Academic Emergency Medicine最新文献

{"title":"Identification of Children With a Positive Ultrasound and Appendicitis Using the Pediatric Appendicitis Risk Calculator: Retrospective Cohort Study.","authors":"Nouf Aljahdali, Andrea S Doria, Carina Man, Joshua Ramjist, Michael Bravo, Adrienne Davis, Keren Shahar-Nissan, Reut Ram, Annie Daviko, Suzanne Schuh","doi":"10.1111/acem.70118","DOIUrl":"https://doi.org/10.1111/acem.70118","url":null,"abstract":"<p><strong>Objectives: </strong>Up to 10% of positive ultrasounds (US) for suspected pediatric appendicitis are false positive. Minimizing the negative appendectomy rate is gaining importance as a quality indicator, with a proposed benchmark of < 2%. The validated Pediatric Appendicitis Risk Calculator (pARC) score [range 0%-100%] used alone identifies the entire appendicitis risk spectrum, whereas the optimal surgical candidates should be at a very high risk. Therefore, pARC risk stratification in conjunction with positive US may be useful to identify the best surgical candidates. The primary objective was to determine the proportion of children with positive US plus medium-high risk pARC ≥ 25% with appendicitis.</p><p><strong>Hypothesis: </strong>We hypothesized this proportion would be 98%, with lower 95% CI ≥ 96%.</p><p><strong>Methods: </strong>A retrospective cohort study of 327 previously healthy children 4-17 years old at a pediatric ED with suspected appendicitis and positive US interpretations. Four investigators abstracted demographic, clinical, and imaging data. pARC includes seven demographic, clinical, and laboratory variables and is quantified according to the published formula. The primary outcome was appendicitis, based on pathology. All non-operated patients underwent a follow-up to exclude missed appendicitis.</p><p><strong>Results: </strong>A total of 294/327 (89.9%) patients with positive US had pathology-proven appendicitis, and 33 (10.1%) had no appendicitis; pARC ≥ 25% was assigned to 259/327 (79.2%) patients. In total, 255/259 (98.5%) children with pARC ≥ 25% had pathology-proven appendicitis (95% CI 96.1-99.6) versus 39/68 (57.3%) with pARC < 25%; p < 0.0001. Probability of no appendicitis increased with decreasing pARC cut-offs from 0/230 (0%) for pARC ≥ 40% to 13/284 [4.6% (2.5-7.7)] for pARC ≥ 15%. The pARC ≥ 25% plus positive US combination had sensitivity 86.7% (82.3-90.4), specificity 87.9% (71.8-96.6), positive predictive value 98.5% (96.1-99.6), and negative predictive value 42.6% (30.7-55.2).</p><p><strong>Conclusions: </strong>In children with suspected appendicitis, a combination of positive US and pARC ≥ 25% carries a very high probability of appendicitis. Children with lower pARCs may be candidates for clinical re-evaluation or further imaging.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758917","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":"Commentary on \"The Use of TENS for the Treatment of Back Pain in the Emergency Department: A Randomized Controlled Trial\".","authors":"Tatsuya Tanaka, Akira Matsuno","doi":"10.1111/acem.70112","DOIUrl":"https://doi.org/10.1111/acem.70112","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726442","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":"Exploring Patients' Perceptions of an Advance Care Planning Intervention in the Emergency Department: A Qualitative Study.","authors":"Youkie Shiozawa, Saaya Morton, Nanako Shirai, Hannah Oelschlager, Lucy Kiernat, Anita N Chary, Anna C Revette, Adrian Haimovich, Smit Desai, Kai-Wei Chang, Shan W Liu, Maura Kennedy, Mara A Schonberg, Kei Ouchi","doi":"10.1111/acem.70109","DOIUrl":"https://doi.org/10.1111/acem.70109","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency department (ED) visits offer opportunities for seriously ill patients to formulate future medical care goals, yet ED clinicians lack practical strategies for these conversations. ED GOAL, a behavioral intervention, engages seriously ill yet clinically stable older adults in the ED to address advance care planning (ACP) with their outpatient clinicians. In a randomized trial, goals-of-care documentation was significantly higher in the intervention group compared to controls after three (24.3% vs. 9.9%, p = 0.03) and 6 months (31.4% vs. 12.7%, p < 0.01). This study is a sub-analysis to learn about intervention arm participants' perceived benefits and obstacles of the intervention.</p><p><strong>Methods: </strong>We conducted semi-structured interviews between October 2022 and August 2024 (N = 52) with intervention-arm patients aged 50+ years at three hospitals in Boston, Massachusetts. Using rapid qualitative analyses, we identified themes in intervention-arm participants' comments to open-ended questions about the intervention's benefits and obstacles to continue ACP outside the ED.</p><p><strong>Results: </strong>Of 70 intervention-arm participants, 52 completed interviews, of which two were surrogates. ED GOAL motivated most patients to initiate ACP with outpatient clinicians and loved ones and improved the quality of conversations by clarifying patients' wishes and improving patient-clinician relations. Barriers to continuing ACP were the lack of clinician availability and patient/surrogate readiness. Those with clear care goals found the intervention less useful yet harmless.</p><p><strong>Conclusions: </strong>The intervention provided participants with insights into actionable ACP steps. To address the lack of clinician availability, these conversations may be completed by non-physician clinicians or through non-personnel resources. Better tailored ACP interventions may improve patients' readiness.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05209880.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740820","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":"Balanced Crystalloids for Pediatric Sepsis and Septic Shock.","authors":"Brit Long, Michael Gottlieb","doi":"10.1111/acem.70115","DOIUrl":"https://doi.org/10.1111/acem.70115","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726441","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 on \"Prevalence of Violence Against Health Care Workers Among Agitated Patients in an Urban Emergency Department\".","authors":"Tatsuya Tanaka, Akira Matsuno","doi":"10.1111/acem.70103","DOIUrl":"https://doi.org/10.1111/acem.70103","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688587","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":"Inconsistencies in the Impact of Electronic Health Record-Based Clinical Decision Support on Reducing Potentially Inappropriate Medications in Older Adults.","authors":"Brijesh Sathian, Hanadi Al Hamad, Israel Júnior Borges do Nascimento","doi":"10.1111/acem.70107","DOIUrl":"https://doi.org/10.1111/acem.70107","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673694","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":"La Sagrada.","authors":"Rama A Salhi","doi":"10.1111/acem.70111","DOIUrl":"https://doi.org/10.1111/acem.70111","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681742","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":"Reply: Inconsistencies in the Impact of Electronic Health Record-Based Clinical Decision Support on Reducing Potentially Inappropriate Medications in Older Adults.","authors":"Gina A Elder, Kevin King, Marc Willner, Matthew J Campbell, Baruch S Fertel, Saket Saxena, Stephen Meldon","doi":"10.1111/acem.70106","DOIUrl":"https://doi.org/10.1111/acem.70106","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673695","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":"Benzodiazepine Co-Exposure Among Patients Presenting to the Emergency Department With a Confirmed Opioid Overdose.","authors":"Adrienne Hughes, Hannah Spungen, Rachel Culbreth, Kim Aldy, Alex Krotulski, Robert G Hendrickson, Alexandra Amaducci, Bryan Judge, Christopher Meaden, Diane P Calello, Jennie Buchanan, Joseph Carpenter, Joshua Shulman, Jeffrey Brent, Paul Wax, Sharan Campleman, Michael Levine, Evan Schwarz, Alex F Manini","doi":"10.1111/acem.70104","DOIUrl":"https://doi.org/10.1111/acem.70104","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous exposure to both benzodiazepines and opioids can lead to synergistic respiratory depression, complicating overdose management. Our objective was to report on the detection of prescription and novel benzodiazepine co-exposures among patients treated in emergency departments (EDs) with suspected opioid overdoses. We aimed to describe novel benzodiazepine exposures in this population and to compare the clinical severity of co-exposure to benzodiazepines and opioids versus opioids alone.</p><p><strong>Methods: </strong>This study utilized data from the Toxicology Investigators Consortium (ToxIC) Fentalog Study, an observational study at 10 ED sites (Sept 2020-Dec 2023). Waste serum samples were analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) for the presence of over 1200 novel psychoactive substances (NPS), drugs, therapeutics, and metabolites. Analyses included demographics, clinical severity, and outcomes among those with prescription benzodiazepines, novel benzodiazepines, or no benzodiazepines.</p><p><strong>Results: </strong>Among the patients with opioids present (n = 1427), 29.0% of patients had detectable benzodiazepines. 20.5% of patients had detectable prescription benzodiazepines, and 8.5% of patients had detectable novel benzodiazepines. The most commonly detected prescription benzodiazepine was alprazolam (39.3%); the most common novel benzodiazepine was bromazolam (46.3% of novel benzodiazepines). The median age of those with novel benzodiazepines was 34, which was younger than those without benzodiazepines (40) and those with prescription benzodiazepines (41; p = 0.001). Patients without benzodiazepines received naloxone more frequently (p = 0.02), while novel benzodiazepine co-exposure was associated with higher naloxone nonresponse rates (p = 0.03). Patients with novel benzodiazepines (compared to the opioid-only group) had increased odds of requiring mechanical ventilation (aOR: 2.14; 95% CI: 1.07, 4.05) after adjusting for age, gender, race and ethnicity, and the presence of prescription benzodiazepines and/or fentanyl.</p><p><strong>Conclusions: </strong>Nearly a third of patients with confirmed opioid overdose presenting to the ED also had concomitant benzodiazepine exposures. Those with novel benzodiazepines had significantly higher odds of intubation, suggesting greater severity of overdose.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635924","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":"The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients.","authors":"Ula Hwang, Natalia Sifnugel, Inessa Cohen, Ling Han, Katy Araujo, Luann M Bianco, Cynthia A Brandt, Sandra Capelli, Christopher R Carpenter, Daniel S Cruz, Scott M Dresden, Ivy L Fishman, Katrina Gipson, S Nicole Hastings, William W Hung, Raymond Kang, Mechelle Lockhart, Daniella Meeker, Ugochi Ohuabunwa, Sierra Ottilie-Kovelman, Caitlin Partridge, Timothy F Platts-Mills, Jacqueline Sandoval, Zachary Taylor, Debra F Tomasino, Camille P Vaughan","doi":"10.1111/acem.70101","DOIUrl":"10.1111/acem.70101","url":null,"abstract":"<p><strong>Objectives: </strong>Multicenter research of geriatric emergency department (GED) care remains limited. Our objectives were to: 1. Prospectively collect data prioritized by the Geriatric Emergency care Applied Research (GEAR) network, a transdisciplinary taskforce for GED care, and create a multicenter GED research repository of prospective and electronic health record (EHR) data, 2. Assess concordance between prospective and EHR data.</p><p><strong>Methods: </strong>The GEAR Standardization Study (GEARSS) is a multicenter, prospective study of older emergency department (ED) patients (65+) focusing on the 4Ms of age-friendly care (mobility, medication safety, mentation, what matters) and elder mistreatment. Demographic and clinical data were collected via interviews by trained research assistants (RA) on Days 0, 4, 30, and 90 and linked to EHR. Prevalence of chronic comorbidities and incident delirium were measured and reported using descriptive statistics. Prospective and EHR data concordance was assessed with Cohen's Kappa.</p><p><strong>Results: </strong>999 participants were recruited from 5 EDs (3/25/2021-6/30/2022) across 3 institutions: Grady Health System, Northwestern Memorial Hospital, and Yale New Haven Health. The cohort was 57.0% female, 55.2% White, 39.1% Black, and 3.4% Hispanic, and the mean age was 75.1 years. For rheumatologic disease, peptic ulcer disease, diabetes, renal disease, and cancer, prevalence differed between prospective and EHR data by > 10%. About two-thirds of participants were at risk for falls. Concordance between prospective and EHR data was good for ethnicity (K = 0.73); excellent for sex (K = 1.00), age (K = 1.00), and race (K = 0.98); fair for disposition (K = 0.53); slight for ED observation status (K = 0.33) and dementia diagnosis (K = 0.24); poor for delirium presence (K = 0.07).</p><p><strong>Conclusion: </strong>In GEARSS, demographic variables aligned strongly between prospective and EHR data, while diagnosis, disposition, and mentation factors did not. This multicenter data source provides preliminary findings for common geriatric syndromes and conditions. Choice of measures using these data should be driven by GED research questions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615782","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}