Academic Emergency Medicine最新文献

{"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":"Low-cost interventions to increase uptake of cervical cancer screening among emergency department patients: Results of a randomized clinical trial.","authors":"David Adler, Nancy Wood, Kevin Fiscella, Karen Mustian, Ellen Tourtelot, Joely Merriman, Sydney Chamberlin, Beau Abar","doi":"10.1111/acem.15101","DOIUrl":"10.1111/acem.15101","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer (CC) is preventable. CC screening decreases CC mortality. Emergency department (ED) patients are at disproportionately high risk for nonadherence with CC screening recommendations. The ED, therefore, is a target-rich environment for interventions to promote CC screening.</p><p><strong>Methods: </strong>We conducted a randomized clinical trial to test and compare the efficacies of (1) basic referral for CC screening and (2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of CC screening among ED patients. Participants aged 21-65, identified as in need of CC screening, were randomized to study arms and followed up at 150 days to assess interval CC screening uptake (primary outcome) and analyze methods-related moderators of intervention effects. Participants were recruited from a large, urban ED and a small, rural ED within the same health care system. Intervention arms were compared to historical controls.</p><p><strong>Results: </strong>A total of 4035 patients were surveyed, with 1089 identified as requiring CC screening and subsequently randomized. Upon 150-day follow-up, 20% of individuals in the basic referral arm and 23% of individuals in the basic referral plus text messaging arm had obtained screening. Screening uptake in the historical control group was found to be 10% over a 150-day period. The overall difference between prospective arms was not significant (p = 0.219). However, moderation analysis found that women ≥40 years old demonstrated greater uptake of screening after the higher intensity intervention compared to the lower (p = 0.032). The differences in screening uptake between both interventions, individually and combined, when compared to controls was significant (p ≤ 0.001).</p><p><strong>Conclusions: </strong>This study demonstrates that both of the evaluated low-intensity ED-based interventions significantly increase subsequent CC screening uptake compared to historical controls. The higher intensity intervention significantly increased screening uptake compared to the lower intensity intervention among women ≥40 years old.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"776-784"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051270","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":"Ode to my daughter.","authors":"Tommaso Bellini","doi":"10.1111/acem.70023","DOIUrl":"10.1111/acem.70023","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"819-820"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612965","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":"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":"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":"785-791"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","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":"The moral injury of zeeple-zoople.","authors":"Nike Izmaylov, Michelle Izmaylov","doi":"10.1111/acem.70025","DOIUrl":"10.1111/acem.70025","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"821-822"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655848","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":"Effect of blood alcohol on the diagnostic accuracy of glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 for traumatic intracranial hemorrhage: A TRACK-TBI study.","authors":"Mark Harris, John K Yue, Sonia Jain, Xiaoying Sun, Ava M Puccio, Raquel C Gardner, Kevin K W Wang, David O Okonkwo, Esther L Yuh, Pratik Mukherjee, Lindsay D Nelson, Sabrina R Taylor, Amy J Markowitz, Ramon Diaz-Arrastia, Geoffrey T Manley, Frederick K Korley","doi":"10.1111/acem.15109","DOIUrl":"10.1111/acem.15109","url":null,"abstract":"<p><strong>Background: </strong>Acute intoxication is common in patients evaluated for traumatic brain injury (TBI). However, the effect of elevated blood alcohol levels (BALs) on the diagnostic accuracy of FDA-cleared biomarkers for evaluating traumatic intracranial injury on computed tomography (CT) scan, namely, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), has not been well studied.</p><p><strong>Methods: </strong>We investigated the effect of significantly elevated (>300 mg/dL) and modestly elevated BAL (81-300 mg/dL) at emergency department presentation on the diagnostic accuracy of GFAP and UCH-L1 for predicting a positive CT in patients presenting to 18 U.S. Level I trauma centers within 24 h of TBI as part of the prospective, Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Plasma GFAP and UCH-L1 were measured using Abbott i-STAT Alinity and ARCHITECT assays. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Of 2320 TRACK-TBI participants studied, 54 (2.3%), 332 (14.3%), 1209 (52.1%), and 725 (31.3%) had significantly elevated BAL, modestly elevated BAL, nonelevated BAL (0-80 mg/dL), and no BAL available, respectively; 48.3% of the cohort had a positive brain CT. Those with significantly elevated and modestly elevated BAL were more likely to have positive CT (61.1% and 60.5% vs. 46.9% and 44.0%) and had higher plasma GFAP and UCH-L1 levels than those with nonelevated BAL and no BAL available. The AUC of GFAP and UCH-L1 combined for predicting CT positivity was higher in those with significantly elevated BAL (0.949) than those with modestly elevated BAL (0.858), nonelevated BAL (0.849), and no BAL available (0.883).</p><p><strong>Conclusions: </strong>Modestly and significantly elevated BAL does not lower the diagnostic accuracy of GFAP and UCH-L1 for predicting traumatic intracranial injury on CT. These biomarkers may be useful in decreasing avoidable brain CT imaging in persons with acute alcohol intoxication.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"748-758"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447711","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":"Reevaluating biomarker accuracy in alcohol-intoxicated TBI patients.","authors":"Brijesh Sathian, Hanadi Al Hamad","doi":"10.1111/acem.70043","DOIUrl":"10.1111/acem.70043","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"813-814"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953020","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":"Accuracy of the Orlando Head CT Criteria in detecting clinically significant abnormalities in patients without head trauma: A systematic review and meta-analysis.","authors":"David D Cassidy, Steven G Rothrock, Grant Wandling, Chrisi T Myers, Kristina Arwady, Stephanie Schiffert, Max Trojano, Ryan Sawyers, Christian Iuteri, Connor Byrne","doi":"10.1111/acem.70065","DOIUrl":"10.1111/acem.70065","url":null,"abstract":"<p><strong>Background: </strong>This systematic review and meta-analysis evaluated the accuracy of the Orlando Head CT Criteria (focal deficit, altered mental status, age≥60, headache with vomiting) in predicting clinically significant abnormalities (CSAs) in ED patients without trauma.</p><p><strong>Methods: </strong>This study followed PRISMA-DTA guidelines. Searched databases included PubMed, EMBASE, Web of Science, CINAHL, Google Scholar, and gray literature. Studies were included if they contained ED patients without trauma and analyzed accuracy of the Orlando Head CT Criteria. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios (LRs) were calculated using a bivariate mixed model with a random-effects approach. Risk of bias and applicability were assessed via QUADAS-2 and certainty of evidence via the GRADE framework. Heterogeneity was assessed via forest plots, a hierarchical summary receiver operating characteristic curve and subgroup analysis. Sensitivity analysis was performed using the leave-one-out method. Threshold effects were investigated via Spearman's correlation and publication bias using Deeks' funnel plot.</p><p><strong>Results: </strong>Seven studies (8914 patients) were included: four prospective and three retrospective. Orlando Head CT Criteria were 98.4% (95% confidence interval [CI] 97.1%-99.1%) sensitive, 17.9% (95% CI 12.3%-25.3%, 95% CI) specific with a DOR of 13.4 (95% CI 6-29.6) and negative LR (-LR) of 0.09 (95% CI 0.04-0.19) in predicting CSA CT scans. Implementation of these criteria would have decreased CT use by 16.2% (95% CI 9.7%-23.9%). GRADE certainty of evidence was moderate. No subgroup or single study was a source of heterogeneity. There were no threshold effects (Spearman ρ = -0.26). We found no publication bias (Deeks' funnel plot asymmetry test, p = 0.71).</p><p><strong>Conclusion: </strong>Orlando Head CT Criteria were sensitive in detecting CSA CT scans with a low -LR. Further studies are required to assess whether these criteria can decrease CT use or augment clinical judgment for patients undergoing nontrauma cranial CT.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"792-801"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109370","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":"Does this patient have Lyme disease?","authors":"Fatima Johari","doi":"10.1111/acem.70037","DOIUrl":"10.1111/acem.70037","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"807-809"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750679","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}