Academic Emergency Medicine最新文献

{"title":"Overlooking Barriers to Safe and Effective Emergency Department Discharge.","authors":"Thomas K Hagerman, Fabrice I Mowbray, Tiara Lang, Maryam Nour, Jo-Ann K Rammal, Samantha Odeesho, Seraj Farhat, Howard Klausner, Mansoor Siddiqui, Joseph Miller","doi":"10.1111/acem.70320","DOIUrl":"https://doi.org/10.1111/acem.70320","url":null,"abstract":"<p><strong>Background: </strong>Physician awareness of a patient's social and functional barriers to effective and safe care after discharge from the emergency department (ED) is crucial. Yet, limited data exist evaluating the ability of resident physicians to identify these barriers.</p><p><strong>Methods: </strong>We performed a prospective cohort study of patients age ≥ 18 at a single urban ED with an emergency medicine (EM) residency program from 10/2024 to 5/2025. A research team member assessed barriers with each patient, including transportation access, difficulty affording medications, need for assistance with activities of daily living (ADL), and lack of a primary care provider. We measured health literacy and cognitive function with the Rapid Estimate of Adult Literacy in Medicine-Revised and Mini-Cog, respectively. Patient report or measurement of barriers (criterion standard) was matched to written survey data completed by the EM resident caring for the patient. We calculated sensitivity of resident identification of barriers and measured agreement using Cohen's kappa.</p><p><strong>Results: </strong>The sample included 234 patients with complete barrier data cared for by 40 EM residents. Patients consistently reported barriers at higher rates than physicians. Physicians had poor sensitivity for accurate identification of patient barriers. For example, 20.4% of patients reported they had no primary care physician (PCP) and 9.8% of residents reported their patient had no PCP [sensitivity 26.1% (95% CI 14.3-41.1), κ = 0.25]. Limited health literacy was identified in 59.0% of patients and reported by 37.6% of residents [sensitivity 44.7% (95% CI 35.7-53.9), 57.7% agreement]. Abnormal cognition was present in 53.6% of adults age ≥ 65 and reported by 16.7% of residents [sensitivity 27.3% (95% CI 13.3-45.5), 58.6% agreement].</p><p><strong>Conclusions: </strong>Patients report barriers to effective care transitions after ED discharge at higher rates than resident physicians identify these barriers. Poor agreement between patient-reported and physician-identified challenges suggests a need for enhanced training, systematic screening, and interdisciplinary collaboration.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70320"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832200","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":"Naloxone Administration in Relation to Fentanyl, Xylazine, CNS Depressants, and Stimulants Exposure After Suspected Opioid Overdose: A Pilot Study.","authors":"Roland C Merchant, Brittany Chapman, Patricia Mae Martinez, Alex Krotulski, Sara Walton, Carmen Vargas-Torres, John Broach, Kavita M Babu","doi":"10.1111/acem.70280","DOIUrl":"10.1111/acem.70280","url":null,"abstract":"<p><strong>Objectives: </strong>In this pilot, observational study, we characterized naloxone doses individuals received after suspected opioid overdoses in comparison to concentrations of fentanyl, xylazine, central nervous system (CNS) depressants, and stimulants detected in their blood.</p><p><strong>Methods: </strong>Adults (≥ 18 years old) with suspected opioid overdose presenting to two academic urban US emergency departments (EDs) were recruited between October 2022 and January 2025. Naloxone parenteral equivalents administered prior to ED arrival were compared to fentanyl and xylazine as well as to CNS depressant (e.g., benzodiazepines) and stimulant (e.g., cocaine) blood concentrations.</p><p><strong>Results: </strong>Of the 106 participants, 72% had detectable concentrations of fentanyl; 49% xylazine; 44% CNS depressants; and 74% stimulants. Total mean naloxone parenteral equivalents administered were 3.45 mg (SD 2.13), median 4.0 (IQR 2-4), and mean first dose was 1.98 (SD 1.1), median 2.0 (IQR 2-2). Xylazine concentrations increased moderately as fentanyl concentrations increased (Spearman ρ = 0.45, p < 0.001). Participants whose fentanyl concentrations were in the 4th quartile had received more naloxone (4.67 mg) than those with fentanyl concentrations in the 3rd, 2nd, and 1st quartiles (4.67, 3.22, and 2.74 mg of naloxone, respectively) (p < 0.01 for all comparisons). Of the 52 participants exposed to xylazine, those with xylazine concentrations in the 4th quartile generally had received more naloxone (5.03 mg) than those in the 3rd, 2nd, and 1st xylazine quartiles (3.35, 2.92, and 3.27 mg of naloxone, respectively), but these comparisons did not reach statistical significance (p > 0.05).</p><p><strong>Conclusions: </strong>The typical dose of naloxone needed in suspected opioid overdoses within a fentanyl endemic area was 4 mg. This dose was similar when xylazine co-exposure occurred, although it tended to be higher with higher xylazine concentrations detected. However, fentanyl was also present at higher levels when greater amounts of xylazine were present.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70280"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607805","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":"Predictors of Emergency Department Transfer Among Older Adults Seen by an Emergency Medicine Mobile Integrated Health Team.","authors":"Maura Kennedy, Sharon Pang, Melissa A Meeker, Ilianna Santangelo, Shan W Liu, Kei Ouchi, Stephen Dorner, Benjamin A White, Lauren M Nentwich, Matthew L Russell, Emily Hayden","doi":"10.1111/acem.70292","DOIUrl":"10.1111/acem.70292","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to describe the utilization of an emergency medicine-led mobile integrated health program, the Mobile Response Program (MRP), by older adults and identify predictors of being directed to the emergency department (ED).</p><p><strong>Methods: </strong>This retrospective observational cohort study included patients 65 years and older referred to MRP between 4/2021-1/2023. Collected covariates included demographics, comorbidities, referral reasons and outcomes, and for accepted referrals number of visits, tests, treatments, and disposition. We used logistic regression to identify predictors of being referred to the ED as compared to evaluation and treatment by MRP.</p><p><strong>Results: </strong>During the study, 1167 referrals were made for older adults of which 813 were accepted and received a visit, and 129 were declined and directed to the ED. Common referral reasons included shortness of breath, cough/upper respiratory infection, soft tissue infection, volume overload, urinary complaints, and confusion. Predictors of MRP declining the referral and directing patients to the ED included confusion, fall, dizziness, and failure to thrive, whereas referrals for cough had higher odds of acceptance. Among patients with an MRP visit, 19% were directed to the ED, and an additional 4% were directed to the ED but declined to go. Predictors of ED direction after MRP visits included confusion, failure to thrive, electrocardiogram performance, and nebulizer treatments; visits with COVID testing or antibiotic administration had lower odds of being directed to the ED.</p><p><strong>Conclusions: </strong>Among older adults referred to the MRP for acute medical needs, most were safely treated at home. Geriatric syndromes and non-specific complaints were associated with greater odds of being directed to the ED from the original referral and after MRP evaluation. These findings can help improve the design of these programs to meet the needs of older adults.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70292"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687629","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":"Navigating Medication Risk in the ED: Communication Preferences of Older Adults Regarding Deprescribing.","authors":"Grace Burud, Emma Lopes, Smeet Bhimani, Parag Goyal, Joshua Niznik, Kaitlin Donvan, Andrew Dodson, Kevin Musgrow, Greta Anton, Ula Hwang, Michelle L Meyer, Martin F Casey","doi":"10.1111/acem.70287","DOIUrl":"10.1111/acem.70287","url":null,"abstract":"<p><strong>Objectives: </strong>Patients and experts agree that potentially inappropriate medications should be reconsidered after adverse drug events (ADEs), yet emergency providers are often hesitant to discuss deprescribing in deference to outpatient prescribers. We sought to explore patient communication preferences for deprescribing in the emergency department (ED) after an ADE.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey study of older adults aged 65 years and older presenting to a southeastern, academic ED from June 2024 to October 2024. While awaiting results, eligible participants completed a best-worst scaling survey comparing seven potential ED communication strategies for prompting deprescription of daily aspirin. The primary analysis tested whether an ED-initiated \"therapeutic pause\" (\"Considering your bleeding, I would like you to hold your aspirin until you can discuss with your primary care provider\") was preferred by > 50% of participants over a generic discharge referral to a primary care provider through a one-sided binomial test. Secondary analyses used conditional logistic regression to evaluate relative preference across all seven deprescribing phrases.</p><p><strong>Results: </strong>In total, 102 patients completed the survey with a mean (SD) age of 75 years old (std dev 7). Among all respondents, 62% (95% CI, 52%-71%) preferred an ED-initiated 'therapeutic pause' of aspirin with primary care follow-up to the generic PCP deferral approach (p = 0.01). The least preferred statement was a strict deprescribing recommendation (\"I do not think you need aspirin anymore\"), which was selected as the least-favored communication approach in 65% of choice tasks. In conditional logistic regression, the therapeutic pause had greater odds of being selected as most preferred compared to the least preferred phrase (OR 9.3; 95% CI, 6.3-13.8).</p><p><strong>Conclusion: </strong>Our study suggests that ED physicians may take a proactive approach in addressing potential deprescribing in caring for patients with ADEs, such as initiating a therapeutic pause of aspirin after an episode of bleeding.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70287"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669618","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":"An Underrecognized Problem: Missed and Delayed Carbidopa-Levodopa Administration in Emergency Department Patients With Parkinson's Disease.","authors":"Natalie M Elder, Erica M Lash, Christopher Tomkins-Tinch","doi":"10.1111/acem.70269","DOIUrl":"10.1111/acem.70269","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with Parkinson's disease (PD) frequently present to the Emergency Department (ED). Whether for PD-related complications or unrelated concerns, maintaining their antiparkinsonian medication regimen without interruption is crucial. Delays or omissions can lead to significant morbidity and mortality. Despite this, the importance of timely ordering and administration of antiparkinsonian medications is often underrecognized in the ED.</p><p><strong>Methods: </strong>We performed a retrospective chart review across a single health system comprising one academic and five community EDs, three of which are critical access hospitals. Adults aged ≥ 65 years with an active outpatient carbidopa-levodopa (C-L) prescription presenting between September 1, 2024, and August 31, 2025, were included. The primary outcome was the proportion of patients who received their prescribed C-L during the ED encounter. Timeliness was assessed using two definitions: a primary, idealized standard of administration within 30 min of the scheduled dose, and a secondary, system-based standard of administration within a two-hour window.</p><p><strong>Results: </strong>A total of 282 patient encounters involving 87 unique patients were included (mean age 80.1 years; 61.7% male; 99.3% White). Mean ED length of stay (LOS) was 8 h and 53 min. C-L was administered in only 91 encounters (32.3%). Among the 282 ED encounters, 12 (4.3%) met the idealized timeliness definition for C-L administration, and 18 (6.4%) met the system-defined standard. Among the 91 encounters with a C-L order, 13.2% met the ideal definition and 19.8% met the system standard. Mean time from ED arrival to medication administration was 6 h 11 min. Most administrations occurred 1-4 h (39.6%) or 4-8 h (26.4%) after the scheduled dose.</p><p><strong>Conclusion: </strong>Less than one-third of older adults with PD received their home antiparkinsonian medication in the ED, and fewer than 10% received it on time. Targeted interventions to ensure timely medication administration are needed to prevent iatrogenic harm in this vulnerable population.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70269"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571788","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":"Multi-Factorial and Multi-Component Fall Prevention Interventions Initiated From the Emergency Department: A Systemic Review and Meta-Analysis.","authors":"Lauren T Southerland, Fabrice I Mowbray, Ian A Tarnovsky, Alexander X Lo, Sangil Lee, Kristie Harper, Suzanne V Ryer, Charles L Maddow, Christopher R Carpenter, Aaron J Malsch, Luna Ragsdale, Shan W Liu","doi":"10.1111/acem.70245","DOIUrl":"10.1111/acem.70245","url":null,"abstract":"<p><strong>Background: </strong>Fall risk screening and prevention interventions initiated from the Emergency Department (ED) are endorsed by current national guidelines. We aimed to evaluate the effectiveness of ED-based multi-factorial and multi-component interventions to prevent falls.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of interventions for fall prevention initiated in the ED for older patients (age ≥ 60 years). Multi-component and multi-factorial interventions were included. We excluded studies without a control or comparison group. The published literature was searched from 2019 to May 2024. Risk of bias was assessed with the Newcastle Ottawa tool for observation studies and the Cochrane Risk of Bias v2 for randomized trials. A meta-analysis was completed for the outcomes with multiple studies.</p><p><strong>Results: </strong>The search resulted in 6312 abstracts with 2571 duplicates, for 3741 unique citations. A total of 18 studies were included in the systematic review; 5 were rated as high risk of bias/low quality. The articles were heterogenous in the intervention type (8 multi-factorial and 8 multi-component), setting (ED focused vs. outpatient), intervention components (i.e., nurses, physicians, therapists), and size (103-1435 participants). The interventions did not decrease risk of falls at 3 months (risk difference 0.05 95% CI [0.00; 0.09]), 6 months (0.07 [-0.04; 0.18]) or 12 months (-0.02 [-0.11; 0.07]). ED revisits at 1 month (-0.01 [-0.03; 0.00]), 3 months (-0.04 [-0.14; 0.06]), and 12 months (0.02 [-0.05; 0.25]) were also unchanged. Mortality and hospitalization rates were also unaffected. Improvement in functional status was noted in 4 of 5 studies reporting this outcome.</p><p><strong>Conclusions: </strong>Multi-factorial and multi-component fall prevention interventions initiated from the ED did not decrease falls or recurrent healthcare use. These interventions may improve functional status in older adults at fall risk. Comparisons are limited by the heterogeneity in types of interventions, intervention compliance, and timing of outcomes.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70245"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759482","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":"Age-Specific Clinical Biomarker Ranges in Acute Head Injury, Non-TBI Trauma, and Healthy Control Subjects in the Emergency Department.","authors":"Katherine D Mayes, Timothy E Van Meter, Nazanin Mirshahi, Sally Boyd, Danielle Sandsmark, Katya Rascovsky, Ramon Diaz-Arrastia, Justin Weppner, W Frank Peacock, Damon R Kuehl","doi":"10.1111/acem.70298","DOIUrl":"10.1111/acem.70298","url":null,"abstract":"<p><strong>Objectives: </strong>Blood-based biomarkers for traumatic brain injury (TBI) are increasingly integrated into diagnostic algorithms, but their interpretation may be confounded by age-related neurological changes. This study quantified the relative effects of age and TBI on biomarker concentrations to determine whether age-related variation approaches or exceeds that associated with injury.</p><p><strong>Methods: </strong>Serum biomarkers were analyzed from 762 adults enrolled in the HeadSMART II and HeadSMART Geriatric studies, including healthy controls (n = 88), non-head trauma controls (n = 99), and mild TBI patients (GCS 13-15, n = 575). Participants were categorized by age (18-40, 41-64, 65-74, ≥ 75 years). Six TBI-relevant biomarkers (glial fibrillary acidic protein [GFAP], brain-derived neurotrophic factor [BDNF], neurogranin [NRGN], α-synuclein [SNCA], suppression of tumorigenicity 2 [ST2], and von Willebrand factor [vWF]) were quantified using validated immunoassays (BRAINBox Solutions). Biomarker levels were compared using two-way ANOVA, and the relative effects of age and injury were estimated using Cohen's f.</p><p><strong>Results: </strong>Age significantly influenced several biomarkers. GFAP showed strong age-related increases, with significant elevations across age strata (p < 0.001), exceeding the effect of head injury alone. vWF also increased significantly with age (p < 0.001), while ST2 did not show a main effect of age (p = 0.404), although age interacted with group (p < 0.001). SNCA demonstrated modest age effects (p = 0.001), particularly in older trauma and TBI participants. NRGN showed no significant age-related changes (p = 0.454), and BDNF exhibited age effects within interaction terms (p < 0.001). Overall, age-associated effect sizes for GFAP and vWF were comparable to, or greater than, those of head injury.</p><p><strong>Conclusions: </strong>Age exerts substantial influence on circulating biomarker concentrations, particularly GFAP and vWF, often rivaling or exceeding TBI-related changes. Diagnostic algorithms that fail to adjust for age may risk misclassification, especially among older adults, underscoring the need for age-normalized biomarker interpretation.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70298"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759476","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":"Association of Early Steroid and Antibiotic Therapy With Airway Outcomes in Adult Epiglottitis: A 10-Year Multicenter Retrospective Cohort Study.","authors":"Joseph O'Brien, Dominic R Muccio, Jon W Schrock","doi":"10.1111/acem.70285","DOIUrl":"10.1111/acem.70285","url":null,"abstract":"<p><strong>Background: </strong>Adult epiglottitis is an uncommon but potentially life-threatening condition requiring rapid recognition and airway-focused management, yet evidence regarding early medical therapy is limited. We evaluated temporal trends in adult epiglottitis and examined associations between early corticosteroid or antibiotic therapy and clinically important outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults (≥ 18 years) presenting to U.S. emergency departments with acute epiglottitis between 2014 and 2024 using the TriNetX Research Network. Cases were identified using the ICD-10 code J05.1; patients with preexisting tracheostomy were excluded. Early therapy was defined as systemic corticosteroid or parenteral antibiotic administration within 24 h of presentation. The primary outcome was endotracheal intubation; secondary outcomes included ICU admission, 30-day ED recidivism, and 30-day mortality. Propensity score matching (1:1) and multivariable Cox proportional hazards models were used to estimate risk ratios (RRs) and hazard ratios (HRs).</p><p><strong>Results: </strong>The annual incidence proportion of adult epiglottitis increased from 0.002% in 2014 to 0.005% in 2024 (RR per year 1.09; 95% CI 1.08-1.10), with the steepest rise among adults aged 60-74 years. In matched cohorts, early corticosteroid therapy was associated with lower risks of intubation (RR 0.48; 95% CI 0.26-0.88) and ICU admission (RR 0.71; 95% CI 0.55-0.92). Early antibiotic therapy demonstrated similar associations for intubation (RR 0.54; 95% CI 0.34-0.85) and ICU admission (RR 0.72; 95% CI 0.60-0.86). In adjusted Cox models, early steroids (HR 0.33; 95% CI 0.25-0.44) and early antibiotics (HR 0.50; 95% CI 0.34-0.75) were independently associated with lower hazards of intubation. Older age, comorbidities, and hypoxia were strong predictors of airway compromise.</p><p><strong>Conclusions: </strong>Adult epiglottitis incidence has increased over the past decade, particularly among older adults. Early corticosteroid and antibiotic therapy were independently associated with lower risks of intubation and ICU admission, supporting current clinical practice favoring timely medical therapy in adults with suspected epiglottitis.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70285"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759542","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":"Comparison of 8.4% Sodium Bicarbonate vs. 3% Sodium Chloride in Severe Hyponatremia: A Retrospective Cohort Study.","authors":"Francisco Ibarra, Johan Hsu, Anhadh Jassal, Ikroop Miglani, Shriya Deshpande, Martin Garcia, Taejung Song","doi":"10.1111/acem.70283","DOIUrl":"10.1111/acem.70283","url":null,"abstract":"<p><strong>Background: </strong>Management of severe hyponatremia requires rapid correction with 100-150 mL of 3% sodium chloride (HTS), but the lack of commercially available, ready-to-use HTS doses may contribute to delays and dosing errors. In contrast, 8.4% sodium bicarbonate (HTB) is available as a 50 mL prefilled syringe and provides a comparable sodium load, though it is not a guideline-endorsed intervention. This study evaluated whether HTB produces a serum sodium increase comparable to HTS.</p><p><strong>Methods: </strong>The primary purpose of this retrospective cohort study was to determine the number of patients whose serum sodium concentrations increased ≥ 4 mEq/L following administration of HTB or HTS. Patients were included if they were adults, had an initial serum sodium concentration ≤ 120 mEq/L, and received a single dose of HTB (50 mL) or HTS (100 mL) from January 2019 through December 2024.</p><p><strong>Results: </strong>A total of 21 patients were included in each group. The number of patients whose post-intervention serum sodium concentration increased by ≥ 4 mEq/L in the HTB and HTS groups was 10 (48%) and 2 (10%), respectively (p = 0.01). The median (IQR) change in serum sodium concentrations following study drug administration in the HTB and HTS groups was 3 mEq/L (1 to 5) and 0 mEq/L (-0.5 to 2), respectively (p = 0.005). There were no significant differences between the groups in the change in serum bicarbonate concentrations, chloride concentrations, and anion gap levels following study drug administration. No osmotic demyelination syndrome events were reported in the total population.</p><p><strong>Conclusions: </strong>This study found that a single 50 mL dose of HTB more often resulted in obtainment of guideline-recommended post-intervention serum sodium goal concentrations than a 100 mL HTS dose. Additional studies are needed to confirm these findings and provide a more comprehensive assessment of safety and efficacy outcomes.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70283"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621485","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":"Federated Meta-Analysis of HEART Score Performance for Emergency Department Chest Pain.","authors":"Hao Wang, Eric Chou, Richard D Robinson, Ali Farzad, Nicholas Saltarelli, Garrett Johnson, James d'Etienne, Simon A Mahler","doi":"10.1111/acem.70284","DOIUrl":"10.1111/acem.70284","url":null,"abstract":"<p><strong>Objectives: </strong>Multicenter evaluation of emergency department (ED) risk stratification tools is often limited by barriers to patient-level data sharing. We used the HEART score as a clinical use case to evaluate whether a federated diagnostic meta-analytic approach yields performance estimates comparable to those obtained from centralized patient-level analysis for predicting 30-day major adverse cardiovascular events (MACE30).</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter observational study across six EDs between January 1, 2020, and December 31, 2023. Adult patients presenting with chest pain who had a documented HEART score were included. MACE30 was defined as acute myocardial infarction, coronary revascularization, or all-cause mortality. The diagnostic performance of the HEART score was evaluated using a federated bivariate random-effects meta-analysis based on site-level 2 × 2 tables, yielding pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) estimates. These results were compared with performance metrics derived from centralized patient-level analysis.</p><p><strong>Results: </strong>Among 57,906 ED encounters with documented HEART scores, MACE30 occurred in 2.2%. In federated meta-analysis, the HEART score demonstrated high specificity and negative predictive value, consistent with its intended rule-out function, with modest between-site variability. The pooled HSROC area under the curve was 0.759 (95% CI, 0.646-0.831). Centralized patient-level analysis yielded similar discrimination (AUROC 0.785; 95% CI, 0.776-0.794). Differences between federated and centralized estimates were small and clinically modest, reflecting preservation of site-level heterogeneity and variation in outcome prevalence across EDs.</p><p><strong>Conclusions: </strong>Federated diagnostic meta-analysis produced HEART score performance estimates closely aligned with those obtained from centralized patient-level data. This approach enabled scalable, privacy-preserving multicenter evaluation of ED risk-stratification tools while accommodating heterogeneity across practice settings.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70284"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626983","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}