Academic Emergency Medicine最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor.","authors":"Çagrı Türkücü, Kamil Kokulu, Ekrem T Sert, Hüseyin Mutlu","doi":"10.1111/acem.70041","DOIUrl":"https://doi.org/10.1111/acem.70041","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958039","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":"Evaluation of the Ottawa Department of Emergency Medicine scholarship points program.","authors":"Krishan Yadav, Jeffrey J Perry, Ariel Hendin, Christopher Nussbaum, Christian Vaillancourt, Ian G Stiell, Warren J Cheung","doi":"10.1111/acem.70039","DOIUrl":"https://doi.org/10.1111/acem.70039","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054128","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":"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":"https://doi.org/10.1111/acem.70038","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine or methadone: A single-center survey of patient preference in an urban emergency department.","authors":"Corey Hazekamp, Austin Parish, Anthony Scoccimarro","doi":"10.1111/acem.70040","DOIUrl":"https://doi.org/10.1111/acem.70040","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959758","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":"Re: Comparison of the incidence of recovery agitation with two different doses of ketamine in procedural sedation: A randomized clinical trial.","authors":"Pooya Payandemehr, Narjes Akhlaghi","doi":"10.1111/acem.70042","DOIUrl":"https://doi.org/10.1111/acem.70042","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963414","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":"Reevaluating biomarker accuracy in alcohol-intoxicated TBI patients.","authors":"Brijesh Sathian, Hanadi Al Hamad","doi":"10.1111/acem.70043","DOIUrl":"https://doi.org/10.1111/acem.70043","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953020","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 use of TENS for the treatment of back pain in the emergency department: A randomized controlled trial.","authors":"Karalynn Otterness, Brian McMahon, Mason Ma, Henry C Thode, Adam J Singer","doi":"10.1111/acem.70013","DOIUrl":"https://doi.org/10.1111/acem.70013","url":null,"abstract":"<p><strong>Objective: </strong>Back pain is one of the most common complaints in the emergency department (ED). Since current pharmacological treatments for back pain are often suboptimal, a multimodal approach that includes nonpharmacological modalities has promise to improve pain management. The objective of the current study was to test the hypothesis that transcutaneous electrical nerve stimulation (TENS) would be more effective at relieving back pain than sham TENS.</p><p><strong>Methods: </strong>We conducted a patient- and observer-blinded, randomized controlled trial that included adult (≥18 years) ED patients with lumbar or thoracic back pain of at least moderate pain severity. Participants were randomly assigned (1:1) to TENS or sham TENS. The primary outcome was absolute reduction in pain severity at 30 min after treatment measured with a verbal numeric scale from 0 to 10 (none to worst). A sample of 80 patients had 80% power to detect a 1.5-point between-group difference in pain severity. The trial was registered with ClinicalTrials.gov (NCT04227067).</p><p><strong>Results: </strong>We enrolled 80 subjects (40 to the TENS group, 40 to the sham group). Mean (±SD) age was 46 (±16) years, and 51% were female. Mean (±SD) pain scores before and after treatment were 8.4 (±1.6) and 6.8 (±2.4) in patients treated with TENS. Mean (±SD) pain scores before and after treatment were 8.0 (±1.7) and 7.5 (±2.1) in patients treated with sham TENS. The mean (±SD) reduction in pain score was significantly greater in TENS versus sham patients, 1.7 (±2.0) versus 0.5 (±1.0; p = 0.002). Rescue medication was administered to fewer patients treated with TENS than with sham (45% vs. 73%, p = 0.02) and patient satisfaction was higher in the TENS than in the sham group (78% vs. 50%, p = 0.02).</p><p><strong>Conclusions: </strong>TENS was more effective than sham TENS at reducing pain severity in adult ED patients with back pain.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810154","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":"Evaluation of protocol fidelity for prehospital antibiotic administration.","authors":"Laurel O'Connor, Michael Hall, John P Broach, Martin A Reznek","doi":"10.1111/acem.70015","DOIUrl":"https://doi.org/10.1111/acem.70015","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a common, critical, time-sensitive medical emergency, with mortality rates of up to 56%. Early antibiotic administration is a cornerstone of sepsis management, yet prehospital antibiotic administration remains uncommon in the United States.</p><p><strong>Methods: </strong>This prospective observational study evaluated the implementation of a prehospital sepsis protocol in an urban EMS system. Patients were eligible for prehospital antibiotic administration if they were ≥18 years old, hypotensive (SBP < 90 mm Hg), and febrile or hypothermic (<96.8°F or >100.4°F). Paramedics drew blood cultures and administered piperacillin/tazobactam or ceftriaxone. A report was generated to prospectively identify patients eligible for the study by hemodynamic data and/or if they were administered prehospital antibiotics. Demographic, operational, and clinical data were abstracted from patient care records and electronic health records. Outcomes were reported descriptively.</p><p><strong>Results: </strong>A sample of 147 patients was included for encounters from December 1, 2019, to December 1, 2024 (mean age 72.8 years, 31.3% female). Antibiotics were administered to 132 patients (89.8%). Of encounters with antibiotic administrations, 127/132 (96.2%) complied with the clinical protocol, and five (3.8%) were protocol violations. Additionally, six patients (4.1%) were inappropriately not administered antibiotics, and nine patients (6.1%) had contraindications to the protocol, so antibiotics were withheld. Of 356 blood culture bottles that underwent laboratory analysis, nine (2.5%) were contaminated. The mean (±SD) time from patient contact to antibiotics was 32.7 (±8.2) min.</p><p><strong>Conclusions: </strong>Prehospital clinicians can reliably and safely administer antibiotics for sepsis with hypotension and severe sepsis, observing high protocol adherence and low contamination rates while expediting time from recognition of sepsis to first antibiotics. These findings support the integration of prehospital antibiotics into broader sepsis care pathways. Expanding such protocols could improve compliance with sepsis care quality measures and enhance patient outcomes, particularly in resource-constrained environments.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771079","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":"Research priorities for pediatric pain management in emergency medicine.","authors":"Daniel S Tsze, Rebecca K Burger, Eileen J Klein, Todd P Chang, Neil G Uspal, Alessandra Guiner-da Silva, Lorin R Browne, Keli D Coleman, Corrie E Chumpitazi, Amy L Drendel","doi":"10.1111/acem.70028","DOIUrl":"https://doi.org/10.1111/acem.70028","url":null,"abstract":"<p><strong>Background: </strong>There is a high prevalence of acute pain in children cared for in the emergency care setting. However, there are still significant gaps in knowledge regarding optimal pain management. We aimed to develop a prioritized research agenda that identifies key questions for pediatric pain management in the emergency care setting that will guide future research and optimize care for children.</p><p><strong>Methods: </strong>We used a modified Delphi approach to achieve consensus among a multidisciplinary and geographically diverse expert advisory group. An initial list of 108 research questions was identified, with successive rounds of questionnaires conducted until there was a convergence of opinion or a point of diminishing returns was reached. The list was iteratively refined each round by advisory group members who ranked research questions and provided suggestions for potential additional questions and feedback regarding questions considered.</p><p><strong>Results: </strong>Twenty-nine advisory group members participated in the modified Delphi approach. Over the course of two rounds, we identified 10 research questions as the highest priority for future investigation. These questions included topics addressing short- and long-term outcomes related to inadequately assessed and treated pain, patient- and family-centered outcomes, optimizing analgesia in the emergency department (ED) and at home after discharge from the ED, nonpharmacologic/integrative treatments, novel analgesic treatments and strategies, children with difficult-to-treat pain, prehospital pain management, eliminating health disparities, opioid misuse/abuse, and dissemination and implementation.</p><p><strong>Conclusions: </strong>The 10 research questions identified as highest priority can inform future work by researchers, funders, policy makers, and other key decision makers who aim to meaningfully advance the management of pain in children cared for in the emergency care setting.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778724","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}