Academic Emergency Medicine最新文献

{"title":"Sex disparities in chlamydia and gonorrhea treatment in U.S. adult emergency departments: A systematic review and meta-analysis.","authors":"Rachel E Solnick, Rahi Patel, Ethan Chang, Carmen Vargas-Torres, Maaz Munawar, Carlin Pendell, Judith E Smith, Ethan Cowan, Keith E Kocher, Roland C Merchant","doi":"10.1111/acem.70070","DOIUrl":"https://doi.org/10.1111/acem.70070","url":null,"abstract":"<p><strong>Background: </strong>Empiric antibiotic treatment for gonorrhea (GC) and chlamydia (CT) is common in U.S. emergency departments (EDs) due to the delayed availability of test results. Local studies have identified sex-based disparities in sexually transmitted infection (STI) care, with females potentially receiving less empiric treatment than males. This study evaluates how STI treatment aligns with laboratory-confirmed results to quantify potential overtreatment and undertreatment rates and investigates sex differences for these outcomes.</p><p><strong>Methods: </strong>We conducted a preregistered (PROSPERO #241429) systematic review and meta-analysis of studies published between January 2010 and January 2025 in U.S. EDs, excluding studies conducted exclusively in pediatric settings. Searches were performed in Medline, Cochrane, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Data from 19 studies encompassing 32,593 tested patients were analyzed using a random-effects model to calculate pooled estimates. Primary outcomes included GC/CT positivity, empiric treatment rates, and discordance between treatment and test results stratified by sex.</p><p><strong>Results: </strong>Overall GC/CT positivity was 14% (95% confidence interval [CI] 12%-16%): 11% (95% CI 8%-14%) in females and 25% (95% CI 23%-26%) in males. Antibiotics were given to 46% (95% CI 38%-54%) of patients: 31% (95% CI 24%-37%) of females and 73% (95% CI 65%-80%) of males. Among patients with negative test results, 38% (95% CI 30%-47%) received antibiotics (i.e., potential overtreatment): 27% (95% CI 20%-34%) of females and 64% (95% CI 55%-73%) of males. Conversely, 39% (95% CI 31%-46%) of laboratory-positive patients did not receive antibiotics (i.e., potential undertreatment): 52% (95% CI 46%-57%) of females and 15% (95% CI 12%-17%) of males.</p><p><strong>Conclusions: </strong>Significant sex-based disparities exist in ED empiric antibiotic treatment for GC/CT. Females were 3.5 times more likely than males to be potentially undertreated. These findings underscore the need for targeted interventions to reduce disparities and improve treatment accuracy. Interpretation is limited by study heterogeneity and incomplete sex-specific data.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273929","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 Factors Associated With Ventricular Dysrhythmia in Emergency Department Patients With Severe QTc Prolongation After Drug Overdose.","authors":"Michael D Simpson, Katherine B Tang, Michael W Donnino, Peter R Chai, Rachel Culbreth, Sharan Campleman, Paul Wax, Alex F Manini, Michele M Burns","doi":"10.1111/acem.70083","DOIUrl":"https://doi.org/10.1111/acem.70083","url":null,"abstract":"<p><strong>Background: </strong>Management of severe prolongation of the corrected QT interval (QTc) following acute drug overdose presents a challenge to clinicians, as resulting ventricular dysrhythmias are rare but life-threatening. This study aimed to identify which patients with severe QTc prolongation on presentation to the emergency department (ED) after overdose will develop ventricular dysrhythmias, death, cardiac arrest, the need for rhythm control, or extracorporeal membrane oxygenation utilization.</p><p><strong>Methods: </strong>Secondary analysis of Toxicology Investigators Consortium Core Registry data from 2013 to 2023. We included patients ≥ 13 years old with acute or acute-on-chronic overdose, toxicology consultation in the inpatient or ED setting, and initial ED electrocardiogram QTc ≥ 500 ms. We excluded patients with no or unknown toxicologic exposure, symptoms unlikely or unknown whether related to exposure, or missing data. The primary outcome was ventricular dysrhythmia. Secondary outcomes included death, cardiac arrest, rhythm control, and extracorporeal membrane oxygenation. Independent variables included patient and overdose characteristics, initial QTc and bicarbonate values, clinical findings, and drug exposures. Multivariable logistic regression was performed with ventricular dysrhythmia as the dependent variable to identify potential predictors. Diagnostic test characteristics were calculated for risk factors identified in the regression model.</p><p><strong>Results: </strong>Of 2764 patients screened, 1265 were included. Forty-eight (3.79%) patients developed ventricular dysrhythmias. Bradycardia (aOR 3.12, 95% CI 1.35-6.90), acidosis (aOR 3.02, 95% CI 1.42-6.23), and shock (aOR 4.54, 95% CI 2.07-9.75) were independently associated with ventricular dysrhythmia on regression analysis and were each associated with every secondary outcome. The absence of any of these findings had a negative predictive value of 98.2% (97.2%-98.9%) for developing ventricular dysrhythmia.</p><p><strong>Conclusions: </strong>In this large international data registry, we identified predictors of ventricular dysrhythmia in patients presenting to the ED after overdose in the setting of severe QTc prolongation.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257083","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":"Relative Urgency: Between Heart Attacks and Sore Throats.","authors":"F Javier Montero-Perez","doi":"10.1111/acem.70079","DOIUrl":"https://doi.org/10.1111/acem.70079","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245606","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":"Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage Is Associated With Behavioral Intervention: A Cross-Sectional Study.","authors":"Amy D Costigan, Martin A Reznek, Christopher Slocum, Maureen M Canellas, Alexandra M Sanseverino, Vincent Kan, Janell Forget, Laurel C O'Connor","doi":"10.1111/acem.70082","DOIUrl":"https://doi.org/10.1111/acem.70082","url":null,"abstract":"<p><strong>Objective: </strong>Incidents of aggression and hostility towards staff in emergency departments (EDs) have escalated in frequency and severity, posing a serious threat to the well-being of patients and healthcare providers. Research on predictive tools for identifying individuals at risk of violent behavior in the ED remains scarce. The objective of this study was to assess the association between the Dynamic Appraisal of Situational Aggression (DASA) score assigned at triage and physical restraint or medications administered for safety during an ED encounter.</p><p><strong>Methods: </strong>From January 11, 2023 to December 31, 2023, patients ≥ age 18 were assigned a DASA score during triage at five EDs. Subjects' triage DASA scores, demographic characteristics, and clinical outcomes were abstracted from the electronic health record. Subjects were risk-stratified into validated DASA risk categories for aggression (low, moderate, high, or imminent). Outcomes were measured by documented physical restraint or the administration of injected antipsychotic medication with or without a benzodiazepine. Modified Poisson regressions were used to calculate the crude and adjusted prevalence ratios (PRs) of any intervention (physical restraints and medication administration) by DASA score.</p><p><strong>Results: </strong>159,154 qualifying ED encounters were identified (mean age 51.5, 53.5% female). Increasing DASA score was associated with increasing PR of any behavioral intervention: physical restraint and/or safety medication administration. An imminent-risk DASA score was associated with an adjusted PR of 4.71 (CI 3.65-6.06, p < 0.001) for any intervention, 3.63 (CI 3.25-4.05, p < 0.001) for physical restraint, and 5.26 for any medication administration (CI 4.08-6.78, p < 0.001) compared to patients with a DASA score of 0.</p><p><strong>Conclusions: </strong>Elevated DASA scores at ED triage were associated with an increased risk of patient restraint and safety medication administration during the ED encounter. Future research should assess how proactive interventions based on DASA scores influence violence risk and investigate the predictive value of consecutive DASA evaluations throughout ED encounters.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245605","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":"Formal Education in Life.","authors":"Zhaohui Su","doi":"10.1111/acem.70078","DOIUrl":"https://doi.org/10.1111/acem.70078","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223937","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":"Standards for Point-of-care Ultrasound Research Reporting (SPUR): A modified Delphi to develop a framework for reporting point-of-care ultrasound research.","authors":"Nikolai Schnittke, Frances M Russell, Michael Gottlieb, Samuel H F Lam, David O Kessler, Lynn P Roppolo, Stephanie C Demasi, Patricia Henwood, Yiju Teresa Liu, Jennifer R Marin, Jason Nomura, Joseph R Pare","doi":"10.1111/acem.70069","DOIUrl":"https://doi.org/10.1111/acem.70069","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is a bedside diagnostic modality that depends on technical, operator-specific, patient-specific, and clinical context factors. Existing research reporting guidelines do not explicitly address these considerations as they pertain to replicability and generalizability of POCUS studies. The objective of this study was to create a framework to assist investigators, reviewers, and clinicians in reporting and evaluating the quality of POCUS research.</p><p><strong>Methods: </strong>We applied a two-stage consensus-building approach. First, a steering committee reviewed available literature and existing guidelines to generate a novel list of items and explanatory subitems relevant to POCUS research. We vetted the list by soliciting public comments from individuals affiliated with POCUS-oriented professional organizations. Second, a consensus panel of experts, defined as POCUS researchers with a minimum of three first or senior author, POCUS-relevant publications completed a three-round Delphi survey. Consensus was defined as agreement by ≥80% of the panel. Items that did not reach consensus after three rounds were excluded.</p><p><strong>Results: </strong>Twenty POCUS experts participated in the study, completing all three survey rounds. The panel reached consensus to include 19/21 items and 62/119 subitems. The resulting instrument addresses variables related to technical hardware and settings (three items), specifics of the POCUS examination (two items), participant characteristics (two items), operator characteristics (five items), data analysis and interpretation (three items), and study-specific considerations (four items).</p><p><strong>Conclusions: </strong>The Standards for Point-of-Care Ultrasound Research Reporting (SPUR) can aid researchers, reviewers, and clinicians in the design, dissemination, and critical appraisal of POCUS research.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223938","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":"Cleared.","authors":"Brent R Carr","doi":"10.1111/acem.70077","DOIUrl":"https://doi.org/10.1111/acem.70077","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214613","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":"Correction to \"Consent to advanced imaging in antenatal pulmonary embolism diagnostics: Prevalence, outcomes of nonconsent and opportunities to mitigate delayed diagnosis risk\".","authors":"","doi":"10.1111/acem.70073","DOIUrl":"https://doi.org/10.1111/acem.70073","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207355","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":"Response to \"Reevaluating biomarker accuracy in alcohol-intoxicated TBI patients\" by Drs. Sathian and Al Hamad.","authors":"Frederick K Korley","doi":"10.1111/acem.70064","DOIUrl":"https://doi.org/10.1111/acem.70064","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207356","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":"Response to racial disparities and patient-centered choice in medications for opioid use disorder: A commentary on Hazekamp et al.","authors":"Corey Hazekamp, Anthony Scoccimarro","doi":"10.1111/acem.70072","DOIUrl":"https://doi.org/10.1111/acem.70072","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155533","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}