Academic Emergency Medicine最新文献

{"title":"Comment on \"Diagnostic Accuracy and Application of Subarachnoid Hemorrhage Decision Rules Among Patients With Non-Traumatic Acute Headache: A Systematic Review\".","authors":"Rachana Mehta, Ranjana Sah","doi":"10.1111/acem.70123","DOIUrl":"https://doi.org/10.1111/acem.70123","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858787","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":"Identifying Hospitalized Patients at Risk of Developing Severe Alcohol Withdrawal Syndrome.","authors":"Stephanie Cung, Sierra F Williams, Noah Berland","doi":"10.1111/acem.70122","DOIUrl":"https://doi.org/10.1111/acem.70122","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858788","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":"Psychological Comorbidity in Patients Presenting to the Emergency Department With Low-Risk Chest Pain and Anxiety.","authors":"Linh Dang, Kurt Kroenke, Jill Connors, Timothy E Stump, Patrick O Monahan, Yelena Chernyak, Emily Holmes, Colin Hoffman, Kevin Prather, Paul I Musey","doi":"10.1111/acem.70113","DOIUrl":"https://doi.org/10.1111/acem.70113","url":null,"abstract":"<p><strong>Objective: </strong>Low-risk chest pain (LRCP) is one of the most common conditions presenting in the emergency department (ED) and is strongly associated with anxiety. The purpose of this study is to determine the prevalence of other psychological comorbidities and clinical factors associated with severe anxiety in LRCP.</p><p><strong>Methods: </strong>Baseline data is analyzed from the PACER trial comparing the effectiveness of two telehealth interventions for LRCP patients with anxiety. Key eligibility criteria are a HEART score < 7 and either a GAD-7 anxiety score ≥ 8 or a positive PHQ screener for panic disorder. Psychological comorbidity measures included the Patient Health Questionnaire 8-item (PHQ-8) depression scale, the PHQ-14 somatization scale, the Primary Care Posttraumatic Stress Disorder Screen, the Sheehan Disability Scale, and the General Self-Efficacy Scale. Multivariable modeling is used to determine factors associated with severe anxiety.</p><p><strong>Results: </strong>The 375 patients had a mean age of 39.9; 70.9% were women; 62.9% were White, 32.6% Black, and 4.5% other race. The majority (75%) screened positive for panic disorder, and 42% of participants had severe anxiety (GAD-7 ≥ 15). Non-anxiety psychological comorbidity was very high; the proportion of patients exceeding scale cut points was 58% for depression, 57% for PTSD, 52% for somatization, 59% for high disability, and 31% for low self-efficacy; each was significantly associated with severe anxiety on univariable analysis. Four patient characteristics were independently associated with severe anxiety in multivariable models: odds ratios (95% CI) were 2.7 (1.5-4.9) for depression, 2.3 (1.4-3.9) for low self-efficacy, 2.1 (1.2-3.6) for low education (high school or less), and 1.8 (1.0 to 3.3) for female sex.</p><p><strong>Conclusions: </strong>LRCP is accompanied not only by anxiety but also by other potentially treatable psychological comorbidities Severe anxiety is more common in individuals with depression, low self-efficacy, lower education, and possibly women.</p><p><strong>Trail registration: </strong>PACER is registered in clinicaltrials.gov identifier: NCT04811521.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803251","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":"Trends in Emergency Care Provided by Non-Physician Providers and Physicians: 2009-2021.","authors":"Summer Ghaith, Cameron Gettel, Megan McElhinny, Aidan F Mullan, Molly M Jeffery, Rachel A Lindor","doi":"10.1111/acem.70098","DOIUrl":"https://doi.org/10.1111/acem.70098","url":null,"abstract":"<p><strong>Objectives: </strong>We describe the types of emergency department (ED) visits managed by non-physician providers (NPPs), including physician assistants and nurse practitioners, and emergency medicine (EM) physicians, assessing shifts in care patterns over time.</p><p><strong>Methods: </strong>We used data from the National Hospital Ambulatory Medical Care Survey collected from 2009 to 2021. We classified visits by provider type: physician only, physician with resident, physician with NPP, and NPP only. We described characteristics of visits by provider type, including patient demographics, triage urgency, imaging, length of stay, and disposition, and analyzed using Poisson regression. We described the change in type of provider seen over this study period and further analyzed by triage urgency and hospital location.</p><p><strong>Results: </strong>Of 1.684 billion estimated ED visits from 2009 to 2021, 1.171 billion were managed by physicians without residents or NPPs (physicians only), 136.3 million by physicians with residents, 209.1 million by physicians with NPPs, and 167.4 million by NPPs only. Patients seen by physicians only were older, were triaged as having more urgent needs, had a longer ED length of stay, and were more likely to be admitted compared to those seen by NPPs only. Physician-only visits decreased from 77% to 62%, while NPP-only visits increased from 6% to 11%. The physician with the NPP group similarly grew from 9% to 17%. For visits assigned a triage urgency level of 2 (\"emergent\"), physician-only visits decreased by 20%, physician with NPP visits increased by 13%, and NPP-only visits increased by 3%. In metropolitan areas, physician-only visits dropped 14%, with a 5% increase in NPP-only visits. In non-metropolitan areas, physician-only visits decreased 17%, with a 9% increase in NPP-only visits.</p><p><strong>Conclusions: </strong>The EM workforce has shifted, with NPPs seeing a higher percentage of patients, including both lower- and higher-acuity patients. This shift is particularly prominent in rural areas but is evident across all regions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803252","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":"Response to the Commentary on Sheppard et al.'s Study of First Trimester POCUS Behaviors.","authors":"Gillian Sheppard, Kathy Boutis, Martin Pusic","doi":"10.1111/acem.70120","DOIUrl":"https://doi.org/10.1111/acem.70120","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793237","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":"Effects of a Geriatric Emergency Department Multidisciplinary Intervention on Functional Status and Quality of Life: A Pre/Post Cohort Study.","authors":"Lauren T Southerland, Julie A Stephens, Katherine M Hunold, Christopher R Carpenter, Lorraine C Mion, Lucas Krupinski, Carson R Reider, Jeffrey M Caterino","doi":"10.1111/acem.70119","DOIUrl":"https://doi.org/10.1111/acem.70119","url":null,"abstract":"<p><strong>Background: </strong>Geriatric screening and multidisciplinary assessment of older adults in the Emergency Department (ED) decrease hospitalizations and ED revisits. The impact on patient-reported outcomes of health-related quality of life (HRQoL) and functional status is not known.</p><p><strong>Methods: </strong>A hybrid type II implementation/effectiveness prospective cohort study was conducted in an academic ED. The intervention bundle was geriatric screening for delirium, fall risk, and transition of care needs, and multidisciplinary assessment. All older adults (≥ 65 years) placed in the ED observation unit were eligible. HRQoL and functional status were obtained at the ED visit, 30, and 90 days, and were compared between the pre- and post-intervention implementation cohorts. Secondary outcomes included ED revisits, falls, mortality, and intervention adoption measures.</p><p><strong>Results: </strong>From 2019 to 2023, 368 adults participated in the study: Most were community-dwelling (97%) and had multiple comorbidities. The pre (n = 138) and post (n = 230) cohorts did not differ in baseline functional status or HRQoL. The rate of geriatric screening improved from 12.3% in the pre-implementation cohort to 91.3% in the post-implementation cohort (p < 0.01). Multispecialty consultation also increased (68.1%-91.3%, p < 0.01). The proportion who had a post-ED visit decline in functional status did not differ between cohorts. Physical HRQoL declined similarly in both cohorts (-0.73 vs. -0.33, p = 0.61) at 90 days. Mental HRQoL improved in both cohorts; improvement was greater in the pre-cohort (2.35 vs. 0.32, p = 0.02). ED revisits and re-hospitalizations were unchanged (30 days: 23.0% vs. 17.2%, p = 0.18, and 90 days: 37.8% vs. 34.8%, p = 0.57). The intervention decreased falls at 30 and 90 days (30 days: 9.7% vs. 3.2%, p = 0.04; 90 days: 22.1% vs. 7.9%, p < 0.01).</p><p><strong>Conclusions: </strong>Geriatric screening in the ED increased identification of geriatric syndromes and multidisciplinary consultation. The intervention was associated with decreased falls but did not affect HRQoL or reduce functional decline post ED visit.</p><p><strong>Trial registration: </strong>clinicaltrials.gov: NCT04068311.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793236","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":"Characteristics, Interventions, and Outcomes for Patients Presenting to the Emergency Department With Abdominal Pain.","authors":"Summer Ghaith, Ronna L Campbell, Zachary Ginsberg, Megan McElhinny, Derick D Jones, Aidan F Mullan, Rachel A Lindor","doi":"10.1111/acem.70110","DOIUrl":"https://doi.org/10.1111/acem.70110","url":null,"abstract":"<p><strong>Objective: </strong>We sought to characterize patients presenting to emergency departments (EDs) with abdominal pain and to validate risk categories defined by the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) for low-risk recurrent abdominal pain.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients presenting with abdominal pain between November 2019 and November 2023 across 21 EDs in Arizona, the Midwest, and Florida. Patients were categorized per GRACE-2 into recurrent and non-recurrent pain as well as low- and high-risk groups. Primary outcomes included 72-h returns and mortality at 30 and 90 days.</p><p><strong>Results: </strong>The study included 162,494 visits (112,896 unique patients; median age 46 years; 61.2% female). Among these, 4.3% had low-risk recurrent abdominal pain. Patients with recurrent and non-recurrent low-risk pain had similar ED length of stay and discharge rates to each other, compared to patients with high-risk pain who had longer length of stay and lower discharge rates. At 30 days after the ED encounter, patients with low-risk recurrent abdominal pain had similar mortality to patients with low-risk non-recurrent pain (0.4% vs. 0.3%; adjusted RR = 1.31, 95% CI: 0.85-2.03), while they had significantly lower mortality than patients with high-risk recurrent abdominal pain (0.4% vs. 2.3; adjusted RR = 3.14, 95% CI: 2.02-4.89).</p><p><strong>Conclusions: </strong>This study highlights the heterogeneity in patients presenting to the ED with abdominal pain. Among these patients, those with low-risk recurrent pain demonstrated similar lengths of stay, discharges, and mortality rates to those with low-risk non-recurrent pain and less favorable lengths of stay, discharges, and mortality rates compared to those with any high-risk features. These findings suggest that low- and high-risk features may be more useful than recurrent or non-recurrent pain in identifying patients who could benefit from more robust ED evaluations.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787984","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":"Re: Comparison of the incidence of recovery agitation with two different doses of ketamine in procedural sedation: A randomized clinical trial.","authors":"Pooya Payandemehr, Narjes Akhlaghi","doi":"10.1111/acem.70042","DOIUrl":"10.1111/acem.70042","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"947"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963414","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":"Abortion care in the emergency department: A national survey of emergency physicians' perspectives.","authors":"Abigail M Kempf, Miriam R Singer, Maetal Haas-Kogan, Andrea Pelletier, Ari B Friedman, Sarah Rae Easter, Deborah Bartz","doi":"10.1111/acem.70002","DOIUrl":"10.1111/acem.70002","url":null,"abstract":"<p><strong>Objective: </strong>The emergency department (ED) is an essential setting for diagnosis of pregnancy, confirmation of pregnancy location, and management of pregnancy loss and other complications. This health care service delivery is especially important for patients with limited or complicated access into reproductive health care elsewhere. We seek to assess emergency physicians' knowledge, training, attitudes, and practices related to pregnancy options counseling, reproductive health referrals, and provision of medical- and procedural-induced abortion.</p><p><strong>Methods: </strong>We surveyed a sample of emergency physicians in person at a U.S. national medical meeting regarding knowledge, attitudes, and practices related to reproductive health care delivery. Wilcoxon rank sum tests were used to evaluate differences between abortion-restrictive and -permissive states and chi-square tests were used to compare proportions between the two groups and Wilcoxon signed rank was used to compare median scores between questions. Thematic analysis was used to review qualitative responses.</p><p><strong>Results: </strong>Of the 295 emergency physicians approached, 252 (85.4%) completed study procedures. The majority (n = 218, 86.5%) practiced in abortion-permissive states. Most (n = 178, 70.6%) supported abortion provision in the ED if legally allowed, though only about half (n = 131, 52.0%) reported ever prescribing medication abortion pills. Despite higher proportions reporting training in services, a small minority responded they could still independently provide pregnancy options counseling (25.1%), direct referrals for abortion (34.9%), medical management for early pregnancy loss (15.1%) or induced abortion (10.7%), or uterine aspiration for any pregnancy indication (1.6%). Training and knowledge were similar, though practice patterns and attitudes differed when comparing abortion-restrictive to -permissive states.</p><p><strong>Conclusions: </strong>This national survey demonstrates that, while most emergency physicians support the provision of abortion care in this setting, they do not routinely provide this care due to a variety of factors including lack of knowledge, lack of training, and legal and institutional restrictions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"848-856"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482007","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":"Paper.","authors":"Jonathan D Talmud","doi":"10.1111/acem.70063","DOIUrl":"10.1111/acem.70063","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"949"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959707","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}