Academic Emergency Medicine最新文献

{"title":"Failure rate of the pulmonary embolism rule-out criteria rule for adults 35 years or younger: Findings from the RIETE Registry.","authors":"Thibaut Jossein, Lucia Mazzolai, Alicia Lorenzo Hernández, Sonia Otálora Valderrama, Marija Zdraveska, Agustina Rivas Guerrero, Antonio López Ruiz, Pierpaolo Di Micco, Manuel Monreal, Olivier Hugli","doi":"10.1111/acem.15046","DOIUrl":"10.1111/acem.15046","url":null,"abstract":"<p><strong>Background: </strong>The use of a computed tomography pulmonary angiogram to diagnose pulmonary embolism (PE) has increased, leading not only to higher PE diagnoses but also to overdiagnosis and unnecessary radiation exposure, even in young patients despite a lower PE incidence. The aim of this study was to assess the failure rate of the pulmonary embolism rule-out criteria 35 (PERC-35) rule developed to reduce unnecessary testing in individuals aged ≤35 years among patients included in the Registro Informatizado de la Enfermedad TromboEmbolica Venosa (RIETE) Registry.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the RIETE Registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the missed PE rate using PERC-35 criteria. Secondary outcomes included the comparison of demographic and clinical characteristics, PE localization, treatment strategies, and outcomes between PERC-negative (PERC-35N) versus PERC-positive (PERC-35P) patients.</p><p><strong>Results: </strong>Of 58,918 adult patients with acute PE, the PERC-35 rule demonstrated a low missed PE rate of 0.35% (n = 204), with an upper 95% confidence interval [CI] of 0.40%. The missed rate was 7.0% (95% CI 6.0%-7.9%) in the 18- to 35-year subgroup. Compared to PERC-35P patients, PERC-35N patients were younger (mean age 28.4 years), with a lower body mass index, and included a higher proportion of pregnant/postpartum women. PERC-35N patients had a significantly lower rate of chronic diseases and presented less frequently with dyspnea or syncope but more often with chest pain. They showed lower rates of positive D-dimer and troponin levels. PERC-35N patients experienced fewer major bleeding episodes, similar recurrence rates of PE/deep vein thrombosis, and no deaths during anticoagulation.</p><p><strong>Conclusions: </strong>The PERC-35 rule demonstrated a low failure rate to exclude PE in patients aged 18-35 years and could reduce imaging and radiation exposure in young patients with a low PE pretest probability if confirmed prospectively.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"414-425"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709023","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":"Respiratory pathogen testing in children in the postpandemic era in Illinois.","authors":"Sriram Ramgopal, Kenneth A Michelson","doi":"10.1111/acem.15060","DOIUrl":"10.1111/acem.15060","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"463-466"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798955","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":"Is older age an appropriate criterion alone for ordering cervical spine CT after trauma.","authors":"Rachel Rodriguez, Shannon Greenberg","doi":"10.1111/acem.15001","DOIUrl":"10.1111/acem.15001","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"471-472"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905512","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":"Artificial intelligence-based clinical decision support in the emergency department: A scoping review.","authors":"Hashim Kareemi, Krishan Yadav, Courtney Price, Niklas Bobrovitz, Andrew Meehan, Henry Li, Gautam Goel, Sameer Masood, Lars Grant, Maxim Ben-Yakov, Wojtek Michalowski, Christian Vaillancourt","doi":"10.1111/acem.15099","DOIUrl":"10.1111/acem.15099","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI)-based clinical decision support (CDS) has the potential to augment high-stakes clinical decisions in the emergency department (ED). However, its current usage and translation to implementation remains poorly understood. We asked: (1) What is the current landscape of AI-CDS for individual patient care in the ED? and (2) What phases of development have AI-CDS tools achieved?</p><p><strong>Methods: </strong>We performed a scoping review of AI for prognostic, diagnostic, and treatment decisions regarding individual ED patient care. We searched five databases (MEDLINE, EMBASE, Cochrane Central, Scopus, Web of Science) and gray literature sources from January 1, 2010, to December 11, 2023. We adhered to guidelines from the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. We published our protocol on Open Science Framework (DOI 10.17605/OSF.IO/FDZ3Y).</p><p><strong>Results: </strong>Of 5168 unique records identified, we selected 605 studies for inclusion. The majority (369, 61%) were published in 2021-2023. The studies ranged over a variety of clinical applications, patient populations, and AI model types. Prognostic outcomes were most commonly assessed (270, 44.6%), followed by diagnostic (193, 31.9%) and disposition (115, 19%). Most studies remained in the earliest phase of preclinical development (572, 94.5%) with few advancing to later phases (33, 5.5%).</p><p><strong>Conclusions: </strong>By thoroughly mapping the landscape of AI-CDS in the ED, we demonstrate a rapidly increasing volume of studies covering a breadth of clinical applications, yet few have achieved advanced phases of testing or implementation. A more granular understanding of the barriers and facilitators to implementing AI-CDS in the ED is needed.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"386-395"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187903","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":"Opening invisible wounds.","authors":"Laura E Walker, Alexander Finch, Jason Carney","doi":"10.1111/acem.15054","DOIUrl":"10.1111/acem.15054","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"474-475"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715003","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. response to Ian Stiell's letter to the editor.","authors":"Mahla Radmard, Armin Tafazolimoghadam, Arjun Chanmugam, David M Yousem","doi":"10.1111/acem.15000","DOIUrl":"10.1111/acem.15000","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"477"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905511","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 yellow crash.","authors":"James Seymour Huntley","doi":"10.1111/acem.15086","DOIUrl":"https://doi.org/10.1111/acem.15086","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"32 4","pages":"481"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960003","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":"In reply to: Reevaluating the pulmonary embolism rule-out criteria in younger adults-Insights from the RIETE registry.","authors":"Thibaut Jossein, Olivier Hugli","doi":"10.1111/acem.15110","DOIUrl":"10.1111/acem.15110","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"480"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997825","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":"Does this patient have Lyme disease?","authors":"Fatima Johari","doi":"10.1111/acem.70037","DOIUrl":"https://doi.org/10.1111/acem.70037","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750679","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 and validation of the Patient-Reported Outcome Measure-Older adult care Transitions from the Emergency Department (PROM-OTED) tool.","authors":"Cameron J Gettel, Arjun K Venkatesh, Ivie Uzamere, James Galske, Tonya Chera, Marney A White, Ula Hwang","doi":"10.1111/acem.70029","DOIUrl":"https://doi.org/10.1111/acem.70029","url":null,"abstract":"<p><strong>Background: </strong>Care transitions from the emergency department (ED) to the community represent a critical period that can significantly impact clinical outcomes of older adults, yet there is a lack of standardized tools to measure patient-reported experiences and outcomes during this transition. Our objective was to develop and validate the Patient-Reported Outcome Measure-Older adult care Transitions in the ED (PROM-OTED) tool to measure care transition outcomes within 4-10 days after ED discharge.</p><p><strong>Methods: </strong>Older adults (65+ years) discharged from four EDs were enrolled between November 2021 and April 2024 in a multiphase process: qualitative interviews, item generation, member checking, cognitive debriefing, technical expert panel review, and psychometric evaluation and validation. We employed descriptive statistics, item analysis, interitem correlation, and factor analyses to assess the tool's validity and reliability.</p><p><strong>Results: </strong>Across all phases, we enrolled 290 older adults. The final 18-item PROM-OTED tool included items that addressed understanding of discharge instructions, medication management, follow-up care, and quality of life. The tool demonstrated feasibility with a mean (±SD) completion time of 4.97 (±3.04) min and was able to be administered electronically or via telephone. The tool additionally demonstrated excellent internal consistency (Cronbach's alpha 0.9376, McDonald's omega 0.9988) and good test-retest reliability (r = 0.8437). Exploratory factor analysis supported a robust factor structure and significant correlations between the PROM-OTED tool with the Care Transitions Measure-3, a general measure of hospital discharge quality of care, support its concurrent validity.</p><p><strong>Conclusions: </strong>The PROM-OTED tool is a reliable and preliminarily valid instrument for use during the immediate post-ED period, with potential clinical applications in enhancing discharge practices and assessing care transition outcomes of older adults during observational or interventional studies.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741777","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}