Academic Emergency Medicine最新文献

{"title":"Epidemiology of sepsis presentations and management among United States emergency departments from 2016 to 2023.","authors":"Michael Gottlieb, Emily Wusterbarth, Robert Hlavin, Kyle Bernard, Eric Moyer","doi":"10.1111/acem.15057","DOIUrl":"10.1111/acem.15057","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"467-470"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738014","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":"Is older age an appropriate criterion alone for ordering cervical spine computed tomography after trauma.","authors":"Mahla Radmard, Armin Tafazolimoghadam, Meisam Hoseinyazdi, Mona Shahriari, Javad R Azadi, Arjun Chanmugam, David M Yousem","doi":"10.1111/acem.14976","DOIUrl":"10.1111/acem.14976","url":null,"abstract":"<p><strong>Background: </strong>Cervical spine computed tomography (CSCT) scans are frequently performed in older emergency department (ED) trauma patients based on the 65-year-old high-risk criterion of the Canadian Cervical Spine Rule (CCR). We sought to determine the positivity rate of CSCT scans in symptomatic and asymptomatic patients to assess the current applicability of age in the CCR.</p><p><strong>Methods: </strong>We reviewed CSCT ED reports from two institutional hospitals from 2018 to 2023. The primary variable was age; however, we also recorded fracture types and sites and type of treatments. Patients were separated into symptomatic and asymptomatic cohorts. We used a Fisher's exact test to compare variables between the asymptomatic and symptomatic groups and chi-square tests for comparison between age groups.</p><p><strong>Results: </strong>Of 9455 CSCTs performed in patients ≥ 65 years, 192 (2.0%) fractures were identified (113 females); 28 (0.30%) were in asymptomatic patients. The rates of fractures (1.6%) and asymptomatic fractures (0.18%) were lowest in the 65- to 70-year age group. There were no distinguishing features as to the level or part of the vertebra fractured or surgical treatment rate between asymptomatic and symptomatic patients.</p><p><strong>Conclusions: </strong>Cervical spine fractures in posttrauma patients ≥ 65 years are uncommon, with the lowest incidence in those 65 to 70 years old. Excluding asymptomatic individuals aged 65-70 from routine CSCT presents a minimal risk of missed fractures (0.18%). This prompts consideration for refining age-based screening and integrating shared decision making into the clinical protocol for this demographic, reflecting the low incidence of fractures and the changing health profile of the aging population.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"396-402"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465360","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":"Facilitators to implementing preventive health interventions for adolescents in the emergency department: A multicenter qualitative analysis.","authors":"Emily Rutland, Mona Bugaighis, Andrea T Cruz, Monika K Goyal, Rakesh D Mistry, Jennifer L Reed, John S Santelli, Peter S Dayan, Lauren S Chernick","doi":"10.1111/acem.15043","DOIUrl":"10.1111/acem.15043","url":null,"abstract":"<p><strong>Objectives: </strong>Adolescents frequently use the emergency department (ED) to meet their health care needs, and many use the ED as their primary source of care. The ED is therefore well situated to provide preventive health care to large numbers of adolescents. The objective of this multicenter qualitative analysis was to identify factors that influence the implementation of preventive health care interventions for adolescent patients in the ED.</p><p><strong>Methods: </strong>We conducted semistructured interviews with ED health care providers (HCPs) from five academic pediatric EDs in distinct geographic regions. We developed an interview guide to explore HCP attitudes and beliefs related to implementing preventive health interventions in the ED. Interviews were recorded, transcribed, and coded by three investigators. The Consolidated Framework for Implementation Research (CFIR) was used as a guide to code and analyze interview data. We collaboratively generated themes that represent factors that are perceived to facilitate the implementation of preventive health interventions for adolescent patients in the ED setting.</p><p><strong>Results: </strong>We conducted 38 interviews (18 pediatric emergency medicine attendings/fellows, 11 registered nurses, five nurse practitioners, or and four physician assistants). We generated 10 themes across the five CFIR domains: innovation characteristics (designing interventions to promote adolescent engagement), inner setting (integrating interventions into ED workflow and scope, minimizing provider burden), outer setting (involving the community, aligning with departmental and institutional missions), individuals (identifying champions), and implementation process (involving key stakeholders early, having patience, and targeting all patients to reduce stigma).</p><p><strong>Conclusions: </strong>Factors facilitating implementation of preventive health interventions for adolescent patients in the ED encompassed multiple CFIR domains, elucidating how the delivery of preventive health interventions for this patient population in the ED requires considering numerous factors comprehensively. These data suggest methods to enhance and facilitate implementation of preventive health interventions for adolescents in the ED.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"434-443"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581859","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 the pulmonary embolism rule-out criteria in younger adults: Insights from the RIETE registry.","authors":"Adhrith Vutukuri, Quang La","doi":"10.1111/acem.15078","DOIUrl":"https://doi.org/10.1111/acem.15078","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"32 4","pages":"476"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955824","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":"High-velocity nasal insufflation versus noninvasive positive pressure ventilation for moderate acute exacerbation of chronic obstructive pulmonary disease in the emergency department: A randomized clinical trial.","authors":"David P Yamane, Christopher W Jones, R Gentry Wilkerson, Joshua J Oliver, Soroush Shahamatdar, Aditya Loganathan, Taylor Bolden, Ryan Heidish, Connor L Kelly, Amy Bergeski, Jessica S Whittle, George C Dungan, Richard Maisiak, Andrew C Meltzer","doi":"10.1111/acem.15038","DOIUrl":"10.1111/acem.15038","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) involve dyspnea, cough, and chest discomfort; frequent exacerbations are associated with increased mortality and reduced quality of life. Noninvasive positive pressure ventilation (NiPPV) is commonly used to help relieve symptoms but is limited due to patient intolerance. We aimed to determine whether high-velocity nasal insufflation (HVNI) is noninferior to NiPPV in relieving dyspnea within 4 h in ED patients with acute hypercapnic respiratory failure.</p><p><strong>Methods: </strong>This randomized control trial was conducted in seven EDs in the United States. Symptomatic patients with suspected COPD, partial pressure of carbon dioxide (pCO₂) ≥ 60 mm Hg, and venous pH 7.0-7.35 were randomized to receive HVNI (n = 36) or NiPPV (n = 32). The primary outcome was dyspnea severity 4 h after the initiation of study intervention, as measured by the Borg score. Secondary outcomes included vital signs, oxygen saturation, venous pCO₂, venous pH, patient discomfort level, and need for endotracheal intubation.</p><p><strong>Results: </strong>Sixty-eight patients were randomized between November 5, 2020, and May 10, 2023 (mean age 65.6 years; 47% women). The initial pCO₂ was 77.7 ± 13.6 mm Hg versus 76.5 ± 13.6 mm Hg and the initial venous pH was 7.27 ± 0.063 versus 7.27 ± 0.043 in the HVNI and NiPPV groups, respectively. Dyspnea was similar in the HVNI and NiPPV groups at baseline (dyspnea scale score 5.4 ± 2.93 and 5.6 ± 2.41) and HVNI was noninferior to NiPPV at the following time points: 30 min (3.97 ± 2.82 and 4.54 ± 1.65, p = 0.006), 60 min (3.09 ± 2.70 and 4.07 ± 1.77, p < 0.001), and 4 h (3.17 ± 2.59 and 3.34 ± 2.04, p = 0.03). At 4 h, there was no difference between the groups in the pCO₂ mm Hg (68.76 and 67.29, p = 0.63). Patients reported better overall comfort levels in the HVNI group at 30 min, 60 min, and 4 h (p = 0.003).</p><p><strong>Conclusions: </strong>In participants with symptomatic COPD, HVNI was noninferior to NiPPV in relieving dyspnea 4 h after therapy initiation. HVNI may be a reasonable treatment option for some patients experiencing moderate acute exacerbations of COPD in the ED.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"403-413"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811776","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":"GRACE-4 letter to the editor \"Opening invisible wounds\" response.","authors":"Bjug Borgundvaag, Hasan Sheikh","doi":"10.1111/acem.15071","DOIUrl":"10.1111/acem.15071","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"478-479"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852060","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 ethics of proximity: Enrolling patients in emergency department hallway beds for suicide research.","authors":"Barton W Palmer, Sarah A Arias, Denise R Dunlap, Gwyneth E Gould, Mhd Basheer Rahmoun, Edwin D Boudreaux, Camille Nebeker","doi":"10.1111/acem.15107","DOIUrl":"10.1111/acem.15107","url":null,"abstract":"<p><strong>Background: </strong>Suicide is the 10th leading cause of death in the United States. Prior research suggests that 10% of people who died by suicide received some form of emergency department (ED) treatment in the 2 months preceding death. The risk of attempted suicide is high during transition back to the community after discharge from the ED, so this is an important opportunity to develop effective empirically validated prevention methods. However, the physical layout and crowded nature of most contemporary EDs, resulting in high rates of \"hallway bed\" assignments, presents some ethical challenges to conducting the requisite behavioral health research in ED settings.</p><p><strong>Methods and results: </strong>In this report, we illustrate the clinical/research ethics controversy through the example of a specific ED-based suicide prevention research protocol, in which the proposed hallway bed recruitment was initially rejected by the institutional review board (IRB) based on concerns about privacy, data confidentiality, and related considerations. Through a consultation process that involved the IRB representatives, the research team (including ethicists), and ED personnel, along with the collection of data to evaluate the risk of compromised confidentiality in hallway bed settings, a viable and ethically grounded approach was reached.</p><p><strong>Conclusions: </strong>This example illustrates the ethical considerations when enrolling patients who occupy a hallway bed into research and the value of a collaborative/problem solving focused dialogue between investigators, ethicists, and IRB personnel.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"454-462"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031729","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":"Precision emergency medicine in health care delivery and access: Framework development and research priorities.","authors":"Rama A Salhi, Keith E Kocher, Margaret Greenwood-Ericksen, Rishi Khakhkhar, Melis Lydston, Jody A Vogel, Kori S Zachrison","doi":"10.1111/acem.15028","DOIUrl":"10.1111/acem.15028","url":null,"abstract":"<p><strong>Background: </strong>The integration of precision emergency medicine (EM) into our conceptualization of the health care system affords the opportunity to improve health care access, delivery, and outcomes for patients. As part of the Society for Academic Emergency Medicine (SAEM) Consensus Conference, we conducted a rapid literature review to characterize the current state of knowledge pertaining to the intersection of precision EM (defined as the use of big data and technology to deliver acute care for individual patients and their communities) with health care delivery and access. We then used our findings to develop a proposed conceptual model and research agenda.</p><p><strong>Methods: </strong>We completed a rapid review of the existing literature on the utilization of big data and technology to ensure and enhance access to acute/unscheduled care for individual patients and their communities. Literature searches were conducted using Ovid MEDLINE, Embase.com, Cochrane CENTRAL via Ovid, and ClinicalTrials.gov in January 2023. Using the identified articles, we determined core domains, developed a framework to guide the conceptualization of precision EM in health care delivery and access, and used these to identify a research agenda.</p><p><strong>Results: </strong>Of the 815 studies identified for initial screening, 60 underwent full-text review by our technical expert panel and 21 were included in the evaluation. Core domains identified included expedited/personalized prehospital care, delivery to the right level of care, personalized ED care, alternatives to ED care/post-ED care, prediction tools for system readiness, and creation of equitable systems of care. A research agenda with four priority research questions was defined following identification of the core domains.</p><p><strong>Conclusions: </strong>Precision EM includes consideration of the health care delivery system as a mechanism for improving access to emergency care using data-driven strategies. This provides a unique opportunity to use data and technology to advance systems of care while also centering patients, communities, and equity in these advances.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"444-453"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387135","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":"Is older age an appropriate criterion alone for ordering cervical spine computed tomography after trauma, by M Radmard et al.","authors":"Ian Stiell","doi":"10.1111/acem.14999","DOIUrl":"10.1111/acem.14999","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"473"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905510","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":"Comparison of the analgesic dose of intravenous ketamine versus ketorolac in patients with chest trauma: A randomized double-blind clinical trial.","authors":"Hossein Zabihi Mahmoodabadi, Zeynab Seyed Javadein, Fatemeh Moosaie, Ali Faegh, Maryam Bahreini","doi":"10.1111/acem.15050","DOIUrl":"10.1111/acem.15050","url":null,"abstract":"<p><strong>Background: </strong>Pain management is a critical part of treatment in patients with chest trauma. Opioids and nonsteroidal anti-inflammatory drugs have been the most commonly used medications. However, their side effects have drawn attention to other medications. In this study, we aimed to assess the effect of the analgesic dose of ketamine in patients with chest trauma in comparison to ketorolac.</p><p><strong>Methods: </strong>A randomized, double-blind clinical trial was conducted in three hospitals. Patients were randomly allocated into two groups: 45 in the ketorolac group (30 mg intravenous [IV] and 45 in the ketamine group [0.25 mg/kg IV]). Pain was rated via numeric rating scale (NRS) before and 30 and 60 min after the drug injection. Morphine was used as the rescue medication. Furthermore, the adverse events of the two study regimens were rated.</p><p><strong>Results: </strong>Pain was more significantly relieved in the ketamine group, 30 and 60 min after drug administration, compared to ketorolac (median [IQR] 95% CI 30-min NRS 3.0 [1.0] 2.8-3.5 vs. 5.0 [4.5] 4.2-5.8, p = 0.006; and 60-min NRS 3.0 [2.0] 2.7-3.7 vs. 5.6 [1.7] 4.7-6.4, p < 0.001), respectively. Among patients with a chest tube, pain was more significantly controlled in the ketamine group (p < 0.001). Also, patients in the ketamine group needed less rescue pain medications compared to the ketorolac group although they reported more frequent nausea.</p><p><strong>Conclusion: </strong>Ketamine can be an effective analgesic in patients with chest trauma in acute settings with or without rib fracture.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"426-433"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906237","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}