American Journal of Emergency Medicine最新文献

{"title":"The emergency department visit as an opportunity for sexually transmitted infection screening and linkage to care in early pregnancy.","authors":"Ngozi V Pierce, Ellen Almirol, Kimberly A Stanford","doi":"10.1016/j.ajem.2026.07.043","DOIUrl":"https://doi.org/10.1016/j.ajem.2026.07.043","url":null,"abstract":"<p><strong>Background: </strong>Inadequate prenatal care (PNC) is linked to adverse pregnancy outcomes, including those related to untreated sexually transmitted infections (STIs) such as syphilis. Many populations with low PNC utilization disproportionately access the emergency department (ED). ED visits in early pregnancy may represent a critical opportunity for screening and linkage to PNC. This study aims to evaluate STI screening, diagnosis rates, and access to PNC among pregnant ED patients.</p><p><strong>Methods: </strong>This is a retrospective review of pregnant individuals who visited a large, urban ED and later delivered the infant at the same hospital or had ectopic pregnancies. Descriptive statistics were used to report testing and PNC data, which were extracted from the electronic medical record.</p><p><strong>Results: </strong>Of 1770 ED visits with positive pregnancy tests, 401 (22.7%) resulted in live births in the same hospital and 69 (3.9%) in ectopic pregnancies. In the live birth group, average gestational age at ED presentation was 9 (SD 4.5) weeks, and 49.1% reported plans to access PNC. Only 13.2% of ED encounters included testing for HIV, 4.7% for syphilis, and 22.9% for gonorrhea/chlamydia. More than half (54.5%) of 32 individuals with gonorrhea or chlamydia and 80% of the five with syphilis were not tested during their ED visit.</p><p><strong>Conclusions: </strong>This study demonstrates large gaps in STI testing and access to PNC among pregnant persons visiting the ED. These findings highlight an important opportunity for early diagnosis, prevention of complications like congenital syphilis, and linkage to PNC for underserved communities utilizing the ED early in pregnancy.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622700","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":"Gender differences in clinical features and outcomes of Fournier's gangrene among emergency department patients.","authors":"Sydney Hudock, Emily Hill, Jon Giolitti, Rachelle Pichot, Jeffrey Jones","doi":"10.1016/j.ajem.2026.07.039","DOIUrl":"https://doi.org/10.1016/j.ajem.2026.07.039","url":null,"abstract":"<p><strong>Background: </strong>Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineal, genital, and perianal regions that predominantly affects men and carries substantial morbidity and mortality. The presentation and outcomes of FG in women remain less well characterized. Our objective was to compare clinical characteristics, treatment, and short-term outcomes between male and female emergency department patients with FG.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients presenting to the EDs of 11 affiliated hospitals across 19 counties in Michigan from 2012 to 2024 with a final diagnosis of FG. Demographics, clinical characteristics, treatments, and outcomes were abstracted and compared between sexes. Primary outcomes included in-hospital death, 30-day mortality, length of stay, readmission, and surgical burden.</p><p><strong>Results: </strong>Among 166 patients, 134 (80.7%) were male, and 32 (19.3%) were female. Women had a higher mean body mass index than men (40.2 vs 36.6, p = 0.01), while age, comorbidity burden, and median Fournier's Gangrene Severity Index were similar. Median length of stay (11 vs 12 days), 30-day readmission (30.6% vs 37.5%), in-hospital mortality (8.2% vs 9.4%), and 30-day mortality (12.7% vs 9.4%) did not differ significantly between sexes. Higher severity scores predicted death or prolonged hospitalization in both sexes.</p><p><strong>Conclusions: </strong>In this multi-hospital cohort, women with FG had disease severity and short-term outcomes broadly similar to those of men. These findings suggest that illness severity, rather than sex alone, is the more important driver of outcome and support maintaining the same diagnostic urgency and treatment intensity for all patients with suspected FG.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594592","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":"Carotid artery velocity-time integral as a surrogate for left ventricular outflow tract velocity-time integral during fluid resuscitation in the emergency department","authors":"Ümit Korkan,&nbsp;Murat Pekdemir,&nbsp;İbrahim Ulaş Özturan,&nbsp;Nurettin Özgür Doğan,&nbsp;Elif Yaka,&nbsp;Serkan Yılmaz","doi":"10.1016/j.ajem.2026.06.011","DOIUrl":"10.1016/j.ajem.2026.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Accurate stroke volume assessment is essential for guiding fluid resuscitation in critically ill patients. Although left ventricular outflow tract velocity-time integral (LVOT-VTI) is widely used, its acquisition is often challenging in the ED, whereas the easier-to-measure common carotid artery velocity-time integral (CCA-VTI) has limited supporting evidence in heterogeneous ED populations. This study aimed to evaluate the correlation and agreement between CCA-VTI and LVOT-VTI in critically ill ED patients undergoing fluid resuscitation.</div></div><div><h3>Methods</h3><div>This prospective cross-sectional study was conducted in a tertiary-care ED between May and September 2025. Adult patients with critical illness and indications for intravenous fluid resuscitation were enrolled. Bedside ultrasound measurements of LVOT-VTI and CCA-VTI were obtained before and after fluid administration. Correlation was assessed using Spearman's coefficient, and agreement was evaluated using Bland–Altman analysis.</div></div><div><h3>Results</h3><div>Fifty patients were included. LVOT-VTI and CCA-VTI showed strong correlation before fluid resuscitation (<em>r</em> = 0.88; <em>p</em> &lt; 0.001), which increased after resuscitation (<em>r</em> = 0.92; p &lt; 0.001). Among fluid responders (<em>n</em> = 24), correlation increased from <em>r</em> = 0.62 to <em>r</em> = 0.94. Percentage (Δ) changes in CCA-VTI were strongly correlated with LVOT-VTI (<em>r</em> = 0.74, p &lt; 0.001). Bland–Altman analysis demonstrated good agreement between CCA-VTI and LVOT-VTI, with a mean bias of 0.12 cm before resuscitation (95% limits of agreement [LoA], −2.07 to 2.32 cm) and 0.08 cm after resuscitation (95% LoA, −1.26 to 1.41 cm).</div></div><div><h3>Conclusion</h3><div>CCA-VTI demonstrated strong correlation and acceptable agreement with LVOT-VTI in critically ill ED patients and may serve as a practical bedside adjunct when LVOT imaging is challenging.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"108 ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220942","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":"Machine learning models to detect opioid misuse in emergency department patients at triage","authors":"Chirag Chhablani ,&nbsp;Usman Shahid ,&nbsp;Natalie Parde ,&nbsp;Sami Muslmani ,&nbsp;Huiyi Hu ,&nbsp;Dillon Thorpe ,&nbsp;Majid Afshar ,&nbsp;Niranjan Karnik ,&nbsp;Neeraj Chhabra","doi":"10.1016/j.ajem.2026.02.037","DOIUrl":"10.1016/j.ajem.2026.02.037","url":null,"abstract":"<div><h3>Objective</h3><div>Emergency department (ED) encounters represent valuable opportunities to initiate evidence-based treatments for patients with opioid misuse, but few receive such care. Universal manual screening has been proposed to improve patient identification but is uncommon due to its time and resource-intensive nature. We sought to determine the feasibility of identifying patients with opioid misuse at the time of ED triage using machine learning (ML).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 1123 ED encounters (September 2020 – March 2023) at a tertiary hospital. Encounters were enriched for opioid misuse, manually annotated, and chronologically split for training, validation, and testing. Candidate triage-time features included patient demographics, Emergency Severity Index, arrival time of day, chief complaint, comorbidities, and chronic medications. Model performance was evaluated using F1 score, area under the precision–recall curve (AUPRC), accuracy, recall, and AUROC. Post-hoc explainability analyses included SHapley Additive exPlanations (SHAP) and feature importance.</div></div><div><h3>Results</h3><div>All models performed comparably to opioid-related diagnosis codes placed at any time during the encounter. Random Forest (F1 = 0.75 [95%CI 0.70–0.83], AUPRC = 0.88 [0.81–0.93], accuracy = 0.79 [0.70–0.83]) and Gradient Boosting (F1 = 0.77 [0.71–0.82], AUPRC = 0.89 [0.85–0.93], accuracy = 0.81 [0.720.84]) had among the highest F1 score and AUPRC but confidence intervals overlapped with other methods. Explainability analyses highlighted prior drug-use diagnosis codes, triage acuity, and age as top predictors.</div></div><div><h3>Conclusion</h3><div>ML classifiers leveraging routinely collected triage data offer a feasible and scalable alternative to manual screening in flagging opioid misuse before physician evaluation, potentially enabling early harm-reduction interventions. Prospective multi-site validation, calibration, and bias assessments are warranted.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"104 ","pages":"Pages 17-23"},"PeriodicalIF":2.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367374","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":"Temperature at admission and mortality in older adults with infection: Limited prognostic value in non-sepsis cases","authors":"Finn Erland Nielsen ,&nbsp;Osama Bin Abdullah ,&nbsp;Lana Chafranska ,&nbsp;Thomas Andersen Schmidt ,&nbsp;Rune Husås Sørensen","doi":"10.1016/j.ajem.2026.01.045","DOIUrl":"10.1016/j.ajem.2026.01.045","url":null,"abstract":"<div><h3>Background</h3><div>Temperature abnormalities are established prognostic markers in sepsis, but their predictive value in older adults with infection without sepsis remains unclear.</div></div><div><h3>Objective</h3><div>To examine the association between arrival temperature and 28-day all-cause mortality among emergency department patients aged ≥65 years with infection, stratified by sepsis status.</div></div><div><h3>Methods</h3><div>We performed a post-hoc analysis of a prospective cohort from a Danish emergency department. Sepsis was defined as infection plus an acute ≥2 point increase in the Sequential Organ Failure Assessment (SOFA) score. Propensity score matching balanced covariates between groups. The restricted cubic spline regression modelled non-linear temperature-mortality associations. Sensitivity analyses excluded patients with comorbidities that affected baseline SOFA and used the National Early Warning Score (NEWS2) to classify <em>likely sepsis</em>.</div></div><div><h3>Results</h3><div>Among 1431 patients (median age 78.9 years; 49.3% male), 545 (38.1%) met sepsis criteria. In non-sepsis patients, mortality was stable across 36–41 °C with no statistically significant association (global spline <em>p</em> = 0.320), although a modest increase was observed below 36 °C. In sepsis, hypothermia (&lt;36 °C) was associated with higher mortality, whereas fever (&gt;38 °C) was protective. At temperature extremes (&lt;36 °C and &gt; 39 °C), confidence intervals widened substantially due to sparse data. Findings were consistent across sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>In older adults with infection but without sepsis, arrival temperature did not predict 28-day mortality. In sepsis, hypothermia was associated with higher mortality, and fever with lower mortality. The prognostic interpretation of very low or very high temperatures remains uncertain, suggesting clinical caution in these temperature ranges.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"103 ","pages":"Pages 1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081747","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 differences between metformin-associated lactic acidosis and metformin-unrelated lactic acidosis: A descriptive study","authors":"Yuji Okazaki MD ,&nbsp;Fumiya Inoue MD ,&nbsp;Toshihisa Ichiba MD ,&nbsp;Akira Namera PhD","doi":"10.1016/j.ajem.2026.01.027","DOIUrl":"10.1016/j.ajem.2026.01.027","url":null,"abstract":"<div><h3>Background</h3><div>The extent to which metformin contributes to lactic acidosis in metformin-treated patients presenting to the emergency department (ED) remains unclear, particularly when blood metformin concentrations are unavailable. This study aimed to clarify the clinical differences between metformin-associated lactic acidosis (MALA) and metformin-unrelated lactic acidosis (MULA) on ED admission.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study at a tertiary care hospital from January 1, 2023 to July 31, 2025. We included adult patients receiving metformin who presented to the ED with lactic acidosis, defined as pH &lt; 7.35 and lactate ≥5 mmol/L. Patients were classified as having MALA if their serum metformin concentration at ED admission was ≥5 mg/L; others were categorized as MULA.</div></div><div><h3>Results</h3><div>Among 14 patients with available serum metformin concentrations, 3 were classified as MALA and 11 as MULA. MALA patients presented with lower blood pressure at ED admission (median 65/36 versus 130/74 mmHg), more profound acidemia (median pH 7.03 [IQR 6.89–7.06] versus 7.22 [IQR 7.20–7.32]), and higher lactate levels (median 14.8 mmol/L [IQR 14.3–19.0] versus 7.3 mmol/L [IQR 5.7–12.5]). Serum creatinine was also higher in the MALA group (median 2.65 mg/dL [IQR 2.26–6.35]) than in the MULA group (median 1.16 mg/dL [IQR 0.97–1.39]).</div></div><div><h3>Conclusions</h3><div>Although the sample size was small, three clinical clues for identifying MALA may include severe acidemia with hyperlactatemia, kidney impairment, and hypotension. Clinicians may consider MALA when these findings coexist in the absence of measured blood metformin concentrations. Further large-scale studies are warranted to confirm our findings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"103 ","pages":"Pages 9-13"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081746","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":"Pulmonary hypertension in cardiac tamponade: An observational cohort study of in-hospital mortality and echocardiographic findings","authors":"Robert James Adrian MD ,&nbsp;Onyinyechi F. Eke MD, MPH ,&nbsp;Nour Al Jalbout MD ,&nbsp;Moustafa Al Hariri PhD ,&nbsp;Kristofer Montoya MD ,&nbsp;Patricia Hernandez MD ,&nbsp;Hamid Shokoohi MD, MPH","doi":"10.1016/j.ajem.2026.01.013","DOIUrl":"10.1016/j.ajem.2026.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Patients with pulmonary hypertension (PHTN) (i.e., chronic PHTN) have right ventricular hypertrophy, elevated right-sided heart pressures, and frequently have pericardial effusions. When evaluating these patients for cardiac tamponade, the hypertrophy and elevated pressure in right heart may be protective from tamponade by counteracting the pressure from the pericardial effusion. However, these patients may be harmed if echocardiographic signs of tamponade (e.g., right ventricular diastolic collapse) are obscured.</div></div><div><h3>Study objective</h3><div>The effect of PHTN on patients with cardiac tamponade remains unclear. We aimed (1) to evaluate whether PHTN influences the echocardiographic findings of tamponade, and (2) to examine whether PHTN is associated with in-hospital mortality among patients undergoing pericardial drainage primarily for cardiac tamponade.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of adult patients who underwent pericardial drainage within 48 h of emergency department presentation at two academic centers. PHTN probability was classified using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We classified patients in four categories: no PHTN, low probability, intermediate probability, and high probability of PHTN. PHTN parameters were manually extracted from cardiologist-interpreted echocardiography reports. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of echocardiographic findings of cardiac tamponade and their associations with mortality.</div></div><div><h3>Results</h3><div>A total of 249 patients met the inclusion criteria. In-hospital mortality did not significantly differ across PHTN probability categories: no PHTN (63.8%), low probability (9.3%), intermediate probability (20.9%), and high probability (5.3%) (<em>p</em>-values all &gt;0.2). Among patients who died, 50.0% were in the no PHTN group compared to 7.1% in the high probability group (<em>p</em> = 0.222). The echocardiographic impression of cardiac tamponade was significantly lower among patients with high PHTN probability compared to those with no PHTN (64.3% vs. 85.4%, <em>p</em> = 0.041), with a weak negative correlation (<em>r</em> = −0.493) between increasing PHTN probability and tamponade impression.</div></div><div><h3>Conclusions</h3><div>In this cohort of patients undergoing pericardial drainage primarily for cardiac tamponade, PHTN was not significantly associated with in-hospital mortality. However, patients with a high probability of PHTN showed fewer echocardiographic signs of tamponade, suggesting that PHTN may obscure typical sonographic findings of tamponade.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 55-61"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031711","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":"An unintended path: Foley catheter-induced biliary obstruction following gastrostomy tube replacement - A case report","authors":"Wed H. Jadallah,&nbsp;Osama Muhtaseb,&nbsp;Daniel D. Gold","doi":"10.1016/j.ajem.2026.01.041","DOIUrl":"10.1016/j.ajem.2026.01.041","url":null,"abstract":"<div><div>Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for long-term enteral access. Accidental dislodgement is a relatively common occurrence, and in many settings a Foley catheter is inserted as a temporary measure to preserve tract patency until definitive replacement can be performed. Although this practice is routinely employed, Foley catheters lack an external flange and are therefore susceptible to distal migration and associated complications. We describe a case of a 97-year-old woman with advanced dementia who presented to the emergency department with recurrent vomiting and coffee-ground material in her gastrostomy drainage bag after her PEG tube had been replaced with a Foley catheter at a nursing facility. Laboratory evaluation revealed cholestatic liver enzyme elevation, and imaging demonstrated distal migration of the catheter with balloon compression of the distal common bile duct, resulting in obstructive biliary pathology. Repositioning of the Foley catheter and delayed reinsertion of a dedicated PEG tube led to prompt clinical improvement. This case illustrates an underrecognized complication of temporary gastrostomy substitutes and emphasizes the importance of considering catheter migration in patients presenting with unexplained gastrointestinal or biliary symptoms after recent tube replacement. Preventive strategies including external marking, temporary securement measures, and routine radiologic confirmation of tube position may reduce morbidity and avoid unnecessary diagnostic evaluations.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 173-175"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079847","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":"Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis","authors":"Shun Liao ,&nbsp;Yan Li ,&nbsp;Haoran Tang ,&nbsp;Zixiong Li ,&nbsp;Tianqi Xu ,&nbsp;Zongfang Ren","doi":"10.1016/j.ajem.2026.01.006","DOIUrl":"10.1016/j.ajem.2026.01.006","url":null,"abstract":"<div><div>Background: Acute appendicitis poses diagnostic challenges due to symptom overlap with other abdominal conditions, often leading to misdiagnosis or missed diagnosis. This study aimed to develop and validate an interpretable machine learning model based on routine hematological indicators to facilitate rapid diagnosis. Methods: A retrospective analysis was conducted on 408 patients with acute abdominal pain, including both adult and pediatric patients. The median age of patients in the appendicitis group was 37.5 years (IQR: 26.5 years). Univariate logistic regression revealed significant group differences in hematological indicators (all <em>P</em> &lt; 0.001). Three feature selection methods—LASSO, ElasticNet, and Random Forest—were applied, with neutrophil percentage (NE%) and eosinophil percentage (EO%) consistently identified across all methods, and red blood cell (RBC) and white blood cell (WBC) repeatedly selected by at least two methods. Eleven commonly used machine learning classifiers were developed and evaluated on an independent test set. Results: The support vector machine with a radial basis function kernel (SVM-RBF) using LASSO-selected features achieved the best performance, with an AUC (area under the curve) of 0.903 (95% CI: 0.84–0.96), accuracy of 90.2%, sensitivity of 80.3%, and specificity of 100%. The average precision exceeded 0.92, and the calibration curve demonstrated good agreement (Brier score: 0.092). Interpretability analyses with SHAP (Shapley additive explanations) and LIME (local interpretable model-agnostic explanations) applied to the LightGBM (Light Gradient Boosting Machine) model confirmed EO%, RBC, and WBC as the most influential predictors. Conclusion:This parsimonious and interpretable model, relying solely on routine blood indicators, may enable timely and accurate diagnosis of acute appendicitis while providing additional insights, particularly in resource-limited settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 39-48"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031718","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":"Design and development of a Bayesian risk assessment model for bacterial infection (BRAIN) in patients admitted to hospital from ED","authors":"Sandeep Tripathi MD, MS ,&nbsp;Collins Odhiambo PhD ,&nbsp;Jessica Haas MS2","doi":"10.1016/j.ajem.2026.01.001","DOIUrl":"10.1016/j.ajem.2026.01.001","url":null,"abstract":"<div><h3>Background</h3><div>C-reactive Protein (CRP) and Procalcitonin (PCT) are commonly used in conjunction with clinical judgment to assess the risk of bacterial infection. Traditional frequentist methods do not allow the incorporation of clinical suspicion into risk estimation. This study aimed to describe clinical phenotypes based on CRP and PCT levels and develop a Bayesian model to estimate the posterior probability of bacterial infection in emergency department (ED) patients.</div></div><div><h3>Methods</h3><div>Retrospective study across 15 hospitals (2019–2023), including patients admitted from the ED with CRP, PCT, and bacterial cultures obtained within 24 h. Patients categorized into four groups: both markers normal (A), both abnormal (B), only PCT abnormal (C), and only CRP abnormal (D). Bayesian logistic regression models developed using priors of 0.3, 0.5, and 0.7 to reflect varying levels of clinical suspicion. Predictors included age, CRP, PCT, fever, white blood cell count, ESR, ferritin, and viral positivity.</div></div><div><h3>Results</h3><div>Among 10,397 patients (median age, 65; 909 &lt; 18 years), 27.5% had positive cultures, with an 11.2% mortality rate. Culture positivity and mortality were highest in group B (35%), followed by D (24%). Posterior probabilities of infection under high, moderate, and low suspicion priors were 25%, 17.5%, and 10.6%, respectively. PCT was the strongest predictor, with a one log-unit increase associated with a 45% rise in infection probability. AUROC was 0.64; AUPRC 0.43. A R Shiny calculator (BRAIN) was created for bedside application.</div></div><div><h3>Conclusion</h3><div>A Bayesian model incorporating inflammatory markers and clinical judgment provides individualized estimates of bacterial infection risk at the bedside.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 34-38"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031743","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}