Academic Emergency Medicine最新文献

{"title":"Sex disparities in chlamydia and gonorrhea treatment in U.S. adult emergency departments: A systematic review and meta-analysis.","authors":"Rachel E Solnick, Rahi Patel, Ethan Chang, Carmen Vargas-Torres, Maaz Munawar, Carlin Pendell, Judith E Smith, Ethan Cowan, Keith E Kocher, Roland C Merchant","doi":"10.1111/acem.70070","DOIUrl":"10.1111/acem.70070","url":null,"abstract":"<p><strong>Background: </strong>Empiric antibiotic treatment for gonorrhea (GC) and chlamydia (CT) is common in U.S. emergency departments (EDs) due to the delayed availability of test results. Local studies have identified sex-based disparities in sexually transmitted infection (STI) care, with females potentially receiving less empiric treatment than males. This study evaluates how STI treatment aligns with laboratory-confirmed results to quantify potential overtreatment and undertreatment rates and investigates sex differences for these outcomes.</p><p><strong>Methods: </strong>We conducted a preregistered (PROSPERO #241429) systematic review and meta-analysis of studies published between January 2010 and January 2025 in U.S. EDs, excluding studies conducted exclusively in pediatric settings. Searches were performed in Medline, Cochrane, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Data from 19 studies encompassing 32,593 tested patients were analyzed using a random-effects model to calculate pooled estimates. Primary outcomes included GC/CT positivity, empiric treatment rates, and discordance between treatment and test results stratified by sex.</p><p><strong>Results: </strong>Overall GC/CT positivity was 14% (95% confidence interval [CI] 12%-16%): 11% (95% CI 8%-14%) in females and 25% (95% CI 23%-26%) in males. Antibiotics were given to 46% (95% CI 38%-54%) of patients: 31% (95% CI 24%-37%) of females and 73% (95% CI 65%-80%) of males. Among patients with negative test results, 38% (95% CI 30%-47%) received antibiotics (i.e., potential overtreatment): 27% (95% CI 20%-34%) of females and 64% (95% CI 55%-73%) of males. Conversely, 39% (95% CI 31%-46%) of laboratory-positive patients did not receive antibiotics (i.e., potential undertreatment): 52% (95% CI 46%-57%) of females and 15% (95% CI 12%-17%) of males.</p><p><strong>Conclusions: </strong>Significant sex-based disparities exist in ED empiric antibiotic treatment for GC/CT. Females were 3.5 times more likely than males to be potentially undertreated. These findings underscore the need for targeted interventions to reduce disparities and improve treatment accuracy. Interpretation is limited by study heterogeneity and incomplete sex-specific data.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1003-1016"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273929","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":"Current use of push-dose epinephrine: Survey and interview results from academic clinicians in emergency medicine.","authors":"Andrew K Posen, Shaveta Khosla, Terry Vanden Hoek, Renee M Petzel Gimbar","doi":"10.1111/acem.70014","DOIUrl":"10.1111/acem.70014","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1017-1020"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646669","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":"Response to racial disparities and patient-centered choice in medications for opioid use disorder: A commentary on Hazekamp et al.","authors":"Corey Hazekamp, Anthony Scoccimarro","doi":"10.1111/acem.70072","DOIUrl":"10.1111/acem.70072","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1041-1042"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155533","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":"Impact of telemental health on suicide prevention care in U.S. emergency departments.","authors":"Stephanie K Doupnik, Cadence F Bowden, Diana Worsley, Cameron Keating, Ashley A Foster, William Quarshie, Jungwon Min, Paul Schulz, Ilmul Jahan Tani, Zachary Meisel, Steven C Marcus","doi":"10.1111/acem.70055","DOIUrl":"10.1111/acem.70055","url":null,"abstract":"<p><strong>Background: </strong>Mental health concerns are the reason for 7% of U.S. emergency department (ED) visits, and telehealth is increasingly used to provide emergency mental health care. Rural, critical-access hospitals have limited access to in-person mental health care. We sought to describe telemental health care programs in U.S. EDs and test whether access to telemental health care affects use of suicide prevention practices.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of telemental health care and suicide prevention practices at a nationally representative sample of all U.S. EDs associated with acute care general medical hospitals. We used proportionate allocation and nonresponse weighting to generate national estimates. We used weighted adjusted logistic regression models to measure associations between an ED's access to telemental health care and use of six recommended suicide-prevention practices.</p><p><strong>Results: </strong>A total of 606 of 977 eligible EDs completed the survey (62% response rate), weighted to represent 4321 EDs nationally. Telemental health care was used in 68% of EDs, and rural, smaller-volume, and critical-access EDs were more likely to use telemental health care. Critical-access hospitals were more likely to use telemental health care 24/7 and less likely to have access to a telehealth psychiatrist or electronic health record (EHR)-based information sharing. With structural differences being adjusted for, EDs with telemental health care were more likely to assess patients' suicidal intent or plans (adjusted risk ratio [ARR] 1.07, 95% confidence interval [CI] 1.10-1.14) and access to lethal means (ARR 1.13, 95% CI 1.01-1.26). Critical-access EDs with telemental health care were also more likely to provide lethal means safety counseling (ARR 2.11, 95% CI 1.14-3.89).</p><p><strong>Conclusions: </strong>Telemental health care is widely used across all types of EDs, and EDs with telemental health care are more likely to use suicide prevention practices. Critical-access hospitals rely on telemental health care to a great extent and need better access to telehealth psychiatry and EHR information sharing.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"956-965"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957821","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":"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":"10.1111/acem.70040","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"1021-1023"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","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":"Prevalence of Wernicke's Encephalopathy When Receiving Dextrose Before Thiamine: A National Study of Veterans.","authors":"Jamie Jasti, Katherine Sherman, David Gummin, Andrew Farkas","doi":"10.1111/acem.70131","DOIUrl":"https://doi.org/10.1111/acem.70131","url":null,"abstract":"<p><strong>Background/objectives: </strong>A commonly taught principle when treating emergency department (ED) patients with acute alcohol intoxication is to give thiamine before dextrose to avoid precipitating Wernicke's encephalopathy (WE). We sought to evaluate the prevalence of WE among a national sample of veterans who presented to the ED with alcohol intoxication and who then received dextrose before thiamine.</p><p><strong>Methods: </strong>This is a retrospective, cross-sectional study of patients presenting to all Veterans Affairs (VA) Emergency Departments (ED) over a 10-year period (2010-2019). Data was obtained through a Microsoft SQL (Redmond, WA) query of the VA Corporate Data Warehouse. Inclusion criteria were any ED visit with an alcohol intoxication ICD9/10 code and/or serum ethanol result > 50 mg/dL, as well as administration of any intravenous fluids containing dextrose at any concentration. Exclusion criteria was administration of thiamine before dextrose infusion. The primary outcome was diagnosis of WE by ICD9/10 code or manual chart review in the ED, hospitalization, or follow-up visit within 90 days. Data was analyzed with descriptive statistics.</p><p><strong>Results: </strong>120 encounters by 114 individual patients met the inclusion/exclusion criteria, with a median age of 59 (IQR 49-64). There were 104 (91%) male patients, 77 (68%) were white, 27 (24%) were Black, and 6 (5%) were Hispanic. Most patients with a recorded AUDIT-C screened positive for AUD (94%) or had a documented history of alcohol abuse (90%). No cases of Wernicke's encephalopathy were identified by ICD code or manual chart review.</p><p><strong>Conclusion: </strong>Our data suggest that alcohol-intoxicated patients are unlikely to develop Wernicke's encephalopathy with acute dextrose administration. While administering thiamine in alcohol-intoxicated patients is low risk and potentially beneficial, we submit that hypoglycemia treatment should not be delayed for this intervention.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938411","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 Importance of Geriatric Emergency Department Assessments: Recognizing Patient Risks and Value of Data in Research-A Reply.","authors":"Ula Hwang, Inessa Cohen, Christopher Carpenter, Ling Han, William Hung","doi":"10.1111/acem.70136","DOIUrl":"https://doi.org/10.1111/acem.70136","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938530","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":"Letter to \"Effects of a Geriatric Emergency Department Multidisciplinary Intervention on Functional Status and Quality of Life\".","authors":"Kangyu Liu, Neng Wang","doi":"10.1111/acem.70141","DOIUrl":"https://doi.org/10.1111/acem.70141","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938386","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":"Blood Pressure Effects and Risk of Hypotension due to Intravenous Furosemide in Acute Decompensated Heart Failure.","authors":"Nicholas E Harrison, Meghana Bhaskara, Kyle Wilson, Ankit A Desai, Nicholas Montelauro, Phillip Levy, Peter Pang, Robert R Ehrman","doi":"10.1111/acem.70125","DOIUrl":"https://doi.org/10.1111/acem.70125","url":null,"abstract":"<p><strong>Objective: </strong>We quantified the magnitude of systolic blood pressure (SBP) adverse effects associated with intravenous furosemide (IVFu), compared to other factors, during treatment for acute decompensated heart failure (ADHF).</p><p><strong>Methods: </strong>Continuous BP monitoring (598.2 person-hours, 91,210 observations) before and after IVFu was performed in a prospective multicenter ADHF cohort (n = 253). Multivariable-adjusted mixed effects regression was used to determine the amount of SBP reduction and the risk of hypotension attributable to IVFu administration, as opposed to confounders (e.g., non-IVFu treatments and baseline patient characteristics).</p><p><strong>Results: </strong>Median SBP was 124 mmHg (IQR: 105-149) at baseline. Hypotension occurred in 5515 observations (6.0%). The multivariable models explained 79.6% and 58.1% of variance in SBP and risk of hypotension, respectively. Only 1.4% of variance in SBP and 1.7% of hypotension risk were related to IVFu, with the remainder accounted for by confounders. After multivariable adjustment, SBP dropped -11.9 mmHg on average after 80 mg IVFu, reaching a nadir at 147 min (-15.2 mmHg) and partial return to baseline by 6 h (-8.5 mmHg). IVFu-related risk of hypotension after multivariable adjustment depended predominantly on baseline SBP and dose. Risk of hypotension associated with 80 mg IVFu was ≤ 2% with baseline SBP ≥ 120 mmHg. For 40 mg, IVFu-associated hypotensive risk was ≤ 2% with SBPs of 90-100 mmHg, and < 1% with SBP ≥ 110 mmHg. IVFu-associated risk of hypotension returned to zero at 6 h after administration, regardless of dose.</p><p><strong>Conclusions: </strong>Blood pressure reductions after IVFu during ADHF treatment are modest, and hypotension is rare and transient. Most variance in SBP during ADHF treatment is due to other factors.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938403","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 Increasing Burden of Potentially Preventable Deaths due to Hemorrhage in Large Urban U.S. Counties.","authors":"Pawan Acharya, Russell Griffin, Stacy Drake, Mckinley Williams, Sheza Hassan, Junaid Razzak, Jeffery Kerby, John B Holcomb, Zain Hashmi","doi":"10.1111/acem.70140","DOIUrl":"https://doi.org/10.1111/acem.70140","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938567","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}