Academic Emergency Medicine最新文献

{"title":"Prophylactic Antibiotics for Mechanically Ventilated Patients.","authors":"Brit Long, Michael Gottlieb","doi":"10.1111/acem.70378","DOIUrl":"https://doi.org/10.1111/acem.70378","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70378"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395562","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":"Validation of a 0/2-Hour Point-Of-Care High Sensitivity Troponin Algorithm: A Multisite US Study.","authors":"Simon A Mahler, Nicklaus P Ashburn, Akalya Villenthi, David A Pearson, Hannah D Pugh, Benjamin T Hutchison, Michael W Supples, Anna C Snavely","doi":"10.1111/acem.70379","DOIUrl":"10.1111/acem.70379","url":null,"abstract":"<p><strong>Objectives: </strong>A 0/2-h algorithm for the i-STAT point-of-care (POC) high sensitivity troponin I (hs-cTnI) assay was recently derived in Australia. The objective of this study was to validate and optimize the performance of the 0/2-h algorithm in a multisite U.S. Emergency Department (ED) cohort.</p><p><strong>Methods: </strong>A prospective cohort study was conducted at three U.S. EDs (February-September 2025). Adults without STEMI and at least one hs-cTnI ordered were accrued. Blood samples were collected simultaneously for POC hs-cTnI measurement on an i-STAT 1 analyzer (Abbott Laboratories) and central laboratory hs-cTnI measurement (Beckman Coulter). The primary outcome was index myocardial infarction (MI), adjudicated by experts using clinical hs-cTnI measures. Diagnostic performance of the Australian 0/2-h algorithm was assessed by calculating negative and positive predictive values (NPV, PPV) with associated 95% confidence intervals. Efficacy, defined as the proportion of patients classified into the rule-out zone, was calculated. Algorithm optimization tested modified cut points to increase efficacy while maintaining NPV ≥ 99% and achieving PPV ≥ 65%.</p><p><strong>Results: </strong>During the study period, 578 patients with complete 0/2-h algorithm assessments were accrued. These patients were 48% (279/578) female, 40% (233/578) non-White, with a median age of 60 years (IQR: 50-70). Index MI occurred in 7.4% (43/578). Algorithm efficacy was 54.8% (317/578) and 8.8% (51/578) were classified to the rule-in zone. Among patients ruled-out, the NPV was 99.4% (95% CI: 97.7%-99.9%). The rule-in zone was associated with a PPV of 62.7% (95% CI: 48.1%-75.9%). Among 36.3% (210/578) patients classified to the observation zone, 4.3% (9/210) had an adjudicated index MI. An optimized 0/2-h algorithm increased efficacy to 60.0% (347/578) while achieving an NPV of 99.4% (95% CI: 97.9%-99.9%) and PPV of 74.4% (95% CI: 58.8, 86.5%) for index MI.</p><p><strong>Conclusions: </strong>The original Australian and optimized 0/2-h algorithms for i-STAT POC hs-cTnI measurement had high NPV and efficacy in a multisite U.S.</p><p><strong>Cohort: </strong></p><p><strong>Trial registration: </strong>Trial Registration: NCT06899776.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 7","pages":"e70379"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468271","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 Novel Pilot Program Using Patient Incentives to Address Emergency Department Boarding and Overcrowding: A Retrospective Observational Study.","authors":"Nancy Glober, Diane Kuhn, Lisa Martin, Lauren Stewart, Pam Tanner-Lauderbaugh, John Sparzo, Michele McCarroll","doi":"10.1111/acem.70359","DOIUrl":"10.1111/acem.70359","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) overcrowding is a routine challenge for most hub hospitals, reported by more than 90% of ED medical directors several times each week. Alternate treatment locations are permissible within the Emergency Medical Treatment and Labor Act (EMTALA) regulations (with patient consent) as long as hospitals screen and stabilize any patient presenting to an ED.</p><p><strong>Methods: </strong>This pilot study explored the feasibility and patient acceptability of offering financial compensation to low-acuity patients who agreed to transfer from an overcrowded ED to critical access hospitals.</p><p><strong>Results: </strong>Four eligible patients requiring medical-surgical admission participated. Transfers included travel vouchers of $300-$500. All transfers were completed safely without retransfer or complications, and all patients were discharged home. The aggregate Net Promoter Score was +75, indicating strong satisfaction.</p><p><strong>Conclusions: </strong>Findings suggest that modest financial incentives may support patient-approved interfacility transfers, ease ED overcrowding, and enhance utilization of underused hospitals while complying with EMTALA. Further study of this model is warranted.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70359"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306708","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 a Modified Sudbury Vertigo Risk Score for Predicting Central Causes of Dizziness in the Emergency Department.","authors":"Shunsuke Soma, Tsukasa Kamitani, Sho Sasaki","doi":"10.1111/acem.70367","DOIUrl":"10.1111/acem.70367","url":null,"abstract":"<p><strong>Background: </strong>Distinguishing central causes of dizziness from peripheral causes in emergency department (ED) patients is a challenging clinical problem. The Sudbury Vertigo Risk Score is a clinical prediction model that supports decision-making by predicting central causes of dizziness. However, its predictor \"benign paroxysmal positional vertigo (BPPV) diagnosis\" may introduce uncertainty and limit clinical usability. Therefore, we developed a modified model in which this predictor was replaced with variables that can be assessed through patient history.</p><p><strong>Methods: </strong>We retrospectively included consecutive patients aged ≥ 15 years who presented with dizziness to an ED between April 2013 and March 2023. The outcome was dizziness due to central lesions, defined as abnormalities identified on neuroimaging and judged by a relevant specialist to be the cause of dizziness. We developed a modified model using multivariable logistic regression in which \"BPPV diagnosis\" was replaced with two predictors-\"trigger (provoked by changes in head position)\" and \"history of dizziness\"-while retaining the other original predictors. We evaluated discrimination using the area under the receiver operating characteristic curve (AUROC) and calibration using a calibration plot. We compared efficiency and safety between the modified model and the Sudbury model.</p><p><strong>Results: </strong>Among 3606 patients, a total of 2958 were eligible. Dizziness due to central lesions was identified in 155 patients (5.2%). The AUROC was 0.85 (95% CI, 0.82-0.88) for the Sudbury model and 0.81 (95% CI, 0.77-0.85) for the modified model. The modified model showed calibration comparable to that of the original model. Safety and efficiency were 0.0% (95% CI, 0.0%-0.5%) and 26.8% (95% CI, 25.2%-28.4%) for the Sudbury model, and 0.9% (95% CI, 0.4%-2.1%) and 18.7% (95% CI, 17.3%-20.1%) for the modified model.</p><p><strong>Conclusion: </strong>The modified model showed comparable performance after replacing BPPV diagnosis with predictors that can be more easily assessed through patient history.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70367"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337394","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":"Rates of Sexual Harassment Among Emergency Medicine Faculty and the Impact on Faculty Engagement.","authors":"A Miller, V M Dandar, P Lema, R Lucas, D Das","doi":"10.1111/acem.70355","DOIUrl":"https://doi.org/10.1111/acem.70355","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70355"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051891","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":"Beyond Hidden Workload: Rethinking Emergency Department Manpower in India.","authors":"Siju V Abraham, Rajeev P C, Babu Urumese Palatty","doi":"10.1111/acem.70370","DOIUrl":"https://doi.org/10.1111/acem.70370","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70370"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300542","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":"Gaps in Documenting Interpreter Service Utilization Among Emergency Department Clinicians Treating Patients With Limited English Proficiency.","authors":"Michael Gottlieb, Aamina Naveed, Emily Nguyen, Ildemaro J González, Carlos Olvera, Giles W Slocum","doi":"10.1111/acem.70361","DOIUrl":"10.1111/acem.70361","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70361"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238425","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":"End Tidal O₂: A Promising New Metric for Optimizing Preoxygenation and RSI Safety in the Emergency Department.","authors":"Nicholas D Caputo, Matthew Oliver, Reuben J Strayer","doi":"10.1111/acem.70364","DOIUrl":"https://doi.org/10.1111/acem.70364","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70364"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306683","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":"Outcomes of Acute PE Treated With DOACs in the Veterans Affairs Health System: A Retrospective Cohort Study.","authors":"Michael Dore, Ryan Duffy","doi":"10.1111/acem.70360","DOIUrl":"10.1111/acem.70360","url":null,"abstract":"<p><strong>Background: </strong>Although guidelines support outpatient management for low-risk pulmonary embolism, U.S. emergency department (ED) adoption remains low, partly due to limited contemporary evidence. Direct oral anticoagulant (DOAC) era studies are small or European and typically classify all sPESI > 0 as high risk. More granular U.S. outcomes are needed to inform which patients can be safely discharged.</p><p><strong>Objectives: </strong>To characterize 30-day all-cause mortality by sPESI in patients with an acute PE treated with a DOAC.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>United States Veterans Affairs (VA) Health System, 2015 to 2024.</p><p><strong>Participants: </strong>Adult patients diagnosed with an acute PE in a VA ED were prescribed a DOAC within one day.</p><p><strong>Exposure: </strong>Hospital admission.</p><p><strong>Main outcomes: </strong>30-day all-cause mortality.</p><p><strong>Results: </strong>A total of 6,427 first-time acute PEs were treated with a DOAC. Thirty-day mortality rates by sPESI were: sPESI 0: 0.0%, sPESI 1: 0.4%, sPESI 2: 1.8%, sPESI 3: 3.8%, sPESI 4: 8.8%, sPESI 5: 21.1%, and sPESI 6: 25.0%. Of 3,799 patients with sPESI < 2, 2,578 (67.9%) were hospitalized with a median length of stay of 24 h. After adjusting for covariates, odds of 30-day all-cause mortality were similar regardless of admission vs. ED discharge (OR 1.32, 95% CI 0.40, 4.36, p = 0.65).</p><p><strong>Conclusions: </strong>In this large U.S. DOAC-era cohort, patients with sPESI 0 or 1 had very low 30-day mortality, and hospitalization did not appear to improve outcomes. Despite this, two-thirds were admitted. These findings support expanding outpatient management of acute PE and reducing short-stay, low-value hospitalizations if no other indication for admission exists.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70360"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275649","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":"Predicting Echocardiography Findings in Adults Presenting to the Emergency Department With Syncope: An External Validation of the ROMEO Score.","authors":"John DeAngelis, Gymar Vargas, Robert E Weiss, Carolyn Winskill, Edward H Suh, Dana L Sacco, Nancy Wood, Daniel K Nishijima, Alan B Storrow, Jonathan Schimmel, Timothy J Poterucha, Pierre A Elias, Nataly Beltre, Marc A Probst","doi":"10.1111/acem.70366","DOIUrl":"10.1111/acem.70366","url":null,"abstract":"<p><strong>Background: </strong>Syncope is common in the Emergency Department (ED) and can be associated with structural heart disease (SHD). Transthoracic echocardiography (TTE) is commonly ordered to assess for SHD.</p><p><strong>Objective: </strong>To externally validate the previously developed ROMEO score, which identifies patients with syncope who are at very low risk of significant findings on TTE.</p><p><strong>Design: </strong>Secondary analysis of a multicenter, prospective, observational cohort study.</p><p><strong>Setting: </strong>One community and five academic EDs in the United States.</p><p><strong>Participants: </strong>Adults (≥ 40 years old) presenting to the ED with syncope or presyncope, without a serious ED diagnosis.</p><p><strong>Interventions: </strong>Receipt of TTE within 30 days of the index visit.</p><p><strong>Measurements: </strong>Our primary outcome was the rate of significant findings on TTE within 30 days of the index ED visit. We calculated the sensitivity, specificity, negative and positive predictive values (NPV, PPV), and the area under the curve (AUC) of the ROMEO score.</p><p><strong>Results: </strong>We enrolled 1287 patients, of whom 427 underwent TTE. 88 (20.6%) had a significant finding. A ROMEO score of zero had a sensitivity of 98.9% and a NPV of 98.6%. The specificity and PPV were 20.2% and 24.3%, respectively. The AUC was 0.83 (95% CI: 0.79 to 0.87).</p><p><strong>Limitations: </strong>Given the rate of non-enrollment of screened patients, there is potential for selection bias. Our study sample was biased toward urban, academic centers; the results may not apply to community settings.</p><p><strong>Conclusions: </strong>The ROMEO score demonstrates strong predictive performance and may be useful to help clinicians identify patients who are unlikely to benefit from TTE.</p><p><strong>Trial registration: </strong>ClinicalTrial.gov identifier: NCT04533425.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70366"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306696","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}