Academic Emergency Medicine最新文献

{"title":"Clinician-level variation in admission practices for common conditions in Veteran Affairs emergency departments.","authors":"Alexander T Janke, Aaron Dalton, Keith E Kocher, Anita A Vashi","doi":"10.1111/acem.70020","DOIUrl":"https://doi.org/10.1111/acem.70020","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Affairs (VA) Healthcare System seeks to improve value of care. Variations in hospital admission practices may be a target to improve the efficiency and quality of emergency care.</p><p><strong>Method: </strong>This was a retrospective cross-sectional analysis of 113 VA emergency departments (EDs) from October 1, 2015 to June 8, 2023. ED visits were included if their primary diagnosis matched one of 535 ICD-10 codes within the previously developed admission intensity measure, encompassing 16 clinical conditions with known variation in admission practices and opportunities for outpatient management. The primary outcome was the standard deviation (SD) of clinician-level, risk-adjusted admission rates for each condition, calculated using multilevel, hierarchical models accounting for patient sociodemographic and clinical characteristics. We then summarized the SD of clinician admission rates, based on total admission volume at VA. We further assessed the association between clinician admission intensity and 72-h ED return visits resulting in hospitalization, a safety indicator, using Pearson correlation coefficients.</p><p><strong>Results: </strong>During the study period, 18.5 million ED visits were recorded across 9350 clinicians, with 3,815,094 visits (20.6%) having primary diagnoses matching one of the 16 clinical conditions included in the admission intensity measure. Patients' mean (±SD) age was 63.3 (SD 15.4) years, and 89.9% were male. Among the 16 conditions, chest pain accounted for the highest number of admissions (229,507) and exhibited the greatest variation (SD ±14.7%) in clinician-level admission rates, while nephrolithiasis had the lowest variation (SD ±4.6%). There was no significant association between clinician admission rates and 72-h ED returns (Pearson correlation 0.018).</p><p><strong>Conclusion: </strong>A previously developed admission intensity measure may help identify improvement opportunities in hospitalization practices across VA EDs. Chest pain was the most common condition among those in the measure, and subject to the most variability in admission practices among clinicians.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646668","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":"Intravenous Magnesium: Prompt use for Asthma in Children Treated in the Emergency Department (IMPACT-ED), a pilot randomized trial.","authors":"Michael D Johnson, Bashar S Shihabuddin, Bradley J Barney, Mengtao Dai, Toni Harbour, Yeojin Jung, Kameron N Clinton, Breanna Vance, Madison Reilly, Joseph J Zorc","doi":"10.1111/acem.70006","DOIUrl":"https://doi.org/10.1111/acem.70006","url":null,"abstract":"<p><strong>Background: </strong>Asthma is the most common chronic illness of childhood and a leading cause of hospitalization and health care costs for children. Intravenous magnesium sulfate (IVMg) may help severely ill children avoid hospitalization when added to standard treatment in an emergency department (ED), but this has not been adequately evaluated in a large trial. We conducted a pilot trial to test procedures and gather information to plan a large multicenter trial.</p><p><strong>Methods: </strong>Children 2-17 years old with severe acute asthma were randomized in a multicenter, double-blind, controlled trial of placebo (saline, 1 mL/kg, max 40 mL), low-dose IVMg (50 mg/kg, max 2 g), or high-dose IVMg (75 mg/kg, max 3 g) in addition to standard asthma therapy at the EDs of three tertiary pediatric hospitals between September 2022 and May 2023. We assessed the feasibility of delivering study drug within 90 min of treatment (defined as the start of the first inhaled albuterol) and monitoring for hypotension and obtained blood samples for pharmacologic analysis. Our target enrollment was one participant per site per week (90 total).</p><p><strong>Results: </strong>A total of 52 patients were randomized, and 49 received study drug. Median (Q1, Q3) participant age was 6.3 (4.6, 9.6) years and 35 (67.3%) were male. Among 52 randomized participants, study drug was delivered within 90 min to 34 (65.4%), 486/542 (89.7%) anticipated blood pressure measurements were within time frames, 138/156 (88.5%) anticipated blood samples were obtained, and 38 (73.1%) were hospitalized. Hypotension was measured within 2 h of study drug administration in 2/18 (11.1%) who received placebo and 2/31 (6.5%) who received IVMg.</p><p><strong>Conclusions: </strong>Most anticipated blood pressure measurements and blood samples were obtained. Hypotension occurred at rates similar to previous reports. Lower-than-expected enrollment (related to low patient volumes) and timely delivery of study drug will require consideration for a larger trial.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646688","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":"Ode to my daughter.","authors":"Tommaso Bellini","doi":"10.1111/acem.70023","DOIUrl":"https://doi.org/10.1111/acem.70023","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612965","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":"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":"https://doi.org/10.1111/acem.70010","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1111/acem.70024","DOIUrl":"https://doi.org/10.1111/acem.70024","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612962","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":"Endovascular therapy for acute vertebrobasilar occlusion stroke.","authors":"Brit Long, Michael Gottlieb","doi":"10.1111/acem.70019","DOIUrl":"https://doi.org/10.1111/acem.70019","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612952","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":"Un-clearance.","authors":"Marc Borenstein","doi":"10.1111/acem.70018","DOIUrl":"https://doi.org/10.1111/acem.70018","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","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":"Understanding frailty screening of older adults in the emergency department: A survey of emergency physicians in Ontario.","authors":"Priyank Bhatnagar, Don Melady, Cameron Thompson, Shelley McLeod, Alice Gray, Keerat Grewal","doi":"10.1111/acem.70016","DOIUrl":"https://doi.org/10.1111/acem.70016","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603349","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":"Validation of the Sudbury Vertigo Risk Score to risk stratify for a serious cause of vertigo.","authors":"Elliot Tissot van Patot, Danielle Roy, Elger Baraku, Kashyap Patel, Sarah McIsaac, Ravinder Singh, Daniel Lelli, Darren Tse, Peter Johns, Krishan Yadav, David W Savage, Jeffrey J Perry, Robert Ohle","doi":"10.1111/acem.70017","DOIUrl":"https://doi.org/10.1111/acem.70017","url":null,"abstract":"<p><strong>Introduction: </strong>In 2022, nearly 0.5 million Canadians visited an emergency department (ED) for dizziness, accounting for over 3.5% of all ED visits. Of these patients, only 2%-5% received a serious diagnosis. The cost of ED and inpatient care for dizziness in Canada exceeds $200 million per year, of which neuroimaging accounts for a large proportion. Over one-third of dizziness patients undergo a CT scan of the head, 96% of which are negative. Despite extensive investigation, patients discharged with a benign dizziness diagnosis have a 50-fold increased risk of being admitted to the hospital within 7 days with a diagnosis of stroke. Our study aimed to derive a clinical risk score to guide the investigation and referral for serious causes of vertigo in ED patients.</p><p><strong>Methods: </strong>This multicenter historical cohort study was conducted over 7 years at three university-affiliated tertiary care EDs. Patients presenting with vertigo, dizziness, or imbalance were recruited. The main outcome was an adjudicated serious diagnosis, defined as stroke, transient ischemic attack, vertebral artery dissection, or brain tumor. We estimated a sample size of 4450 patients, based on a 2% prevalence of serious outcomes, to evaluate the sensitivity with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 4559 patients were enrolled (mean age 78.1 years, 57.8% women), with serious events occurring in 104 (2.3%) patients. The C-statistic was 0.95 (95% CI 0.92-0.98). The risk of a serious diagnosis ranged from 0% for a score of <5 to 16.7% for a score >8. Sensitivity for a serious diagnosis was 100% (95% CI 96.5%-100%) and specificity was 69.2% (95% CI 67.8%-70.51%) for a score <5.</p><p><strong>Conclusion: </strong>The Sudbury Vertigo Risk Score effectively identifies the risk of a serious diagnosis in patients with dizziness. Thus, it guides further investigation, consultation, and treatment decisions and ultimately improves resource utilization and reduces missed diagnoses.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603358","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}