American Journal of Emergency Medicine最新文献

{"title":"The Authors Respond.","authors":"Arian Zaboli, Gianni Turcato","doi":"10.1016/j.ajem.2025.06.045","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.06.045","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499478","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":"Social vulnerability index predictive of being ‘left without being seen’ in the emergency department","authors":"Maureen Schick BSN ,&nbsp;Nicole Fumo MPH ,&nbsp;Lauren Nickel PhD ,&nbsp;Jamie Aranda MD ,&nbsp;Robert Mackenzie MA ,&nbsp;Nancy Jacobson MD","doi":"10.1016/j.ajem.2025.06.032","DOIUrl":"10.1016/j.ajem.2025.06.032","url":null,"abstract":"<div><h3>Study objective</h3><div>This study assesses whether the Social Vulnerability Index (SVI) predicts the likelihood of being ‘Left Without Being Seen’ (LWBS) in the emergency department (ED). A cohort of 73,044 patient encounters between May 1, 2022 and April 30, 2023 in an academic, urban, tertiary care ED was analyzed using logistic regression to evaluate for SVI as a predictor of LWBS disposition.</div></div><div><h3>Methods</h3><div>Patient addresses were geocoded using ArcGIS Pro 3.3 to obtain SVI data at the census tract level. Overall SVI and its four component themes (socioeconomic status, household characteristics, racial and ethnic minority status, housing type and transportation) were analyzed for predictive value. Statistical models assessed LWBS likelihood for every 0.1-unit increase in SVI.</div></div><div><h3>Results</h3><div>LWBS patients accounted for 5.4 % (3880) of total patient encounters, with higher mean SVI scores (0.73, SD = 0.27) compared to seen patients (0.67, SD = 0.30, <em>p</em> &lt; 0.001). Each 0.1-unit increase in SVI was predictive of a 7 % increase in the likelihood of being LNS (<em>p</em> &lt; 0.01). Among component themes, racial and ethnic minority status showed the strongest correlation, with a 13 % increase in the likelihood of being LWBS per 0.1-unit increase in SVI.</div></div><div><h3>Conclusions</h3><div>Higher SVI scores strongly predicted being LWBS overall and across all themes. SVI may be used to predict a person's risk of limited access to emergency care, as represented by arriving at the ED but leaving before being seen. Integrating SVI into ED and health system workflows could aid in identifying at-risk populations, addressing systemic barriers, and improving equitable access to care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 191-196"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501763","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 Chat-GPT in triage: Still far from surpassing human expertise - An observational study.","authors":"Shuang Qiu, Yiyi Zhu, Fang Wu","doi":"10.1016/j.ajem.2025.06.046","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.06.046","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509562","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 impacting military emergency medicine residents' sleep and barriers to seeking help: A sequential exploratory mixed-methods study","authors":"Joshua J. Oliver MD, MPH ,&nbsp;David S. Ediger MD ,&nbsp;Jillian F. Phelps MD ,&nbsp;Ariel L. Hoffman MD, MPH ,&nbsp;Alexander W. Martin ,&nbsp;Sadie A. Martin ,&nbsp;Rachel E. Bridwell MD ,&nbsp;Simon D. Aebersold MA ,&nbsp;Rebekah Cole Phd, MEd ,&nbsp;Jeffrey C. Ransom PhD, DNP, FNP-BC","doi":"10.1016/j.ajem.2025.06.044","DOIUrl":"10.1016/j.ajem.2025.06.044","url":null,"abstract":"<div><div>Emergency medicine (EM) resident physicians face unique challenges in adhering to the principles of sleep hygiene due to the nature of EM shift work. They are at higher risk for sleep disorders, sleep-related errors and accidents, and impaired performance due to constantly changing schedules. Military residents also perceive a stigma against seeking mental health care and taking sleeping medications.</div><div>This mixed-methods study investigated sleep quality and barriers to seeking care among EM residents at a single center, three-year, Active-Duty military EM residency program. A survey was made available to all 36 EM residents assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) with a target response rate of 66.7 %. The purpose of using the ESS was to identify at least 9 EM residents with excessive daytime sleepiness to participate in semi-structured interviews about their sleeping experiences. Excessive daytime sleepiness is defined as ≥11 on the ESS. These interviews were coded using a phenomenological approach to data analysis.</div><div>Of the 36 EM residents in the program, 24 (66.7 %) completed the survey. Of these, 11 scored ≥11 on the ESS. Of these, nine EM residents participated in semi-structured interviews. Thematic saturation was achieved, and four themes emerged from interviews: 1) challenges with sleep hygiene; 2) less satisfied with sleep since starting residency; 3) normalization of poor sleep; and 4) taking medication for sleep is stigmatized. Results revealed significant difficulties adhering to the principles of sleep hygiene due to inconsistent sleep-wake times. Participants identified difficulty avoiding caffeine, alcohol, and large meals before bed, and felt their sleep had worsened since starting residency. Though residents often discussed sleep difficulties with colleagues, these conversations normalized sleeping problems and reduced help-seeking behavior. Participants perceived a stigma against using prescription medication for sleep.</div><div>This study highlights significant sleep disturbances experienced by EM residents in this study and an inability to adhere to the principles of sleep hygiene. Normalization of sleep disturbances in residency seems to impede residents from seeking professional help. Further research should focus on targeted interventions to improve resident sleep hygiene, promote help-seeking behavior, and reduce the stigma associated with prescription drug use, when necessary. Additional studies are needed to examine the generalizability of these results to other training programs.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 122-127"},"PeriodicalIF":2.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366716","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":"Age and sex related differences in clinical manifestations and severity of acute cocaine toxicity presentations to European emergency departments","authors":"Òscar Miró ,&nbsp;Miguel Galicia ,&nbsp;Paul I. Dargan ,&nbsp;David M. Wood ,&nbsp;Alison M. Dines ,&nbsp;Fridtjof Heyerdahl ,&nbsp;Knut Erik Hovda ,&nbsp;Matthias Liechti ,&nbsp;Odd Martin Vallersnes ,&nbsp;Florian Eyer ,&nbsp;Guillermo Burillo-Putze","doi":"10.1016/j.ajem.2025.06.035","DOIUrl":"10.1016/j.ajem.2025.06.035","url":null,"abstract":"<div><div>The purpose of this work is to investigate if clinical manifestations and severity associated with acute cocaine toxicity differ according to patient age and sex, analyzing presentations in the Euro-DEN Plus dataset from 2013 to 2023 in which cocaine was the only drug involved (except for ethanol).</div><div>We consider the age as a continuous variable using non-linear restricted cubic spline (RCS) models, and biological sex as a binary variable, and we also analyze another 14 clinical manifestations recorded during emergency department (ED) care. As markers of severity, we recorded hospitalization, critical care (ICU) admission and in-hospital death. Associations were reported as odds ratio (OR) adjusted by sex/age (as needed.</div><div>Our results shows that 9365 of 83,452 Euro-DEN Plus presentations (11.2 %) were due to cocaine use alone. The most frequent clinical manifestations were anxiety (31 %), chest pain (28 %), and agitation/aggressiveness (26 %). Arrhythmias, hypertension, and hallucinations were more frequent in older patients; agitation/aggressiveness, psychosis and hyperthermia in middle age, and seizures predominated in younger patients. Regarding differences accorded to sex, women more frequently presented to the ED with vomiting, headache, anxiety, or hypotension, and men with hyperthermia, chest pain, hypertension, or arrhythmias. 3 % of all cases needed ICU admission, 22 % hospitalization in a conventional ward and 0.4 % of cases die. All these severity markers increased with age. Hospitalization was more frequent in men.</div><div>These data allow us to conclude that the prevalence of some clinical features typically associated with acute cocaine toxicity and toxicity severity differed according to age and sex.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 151-160"},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480454","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":"Optimizing diagnostic precision: the role of cut-off selection in predictive performance studies.","authors":"Emre Kudu, Buğra İlhan","doi":"10.1016/j.ajem.2025.06.043","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.06.043","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487224","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":"Comparison of time to sedation after rapid sequence intubation using long-acting neuromuscular blockers between the ED and ICU","authors":"Amanda C. Cappuccilli PharmD ,&nbsp;Preeyaporn Sarangarm PharmD ,&nbsp;Joanna Dukes PharmD ,&nbsp;Kevin Kaucher PharmD","doi":"10.1016/j.ajem.2025.06.042","DOIUrl":"10.1016/j.ajem.2025.06.042","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the proportion of patients who receive an appropriate sedative within 15 min of receiving rocuronium for intubation between Emergency Department (ED) and Intensive Care Unit (ICU) patients. The study aims to assess whether patients receive appropriate sedation within 15 min of paralysis as delays in sedation can result in paralysis with awareness which can result in psychological harm. Comparing results between these two critical care areas can identify process improvement targets for future efforts.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients intubated using rocuronium in the ED or ICU at a large urban academic medical center. We included those 18–89 years of age, and use of rocuronium for Rapid Sequence Intubation (RSI). The primary outcome is the proportion of patients given a sedative agent given within 15 min of induction (N%). Secondary outcomes include comparison between those intubated in the ED and ICU on time to sedation after intubation, total amount of sedative/analgesic given within first 60 min vs 60–120 min post-RSI, and patient sedation intensity scores between 0 and 60 vs 61–120 min post-RSI.</div></div><div><h3>Results</h3><div>370 patients were included in the final analysis. A similar proportion of patients received sedatives within 15 min of induction agent administration in the ED and ICU (39 % vs. 40 %; difference 0.8 %, 95 % CI –10.6 to 9.1). The median time to sedation following RSI was 15 min in the ED and 13 min in the ICU (difference 2.0 %, 95 % CI –5.5 to 5.0). The relative amount of sedation received after RSI significantly increased in both groups from the first and second hours, likely correlating to the return of neuromuscular function in the second hour and ability to assess sedative requirements.</div></div><div><h3>Conclusion</h3><div>Patients in the ED and ICU face low rates of timely sedation following RSI with rocuronium.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 128-133"},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366718","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":"Hidden in plain sight: A malpositioned intrauterine device as the culprit of acute pelvic pain - a case report.","authors":"Sarah Petelinsek, Isabel Shimanski, Megan Fix, Taylor Mendenhall, Patrick G Hughes","doi":"10.1016/j.ajem.2025.06.037","DOIUrl":"10.1016/j.ajem.2025.06.037","url":null,"abstract":"<p><p>Malpositioned intrauterine devices (IUDs) are not yet a well recognized cause of acute pelvic pain. Correct identification relies on recognizing key imaging findings such as low-lying or endocervical positioning, and an understanding that acute pelvic pain may be the result of a malpositioned IUD. We report the case of a 28-year-old sexually active female (she/her/hers) with a history of a malpositioned IUD, who presented with sudden onset, unprovoked, right sided pelvic pain. She denied hematuria, dysuria, vaginal discharge, or vaginal bleeding. On physical examination she noted right-sided pelvic tenderness below McBurney's point; however, a pelvic examination was deferred. Ultrasound revealed an IUD in the endocervical canal. A CT confirmed a low-lying IUD. These findings were initially interpreted as normal. Only after follow-up with primary care, the IUD was removed and the patient reported complete resolution of her symptoms. This case highlights the importance of recognizing malpositioned IUDs on imaging. As in this case, misdiagnosis can result in overtesting and delays in patient care. Emergency providers should be familiar with radiographic findings and include malpositioned IUDs on their differential diagnosis.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340726","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":"MRI timing and clinical outcomes in blunt moderate-severe pancreatic trauma: Implications for practice management and care optimization","authors":"Andrew Ford B.S. ,&nbsp;Nikita Nunes Espat M.S ,&nbsp;Philip Lee B.S ,&nbsp;Brevin O’Connor B.S ,&nbsp;Ariel Hus B.S ,&nbsp;Yumna Indorewala B.S ,&nbsp;Sarthak Kumar B.S ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.ajem.2025.06.030","DOIUrl":"10.1016/j.ajem.2025.06.030","url":null,"abstract":"<div><h3>Introduction</h3><div>This analysis will evaluate the impact of magnetic resonance imaging (MRI) timing (≤24 h versus &gt;24 h) from emergency department (ED) arrival on injury characteristics and clinical outcomes in adult trauma patients with blunt moderate-severe abdominal pancreatic injury.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was performed using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database. Adult patients with moderate-severe (ISS ≥ 9) blunt abdominal trauma (AIS abdomen &gt;2) who underwent abdominal MRI were included. Outcomes included mortality, time to surgical intervention, intensive care unit length of stay (ICU-LOS), ventilator-free days (VFDs), complication rates, and discharge disposition.</div></div><div><h3>Results</h3><div>Receiving MRI ≤24 h from ED arrival was associated with lower mortality (aOR 0.335, <em>p</em> = 0.332), significantly less time to intervention (β −26.190, <em>p</em> = 0.027), and significantly shorter ICU-LOS (β = −2.948, <em>p</em> = 0.031) compared to patients receiving MRI &gt; 24 h. There were no significant differences in VFDs (β 0.979, <em>p</em> = 0.692) or in-hospital complications (aOR 0.088, <em>p</em> = 0.124–0.999) between groups. Patients receiving MRI ≤24 h were significantly more likely to be discharged home (aOR 2.839, <em>p</em> = 0.044) and significantly less likely to be discharged to an acute rehabilitation facility (aOR 0.104, <em>p</em> = 0.004) compared to MRI &gt; 24 h.</div></div><div><h3>Conclusion</h3><div>MRI utilization within 24 h of ED arrival has resulted in detecting the majority of pancreatic traumatic injuries with various severity &amp; anatomic regions, reduced mortality odds, significantly reduced ICU-LOS days, shorter time to surgical intervention, and increased likelihood of home discharge, with no significant differences in complication rates compared to those receiving MRI &gt; 24 h.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 104-109"},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330907","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":"Validation of a chart review method for identifying delirium in the emergency department","authors":"Piayeng Thao BS ,&nbsp;Kayla P. Carpenter BS ,&nbsp;Annelise S. Howick BA ,&nbsp;Aidan F. Mullan MA ,&nbsp;Madeline A. Boie ,&nbsp;Ian W. Maia MD, PhD ,&nbsp;Allyson K. Palmer MD, PhD ,&nbsp;Lauren T. Southerland MD, MPH ,&nbsp;Elizabeth M. Goldberg MD, ScM ,&nbsp;Molly M. Jeffery PhD ,&nbsp;Fernanda Bellolio MD, MSc","doi":"10.1016/j.ajem.2025.06.025","DOIUrl":"10.1016/j.ajem.2025.06.025","url":null,"abstract":"<div><h3>Objective</h3><div>To validate the Chart-based Delirium Identification Instrument (CHART-DEL) which was developed in the inpatient setting, for identifying delirium in the emergency department (ED).</div></div><div><h3>Methods</h3><div>This retrospective observational study included ED patients aged 75 and older who presented between 2021 and 2023 and were screened for delirium utilizing a validated two-step tool which included the Delirium Triage Screen (DTS) and the Brief Confusion Assessment Method (bCAM). A stratified random sample of 600 medical records were reviewed using the CHART-DEL method. Inter-rater agreement and diagnostic test accuracy were calculated. We followed standardized guidelines for reporting (STROBE).</div></div><div><h3>Results</h3><div>A total of 27,082 visits were included. Median age was 83 years, 51.8 % were women. Twenty percent of patients had known dementia and/or cognitive impairment, and 48.8 % were admitted to the hospital. There were 1197 patients (4.4 %) with delirium in the ED. When compared to the ED assessment, the chart review correctly identified 474/600 cases (accuracy 79.0 %, 95 % CI: 75.5–82.1 %), including 223/300 with delirium (sensitivity 74.3 %, 95 % CI: 68.9–79.1 %), and 251/300 without delirium (specificity 83.7 %, 95 % CI: 78.9–87.6 %). Agreement between the reviewers was 91.0 %. Weight calculations to approximate the original population resulted in an accuracy of 86.4 % (95 % CI: 86.0–86.8 %), sensitivity of 74.2 % (95 % CI: 71.6–76.6 %) and specificity of 87.0 % (95 % CI: 86.6–87.4 %).</div></div><div><h3>Conclusion</h3><div>The CHART-DEL can be applied to the ED setting, but performed better at correctly identifying patients who do not have delirium. Automating this method could improve retrospective delirium detection in the ED and support future clinical applications of delirium screening tools.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"96 ","pages":"Pages 62-68"},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306774","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}