American Journal of Emergency Medicine最新文献

{"title":"Identifying mobility instruments used in emergency departments and evaluating their measurement properties: A systematic review","authors":"L.D.S. Alves ,&nbsp;S.P. Vella ,&nbsp;E.A.B. Figueiredo ,&nbsp;A. Chiarotto ,&nbsp;C.G. Maher ,&nbsp;D. Coombs ,&nbsp;G.C. Machado","doi":"10.1016/j.ajem.2025.09.014","DOIUrl":"10.1016/j.ajem.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Emergency clinicians need a measure of mobility that is valid, reliable, and quick and simple to administer. This review aimed to identify the available mobility instruments used to assess patients in the emergency department and to summarize their measurement properties.</div></div><div><h3>Methods</h3><div>We performed a systematic review in accordance with the PRISMA-COSMIN guideline. We searched electronic databases; PsycINFO, CINAHL, MEDLINE, and EMBASE from inception to March 2025 and included peer-reviewed publications that reported mobility instruments used in the emergency department and/or evaluated their measurement properties. The risk of bias of included studies was rated and the measurement properties (e.g. reliability) of included mobility instruments were summarized. We assessed the certainty of evidence for each measurement property using the GRADE approach, and provided an overall recommendation.</div></div><div><h3>Results</h3><div>Sixteen studies describing eight different mobility instruments were included. Two studies reported measurement properties for the 30 s Chair-Stand test, Cumulated Ambulation Score and the 4 m Gait Speed test. The measurement properties included reliability, measurement error, criterion and construct validity, and responsiveness. Each of the mobility instruments had ‘sufficient’ reliability and were recommended as being potentially suitable for use. Only evidence relating to the reliability of the 30 s Chair-Stand test was graded to be of high quality.</div></div><div><h3>Conclusion</h3><div>The 30 s Chair-Stand test, Cumulated Ambulation Score and the 4 m Gait Speed test are potentially suitable for use in the emergency department. There is a need for high-quality clinimetric studies to evaluate the measurement properties of mobility instruments used in the ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 289-297"},"PeriodicalIF":2.2,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049259","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":"Pre-trained large language models outperform statistics and machine learning forecasting visits in the emergency departments","authors":"Yi-Chang Yen ,&nbsp;Chin-Chieh Wu ,&nbsp;Shu-Hui Chen ,&nbsp;Kuan-Fu Chen","doi":"10.1016/j.ajem.2025.09.008","DOIUrl":"10.1016/j.ajem.2025.09.008","url":null,"abstract":"<div><h3>Objectives</h3><div>The unpredictability of emergency department (ED) visits is a significant reason for ED crowding. This study aims to compare different conventional statistical learning, machine learning, and large language models (LLM) methods to forecast daily ED visits at primary, secondary, and tertiary hospitals across different regions in Taiwan, during the pre-COVID-19, COVID-19, and post-pandemic periods.</div></div><div><h3>Methods</h3><div>Daily ED visits records from 2007 to 2022, derived from the electronic medical records of six hospitals across Taiwan, were combined with calendar data and COVID-19 pandemic indicators to serve as input features. The primary objective was to develop models for a seven-day forecast horizon. Both statistical models, such as SARIMAX and Prophet, and machine learning models, including Light Gradient Boosting Machine (LightGBM), Long Short-Term Memory (LSTM), DLinear, and Time-series Dense Encoder (TiDE), were developed using training datasets from 2007 to 2017. We then compared the performances of the statistical models, machine learning models, and a pre-trained transformer-based LLM on the testing set (2018–2022), which included the pre-COVID-19, COVID-19, and post-pandemic periods. We used the Mean Absolute Percentage Error (MAPE), defined as the percentage difference between the predicted and actual values, as the metric.</div></div><div><h3>Results</h3><div>A total of 7,540,271 ED visits and 31,064 data points were recorded across two tertiary, three regional, and one primary hospital. The conventional statistical models revealed a significant seven-day cycle pattern in ED visit data across the hospitals. Daily ED visits surged significantly during the COVID-19 pandemic. The pre-trained LLM demonstrated the best overall performance (MAPE 7.59, 95 % CI: 7.20–7.99), closely followed by LightGBM (MAPE 8.08, 95 % CI: 7.67–8.50). Specifically, TiDE (MAPE 5.89, 95 % CI: 5.48–6.29) and Prophet (MAPE 6.80, 95 % CI: 6.41–7.18) performed best in the pre-COVID-19 period. Although the abrupt changes during COVID-19 led to declines in the performance of all models, the pre-trained LLM and LightGBM demonstrated resilience, with MAPEs of 9.03 (95 % CI 8.32, 9.77) and 10.60 (95 % CI 9.77, 11.52), respectively.</div></div><div><h3>Conclusions</h3><div>The pre-trained LLM showed superior overall performance in forecasting ED visits, particularly during the pandemic and post-pandemic periods. LightGBM performed relatively well across all periods. Prophet and TiDE demonstrated favorable and stable performance only during the pre-pandemic period. These findings underscore the potential of advanced time series models to improve ED visit forecasts.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 298-308"},"PeriodicalIF":2.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049260","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":"Use of e-point septal separation to screen for left ventricular function in children","authors":"Elena Chen MD ,&nbsp;Sriram Ramgopal MD ,&nbsp;Douglas Lorenz PhD ,&nbsp;Pei-Ni Jone MD ,&nbsp;Russ Horowitz MD","doi":"10.1016/j.ajem.2025.09.013","DOIUrl":"10.1016/j.ajem.2025.09.013","url":null,"abstract":"<div><h3>Objective</h3><div><em>E</em>-point septal separation (EPSS) is a point-of-care ultrasound measurement used to screen for left ventricular systolic dysfunction (LVSD) in adults. We evaluated the distribution of EPSS in children and determined the association between EPSS and presence/extent of LVSD.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center study of pediatric echocardiograms performed between January 2019 and February 2023. Our outcome was LVSD (as mild, moderate, and severe based on ejection fraction and/or fractional shortening criteria). We evaluated the association between EPSS and LVSD and moderate-severe systolic dysfunction. We reported sensitivity, specificity and predictive values when using 7.0 mm (commonly used adult criteria) and statistically-selected EPSS thresholds.</div></div><div><h3>Results</h3><div>We included 770 echocardiograms; 148 had LVSD (104 mild, 32 moderate, and 12 severe). EPSS increased with increasing LVSD. The area under the receiver operator curve (AUROC) was 0.92 (95 % confidence interval [CI] 0.89–0.95) for EPSS and any LVSD and 0.94 (95 % CI 0.87–1.00) for EPSS and moderate-severe systolic dysfunction. Using a 7.0 mm threshold for any LVSD, sensitivity was 76.4 % (95 % CI 68.5–82.8 %) and specificity was 95.8 % (95 % CI 93.8–97.2 %). An optimal threshold of 6.0 mm improved sensitivity to 81.8 % (95 % CI 74.4–87.4 %). For children 0–3 years old, a threshold of 4.9 mm demonstrated better sensitivity (77.8 %, 95 % CI 51.9–92.6 %) compared to the 7.0 mm threshold (55.6 %, 95 % CI 31.3–77.6 %). For children &gt;3 years old, the 7.0 mm and optimal thresholds performed similarly for moderate-severe systolic dysfunction.</div></div><div><h3>Conclusions</h3><div>EPSS is a promising screening technique for pediatric LVSD. The 7.0 mm threshold may be an adequate screen for older children.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 39-45"},"PeriodicalIF":2.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093103","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":"Stone, paper… seizure? A case report of hypocalcemic seizures worsened by anti-seizure medications.","authors":"C K Amith, Shrirang Shriram Joshi, K V Pavan Kumar, Manasvi Gupta, Nayer Jamshed","doi":"10.1016/j.ajem.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.009","url":null,"abstract":"<p><p>Refractory seizures in the emergency department (ED) may result from overlooked metabolic causes. Primary hypoparathyroidism is a rare but treatable etiology, sometimes associated with Fahr's syndrome. We report a 27-year-old man with a known seizure disorder presenting with multiple daily generalized tonic-clonic seizures unresponsive to polytherapy. Examination revealed positive Trousseau's and Chvostek's signs. Laboratory tests demonstrated severe hypocalcemia, hyperphosphatemia, and markedly reduced intact parathyroid hormone, consistent with primary hypoparathyroidism. Non-contrast CT head revealed bilateral basal ganglia calcifications. Recent initiation of phenytoin and carbamazepine-potent enzyme inducers-aggravated hypocalcemia by accelerating vitamin D metabolism. The patient was treated with intravenous calcium gluconate, magnesium sulfate, and switched to levetiracetam. Calcium normalized within 24 h, and seizures resolved. This case highlights the importance of considering metabolic disturbances in ED patients with worsening seizures despite appropriate anti-seizure therapy, and the potential for anti-seizure medications to exacerbate underlying conditions.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056315","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: Acute appendicitis in the adult patient","authors":"Brit Long MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.09.007","DOIUrl":"10.1016/j.ajem.2025.09.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute appendicitis is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.</div></div><div><h3>Objective</h3><div>This paper evaluates key evidence-based updates concerning appendicitis in the adult patient for the emergency clinician.</div></div><div><h3>Discussion</h3><div>Acute appendicitis can present with a variety of signs and symptoms in adults, and no single history or examination finding can exclude the diagnosis of appendicitis. The presence of right lower quadrant pain or tenderness, migrating pain, Rovsing's sign, psoas sign, and obturator sign are suggestive of the diagnosis. A combination of normal white blood cell count, neutrophil distribution, and c-reactive protein suggest appendicitis is less likely. Several risk stratification tools are available, including the original and modified Alvarado score, the Appendicitis Inflammatory Response (AIR) score, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, and the Adult Appendicitis Score (AAS). Current evidence and guidelines suggest the AIR, AAS, and RIPASA have the highest diagnostic accuracy. Patients determined to be low risk on these scores may not require further diagnostic evaluation when used with shared decision-making. Patients who are not low risk warrant further investigation. A variety of imaging tests are available, including computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI). US or CT may be used as the first-line imaging modality in adults. US and MRI are the recommended imaging tests in pregnant females. All patients with acute appendicitis should receive surgical consultation, and antibiotics should be administered. Evidence suggests that non-operative management with antibiotics alone may be safe in select patients with uncomplicated appendicitis, particularly those without appendicolith. Surgical intervention is recommended in pregnancy.</div></div><div><h3>Conclusions</h3><div>An understanding of literature updates can improve the ED care of patients with appendicitis.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 262-268"},"PeriodicalIF":2.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026883","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":"Outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in severely injured adult trauma patients with isolated thoracic or abdominal trauma in Hemorrhagic shock","authors":"Sanjan Kumar B.S ,&nbsp;Philip Lee B.S ,&nbsp;Ariel Hus B.S ,&nbsp;Ruth Zagales B.S ,&nbsp;Cameron Nishida B.S ,&nbsp;Deepa Elangovan B.S ,&nbsp;Kathleen Schuemann MD, FACS ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.ajem.2025.08.068","DOIUrl":"10.1016/j.ajem.2025.08.068","url":null,"abstract":"<div><h3>Background</h3><div>There is conflicting literature regarding mortality outcomes associated with REBOA usage in patients with severe thoracic or abdominal trauma. Our study aims to assess the benefits and negative implications of REBOA use in adult trauma patients in hemorrhagic shock with severe thoracic or abdominal injuries.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database from 2017 to 2023 to evaluate adult patients with severe isolated thoracic or abdominal trauma undergoing REBOA placement. Patients were stratified by REBOA zone, type of injury, and trauma center level. Primary outcomes included Emergency Department (ED) and 24-h mortality. Secondary outcomes included time to hemorrhage control, transfusion volumes, and complications.</div></div><div><h3>Results</h3><div>In severely injured adult trauma patients with thoracic or abdominal injuries, REBOA was significantly associated with increased mortality (aOR: 15.456, 95 % CI: 3.340–71.516, <em>p</em> &lt; 0.001), 4-h transfusion requirements (β = 3177.081, 95 % CI: 59.315–6294.848, <em>p</em> = 0.046), and 24-h transfusion requirements (β = 2750.609, 95 % CI: 704.078–4797.141, <em>p</em> = 0.008) in both blunt and penetrating injuries. Patients who underwent REBOA at level II trauma centers had greater odds of 24-h mortality. No significant differences were observed in time to hemorrhage control or complication rates.</div></div><div><h3>Conclusion</h3><div>REBOA use in adult trauma patients with severe thoracic or abdominal trauma consistently led to increased mortality and blood transfusion requirements even when outcomes were stratified by REBOA zone placement and trauma center level. REBOA use should be cautiously considered on a case-by-case basis in severely injured patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 245-255"},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019024","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":"Management of tracheostomal hemorrhage complicated by obstructing clot in a post-laryngectomy patient presenting to a rural emergency department.","authors":"Ryan Duhé, Gracelyn Metts, Evan Stravolo","doi":"10.1016/j.ajem.2025.08.063","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.08.063","url":null,"abstract":"<p><p>Total laryngectomy (TLE) results in the permanent separation of the respiratory and digestive tracts, requiring all airway interventions to occur exclusively via a neck stoma. Although airway obstruction in post-laryngectomy patients is uncommon, it can rapidly become fatal without prompt recognition and understanding of the altered anatomy. Here, we report the case of a patient with a recent TLE for squamous cell carcinoma, who presented to a rural Emergency Department (ED) in acute respiratory distress. Emergency Medical Service (EMS) providers reported profuse tracheostomal bleeding and hypoxia, with an oxygen saturation of 55 % on room air. On arrival at the ED, the patient was in severe acute distress with active hemorrhage and partial tracheostoma obstruction due to a large, gelatinous clot. Manual removal of the clot, along with an attached tracheobronchial cast, resulted in respiratory improvement. Ongoing hemorrhage was controlled with digital pressure in the suprasternal notch, intravenous tranexamic acid (TXA), and fluid resuscitation. Laboratory evaluation revealed a significant drop in hemoglobin from 12.1 g/dL at recent discharge to 8.9 g/dL, necessitating transfusion of two units of packed red blood cells. The patient was stabilized and transferred to a tertiary care center, where bronchoscopy revealed an anterior tracheal erosion as the source of bleeding and was eventually discharged in stable conditions. This case highlights a rare occurrence of life-threatening airway obstruction due to TLE-related hemorrhage at the tracheal stoma, for which Emergency Medicine providers should remain vigilant and prepare to act swiftly to secure the airway and prevent any catastrophic outcomes.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031278","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":"Reader comment regarding \"[Electrocardiogram essentials: Bradycardia]\".","authors":"Mazen M Kawji","doi":"10.1016/j.ajem.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.003","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034895","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":"Abdominal compartment syndrome in the pediatric population – Case series and review of the literature","authors":"M.D. Yael Dreznik ,&nbsp;Emanuele Giliadov ,&nbsp;Gal yekutiel M.D ,&nbsp;Gili Kadmon M.D ,&nbsp;Maya Paran M.D ,&nbsp;Anastasia Almog M.D ,&nbsp;Elhanan Nachum M.D ,&nbsp;Dragan Kravarusic M.D","doi":"10.1016/j.ajem.2025.09.001","DOIUrl":"10.1016/j.ajem.2025.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Abdominal compartment syndrome (ACS) in children is a rare but life-threatening condition caused by increased intra-abdominal pressure leading to multi-organ dysfunction. Despite its severity, pediatric ACS remains underrecognized, with limited data available to guide diagnosis and management.</div></div><div><h3>Aim</h3><div>This study aims to contribute to the scarce literature by summarizing our institutional experience in diagnosing and managing pediatric ACS.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of all patients under 18 years who underwent decompressive laparotomy for ACS between 2014 and 2024 at a single tertiary pediatric center. Data included demographics, underlying conditions, surgical details, and clinical outcomes.</div></div><div><h3>Results</h3><div>Nine children, aged one week to seven years, were diagnosed with ACS and treated surgically. Etiologies varied and included postoperative complications, sepsis, and congenital anomalies such as Hirschsprung's disease, cyanotic congenital heart disease, and imperforate anus. Surgical approaches included decompressive laparotomy with or without bowel resection and open abdomen management using a Bogota bag. Despite intensive care, the mortality rate exceeded 50 % (5/9 patients).</div></div><div><h3>Conclusions</h3><div>Pediatric ACS is a heterogeneous condition with limited published data and significant mortality. Improved awareness, early recognition of warning signs, and timely surgical decompression are critical to improving outcomes in this vulnerable population.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 269-275"},"PeriodicalIF":2.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026882","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":"Factors associated with acute unscheduled care visits for asthma in the all of US dataset","authors":"Deyaneira Gonzalez Rodriguez ,&nbsp;Qinxin Yuan ,&nbsp;Tolulope Bakare ,&nbsp;Sangil Lee MD, MS ,&nbsp;R. Andrew Taylor MD, MHS","doi":"10.1016/j.ajem.2025.09.002","DOIUrl":"10.1016/j.ajem.2025.09.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Asthma exacerbations can cause patients to visit the emergency department (ED) without prior appointments. This study analyzed factors associated with unscheduled ED visits among asthma patients by examining the All of Us Research Program dataset.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the All of Us database (2018–2024). Electronic health records (EHR) were utilized to identify asthma patients based on physician-reported asthma diagnoses. Patients were divided into three groups based on ED visit frequency during the study period: General Asthma Patients (no ED visits), Single ED Visit Asthma Patients (one visit), and Frequent ED Visit Asthma Patients (more than one visit). Python and R were utilized to perform a multinomial logistic regression analysis in order to examine demographic factors, social determinants, healthcare accessibility, neighborhood conditions and comorbidities.</div></div><div><h3>Results</h3><div>The research included 47, 227 asthma patients from a total participant pool of 409,420 individuals. The study included 33,046 (70.0 %) General Asthma Patients with no ED visit record, 4779 (10.1 %) Single ED Visit Asthma Patients with a single reported visit and 9402 (19.9 %) Frequent ED Visit Asthma Patients with two or more ED visits. Factors significantly associated with frequent ED visits included income less than $10,000/year (OR = 1.42; 95 % CI [1.25–1.61]), Black/African American race (OR = 2.08; 95 % CI [1.61–2.68]), chest pain (OR = 2.31; 95 % CI [2.16–2.48]), hypertension (OR = 1.19; 95 % CI [1.11–1.28]), respiratory tract infections (OR = 1.60; 95 % CI [1.50–1.71]), anxiety (OR = 1.17; 95 % CI [1.08–1.28]), living near abandoned buildings (OR = 1.20; 95 % CI [1.14–1.26]), and perceived daytime neighborhood unsafety (OR = 1.07; 95 % CI [1.02–1.13]). Protective factors included higher income (&gt;$200,000/year, OR = 0.55; 95 % CI [0.42–0.70]), insurance coverage (OR = 0.65; 95 % CI [0.58–0.71]), older age (OR per year = 0.99; 95 % CI [0.99–0.99]), and male sex (OR = 0.86; 95 % CI [0.81–0.92]). Female patients and younger age were associated with increased likelihood of ED visits.</div></div><div><h3>Conclusions</h3><div>The frequency of unscheduled ED visits for asthma patients was significantly influenced by social determinants which include race, socioeconomic status, neighborhood factors, and specific comorbidities. Understanding these disparities can aid in the improvement of asthma management and the development of targeted interventions to address these critical factors.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"98 ","pages":"Pages 276-282"},"PeriodicalIF":2.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049258","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}