Academic Emergency Medicine最新文献

{"title":"Emergency Physician Versus Telemedicine Neurologist Assessment for Thrombolytic Indication in the Treatment of Acute Ischemic Stroke (AIS).","authors":"Nicholas Linares, John Cambron, Tom Xu, Brook Danboise, Peter Richman","doi":"10.1111/acem.70096","DOIUrl":"https://doi.org/10.1111/acem.70096","url":null,"abstract":"<p><strong>Background and objectives: </strong>Through the advent of telemedicine, ED patients in many smaller and rural hospitals have gained access to input from neurologists for the decision to provide thrombolytics (tPA) for AISCVA. We evaluated the interrater agreement between teleneurologists and emergency physicians (EP) for the indication to give thrombolytic tPA to ED patients with symptoms suggestive of AISCVA.</p><p><strong>Methods: </strong>This was a prospective, observational study conducted at an urban, community teaching hospital. A convenience sample of adult ED patient encounters for possible AISCVA symptoms < 4.5 h duration was included for analysis. Immediately following bedside evaluations, EPs filled out a structured form regarding their history, exam, and assessment of indications for thrombolytic tPA therapy. Subsequently, each patient was evaluated by a teleneurologist, and their assessment was recorded. Multivariate logistic regression was performed. Interrater agreement was assessed by 𝜅.</p><p><strong>Results: </strong>A total of 92 patients were enrolled; mean age 61 ± 15 years, 47% female, mean NIHSS 7 ± 6, 11% prior AISCVA past 3 months, intracranial hemorrhage on CT 5%, 8% discharged home from ED, 10% neurointerventional procedure. Thrombolytic tPA was received by 18 patients (20%). Agreement between EPs and teleneurologist for ± thrombolytic tPA indicated was moderate (86% agreement; 𝜅 = 0.58) and the reason for thrombolytic tPA ineligibility substantial (83% agreement; 𝜅 = 0.77). In five (5.4%) cases, the EP determined that thrombolytic tPA was indicated, the teleneurologist disagreed and the patient did not receive thrombolytic tPA. On the other hand, in nine (9.8%) cases, the EP felt thrombolytic tPA was not indicated and the teleneurologist assessed that it should be administered. For three cases, patients did not receive thrombolytic tPA despite the + teleneurologist impression that it was indicated, including one where the EP dissented.</p><p><strong>Conclusion: </strong>Within our study group of patients evaluated for possible AISCVA, agreement between EP and teleneurologists for thrombolytic tPA indication was moderate and their agreement for thrombolytic tPA ineligibility reasons was substantial.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558777","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":"Pathway for a Diverse and Sustainable Emergency Medicine Clinician-Scientist Workforce: Recommendations From the 2024 SAEM Consensus Conference.","authors":"Robert W Neumar, Dowin Boatright, Melissa McMillian, Theodore Corbin, Marquita S Norman, Jody Vogel, Clifton W Callaway, Lynne Holden, Ava E Pierce, Linda Regan, Lynne D Richardson, Caitlin R Ryus, Opeolu Adeoye, Andra Blomkalns, Charles J Gerardo, Nathan Kuppermann, Gail D'Onofrio","doi":"10.1111/acem.70076","DOIUrl":"https://doi.org/10.1111/acem.70076","url":null,"abstract":"<p><strong>Objectives: </strong>The 2024 Society for Academic Emergency Medicine Consensus Conference focused on developing a pathway to build and support a diverse and sustainable emergency medicine (EM) clinician-scientist workforce. The underlying premise is that the specialty of EM needs a robust clinician-scientist workforce to fulfill its research mission of creating new knowledge to improve patient care and outcomes.</p><p><strong>Methods: </strong>Preconference workgroups assessed existing pathways to develop and support EM clinician-scientists and generated unranked lists of strategies to holistically and comprehensively grow the clinician-scientist workforce. These strategies were refined and prioritized during a one-day, in-person conference, which was followed by a virtual conference to reach consensus on metrics, goals, and timelines for implementation.</p><p><strong>Results: </strong>Overarching strategies included fostering a departmental culture that values research, addressing barriers to recruiting and retaining a diverse research work force, and enhancing the national reputation of EM research. At the undergraduate and medical school stage, creating a portfolio of medium- and long-term research training opportunities with EM faculty mentors was the highest priority. At the resident and fellow stage, top priorities were dedicated research training built into EM residencies and clinical fellowships. Early-career faculty strategies prioritized departmental support for federally funded K awards. Mid-career faculty strategies prioritized securing federal support for research mentoring, leading institutional training grants, and building research teams that include PhD scientists. At all stages, we addressed recruitment and retention of trainees and faculty from disadvantaged and underserved groups.</p><p><strong>Conclusions: </strong>These prioritized strategies with respective metrics, goals, timelines, and responsible parties provide a roadmap for EM to build a broadly inclusive and sustainable clinician-scientist workforce, capable of creating the new knowledge needed to advance emergency medical care. Successful implementation will require substantial commitment and investment from national EM organizations and academic department chairs. The result will be improved care and outcomes for the patients and communities we serve.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558779","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":"In Reply.","authors":"Samuel A Boes, Brian E Driver","doi":"10.1111/acem.70102","DOIUrl":"https://doi.org/10.1111/acem.70102","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558778","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 and Application of Subarachnoid Hemorrhage Decision Rules Among Patients With Non-Traumatic Acute Headache: A Systematic Review and Meta-Analysis.","authors":"Mahdi Roostaei, Nadia Saniee, Seyyed Amir Yasin Ahmadi, Mahdi Rezai, Arash Tehrani-Banihashemi, Hamid Reza Baradaran, Farzaneh Barzkar","doi":"10.1111/acem.70087","DOIUrl":"https://doi.org/10.1111/acem.70087","url":null,"abstract":"<p><strong>Background: </strong>The Ottawa and Emerald rules were developed to aid in the diagnosis of subarachnoid hemorrhage (SAH) and to determine whether a CT scan is necessary for patients presenting with non-traumatic acute headaches in the emergency department. Numerous studies have been conducted to validate these clinical decision rules. In this study, we aimed to investigate the pooled diagnostic accuracy of these rules and their impact on imaging utilization.</p><p><strong>Methods: </strong>In this PRISMA-DTA-compliant systematic review, a comprehensive search was done in databases including PubMed, Scopus, Embase, and Web of Science. Then, screening, selection of studies, and data extraction were performed and the QUADAS-2 tool was used for critical appraisal. The true positives (TP), false negatives (FN), false positives (FP), and true negatives (TN) were extracted to calculate pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and Diagnostic Odds Ratio (DOR) with 95% CIs. The effect of Ottawa rule on CT scan utilization was assessed by calculating pooled odds ratios for the number of CT scans in SAH and non-SAH groups before and after applying the rule.</p><p><strong>Results: </strong>The pooled sensitivity, specificity, negative LR, and positive LR for the Ottawa SAH rule were 99% (95% CI: 92%-100%), 23% (95% CI: 16%-32%), 0.025 (95% CI: 0.003%-0.193%), and 1.29 (95% CI: 1.16%-1.42%) respectively. Similarly, these measures for the Emerald SAH rule were 99% (95% CI: 71%-100%), 27% (95% CI: 15%-43%), 0.065 (95% CI: 0.004%-1.072%), and 1.34 (95% CI: 1.1%-1.62%), respectively. The pooled odds ratio for CT scan utilization for the Ottawa rule was 1.15 (95% CI: 0.62%-2.13%).</p><p><strong>Conclusion: </strong>Both rules are highly sensitive for excluding SAH in patients with non-traumatic acute headaches presenting to the emergency department but have low specificity and do not significantly reduce CT scan utilization.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD42023476444.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551685","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":"\"Pending Trauma Workup\".","authors":"Anant Shukla, Michelle Izmaylov","doi":"10.1111/acem.70100","DOIUrl":"https://doi.org/10.1111/acem.70100","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537678","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":"Letter to the Editor: Bridging the Implementation Gap in Emergency AI-CDSS Research.","authors":"Erkan Boğa","doi":"10.1111/acem.70092","DOIUrl":"https://doi.org/10.1111/acem.70092","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537680","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":"Effect of Vitamin D Supplementation on Prevention of Acute Respiratory Infections.","authors":"Fatima Johari","doi":"10.1111/acem.70097","DOIUrl":"https://doi.org/10.1111/acem.70097","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537679","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":"Efficacy of Tirzepatide, Retatrutide, and Semaglutide for Weight Loss in Obese Individuals Without Diabetes.","authors":"Bastu Adebayo Olowo-Oribi, Richard James Salway","doi":"10.1111/acem.70088","DOIUrl":"https://doi.org/10.1111/acem.70088","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525971","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":"Emergency Department Visit Frequency Among Adults With Chronic Abdominal Pain: Findings From the 2023 US National Health Interview Survey.","authors":"B Michael Ray, Kyle J Kelleran, Maria C Kaisler, Andrew C Meltzer","doi":"10.1111/acem.70085","DOIUrl":"https://doi.org/10.1111/acem.70085","url":null,"abstract":"<p><strong>Objective: </strong>Abdominal pain is a leading symptom prompting emergency department (ED) visits, but the specific contribution of chronic abdominal pain (CAP) to ED utilization is not well established. This study assessed whether CAP is associated with increased ED visits and identified predictors of ED utilization among individuals with CAP.</p><p><strong>Methods: </strong>Using the 2023 U.S. National Health Interview Survey (NHIS), CAP was defined as \"bothersome\" abdominal pain occurring \"most\" or \"every day\" over the prior 3 months. Comparisons were made by demographics, disability, mental health conditions, past medical history (PMH), and social determinants of health (SDOH). Multinomial regression models identified predictors of single and multiple ED visits, and an aggregate model assessed the impact of BioPsychoSocial variables.</p><p><strong>Results: </strong>CAP was reported by 2.8% (n = 4,585,878) of respondents and was associated with higher percentages of disability (31.7% vs. 7.2%), anxiety (51.9% vs. 17.6%), depression (49.4% vs. 17.8%), comorbidities such as hypertension (46.5% vs. 30.6%), and SDOH-related challenges like difficulty refilling prescriptions (23.8% vs. 5.2%) and cost-related care access (22.6% vs. 5.9%). CAP increased the odds of a single ED visit (OR: 2.2, 95% CI: 1.7-2.9) and multiple visits (OR: 4.2, 95% CI: 3.2-5.6). Adjusting for PMH reduced the odds of single ED visits by 33% (OR: 1.7, 95% CI: 1.2-2.3), while adjusting for SDOH reduced multiple visits by 100.1% (OR: 2.1, 95% CI: 1.5-2.9). The aggregate model reduced the odds of single and multiple visits by 49.4% and 120%, respectively (Single OR: 1.5, 95% CI: 1.1-2.0; Multiple OR 1.9, 95% CI: 1.4-2.7).</p><p><strong>Conclusion: </strong>This nationally representative analysis suggests that individuals with CAP have significantly higher ED utilization and face greater burdens of disability, mental health conditions, comorbidities, and SDOH-related barriers. These findings highlight the potential value of addressing BioPsychoSocial factors to reduce ED reliance and support comprehensive care for CAP patients.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504446","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":"Return Visits Among Emergency Department Patients Leaving Against Medical Advice.","authors":"Michael Gottlieb, Eric Moyer, Kyle Bernard, Kevin G Buell","doi":"10.1111/acem.70091","DOIUrl":"https://doi.org/10.1111/acem.70091","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482866","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}