Academic Emergency Medicine最新文献

{"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":"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":"SAEM26 Abstracts.","authors":"","doi":"10.1111/acem.70305","DOIUrl":"https://doi.org/10.1111/acem.70305","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 Suppl 1 ","pages":"S8-S428"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969474","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":"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":"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":"Sand.","authors":"Alexander D McGinley","doi":"10.1111/acem.70327","DOIUrl":"https://doi.org/10.1111/acem.70327","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70327"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939796","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":"Unheard Voices: A Systematic Review of the Experiences of Patients With Bipolar Disorder in the Emergency Department.","authors":"Elsy Willis, Ali Raza Gangji, Emma Morton, Eddy Lang","doi":"10.1111/acem.70324","DOIUrl":"https://doi.org/10.1111/acem.70324","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70324"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969494","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":"Impact of Point-of-Care Ultrasound on Patient-Family Experience and Behavioral Response in a Pediatric Emergency Department: A Randomized Control Survey Trial.","authors":"Samuel A Gutierrez, Matthew Hays, Pamela Soriano, Benjamin K Nti","doi":"10.1111/acem.70295","DOIUrl":"10.1111/acem.70295","url":null,"abstract":"<p><strong>Background: </strong>Existing literature indicates that patients respond positively to point-of-care ultrasound (POCUS) across various clinical settings. However, limited research explores how patient-families perceive its use in pediatric emergency department (ED) care. Our study aims to evaluate POCUS's impact on patient experience, stress, and anxiety in the pediatric ED.</p><p><strong>Methods: </strong>We conducted a randomized study (1:1) of pediatric patients (≤ 17 years) presenting with a clinical indication for POCUS (lung, FAST, cardiac, or soft tissue applications). Patients were assigned to either a POCUS or non-POCUS group, excluding those who were unstable or had prior POCUS evaluations. Patient-families completed pre- and post-surveys (5-point Likert scale) at triage and ED disposition. Demographic data were obtained from the electronic medical record. Statistical analyses included Chi-Square, Fisher's Exact, Wilcoxon, and sign tests (α = 0.05) to compare group responses and assess for changes in responses over time.</p><p><strong>Results: </strong>A total of 200 patient-families were enrolled. The cohort was primarily English-speaking, non-Hispanic White males, with an average age of 5.16 years (SEM ±0.37). Common chief complaints included cough (34%), fever (15%), abdominal pain (14%), and shortness of breath (13%). No significant differences were observed in patient experience or ED length of stay. Sign tests indicated significant reductions in stress and anxiety within both groups from pre- to post-survey assessments [Anxiety: p < 0.0001 (POCUS), p = 0.0003 (non-POCUS); Stress: p < 0.0001 (POCUS), p < 0.0001 (non-POCUS)]. POCUS patient-families reported a significantly greater perceived importance of imaging and stated that POCUS directly alleviated their stress and anxiety.</p><p><strong>Conclusion: </strong>The primary outcome, magnitude of change in stress and anxiety, demonstrated significant reductions in both POCUS and non-POCUS groups. Despite similar findings within each group, families receiving POCUS reported greater perceived importance of imaging and strong support for its use, highlighting its potential to enhance patient-centered care and support further research into its optimal implementation in pediatric emergency care.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70295"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148025597","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}