American Journal of Emergency Medicine最新文献

{"title":"Evaluation of the prehospital characteristics of traumatic amputation cases: A retrospective observational study","authors":"Mehmet Yılmaz MD ,&nbsp;Burak Bekgöz MD ,&nbsp;İshak Şan MD","doi":"10.1016/j.ajem.2026.01.003","DOIUrl":"10.1016/j.ajem.2026.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to comprehensively assess the epidemiological, etiological, and operational characteristics of prehospital traumatic amputations with a specific focus on demographic patterns, injury mechanisms, anatomical distribution, and emergency medical services (EMS) response intervals and distances.</div></div><div><h3>Methods</h3><div>This retrospective observational study initially assessed 1704 suspected traumatic amputation cases recorded in the Ankara Ambulance Service Operations System between January 2018 and December 2023. After applying the exclusion criteria of on-scene death (<em>n</em> = 60), interfacility transfer (<em>n</em> = 556), and non-amputation trauma (<em>n</em> = 72), a total of 1016 eligible cases were included in the final analysis. Extracted variables included patient demographics, injury etiology, extremity involvement (upper vs. lower), urban vs. rural location, prehospital vital signs, and operational metrics (dispatch-to-arrival, on-scene, and scene-to-hospital times and corresponding distances). Statistical analyses entailed chi-square or Fisher exact tests for categorical variables, <em>t</em>-tests or Mann–Whitney <em>U</em> tests for continuous variables, and Bonferroni corrections for multiple comparisons.</div></div><div><h3>Results</h3><div>The median age of the patients was 32 years (IQR: 21–47) and 75.8% were male. Upper extremity amputations predominated (79.5%), particularly in cases of occupational (86.5%) and domestic (86.1%) injuries, while lower extremity amputations were more frequent in traffic accidents (34.9%). Occupational accidents were significantly more common among men and domestic accidents among women (<em>p</em> &lt; 0.001, Bonferroni-adjusted). Rural patients had significantly longer call-to-arrival times (median: 15.0 vs. 8.0 min), scene-to-hospital times (21.0 vs. 13.0 min), and total distances (median 45.0 vs. 17.0 km) than urban patients (all <em>p</em> &lt; 0.001). Traffic accidents had the longest on-scene times (median: 10.8 min) compared to occupational (9.0 min) and domestic (8.8 min) injuries (p &lt; 0.001). Vital signs showed no significant differences between upper and lower extremity cases.</div></div><div><h3>Conclusion</h3><div>Prehospital traumatic amputations in this large cohort displayed clear demographic and etiological trends, with upper extremity injuries predominating and distinct sex- and mechanism-specific patterns. Rural–urban disparities in prehospital times and distances were pronounced and traffic-related amputations required longer on-scene management. These findings highlight the need for targeted prevention strategies, EMS workflow optimization, and the strengthening of rural trauma systems to improve survival and limb salvage outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 126-130"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068798","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":"Performance of the ESC 0/1 h hs-cTnI algorithm in suspected NSTEMI patients with normal versus abnormal electrocardiograms","authors":"Zi-qiu Feng ,&nbsp;Fen Xu ,&nbsp;Ye-nan Fu ,&nbsp;Fang-fang Yang ,&nbsp;Yang Li ,&nbsp;Bing-hua Yang ,&nbsp;Yan Liang ,&nbsp;Zhou Zhou ,&nbsp;Ya-hui Lin","doi":"10.1016/j.ajem.2026.01.026","DOIUrl":"10.1016/j.ajem.2026.01.026","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic and prognostic performance of the ESC 0/1-h high-sensitivity cardiac troponin I(hs-cTnI) algorithm in emergency department patients with suspected non-ST-segment elevation myocardial infarction(NSTEMI), stratified by by initial electrocardiogram (ECG) findings.</div></div><div><h3>Methods</h3><div>This retrospective analysis included 1535 patients with suspected ACS. Based on initial ECG, patients were categorized into normal (<em>n</em> = 888) or abnormal (<em>n</em> = 647) groups,with the abnormal group further stratified into ischemic (<em>n</em> = 464) and non-ischemic (<em>n</em> = 183).The ESC 0/1 h hs-cTnI algorithm was applied for risk stratification. Diagnostic performance (sensitivity, specificity, NPV, PPV) was evaluated against clinical diagnosis. Prognostic value for 30-day and 180-day all-cause mortality and major adverse cardiovascular events (MACE) was assessed.</div></div><div><h3>Results</h3><div>Sensitivity and NPV in the abnormal ECG group were both 100%, compared to 98.8% and 99.5% in the normal ECG group. Specificity was significantly lower in patients with ischemic ECG changes (81.2%) than in the normal ECG group (91.6%, <em>P</em> &lt; 0.001). Subgroup analysis showed slightly lower sensitivity in women (95.5%), patients with pain onset ≤3 h (97.9%), and those aged ≤65 years (98.1%) within the normal ECG group. The algorithm effectively stratified mortality risk in both groups but showed limited discrimination for MACE in the abnormal ECG group.</div></div><div><h3>Conclusion</h3><div>The ESC 0/1-h hs-cTnI algorithm provides excellent rule-out safety across all ECG presentations. Crucially, a lower specificity—driven primarily by the ischemic ECG phenotype—suggests a higher risk of false-positive rule-in in this subgroup. Clinicians should integrate ischemic ECG patterns with clinical history to interpret algorithm results. Additionally, vigilance for potential under-detection in specific normal-ECG subgroups (women, younger patients, early presenters) remains warranted.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 114-122"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068932","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":"Derivation and validation of a clinical prediction score for ICU utilization at trauma intake","authors":"Michael Makutonin ,&nbsp;Atharva V. Sapre ,&nbsp;Thomas R. Hartka ,&nbsp;Bruce M. Lo ,&nbsp;Michael Lozano Jr. ,&nbsp;Moira Smith ,&nbsp;Andrew C. Meltzer ,&nbsp;R. Andrew Taylor","doi":"10.1016/j.ajem.2026.01.047","DOIUrl":"10.1016/j.ajem.2026.01.047","url":null,"abstract":"<div><h3>Background</h3><div>Delayed admission to the intensive care unit (ICU) after trauma can lead to tripling of in-hospital mortality. Accurate ICU resource prediction at initial trauma assessment can help appropriately target resources and transfers for these patients and improve timeliness of ICU care delivery. Existing models for predicting ICU need in trauma, often have low generalizability or accuracy. This study aims to bridge this gap by deriving and externally validating a sensitive, temporally stable, registry-based prediction model for identifying trauma patients requiring ICU care during emergency department (ED) stabilization.</div></div><div><h3>Methods</h3><div>Trauma encounters from the U.S. National Trauma Data Bank (NTDB) between 2015 and 2021 were used to predict ICU care at index hospitalization. Predictor variables were derived from clinical, demographic, procedural, and diagnostic data. Exclusion criteria included patients under 17, encounters with missing ED lengths of stay, encounters from non-ACS Level 1 or 2 centers, and transfers with incomplete initial stabilization data. A logistic regression (LR) model was trained on data from 2015 to 2020 with five-fold cross-validation and calibrated for a 99% sensitivity threshold. The model was subsequently tested on 2021 data withheld from initial training and validation. Fairness analysis was conducted to measure model performance across race, sex, and insurance status.</div></div><div><h3>Results</h3><div>Of 16,877,474 trauma encounters in the NTDB, 14.3% met inclusion criteria. The logistic regression model achieved an AUC of 0.855 and PR-AUC of 0.705 during internal validation, translating to 99.2% sensitivity and 8.6% specificity. When applied to the 2021 test set, the model maintained 99.0% sensitivity and 9.9% specificity. Model discrimination was slightly higher for Medicare patients, White patients, and male patients. However, the model's sensitivity declined to 73% in non-ACS-verified Level I/II centers.</div></div><div><h3>Significance</h3><div>This study demonstrates that for trauma patients presenting to ACS-verified Level I or II centers, the need for intensive care can be predicted with very high sensitivity using routinely available clinical variables. The model provided a generalizable framework for early ICU triage, reducing unnecessary activations while ensuring an extremely low rate of under-triage. Prospective integration of this model into trauma workflows could significantly improve ICU resource mobilization without compromising patient safety.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 166-169"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079849","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":"Exertional and classic heat stroke: A narrative review","authors":"Rosie I. Perez ,&nbsp;Maria J. Londono ,&nbsp;Bryan Everitt ,&nbsp;Douglas Young ,&nbsp;R. Lyle Hood ,&nbsp;Robert A. De Lorenzo ,&nbsp;Brendon P. McDermott","doi":"10.1016/j.ajem.2026.01.008","DOIUrl":"10.1016/j.ajem.2026.01.008","url":null,"abstract":"<div><div>Exertional (EHS) and classic heat stroke (CHS) share similarities in pathophysiology, progression, and potential sequelae. Further, quick recognition and management demonstrate favorable outcomes. Limited publications have examined parallels between types of heat stroke. Therefore, the purpose of this review was to search available literature and critically outline current evidence-informed clinical management of heat stroke. Our result was a thorough search and analysis of related literature that answers questions related to heat stroke. The pathophysiology of heat stroke is similar between EHS and CHS, with the only difference being onset predisposition and typical affected population. The main driver toward EHS includes exercise intensity inconsistent with environmental demands. CHS often presents in geriatric or pediatric populations and in patients with predisposing thermoregulatory limitations. Although debate continues in diagnostic criteria, both EHS and CHS are diagnosed with concomitant hyperpyrexia and central nervous system dysfunction. Following initial onset, the progression of cell death, tissue and organ failure, and potentially fatal outcome remains consistent between EHS and CHS. Emergency management of EHS has resulted in 100% survival when prompt diagnosis and effective treatment are administered. Results are not as favorable with CHS, albeit with a lack of robust data. The available evidence suggests similar management protocols would potentially improve outcomes with CHS. A potential addition to successful cooling may include hemodynamic support. Lastly, recommendations for enhanced data and documentation for heat stroke in emergency management could help foster consistent, updated clinical guidelines.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 49-54"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031731","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":"Radiopaque pediatric oxygen absorber ingestion and the hidden risks of active packaging","authors":"Mehmet Yorgun ,&nbsp;Ruhi Cüre","doi":"10.1016/j.ajem.2026.01.004","DOIUrl":"10.1016/j.ajem.2026.01.004","url":null,"abstract":"<div><div>We report the case of a 5-year-old girl who presented to the emergency department after accidental ingestion of the contents of an oxygen absorber sachet found in packaged food. Abdominal radiography demonstrated multiple fine, diffusely distributed radiopaque granules throughout the stomach and small bowel, producing a distinctive sandstorm-like appearance. The ingested material was confirmed to be iron powder mixed with sodium chloride, a compound commonly used in active food packaging with low gastrointestinal bioavailability. The patient exhibited no symptoms during the observation period and no specific intervention was required. This case demonstrates an unusual but recognisable radiographic pattern associated with oxygen absorber ingestion. It also emphasises the importance of differentiating this condition from other radiopaque foreign bodies to support appropriate clinical management.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 62-64"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039442","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":"Association of pre-intubation bag-valve-mask ventilation with hypoxemia and regurgitation in the ED: A multicenter cohort study","authors":"Jin Takahashi ,&nbsp;Haruka Tsuji ,&nbsp;Hiraku Funakoshi ,&nbsp;Hiroshi Okamoto ,&nbsp;Yusuke Hagiwara ,&nbsp;Hiroko Watase ,&nbsp;Takao Ono ,&nbsp;Sakina Kadomatsu ,&nbsp;Tatsuhiko Hata ,&nbsp;Kohei Hasegawa ,&nbsp;Takashi Shiga ,&nbsp;Tadahiro Goto ,&nbsp;Japanese Emergency Medicine Network Investigators","doi":"10.1016/j.ajem.2026.01.012","DOIUrl":"10.1016/j.ajem.2026.01.012","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness of pre-intubation bag-valve-mask (BVM) ventilation for rapid sequence intubation (RSI) in the emergency department (ED) remains uncertain. In this study, we investigated whether pre-intubation BVM ventilation was associated with a lower risk of peri-intubation hypoxemia.</div></div><div><h3>Methods</h3><div>We analyzed data from a multicenter prospective observational study conducted in 14 EDs across Japan. Adult (≥18 years) patients who underwent RSI between 2020 and 2023 were included. The primary outcome was peri-intubation hypoxemia (SpO₂ &lt;90%), and the secondary outcome was regurgitation. Missing data were imputed using multiple imputations. Propensity scores were estimated using predefined covariates (age, sex, body mass index, COVID-19, modified LEMON score, intubation indication, device, intubator's specialty, preoxygenation method, pre-intubation SpO₂, and participating institutions). Treatment effects were evaluated using stabilized inverse probability of treatment weighting (IPTW) and sensitivity analysis with 1:1 matching.</div></div><div><h3>Results</h3><div>Among the 1481 patients, 589 (40%) received pre-intubation BVM. Overall, 204 patients (14%) experienced peri-intubation hypoxemia. The BVM group had a lower unadjusted risk of hypoxemia than the non-BVM group (10% vs. 16%; <em>p</em> &lt; 0.001). However, after stabilized IPTW, BVM ventilation was not significantly associated with hypoxemia (adjusted risk difference −3.2%; 95% CI, −7.8% to 1.5%). Sensitivity analysis using 1:1 matching yielded consistent results (risk difference 0.9%; 95% CI, −3.8% to 5.6%). There was no significant difference in the incidence of regurgitation between the BVM and non-BVM groups (1% vs. 1%; <em>p</em> = 0.24).</div></div><div><h3>Conclusion</h3><div>In this multicenter study, pre-intubation BVM ventilation during RSI in the ED was not associated with a reduced risk of peri-intubation hypoxemia.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 108-113"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038939","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":"Remote real-time ambulatory ECG monitoring of the longest RR interval and corresponding arrhythmias during altitude ascent","authors":"Li-Hong Zheng,&nbsp;Yan Wang,&nbsp;Xue-Wen Huang,&nbsp;Miao Li,&nbsp;Hai-Ying Xian,&nbsp;Chun-Xia Guo,&nbsp;Zi-Yang He,&nbsp;Lin Ma","doi":"10.1016/j.ajem.2026.01.020","DOIUrl":"10.1016/j.ajem.2026.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to characterize the longest RR intervals and associated arrhythmias during the early phase of rapid ascent to high altitude environments using ambulatory electrocardiography (AECG), with the aim of informing strategies to prevent acute high-altitude illness and cardiovascular adverse events.</div></div><div><h3>Methods</h3><div>Participants residing at low altitude underwent rapid ascent to high-altitude locations at 3060 m, 3460 m, and 4014 m. Beginning on the first day at altitude, AECG monitoring was conducted for more than 24 h using a Model 401 wearable ECG monitor, enabling remote, real-time data transmission via a 4G network and immediate clinical response to high-risk arrhythmias. Cloud-based storage and analytic platforms facilitated statistical evaluation of the longest RR intervals and corresponding rhythm types.</div></div><div><h3>Results</h3><div>(1) The longest RR intervals and associated arrhythmias were primarily observed during nighttime sleep. (2) Statistically significant differences (<em>p</em> &lt; 0.05) were found among the three altitude groups in the incidence of the longest RR intervals &lt;1.00 s, abnormal rhythms associated with the longest RR intervals, premature beats corresponding to the longest RR intervals, and sinus pause episodes. (3) The primary arrhythmias associated with the longest RR intervals included ventricular premature beats, second-degree type II atrioventricular block, high-degree atrioventricular block, sinus pause, and atrial fibrillation.</div></div><div><h3>Conclusion</h3><div>Clinically significant bradyarrhythmia may occur during rapid ascent to altitudes between 3060 m and 4014 m, particularly during nocturnal hours. These findings highlight the need to consider targeted preventive attention during nighttime exposure, given the high prevalence of nocturnal bradyarrhythmias. Remote real-time AECG monitoring may serve as a useful tool for early detection and intervention in populations at risk of altitude-related cardiac rhythm disturbances.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 98-103"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039487","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":"Are antibiotics an effective initial treatment for acute appendicitis compared to appendectomy?","authors":"Peter Victoria,&nbsp;Joshua Easter,&nbsp;Brit Long","doi":"10.1016/j.ajem.2026.01.018","DOIUrl":"10.1016/j.ajem.2026.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Acute appendicitis is among the most common emergency presentations and has traditionally been treated with appendectomy. However, recent randomized controlled trials suggest that antibiotic therapy is a reasonable, non-operative alternative for appropriately selected patients who understand the risks. The purpose of this review article was to summarize findings from a recent individual patient data meta-analysis comparing antibiotic therapy versus appendectomy in adults with imaging-confirmed acute appendicitis.</div></div><div><h3>Methods</h3><div>The reviewed meta-analysis included six randomized controlled trials encompassing 2101 adult patients. A one-stage analysis was performed applying an intention-to-treat analysis. A mixed-effects model accounted for study-level clustering. Complications were standardized using the Clavien-Dindo classification, a widely used tool for classification of surgical complications. The primary endpoint was the overall complication rate at one year, and secondary outcomes included rate of step-up appendectomy, hospital length of stay, and time away from work.</div></div><div><h3>Results</h3><div>No significant difference in overall, major, or minor complication rates was found at one year between patients receiving initial antibiotic therapy and those undergoing appendectomy. 34% of patients treated with antibiotics required delayed appendectomy within one year and 25% of those patients were found to have complicated appendicitis. In contrast, patients with an appendicolith demonstrated significantly higher complication rates, and 49% required subsequent appendectomy.</div></div><div><h3>Conclusions</h3><div>Antibiotic therapy is a reasonable initial management strategy for adults with uncomplicated, imaging-confirmed acute appendicitis as long as patients understand the risks. However, caution is warranted in those with an appendicolith due to increased risk of complications and treatment failure with antibiotic therapy.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 104-107"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038937","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":"Rapid feedback on my emergency department hemorrhagic stroke care? It improves telestroke and in-person treatment times","authors":"Nick M. Murray MD ,&nbsp;Paul D. Johnson MD ,&nbsp;Gabriel V. Fontaine PharmD, MBA ,&nbsp;Trina Johnson RN ,&nbsp;Jami Hassler RN ,&nbsp;Heidi Hafen RN, NP ,&nbsp;Michelle Aucoin RN ,&nbsp;Lesley Miller RN ,&nbsp;Anne M. Anderson RN ,&nbsp;Chamonix Johnston RN, MPH ,&nbsp;Marilyn McKasson MD ,&nbsp;Kyle Hobbs MD ,&nbsp;H. Adrian Püttgen MD","doi":"10.1016/j.ajem.2026.01.023","DOIUrl":"10.1016/j.ajem.2026.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Rapid time to treatment of intracerebral hemorrhage (ICH) is important but not consistently achieved in emergency departments (EDs). The concept of CODE-ICH is now well-described, yet mechanisms to improve ED provider and system operation to reduce treatment times are lacking.</div></div><div><h3>Objective</h3><div>We aim to evaluate ICH treatment time metrics before and after a standardized ICH provider feedback intervention, individualized for each patient with an acute spontaneous ICH in the ED.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort of consecutive patients ≥18 years old with an acute ICH were identified from March 1, 2022 to January 1, 2025 within a network of an integrated healthcare system in the U.S. A rapid feedback intervention for all providers involved in the patient case was developed to contain specific treatment times compared to goals, which, when not met, prompted a root cause analysis. Patients were grouped into pre- and post-intervention cohorts. The primary endpoints were CT scout time to antihypertensive and/or anticoagulation reversal agent administration and ICH orderset utilization. Secondary outcomes were effect of in-person daytime versus telehealth nighttime coverage, length of stay, and discharge disposition.</div></div><div><h3>Results</h3><div>A total of 226 patients met inclusion criteria, 108 pre- and 118 post-intervention, with similar age (median: 68 vs. 69 years) and 54% were female. Pre- to post-intervention median NIHSS was the same (10; <em>p</em> = 0.25), as were median ICH scores (pre: 2.0, interquartile range, IQR, 0–3 vs. post: 1.0, IQR 1–3; <em>p</em> = 0.90). Median post-intervention CT to antihypertensive treatment was 7 min faster (pre: 21 min, IQR 23–52 vs. post: 14 min, IQR 7–26; <em>p</em> = 0.0012), and median CT to anticoagulation reversal agent administration was 11 min faster (pre: 40 min, IQR 30–64 vs. post: 29 min, IQR 18–40; <em>p</em> = 0.03). The intervention was associated with increased orderset usage (54% pre- to 96% post-intervention; <em>p</em> = 0.0001).</div></div><div><h3>Conclusions</h3><div>A rapid, root-cause focused ICH feedback intervention improved standardized orderset usage and resultant faster treatment times for blood pressure and anticoagulation reversal in the ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 65-70"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038936","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":"Info for authors","authors":"","doi":"10.1016/S0735-6757(26)00017-3","DOIUrl":"10.1016/S0735-6757(26)00017-3","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Page A6"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396913","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}