Academic Emergency Medicine最新文献

{"title":"Evaluation of CTPA Ordering for Pulmonary Embolisms by Patient Race and Ethnicity.","authors":"Angela Mastrianni, Sumaiya Islam, Minal Chawla, Amelia Shunk, Dee Luo, Katherine L Dauber-Decker, Stephanie M Izard, Codruta Chiuzan, Jeffrey Solomon, Michael Qiu, Shreya Sanghani, Sundas Khan, Thomas McGinn, Angela F Jarman, Michael Diefenbach, Safiya Richardson","doi":"10.1111/acem.70159","DOIUrl":"https://doi.org/10.1111/acem.70159","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231178","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":"Advanced Imaging in Suspected Antenatal Pulmonary Embolism in Community Practice: Preferences, Indeterminacy, and Clinician Response.","authors":"David R Vinson, Madeline J Somers, Cydney E Middleton, Lara Zekar, Edward Qiao, Sara T Woldemariam, Nachiketa Gupta, Luke S Poth, Thomas H Urbania, Ryan D Niederkohr, Mary E Reed, Jeffrey D Sperling, Nareg H Roubinian","doi":"10.1111/acem.70153","DOIUrl":"https://doi.org/10.1111/acem.70153","url":null,"abstract":"<p><strong>Background: </strong>Which advanced imaging modality-computed tomography pulmonary angiography (CTPA) or lung scintigraphy-is optimal to evaluate for suspected pulmonary embolism (PE) in pregnancy is debated. Practice patterns, prevalence of indeterminate imaging, and clinician response in contemporary community hospitals are not well understood.</p><p><strong>Methods: </strong>This retrospective cohort study included gravid adults in the emergency department (ED) and Labor and Delivery units (LDUs) who underwent advanced PE imaging 10/1/2021-3/31/2023. We excluded patients with COVID-19. Physician preferences were compared overall and in the subset of scintigraphy-eligible cases, i.e., those with imaging ordered when scintigraphy was available (7:00 a.m.-5:00 p.m.) and not contraindicated by abnormalities on chest radiography (CXR). We reported 48-h incidence of post-indeterminacy imaging and 90-day incidence of venous thromboembolism (VTE).</p><p><strong>Results: </strong>Among 315 eligible cases, the median patient age was 31.0 years (IQR 26.5-35.5) with 164 (52.1%) in the third trimester. Index images included 288 (91.4%) CTPA and 27 (8.6%) scintigraphy, 25 of which were low-dose perfusion scans. PE was diagnosed in 5 (1.6%), all by CTPA. Among 116 scintigraphy-eligible cases, CTPA was favored: 82.8% versus 17.2%, with similar patterns between ED and LDU clinicians. CTPA diagnosed pneumonia in 6 cases (2.1% of 288) not previously identified on CXR and excluded pneumonia in 5 cases in which CXR suggested consolidation. Indeterminacy was more common with non-positive CTPA (24.7% [70/283]) than non-positive scintigraphy (0% [0/27]), p < 0.001. Only 7.1% (5/70) of patients with suboptimal non-positive CTPA received advanced imaging within 48 h, and none of the remaining 65 patients developed VTE or died within 90 days.</p><p><strong>Conclusions: </strong>In this multicenter community setting with a low prevalence of PE, CTPA was preferentially ordered over lung scintigraphy in both the ED and LDU, even when both modalities were available and indicated. Indeterminate results were more prevalent with CTPA and often failed to trigger additional advanced imaging.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197644","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":"Clinically Significant Neuroimaging Findings Among Pediatric Patients Presenting to the Emergency Department With Symptoms of Psychosis: A Multicenter Retrospective Study.","authors":"Jennifer A Hoffmann, Tapan K Parikh, Doug Lorenz, Michael P Goldman, Emily M Powers, Shilpa J Patel, Ilana S Lavina, Theodore W Heyming, Jasmin T England, Mohsen Saidinejad, Ilene Claudius, Pallavi Ghosh, Daniel J Shapiro, Tricia B Swan, Kamali L Bouvay, Eileen Murtagh Kurowski, Nadine M Smith, Justin R Davis, Alexander B Moxam, Eli J Muhrer, Rohit P Shenoi, Elyse N Portillo, Ron L Kaplan, Neil G Uspal, Robert M Lapus, Andrea T Vo, Daniel B Fenster, Danielle B Barrocas, Deborah R Liu, Pradip P Chaudhari, Rachel Cafferty, Stephen B Freedman, Jerri A Rose, Megan F Evers, Ashley M Metcalf, Fareed Saleh, Jennifer Dunnick, Raymond D Pitetti, Yashas R Nathani, Muhammad Waseem, Todd A Florin","doi":"10.1111/acem.70155","DOIUrl":"https://doi.org/10.1111/acem.70155","url":null,"abstract":"<p><strong>Background: </strong>The clinical utility of diagnostic neuroimaging for pediatric patients presenting to the emergency department (ED) for psychosis remains unclear. We sought to estimate the prevalence of and characteristics associated with clinically significant neuroimaging findings among pediatric patients presenting to the ED with symptoms of psychosis who had neuroimaging performed.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included visits by patients 5 to < 18 years old presenting with symptoms of psychosis to 28 EDs affiliated with the Pediatric Emergency Medicine Collaborative Research Committee from 2016 to 2019 and had neuroimaging performed. We estimated the rate of clinically significant neuroimaging findings, defined as those resulting in further testing, treatment, or medical admission, overall and by imaging modality. Multivariable logistic regression models examined presenting features associated with clinically significant findings.</p><p><strong>Results: </strong>Clinically significant neuroimaging findings were identified in 5.4% (95% CI 4.2%, 6.9%) of 1118 ED visits (54% male, median [IQR] 14 [11-16] years old). Clinically significant findings occurred in 4.9% (34/699) of head computed tomography scans and 7.5% (45/604) of brain magnetic resonance imaging studies (p = 0.07). In a model that imputed missing data, no presenting features were associated with clinically significant neuroimaging findings. In a model that treated missing documentation as absence of the clinical feature, the adjusted odds of clinically significant neuroimaging findings were lower among ED visits by patients with suspected alcohol or substance use (aOR 0.38, 95% CI 0.16, 0.87).</p><p><strong>Conclusion: </strong>Among pediatric patients presenting to the ED with symptoms of psychosis who had neuroimaging obtained, approximately 1 in 20 had clinically significant findings. Suspected alcohol or substance use was associated with lower odds of clinically significant neuroimaging findings, although this finding was not consistent across modeling approaches. Prospective studies are needed to definitively evaluate the utility of neuroimaging among children and adolescents presenting to the ED with symptoms of psychosis.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190584","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":"Single Dose Epinephrine Protocol Is Associated With Improved Survival of Older Adults With Out-Of-Hospital Cardiac Arrest.","authors":"Ethan J Lilien, Nicklaus P Ashburn, Tyler S George, Anna C Snavely, Bryan P Beaver, Casey G Costa, Michael A Chado, Harris A Cannon, James E Winslow, R Darrell Nelson, Jason P Stopyra, Simon A Mahler","doi":"10.1111/acem.70154","DOIUrl":"https://doi.org/10.1111/acem.70154","url":null,"abstract":"<p><strong>Background: </strong>A single-dose epinephrine protocol (SDEP) for out-of-hospital cardiac arrest (OHCA) was recently found to have similar survival to hospital discharge (survival) rates compared to a multidose epinephrine protocol (MDEP). It remains unknown if survival rates vary for SDEP vs. MDEP by age. This study aims to determine if an SDEP protocol improves survival in distinct age groups.</p><p><strong>Methods: </strong>We conducted a pre-post implementation study (MDEP vs. SDEP) in 5 North Carolina EMS systems from 11/01/2016-10/29/2019 among adult OHCA patients. Demographics and the outcome of survival were sourced from the Cardiac Arrest Registry to Enhance Survival. Patients were categorized as older (≥ 65 years), middle-aged (46-64 years), and young (18-45 years). Survival rates were compared pre vs. post SDEP implementation within age groups using Generalized Estimating Equations to account for clustering within EMS systems and adjust for sex, race, witnessed arrest, AED application, rhythm type, bystander CPR, arrest location, and EMS response time. The interaction of SDEP implementation with age group was evaluated.</p><p><strong>Results: </strong>Among 1690 patients (899 MDEP, 791 SDEP), 864 were older, 538 were middle-aged, and 288 were young. Survival occurred in 13.6% (122/899) in the MDEP group and 15.4% (122/791) in the SDEP group. SDEP was associated with improved survival in older patients (12.2% [50/409] vs. 6.6% [30/455]; OR: 1.95, 95% CI 1.58-2.41) and similar survival in middle-aged (17.5% [47/268] vs. 18.2% [49/270]; OR: 0.96, 95% CI 0.53-1.25) and young (21.9% [25/114] vs. 24.7% [43/174]; OR: 0.88, 95% CI 0.41-1.90) patients. After adjusting, SDEP remained associated with improved survival among older adults (aOR: 1.87, 95% CI 1.36-2.56) and similar survival rates among middle-aged (aOR: 0.85, 95% CI 0.63-1.15) and young (aOR: 0.82, 95% CI 0.41-1.64) patients. The interactions of SDEP implementation between older and middle-aged (p = 0.001) and older and young (p = 0.05) patients indicate a differential effect.</p><p><strong>Conclusion: </strong>SDEP was associated with improved survival rates among older adults.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147433","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":"Comment on \"Efficacy and Safety of Adjunct Medications in ED Ultrasound-Guided Nerve Blocks\".","authors":"Chitta Ranjan Mohanty, Rakesh Vadakkethil Radhakrishnan, Reshmitha Boyana, Shubha Vijay Nayak","doi":"10.1111/acem.70150","DOIUrl":"https://doi.org/10.1111/acem.70150","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145123909","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":"Operational Impact of Redirection From the Pediatric Emergency Department: A Matched Cross-Sectional Study.","authors":"Erica Qureshi, Brett Burstein, Kelly Cummins, Garth Meckler, Jessica Moe, Steven P Miller, Quynh Doan","doi":"10.1111/acem.70151","DOIUrl":"https://doi.org/10.1111/acem.70151","url":null,"abstract":"<p><strong>Background: </strong>Programs redirecting patients with non-urgent presentations from Emergency Departments (EDs) to the community (ED2C), by providing them a booked community appointment in lieu of waiting for ED care, may reduce ED crowding. We sought to evaluate the department- and patient-level impact of an ED2C program in an urban tertiary pediatric ED.</p><p><strong>Methods: </strong>We conducted a matched cross-sectional study to describe patients redirected by a pediatric ED2C program and determine if the program changed ED operations. Days with the program were matched on day type (weekday vs. weekend) and department volume (±10%) to days when ED patients were not being redirected. Measures of ED flow and utilization on days with and without the program were compared using t-tests and linear regression models.</p><p><strong>Results: </strong>Of the 6164 patients eligible for the ED2C program for 53 days that redirection was offered, 900 were redirected (14.6%). On average, 17.7 (SD 8.5) patients were redirected and 92.4 (SD 23.7) eligible patients were not redirected each day the ED2C was in operation. Patients who were redirected had a significantly shorter length of stay (LOS) than those who were eligible but not redirected (2.9 ± 2.0 h vs. 8.5 ± 4.3 h, p-value < 0.0001). Three patients who were redirected (0.3%) and 11 eligible but not redirected (0.2%) returned to the ED and were hospitalized. Average median departmental LOS, time to physician assessment, daily proportion hospitalized patients, proportion of patients left without being seen, and ED return visits did not differ on days with and without the program.</p><p><strong>Conclusions: </strong>A small proportion of eligible patients were redirected. These patients experienced a lower LOS, without increasing the proportion of return visits. ED operations were unchanged. Refining eligibility criteria for pediatric redirection with an emphasis on patient safety is necessary.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090908","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":"Making the Stakes Clear: Career-Long Projections and Organizational Drivers of PEM Starting Salary Differences.","authors":"Chang Hu, Wenying Huang, Wen Zhang","doi":"10.1111/acem.70152","DOIUrl":"https://doi.org/10.1111/acem.70152","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079541","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":"Parental Stress in Academic Emergency Medicine Physicians.","authors":"Deborah B Diercks, Michelle Lall, Anne Messman, Ellen O'Connell, Meagan Hunt, Mia Karamatsu, Katie Pettit, D Mark Courtney","doi":"10.1111/acem.70145","DOIUrl":"https://doi.org/10.1111/acem.70145","url":null,"abstract":"<p><strong>Background: </strong>Recent publications have shown that women are more likely to leave emergency medicine at a younger age than men. We aim to describe the prevalence of parental stress in academic emergency medicine and its association with scheduling practices and desire to leave medicine.</p><p><strong>Methods: </strong>Blinded survey sent to eight geographically diverse academic sites. Survey included five domains: academic rank and perception of progress, child and childcare characteristics, clinical scheduling practices, plans to leave medicine, and validated psychometric measures including the Parental Stress Scale (PSS: normal population score 35-45). Likert scale responses were dichotomized as either moderate/extremely likely versus less than moderately likely/unsure. Descriptive statistics were calculated, and linear and multivariate regression analyses were performed using STATA 16.</p><p><strong>Results: </strong>A total of 280 surveys were accessed, and 225 (80%) surveys had PSS completed. Of this cohort, there were 90 females, 123 men, 1 intersex, and 15 surveys had no sex reported. The median number of children was 2 (IQR 1-3), and the median age of the youngest child was 4 (IQR 1-9). The parental stress scale median score was 40 (IQR 35-46). There was no significant difference in the parental stress scale by sex. The number of children (B-coeff -1.88, p = 0.007), age of the youngest child (B-coeff -4.2, p = 0.000), use of daycare (B-coeff 3.8, p = 0.027), ability to preference times of shifts (day, swing, night shift) (B-coeff -2.4, p = 0.046), being a nocturnist (B-coeff 2.75, p = 0.006), and being able to completely set their own schedule in terms of days and times worked (B-coeff -2.19, p = 0.03) were associated with the PSS score. The parental stress scale was not associated with the likelihood to leave emergency medicine or leave the current job in 5 years.</p><p><strong>Conclusion: </strong>Academic emergency physicians had parental stress scale scores similar to the general population. Parental stress scale score was not associated with a plan to leave emergency medicine.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051320","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":"High Altitude Pulmonary Edema Response to Continuous Airway Positive Pressure: A Randomized Controlled Trial: The HAPER CAPER Trial.","authors":"Todd Bolotin, Sachin Subedi, Sushil Dahal, Christina Walker, Kimberly Chung, Ava Martz, David Gemmel, Quincy Chopra, Chad Donley","doi":"10.1111/acem.70126","DOIUrl":"https://doi.org/10.1111/acem.70126","url":null,"abstract":"<p><strong>Background: </strong>Morbidity and mortality in cardiogenic pulmonary edema have been reduced by noninvasive positive-pressure airway maneuvers. The value of continuous positive airway pressure (CPAP) for the treatment of high-altitude pulmonary edema (HAPE) is uncertain. The purpose of this study was to evaluate the efficacy and speed of CPAP for HAPE resolution.</p><p><strong>Methods: </strong>A prospective, investigator-initiated, multicenter, randomized, double-blind controlled trial of high-flow oxygen with CPAP versus sham CPAP with high-flow oxygen (oxygen-only group) was conducted. Sixty-four dyspneic adults with maximum oxygen saturation < 85%, recent arrival at high altitude, and noncardiogenic pulmonary edema on chest radiography were randomized to receive CPAP treatment plus usual care or usual care (oxygen-only) delivered through a sham CPAP mask. The primary endpoint was the clinical resolution of HAPE.</p><p><strong>Results: </strong>HAPE resolution in the CPAP plus high FiO₂ group and the high flow oxygen alone group was similar. However, this finding should be interpreted cautiously due to this study being slightly underpowered. There was no significant difference in time to resolution (CPAP ~158 min vs. oxygen ~178 min, p = 0.297). Both therapies were effective, with a mean time to resolution of HAPE of approximately 2.5 to 3 h. No treatment-related adverse outcomes, intubations, or mortality were observed in either group.</p><p><strong>Conclusion: </strong>Both CPAP with high-flow oxygen and high-flow oxygen alone are highly effective for the treatment of HAPE. CPAP conferred no improvement in the time to resolution of HAPE. High-flow oxygen therapy requires significantly less resource utilization for similar benefits in the treatment of HAPE.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04186598.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038814","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":"Hemodynamics Following Dexmedetomidine Loading Dose From Infusion.","authors":"Deepika Sivakumar, Andrew J Webb, Emily Porter, Nicholas Petrucelli, Bryan D Hayes","doi":"10.1111/acem.70147","DOIUrl":"https://doi.org/10.1111/acem.70147","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038765","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}