Academic Emergency Medicine最新文献

{"title":"Safety of treating low-risk patients with acute pulmonary embolism at home.","authors":"Sophia Bouzrara, Raymond Beyda","doi":"10.1111/acem.70044","DOIUrl":"https://doi.org/10.1111/acem.70044","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141098","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":"Cost-effectiveness of early noninvasive cardiac testing for suspected acute coronary syndrome.","authors":"Aniket A Kawatkar, Praveen Thokala, Steve Goodacre, Aileen S Baecker, Adam L Sharp, Rita F Redberg, Ming-Sum Lee, Maros Ferencik, Benjamin C Sun","doi":"10.1111/acem.70066","DOIUrl":"https://doi.org/10.1111/acem.70066","url":null,"abstract":"<p><strong>Background: </strong>Early noninvasive cardiac testing (NIT) is often performed in the initial workup of patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS). Our study objective was to calculate the cost-effectiveness of adopting early NIT for risk stratification to avoid future nonfatal acute myocardial infarction (MI) or death.</p><p><strong>Methods: </strong>To obtain the incremental difference in cost and clinical outcomes, we first conducted a multicenter retrospective cohort study within the member population of the Kaiser Permanente Southern California integrated health care delivery system. We then adapted existing cost effectiveness models to generate long-term costs and quality-adjusted life-years (QALYs) gained by NIT.</p><p><strong>Results: </strong>The cohort included 89,387 patients (mean age 57 years, 58% female) and 19% received early NIT. Total cost was higher by $2357 (95% confidence interval [CI] $77 to $4821) for early NIT compared to no early NIT and was mainly due to the increased cost of the index ED visit. Early NIT was associated with lower composite risk of death/nonfatal MI (absolute risk difference -3.7%, 95% CI -4.4% to -3.01%) during a 1-year follow-up. From a payor's perspective, early NIT was cost-effective at $5268/QALYs.</p><p><strong>Conclusions: </strong>In patients with suspected ACS evaluated in the ED, incorporation of early NIT was associated with an overall increase in cost of health care that was driven by increased cost of the initial ED visit. However, due to the significant clinical benefits, early NIT was cost-effective in the low- and intermediate-risk patients while it is a dominant strategy in high-risk patients saving cost and QALYs.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136200","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":"Racial disparities and patient-centered choice in medications for opioid use disorder: A commentary on Hazekamp et al.","authors":"Wen Ling Chen, Lien-Chung Wei","doi":"10.1111/acem.70071","DOIUrl":"https://doi.org/10.1111/acem.70071","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136204","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":"Variation in point-of-care ultrasound privileges in academic emergency departments.","authors":"Zachary Boivin, Arjun K Venkatesh, Christopher L Moore","doi":"10.1111/acem.70067","DOIUrl":"https://doi.org/10.1111/acem.70067","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126439","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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-21","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":"Negative feedback.","authors":"James S Huntley","doi":"10.1111/acem.70068","DOIUrl":"https://doi.org/10.1111/acem.70068","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092034","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":"Reply to Pelaccia et al.: hold on the bathwater.","authors":"Pat Croskerry, Mike Clancy","doi":"10.1111/acem.70057","DOIUrl":"https://doi.org/10.1111/acem.70057","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075324","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":"Combined screening of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in an emergency department: The URDEPTRIO cross-sectional study.","authors":"Chris Wong, Quentin Le Hingrat, Florian Salipante, Vincent Mackiewicz, Florence Damond, Lucile Larrouy, Christophe Choquet, Dan Pospai, Karen Champenois, Diane Descamps, Judith Leblanc, Paul Loubet, Enrique Casalino, Jade Ghosn, Donia Bouzid","doi":"10.1111/acem.70060","DOIUrl":"https://doi.org/10.1111/acem.70060","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075322","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":"Implementation of geriatric clinical decision support in the emergency department for potentially inappropriate medications.","authors":"Gina A Elder, Kevin King, Marc Willner, Matthew J Campbell, Baruch S Fertel, Saket Saxena, Stephen Meldon","doi":"10.1111/acem.70059","DOIUrl":"https://doi.org/10.1111/acem.70059","url":null,"abstract":"<p><strong>Objectives: </strong>The use of potentially inappropriate medications (PIMs) in older adults in the emergency department (ED) is associated with increased risk of readmissions and adverse drug reactions. We sought to assess the impact of electronic health record (EHR)-based geriatric clinical decision support (CDS) on adherence to geriatric recommendations for targeted PIMs prescribed to older adults while in the ED and at ED discharge.</p><p><strong>Methods: </strong>We performed a multicenter pre-post implementation cohort study comparing adherence to geriatric recommendations before and after implementation of ED geriatric CDS for patients 65 years or older for a targeted list of 12 PIMs. ED geriatric CDS consisted of custom order panels with clinical guidance for preferred alternative agents or preferred geriatric dosing if providers opted to proceed with ordering a targeted PIM; CDS was implemented for both medications ordered during the ED visit as well as outpatient prescriptions ordered at discharge. The primary outcomes were the proportions of ED orders and discharge prescriptions adherent to ED geriatric CDS recommendations.</p><p><strong>Results: </strong>A total of 6745 ED orders and 1440 discharge prescriptions were eligible for study inclusion. The proportion of targeted PIMs consistent with geriatric CDS recommendations was higher in the postimplementation group compared to preimplementation group for both ED orders (52% vs. 71%; difference 19%, 95% confidence interval [CI] 16.8%-21.3%) and discharge prescriptions (0.5% vs. 31.7%; difference 31.1%, 95% CI 27.5%-34.7%). In the postimplementation period, geriatric CDS order panel utilization for targeted PIMs was 62.1% for ED orders and 36.7% for discharge prescriptions. Among orders placed through ED geriatric CDS order panels, 90% of ED orders and 80.4% of discharge prescriptions were adherent to geriatric CDS recommendations.</p><p><strong>Conclusions: </strong>EHR-based CDS for older adults in the ED increased the proportion of ED orders and discharge prescriptions adherent to geriatric drug therapy recommendations.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960510","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":"Paper.","authors":"Jonathan D Talmud","doi":"10.1111/acem.70063","DOIUrl":"https://doi.org/10.1111/acem.70063","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959707","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}