Academic Emergency Medicine最新文献

{"title":"An assessment of bias in driver's license suspension based on toxicology screening of patients in serious motor vehicle collisions.","authors":"Neil Singh Bedi, Eilish Carpenter, Dolma Tsering, Yanhua Zhou, Rachel Raubenhold, Lisa Allee, Eric J Mahoney, Alysse Wurcel, Elena Byhoff","doi":"10.1111/acem.15118","DOIUrl":"10.1111/acem.15118","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031687","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":"Improving benign paroxysmal positional vertigo management in the emergency department: A longitudinal study post-GRACE-3.","authors":"Camille Gerlier, Linda Mehenni, Gilles Chatellier, Marine Cachanado, Olivier Ganansia","doi":"10.1111/acem.15115","DOIUrl":"https://doi.org/10.1111/acem.15115","url":null,"abstract":"<p><strong>Background: </strong>Vertigo is a priority for training and decision support in emergency departments (ED). Benign paroxysmal positional vertigo (BPPV), though manageable at bedside, remains frequently underdiagnosed and undertreated. This study assessed the effectiveness of a two-tiered educational intervention on posterior and horizontal BPPV management in the ED setting.</p><p><strong>Methods: </strong>Longitudinal program evaluation study conducted over a year in a French ED, following GRACE-3 guidelines, involving patients with triggered episodic vestibular syndrome or brief vertigo without nystagmus. Two 6-month periods were compared: before (control cohort) and after (intervention cohort) an educational intervention of standardized training and an online decision support tool. The primary outcome was the prevalence of evidence-based BPPV diagnoses.</p><p><strong>Results: </strong>Of the 382 patients included, 166 were in the control cohort (43.5%) and 216 were in the intervention cohort (56.5%). The intervention cohort had a higher rate of evidence-based BPPV diagnoses compared to the control cohort (38.0% vs. 16.9%), with an effect size of 21.1 (95% confidence interval [CI] 11.5-29.6, p < 0.0001). Canalith repositioning maneuvers were performed more frequently in the intervention cohort (90.2% vs. 57.7%), with an effect size of 33.1 (95% CI 13.2-53.1). Posttreatment tests showed a nonsignificant difference of 79.5% of intervention cohort patients testing negative versus 75.0% in the control cohort. ED length of stay was shorter in the intervention cohort (137 min vs. 247 min), with an effect size of -109.5 (95% CI -154.0 to -65.0). ED revisits within 1 month were similar (2.3% vs. 1.2%). During the intervention period, clinicians' satisfaction was correlated with the effectiveness of their clinical management.</p><p><strong>Conclusions: </strong>A standardized educational intervention demonstrated enhancing BPPV screening and improved evidence-based diagnosis, showing promise of more efficient treatment in the ED. Further multicenter studies are warranted to evaluate impacts on patient-reported outcomes and resource optimization.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031690","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 ethics of proximity: Enrolling patients in emergency department hallway beds for suicide research.","authors":"Barton W Palmer, Sarah A Arias, Denise R Dunlap, Gwyneth E Gould, Mhd Basheer Rahmoun, Edwin D Boudreaux, Camille Nebeker","doi":"10.1111/acem.15107","DOIUrl":"https://doi.org/10.1111/acem.15107","url":null,"abstract":"<p><strong>Background: </strong>Suicide is the 10th leading cause of death in the United States. Prior research suggests that 10% of people who died by suicide received some form of emergency department (ED) treatment in the 2 months preceding death. The risk of attempted suicide is high during transition back to the community after discharge from the ED, so this is an important opportunity to develop effective empirically validated prevention methods. However, the physical layout and crowded nature of most contemporary EDs, resulting in high rates of \"hallway bed\" assignments, presents some ethical challenges to conducting the requisite behavioral health research in ED settings.</p><p><strong>Methods and results: </strong>In this report, we illustrate the clinical/research ethics controversy through the example of a specific ED-based suicide prevention research protocol, in which the proposed hallway bed recruitment was initially rejected by the institutional review board (IRB) based on concerns about privacy, data confidentiality, and related considerations. Through a consultation process that involved the IRB representatives, the research team (including ethicists), and ED personnel, along with the collection of data to evaluate the risk of compromised confidentiality in hallway bed settings, a viable and ethically grounded approach was reached.</p><p><strong>Conclusions: </strong>This example illustrates the ethical considerations when enrolling patients who occupy a hallway bed into research and the value of a collaborative/problem solving focused dialogue between investigators, ethicists, and IRB personnel.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031729","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":"Clinical trials in the emergency department: Concierge coordinators to reduce attrition.","authors":"Liam R Pauli, Claire S Wilson, Breana McBryde, Lauren R Zimmerman, Richard E Rothman, Bhakti Hansoti","doi":"10.1111/acem.15108","DOIUrl":"https://doi.org/10.1111/acem.15108","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031689","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":"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":"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":"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}