Academic Emergency Medicine最新文献

{"title":"Using natural language processing to identify emergency department patients with incidental lung nodules requiring follow-up.","authors":"Christopher L Moore, Vimig Socrates, Mina Hesami, Ryan P Denkewicz, Joe J Cavallo, Arjun K Venkatesh, R Andrew Taylor","doi":"10.1111/acem.15080","DOIUrl":"https://doi.org/10.1111/acem.15080","url":null,"abstract":"<p><strong>Objectives: </strong>For emergency department (ED) patients, lung cancer may be detected early through incidental lung nodules (ILNs) discovered on chest CTs. However, there are significant errors in the communication and follow-up of incidental findings on ED imaging, particularly due to unstructured radiology reports. Natural language processing (NLP) can aid in identifying ILNs requiring follow-up, potentially reducing errors from missed follow-up. We sought to develop an open-access, three-step NLP pipeline specifically for this purpose.</p><p><strong>Methods: </strong>This retrospective used a cohort of 26,545 chest CTs performed in three EDs from 2014 to 2021. Randomly selected chest CT reports were annotated by MD raters using Prodigy software to develop a stepwise NLP \"pipeline\" that first excluded prior or known malignancy, determined the presence of a lung nodule, and then categorized any recommended follow-up. NLP was developed using a RoBERTa large language model on the SpaCy platform and deployed as open-access software using Docker. After NLP development it was applied to 1000 CT reports that were manually reviewed to determine accuracy using accepted NLP metrics of precision (positive predictive value), recall (sensitivity), and F1 score (which balances precision and recall).</p><p><strong>Results: </strong>Precision, recall, and F1 score were 0.85, 0.71, and 0.77, respectively, for malignancy; 0.87, 0.83, and 0.85 for nodule; and 0.82, 0.90, and 0.85 for follow-up. Overall accuracy for follow-up in the absence of malignancy with a nodule present was 93.3%. The overall recommended follow-up rate was 12.4%, with 10.1% of patients having evidence of known or prior malignancy.</p><p><strong>Conclusions: </strong>We developed an accurate, open-access pipeline to identify ILNs with recommended follow-up on ED chest CTs. While the prevalence of recommended follow-up is lower than some prior studies, it more accurately reflects the prevalence of truly incidental findings without prior or known malignancy. Incorporating this tool could reduce errors by improving the identification, communication, and tracking of ILNs.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997976","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":"Suicidal thoughts and behaviors among gender-minority adolescents in the emergency department.","authors":"Kara Mesznik, Cheryl A King, Adam Horwitz, Michael Webb, Bradley J Barney, Jennifer A Hoffmann, David Brent, Jacqueline Grupp-Phelan, Lauren S Chernick","doi":"10.1111/acem.15090","DOIUrl":"https://doi.org/10.1111/acem.15090","url":null,"abstract":"<p><strong>Objective: </strong>Gender-minority youth, whose gender identity differs from their sex assigned at birth, have elevated suicide risk compared to cisgender youth, yet few studies examine their suicide risk in the emergency department (ED). Our objectives were to determine the prevalence of and assess risk and protective factors associated with prior suicide attempt (SA) and recent suicide ideation (SI) among gender-minority adolescents in the ED.</p><p><strong>Methods: </strong>We conducted a secondary analysis of gender-minority adolescents in the Emergency Department Screening for Teens at Risk for Suicide (ED-STARS) multicenter, random-series prospective cohort study. Prior SA and recent SI were based on the Columbia Suicide Severity Rating Scale and Ask Suicide-Screening Questions, respectively. We conducted Firth's logistic regressions to assess risk and protective factors associated with prior SA and recent SI.</p><p><strong>Results: </strong>Of 6641 adolescent participants in ED-STARS, 280 (4.2%) identified as gender minority. Of the gender minorities, 72% presented with a nonpsychiatric complaint, 37% admitted to a prior SA, and 25% reported recent SI. Prior SA was associated with the number of self-harm methods in the prior 12 months (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.3-1.9), sexual minority (aOR 5.0, 95% CI 2.5-10.6), and mother's history of prior SA (aOR 3.6, 95% CI 1.5-9.2). Recent SI was associated with hopelessness (aOR 4.2, 95% CI 1.5-13.9), lower positive affect (aOR 0.9, 95% CI 0.8-1.0), sexual minority (aOR 8.3, 95% CI 2.5-37.8), five or more self-harm events in the prior 12 months (aOR 4.9, 95% CI 2.1-11.6), and number of illicit drug classes (aOR 1.9, 95% CI 1.2-3.2).</p><p><strong>Conclusions: </strong>Among gender-minority ED adolescent patients, one in three experienced a SA prior to the ED visit. One in four endorsed SI within 2 weeks of the ED visit. The identified risk and protective factors among gender-minority adolescents may inform future ED-based efforts to detect and reduce suicide risk.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997974","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 to: Reevaluating the pulmonary embolism rule-out criteria in younger adults-Insights from the RIETE registry.","authors":"Thibaut Jossein, Olivier Hugli","doi":"10.1111/acem.15110","DOIUrl":"https://doi.org/10.1111/acem.15110","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997825","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 utilization by youth before and after firearm injury.","authors":"Samaa Kemal, Rebecca E Cash, Kenneth A Michelson, Elizabeth R Alpern, Margaret Samuels-Kalow","doi":"10.1111/acem.15095","DOIUrl":"https://doi.org/10.1111/acem.15095","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) visits may serve as opportunities for firearm injury prevention and intervention efforts. Our objective was to determine ED utilization by youth before and after firearm injury.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of ED encounters by youth (0-18 years old) with firearm injury from eight states using the 2019 State ED and Inpatient Databases. Our primary outcome was an ED encounter (1) 90 days before or (2) 90 days after index injury. We used generalized estimating equations, accounting for hospital clustering, to determine associations between ED utilization and ED type (pediatric vs. general), youth age, sex, race and ethnicity, urbanicity, and insurance status.</p><p><strong>Results: </strong>We identified 1035 ED encounters for firearm injury (median [IQR] age 17 (15-18) years, 85.3% male, 63.3% non-Hispanic Black, 68.6% publicly insured, 90.5% living in a metropolitan area, 52.8% general ED). In the 90 days before an index injury, 12.8% of youth had an ED encounter; of these, 68.2% occurred in general EDs, and 18.2% were for trauma. In the 90 days after an index injury, 22.1% of youth had an ED encounter; of these, 50.0% occurred in general EDs, and 22.6% were for trauma. We found no significant association between ED type and ED utilization patterns. Few youths changed ED type across longitudinal encounters.</p><p><strong>Conclusions: </strong>Youth have high rates of ED utilization before and after firearm injury. Half of firearm-injured youth receive their emergency care exclusively in general EDs. Implementing firearm injury prevention and intervention efforts in all ED settings is critical.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998330","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":"Corticosteroids for community-acquired bacterial pneumonia.","authors":"Hossein Kalantari, Getaw Worku Hassen","doi":"10.1111/acem.15098","DOIUrl":"https://doi.org/10.1111/acem.15098","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998328","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":"Impact of an Oregon health policy aimed at strengthening adolescent linkage to outpatient mental health care from the emergency department.","authors":"Liliya Kraynov, Christina Charlesworth, Esther Choo, K John McConnell","doi":"10.1111/acem.15063","DOIUrl":"https://doi.org/10.1111/acem.15063","url":null,"abstract":"<p><strong>Background: </strong>Oregon introduced a state policy, HB 3090, on October 6, 2017, which increased requirements on emergency departments (EDs) to improve transitions to outpatient mental health care. The objective of this study was to examine the policy's impact among low-income adolescent patients who face severe barriers to follow-up.</p><p><strong>Methods: </strong>This was a retrospective cohort study of visits by Medicaid enrollees ages 14-18 presenting to any Oregon ED for a mental health concern between January 1, 2016, and December 31, 2019. We calculated standardized mean differences and used interrupted time series models to evaluate the association of HB 3090 with 14-day mental health follow-up, in-ED services, and inpatient admissions, adjusting for gender, race/ethnicity, primary language, and calendar months.</p><p><strong>Results: </strong>Among 26,071 adolescent mental health-related ED visits, we found an estimated increase of 3.63 percentage points (pp; 95% confidence interval [CI] 0.27 to 6.99) in the adjusted probability of a 14-day outpatient mental health claim postpolicy. However, this effect was attenuated over time, with a slope change of -0.25 pp (95% CI -0.5 to 0) for each month thereafter. The probability of receiving mental health services in the ED or inpatient admission did not change in association with the policy.</p><p><strong>Conclusions: </strong>There was a small increase in short-term outpatient mental health visits after the policy, but the association weakened over time, and other key outcomes did not change. Putting pressure on EDs to perform better in this area is likely to be a minimally effective strategy without accompanying strengthening of mental health resources.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997701","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":"Alcohol withdrawal syndrome presentations to emergency departments in the United States from 2015 to 2023.","authors":"Michael Gottlieb, Nicholas Chien, Eric Moyer, Kyle Bernard, Gary D Peksa","doi":"10.1111/acem.15093","DOIUrl":"https://doi.org/10.1111/acem.15093","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol withdrawal syndrome (AWS) is a common condition prompting emergency department (ED) presentation. However, there are limited recent, large-scale, robust data available on the incidence, admission, and medical treatment of AWS in the ED.</p><p><strong>Methods: </strong>This was a retrospective cohort study of ED presentations for AWS from January 1, 2016, to December 31, 2023, using Epic Cosmos. All ED visits with ICD-10 codes corresponding to AWS were included. Outcomes included percentage of total ED visits, percentage admitted, length of stay (LOS), and medications administered. Binary logistic regression models were used to measure the relationship between time and dependent variables and reported as odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Out of 242,804,798 ED encounters, 670,430 (0.28%) visits were due to AWS with a rise over time (OR 1.074, 95% CI 1.072-1.075). Of these, 386,618 (57.7%) were admitted (46.2% inpatient floor, 11.5% ICU). Median (IQR) hospital LOS was 3 (2-5) days and median (IQR) ICU LOS was 2 (1-4) days. Among all ED patients, benzodiazepine use declined over time (84.9% to 77.1%; OR 0.917, 95% CI 0.914-0.920), while phenobarbital (4.0% to 21.2%; OR 1.255, 95% CI 1.250-1.259) and gabapentin (11.0% to 16.3%; OR 1.054, 95% CI 1.050-1.057) use increased. Oral and intravenous (IV) benzodiazepines were common (63.1% and 66.6%, respectively). Among IV benzodiazepines, lorazepam was most common (59.9%). Among those discharged from the ED, 29.0% were prescribed benzodiazepines (chlordiazepoxide 21.1%, lorazepam 5.5%, diazepam 1.9%). Anticraving medications, such as gabapentin (1.5%), naltrexone (0.4%), and acamprosate (<0.1%) were uncommon, but rising over time.</p><p><strong>Conclusions: </strong>AWS represents a common reason for ED presentation, with most patients being admitted. We identified a rising incidence with a shift in management to include agents such as phenobarbital and gabapentin. These findings provide important evidence on current trends in AWS to inform health policy and knowledge translation efforts as well as emphasizing the need for ongoing research and evaluation of clinical practices to optimize outcomes for patients with AWS.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998327","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 early mortality model for patients admitted after presenting to a tertiary medical center emergency department.","authors":"Justin K Brooten, Jaime L Speiser, Jennifer L Gabbard, David P Miller, Simon A Mahler, Adam S Turner, Rebecca L Omlor, Michelle M Mielke, David M Cline","doi":"10.1111/acem.15096","DOIUrl":"https://doi.org/10.1111/acem.15096","url":null,"abstract":"<p><strong>Objectives: </strong>Identifying patients in the emergency department (ED) at higher risk for in-hospital mortality can inform shared decision making and goals-of-care discussions. Electronic health record systems allow for integrated multivariable logistic regression (LR) modeling, which can provide early predictions of mortality risk in time for crucial decision making during a patient's initial care. Many commonly used LR models require blood gas analysis values, which are not frequently obtained in the ED. The goal of this study was to develop an all-cause mortality prediction model, derived from commonly collected ED data, which can assess mortality risk early in ED care.</p><p><strong>Methods: </strong>Data were obtained for all patients, age 18 and older, admitted from the ED to Atrium Health Wake Forest Baptist from April 1, 2016, through March 31, 2020. Initial vital signs including heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse oximetry, weight, body mass index, comprehensive metabolic panel, and a complete blood count were electronically retrieved for all patients. The prediction model was developed using LR. The ED early mortality (EDEM) model was compared with the rapid Emergency Medicine Score (REMS) for performance analysis.</p><p><strong>Results: </strong>A total of 45,004 patients met inclusion criteria, comprising a total of 77,117 admissions. In this cohort, 52.8% of patients were male and 47.2% were female. The model used 35 variables and yielded an area under the receiver operating characteristic curve (AUC) of 0.889 (95% CI 0.874-0.905) with a sensitivity of 0.828 (95% CI 0.791-0.860), a specificity of 0.788 (95% CI 0.783-0.794), a negative predictive value of 0.995 (95% CI 0.994-0.996), and a positive predictive value of 0.084 (95% CI 0.076-0.092). This outperformed REMS in this data set, which yielded an AUC of 0.500 (95% CI 0.455-0.545).</p><p><strong>Conclusions: </strong>The EDEM model was predictive of in-hospital mortality and was superior to REMS.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998329","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":"Iowa emergency departments lack board-certified emergency physicians: A comprehensive statewide emergency department workforce study.","authors":"Natalie Boone, Timothy Samuelson, Nicholas Mohr, Nash Whitaker, Brian Jennett, Nicholas Kluesner","doi":"10.1111/acem.15102","DOIUrl":"https://doi.org/10.1111/acem.15102","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The emergency physician (EP) workforce has been a recent focus after a workforce projection predicted a surplus of EPs by 2030. A previous study of Iowa emergency departments (EDs) demonstrated wide variability in ED staffing patterns and attributed it to the lack of EP job candidates. With the recent increase in emergency medicine (EM) residency positions, the objectives of this study were to understand how Iowa ED physician staffing has changed in regard to presence of board-certified EPs and what operational differences in Iowa EDs may be associated with staffing to provide insight into what may be occurring in other predominantly rural states.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An electronic and telephone survey of nonfederal Iowa EDs was conducted using a structured data collection instrument. Responses were collected from a leadership representative at each facility (medical director or nurse manager). The data collection included both objective staffing data and Likert-style questions about reasons for staffing and operational practices. We obtained hospital characteristics from the American Hospital Association and directly compared these results to a similar Iowa study conducted in 2013. Summary data were presented as counts and percentages, and physician staffing was compared between critical-access hospitals (CAHs) and non-CAHs. CAHs represent a type of rural hospital in the rural setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Responses from 113 of 116 (97%) Iowa EDs were recorded. Of responding EDs, 19 (17%) were staffed exclusively by EM residency-trained and/or EM board-certified physicians (EPs), 72 (66%) were staffed by a combination of EPs and non-EPs (physicians who completed a residency other than EM), 19 (17%) were staffed exclusively by non-EPs, and 52 (46%) were staffed either fully or at times by advanced practice providers (APPs) without in-house supervision. In the subgroup of CAHs, only three (4%) staff only EPs, compared with 16 (42%) of non-CAHs (difference 38%, 95% confidence interval [CI] 24.6%-51.2%). Providers staffing CAHs were more likely than those at non-CAHs (88% vs. 63%, difference 25%, 95% confidence interval [CI] 9.5%-40.2%) to have responsibilities outside the ED, the most common being inpatient cardiac arrest management (n = 84, 74%). The most common reason for hiring EPs was the quality of care they provide (n = 47, 58%), and the most common reason for hiring non-EPs was low availability of EPs (n = 56, 70%). Compared to the 2013 Iowa ED workforce study, the proportion staffed by EPs only were similar (increased by 5.5%, 95% CI -14.7% to 3.7%) and by non-EPs only was similar (decreased by 10.5%, 95% CI -0.4% to 21.3%). EDs staffed solely by APPs decreased from decreased by 13.2% (95% CI 0.3%-26.2%) to 47% in 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Iowa EDs are predominantly staffed by non-EPs, and this remains unchanged despite a decade of increasing EM residency positions nati","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998040","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":"Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers.","authors":"Prashant Mahajan, Emily White, Kathy Shaw, Sarah J Parker, James Chamberlain, Richard M Ruddy, Elizabeth R Alpern, Jacqueline Corboy, Andrew Krack, Brandon Ku, Daphne Morrison Ponce, Asha S Payne, Elizabeth Freiheit, Gregor Horvath, Giselle Kolenic, Michele Carney, Nicole Klekowski, Karen J O'Connell, Hardeep Singh","doi":"10.1111/acem.15087","DOIUrl":"https://doi.org/10.1111/acem.15087","url":null,"abstract":"<p><strong>Objectives: </strong>We applied three electronic triggers to study frequency and contributory factors of missed opportunities for improving diagnosis (MOIDs) in pediatric emergency departments (EDs): return visits within 10 days resulting in admission (Trigger 1), care escalation within 24 h of ED presentation (Trigger 2), and death within 24 h of ED visit (Trigger 3).</p><p><strong>Methods: </strong>We created an electronic query and reporting template for the triggers and applied them to electronic health record systems of five pediatric EDs for visits from 2019. Clinician reviewers manually screened identified charts and initially categorized them as \"unlikely for MOIDs\" or \"unable to rule out MOIDs\" without a detailed chart review. For the latter category, reviewers performed a detailed chart review using the Revised Safer Dx Instrument to determine the presence of a MOID.</p><p><strong>Results: </strong>A total of 2937 ED records met trigger criteria (Trigger 1 1996 [68%], Trigger 2 829 [28%], Trigger 3 112 [4%]), of which 2786 (95%) were categorized as unlikely for MOIDs. The Revised Safer Dx Instrument was applied to 151 (5%) records and 76 (50%) had MOIDs. The overall frequency of MOIDs was 2.6% for the entire cohort, 3.0% for Trigger 1, 1.9% for Trigger 2, and 0% for Trigger 3. Brain lesions, infections, or hemorrhage; pneumonias and lung abscess; and appendicitis were the top three missed diagnoses. The majority (54%) of MOIDs cases resulted in patient harm. Contributory factors were related to patient-provider (52.6%), followed by patient factors (21.1%), system factors (13.2%), and provider factors (10.5%).</p><p><strong>Conclusions: </strong>Using electronic triggers with selective record review is an effective process to screen for harmful diagnostic errors in EDs: detailed review of 5% of charts revealed MOIDs in half, of which half were harmful to the patient. With further refining, triggers can be used as effective patient safety tools to monitor diagnostic quality.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996685","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}