Academic Emergency Medicine最新文献

{"title":"The Sea Keeps No Hours.","authors":"Tommaso Bellini","doi":"10.1111/acem.70384","DOIUrl":"10.1111/acem.70384","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70384"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597513","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":"In the Valley of Broken Wings.","authors":"Samia Farooqi","doi":"10.1111/acem.70375","DOIUrl":"https://doi.org/10.1111/acem.70375","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70375"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395603","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":"A Dizzying Number of Clinical Decision Rules … and Do We Need Them?","authors":"Jonathan A Edlow","doi":"10.1111/acem.70374","DOIUrl":"https://doi.org/10.1111/acem.70374","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70374"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350234","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":"Assessing Risk of Early ICU Admission or Death at Emergency Department Triage: Clinical Judgment Versus Early Warning Scores.","authors":"Nicola Bonadia, Piergiacomo Maria Cacciamani Fanelli, Davide Antonio Della Polla, Valeria Maccauro, Giuseppe De Matteis, Andrea Piccioni, Antonio Gasbarrini, Claudio Sandroni, Francesco Franceschi, Marcello Covino","doi":"10.1111/acem.70377","DOIUrl":"10.1111/acem.70377","url":null,"abstract":"<p><strong>Background: </strong>Early Warning Scores (EWS) are widely used to standardize the identification of clinical deterioration, yet their comparative performance against clinical judgment in Emergency Department (ED) triage remains uncertain. We aimed to evaluate whether commonly used EWS match or outperform clinical judgment in predicting early adverse outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective observational study including 361,927 adult ED presentations at a tertiary-care academic center from 2015 to 2024. Clinical judgment was operationalized as the triage category assigned at the initial evaluation. Five EWS (NEWS, NEWS2, MEWS, REMS, and ViEWS) were computed using vital signs recorded at ED presentation. The primary outcome was a composite of 24-h mortality or intensive care unit (ICU) admission. Discrimination, calibration, decision curve analysis, and reclassification metrics were used to compare models.</p><p><strong>Results: </strong>The primary outcome occurred in 1.17% of patients. Discriminatory performance was highest for ViEWS (AUC 0.875) and clinical judgment (AUC 0.872), with no significant difference between them. Other EWS demonstrated significantly lower AUCs. In precision-recall and threshold-based analyses, clinical judgment maintained higher specificity at higher-risk thresholds while preserving adequate sensitivity. Decision curve analysis showed comparable or greater net benefit for clinical judgment than for all tested EWS across clinically relevant thresholds. Reclassification metrics showed no improvement with EWS over clinical judgment.</p><p><strong>Conclusion: </strong>Commonly used EWS did not clearly outperform triage clinical judgment in predicting early ICU admission or death. These findings support further investigation of how structured scores and clinical judgment may provide complementary information, particularly in identifying patients whose risk may be modified by timely escalation of care.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70377"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468239","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 Severity Scores and High-Flow Nasal Cannula Initiation in Infants With Bronchiolitis: A Multicenter Emergency Department Cohort Study.","authors":"Andrea Rivera-Sepulveda, Joel Hernandez, Michael Stoner, Matthew M Davis","doi":"10.1111/acem.70380","DOIUrl":"10.1111/acem.70380","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70380"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443653","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":"Racial and Demographic Differences in Use of a Trauma Center Confidential Status Policy.","authors":"Drew J Wodecki, Ilana Osowiecki, Christy Adams, Tiffani J Johnson, Shani A L Buggs, Heather M Siefkes","doi":"10.1111/acem.70388","DOIUrl":"10.1111/acem.70388","url":null,"abstract":"<p><strong>Objectives: </strong>Confidential status is a hospital trauma center practice of restricting communication with all visitors of violently injured patients, including family and friends. The practice is intended to protect patients and staff from harm in situations involving violence or safety concerns, though it may have unintended negative impacts.</p><p><strong>Methods: </strong>A mixed-methods study using retrospective cohort and qualitative study designs was conducted at a single urban academic Level 1 trauma center with a confidential status practice. Using retrospective chart review of traumatically injured patients from 2015 to 2020, we performed multivariable logistic regression examining associations between placement on confidential status and patient characteristics including age, race/ethnicity, and intent of injury. Surveys and semi-structured interviews were conducted to examine knowledge of the confidential status policy and perceived effects on patient care and clinical workflow.</p><p><strong>Results: </strong>Of the 42,540 traumatically injured patients were included, 319 were placed on confidential status. Those with confidential status were most commonly injured by assault (62%). Multivariable regression showed Black (OR 2.69, 95% CI 1.97-3.68) and Latine (OR 1.46, 95% CI 1.03-2.07) patients were more likely to be placed on confidential status compared to White patients. All survey respondents reported providing direct care for patients in which the confidential status was enforced; however, only 38% reported having read the policy. Most respondents reported neutral perceptions regarding the policy's impact on patient care and patient experience, while only 12% reported positive perceptions. Four qualitative themes were identified: family trauma, discrimination, stressed workplace environment, and policy ineffectiveness.</p><p><strong>Conclusions: </strong>Racial/ethnic differences were observed in the use of confidential status. Staff perceptions raised concerns regarding unintended negative effects of the policy on patients and families.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70388"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629186","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":"Enhancing Patient-Centered Care for Older Adults: Development and Evaluation of an Emergency Department Pathway.","authors":"Maren Clark, Jean Hoffman, Greg Adams, Yaxu Zhuang, Elizabeth Goldberg","doi":"10.1111/acem.70372","DOIUrl":"https://doi.org/10.1111/acem.70372","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70372"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395504","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 Role of Satisfaction, Trust, and Shared Decision-Making in Opioid Misuse Risk After Unmet Analgesic Preferences for Acute Pain.","authors":"Max Jordan Nguemeni Tiako, Abby Dolan, Frances Shofer, Jeanmarie Perrone, Marilyn M Schapira, Zachary Meisel","doi":"10.1111/acem.70383","DOIUrl":"10.1111/acem.70383","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70383"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547422","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 Randomized Experiment of Mailed Incentives to Improve Emergency Physician Survey Participation.","authors":"Steven C Marcus, Mark Olfson, Sara Wiesel Cullen, Nicholas Cardamone, Rebecca Del Rossi, Raina M Merchant, Tony Liu, Timothy Schmutte, Ming Xie, Nathaniel J Williams","doi":"10.1111/acem.70385","DOIUrl":"10.1111/acem.70385","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70385"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629242","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":"Screening and Interventions for Elder Mistreatment: Geriatric Emergency Department Guidelines 2.0 Systematic Review.","authors":"Daniel Baek, Satheesh Gunaga, Christian H Nickel, Charles L Maddow, Brianna Fitzgerald, Neha Bajaj, Shan W Liu, Colin Eng Choon Ong, Kristin Lees Haggerty, Tony Rosen","doi":"10.1111/acem.70373","DOIUrl":"10.1111/acem.70373","url":null,"abstract":"<p><strong>Background: </strong>Elder mistreatment is common, underreported, and associated with significant morbidity and mortality. Emergency department (ED) visits provide an important opportunity to identify elder mistreatment and initiate intervention, but the evidence for the impact of screening or intervention strategies in this clinical setting is not well characterized. Our goal was to conduct systematic literature reviews to describe the impact of ED-based screening tools and ED-initiated interventions for elder mistreatment.</p><p><strong>Methods: </strong>We conducted two systematic reviews following PRISMA 2020 guidelines using predefined Patient Intervention Comparator Outcome (PICO) frameworks. PICO 1 evaluated ED based screening tools for patients aged 60 years and older. PICO 2 evaluated ED initiated interventions for patients with known or suspected elder mistreatment. Searches were performed in MEDLINE, Embase, Web of Science, and Cochrane CENTRAL from December 2018 through December 2024 and supplemented by prior scoping reviews.</p><p><strong>Results: </strong>For PICO 1 (ED screening) the prior scoping review identified 5 studies and the updated search identified 208 additional articles, of which 5 studies underwent full-text review. For PICO 2 (ED intervention), the prior scoping review identified 5 studies and the updated search identified 191 additional articles, of which 2 studies underwent full-text review. No studies were identified that met full inclusion criteria for either PICO. Existing studies described multiple screening tools and multidisciplinary intervention models, but lacked comparator groups, standardized reference standards, or clinically meaningful outcome measures required for inclusion.</p><p><strong>Conclusions: </strong>These empty systematic reviews emphasize the large existing knowledge gaps about ED elder mistreatment screening and intervention. These gaps affect the ability to make practice recommendations and highlight opportunities for future rigorous research to inform guideline development.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70373"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417625","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}