Academic Emergency Medicine最新文献

{"title":"Limitations of the GEARSS Study in Capturing Accurate Diagnoses and Risk Estimates in Older Emergency Department Patients.","authors":"Brijesh Sathian, Israel Nascimento, Hanadi Al Hamad","doi":"10.1111/acem.70138","DOIUrl":"https://doi.org/10.1111/acem.70138","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938432","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":"Efficacy and Safety of Adjunct Medications in ED Ultrasound-Guided Nerve Blocks: A National Ultrasound-Guided NeRVE (NURVE) Block Registry Study.","authors":"Joseph Brown, Fred Milgrim, Lachlan Driver, Melissa A Meeker, Ryan Tucker, Nhu-Nguyen Le, Arun Nagdev, Nicole M Duggan, David Martin, Michael Heffler, Hamid Shokoohi, Andrea Dreyfuss, Christopher Fung, Leland Perice, Natalie Truong, S Zan Jafry, Michael Macias, Matthew Riscinti, Andrew Goldsmith","doi":"10.1111/acem.70128","DOIUrl":"https://doi.org/10.1111/acem.70128","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided nerve blocks (UGNBs) are a core component of multimodal analgesia for acute pain management in emergency departments (EDs). In addition to using standard local anesthetics, adjuncts have been demonstrated to extend the duration of UGNBs. We evaluated the efficacy and safety of dexamethasone and epinephrine as anesthetic adjuncts in UGNBs in the ED.</p><p><strong>Methods: </strong>Data were analyzed from the National Ultrasound-guided neRVE (NURVE) Block Registry, a retrospective, multicenter, observational registry evaluating UGNBs performed in 11 EDs from January 1, 2022, to December 31, 2023. A generalized linear mixed effects model (GLMER) with a binomial family examined factors associated with pain reduction when comparing adjunct vs. non-adjunct UGNBs. The dependent variable and primary outcome were pain reduction. Secondary outcomes included safety, dosing of adjuncts, and complications.</p><p><strong>Results: </strong>A total of 29.6% (812/2742) of UGNBs received adjuncts, most commonly dexamethasone (72.5%, 589/812) and epinephrine (23.5%, 191/812). Dexamethasone had a 1.99 odds ratio of > 50% pain reduction versus isolated local anesthetic blocks, while epinephrine had an odds ratio of 0.99 for > 50% pain reduction. There was no association between adjunct use and complications.</p><p><strong>Conclusion: </strong>Compared to isolated local anesthetic nerve blocks, dexamethasone had an association with improved pain control within 60 min; without additional safety concerns in a large retrospective dataset. Prospective studies are needed to further investigate these findings in the ED setting.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938399","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":"Predictors of 30-Day Recurrent Emergency Department Visits for Hyperglycemia in Patients With Diabetes: A Multicentre Prospective Cohort Study.","authors":"Justin W Yan, Nicolas Woods, Kristine Van Aarsen, Joe Thorne, Igor Karp, Tamara Spaic, Selina L Liu, Ian G Stiell","doi":"10.1111/acem.70133","DOIUrl":"https://doi.org/10.1111/acem.70133","url":null,"abstract":"<p><strong>Objectives: </strong>Identifying predictors of increased healthcare utilization for hyperglycemia may have important implications for designing interventions to improve patient outcomes and reduce costs. Studies examining predictors of 30-day recurrent ED hyperglycemia visits have been limited due to their retrospective nature. This study's objective was to prospectively identify predictors of 30-day recurrent ED visits for hyperglycemia in patients with diabetes.</p><p><strong>Methods: </strong>We conducted a multicentre, prospective cohort study of adults ≥ 18 years at one of four Canadian tertiary care, academic EDs with a diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Multivariable logistic regression analysis was used to identify variables independently associated with recurrent 30-day ED visits for hyperglycemia.</p><p><strong>Results: </strong>We enrolled 594 patients; 80 (13.5%) had a recurrent ED visit for hyperglycemia within 30 days. Independently associated predictors of 30-day recurrent visits on complete case analysis include substance abuse history (odds ratio [OR] 2.32, 95% confidence interval [CI]: 1.23-4.38) and initial laboratory blood glucose (OR 1.04, 95% CI: 1.01-1.07), while a new diabetes diagnosis was negatively associated (OR 0.29, 95% CI: 0.09-0.94). Sensitivity analysis using multiple imputation for missing data found the following independently associated variables: substance abuse history (OR 2.55, 95% CI: 1.34-4.85), previous ED visit within the past 14 days (OR 2.14, 95% CI: 1.02-4.48), and initial laboratory blood glucose (OR 1.04, 95% CI: 1.01-1.07). Two variables were negatively associated: recent hospitalization within the past 30 days (OR 0.40, 95% CI: 0.19-0.98) and new diabetes diagnosis (OR 0.37, 95% CI: 0.14-0.97).</p><p><strong>Conclusions: </strong>This multicentre prospective study reports predictors independently associated with 30-day recurrent ED visits for hyperglycemia. These predictors should be considered by ED clinicians when making disposition and follow-up plans for this important patient population, and future interventions should explore the interaction between hyperglycemia and substance use to prevent recurrent ED visits and reduce healthcare system costs and utilization.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938419","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":"Comment on \"Psychological Comorbidity in Patients Presenting to the Emergency Department With Low-Risk Chest Pain and Anxiety\".","authors":"Yue Wang, Quan Zhou, Bo Chen","doi":"10.1111/acem.70137","DOIUrl":"https://doi.org/10.1111/acem.70137","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938462","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":"Using a Central Outcomes Center to Reduce Attrition in a Longitudinal ED-Based Pediatric Study.","authors":"Elizabeth D Rosenthal, Daniel K Nishijima, 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, Mark R Zonfrillo, T Charles Casper, Beth S Slomine","doi":"10.1111/acem.70124","DOIUrl":"https://doi.org/10.1111/acem.70124","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938556","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":"Commentary on Sheppard et al.'s Study of First Trimester POCUS Behaviors.","authors":"Volkan Ercan, Caglar Kuas, Murat Cetin","doi":"10.1111/acem.70130","DOIUrl":"https://doi.org/10.1111/acem.70130","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938397","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":"Linkage to Outpatient Methadone Treatment From the Emergency Department and Hospital.","authors":"Alice Zhang, Jasmine Barnes, James Sherman, Nicole O'Donnell, Rosemary Velez, Samantha Huo, Ashish Thakrar, Margaret Lowenstein, Jeanmarie Perrone, Austin S Kilaru","doi":"10.1111/acem.70135","DOIUrl":"10.1111/acem.70135","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991261","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":"Hurting for Options: Emergency Department Utilization for Chronic Pain in a Safety-Net Hospital.","authors":"Chun Nok Lam, Ryan Lui, Robert Allen, Tiffany Abramson, Emily Johnson, Elizabeth Burner, Doerte U Junghaenel, Michael Menchine","doi":"10.1111/acem.70127","DOIUrl":"https://doi.org/10.1111/acem.70127","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic pain frequently visit the emergency department (ED) due to accessibility of care, but the impact is underestimated. This study examines the prevalence and characteristics of patients who visited the ED for chronic pain at an urban safety-net hospital.</p><p><strong>Methods: </strong>A systematic sampling strategy was used to survey adult ED patients between June and August 2024. We categorized participants who visited the ED as having (1) chronic pain, (2) acute pain, or (3) nonpain conditions. The study collected data on self-reported demographics and health access information, and hospital records on ED wait time, length of stay, insurance, and arrival time. Chi-square tests and regression models compared differences across groups.</p><p><strong>Results: </strong>Of the 602 participants (64% Medicaid, 78% Hispanic/Latino), 18% visited the ED for chronic pain. This group of participants was more likely to report worse health status, visiting the ED as a usual place for care, despite being more likely to have seen a health care provider within a week before their ED visit. Furthermore, they had a longer ED length of stay and were more likely to arrive after business hours (4:30 pm) and perceive their ED visit as an emergency compared to those who visited the ED for acute pain and nonpain conditions. There is no difference in ED workup, specialty service involvement, and consultation.</p><p><strong>Discussion: </strong>Chronic pain is highly prevalent in a safety-net ED patient population. Patients with chronic pain present to the ED because they feel the condition is emergent. The lack of different ED treatment strategies highlights that perhaps ED providers have a general approach to painful conditions regardless of chronicity. Health systems need to better assess the burden of chronic pain in the ED and develop programs to help manage such patients in an effective and efficient manner.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938460","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":"Want to Grow? Just Say Yes…Mostly.","authors":"Judd E Hollander","doi":"10.1111/acem.70129","DOIUrl":"https://doi.org/10.1111/acem.70129","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870811","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":"Development of a Fall Risk Score for Older Adults Incorporating Electronic Health Record and Emergency Department Screening Measures.","authors":"Brian Suffoletto, Micaela Steube, Waverly Mayer, Caitlin Toth, Nick Ashenburg, Michelle Lin, Michael Losak","doi":"10.1111/acem.70121","DOIUrl":"https://doi.org/10.1111/acem.70121","url":null,"abstract":"<p><strong>Background: </strong>Older adults have high rates of falls after Emergency Department (ED) discharge; yet existing screening tools either underperform or are too difficult to deploy. This study aimed to evaluate a parsimonious predictive model for falls within 6 months post-ED discharge, utilizing both typical electronic health record (EHR) data and brief ED-based screenings.</p><p><strong>Methods: </strong>In a prospective cohort study from September 2023 to May 2024, 412 community-dwelling adults aged ≥ 60 years who ambulate without assistance were enrolled during ED visits. Baseline data included EHR-derived variables (e.g., comorbidities, medication use) and ED screens (e.g., living situation, fall history). Participants were followed for 6 months to document fall occurrences. Multivariable LASSO logistic regression models to predict any fall were then constructed: Model 1 (EHR), Model 2 (ED screens), and Model 3 (combined). Model performance was evaluated using discrimination and calibration metrics, including area under the receiver operating characteristic (AUC) curves.</p><p><strong>Results: </strong>Of the 356 participants with complete follow-up, 104 (29.2%) experienced at least one fall. Model 3 demonstrated superior predictive performance (AUC = 0.75) compared to Model 1 (AUC = 0.67) and Model 2 (AUC = 0.71). Significant predictors in the combined model included anemia (OR = 3.19), use of oral hypoglycemics (OR = 2.26), living with less than two other people (OR = 3.79), infrequently leaving home (OR = 1.97), and a history of ≥ 3 falls in the prior 6 months (OR = 12.11). A risk score made up of 9 items (6 EHR; 3 ED screen) categorizing participants as high risk (score 6-25) or low risk (score 0-5) resulted in sensitivity = 64%, specificity = 75%, positive likelihood ratio = 2.54, and negative likelihood ratio = 0.49.</p><p><strong>Conclusions: </strong>Integrating EHR data with brief ED-based screenings enhances the prediction of fall risk among older adults post-ED discharge. The developed risk score effectively stratifies patients into low versus high risk, facilitating targeted prevention interventions. Further validation in independent cohorts is needed.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870810","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}