Academic Emergency Medicine最新文献

{"title":"Correction to \"Severe Hyponatremia in the Emergency Department. Incidence of Cerebral Edema and Risk of Osmotic Demyelination Syndrome\".","authors":"","doi":"10.1111/acem.70311","DOIUrl":"https://doi.org/10.1111/acem.70311","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70311"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759484","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":"Preemptive Anticoagulation for Patients With Suspected Pulmonary Embolism in the Emergency Department: An International Survey of Emergency Physicians.","authors":"Keerat Grewal, William B Stubblefield, Scott D Casey, Kerstin de Wit, David R Vinson, Cameron Thompson, Olivier Hugli","doi":"10.1111/acem.70297","DOIUrl":"10.1111/acem.70297","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend therapeutic anticoagulation for select patients with suspected pulmonary embolism (PE) while awaiting confirmatory imaging. International practice regarding preemptive anticoagulation in the emergency department (ED) is not well understood. We aimed to describe emergency physician use of preemptive anticoagulation in patients with suspected PE and identify characteristics associated with its use.</p><p><strong>Methods: </strong>We conducted an international survey of emergency physicians. The survey was distributed between November 2024 and May 2025. Physicians were asked about use of preemptive anticoagulation, factors associated with use, knowledge of international guidelines, and availability of local protocols. A clinical vignette examined decision making surrounding initiation of preemptive anticoagulation. Multivariable logistic regression models were used to examine factors associated with (1) sometimes/always using preemptive anticoagulation and (2) with use in the vignette.</p><p><strong>Results: </strong>There were 413 responses (27.6% response rate) from 13 countries. Among respondents, 23.1% reported never providing preemptive anticoagulation, 73.9% reported sometimes using it, and 2.9% reported always using it. Over two-thirds of respondents were unaware of recommendations for using preemptive anticoagulation and half reported their institution did not have protocols for preemptive anticoagulation. In multivariable regression, more clinical experience (OR: 1.81, 95% CI: 1.38-2.38), higher self-rated knowledge about PE (OR: 2.05, 95% CI: 1.03-4.06), and more concern for cardiovascular deterioration (OR: 3.21, 95% CI: 1.88-5.49) were positively associated with sometimes/always using preemptive anticoagulation. More concern for bleeding was associated with a lower odds of sometimes or always using preemptive anticoagulation. In the vignette, respondents with institutional protocols for preemptive anticoagulation had higher odds of starting preemptive anticoagulation and those with more concern for bleeding had lower odds of starting it.</p><p><strong>Conclusion: </strong>Use of preemptive anticoagulation for patients with suspected PE was low. Most physicians were unaware of guidelines supporting its use and do not have institutional protocols to guide use of preemptive anticoagulation. Implementation and use of institutional protocols may increase guideline-directed preemptive anticoagulation in select patients.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70297"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759506","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":"Barriers to Successful Research Compensation in a Multicenter Pediatric Acute Care Study.","authors":"Mitchell T Walters, Daniel J Tancredi, Beth S Slomine, Elizabeth D Rosenthal, Tara E Gammi, Nathan Kuppermann, Stacy J Suskauer, Kristy Arbogast, Mohamed K Badawy, Daniel J Corwin, Andrea T Cruz, Stephanie M Ruest, Danny G Thomas, T Charles Casper, Daniel K Nishijima","doi":"10.1111/acem.70282","DOIUrl":"10.1111/acem.70282","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70282"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643637","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":"Diagnostic Accuracy of Examination, Brain-Type Natriuretic Peptide, and Imaging for Volume Overload.","authors":"Brit Long, Craig White, Michael Gottlieb","doi":"10.1111/acem.70312","DOIUrl":"https://doi.org/10.1111/acem.70312","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70312"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759514","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":"Euglycemic Diabetic Ketoacidosis Treatment Protocol With Increased Dextrose Supplementation to Prevent Hypoglycemia.","authors":"Alexander T Clark, Jordan Sell, Lynn Ang, Nazanene H Esfandiari, James A Cranford, Nathan L Haas","doi":"10.1111/acem.70278","DOIUrl":"10.1111/acem.70278","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70278"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13031160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525325","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":"Prospective Validation of A Novel Scale for Triage Assessment of Frailty in the Emergency Department (ED-FraS).","authors":"Chiat Qiao Liew, Shu-Hsien Hsu, Ming-Tai Cheng, Chia-Hsin Ko, Pei-Chun Hsieh, Hsiu-Yen Lin, Yi-Shan Lin, Chien-Hua Huang, Wei-Tien Chang, Chu-Lin Tsai","doi":"10.1111/acem.70279","DOIUrl":"10.1111/acem.70279","url":null,"abstract":"<p><strong>Background: </strong>Older adults account for a disproportionate share of emergency department (ED) visits and are often present with complex needs. Frailty is a key determinant of adverse outcomes in this population. We previously developed the Emergency Department Frailty Scale (ED-FraS), a novel clinician-judgment-based instrument. This study prospectively validated the ED-FraS when used by triage nurses and evaluated its predictive performance for hospital admission and ED length of stay (EDLOS).</p><p><strong>Methods: </strong>This prospective observational study was conducted at a tertiary academic medical center in Taiwan between February and July 2025. Triage nurses assessed patients aged ≥ 65 years using the ED-FraS during routine triage encounters. We evaluated the association between ED-FraS levels (1-5) and hospital admission and EDLOS. We compared the predictive performance of ED-FraS, the standard Taiwan Triage and Acuity Scale (TTAS), and a modified TTAS (mTTAS), which integrated frailty scores. Discriminative ability was measured using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>A total of 550 older adults were enrolled (mean age 77.2 years). Higher ED-FraS levels were significantly associated with increased admission rates (25.0% in level 1 vs. 59.4% in level 5) and prolonged median EDLOS (2.6 vs. 27.3 h). The mTTAS demonstrated superior discriminatory ability for hospital admission (AUROC 0.720) compared to TTAS (0.657) or ED-FraS alone (0.638). Nurses reported the tool was feasible, taking < 30 s to complete.</p><p><strong>Conclusions: </strong>The ED-FraS is a feasible and valid tool for identifying older adults at risk of adverse outcomes during triage. Integrating frailty assessment into standard triage systems enhances risk stratification and may improve resource allocation for vulnerable older adults.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70279"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571327","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":"Comparative Evaluation of Machine Translation Accuracy of Emergency Department Discharge Instructions: A Non-Inferiority Study.","authors":"Giovanni Rodriguez, Patricia Hernández, Christopher Kirwan, Lisette Dunham, Sayon Dutta","doi":"10.1111/acem.70289","DOIUrl":"10.1111/acem.70289","url":null,"abstract":"<p><strong>Background: </strong>Patients with limited English proficiency (LEP) face disproportionate risks at emergency department (ED) discharge. Professional interpretation improves outcomes, but real-time written translations remain difficult to provide in many EDs. Modern transformer-based large language models (LLMs) may offer improved translation quality compared with older systems, yet their performance on ad hoc provider-written ED discharge instructions is not well established.</p><p><strong>Methods: </strong>We conducted a blinded cross-sectional non-inferiority study of English-language ED discharge instructions translated into Spanish, Brazilian Portuguese, and Simplified Chinese comparing Google Translate and ChatGPT-4o versus professional medical interpreters. Fifty-three randomly selected provider-written instructions (100-500 words, preserving spelling/grammar errors) were translated, yielding 477 unique translations. Professional medical interpreters, blinded to translation method, independently scored each translation on fluency, adequacy, meaning, and severity on a five-point Likert scale. Inter-rater reliability between the professional interpreter evaluations was calculated. A 0.5-point non-inferiority margin was pre-specified, and adjusted mean Likert rating differences generated by mixed effects models for each accuracy dimension were compared between translation methods for each language. The proportion of clinically significant translation errors was compared between methods, as was the ability of evaluators to guess the translation method.</p><p><strong>Results: </strong>Inter-rater reliability was high across languages. Both machine translation methods were non-inferior to professional interpreters for adequacy, meaning, and severity in Spanish and Portuguese, and for all four domains in Chinese. For fluency, Google Translate and ChatGPT-4o were inferior in Spanish and Portuguese but non-inferior in Chinese. The frequency of clinically significant errors did not differ significantly by translation method. Evaluators, blinded to method, frequently misidentified machine translations as professional.</p><p><strong>Conclusions: </strong>In this multi-language evaluation of real-world ED discharge instructions, Google Translate and ChatGPT-4o were non-inferior to professional interpreters for most domains of translation accuracy.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70289"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687704","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":"Characteristics of Adolescents With Elevated Suicide Risk Presenting to the ED With Physical Health Complaints.","authors":"Polina Krass, Renata A Sanders, Abigail M Ross, Evan M Dalton, Priyanka Joshi, Joel A Fein, Stephanie K Doupnik","doi":"10.1111/acem.70307","DOIUrl":"10.1111/acem.70307","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70307"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759479","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":"Association Between American Society of Anesthesiologists Physical Status Classification System and Remimazolam Sedation Outcomes.","authors":"Caroline H Brynning, Simone P Busch, Anne L Krarup, Dorte Melgaard","doi":"10.1111/acem.70306","DOIUrl":"10.1111/acem.70306","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam (RM) is an ultrashort-acting benzodiazepine with pharmacodynamic properties ideal for procedural sedation in emergency departments (EDs). This study evaluated the safety of RM when used for procedural sedation of American Society of Anesthesiologists (ASA) I-III patients in the ED.</p><p><strong>Aims: </strong>To compare the occurrence of no or mild/moderate respiratory complications during procedural sedation in patients with ASA scores I, II, and III. Secondarily, to compare clinical characteristics of RM sedations between the ASA groups.</p><p><strong>Methods: </strong>This qualitative improvement study was conducted in 2024 and 2025 at a Danish Level 1 trauma center. RM was administered to ASA I-III patients ≥ 12 years of age as procedural sedation by emergency medicine physicians or nurses educated in airway management, RM sedation, and adverse events. Safety was measured by the occurrence of respiratory problems graded as none, mild, moderate, or severe.</p><p><strong>Results: </strong>Of the 540 patients sedated with RM, 95%-100% in ASA I-III had no or mild/moderate respiratory complications, with ASA I and III being the safest groups (p < 0.014). ASA III patients had the most potential airway risks, but still experienced fewer severe respiratory complications than ASA II patients (4.7% vs. 1.3%, p = 0.014). The RM dose was found to be age-, gender- and ASA score-dependent.</p><p><strong>Conclusions: </strong>RM showed great potential for procedural sedation and was safe for procedural sedation of ASA I-III patients in the ED, with few serious respiratory complications, even in high doses and with high-risk profiles.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70306"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759486","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":"Characteristics Associated With Community Violence Prevention Programs in US Hospitals: A Cross-Sectional Survey Analysis.","authors":"Vivek A Ashok, Katherine Yun, Matthew J Klebanoff, Elinore Kaufman, Jaya Aysola, Therese S Richmond","doi":"10.1111/acem.70300","DOIUrl":"10.1111/acem.70300","url":null,"abstract":"<p><strong>Background: </strong>Violence is a social determinant of health, and hospitals are well-positioned to promote patient well-being by addressing its root causes. Understanding factors associated with hospital engagement in community violence prevention can guide intervention development and capacity building.</p><p><strong>Objective: </strong>To examine hospital and county-level factors associated with the presence of community violence prevention programs (CVPPs) in U.S. hospitals.</p><p><strong>Methods: </strong>This cross-sectional study linked data from the 2022 American Hospital Association Annual Survey with county-level socioeconomic and demographic data from the US Census Bureau and all-cause homicide rates from the US Centers for Disease Control and Prevention. The sample included general medical and surgical hospitals with Medicare identification numbers. Survey-adjusted logistic regression assessed associations between hospital CVPP presence and all-cause homicide. Our response variable was whether or not the hospital had a CVPP, and our explanatory variable was county-level all-cause homicide rates. We adjusted for hospital characteristics and county-level socio-demographics.</p><p><strong>Results: </strong>Of 4,374 hospitals, 990 (22.6%) reported having CVPPs. Compared to those without CVPPs, hospitals with CVPPs were more likely to be nonprofit (85.0% vs. 62.9%), large (> 500 beds; 16.9% vs. 4.7%), have more annual ED visits (51,873.9 vs. 26,224.5), and be urban (81.1% vs. 51.8%) (all p < 0.001). They also more frequently offered outpatient psychiatric (86.1% vs. 46.9%), substance use (74.4% vs. 23.2%), and pain management (93.1% vs. 65.2%) services. In adjusted models, homicide rates were not associated with CVPP presence (aOR = 1.01, 95% CI [0.99, 1.04]). CVPP presence was independently associated with nonprofit ownership, larger size, trauma designation, and lower social deprivation in urban counties.</p><p><strong>Conclusions: </strong>Hospital and community characteristics, rather than homicide rates, predict CVPP presence. CVPPs are concentrated in larger, urban, well-resourced hospitals rather than in areas with the highest homicide rates, highlighting potential misalignment between program placement and community need.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 4","pages":"e70300"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759536","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}