American Journal of Emergency Medicine最新文献

{"title":"Agitation management strategies for older adults in the emergency department or with emergency medical services: A scoping review","authors":"Fatima I. Shah BSc (Hons) ,&nbsp;Grace Lew BHSc (Hons) ,&nbsp;Zeeshan Chawdhry ,&nbsp;Krista Reich MD, MSc ,&nbsp;Kathryn Crowder MD ,&nbsp;Diane L. Lorenzetti PhD ,&nbsp;Margaret McGillivray BSc, M.D, CCFP (EM and COE) ,&nbsp;Zahra Goodarzi BHSc (Hon). MD. MSc. FRCPC","doi":"10.1016/j.ajem.2025.04.019","DOIUrl":"10.1016/j.ajem.2025.04.019","url":null,"abstract":"<div><h3>Background</h3><div>Agitation is common in the emergency department (ED) and with emergency medical services (EMS), which can pose significant challenges to safety and patient care. In older adults, agitation is a common symptom of dementia or delirium.</div></div><div><h3>Rationale</h3><div>Managing agitation in older adults is challenging in emergency care environments. A scoping review of literature for agitation management approaches for older adults in ED/EMS environments was completed.</div></div><div><h3>Methods</h3><div>We searched Medline, Embase, and APA PsycINFO, combining key words and subject headings for 3 concepts: “older adults, aged 65 and older,” “agitation/dementia/delirium,” and “ED/EMS.” Studies which explored management strategies for older adults with agitation, dementia, or delirium in the ED or EMS were included. Studies with younger populations (&lt;65 years old) and/or lacking patient data specifically from the ED or EMS were excluded.</div></div><div><h3>Results</h3><div>A total of 7113 studies were screened, of which 22 were included in this review: pharmacological (<em>n</em> = 8), non-pharmacological (<em>n</em> = 5), multi-component (<em>n</em> = 3) treatments, and recommendations (<em>n</em> = 6). Most were in the ED, and 5038 older adults were included across all studies. Antipsychotics and benzodiazepines to manage agitation were common. Non-pharmacological and multi-component interventions were less commonly evaluated and lacked exploration of patient outcomes. Recommendations stressed caution with pharmacological medications rather than prioritizing non-restraint strategies.</div></div><div><h3>Discussion</h3><div>Most studies identified use of pharmacological treatment for agitation amongst older adults in ED/EMS settings, however, are not found to be overly effective and are associated with patient harm. There is a significant gap in evidence specific to EMS settings and evaluation of effectiveness of non-pharmacological interventions, highlighting the need for further research.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 81-95"},"PeriodicalIF":2.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870378","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":"Impact of antihypertensive administration strategy on time to thrombolysis in acute ischemic stroke","authors":"Katelyn Williams,&nbsp;Lisa Hayes,&nbsp;Ana Negrete,&nbsp;Dennis Marjoncu,&nbsp;Michael Samarin","doi":"10.1016/j.ajem.2025.04.030","DOIUrl":"10.1016/j.ajem.2025.04.030","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (&gt; 185/110 mmHg) which requires treatment before thrombolysis. The purpose of this study is to determine the optimal strategy to lower blood pressure before thrombolysis in AIS.</div></div><div><h3>Methods</h3><div>This is a retrospective study of adult patients diagnosed with AIS who received antihypertensives before thrombolysis between March 2022 and November 2023 at Methodist LeBonheur Healthcare. Cohorts were divided by the initial type of antihypertensive used: intravenous push (IVP) or continuous infusion (CI). The primary outcome was antihypertensive-to-needle (ATN) time. Other outcomes included door-to-needle (DTN) time, functional outcomes, need for rescue antihypertensives, and adverse effects.</div></div><div><h3>Results</h3><div>One hundred patients were included: 44 in the IVP group and 56 in the CI group. The median age was 67 years. The highest systolic blood pressure before thrombolysis was higher in the CI group (207 mmHg versus 193 mmHg, <em>p</em> &lt; 0.001). The median ATN time was shorter in the IVP group (9.5 min versus 15 min, <em>p</em> = 0.005). Door-to-needle time was shorter in the IVP group (57.5 min versus 67 min, <em>p</em> = 0.038). There were no statistically significant differences in use of rescue antihypertensives, adverse effects, or functional outcomes at discharge.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that IVP antihypertensives as the initial antihypertensive strategy may decrease the time to thrombolysis in AIS patients who require blood pressure lowering without increasing rates of adverse effects. Functional outcomes were not impacted positively or negatively. Larger prospective studies are needed to confirm these results.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 10-14"},"PeriodicalIF":2.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847764","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":"Impact of weather conditions on the development of subarachnoid hemorrhage: A retrospective analysis","authors":"Seiji Hirota ,&nbsp;Tsubasa Murakami ,&nbsp;Marina Minami ,&nbsp;Masamitsu Eitoku ,&nbsp;Kingo Nishiyama ,&nbsp;Narufumi Suganuma ,&nbsp;Takashi Kawano","doi":"10.1016/j.ajem.2025.04.025","DOIUrl":"10.1016/j.ajem.2025.04.025","url":null,"abstract":"<div><h3>Background</h3><div>Subarachnoid hemorrhage (SAH) is a serious emergent condition. Studies investigating the climatic characteristics at the time of onset or immediately after onset, rather than on the day of onset, are scarce.</div></div><div><h3>Aim</h3><div>We aimed to clarify the climatic characteristics involved in the development of SAH by analyzing emergency transport data from Kochi Prefecture.</div></div><div><h3>Methods</h3><div>Emergency transport data from 2015 to 2021 were extracted from the emergency medical and regional disaster information system. The control group was selected from a database of traffic accident cases with sudden onset. First, a logistic regression analysis was performed on SAH and control groups to examine the factors affecting the development of SAH. Second, a matched case-control study and conditional logistic regression analysis were performed.</div></div><div><h3>Results</h3><div>A total of 272,634 patients were transported during the study period. Of these, 848 were in the SAH group. In the logistic regression analysis, temperature at onset, relative humidity at onset, temperature decrease from the previous day (TDP) post 1, and temperature change from the previous day (TCP) post 1 influenced the onset of SAH. After matching for sex, age, month of onset, time of onset, and transporting fire department in the SAH and control groups, only temperature at onset affected SAH onset. Conditional univariate analysis with temperature at onset as a quintile showed that SAH incidence increased approximately 2.0-fold with cooler temperatures.</div></div><div><h3>Conclusion</h3><div>We found that lower temperature at onset was a significant climatic characteristic involved in the onset of SAH in Kochi Prefecture.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 15-20"},"PeriodicalIF":2.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847765","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":"AI-Assisted Blood Gas Interpretation: A Comparative Study With an Emergency Physician","authors":"Mehmet Gün","doi":"10.1016/j.ajem.2025.04.028","DOIUrl":"10.1016/j.ajem.2025.04.028","url":null,"abstract":"<div><h3>Background</h3><div>Blood gas interpretation is critical in emergency settings. Large language models like ChatGPT are increasingly used in clinical contexts, but their accuracy in interpreting arterial blood gases (ABGs) requires further validation.</div></div><div><h3>Objective</h3><div>To evaluate ChatGPT's interpretive concordance with an emergency physician across 25 theoretical ABG scenarios.</div></div><div><h3>Methods</h3><div>ABG cases covering respiratory and metabolic emergencies (e.g., COPD, DKA, AKI, sepsis, poisoning) were analyzed by both ChatGPT and a specialist. Five interpretation criteria were used: pH, primary disorder, compensation, likely diagnosis, and clinical recommendation.</div></div><div><h3>Results</h3><div>Concordance was ≥90% in COPD, asthma, and pulmonary edema; 80–90% in DKA, AKI, and lactic acidosis; &lt;70% in toxicologic and mixed acid-base cases. ChatGPT's recommendations were clinically safe even when diagnostic clarity was limited.</div></div><div><h3>Conclusion</h3><div>ChatGPT shows high concordance with clinical interpretation in typical ABG cases but has limitations in complex or contextual diagnoses. These findings support its potential as a supportive tool in emergency medicine.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 1-2"},"PeriodicalIF":2.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143842776","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":"Cardiac arrest due to airway obstruction in Angiotensin-converting enzyme inhibitor-induced angioedema.","authors":"Antoine Ducuing, Eric Deberdt","doi":"10.1016/j.ajem.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.04.022","url":null,"abstract":"<p><p>Angiotensin-converting enzyme inhibitor-induced angioedema is a rare but serious side effect of angiotensin-converting enzyme inhibitors (ACEi). It causes bradykinin accumulaztion, leading to the swelling of various tissus, including upper airway. A significant proportion of affected patients require intubation to secure the airway, and in the most severe cases, a tracheostomy. Here, we present the case of a 63-year-old male patient who suffered hypoxic cardiopulmonary arrest due to ACEi-induced angioedema. Due to complete airway obstruction, this patient required an emergency cricothyroidotomy followed by a tracheostomy for effective ventilation. Despite the severity of his condition, the patient made a full recovery. This case highlights the severity ACEi-induced angioedema, the importance of early detection, and the need for emergency airway management in critical cases.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041423","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":"Effectiveness of inhaled methoxyflurane in acute pain in an emergency department – A systematic review of randomized controlled trials","authors":"Louisa Lam ,&nbsp;Hendrika J. Brouwer ,&nbsp;Meena Gupta ,&nbsp;Chin Jin Ker ,&nbsp;Conor Jones ,&nbsp;Areeb Athar ,&nbsp;Cristina Roman ,&nbsp;Biswadev Mitra ,&nbsp;Lisa Brichko ,&nbsp;Carl Luckhoff ,&nbsp;Natasha Jennings ,&nbsp;Peter Cameron","doi":"10.1016/j.ajem.2025.04.021","DOIUrl":"10.1016/j.ajem.2025.04.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Inhaled Methoxyflurane has emerged as a popular analgesic agent for the management of acute traumatic pain in emergency settings. The aim of this review was to assess the analgesic efficacy of methoxyflurane compared to placebo and standard analgesics.</div></div><div><h3>Methods</h3><div>We performed a systematic review of the literature with searches of seven databases (Medline Complete, CINAHL Complete, OVID Emcare, Embase Classic + Embase, Cochrane Library, Scopus and Web of Science Core Collection) for randomized controlled trials where patients presented to the emergency department with acute traumatic pain and were administered inhaled methoxyflurane compared to placebo or standard analgesics. The primary outcome was the effectiveness of analgesia. Secondary outcomes were adverse events and patient and clinician satisfaction.</div></div><div><h3>Results</h3><div>The literature search produced 250 results, of which six met the eligibility criteria. All six studies reported improved pain scores with pain reduction of up to −30.392 mm on a 100 mm VAS scale and − 5.75 on an NRS 0–10 point scale for the methoxyflurane groups. All six studies concluded a shorter time to obtain pain relief for patients in the methoxyflurane groups. Patients and clinicians reported higher satisfaction in the methoxyflurane groups and there was a low incidence of adverse events.</div></div><div><h3>Conclusion</h3><div>Inhaled methoxyflurane provides rapid and effective pain relief for acute trauma, consistently outperforming placebo and standard treatments and improving patient and clinician satisfaction.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 37-45"},"PeriodicalIF":2.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858950","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":"Evaluating outcomes of patients with suspected pulmonary embolism using an age-adjusted cutoff with a D-dimer unit-based assay","authors":"Daniel Novak DO, MBA,&nbsp;Eric Quinn MD,&nbsp;Mahlaqa Butt DO, MPH,&nbsp;Aparna Saha MD, MPH,&nbsp;Corey Weiner MD,&nbsp;Lea Cohen MD,&nbsp;Ariella Cohen MD,&nbsp;Sergey Motov MD,&nbsp;Eitan Dickman MD","doi":"10.1016/j.ajem.2025.04.026","DOIUrl":"10.1016/j.ajem.2025.04.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Studies have suggested that an age-adjusted D-dimer (AADD) could improve specificity while maintaining sensitivity for the diagnosis of pulmonary embolism (PE). Most laboratories and published data report D-dimer in fibrinogen equivalent units, but some laboratory assays report using D-dimer units (DDU). However, only two small studies have examined AADD with a DDU-based assay. Our study aims to assess the sensitivity and specificity of AADD cutoffs, compared to the conventional cutoffs, in a large cohort of patients who underwent D-dimer testing using a DDU-based assay, for suspected PE.</div></div><div><h3>Methods</h3><div>We included 1831 patients who presented to the emergency department and underwent a diagnostic workup that included a D-dimer test followed by computed tomography pulmonary angiography (CTA). The laboratory utilized the HemosIL D-Dimer HS reagent, reporting D-dimer values in DDU (ng/mL). We retrospectively adjusted D-dimer levels for patients using the formula: age (years) x 5 ng/mL. This adjustment created a comparison group to evaluate the test characteristics of the AADD cutoff compared to the conventional cutoff.</div></div><div><h3>Results</h3><div>The conventional D-dimer cutoff of 230 ng/mL had a sensitivity of 97.4 % (95 % Confidence Interval [CI]: 95.3–99.4 %), specificity of 7.3 % (CI: 6.0–8.6 %), positive predictive value (PPV) of 13 % (CI: 11.4–14.6 %), and negative predictive value (NPV) of 95.1 % (CI: 91.3–98.9 %). The AADD cutoff had a sensitivity of 96.1 % (CI: 93.5–98.6 %), specificity of 16.6 % (CI: 14.8–18.4 %), PPV of 14.1 % (CI: 12.3–15.8 %), and NPV of 96.7 % (CI: 94.6–98.8 %).</div></div><div><h3>Conclusion</h3><div>In this study using a DDU-based assay, the specificity of the AADD cutoff was greater while the sensitivity was similar to that of the unadjusted cutoff, with no statistically significant difference observed.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 25-30"},"PeriodicalIF":2.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852180","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":"Reliability of measuring serum C-reactive protein or procalcitonin with Rochester criteria in febrile neonates aged 8–28 days","authors":"Jung Lee MD, MSc ,&nbsp;En-Pei Lee MD ,&nbsp;Wei-Hung Wu ,&nbsp;Mei-Yin Lai MD ,&nbsp;I-Hsyuan Wu MD ,&nbsp;Shih-Ming Chu MD ,&nbsp;Nai-Chia Fan MD ,&nbsp;Po-Cheng Yen MS ,&nbsp;Cheng-Hsun Chiu MD, PhD ,&nbsp;Chen-Wei Yen MD","doi":"10.1016/j.ajem.2025.04.015","DOIUrl":"10.1016/j.ajem.2025.04.015","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the utility of measuring serum C-reactive protein (CRP) or procalcitonin (PCT) level in conjunction with the Rochester criteria to exclude invasive bacterial infection (IBI) and urinary tract infection (UTI) in neonates aged 8–28 days with fever without an identifiable source of infection (FWSI).</div></div><div><h3>Methods</h3><div>The medical records of all neonates aged 8–28 days with FWSI presenting to our pediatric emergency department between January 2018 and December 2022 were analyzed retrospectively. Only those who underwent workup based on the Rochester criteria with the serum biomarkers were included. Our findings were validated in a separate cohort in 2023.</div></div><div><h3>Results</h3><div>In total, 191 neonates were included in the study, 54 (28.27 %) of whom had IBI and/or UTI. Serum biomarkers were analyzed, and higher CRP (<em>p</em> &lt; 0.001) and PCT (<em>p</em> = 0.013) levels were found to be associated with IBI and UTI on multivariate logistic regression analysis. To exclude IBI and UTI, combining the Rochester criteria with a PCT &lt; 0.5 ng/mL (Chang Gung criteria) had a higher negative predictive value (NPV) of 100.00 % than the Rochester criteria alone (93.06 %) and a similar positive predictive value (40.60 % and 41.18 %, respectively). Chang Gung criteria was validated in a cohort of 42 neonates aged 8–28 days with FWSI in 2023.</div></div><div><h3>Conclusion</h3><div>Using PCT at a threshold of 0.5 ng/mL alongside the Rochester criteria (Chang Gung criteria) provides a higher NPV for excluding IBI and UTI in neonates aged 8–28 days with FWSI.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"93 ","pages":"Pages 192-199"},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839514","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 “Abdominal pain in the emergency department: 50 years on” [American Journal of Emergency Medicine (92) 2025 (135–137)]","authors":"Moira E. Smith MD ,&nbsp;Noel R. Mukubwa ,&nbsp;Robert D. Powers MD","doi":"10.1016/j.ajem.2025.03.062","DOIUrl":"10.1016/j.ajem.2025.03.062","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Page 257"},"PeriodicalIF":2.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927439","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 effectiveness of emergency medicine follow-up in attaining closed loop communication and downstream follow-up","authors":"Jorge Fradinho PhD MENG MS ,&nbsp;Maria Cadman BSN RN ,&nbsp;Ryan C. Burke PhD, MPH ,&nbsp;Maxwell Blodgett MD ,&nbsp;Richard Wolfe MD ,&nbsp;Jayson Carr MD ,&nbsp;Shamai Grossman MD MS","doi":"10.1016/j.ajem.2025.04.020","DOIUrl":"10.1016/j.ajem.2025.04.020","url":null,"abstract":"<div><h3>Background</h3><div>Utilization of different Electronic Health Records (EHR) impedes communication between Emergency Medicine (EM) and Primary Care Provider (PCP) necessitating study on EM's effectiveness in enabling continuity of care following patient discharge. This study's objective was to evaluate the effectiveness of an EM-based follow-up program using secure email for closed-loop communication and follow-up of incidental findings (IF) after EM discharge.</div></div><div><h3>Methods</h3><div>Retrospective study of IFs from two Emergency Departments (ED) and one urgent care between 9/1/20–8/30/21. Preceding day IFs were identified by an EM Quality Assurance (QA) team who then notified the patient's PCP via email. Automated rules-based natural language processing (NLP) of emails linking data to EHRs. Chart reviewing of outcomes included whether closed loop communication was established (via a PCP reply acknowledging IF receipt) and whether follow-up care occurred within 12 months. Multivariate logistic regression models examined factors associated with each outcome.</div></div><div><h3>Results</h3><div>Of 1781 IF notifications, 62 % were female, 77 % white, and 91 % English speaking. PCP replied to 39.1 %; 64.9 % were ultimately followed-up. Patient and IF characteristics were not associated with PCP reply. PCP tenure and EM/PCP EHR system concordance were associated with higher adjusted Odds Ratio (aOR) of PCP reply (aOR 1.05 [1.04–1.07] vs 2.6 [2.0–3.3]). Laboratory IFs were followed-up more than imaging IFs (aOR 1.94 [1.46–2.6]). EM/PCP Use of same EHR was associated with higher odds of some form of follow-up (aOR: 2.1 [1.7–2.7]).</div></div><div><h3>Conclusions</h3><div>While email notifications and using the same EHR improve continuity of care, they are insufficient on their own. More comprehensive solutions are needed to enable EM-PCP communication and patient follow-up.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"94 ","pages":"Pages 3-9"},"PeriodicalIF":2.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143842775","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}