safe alternative to hundreds of patients who would otherwise have been admitted and often boarding in our ED for hours to days. Health systems dealing with capacity challenges may consider implementing an individualized version of this program.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 166-172"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886208","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":"Clinical features of alcoholic ketoacidosis with and without lactic acidosis: A retrospective descriptive study","authors":"Keisuke Maeda ,&nbsp;Yuji Okazaki ,&nbsp;Fumiya Inoue ,&nbsp;Kenichiro Kashiwa ,&nbsp;Noritomo Fujisaki ,&nbsp;Takayuki Otani ,&nbsp;Toshihisa Ichiba","doi":"10.1016/j.ajem.2025.04.056","DOIUrl":"10.1016/j.ajem.2025.04.056","url":null,"abstract":"<div><h3>Background</h3><div>Alcoholic ketoacidosis (AKA) is a potentially life-threatening condition due to high anion gap metabolic acidosis in chronic alcohol use. While lactic acidosis (LA) is typically uncommon in AKA, AKA without concurrent acute conditions is occasionally complicated with LA. The aim of this study was to clarify the clinical features in isolated AKA patients with LA and those without LA.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at a tertiary hospital between January 2021 and January 2024. We identified isolated AKA patients aged ≥20 years who presented with high anion gap metabolic acidosis, elevated ketones in serum or urine, and alcohol use disorder. Patients were classified into those with LA (lactate ≥4 mmol/L) and those without LA. We examined the clinical characteristics and outcomes in both groups and analyzed lactate trends during hospitalization in patients with LA.</div></div><div><h3>Results</h3><div>Of 41 patients with AKA, 33 patients (80 %) had LA despite the fact that thiamine levels were similar in the two groups. Total ketone body and β-hydroxybutyrate levels in patients with LA were lower than those in patients without LA. Median lactate levels (10.7 mmol/L, IQR 7.7–14.5) in patients with LA decreased by approximately 1 mmol/L per hour during the first six hours post-admission. None of the patients died during hospitalization.</div></div><div><h3>Conclusions</h3><div>Isolated AKA is likely to be complicated with hyperlactatemia. Higher lactate levels tended to be observed in cases with lower ketone levels. Lactate levels in isolated AKA with LA declined steadily. Further studies are needed to confirm our findings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 148-152"},"PeriodicalIF":2.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876551","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":"Development and validation of the discharge severity index for post-emergency department hospital readmissions","authors":"Norawit Kijpaisalratana ,&nbsp;Abdel Badih El Ariss ,&nbsp;Adi Balk ,&nbsp;Suhanee Mitragotri ,&nbsp;Kian D. Samadian ,&nbsp;Barry J. Hahn ,&nbsp;Adriana Coleska ,&nbsp;Joshua J. Baugh ,&nbsp;Ahmad Hassan ,&nbsp;Jarone Lee ,&nbsp;Ali S. Raja ,&nbsp;Shuhan He","doi":"10.1016/j.ajem.2025.04.045","DOIUrl":"10.1016/j.ajem.2025.04.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospital readmissions often result from a combination of factors, including inadequate follow-up care, poor discharge planning, patient non-adherence, and social determinants of health (SDOH) that impact access to healthcare and follow-up resources, many of which are beyond provider control. Enhanced post-discharge strategies, including risk stratification, are essential. This study aims to develop and validate the Discharge Severity Index (DSI) to predict readmission risk and optimize resource allocation for effective follow-up care.</div></div><div><h3>Methods</h3><div>This single-center retrospective study analyzed ED visits from the Medical Information Mart for Intensive Care IV, dividing the data into derivation (75 %) and validation (25 %) cohorts. Univariate analyses were conducted on factors commonly available for most discharges, including patient age, the latest vital signs recorded, medical complexity, and ED length of stay (LOS). Multiple logistic regression (MLR) was employed to identify independent risk factors of patients revisiting the ED within a week and being subsequently admitted to the hospital. Adjusted parameter estimates from the MLR were used to develop a predictive model.</div></div><div><h3>Results</h3><div>Among 229,920 patients discharged from the ED, 1.92 % were readmitted. The analysis identified seven variables correlated with this outcome, with six significant risk factors pinpointed through MLR: age above 65, heart rate over 100, and oxygen saturation below 96 % (assigned 1 point each), along with having more than five active medications administered during the hospital stay or a LOS exceeding 3 h (assigned 2 points each). Using these scores, we categorized patients into five DSI groups, reflecting escalating readmission risk from DSI 5 (lowest risk) to DSI 1 (highest risk): DSI 5 (0; OR: 1.0), DSI 4 (1–2; OR: 3.49), DSI 3 (3–4; OR: 8.44), DSI 2 (5–6; OR: 11.65), and DSI 1 (&gt;6; OR: 14.63). The seven-day readmission rates were comparable between the development and validation cohorts. For instance, for DSI 1, the rates were 5.16 % in the development cohort and 4.67 % in the validation cohort. For DSI 2, the rates were 4.16 % and 4.04 %, respectively.</div></div><div><h3>Conclusion</h3><div>This study seeks to develop and validate the DSI, proposing its effectiveness as a tool for healthcare providers to categorize patients by their risk of post-discharge admission from the ED. The utilization of this tool has the potential to lead to a more informed allocation of resources after discharge.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 125-132"},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873547","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":"Emergency medicine updates: Cardiac arrest airway management","authors":"Brit Long MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.04.053","DOIUrl":"10.1016/j.ajem.2025.04.053","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac arrest is the loss of systemic circulation. The approach to airway management is an important component of the resuscitation of patients in cardiac arrest.</div></div><div><h3>Objective</h3><div>This paper evaluates key evidence-based updates concerning airway management in cardiac arrest.</div></div><div><h3>Discussion</h3><div>Management of cardiac arrest focuses on cardiopulmonary resuscitation (CPR), including high-quality chest compressions and ventilation. Resuscitation should prioritize circulation with high-quality compressions, but as the resuscitation continues, airway management is necessary to provide ventilation. During initial CPR efforts, a compression to ventilation ratio of 30:2 is recommended. Bag-valve-mask (BVM) ventilation is an effective means of ventilation during CPR efforts, though providers should ensure appropriate mask seal with a two-person BVM strategy (one person holding the mask and one person ventilating) if possible. Breaths should be provided over less than 1 s with enough tidal volume to cause chest rise. Advanced airways include a supraglottic airway (SGA) or endotracheal tube via endotracheal intubation (ETI). If an advanced airway is present, one asynchronous ventilation should be provided every 8–10 s. An advanced airway may be considered with an asphyxial cause of arrest, those with prolonged arrest or transport, and cases managed with limited numbers of experienced personnel, though compressions must not be interrupted for placement of an advanced airway. An SGA is a viable option for an advanced airway. In settings with high ETI success rate, ETI may be performed, but in other settings SGA is recommended. If performing ETI, video laryngoscopy is associated with an improved view of the glottis and higher first pass success compared to direct laryngoscopy. Cricoid pressure is not recommended. Confirmation of ETI is necessary. Following ETI and return of spontaneous circulation, a lung protective strategy of ventilation is recommended while avoiding hypoxia.</div></div><div><h3>Conclusions</h3><div>An understanding of literature updates regarding airway management can improve the ED care of patients in cardiac arrest.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 158-165"},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886400","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":"Rivastigmine as an alternative treatment for anticholinergic toxidrome in light of the physostigmine shortage: A case series","authors":"M. Berg PharmD,&nbsp;A. Strand MD,&nbsp;N.D. Garrett PhD,&nbsp;A. Keric PharmD, BCPS, BCCCP,&nbsp;J. Wilkinson MD","doi":"10.1016/j.ajem.2025.04.047","DOIUrl":"10.1016/j.ajem.2025.04.047","url":null,"abstract":"<div><h3>Introduction</h3><div>Physostigmine is an acetylcholinesterase inhibitor historically used for the treatment of anticholinergic toxicity. Supply of physostigmine has been limited as the US manufacturer recently stopped production. Rivastigmine, a long-acting acetylcholinesterase inhibitor FDA-approved for the treatment of Alzheimer's and Parkinson's disease dementia, is a potential alternative to physostigmine. There are few case reports and case series demonstrating the safe and effective use of both oral and transdermal rivastigmine for anticholinergic toxicity. The objective of this study was to describe the effects of rivastigmine in patients with anticholinergic toxicity.</div></div><div><h3>Methods</h3><div>A retrospective case review of patients that received rivastigmine at a metropolitan level-1 trauma center between January 2022–January 2024 resulted in 12 patients who met inclusion/exclusion criteria and were included in this analysis. Data collected included xenobiotic ingested, co-ingestions, symptoms on presentation, rivastigmine capsule and/or patch administration, adverse events, benzodiazepine administration, disposition, ICU and hospital length of stay.</div></div><div><h3>Results</h3><div>Of 12 patients, 9 had co-ingestions of other prescription or over-the-counter medications. 2 of 12 patients received both rivastigmine patches and capsules, 8 of 12 received only patches, and 2 of 12 received only capsules. The average dose of rivastigmine patches was 8.66 mg and average capsule dose was 6 mg. None of the patients experienced adverse effects from rivastigmine use. Length of stay ranged from 2 to 9 days with an average of 3.6 days.</div></div><div><h3>Conclusion</h3><div>Our study shows that rivastigmine is a reasonable alternative to physostigmine based on the lack of adverse events reported and symptom relief.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 144-147"},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876627","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":"Nebulized ketamine for acute pain management in the Emergency Department: A systematic review and meta-analysis","authors":"Murat Cetin MD ,&nbsp;Caitlin S. Brown PharmD ,&nbsp;Fernanda Bellolio MD, MSc ,&nbsp;Jefferson Drapkin MPH ,&nbsp;Robert Glatter MD ,&nbsp;Sergey Motov MD ,&nbsp;Lucas Oliveira J. e Silva MD, PhD","doi":"10.1016/j.ajem.2025.04.051","DOIUrl":"10.1016/j.ajem.2025.04.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Ketamine administered in sub-dissociative doses has been effective in managing a variety of painful conditions in the emergency department (ED) and pre-hospital settings. The inhalation route of ketamine administration has gained traction over the past 5 years.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis to evaluate the analgesic efficacy and incidence of adverse effects of nebulized ketamine. We searched Ovid CENTRAL, EMBASE, and MEDLINE databases for randomized controlled trials (RCTs) and observational studies from inception to January 2025, assessing pain reduction, rescue analgesia, and occurrences of adverse effects.</div><div>We used the Cochrane Collaboration tool and a modified Newcastle-Ottawa Scale to evaluate the risk of bias and the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) to evaluate the confidence in the evidence. Mean differences with 95 % confidence intervals (CI) using random effects were used for the meta-analyses.</div></div><div><h3>Results</h3><div>Thirteen studies met the inclusion criteria. Nebulized ketamine had equivalent efficacy to active controls in 8 RCT's. Four RCTs (<em>n</em> = 601) demonstrated no difference in pain reduction between nebulized ketamine and IV morphine with mean difference (MD) 0.28 (CI -0.18 to 0.73) at 30 min, and similar rates of rescue analgesia (16.9 % vs. 17.4 %). Eleven studies reported absence of serious events and no difference in non-serious adverse events (39.1 % ketamine and 37.8 % controls). The level of confidence for the outcomes was deemed to be very low.</div></div><div><h3>Conclusion</h3><div>Administration of ketamine via nebulization for patients with acute painful conditions provided equivalent analgesia with similar safety profile when compared to active controls.</div><div><span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> Registration: N/A.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 110-118"},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873546","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":"Threshold-anxiety in medical students performing a prehospital high-fidelity clinical simulation: Randomized clinical trial","authors":"Rafael Martín-Sánchez ,&nbsp;Miguel Á. Castro Villamor ,&nbsp;Joseba Rabanales-Soto ,&nbsp;Santiago Otero de la Torre ,&nbsp;Francisco T. Martínez Fernández ,&nbsp;Irene Sánchez Soberón ,&nbsp;Ancor Sanz-García ,&nbsp;Francisco Martín-Rodríguez","doi":"10.1016/j.ajem.2025.04.039","DOIUrl":"10.1016/j.ajem.2025.04.039","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to determine the <em>delta</em> anxiety index (pre- and post-simulation) of medical students performing prehospital critical care high-fidelity clinical simulations (sepsis, myocardial infarction, polytrauma and anaphylactic shock) case-by-case. The secondary outcome was to identify clinical scenarios resulting in extreme anxiety levels (&gt; 25 % post-simulation vs. pre-simulation <em>delta</em> anxiety).</div></div><div><h3>Methods</h3><div>A randomized (four prehospital critical care cases), blind, simulation-based clinical trial was performed at the Advanced Clinical Simulation Center of the Medical School of Valladolid University (Spain) with the participation of volunteer last-year medical students (6th year) from September 20, 2022, to April 15, 2024. The STAI questionnaire, epidemiological data and lifestyle habits were assessed. The principal outcome was the <em>delta</em> anxiety level (pre- and post-simulation) on the state subscale of the STAI.</div></div><div><h3>Results</h3><div>A total of 342 participants met the inclusion criteria. The median age was 23 years (IQR: 23–24; range: 22–41), and 67.8 % were female (213 cases). Scenario-by-scenario analysis revealed no significant differences by sex, age, prior simulation training, or role in the simulated scenario (leader or assistant). The polytrauma scenario yielded the worst post-simulation evaluation on the state subscale of the STAI, with a median of 54 points (IQR: 46–66) (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Polytrauma and anaphylactic shock scenarios are more likely to induce extreme anxiety levels in final-year medical students during high-fidelity clinical simulations. Educators must be aware of these potential anxiety levels and carefully design the scenarios, providing adequate preparation and facilitating effective debriefing to optimize learning and mitigate the negative effects of excessive anxiety.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 103-109"},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873545","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":"The impact of the 2024 intravenous fluid shortage on emergency department length of stay and 72-hour return rate","authors":"Bryan A. Stenson MD ,&nbsp;Daniel L. Shaw MD MCSO ,&nbsp;Gordon MacDougall MD ,&nbsp;Joshua Kolikof MD ,&nbsp;Cynthia Gaudet MD ,&nbsp;Anne Grossestreuer PhD ,&nbsp;Leon D. Sanchez MD MPH ,&nbsp;David T. Chiu MD MPH","doi":"10.1016/j.ajem.2025.04.034","DOIUrl":"10.1016/j.ajem.2025.04.034","url":null,"abstract":"<div><h3>Introduction</h3><div>In September 2024, there was an abrupt intravenous (IV) fluid shortage in the United States due to the unexpected closure of a major production facility. In response, hospitals rationed scarce IV fluids. While this was aimed at reducing utilization, the impact on patient care is unclear. This study assesses the impact of reduced IV fluid ordering on emergency department (ED) operational metrics.</div></div><div><h3>Methods</h3><div>Retrospective cohort study at an urban academic medical center ED with 55,000 annual encounters. All patients seen during the pre-shortage (7/1/24–9/30/24) and post-shortage (10/1/24–11/13/24) periods were included. We assessed differences between proportions of patients receiving IV fluid, volume of fluids, length of stay (LOS), and 72-h return rate. We also assessed a subgroup of discharged patients with gastrointestinal illness. Comparisons used a Wilcoxon ranked-sum, Chi-squared or Fisher's exact test as appropriate. Logistic regression was performed with controls for age, gender, and emergency severity index (ESI).</div></div><div><h3>Results</h3><div>IV fluids were given in a smaller proportion of patients (20 % vs 24 %, <em>p</em> &lt; 0.001) and at lower volumes post-shortage. Discharged patients with gastrointestinal symptoms likewise had lower IV fluid use (30 % vs 42 %, <em>p</em> &lt; 0.001), decreased LOS (7.1 vs 7.8 h, p &lt; 0.001) and no change in 72-h return rate (<em>p</em> = 0.156).</div></div><div><h3>Discussion</h3><div>During the 2024 IV fluid shortage, fewer patients received fluids at lower volumes per patient. This held true for discharged patients with GI symptoms. Overall, LOS decreased without an increase in 72-h return rate. Improved throughput without changes in return rate represents a potential process improvement and warrants further evaluation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 140-143"},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876626","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":"Hepatitis C testing and linkage to care in a safety-net hospital emergency department","authors":"Nicole Lue MD ,&nbsp;Jennifer Lom MD ,&nbsp;Elizabeth Manguso MD, MPH ,&nbsp;Brandi Park MS ,&nbsp;Andres Palacio ,&nbsp;Rapheisha Darby MPH ,&nbsp;Bijal Shah MD ,&nbsp;Anna Yaffee MD, MPH ,&nbsp;Lesley Miller MD, FACP","doi":"10.1016/j.ajem.2025.04.046","DOIUrl":"10.1016/j.ajem.2025.04.046","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In 2020, the CDC expanded hepatitis C (HCV) screening recommendations to include universal screening for persons 18 and older. We implemented universal screening in the emergency department (ED) within a safety-net health system. We aimed to measure HCV prevalence and linkage to care (LTC) outcomes in the ED and compare them to the outpatient clinics within the same health system.</div></div><div><h3>Methods</h3><div>Patients aged 18–79 without HCV qualified for screening. We measured prevalence of both anti-HCV+ (exposure) and HCV RNA+ (active infection). Those with active HCV were flagged for LTC and their charts were followed for outcomes. HCV prevalence and LTC in the ED were compared to those in outpatient clinics over the same time.</div></div><div><h3>Results</h3><div>9511 patients were screened for HCV from 2019 to 2022 in the ED. 6.9 % (659) were anti-HCV+. 54.9 % (320 of 582) of anti-HCV+ individuals or 3.4 % of those screened (320 of 9511) were HCV RNA+. The LTC rate was 24.1 % (77 of 320) and a total of 56 individuals (17.8 % of all HCV RNA+ ED patients, 72.7 % of those linked) initiated treatment. HCV prevalence was higher in the ED compared to the outpatient clinic setting. Demographics and LTC rates also significantly differed between these two cohorts.</div></div><div><h3>Conclusions</h3><div>We identified a higher HCV prevalence in the ED relative to the outpatient clinic setting and significant need for improvement in LTC and HCV treatment initiation. Our findings suggest universal screening is an important tool to diagnose HCV infections but may require novel strategies for improved LTC and treatment initiation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 133-139"},"PeriodicalIF":2.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876625","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}