Academic Emergency Medicine最新文献

{"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}

{"title":"Response to Tangkamolsuk and La RE: Online public response to emergency department diagnostic error report: A qualitative study.","authors":"Timothy J Sanford, Pranav Kaul, Danielle M McCarthy","doi":"10.1111/acem.70007","DOIUrl":"10.1111/acem.70007","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"378-379"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481817","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 problem with how we view medical (and diagnostic) error in emergency medicine.","authors":"Meagan M Ladell, Nancy L Jacobson, Sarah C Yale, Katie L McDermott, Elizabeth L Papautsky, Kenneth R Catchpole, Matthew C Scanlon","doi":"10.1111/acem.15076","DOIUrl":"10.1111/acem.15076","url":null,"abstract":"<p><p>Investigating error in healthcare has long been a central focus of patient safety efforts, yet this approach oversimplifies the complexities of a deeply interconnected and dynamic system. This paper argues that framing patient harm solely as \"error\" has failed to yield meaningful improvements, as it overlooks the broader factors contributing to adverse outcomes. Through a case study, we illustrate how an exclusive focus on error investigation missed critical insights and propose that attention should instead be directed towards identifying and managing hazards. Emphasizing the importance of treating healthcare as a sociotechnical system, we argue for the application of sociotechnical system thinking, particularly in addressing diagnostic errors in high-pressure environments like emergency medicine. The traditional methods, such as root cause analysis, error investigation, and the Swiss cheese model, are no longer sufficient. These outdated frameworks fail to address the systemic challenges clinicians face and often misguide safety interventions. The paper calls for a paradigm shift towards re-designing healthcare systems using human factors research to better align with the complexities of clinical work and the hazards that lead to harm.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"340-347"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539774","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":"My search for light.","authors":"Reginald Barnes","doi":"10.1111/acem.15009","DOIUrl":"10.1111/acem.15009","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"359"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124494","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":"Ruling out pulmonary embolism safely: Standardized reporting of the failure rate.","authors":"Yonathan Freund, Christopher Kabrhel, Scott D Casey, David R Vinson, William B Stubblefield, Jeffrey Kline, Delphine Douillet, Federico Germini, Andrea Penaloza, Olivier Hugli, Pierre-Marie Roy, Kerstin de Wit","doi":"10.1111/acem.15055","DOIUrl":"10.1111/acem.15055","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"360-362"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738016","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 diagnostic errors to diagnostic excellence in emergency care: Time to flip the script.","authors":"Prashant Mahajan","doi":"10.1111/acem.15033","DOIUrl":"10.1111/acem.15033","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"366-368"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455480","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":"Exploring diagnostic stewardship in the emergency department evaluation of pediatric abdominal pain in a statewide quality collaborative.","authors":"Alexander T Janke, Kenneth A Michelson, Keith E Kocher, Kristian Seiler, Michelle L Macy, Michele Nypaver, Prashant V Mahajan, Rajan Arora, Courtney W Mangus","doi":"10.1111/acem.15075","DOIUrl":"10.1111/acem.15075","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic stewardship is the effort to optimize diagnostic testing to reduce errors while avoiding overtesting and overtreatment. Abdominal pain and appendicitis in children are essential use cases. Delayed diagnosis of appendicitis can be dangerous and even life-threatening, but overtesting is harmful.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children aged 5-17 years presenting with abdominal pain to 26 EDs within the Michigan Emergency Department Improvement Collaborative (MEDIC) from May 1, 2016, to February 29, 2024. We defined two outcome measures summarized by ED. First, we describe the cross-sectional imaging:appendicitis visits ratio, defined as the count of ED visits resulting in any cross-sectional imaging (CT or MRI) divided by the count of ED visits with a diagnosis of appendicitis. Second, we describe the delayed diagnosis rate, defined by an ED visit for abdominal pain resulting in a discharge and subsequent return visit with a diagnosis of appendicitis within 7 days.</p><p><strong>Results: </strong>The sample included 120,112 pediatric visits for abdominal pain at 26 EDs; 4967 (4.1%) were diagnosed with appendicitis. The cross-sectional imaging:appendicitis visits ratio varied by site, from as low as 0.2 (95% confidence interval [CI] 0.1-0.2) at a pediatric site to as high as 7.9 (95% CI 4.8-16.4) at an urban ED. The proportion of pediatric ED visits for abdominal pain that resulted in an identified delayed diagnosis of appendicitis was 0.1% (141/120,112). All but four sites had fewer than 10 cases of delayed diagnosis across the study period.</p><p><strong>Conclusions: </strong>In this retrospective cohort study of 120,000+ ED visits for pediatric abdominal pain, we found that the ratio of visits with cross-sectional imaging to diagnosed cases of appendicitis varied widely across EDs. Delayed diagnosis of appendicitis was uncommon. Adherence to best practices and improved imaging quality may hold promise to improve diagnostic stewardship for children with abdominal pain across EDs.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"309-319"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930083","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}