Academic Emergency Medicine最新文献

{"title":"Lock and Protect, Reducing Access to Adolescent Means of Suicide: A Pilot Feasibility Study.","authors":"Ashley M Blanchard, Joandalys Tejada, Shekinah Pettway, Emma Cornell, Jennifer A Hoffmann, Sapana R Patel, Lauren S Chernick, Marian E Betz, Randy P Auerbach, Joan Asarnow, Peter S Dayan","doi":"10.1111/acem.70313","DOIUrl":"https://doi.org/10.1111/acem.70313","url":null,"abstract":"<p><strong>Background: </strong>Providing lethal means counseling to caregivers is an underutilized component of emergency department (ED)-based suicide prevention. We assessed the feasibility and acceptability of Lock and Protect, a web-based lethal means counseling decision aid, among caregivers of adolescents who presented to the ED for self-injurious and/or suicidal thoughts and behaviors.</p><p><strong>Methods: </strong>We conducted a pilot feasibility study of caregiver-adolescent dyads in a pediatric ED. Adolescents were 13-17 years old with current suicidal ideation, suicide attempt, or non-suicidal self-injury. Caregivers received the Lock and Protect intervention plus usual care while their child was in the ED. Feasibility was measured via enrollment rates, duration of time caregivers interacted with Lock and Protect, and tool completion rates. Caregiver acceptability was measured with the Ottawa Acceptability Scale. Follow-up assessments measured changes in home storage at 2- and 4-weeks after enrollment.</p><p><strong>Results: </strong>Of 47 caregivers screened and eligible, 40 enrolled (85.1%), of whom 39/40 and 1/40 reported home access to medications and firearms, respectively. Caregivers found Lock and Protect respectful of their family values about medications (100%) and firearms (97.5%). Almost all caregivers (95.0%) reported the length was \"just right\" and 92.5% reported the amount of information was \"just right\". All caregivers completed the tool in the ED, using it for a mean of 8 min (SD = 3.4 min). All would recommend the tool to others. Ottawa Acceptability Scale scores demonstrated that 95.0% of caregivers found the options in Lock and Protect realistic, and 97.5% found the tool useful for changing home medication access. Follow-up was completed for 77.5% of caregivers, with 20/31 (64.5%) reporting safer home storage of medications.</p><p><strong>Conclusions: </strong>Lock and Protect, a web-based lethal means counseling decision aid, was feasible to administer in the pediatric ED and acceptable to caregivers of adolescents at risk for suicide.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70313"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832237","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 Practice Providers Versus Physicians in Emergency Department Abdominal Pain: Comparison of Length of Stay and Return Visits.","authors":"Emad Awad, Shilpa Raju, Micah Ownbey, Paul Kim, Austin Johnson","doi":"10.1111/acem.70318","DOIUrl":"https://doi.org/10.1111/acem.70318","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70318"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832167","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":"Initial 12 mg Versus 6 mg Adenosine for Supraventricular Tachycardia in the Emergency Department.","authors":"Ekrem Taha Sert, Kamil Kokulu, Oğuz Yürük, Emin Hüseyin Akar, Muhammed Ali Topuz","doi":"10.1111/acem.70309","DOIUrl":"10.1111/acem.70309","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the efficacy and safety of an initial 12 mg versus 6 mg adenosine dose for sinus rhythm conversion in patients presenting with supraventricular tachycardia (SVT) in the emergency department (ED).</p><p><strong>Methods: </strong>This prospective observational study was conducted between February 2025 and January 2026. Adult patients (≥ 18 years) presenting to the ED with hemodynamically stable SVT confirmed by 12-lead electrocardiography (ECG) were included. Patients were categorized into two groups according to the initial adenosine dose administered (6 mg vs. 12 mg). To address potential selection bias, 1:1 propensity score matching (PSM) was performed. The primary outcome was successful first-dose sinus rhythm conversion. Secondary outcomes included adenosine-related adverse effects and SVT recurrence during the ED stay.</p><p><strong>Results: </strong>A total of 142 patients were analyzed (n = 71 per group). First-dose conversion was significantly higher with 12 mg compared with 6 mg (83.1% vs. 52.1%). In the PSM cohort (n = 104), the 12 mg dose maintained its superior efficacy (82.7% vs. 53.8%). The PSM-adjusted odds ratio for successful conversion was 4.12 (95% confidence interval [CI]: 1.85-9.14), with a number needed to treat (NNT) of 3.8 (95% CI: 2.5-8.3). SVT recurrence was numerically lower in the 12 mg group (1.4% vs. 9.9%). Adverse effects were similar between groups.</p><p><strong>Conclusions: </strong>An initial 12 mg adenosine dose was associated with higher first-dose sinus rhythm conversion than 6 mg, while adverse effects were similar between groups.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70309"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758915","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":"Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED): Multicenter Derivation and Evaluation of a Task-Level Workload Measure.","authors":"Garth Meckler, Jeffrey N Bone, Tania Principi, Bruce Wright, Jocelyn Gravel, Ahmed Mater, Devin Singh, Matthias Görges, Tibor van Rooij, Katrina F Hurley, Quynh Doan","doi":"10.1111/acem.70314","DOIUrl":"https://doi.org/10.1111/acem.70314","url":null,"abstract":"<p><strong>Background: </strong>Physician workload in pediatric emergency departments (PEDs) is associated with patient safety, quality of care, and clinician well-being, but is commonly inferred from proxy measures such as visit volume, acuity, or throughput metrics that incompletely capture the contextual and cognitive demands of clinical care. The Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED) was developed to quantify workload at the level of discrete clinical tasks. We derived workload estimates and evaluated the reliability, precision, and contextual responsiveness of SWAMPED.</p><p><strong>Methods: </strong>We conducted a multicenter cross-sectional study of PED physicians at tertiary children's hospitals within the Pediatric Emergency Research Canada network. Participants independently scored 46 care components using the NASA Task Load Index, a validated multidimensional instrument that measures perceived workload associated with a specific task (in this case a clinical care component) accounting for six domains of effort (mental, physical, time, effort, performance, and frustration). Six extrinsic patient and systems-level modifiers were assessed for their impact on component-level workload. We assessed score distributions, interrater agreement using intraclass correlation coefficients (ICC), precision of component estimates, and extrinsic modifiers' effects using mixed-effects models.</p><p><strong>Results: </strong>Sixty-two physicians from 11 sites participated. Interrater agreement across care components was good (ICC: 0.69, 95% CI: 0.60-0.78). Mean workload scores varied across care components (range 22.1-99.5) with high precision (95% CI margin of error of 2.5-6.5 points; relative margin 5%-10%). Most components demonstrated increased workload in the presence of extrinsic modifiers, while intrinsic physician characteristics were not associated with significant differences in workload scores.</p><p><strong>Conclusions: </strong>SWAMPED generated reliable and precise, task-specific workload estimates and demonstrated sensitivity to clinically relevant contextual modifiers. This approach enables quantitative assessment of physician workload at the task level and provides a foundation for future investigations linking workload to clinical outcomes, clinician performance, and health system planning.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70314"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832188","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":"Diagnostic Accuracy of Lung Ultrasound Findings for Pneumonia in Adults.","authors":"Caleb Bailie, Edem Adika, Christopher Hanuscin, Kelly Maurelus","doi":"10.1111/acem.70319","DOIUrl":"https://doi.org/10.1111/acem.70319","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70319"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832184","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":"Guardian Presence in Research Conducted on Children With Blunt Abdominal Trauma in the Emergency Department.","authors":"Irma T Ugalde, Mohamed Badawy, Kevan A McCarten-Gibbs, Kenneth Yen, Paul Ishimine, Nisa S Atigapramoj, Pradip P Chaudhari, Daniel J Tancredi, Nathan Kuppermann, James F Holmes","doi":"10.1111/acem.70308","DOIUrl":"https://doi.org/10.1111/acem.70308","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70308"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832232","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":"How Often Are Emergency Patients Diagnosed With Diabetic Ketoacidosis Despite Not Meeting Laboratory Criteria?","authors":"Richard T Griffey, Nathan Haas, Ryan M Schneider, Daniel Suarez, Jeffrey A Kline, Rachel Ancona, Paulina Cruz-Bravo","doi":"10.1111/acem.70315","DOIUrl":"https://doi.org/10.1111/acem.70315","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency department (ED) patients with hyperglycemia, acidosis, and/or ketosis may have diabetic ketoacidosis (DKA) or any of several well-described conditions. Though the diagnosis of DKA is based on specific laboratory criteria, DKA often presents with mixed clinical pictures, making a strictly laboratory diagnosis problematic. When laboratories fail to meet criteria, patients may nevertheless be diagnosed with DKA. The extent of this is not reported.</p><p><strong>Methods: </strong>We conducted a retrospective observational study at an urban academic ED (01/01/2019-02/28/2023) of adult patients with point of care (POC) glucose > 300 mg/dL and POC ketone > 1.1 mmol/L and/or an ED diagnosis of DKA. We present the proportion whose initial laboratories met DKA criteria based on one of two laboratory definitions, the proportion whose initial laboratories did not meet criteria but who were nevertheless diagnosed with DKA, and the frequencies of non-DKA diagnoses potentially explaining these laboratory abnormalities. Analyses were descriptive.</p><p><strong>Results: </strong>Of 1676 patients included, 883 (53%, 95% CI: 50, 55) met lab criteria for DKA. Of 740 screening positive by POC testing whose initial labs did not meet DKA criteria, 229 (31%, 95% CI: 28, 34) were diagnosed with DKA. Primary ED diagnoses of the remaining 511 included: hyperglycemia (196, 38%), starvation ketosis (58, 11%), hyperosmotic hyperglycemic state (11, 2%), and other ketosis (9, 2%), while 67 (13%) had a primary diagnosis of infection, 1 (< 1%) metabolic acidosis and 169 (33%) an unrelated diagnosis.</p><p><strong>Conclusion: </strong>In this single center study of patients screening positive for DKA or given an ED diagnosis of DKA, 53% met laboratory criteria for DKA, and of those not meeting criteria, 31% were nevertheless diagnosed with DKA. This suggests that emergency physicians use criteria beyond laboratory values to diagnose DKA and supports the idea that DKA is ultimately a clinical rather than a purely laboratory-diagnosed condition.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70315"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832151","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":"Hello, Person Behind the White Coat.","authors":"Ergi Duli","doi":"10.1111/acem.70323","DOIUrl":"https://doi.org/10.1111/acem.70323","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70323"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832196","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 Medicine Funding Within NIH Is the Least Concentrated of Any Specialty.","authors":"Nicholas M Mohr, Karen I Cyndari, Priyanka Vakkalanka, Brett Faine, Tera Shea, Manish N Shah","doi":"10.1111/acem.70316","DOIUrl":"https://doi.org/10.1111/acem.70316","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70316"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832220","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":"Characteristics and Short-Term Outcomes of Patients With Acute Pulmonary Embolism Requiring Intubation.","authors":"Isabel T Dhar, Cecilie D Baltsen, Drew A Birrenkott, Matthew F Freitas, Buse Bor, Asger Granfeldt, Asger Andersen, Mads D Lyhne, Christopher Kabrhel","doi":"10.1111/acem.70317","DOIUrl":"https://doi.org/10.1111/acem.70317","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe pulmonary embolism (PE) may experience hemodynamic instability with intubation and mechanical ventilation. However, the characteristics and outcomes of intubated PE patients have not been previously described in the literature.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients requiring activation of our hospital's Pulmonary Embolism Response Team (PERT) from 2012 to 2021 who were intubated within 24 h of their acute PE diagnosis. Our primary outcome was peri-intubation hemodynamic instability and death occurring within 30 min. Our secondary outcome was peri-intubation hemodynamic instability and death within 3 h of intubation.</p><p><strong>Results: </strong>We included 51 patients. Within 30 min of intubation, seven (14%) patients had a new or increased vasopressor requirement, four (8%) suffered cardiac arrest, and 1 (2%) required ECMO. Within 3 h, 26 (51%) patients had a new or increased vasopressor requirement, six (12%) suffered cardiac arrest, and five (10%) required ECMO. Patients with a central PE (n = 29, 57%) were more likely to experience peri-intubation hemodynamic instability (OR 3.4, 95% CI [0.95, 13], p = 0.048). Patients who had right ventricular strain on CT (OR 3.7, 95% CI [1.01, 15], p = 0.043) or echocardiogram (OR 8.0, 95% CI [1.9, 42], p = 0.0014) were also more likely to experience hemodynamic instability.</p><p><strong>Conclusion: </strong>Peri-intubation hemodynamic deterioration occurs in more than half of patients with acute PE, and severe events, like cardiac arrest, are common. Physicians should be cautious when intubating PE patients. Further research is needed to identify optimal strategies to treat PE patients who require intubation.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70317"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832204","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}