Academic Emergency Medicine最新文献

{"title":"Discharge Destination Is Not Disability: Why Baseline Function Matters in Geriatric Trauma.","authors":"Daniel Robson","doi":"10.1111/acem.70399","DOIUrl":"https://doi.org/10.1111/acem.70399","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70399"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102543","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":"Conservative Versus Higher Oxygen Targets Post-Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.","authors":"Muhammad Mustafa Khan, Abdul Saboor, Mansoor Aqil, Rayaan Jan, Rudaina Hanif, Abdul Muiz, Abdul Haseeb, Muhammad Hamad Khan, Tuba Gul, Abdullah Abdullah, Sandara Bashir, Hassan Khalil, Musaddiq Shah, Abid Ali","doi":"10.1111/acem.70422","DOIUrl":"10.1111/acem.70422","url":null,"abstract":"<p><strong>Background: </strong>Optimal oxygenation following return of spontaneous circulation (ROSC) remains uncertain, as both hypoxemia and hyperoxemia risk secondary injury. We conducted an updated systematic review and meta-analysis comparing the efficacy of restrictive versus higher oxygenation targets.</p><p><strong>Methods: </strong>A systematic review and meta-analysis following the PRISMA 2020 protocol was carried out from database inception through June 2026. Only RCTs examining the impact of restrictive oxygenation versus higher oxygenation for adult CA patients undergoing invasive mechanical ventilation were included. Risks of bias and the quality of the evidence were evaluated using RoB 2 and GRADE tools. A random-effects model was used for data synthesis and presented the results in RR/MD.</p><p><strong>Results: </strong>Eleven RCTs (12 reports) involving 4136 participants were included. Restrictive oxygenation showed no significant difference in all-cause mortality (RR 0.96, 95% CI 0.88-1.06) or unfavorable neurological outcomes (RR 0.96, 95% CI 0.88-1.04). Most subgroup analyses were non-significant, except for reduced mortality in the strict hypothermia subgroup (33°C-34°C), although TSA showed unstable evidence. No significant differences were observed in secondary outcomes. Restrictive oxygenation increased hypoxemia risk (RR 1.65) but improved ventilator-free days (MD 2.14).</p><p><strong>Conclusion: </strong>There is no significant improvement in overall mortality, neurological outcome, or any other major clinical endpoint in adult CA patients with restrictive oxygen compared to higher oxygen therapy. Under current normothermia (36°C-37.5°C) protocols, the accumulated evidence trends toward futility for a restrictive approach, though the definitive information size has not yet been entirely accrued. Although restrictive levels could lead to an increased number of ventilator-free days, there will be an increased risk of hypoxemia.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70422"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178702","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":"Frailty and Hospitalization After Emergency Department Evaluation Within Triage Categories in Older Patients: A Retrospective Cohort Study.","authors":"Natsumi Hata, Masaaki Nagae, Hiroyuki Umegaki","doi":"10.1111/acem.70419","DOIUrl":"https://doi.org/10.1111/acem.70419","url":null,"abstract":"<p><strong>Objectives: </strong>Triage reflects acute urgency, whereas frailty may also influence disposition in older emergency department (ED) patients. This study aimed to estimate the association between Clinical Frailty Scale (CFS)-defined frailty and hospitalization after ED evaluation within Japan Triage and Acuity Scale (JTAS) categories and assess whether the strength varied across triage categories.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study in an urban tertiary hospital in Japan. We identified consecutive triaged ED visits by patients aged ≥ 65 years from November 2025 to March 2026. Visits with CFS scores and covariates constituted the complete-case cohort. CFS ≥ 5 was defined as frailty. The primary outcome was admission to the study hospital or acute-care interhospital transfer. We used a mixed-effects logistic regression model with a CFS-by-JTAS interaction term, adjusting for age, sex, mode of arrival, injury- or poisoning-related visit, living arrangement, and long-term care needs certification, with patient-level random intercept. The global interaction was assessed using a likelihood-ratio test.</p><p><strong>Results: </strong>Among 3127 ED visits, 1526 resulted in hospitalization. In JTAS 1, the adjusted odds ratio (OR) for CFS ≥ 5 was not estimated because of quasi-complete separation. In the model excluding JTAS 1, the adjusted OR was 1.00 (95% confidence interval [CI], 0.65-1.55) in JTAS 2, 1.54 (95% CI: 1.19-1.99) in JTAS 3, and 2.01 (95% CI: 1.13-3.58) in JTAS 4/5. The global CFS-by-JTAS interaction was not statistically significant (P for interaction = 0.091).</p><p><strong>Conclusions: </strong>Category-specific estimates suggested little association in JTAS 2 but were numerically larger in JTAS 3 and JTAS 4/5. However, the global interaction was nonsignificant, providing insufficient evidence that the association differed across categories. Prospective studies should examine the clinical, geriatric, social, decision-related, and healthcare-system factors that may underlie this association among older patients with comparable triage-assessed urgency.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70419"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079424","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":"PROMOTED-EM: Shifting Focus From Cataloging Barriers to Identifying Hidden Determinants of Advancement for Women in Academic Emergency Medicine.","authors":"Adaira Landry, Anita Rohra, Wendy W Sun, Maria Moreira, Wendy C Coates","doi":"10.1111/acem.70416","DOIUrl":"https://doi.org/10.1111/acem.70416","url":null,"abstract":"<p><p>Gender disparities in academic promotion persist despite decades of research documenting their scope. Women remain underrepresented at senior academic ranks in Emergency Medicine, with only 19% of full professors identifying as women. Existing literature has largely cataloged the barriers driving this gap-disproportionate clinical workloads, non-promotable labor burden, sponsorship deficits, and caregiving responsibilities-but has devoted comparatively little attention to the strategies women use to successfully navigate these barriers. This commentary proposes a shift in research focus: From documenting the problem to systematically studying the hidden determinants of advancement among women who have achieved promotion. We introduce PROMOTED-EM, a qualitative research framework organized across 14 domains of academic career life, designed to elicit the tactical, behavioral, and relational strategies that enabled promotion. By centering the experiences of successfully promoted women in Emergency Medicine while explicitly attending to intersectionality and the limitations of survivor bias, this agenda aims to generate actionable, evidence-based guidance for women faculty, department leaders, and institutions committed to closing the promotion gap.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70416"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134791","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":"Reengineering the Concept of Emergency Care.","authors":"R Andrew Taylor","doi":"10.1111/acem.70424","DOIUrl":"10.1111/acem.70424","url":null,"abstract":"<p><p>Emergency departments (EDs) absorb most acute unscheduled care (AUC) in the United States. Routing all of this care through one high-intensity system serves no one well: crowding delays care for time-critical patients; visits that turn on evaluation and coordination, and routine and chronic care defined by longitudinal needs, are delivered episodically and at high cost in a setting built for resuscitation and stabilization; and clinicians trained for emergencies spend much of their time on work the category does not fit. I argue that this is not only a capacity or workflow problem but a conceptual one. In practice, \"emergency care\" is defined by arrival: crossing the ED threshold, not clinical risk, triggers the legal duties, insurance protections, and workflows attached to the label. This was no one's mistake; routing everything through the one door always open was a rational adaptation to a fragmented system. But the adaptation no longer merely persists; it forecloses alternatives. Using conceptual engineering, I trace how history, regulation, payment, public scripts, and lexical entrenchment stabilize this system, and situate it against the social drivers that make ED-as-default ethically necessary and operationally costly. I then propose an ameliorated concept of emergency care: a risk- and time-sensitive, expert-mediated, priority-conferring subset of AUC, determined by structured triage wherever it occurs. Because a definition changes nothing by itself, I outline a phased implementation pathway, show how it applies across delivery settings, including rural and safety-net systems where the ED should remain the local acute care hub, and describe the workforce implications for emergency medicine. The choice posed to the specialty is whether to keep treating crowding, mismatched care, and clinician dissonance as operational problems to optimize within the ED, or to recognize them as properties of what we mean by emergency care and of the system that enacts it.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70424"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Professional Interpreter Use in Emergency Departments: A Systematic Review and Meta-Analysis.","authors":"Henry Li, Ana Ramirez, Lisa Hartling, Jaspreet Khangura, Liz Dennett, Victor Do, Kayathiri Ganeshamoorthy, Samina Ali","doi":"10.1111/acem.70427","DOIUrl":"10.1111/acem.70427","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) increasingly serve linguistically diverse populations. Professional interpretation improves care, yet its use remains variable. Quantifying the prevalence of use and understanding disparities can inform policies and interventions. We conducted a systematic review and meta-analysis to estimate the prevalence of professional interpreter use in English-speaking EDs and compare use across patient populations and countries.</p><p><strong>Methods: </strong>Eight databases were searched from inception to May 15, 2025. We screened full texts included in a prior scoping review to identify studies reporting the prevalence of professional interpreter use among patients requiring interpretation in English-speaking EDs. We pooled prevalence overall and stratified by population (adult vs. children) and country (United States vs. other), with 95% prediction intervals and confidence intervals (CIs). Meta-regression assessed associations between study year and prevalence. Risk of bias was evaluated using the JBI checklist for prevalence studies.</p><p><strong>Results: </strong>Thirty-two studies spanning 1997-2025 involving 65,736 participants were included. Professional interpreters were used in 29% (CI, 20%, 38%) of encounters with patients requiring interpretation. Use was higher with children (49%; CI, 41%, 58%) than adults (16%; CI, 11%, 22%), and higher in the United States (33%; CI, 24%, 43%) than other countries (14%; CI, 4%, 30%). There was no significant association between study year and interpreter use (p = 0.38).</p><p><strong>Conclusions: </strong>Despite known benefits, professional interpreter use in EDs remains low, particularly among adults and outside the United States. Addressing this gap will require coordinated efforts from clinicians, health system leaders, and policymakers to improve access to and accountability for language-concordant care in EDs.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70427"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Robson: Discharge Destination, Although Imperfect and Lacking Granular Detail, Is a Marker for Disability.","authors":"Matthew Bivens","doi":"10.1111/acem.70418","DOIUrl":"https://doi.org/10.1111/acem.70418","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70418"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102586","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":"Risk Stratification of Acute Pulmonary Embolism: Outcomes in Patients With Intermediate sPESI Scores and Negative Cardiac Biomarkers.","authors":"Michael Dore, Ryan Duffy, Omar Melikechi","doi":"10.1111/acem.70425","DOIUrl":"https://doi.org/10.1111/acem.70425","url":null,"abstract":"<p><strong>Background: </strong>Current pulmonary embolism (PE) guidelines support outpatient management for selected low-risk patients, typically identified using the simplified Pulmonary Embolism Severity Index (sPESI). The prognostic value of individual sPESI scores in the direct oral anticoagulant (DOAC) era, particularly when combined with cardiac biomarker assessment, remains uncertain.</p><p><strong>Research question: </strong>To evaluate 7-day and 30-day all-cause mortality among patients with acute PE, sPESI scores of 2 or 3, and negative cardiac biomarkers treated with a DOAC.</p><p><strong>Study design and methods: </strong>Retrospective cohort study of US adults diagnosed with acute PE in a VA emergency department and prescribed a DOAC within 24 h of diagnosis at any U.S. Veterans Affairs (VA) Health System from 2015 to 2024.</p><p><strong>Main outcome measures: </strong>Seven-day and 30-day all-cause mortality.</p><p><strong>Results: </strong>Of 6427 eligible patients, 1365 had an sPESI score of 2 and 455 had an sPESI score of 3 with negative cardiac biomarkers. In the sPESI 2 cohort, 7-day and 30-day mortality were 0.44% and 1.39%, respectively. In the sPESI 3 cohort, rates were 0.22% and 2.20%. Approximately 71% of sPESI 2 patients and 75% of sPESI 3 patients were hospitalized. Hospitalization was not associated with lower 7-day or 30-day mortality in either cohort.</p><p><strong>Interpretation: </strong>Patients with acute PE, sPESI scores of 2 or 3, and negative cardiac biomarkers had low short-term mortality in this large, contemporary DOAC-treated cohort. These findings support prospective studies evaluating outpatient management in carefully selected patients.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70425"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126293","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":"This Is Our Normalcy.","authors":"Sophia Gorgens","doi":"10.1111/acem.70417","DOIUrl":"https://doi.org/10.1111/acem.70417","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70417"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079499","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":"Diagnostic Accuracy of Point of Care Ultrasound for Pulmonary Embolism.","authors":"Brooke Bernardin, Christopher Hanuscin, John Kilpatrick","doi":"10.1111/acem.70415","DOIUrl":"https://doi.org/10.1111/acem.70415","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 10","pages":"e70415"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178636","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}