Academic Emergency Medicine最新文献

{"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":"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":"994-1002"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","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":"From bias to knowledge: A necessary shift to understand diagnostic errors.","authors":"Thierry Pelaccia, Jonathan Sherbino, Peter Wyer","doi":"10.1111/acem.70056","DOIUrl":"10.1111/acem.70056","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1043-1044"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958089","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":"10.1111/acem.70068","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1047"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","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":"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":"10.1111/acem.70067","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1033-1035"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","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":"Early versus delayed colonoscopy for acute lower gastrointestinal bleeding.","authors":"Olalekan Shobowale, Elias Youssef","doi":"10.1111/acem.70061","DOIUrl":"10.1111/acem.70061","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1036-1038"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957515","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":"Neighborhood-level variation in prehospital care of patients with suspected stroke in Rhode Island.","authors":"Rebecca Karb, Tina Burton, Timmy Lin, Janette Baird, Maheen Rana, Tracy E Madsen","doi":"10.1111/acem.70046","DOIUrl":"10.1111/acem.70046","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify neighborhood-level inequities in prehospital stroke care, including EMS utilization and last known well (LKW) to ED presentation, in a small state with one large comprehensive stroke center.</p><p><strong>Methods: </strong>This was a retrospective observational study using 2 years of data (2020-2022) from Get With The Guidelines combined with data collected by a large hospital system in Rhode Island that includes a comprehensive stroke center (CSC), the Rhode Island emergency management system database, and 2020 census data.</p><p><strong>Results: </strong>Census tract disadvantage was significantly associated with LKW to ED arrival times, with individuals from more disadvantaged neighborhoods presenting almost a full hour later than individuals from the least disadvantaged neighborhoods (56.9 min, 95% confidence interval 14.9-90.3 min). EMS use was the strongest predictor of LKW to ED arrival times, and the Latinx population was significantly less likely to utilize EMS compared to the White population.</p><p><strong>Conclusions: </strong>Understanding geographical inequities in stroke recognition and prehospital stroke care can help mitigate important socioeconomic and racial/ethnic disparities. In addition, geospatial analysis provides useful information for targeting intervention strategies to neighborhoods with the longest LKW to ED arrival times and lowest use of EMS.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"966-974"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959935","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":"Effect of host-protein test (TRAIL/IP-10/CRP) on antibiotic prescription and emergency department or urgent care center return visits: The JUNO pilot randomized controlled trial.","authors":"Adam J Singer, Judd E Hollander, Efrat R Kean, Hope Ring, W Frank Peacock, Karina M Soto-Ruiz, Sergey Motov, Joby Thoppil, Phyllis Hendry, Salim Halabi, Andrew C Meltzer, Gary F Headden, Tal Brosh-Nissimov, David Zeltser, Chad M Cannon","doi":"10.1111/acem.70031","DOIUrl":"10.1111/acem.70031","url":null,"abstract":"<p><strong>Objectives: </strong>Determining etiology for adults with symptoms of lower respiratory tract infection (LRTI) is challenging. MeMed BV (MMBV), an FDA-cleared blood test, computationally integrates the levels of three host proteins to differentiate bacterial and viral infections. We evaluated MMBV's impact on safe antibiotic prescribing at emergency department/urgent care centers (ED/UC).</p><p><strong>Methods: </strong>The JUNO randomized controlled trial (RCT; NCT05762302) was a prespecified pilot phase of the JUPITER RCT. JUNO enrolled adult ED/UC patients with LRTI symptoms and clinician's consideration for antibiotic treatment. Inclusion criteria were fever within 7 days and one of cough, sputum production, dyspnea, or auscultation abnormality. Exclusion criteria were prior antibiotic use or immunosuppression. Patients were randomized to standard care (SC) or SC plus MMBV arms. JUNO's primary objective was to assess antibiotic prescription rate in the SC arm; the secondary objective was to assess JUPITER's study design.</p><p><strong>Results: </strong>Eleven centers randomized 260 patients, with 214 included (106 SC, 108 MMBV). Median (IQR) age was 40 (28-55.8) years, 57% were female, and 78.5% were enrolled at ED. Common symptoms were cough (93.0%) and chills (70.0%). Overall, antibiotic prescription rates were 30% (95% CI 22% to 40%) and 24% (95% CI 17% to 33%) in the SC arm versus the MMBV (absolute difference of -6% [95% CI -18% to 6%]). More antibiotics were given with bacterial MMBV scores (41% vs. 78%, absolute difference 37%, 95% CI 6% to 61%; n = 40) and less with viral MMBV scores (25% vs. 12%, absolute difference -13%, 95% CI -25% to 0%; n = 144) in the SC versus MMBV arms. There was no increase in ED/UC return visits (8% vs. 3%, difference -6%, 95% CI -12% to 1%) or hospitalizations (3% vs. 0%, difference -3%, 95% CI -7% to 1%) in the SC arm versus the MMBV arm.</p><p><strong>Conclusions: </strong>JUNO demonstrated that JUPITER's design results in 30% antibiotic prescription rate in the SC arm. JUNO supports that MMBV optimizes antibiotic prescriptions without increasing return ED/UC visits or hospitalizations.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"975-984"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963378","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":"Strategies for successful research recruitment and program implementation in pediatric emergency medicine.","authors":"Jacob G Calamaro, Dunia Hatabah, Laura Benedit, Calvin Abdallah, Bolanle Akinsola, Tal Berkowtiz, Natoli Bora, Rebecca K Burger, Jordan E Bryant, Melissa N Cameron, Gabrielle Fisher, Sandy Francois, Robert Grell, Mark Griffiths, Peter Gutierrez, Afshin Heidari, Ashley Hoyos, Shabnam Jain, Kaitlin Jones, Naghma Khan, Sravani Konatham, Rawan Korman, Jeffrey Ling, Wendalyn Little, Vivian Luu, Giorgi Maziashvili, Kathryn Mawhinney, Marc McCloskey, Lauren Middlebrooks, Carrie Ng, Emily Perez, Grace Promer, Naina Reddy, Chris A Rees, Mara Rodriguez, Avnee Sarnaik, Harold K Simon, Bridget A Wynn, Maria Yasmine, Claudia R Morris","doi":"10.1111/acem.70038","DOIUrl":"10.1111/acem.70038","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1024-1026"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951911","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":"Racial, ethnic, and sex disparities in buprenorphine treatment from emergency departments by discharge diagnosis.","authors":"Neeraj Chhabra, Dale Smith, Natalie Parde, Nicole Hsing-Smith, Joseph M Bianco, R Andrew Taylor, Gail D'Onofrio, Niranjan S Karnik","doi":"10.1111/acem.70035","DOIUrl":"10.1111/acem.70035","url":null,"abstract":"<p><strong>Objectives: </strong>Racial and sex disparities are noted in the administration and prescribing of buprenorphine from emergency departments (EDs) nationally. It is unknown whether disparities persist when accounting for the specific discharge diagnosis addressed during encounters such as opioid overdose or withdrawal.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of opioid-related ED encounters from January 2020 through December 2023 using a national database, Epic Cosmos. We analyzed the effect of opioid encounter subtype-overdose or withdrawal-on receipt of buprenorphine using multivariable logistic regression adjusting for demographics and measured confounding variables. Encounter subtypes were defined by diagnosis codes and buprenorphine receipt was defined as administration or prescribing. We evaluated for racial, ethnic, and sex disparities within encounter subtypes for withdrawal and overdose.</p><p><strong>Results: </strong>We examined 1,088,033 opioid-related encounters. Adjusted odds for buprenorphine receipt were greater for encounters involving withdrawal (odds ratio [OR] 2.22, 95% CI 2.18-2.26), though reduced for overdose (OR 0.52, 95% CI 0.51-0.53) and other opioid complications (OR 0.69, 95% CI 0.64-0.70). Males were more likely to receive buprenorphine (OR 1.18, 95% CI 1.16-1.19) than females. All racial minorities excepting American Indian/Native American patients (OR 1.04, 95% CI 1.00-1.08) were less likely to receive buprenorphine than White patients (Asian OR 0.85, 95% CI 0.79-0.81; Black OR 0.80, 95% CI 0.79-0.81; Native Hawaiian/Pacific Islander OR 0.79, 95% CI 0.71-0.89). Subtype analyses indicated decreased odds for buprenorphine receipt for female patients across all subtypes. An increased odds for buprenorphine receipt among Black patients (OR 1.04, 95% CI 1.01-1.07; ref. White race) was noted in encounters involving opioid withdrawal but disparities persisted for opioid overdose.</p><p><strong>Conclusions: </strong>The administration and prescribing of buprenorphine in the ED is heavily influenced by the presence of opioid withdrawal. Disparities disadvantage female patients and racial minorities. Some racial disparities, particularly among Black patients, are not evident when solely considering encounters involving opioid withdrawal. System-level interventions are needed to address disparities and improve the equitable uptake of ED-initiated buprenorphine.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"985-993"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958796","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":"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":"10.1111/acem.70071","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1039-1040"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","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}