Academic Emergency Medicine最新文献

{"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":"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":"526-531"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","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":"The cost of saving lives: Complications arising from prehospital tourniquet application.","authors":"Mor Rittblat, Sami Gendler, Nir Tsur, Irina Radomislensky, Arnona Ziv, Moran Bodas","doi":"10.1111/acem.15070","DOIUrl":"10.1111/acem.15070","url":null,"abstract":"<p><strong>Background: </strong>Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors.</p><p><strong>Methods: </strong>This retrospective observational study reviewed the medical records of adult trauma casualties (>18 years) hospitalized at Chaim Sheba Medical Center (SMC) between 2010 and 2020 who had a TQ applied in the prehospital setting. The primary outcome was the rate and type of complications. Logistic regression analyses identified risk factors using demographic, injury, and clinical data.</p><p><strong>Results: </strong>From 2010 to 2020, a total of 84 trauma casualties with documented prehospital TQ application were hospitalized at SMC. Of these, 20 (23.81%) experienced TQ-related complications, including local infection, compartment syndrome, and thromboembolism. The average TQ application time was 44.2 min, with no significant difference between those with and without complications. However, significant differences were noted in the mechanism of injury (MOI), wound contamination levels, indications for TQ application, and initial blood test results (p < 0.05). Logistic regression analyses revealed length of stay (LOS) and injuries from falls were significantly associated with the development of complications.</p><p><strong>Conclusions: </strong>This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"532-541"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833415","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":"Words to live by: Using medic impressions to identify the need for prehospital lifesaving interventions.","authors":"Aaron C Weidman, Zach Sedor-Schiffhauer, Chase Zikmund, David D Salcido, Francis X Guyette, Leonard S Weiss, Ronald K Poropatich, Michael R Pinsky","doi":"10.1111/acem.15067","DOIUrl":"10.1111/acem.15067","url":null,"abstract":"<p><strong>Background: </strong>Prehospital emergencies require providers to rapidly identify patients' medical condition and determine treatment needs. We tested whether medics' initial, written impressions of patient condition contain information that can help identify patients who require prehospital lifesaving interventions (LSI) prior to or during transport.</p><p><strong>Methods: </strong>We analyzed free-text medic impressions of prehospital patients encountered at the scene of an accident or injury, using data from STAT MedEvac air medical transport service from 2012 to 2021. EMR records were used to identify LSIs performed for these patients in prehospital settings. Text was cleaned via natural language processing and transformed using term frequency-inverse document frequency. A gradient boosting machine learning (ML) model was used to predict individual patient need for prehospital LSI as well as seven LSI subcategories (e.g., airway interventions, blood transfusion, vasopressor medication).</p><p><strong>Results: </strong>A total of 12,913 prehospital patients were included in our sample (mean age = 52.3 years, 63% men). We observed good ML performance in predicting overall LSI (area under the receiver operating curve = 0.793, 95% confidence interval = [0.776-0.810]; average precision = 0.670, 95% confidence interval = [0.643-0.695] vs. LSI rate of 0.282) and equivalent-or-better performance in predicting each LSI subcategory except for crystalloid fluid administration. We identified individual words within medic impressions that portended high (e.g., unresponsive, hemorrhage) or low (e.g., droop, rib) LSI rates. Calibration analysis showed that models could prioritize correct LSI identification (i.e., high sensitivity) or accurate triage (i.e., low false-positive rate). Sensitivity analyses showed that model performance was robust when removing from medic impressions words that directly labeled an LSI.</p><p><strong>Conclusions: </strong>ML based on free-text medic impressions can help identify patient need for prehospital LSI. We discuss future work, such as applying similar methods to 9-1-1 call requests, and potential applications, including voice-to-text translation of medic impressions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"516-525"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035613","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":"Un-clearance.","authors":"Marc Borenstein","doi":"10.1111/acem.70018","DOIUrl":"10.1111/acem.70018","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"591"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603345","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":"Research themes and key data points for child and adolescent emergency department mental health presentations: A national Delphi study.","authors":"Marietta R John-White, Edmund Proper, Frank Muscara, Franz E Babl, Vicki A Anderson, Catherine L Wilson, Meredith L Borland, Bruce J Tonge, Kylie M Gray, Glenn A Melvin, Amit Kochar, Rohan Borschmann, Richard Haslam, Emma J Tavender, Michael S Gordon, Stuart R Dalziel, Karen Smith, Simon S Craig","doi":"10.1111/acem.15056","DOIUrl":"10.1111/acem.15056","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to identify a prioritized list of research themes and key data points (baseline data and research outcomes) for future studies regarding child and adolescent emergency department (ED) mental health presentations.</p><p><strong>Methods: </strong>A prospective survey-based Delphi process was undertaken in Australia within the Pediatric Research in Emergency Departments International Collaborative (PREDICT) network. Hospital-based and community-based clinicians, researchers, police, ambulance paramedics, pediatric patients, and their carers were recruited to generate research themes and key data points for future pediatric ED mental health research. Responses were collated and analyzed by a steering group consisting of pediatric mental health, medical, and research/academic experts. Participants then prioritized the items through three survey rounds using a 9-point Likert-type scale to generate a final prioritized list.</p><p><strong>Results: </strong>184 participants (36 patients/carers and 148 clinicians/researchers) were recruited and generated 267 items for initial prioritization; 23 completed all survey rounds. The surveys identified a consensus of 71 items: 35 research themes and 36 key data points (11 baseline data points and 25 research outcomes) for future research. The top-rated research themes included patient/staff safety within the ED, the efficacy of dedicated mental health spaces, and the importance of patient follow-up. Important baseline data points included risk factors for mental health presentations and history of child abuse and/or family violence. Top-rated research outcomes included the occurrence of severe behavioral disturbance in the ED, the use of parenteral sedation, and ED re-presentation and/or suicide attempt postdischarge.</p><p><strong>Conclusions: </strong>The Delphi process identified a prioritized list of research themes and key data points that will inform future research on child and adolescent mental health-related ED presentations.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"542-552"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765347","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":"Global emergency medicine: A scoping review of the literature from 2023.","authors":"Braden J Hexom, Nana Serwaa A Quao, N Shakira Bandolin, Joseph Bonney, Morgan C Broccoli, Amanda Collier, Nanaba A Dawson-Amoah, Jonathan Dyal, Vinay Kampalath, J Austin Lee, Chris A Rees, Gabriel Lucca de Oliveira Salvador, Jonathan M Strong, Sean M Kivlehan","doi":"10.1111/acem.70012","DOIUrl":"10.1111/acem.70012","url":null,"abstract":"<p><strong>Objective: </strong>The Global Emergency Medicine Literature Review (GEMLR) highlights the highest-quality research addressing emergency care in resource-limited settings (ECRLS). This 18th edition reviews global emergency medicine (GEM) literature published during 2023.</p><p><strong>Methods: </strong>A scoping review of GEM articles published in 2023 was performed using a systematic PubMed search and manual gray literature (GRAY) search. Reviewers and editors from 10 countries screened articles utilizing case definitions of three categories of GEM research-disaster and humanitarian response (DHR), ECRLS, and emergency medicine development (EMD). After duplicates and those not meeting authorship equity and ethical review requirements were removed, articles were scored according to rubrics for original research (OR), review articles (RE), and GRAY. Those in the top 5% from any category were summarized and critiqued in narrative review.</p><p><strong>Results: </strong>There were 58,291 articles identified in the main search and 11,035 in the GRAY search. A total of 825 articles from the main search and 37 GRAY articles screened in and were scored. Fifty-five main search articles and one GRAY article were included after scoring, a 52.8% increase from 2022 despite <1% change in search volume. ECRLS remained the largest category (63%). As in previous years, articles frequently addressed emergencies in pediatrics (10 articles), trauma (9), prehospital care (8), maternal/neonatal care (6), education/training (6), disaster medicine (4), and airway/sedation management (4). A total of 3.5% of screened-in articles failed to meet GEMLR's new authorship equity and ethics standards.</p><p><strong>Conclusions: </strong>The quantity and quality of GEM research continues to grow as measured by the GEMLR scoring system. A revised search string identified relevant GEM articles with broad application in global settings. New equity guidelines were successfully implemented. This review summarizes the highest quality current GEM research while providing evolving guidelines for best practices in performing this important and rapidly growing work.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"553-569"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571658","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":"Ten-percentage-points difference is not enough for a better experience in getting timely care for emergent patients.","authors":"Amir Mirhaghi","doi":"10.1111/acem.15064","DOIUrl":"10.1111/acem.15064","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"588-589"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852062","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":"Which grading system better predicts 28-day mortality in nontraumatic subarachnoid hemorrhage: Traditional clinical scores or combined grading systems?","authors":"Adem Az, Ozgur Sogut, Ertugrul Altinbilek, Irem Yildirim Oral, Mustafa Calik, Merve Metiner, Abuzer Coskun, Burak Demirci, Ramazan Guven, Ertugrul Altug, Burcu Durmus, Nihat Mujdat Hokenek, Eymen Tekedereli","doi":"10.1111/acem.15121","DOIUrl":"10.1111/acem.15121","url":null,"abstract":"<p><strong>Background: </strong>The objective was to investigate the predictive ability of traditional clinical, radiological scores, and combined grading systems for 28-day mortality in patients with nontraumatic subarachnoid hemorrhage (SAH).</p><p><strong>Methods: </strong>This multicenter cohort study enrolled 451 adults who presented to the emergency departments of six major tertiary care hospitals in Istanbul with nontraumatic aneurysmal SAH. Demographic data; clinical characteristics; and traditional clinical grading scores were recorded, including the Glasgow Coma Scale (GCS), Hunt and Hess scale (HHS), World Federation of Neurological Surgeons (WFNS) scale, modified Fisher scale (mFS), and two combined grading systems, the VASOGRADE and Ogilvy-Carter scales. These data were compared between survivors and nonsurvivors.</p><p><strong>Results: </strong>A total of 451 patients were included, comprising 242 males (53.7%) and 209 females (46.3%), with a mean ± SD age of 54.8 ± 14.1 years. The overall mortality rate was 28.2% (n = 127). Nonsurvivors had significantly lower mean GCS scores and higher HHS, WFNS, mFS, and Ogilvy-Carter scores compared to survivors (all p < 0.001). A significantly higher proportion of nonsurvivors were categorized in the red group based on VASOGRADE (p < 0.001). Multivariable logistic regression analysis identified age, sex, HHS, mFS, WFNS, and VASOGRADE as independent predictors of mortality. The WFNS scale emerged as the most reliable predictor of mortality with an area under the curve of 0.878.</p><p><strong>Conclusions: </strong>Although the GCS and Ogilvy-Carter scales effectively distinguished survivors from nonsurvivors, they were not independent predictors of mortality. The WFNS scale was identified as the most reliable predictor of mortality in aneurysmal SAH patients, followed by the mFS and HHS.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"498-505"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254314","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":"Patterns of emergency department visits prior to dementia or cognitive impairment diagnosis: An opportunity for dementia detection?","authors":"Justine Seidenfeld, Tessa Runels, Joseph L Goulet, Matthew Augustine, Cynthia A Brandt, Susan N Hastings, William W Hung, Luna Ragsdale, Jennifer L Sullivan, Carolyn W Zhu, Ula Hwang","doi":"10.1111/acem.14832","DOIUrl":"10.1111/acem.14832","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"570-573"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11074234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476934","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":"Utility of predictive scales for emergency department patients with a new diagnosis of aneurysmal subarachnoid hemorrhage.","authors":"Jeffrey J Perry, Shane English","doi":"10.1111/acem.70010","DOIUrl":"10.1111/acem.70010","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"586-587"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603354","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}