Academic Emergency Medicine最新文献

{"title":"Smartphone-Based Measurement of Cognition and Physical Function in Older Emergency Department Patients: A Feasibility Study.","authors":"Christie A Hartman, Andrew Leroux, Roland C Merchant, Samantha Roberts, Brianne M Bettcher, Hillary D Lum, Linda Resnik, Sarah D Berry, Meredith Mealer, Vince Mor, Elizabeth Goldberg","doi":"10.1111/acem.70408","DOIUrl":"10.1111/acem.70408","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of emergency department (ED) visits among older adults and represent a critical opportunity to identify cognitive and functional impairments that influence treatment and recovery. While smartphone- and wearable-based assessments are increasingly used to assess cognitive and physical function in older adults, their feasibility in the ED setting, particularly after a fall, remains unclear.</p><p><strong>Methods: </strong>From August 2021 to January 2024, community-dwelling older ED patients (≥ 65 years) were screened for cognitive impairment (six-item screener) and functional limitations (modified Barthel Index, mobility equipment). Apple ResearchKit digital assessments measured cognition (Stroop, Trail Making, reaction time) and physical function (gait/balance, timed walk). Wearable devices monitored movement. Feasibility was examined via attempt and completion rates. Reasons for non-attempt/non-completion and associations with patient characteristics were explored.</p><p><strong>Results: </strong>Among 196 patients (mean age 78.2 ± 7.6 years, 68% women), 77% attempted at least one digital assessment. Cognitive tests had moderate-to-high completion rates (68%-87%) among those who attempted, and completion was associated with lack of cognitive impairment (p = 0.002, 0.002, 0.01, for Stroop, Trail Making, and reaction time tests, respectively). Non-completion was due most often to lack of glasses, not feeling well, or technology issues. Physical function tests had much lower completion rates (18%-20%), and completion was associated with functional status (Barthel Index; p = 0.02, 0.01 for gait and balance and timed walk tests) and mobility equipment use (p = 0.02, 0.03). Low completion rates were mainly due to safety concerns, pain, and injury.</p><p><strong>Conclusions: </strong>Digital assessment of cognitive function is feasible in most older adults presenting to the ED for falls, but physical function tests had low feasibility in this population. Future research will explore whether such data predict clinically relevant outcomes (e.g., time to injury recovery, ED revisits) and can inform personalized intervention (e.g., physical therapy referrals, skilled nursing facility placement).</p><p><strong>Trial registration: </strong>Clinical Trial Number: NCT04304495.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 9","pages":"e70408"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023590","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":"Evidence for Electrocardiographic Patterns Identifying Acute Coronary Occlusion in Non-ST-Elevation Acute Coronary Syndromes: A Scoping Review.","authors":"Andrew P Grimes, Sonja J Maria","doi":"10.1111/acem.70389","DOIUrl":"10.1111/acem.70389","url":null,"abstract":"<p><strong>Background: </strong>Approximately one-quarter to one-third of patients with non-ST-elevation myocardial infarction have a completely occluded culprit coronary artery but are not routinely referred for emergent reperfusion. A growing literature describes electrocardiographic patterns purported to identify acute coronary occlusion (ACO) in non-STEMI populations, but guideline adoption has been limited and inconsistent. We conducted a scoping review to map the extent, characteristics, and methodologies of primary studies examining non-ST-elevation ECG patterns against reference standards for ACO.</p><p><strong>Methods: </strong>Electronic databases were searched and supplemented by backward and forward citation tracking. Primary studies were included evaluating non-ST-elevation ECG patterns against an angiographic or composite reference standard for ACO. Studies using stenosis severity or anatomical disease burden as the reference standard were excluded.</p><p><strong>Results: </strong>Forty-two studies were included, yielding 78 pattern-level data sources spanning 20 ECG patterns. Only 23/78 data sources evaluated undifferentiated ACS patients. Measurable index test definitions were present in 33/78 data sources. Reference standards were highly heterogeneous. Although 70/78 data sources defined a reference standard for ACO, only 29/78 reported diagnostic test accuracy values, most of which were in the LBBB/VPR category.</p><p><strong>Conclusions: </strong>The literature is heterogeneous, methodologically uneven, and concentrated in a small number of pattern categories. Outside the LBBB/VPR criteria, diagnostic test accuracy data in NSTE-ACS populations are sparse, and methodological features that critically affect their interpretation are inconsistently reported. These findings identify substantial gaps in the primary literature and inform the scope of future pattern-specific diagnostic test accuracy systematic reviews.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70389"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663424","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":"Dementia Screening in the Emergency Department: A Communication-Centered Process.","authors":"Anita N Chary, Allison Dobecka, Paulina Katsouli, Aanand D Naik, Anita Bagri Major, Manish N Shah","doi":"10.1111/acem.70391","DOIUrl":"https://doi.org/10.1111/acem.70391","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70391"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13482467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786836","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":"Malnutrition and Geriatric Vulnerability Are Independently Associated With Short-Term Mortality in Older Emergency Department Patients in Taiwan.","authors":"Ying-Ju Chen, Tse-Yao Wang, Jin-Wei Lin, Che-Lin Chiu, Chia-Hui Hsu, Hsien-Hao Huang","doi":"10.1111/acem.70390","DOIUrl":"10.1111/acem.70390","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is common among older adults and is associated with adverse outcomes, yet its impact and relationship with geriatric vulnerability in emergency department (ED) patients remain underrecognized.</p><p><strong>Objectives: </strong>To determine the prevalence, associated factors, and prognostic impact of malnutrition in noncritically ill older adults in the ED.</p><p><strong>Methods: </strong>We conducted an observational study of patients aged ≥ 65 years presenting to the ED. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) and categorized as normal, at risk of malnutrition, or malnourished. Comprehensive geriatric assessment included functional status (activities of daily living (ADL)), frailty, cognitive function, and handgrip strength. Multivariable logistic regression identified factors associated with malnutrition. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were performed to evaluate the association between nutritional status and 30- and 90-day all-cause mortality.</p><p><strong>Results: </strong>Among 1487 patients, 23.3% were malnourished and 46.4% were at risk, with 59.7% overall having impaired nutritional status. Malnourished patients had significantly worse functional status, cognition, and physical performance. Independent factors associated with malnutrition included lower ADL, frailty, and decreased handgrip strength. Malnutrition was associated with significantly lower 30- and 90-day survival (both log-rank p < 0.001) and remained independently associated with both 30-day mortality (adjusted HR, 5.32; 95% CI, 1.36-20.73) and 90-day mortality (adjusted HR, 6.92; 95% CI, 2.16-22.13) after multivariable adjustment.</p><p><strong>Conclusions: </strong>Malnutrition is highly prevalent among older ED patients and is independently associated with increased short-term mortality. Functional decline, frailty, and reduced muscle strength are closely linked to both malnutrition and nutritional risk. Integrating nutritional screening with functional and physical assessment in the ED may improve early identification of high-risk patients and support timely interventions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70390"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672782","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":"Pulse Pressure as a Predictor of Increased 30-Day Mortality in Acute Pulmonary Embolism.","authors":"Justin Pawloski, Rafey Feroze, Gordon Wong, Tarek Hammad, Yulanka Castro-Dominguez, Nour Tashtish, Teresa L Carman, Robert Schilz, Mehdi H Shishehbor, Jun Li","doi":"10.1111/acem.70386","DOIUrl":"10.1111/acem.70386","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70386"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757152","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":"Black Men in Emergency Medicine: A Call to Action.","authors":"Marcus Gresham, Michelle D Lall, Sheryl L Heron","doi":"10.1111/acem.70392","DOIUrl":"10.1111/acem.70392","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70392"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700381","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":"A Hospital Avoidance Pathway With Digitally Supported Follow-Up for Low Back Pain: An Alternative to Emergency Department Care.","authors":"Joseph F Orlando, Maria Zucco, Usha Ritchie, Anne L J Burke, Matthew Beard, Michelle Guerin, Saravana Kumar","doi":"10.1111/acem.70395","DOIUrl":"https://doi.org/10.1111/acem.70395","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a common reason for presentation to an emergency department (ED) but LBP-care in this setting is frequently low-value, costly and often fails to meet system and patient needs. Other service options are urgently required. This study evaluated a novel care pathway that diverted people with suspected non-serious LBP seeking ED-care to a community-based, hospital avoidance service in a large South Australian health network.</p><p><strong>Methods: </strong>A retrospective quantitative analysis was conducted on data extracted from electronic medical records (demographics, service activity, subsequent presentations/admissions) for patients seen March-December 2024, and analyzed using descriptive statistics. Repeated measures analysis of selected EQ-5D-5L items (pain/discomfort, usual activities, anxiety/depression) was conducted using the Wilcoxon signed-rank test. Semi-structured interviews undertaken May-Nov 2024 with consecutive eligible patients explored experiences of care via qualitative thematic analysis.</p><p><strong>Results: </strong>There were 143 patients (mean age = 52.1 years, SD = 19.0) managed via this pathway. All received multidisciplinary care and 101 (78%) registered for digitally supported follow-up. Patients reported significant improvements in pain/discomfort and usual activities (p < 0.05) 2-weeks following initial evaluation, but not anxiety/depression. Most patients (90%) did not present to a public hospital ED within 90 days of intervention. Interviews (n = 20) identified four key themes: faster access and reducing ED pressure, care that meets expectations, digitally supported care assists recovery, and recommendations for improvements in LBP-care.</p><p><strong>Conclusion: </strong>This digitally supported hospital avoidance pathway provided an acceptable alternative to ED-care for patients with LBP with potential to offer significant benefits to the health system.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70395"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757260","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 Yield of Hospitalization for Emergency Department Patients With Syncope and Presyncope.","authors":"Christopher W Baugh, Carolyn Winskill, Edward H Suh, Dana L Sacco, John DeAngelis, Daniel K Nishijima, Jonathan Schimmel, Alan B Storrow, Nancy Wood, Robert E Weiss, Marc A Probst","doi":"10.1111/acem.70393","DOIUrl":"10.1111/acem.70393","url":null,"abstract":"<p><strong>Objectives: </strong>Syncope and presyncope are common emergency department (ED) presentations that may indicate dangerous underlying conditions. For patients without serious ED diagnoses, hospitalization for monitoring and further workup is common, yet the benefits remain unclear. We sought to determine the diagnostic yield of hospitalization among adults with unexplained syncope or presyncope.</p><p><strong>Methods: </strong>We conducted a secondary analysis of data from a prospective, multicenter, observational study enrolling ED patients aged ≥ 40 years with syncope or presyncope and no serious ED diagnosis. We collected 30-day serious adverse outcomes (SAOs), both cardiac and non-cardiac, including only in-hospital SAOs for admitted patients and all SAOs for discharged patients. Logistic and Cox regression analyses compared admitted and discharged participants using propensity score adjustment and matching.</p><p><strong>Results: </strong>Among 1263 patients (mean age 64.8 ± 13.1 years), 74 (5.9%) experienced any SAO, including 62 (4.9%) with serious cardiac outcomes. After propensity-score adjustment, Bayesian logistic regression showed a significant difference in diagnostic yield (OR 3.70 [95% CrI 1.85-6.82]) in the hospitalized cohort. In a propensity-score-matched Cox regression analysis, hospitalization was associated with a shorter time to SAO diagnosis, with an HR of 12.43 (95% CI 2.94-52.48).</p><p><strong>Conclusion: </strong>Hospitalization increased the diagnostic yield for SAOs and accelerated time to diagnosis. It is reasonable to hospitalize select, higher-risk adult patients over 40 years old with presyncope or syncope, even if no dangerous diagnosis is found in the ED.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04533425.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70393"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700376","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":"Transforming Human-AI Collaboration in Emergency Care: The Role of AI in Adaptive Support Across Diagnostic Reasoning Modes.","authors":"Colin John Greengrass, Mike Clancy, Samuel G Campbell, Pat Croskerry","doi":"10.1111/acem.70398","DOIUrl":"https://doi.org/10.1111/acem.70398","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70398"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786859","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":"Age as a Predictor of Mortality, Disability, or Need for Acute Resuscitative Care in Trauma Patients.","authors":"Matthew J Bivens, Ryan C Burke, Christie L Fritz, Michael Skaggs, James Sargent, Alok Gupta, Charles Parsons, Emily Moore, Stephen H Thomas, Carlo L Rosen","doi":"10.1111/acem.70356","DOIUrl":"10.1111/acem.70356","url":null,"abstract":"<p><strong>Objective: </strong>Geriatric trauma patients are at increased risk of death or disability, and some have proposed trauma team activations based on advanced age alone. We sought to determine if there is a specific age at which a different approach to the trauma patient should be taken, based on their age-related risk for death, disability, or for needing acute resuscitative care.</p><p><strong>Methods: </strong>We conducted a retrospective review of one year of data (2022) abstracted from the National Trauma Data Bank, including 984,335 adult trauma patients. The primary outcome was in-hospital mortality. Secondary outcomes were non-functional status at discharge, and a composite outcome created to capture the need for acute trauma interventions that included death in the ED, admission to the ICU, or need for emergent surgery, intubation, angioembolization, blood transfusions or procedures.</p><p><strong>Results: </strong>Analyses adjusted for covariates showed the risk of receiving any acute intervention, including transfusions, surgeries, intubations and bedside procedures, all fell steadily with advancing age, as did risk of immediate death in the emergency department. Risk of death later during hospitalization, or of discharge to a non-functional status, rose steadily with advancing age.</p><p><strong>Conclusion: </strong>Trauma patients have rising mortality with advancing age, and a rise in likelihood of being sent to the ICU for care, but a falling rate of immediate, up-front death in the trauma bay, and a falling rate of receiving the acute, life-saving interventions associated with a trauma team activation. Further investigation is needed to determine the extent to which these findings illustrate differences in injury mechanism and severity, or age-related bias and differences in care.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 8","pages":"e70356"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663372","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}