Academic Emergency Medicine最新文献

{"title":"Federated Meta-Analysis of HEART Score Performance for Emergency Department Chest Pain.","authors":"Hao Wang, Eric Chou, Richard D Robinson, Ali Farzad, Nicholas Saltarelli, Garrett Johnson, James d'Etienne, Simon A Mahler","doi":"10.1111/acem.70284","DOIUrl":"10.1111/acem.70284","url":null,"abstract":"<p><strong>Objectives: </strong>Multicenter evaluation of emergency department (ED) risk stratification tools is often limited by barriers to patient-level data sharing. We used the HEART score as a clinical use case to evaluate whether a federated diagnostic meta-analytic approach yields performance estimates comparable to those obtained from centralized patient-level analysis for predicting 30-day major adverse cardiovascular events (MACE30).</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter observational study across six EDs between January 1, 2020, and December 31, 2023. Adult patients presenting with chest pain who had a documented HEART score were included. MACE30 was defined as acute myocardial infarction, coronary revascularization, or all-cause mortality. The diagnostic performance of the HEART score was evaluated using a federated bivariate random-effects meta-analysis based on site-level 2 × 2 tables, yielding pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) estimates. These results were compared with performance metrics derived from centralized patient-level analysis.</p><p><strong>Results: </strong>Among 57,906 ED encounters with documented HEART scores, MACE30 occurred in 2.2%. In federated meta-analysis, the HEART score demonstrated high specificity and negative predictive value, consistent with its intended rule-out function, with modest between-site variability. The pooled HSROC area under the curve was 0.759 (95% CI, 0.646-0.831). Centralized patient-level analysis yielded similar discrimination (AUROC 0.785; 95% CI, 0.776-0.794). Differences between federated and centralized estimates were small and clinically modest, reflecting preservation of site-level heterogeneity and variation in outcome prevalence across EDs.</p><p><strong>Conclusions: </strong>Federated diagnostic meta-analysis produced HEART score performance estimates closely aligned with those obtained from centralized patient-level data. This approach enabled scalable, privacy-preserving multicenter evaluation of ED risk-stratification tools while accommodating heterogeneity across practice settings.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70284"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626983","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":"Determining Access for a City-Wide Extracorporeal Cardiopulmonary Resuscitation (ECPR) Initiative Using Geospatial Analysis.","authors":"Christiana K Prucnal, Melissa A Meeker, Rebecca E Cash, Erica L Nelson, P Gregg Greenough, Stephen D Hallisey, Annette M Ilg, Christopher Kabrhel, Raghu R Seethala, Paul S Jansson","doi":"10.1111/acem.70288","DOIUrl":"10.1111/acem.70288","url":null,"abstract":"<p><strong>Background: </strong>In select situations, patients experiencing out-of-hospital cardiac arrest (OHCA) may be candidates for extracorporeal cardiopulmonary resuscitation (ECPR). Eligibility criteria for ECPR typically include a maximum time (usually 30 min) from arrest to arrival at an ECPR-capable center, which may exclude populations based on geographic factors.</p><p><strong>Methods: </strong>Using geospatial modeling, we calculated drive times to ECPR-capable hospitals in Boston utilizing census block group centroid coordinates as proxy sites for OHCA locations. We used a fixed dispatch-to-scene arrival time of 7.4 min, extrapolated from Boston EMS median transport time data. We set conditions at the 50th (24 min), 25th (18 min), and 10th (13 min) percentiles for EMS on-scene time and, for each condition, determined access to ECPR with an arrest to arrival criterion of less than 30 min. We analyzed the effect of high- versus low-traffic conditions and then derived the arrest to arrival time necessary to achieve access for 90% of the city.</p><p><strong>Results: </strong>The entire City of Boston was excluded from ECPR with median times and current eligibility criteria. Decreasing time-on-scene to the 25th percentile led to increased access: 16% of block groups with low traffic and 6% of block groups with high traffic. At the 10th percentile for time-on-scene, 55% of block groups had access with low traffic and 28% had access with high traffic. To achieve access for 90% of the city under high-traffic conditions at the 50th percentile for time-on-scene, the criterion for arrest to arrival would need to be extended to 55.8 min.</p><p><strong>Conclusions: </strong>The current arrest to arrival criterion for ECPR excludes the entire City of Boston using median transportation and on-scene times. Increasing access to ECPR should include efforts to decrease prehospital duration, such as minimizing time-on-scene for potential OHCA cases. Future study should examine potential levers to improve access, such as novel prehospital ECPR delivery models, air-based transport, and liberalized arrest to arrival criteria.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70288"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669589","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":"Medication Management of Early Pregnancy Loss in an Urban Texas Emergency Department.","authors":"Lindsay Cline, Emilie Sandfeld, Haley Brunkal, Madeline Fischer, Allison Gilbert, Lauren Fine, Emily E Ager","doi":"10.1111/acem.70293","DOIUrl":"10.1111/acem.70293","url":null,"abstract":"<p><strong>Background: </strong>Among patients with early pregnancy loss (EPL) without medication complications or need for urgent surgical evacuation, treatment should largely be guided by patient preference. However, evidence describing medication management for EPL in the emergency department (ED) setting is limited. We examine the occurrence of medication management of EPL with misoprostol in an urban Texas ED, describe associated clinical outcomes, and identify patient and clinical factors associated with offering this treatment.</p><p><strong>Methods: </strong>This was a retrospective study of patients with confirmed EPL at a single urban academic ED in Texas from November 1, 2022, to May 31, 2024. Data were collected via relevant EHR review. Eligible patients were identified via ICD-10 codes and reviewed using a structured abstraction tool. We identified patients who received expectant or medication management with misoprostol and reported clinical outcomes using descriptive statistics. An exploratory multivariable logistic regression was used to identify characteristics predictive of patients being offered misoprostol.</p><p><strong>Results: </strong>During the study period, 181 patients met our inclusion criteria. Most patients (n = 154; 85.1%) received expectant management. Misoprostol was offered to 44 patients (24%); 27 patients (15.0%) received the medication, all of whom had an OB consult. Seven-day return ED visits were low in both the expectant (n = 18; 11.5%) and medication (n = 2; 7.4%) management groups. Of the 18 patients managed expectantly with a 7-day return ED visit, six received misoprostol during the second visit. OB consultation strongly predicted patients being offered misoprostol (aOR 15.1; 95% CI 4.8-47.61).</p><p><strong>Conclusion: </strong>Medication management was rarely provided to ED patients with confirmed EPL; OB was consulted for all patients who received misoprostol. Return ED visits were rare among patients managed expectantly and with misoprostol. Several patients received misoprostol during a return ED visit, which may suggest a missed opportunity for medication treatment of EPL during initial ED presentation.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70293"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759540","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":"Reflect, Recalibrate, Repeat.","authors":"Ashley Panicker","doi":"10.1111/acem.70273","DOIUrl":"https://doi.org/10.1111/acem.70273","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70273"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571331","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":"Staffing Trends Amid Boarding Challenges: A Five-Year Analysis (2019-2023).","authors":"Mitchell Blenden, Rohini Ghosh, David Chartash, Alyssa Tyransky, Gregory Archual, Jane H Brice, Mary Tanski, Suresh K Pavuluri, Arjun K Venkatesh, Rohit B Sangal","doi":"10.1111/acem.70281","DOIUrl":"10.1111/acem.70281","url":null,"abstract":"<p><strong>Objectives: </strong>To examine trends in clinician staffing in the context of rising Emergency Department (ED) boarding we describe five-year national trends (2019-2023) in boarding hours, attending physician and PA/NP coverage, and hospitalist and nursing support across a multicenter cohort of U.S. EDs.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the Association of Academic Chairs of Emergency Medicine (AACEM) and Academy of Administrators in Academic Emergency Medicine (AAAEM) annual benchmarking survey for academic years 2019 through 2023. The analysis included primary academic, academic affiliate, and community affiliate EDs. Boarding hours, attending physician and PA/NP hours, nursing support, and hospitalist care for patients boarding were evaluated over time. Outcomes were stratified by hospital classification.</p><p><strong>Results: </strong>63 EDs were included in our analysis. Median boarding hours/day increased 61.1% from 206.36 (IQR 89.87, 373.11) to 332.47 (137.43, 548.09) (p = 0.01), while median attending hours remained stable over this time frame from 72.00 (53.90, 91.50) to 72.00 (56.00, 88.00) (p = 0.56). The boarding-to-attending hour ratio increased 55.6% overall from 2.97 (1.33, 4.04) to 4.62 (2.15, 7.42) (p = 0.002). Hospitals providing nursing support for boarders increased 53.6% (95% CI 3.20%, 134.40%) which was statistically significant, whereas hospitalist management of boarding patients increased 28.7% (95% CI 2.60%, 68.10%) which was not statistically significant.</p><p><strong>Conclusion: </strong>ED boarding hours increased substantially over the study period without a proportionate rise in attending staffing, resulting in a marked increase in boarding burden per physician hour. While some hospitals provided funding for increased nursing and hospital coverage to care for boarding patients, these measures have not kept pace with rising boarding demands. These findings highlight a growing mismatch between workload and staffing, underscoring the need for updated staffing models and system-level strategies to address the operational and clinical challenges of ED boarding.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70281"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607729","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":"Single-Shot Regional Anesthesia for Early Rib Fracture-Associated Pain Management: Systematic Review and Network Meta-Analysis.","authors":"Christopher Partyka, Scott Farenden, David Tian, Anthony Delaney, Kate Curtis","doi":"10.1111/acem.70277","DOIUrl":"10.1111/acem.70277","url":null,"abstract":"<p><strong>Study objective: </strong>Regional anesthesia techniques for traumatic rib fractures are rapidly being adopted by clinicians in emergency medicine to augment early pain management; however, the impact of \"single-shot\" techniques remains unclear. This systematic review and network meta-analysis was designed to identify the most effective single-shot regional anesthesia (SSRA) techniques on early pain reduction and other outcomes in adult patients with rib fractures.</p><p><strong>Methods: </strong>We searched PubMed, MEDLINE, EMBASE, CINAHL, and CENTRAL for randomized clinical trials that compared SSRA techniques for the purpose of rib fracture management. The primary outcome was pain score reported at 4-8 h. Secondary outcomes included pain scores to 24 h, respiratory function, opioid requirements, respiratory and procedural complications, hospital length of stay, and mortality. A random-effects meta-analysis was performed on pooled data for each pairwise comparison with effect sizes expressed as weighted mean differences (MD). Network meta-analysis was conducted using a Bayesian framework to simultaneously compare multiple treatments via a common comparator (standard care).</p><p><strong>Results: </strong>We included nine randomized clinical trials with 738 patients. The pooled estimated MD in pain scores at 4-8 h for SSRA techniques compared to standard care -1.81 (95% credible interval [CrI], -2.11 to -1.51; moderate certainty). SSRA was also associated with a significant reduction in opioid requirements at 24 h (MD, -9.35 [95% CrI -11.1 to -7.59]; moderate certainty). NMA failed to demonstrate that any one SSRA technique was more conclusively beneficial than another. Confidence in these results was moderate to low, due to inconsistency in the control arms, imprecision of results, and substantial heterogeneity.</p><p><strong>Conclusion: </strong>The use of SSRA techniques compared to standard care or placebo likely reduces pain scores in the early phase of management of patients with rib fractures. Further studies using standardized controls are required to delineate superiority between different SSRA techniques.</p><p><strong>Trial registration: </strong>PROSPERO Registration: CRD420251003934.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70277"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580114","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":"Canary in the Coal Mine.","authors":"Juhi Varshney","doi":"10.1111/acem.70290","DOIUrl":"10.1111/acem.70290","url":null,"abstract":"<p><p>A young physician reflects on the toll of emergency medicine and finds relief through interoception.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70290"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669583","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":"Addressing Frailty in the Emergency Department: Early Outcomes of a Geriatric Rapid Access Clinic.","authors":"Amine Kaab, Kristina M Kokorelias, Kristine Kim, Lindy Romanovsky","doi":"10.1111/acem.70291","DOIUrl":"10.1111/acem.70291","url":null,"abstract":"<p><strong>Objectives: </strong>Older adults represent a growing proportion of emergency department (ED) visits, with an increased risk of adverse outcomes following discharge, particularly when frailty is present. Access to post-ED geriatric follow-up is often delayed, leaving patients without timely support and increasing their risk of ED revisits and subsequent hospital admissions. This study evaluates a novel Geriatric Rapid Access Clinic (Geri-RAC) designed to provide expedited, specialized follow-up for high-risk older adults discharged from the ED.</p><p><strong>Methods: </strong>A retrospective chart review was conducted of all patients who attended the Geri-RAC at a large academic hospital in Toronto from January 2023 to July 2024. Older adults identified as high-risk in the ED were referred to the clinic. Patient outcomes included ED revisit rates and anticipated hospital admission avoidance; data on clinic performance indicators, patient characteristics, and accessed supports were also measured.</p><p><strong>Results: </strong>Thirty-three patients attended the Geri-RAC during the 19-month pilot. Mean age was 82.6 years, with 81.8% having a Clinical Frailty Scale score ≥ 4. Functional limitations were present in 69.7% of patients. Median wait time from ED referral to appointment was 7 days. Cognitive testing was conducted in 78.7% of attendees and medication de-prescribing was initiated in 48.5%. Most patients (87.9%) were newly connected to support services, averaging 2.6 ± 2.1 service linkages per patient. 45.5% of patients received new specialist referrals. The 7-, 30-, and 90-day ED revisit rates were 0%, 12.1%, and 24.2%, respectively. Admission avoidance was anticipated in 42.4% of cases.</p><p><strong>Conclusions: </strong>The Geri-RAC provided timely access to post-ED follow-up and multidisciplinary care for frail older adults. Early findings highlight the potential for this model to enhance ED discharge planning, facilitate structured care transitions, and decrease reliance on emergency services in this high-risk population.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70291"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759547","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":"Safety of Peripheral Vasoactive Drug Administration in Prehospital and Retrieval Medicine (SPOTLESS-2): A Prospective Observational Cohort Study.","authors":"Robbie Ley Greaves, Aaron Quay, Renee Bolot, Jemma King, Clinton Gibbs","doi":"10.1111/acem.70271","DOIUrl":"10.1111/acem.70271","url":null,"abstract":"<p><strong>Introduction: </strong>Adrenaline and noradrenaline are cornerstones of critical care. Traditionally, delivery of these drugs has been through central venous access due to concerns over the safety of peripheral venous access. However, central venous access also may lead to delays and complications, so there is increasing use of peripheral vasoactive drugs. There is evidence for the safety of peripheral administration in controlled theatre and intensive care settings but limited evidence in Prehospital and Retrieval Medicine.</p><p><strong>Methods: </strong>We conducted a prospective, observational cohort study including patients transferred by Lifeflight Medicine from April 2022 to August 2023. The primary outcome was to establish the safety of peripheral adrenaline and noradrenaline. Patients receiving adrenaline or noradrenaline via peripheral intravenous cannula were included and data on venous access, drug delivery, and complications during transfer was collected. Patients were followed to 24 h post arrival to the receiving facility.</p><p><strong>Results: </strong>A total of 656 patients were screened, 468 met the inclusion criteria. Patients were predominantly men (60%), median age of 64, 74% of patients were transferred by rotary wing. Noradrenaline was the most common infusion (72%) with a median dose of 0.1 μg/kg/min, and 0.13 μg/kg/min for adrenaline. The anterior cubital fossa was the most common infusion site (78%). Septic shock was the most common indication (47%). The median duration of infusion was 85 min. 93.4% of patients experienced no events with the peripheral infusion; of the remaining 31 patients, 13 (2.8%) had minor technical issues with drug delivery, 14 (3%) had minor complications affecting patient care and 4 (0.8%) required conversion to central access in transit. There were no tissue complications at 24 h follow-up.</p><p><strong>Conclusion: </strong>Our data suggests that adrenaline and noradrenaline may be safely administered peripherally in Prehospital and Retrieval Medicine environments, with a low overall risk of complications.</p><p><strong>Trial registration: </strong>The study was pre-registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12622000404729).</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70271"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632470","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 Downstream Effects of Prehospital Opioid Dosing in Older Adults: A Retrospective Cohort Study.","authors":"Sarayna S McGuire, Caitlin S Brown, Allyson K Palmer, Molly M Jeffery, Aidan F Mullan, Jessica A Stanich, Susan M Bower, Chad P Liedl, Lisa C Rentz, Fernanda Bellolio","doi":"10.1111/acem.70294","DOIUrl":"10.1111/acem.70294","url":null,"abstract":"<p><strong>Background: </strong>Older adults experience age-related physiological changes that alter the pharmacokinetics and pharmacodynamics of certain medications, which may necessitate reduced dosing. Our objective was to assess emergency department (ED) and hospital outcomes of older patients administered opioids by emergency medical services (EMS) clinicians.</p><p><strong>Methods: </strong>Retrospective cohort study of adults ≥ 65 years who received an opioid between 2019 and 2024 within a health system-affiliated EMS agency. We excluded patients with an advanced airway and those with no documented weight. Maximum single and cumulative weight-based opioid dosages were classified as low, therapeutic, or high. Outcomes were measured in the ED/hospital and compared using Poisson regression with Huber/White standard errors, adjusted for age, sex, vitals, Glascow Coma Scale, emergency severity index, and chief concern. Results were reported as adjusted risk ratios (aRRs).</p><p><strong>Results: </strong>A total of 6406 patients, including 747 (11.7%, 95% CI: 10.9-12.5) with a high opioid dose, 3663 (57.2%, 95% CI: 56.0-58.4) with a therapeutic dose, and 1996 (31.2%, 95% CI: 30.0-32.3) with a low dose, were included. Receipt of a high maximum single opioid dose versus a low/therapeutic dose (excluding patients receiving a concomitant sedative) was associated with increased risk of altered responsiveness (aRR = 1.28, 95% CI: 1.03-1.58) and delirium (aRR = 2.43, 95% CI: 1.08-5.45) in the ED/hospital setting. When 311 (4.9%) patients who received a concomitant sedative were included, patients who received a high opioid dose similarly had an increased risk of altered responsiveness (aRR = 1.28, 95% CI: 1.06-1.56) and delirium (RR = 2.65, 95% CI: 1.25-5.59), compared to a low/therapeutic dose. There was no difference in outcomes of hypoxia, death within 30 days, or ED length of stay between dose groups.</p><p><strong>Conclusion: </strong>Prehospital administration of high opioid doses to older patients was associated with increased rates of altered responsiveness and delirium. These findings highlight how out-of-hospital care can impact a patient's ED and hospital course.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70294"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759521","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}