Academic Emergency Medicine最新文献

{"title":"A National Study of Tetanus Vaccine Knowledge, Receipt and Acceptance Among Emergency Department Patients.","authors":"Francesco Sergi, Elisa Vaezazizi, Shaokui Ge, Christopher Alvarez, Jesus Torres, Brian Chinnock, Michael Gottlieb, Vijaya Arun Kumar, Kristin L Rising, Efrat Rosenzweig Kean, Stephanie Eucker, Robert M Rodriguez","doi":"10.1111/acem.70401","DOIUrl":"10.1111/acem.70401","url":null,"abstract":"<p><strong>Objective: </strong>The Tetanus, Diphtheria, Pertussis (Tdap, \"tetanus\") vaccine is recommended for adults every 10 years. In a national sample of adult emergency department (ED) patients, we sought to determine (1) knowledge and up-to-date status of the tetanus vaccine; (2) reasons for nonreceipt of the vaccine; (3) vaccine acceptability if offered in the ED; and (4) reasons for nonacceptance in the ED if offered.</p><p><strong>Methods: </strong>This was a cross-sectional survey study among non-critically ill adults at 10 US EDs, asking questions about knowledge, receipt, and acceptability of the tetanus vaccine. Vaccine receipt was determined by self-report. Aggregate responses are reported as descriptive statistics. Logistic regression modeling was performed, and data are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Of 4326 patients approached, 3285 (75.9%) agreed to participate, and 5 were excluded because of incomplete responses. Among 3280 participants, 13.4% had not heard of the vaccine; and 58.0% were not up-to-date. Factors associated with not being up-to-date included age 34-48 (aOR 0.65; 95% CI 0.53-0.81), African American race (aOR 1.46; 95% CI 1.19-1.79), no primary care doctor (aOR 1.29; 95% CI 1.04-1.61) and no insurance (aOR 1.86; 95% CI 1.36-2.56). Among participants not up-to-date, 21.6% would accept it during their ED visit. Primary reasons for nonacceptance were needing more information, concerns about side effects, and preference to get it from their doctor.</p><p><strong>Conclusions: </strong>Over half of adult ED patients are not up-to-date on the tetanus vaccine but only one-fifth would accept it if offered during an ED visit. ED-centered efforts to increase uptake should provide messaging to address vaccine hesitancy.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70401"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863185","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":"Differentiating Normal Healing From Infection in Total Joint Arthroplasty: An Educational and Diagnostic Tool for Emergency Providers Evaluating the Postoperative Patient.","authors":"Thomas W Brown, Andrew T Carusi, Michael Langworthy","doi":"10.1111/acem.70414","DOIUrl":"10.1111/acem.70414","url":null,"abstract":"<p><p>Patients frequently present to the emergency department (ED) with pain, swelling, or erythema in the early period following total joint arthroplasty (TJA). Differentiating normal postoperative inflammation from superficial surgical site infection (S-SSI) or early periprosthetic joint infection (PJI) can be difficult due to overlapping clinical and laboratory features, particularly within the first 30 days after surgery. We seek to provide emergency providers with an efficient and evidence-based framework for differentiating normal healing from early infection following TJA. We accomplish this by reviewing postoperative physiology, temporal response of inflammatory markers and synovial fluid analysis, and existing diagnostic criteria for infection. Normal healing after TJA produces predictable inflammatory responses that commonly exceed thresholds established for chronic PJI diagnosis. Therefore, early PJI diagnosis should utilize a time-dependent interpretation of synovial fluid, while S-SSIs remain primarily clinical diagnoses. A structured diagnostic algorithm can safely reduce unnecessary testing and costs, protect against medicolegal pressures, and provide evidence-based practices for effectively detecting early infection following TJA. This is crucial in the setting of the new Transforming Episode Accountability Model (TEAM) that bundles TJA payment.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70414"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069029","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":"Differential Use of Central Outcomes Center to Maximize Follow-Up in a Study of Adolescents Seeking Care in the Emergency Department.","authors":"Tara E Gammi, Daniel K Nishijima, Elizabeth D Rosenthal, Nathan Kuppermann, Stacy J Suskauer, Kristy B Arbogast, Mohamed K Badawy, Daniel J Corwin, Andrea T Cruz, Daniel J Tancredi, Danny G Thomas, Stephanie M Ruest, T Charles Casper, Beth S Slomine","doi":"10.1111/acem.70413","DOIUrl":"10.1111/acem.70413","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70413"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056820","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":"Emergency Department Guidelines for Orthopedic Consultation in an Academic Trauma Center: Effect on ED Throughput and Consultation Utilization.","authors":"Spencer M Tomberg, Stacy A Trent, Kathleen M Joseph","doi":"10.1111/acem.70402","DOIUrl":"10.1111/acem.70402","url":null,"abstract":"<p><strong>Objectives: </strong>Musculoskeletal injuries account for approximately 20% of presentations to emergency departments (ED) in the United States. While many patients can be treated exclusively by an emergency medicine (EM) clinician, others require consultation with an orthopedic surgeon. The objective of this quality improvement initiative was to develop and evaluate the effect of institutional orthopedic consultation guidelines on ED length of stay (LOS), the percentage of patients with fractures who receive an orthopedic consultation in the ED and orthopedic clinic referrals without an ED orthopedics consultation.</p><p><strong>Methods: </strong>A multidisciplinary team of EM and orthopedic clinicians developed injury-based guidelines for ED patients defining when orthopedic consultation was required, when a phone consultation was required, and when EM clinicians should provide exclusive care. The guidelines were implemented at our institution on June 15, 2022. We performed a retrospective before-after study of all ED patients with orthopedic extremity or pelvis injuries between August 2021 and June 2023 and analyzed changes in ED metrics using multivariable difference-in-differences analysis and quantile regression.</p><p><strong>Results: </strong>A total of 4013 patient visits with fractures of an extremity or the pelvis were included. After adjusting for covariates and temporal trends, ED LOS decreased by a median of 71 min (p < 0.001) after implementation of the guidelines in difference-in-differences analyses. After implementation of the guidelines, orthopedic consultation decreased by 5.5% (95% CI: -10.2, -0.8), and outpatient referrals to orthopedics without an in-person consultation in the ED increased by 11.2% (95% CI: 7.8, 14.5).</p><p><strong>Conclusion: </strong>Institutional guidelines for ED orthopedic consultations increased the number of patients managed exclusively by the EM service, decreased total consultations placed to the orthopedic service and decreased the ED LOS for patients at a large urban Level-1 trauma center.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70402"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918100","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":"Informed Consent for Pediatric Lyme Meningitis Study: In-Person Versus Remote Approach.","authors":"Christian D Pulcini, Thomas H Chun, Jonathan A Race, Desiree N Neville, Rebecca S Green, Andrew S Handel, Courtney E Coyle, Paul L Aronson, Amy D Thompson, Sunil K Sood, Alexandra B Yonts, Kathryn E Kasmire, Christoper Woll, Anna R Huppler, Christina R Hermos, Christina Gagliardo, Mariann N Kelley, Anupam B Kharbanda, Sheila M Nolan, Margaret E Samuels-Kalow, Maia S Rutman, Lise E Nigrovic","doi":"10.1111/acem.70400","DOIUrl":"10.1111/acem.70400","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70400"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148885912","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":"Letter on External Validation of the ROMEO Score A Pathophysiological Perspective on Echocardiography in Syncope.","authors":"Maria Giulia Bellicini","doi":"10.1111/acem.70387","DOIUrl":"https://doi.org/10.1111/acem.70387","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70387"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023626","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":"Response to Letter on External Validation of the ROMEO Score A Pathophysiological Perspective on Echocardiography in Syncope.","authors":"John DeAngelis, Timothy J Poterucha, Pierre A Elias, Marc A Probst","doi":"10.1111/acem.70410","DOIUrl":"https://doi.org/10.1111/acem.70410","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70410"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035981","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":"Chronic Uncontrolled Hypertension in the ED-We Hold This Truth to Be Self Evident.","authors":"Nicholas Eric Harrison, Phillip Levy","doi":"10.1111/acem.70409","DOIUrl":"10.1111/acem.70409","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70409"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954755","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":"Methodological Considerations on Coding Analysis and Sampling in a Study of ED Patient Expectations.","authors":"Mehmet Taylan Koçer, İbrahim Altundağ","doi":"10.1111/acem.70403","DOIUrl":"10.1111/acem.70403","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70403"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954783","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":"Smartphone-Based Measurement of Cognition and Physical Function in Older Emergency Department Patients: A Feasibility Study.","authors":"Christie A Hartman, Andrew Leroux, Roland C Merchant, Samantha Roberts, Brianne M Bettcher, Hillary D Lum, Linda Resnik, Sarah D Berry, Meredith Mealer, Vince Mor, Elizabeth Goldberg","doi":"10.1111/acem.70408","DOIUrl":"10.1111/acem.70408","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of emergency department (ED) visits among older adults and represent a critical opportunity to identify cognitive and functional impairments that influence treatment and recovery. While smartphone- and wearable-based assessments are increasingly used to assess cognitive and physical function in older adults, their feasibility in the ED setting, particularly after a fall, remains unclear.</p><p><strong>Methods: </strong>From August 2021 to January 2024, community-dwelling older ED patients (≥ 65 years) were screened for cognitive impairment (six-item screener) and functional limitations (modified Barthel Index, mobility equipment). Apple ResearchKit digital assessments measured cognition (Stroop, Trail Making, reaction time) and physical function (gait/balance, timed walk). Wearable devices monitored movement. Feasibility was examined via attempt and completion rates. Reasons for non-attempt/non-completion and associations with patient characteristics were explored.</p><p><strong>Results: </strong>Among 196 patients (mean age 78.2 ± 7.6 years, 68% women), 77% attempted at least one digital assessment. Cognitive tests had moderate-to-high completion rates (68%-87%) among those who attempted, and completion was associated with lack of cognitive impairment (p = 0.002, 0.002, 0.01, for Stroop, Trail Making, and reaction time tests, respectively). Non-completion was due most often to lack of glasses, not feeling well, or technology issues. Physical function tests had much lower completion rates (18%-20%), and completion was associated with functional status (Barthel Index; p = 0.02, 0.01 for gait and balance and timed walk tests) and mobility equipment use (p = 0.02, 0.03). Low completion rates were mainly due to safety concerns, pain, and injury.</p><p><strong>Conclusions: </strong>Digital assessment of cognitive function is feasible in most older adults presenting to the ED for falls, but physical function tests had low feasibility in this population. Future research will explore whether such data predict clinically relevant outcomes (e.g., time to injury recovery, ED revisits) and can inform personalized intervention (e.g., physical therapy referrals, skilled nursing facility placement).</p><p><strong>Trial registration: </strong>Clinical Trial Number: NCT04304495.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70408"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023590","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}