Academic Emergency Medicine最新文献

{"title":"Safety of treating low-risk patients with acute pulmonary embolism at home.","authors":"Sophia Bouzrara, Raymond Beyda","doi":"10.1111/acem.70044","DOIUrl":"10.1111/acem.70044","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"935-938"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141098","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":"Clinician-level variation in admission practices for common conditions in Veteran Affairs emergency departments.","authors":"Alexander T Janke, Aaron Dalton, Keith E Kocher, Anita A Vashi","doi":"10.1111/acem.70020","DOIUrl":"10.1111/acem.70020","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Affairs (VA) Healthcare System seeks to improve value of care. Variations in hospital admission practices may be a target to improve the efficiency and quality of emergency care.</p><p><strong>Method: </strong>This was a retrospective cross-sectional analysis of 113 VA emergency departments (EDs) from October 1, 2015 to June 8, 2023. ED visits were included if their primary diagnosis matched one of 535 ICD-10 codes within the previously developed admission intensity measure, encompassing 16 clinical conditions with known variation in admission practices and opportunities for outpatient management. The primary outcome was the standard deviation (SD) of clinician-level, risk-adjusted admission rates for each condition, calculated using multilevel, hierarchical models accounting for patient sociodemographic and clinical characteristics. We then summarized the SD of clinician admission rates, based on total admission volume at VA. We further assessed the association between clinician admission intensity and 72-h ED return visits resulting in hospitalization, a safety indicator, using Pearson correlation coefficients.</p><p><strong>Results: </strong>During the study period, 18.5 million ED visits were recorded across 9350 clinicians, with 3,815,094 visits (20.6%) having primary diagnoses matching one of the 16 clinical conditions included in the admission intensity measure. Patients' mean (±SD) age was 63.3 (SD 15.4) years, and 89.9% were male. Among the 16 conditions, chest pain accounted for the highest number of admissions (229,507) and exhibited the greatest variation (SD ±14.7%) in clinician-level admission rates, while nephrolithiasis had the lowest variation (SD ±4.6%). There was no significant association between clinician admission rates and 72-h ED returns (Pearson correlation 0.018).</p><p><strong>Conclusion: </strong>A previously developed admission intensity measure may help identify improvement opportunities in hospitalization practices across VA EDs. Chest pain was the most common condition among those in the measure, and subject to the most variability in admission practices among clinicians.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"874-902"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646668","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":"Women presenting to emergency departments with vaginitis should be offered single-dose empirical treatment.","authors":"David A Talan, Omai B Gardner, Brett A Faine","doi":"10.1111/acem.70026","DOIUrl":"10.1111/acem.70026","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"941-946"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707901","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":"Association between patient primary language, physical restraints, and intramuscular sedation in the emergency department.","authors":"Anusha Kumar, Caitlin R Ryus, Jossie A Carreras Tartak, Bidisha Nath, Isaac V Faustino, Dhruvil Shah, Leah Robinson, Riddhi Desai, Rebekah Heckmann, R Andrew Taylor, Ambrose H Wong","doi":"10.1111/acem.70004","DOIUrl":"10.1111/acem.70004","url":null,"abstract":"<p><strong>Background: </strong>Despite the importance of effective communication during verbal de-escalation, research regarding patient primary language during management of agitation symptoms is limited. We evaluated associations between patient primary language and use of physical restraints and intramuscular (IM) sedation in the emergency department (ED).</p><p><strong>Methods: </strong>This was a retrospective cohort analysis evaluating physical restraint and IM sedation characteristics using electronic medical records from 13 EDs affiliated with a large regional health care network located in the northeast United States. Data were collected for ED visits from 2013 to 2023 for all adult patients ages 18 and older. We performed logistic regression models using the presence of physical restraint and IM sedation orders as primary outcomes, adjusting for patient primary language, sex assigned at birth, age, race and ethnicity, and chief complaints.</p><p><strong>Results: </strong>In our analysis of 3,406,474 visits, 3,086,512 included English speakers, 250,912 included Spanish speakers, 9,057 included Portuguese speakers, 6,616 included Arabic speakers, 6,425 included Italian speakers, 39,303 included other language speakers, and 7,649 included unknown language speakers; 18,546 visits included use of physical restraints and 48,277 visits included use of IM sedation. After demographic and clinical characteristics were adjusted for, visits with Spanish- and Portuguese-speaking patients had a reduced likelihood of physical restraints and IM sedation compared to English speakers, with adjusted odds ratios (95% confidence intervals) of 0.70 (0.65-0.76) and 0.82 (0.79-0.87) for Spanish speakers and 0.39 (0.20-0.68) and 0.84 (0.66-1.05) for Portuguese speakers, respectively.</p><p><strong>Conclusions: </strong>ED visits with Spanish- and Portuguese-speaking patients were found to have lower odds of physical restraints and IM sedation, while Arabic, Italian, other, and unknown language-speaking patients were found to have higher odds. Factors contributing to linguistic differences in physical restraint and IM sedation use, such as cultural interpretations of behavior, quality of clinical interactions, and patient-clinician communication strategies, merit further investigation.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"836-847"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412769","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":"Intravenous Magnesium: Prompt use for Asthma in Children Treated in the Emergency Department (IMPACT-ED), a pilot randomized trial.","authors":"Michael D Johnson, Bashar S Shihabuddin, Bradley J Barney, Mengtao Dai, Toni Harbour, Yeojin Jung, Kameron N Clinton, Breanna Vance, Madison Reilly, Joseph J Zorc","doi":"10.1111/acem.70006","DOIUrl":"10.1111/acem.70006","url":null,"abstract":"<p><strong>Background: </strong>Asthma is the most common chronic illness of childhood and a leading cause of hospitalization and health care costs for children. Intravenous magnesium sulfate (IVMg) may help severely ill children avoid hospitalization when added to standard treatment in an emergency department (ED), but this has not been adequately evaluated in a large trial. We conducted a pilot trial to test procedures and gather information to plan a large multicenter trial.</p><p><strong>Methods: </strong>Children 2-17 years old with severe acute asthma were randomized in a multicenter, double-blind, controlled trial of placebo (saline, 1 mL/kg, max 40 mL), low-dose IVMg (50 mg/kg, max 2 g), or high-dose IVMg (75 mg/kg, max 3 g) in addition to standard asthma therapy at the EDs of three tertiary pediatric hospitals between September 2022 and May 2023. We assessed the feasibility of delivering study drug within 90 min of treatment (defined as the start of the first inhaled albuterol) and monitoring for hypotension and obtained blood samples for pharmacologic analysis. Our target enrollment was one participant per site per week (90 total).</p><p><strong>Results: </strong>A total of 52 patients were randomized, and 49 received study drug. Median (Q1, Q3) participant age was 6.3 (4.6, 9.6) years and 35 (67.3%) were male. Among 52 randomized participants, study drug was delivered within 90 min to 34 (65.4%), 486/542 (89.7%) anticipated blood pressure measurements were within time frames, 138/156 (88.5%) anticipated blood samples were obtained, and 38 (73.1%) were hospitalized. Hypotension was measured within 2 h of study drug administration in 2/18 (11.1%) who received placebo and 2/31 (6.5%) who received IVMg.</p><p><strong>Conclusions: </strong>Most anticipated blood pressure measurements and blood samples were obtained. Hypotension occurred at rates similar to previous reports. Lower-than-expected enrollment (related to low patient volumes) and timely delivery of study drug will require consideration for a larger trial.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"903-915"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646688","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":"The ethos of emergency medicine: Providing medication abortion in the emergency department.","authors":"Monica Rakesh Saxena","doi":"10.1111/acem.70001","DOIUrl":"10.1111/acem.70001","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"939-940"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397737","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":"Standards for Point-of-care Ultrasound Research Reporting (SPUR): A modified Delphi to develop a framework for reporting point-of-care ultrasound research.","authors":"Nikolai Schnittke, Frances M Russell, Michael Gottlieb, Samuel H F Lam, David O Kessler, Lynn P Roppolo, Stephanie C Demasi, Patricia Henwood, Yiju Teresa Liu, Jennifer R Marin, Jason Nomura, Joseph R Pare","doi":"10.1111/acem.70069","DOIUrl":"10.1111/acem.70069","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is a bedside diagnostic modality that depends on technical, operator-specific, patient-specific, and clinical context factors. Existing research reporting guidelines do not explicitly address these considerations as they pertain to replicability and generalizability of POCUS studies. The objective of this study was to create a framework to assist investigators, reviewers, and clinicians in reporting and evaluating the quality of POCUS research.</p><p><strong>Methods: </strong>We applied a two-stage consensus-building approach. First, a steering committee reviewed available literature and existing guidelines to generate a novel list of items and explanatory subitems relevant to POCUS research. We vetted the list by soliciting public comments from individuals affiliated with POCUS-oriented professional organizations. Second, a consensus panel of experts, defined as POCUS researchers with a minimum of three first or senior author, POCUS-relevant publications completed a three-round Delphi survey. Consensus was defined as agreement by ≥80% of the panel. Items that did not reach consensus after three rounds were excluded.</p><p><strong>Results: </strong>Twenty POCUS experts participated in the study, completing all three survey rounds. The panel reached consensus to include 19/21 items and 62/119 subitems. The resulting instrument addresses variables related to technical hardware and settings (three items), specifics of the POCUS examination (two items), participant characteristics (two items), operator characteristics (five items), data analysis and interpretation (three items), and study-specific considerations (four items).</p><p><strong>Conclusions: </strong>The Standards for Point-of-Care Ultrasound Research Reporting (SPUR) can aid researchers, reviewers, and clinicians in the design, dissemination, and critical appraisal of POCUS research.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"916-925"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223938","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 the Sudbury Vertigo Risk Score to risk stratify for a serious cause of vertigo.","authors":"Elliot Tissot van Patot, Danielle Roy, Elger Baraku, Kashyap Patel, Sarah McIsaac, Ravinder Singh, Daniel Lelli, Darren Tse, Peter Johns, Krishan Yadav, David W Savage, Jeffrey J Perry, Robert Ohle","doi":"10.1111/acem.70017","DOIUrl":"10.1111/acem.70017","url":null,"abstract":"<p><strong>Introduction: </strong>In 2022, nearly 0.5 million Canadians visited an emergency department (ED) for dizziness, accounting for over 3.5% of all ED visits. Of these patients, only 2%-5% received a serious diagnosis. The cost of ED and inpatient care for dizziness in Canada exceeds $200 million per year, of which neuroimaging accounts for a large proportion. Over one-third of dizziness patients undergo a CT scan of the head, 96% of which are negative. Despite extensive investigation, patients discharged with a benign dizziness diagnosis have a 50-fold increased risk of being admitted to the hospital within 7 days with a diagnosis of stroke. Our study aimed to derive a clinical risk score to guide the investigation and referral for serious causes of vertigo in ED patients.</p><p><strong>Methods: </strong>This multicenter historical cohort study was conducted over 7 years at three university-affiliated tertiary care EDs. Patients presenting with vertigo, dizziness, or imbalance were recruited. The main outcome was an adjudicated serious diagnosis, defined as stroke, transient ischemic attack, vertebral artery dissection, or brain tumor. We estimated a sample size of 4450 patients, based on a 2% prevalence of serious outcomes, to evaluate the sensitivity with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 4559 patients were enrolled (mean age 78.1 years, 57.8% women), with serious events occurring in 104 (2.3%) patients. The C-statistic was 0.95 (95% CI 0.92-0.98). The risk of a serious diagnosis ranged from 0% for a score of <5 to 16.7% for a score >8. Sensitivity for a serious diagnosis was 100% (95% CI 96.5%-100%) and specificity was 69.2% (95% CI 67.8%-70.51%) for a score <5.</p><p><strong>Conclusion: </strong>The Sudbury Vertigo Risk Score effectively identifies the risk of a serious diagnosis in patients with dizziness. Thus, it guides further investigation, consultation, and treatment decisions and ultimately improves resource utilization and reduces missed diagnoses.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"863-873"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603358","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":"Response to letter to the editor.","authors":"Çagrı Türkücü, Kamil Kokulu, Ekrem T Sert, Hüseyin Mutlu","doi":"10.1111/acem.70041","DOIUrl":"10.1111/acem.70041","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"948"},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958039","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":"Identification of Children With a Positive Ultrasound and Appendicitis Using the Pediatric Appendicitis Risk Calculator: Retrospective Cohort Study.","authors":"Nouf Aljahdali, Andrea S Doria, Carina Man, Joshua Ramjist, Michael Bravo, Adrienne Davis, Keren Shahar-Nissan, Reut Ram, Annie Daviko, Suzanne Schuh","doi":"10.1111/acem.70118","DOIUrl":"https://doi.org/10.1111/acem.70118","url":null,"abstract":"<p><strong>Objectives: </strong>Up to 10% of positive ultrasounds (US) for suspected pediatric appendicitis are false positive. Minimizing the negative appendectomy rate is gaining importance as a quality indicator, with a proposed benchmark of < 2%. The validated Pediatric Appendicitis Risk Calculator (pARC) score [range 0%-100%] used alone identifies the entire appendicitis risk spectrum, whereas the optimal surgical candidates should be at a very high risk. Therefore, pARC risk stratification in conjunction with positive US may be useful to identify the best surgical candidates. The primary objective was to determine the proportion of children with positive US plus medium-high risk pARC ≥ 25% with appendicitis.</p><p><strong>Hypothesis: </strong>We hypothesized this proportion would be 98%, with lower 95% CI ≥ 96%.</p><p><strong>Methods: </strong>A retrospective cohort study of 327 previously healthy children 4-17 years old at a pediatric ED with suspected appendicitis and positive US interpretations. Four investigators abstracted demographic, clinical, and imaging data. pARC includes seven demographic, clinical, and laboratory variables and is quantified according to the published formula. The primary outcome was appendicitis, based on pathology. All non-operated patients underwent a follow-up to exclude missed appendicitis.</p><p><strong>Results: </strong>A total of 294/327 (89.9%) patients with positive US had pathology-proven appendicitis, and 33 (10.1%) had no appendicitis; pARC ≥ 25% was assigned to 259/327 (79.2%) patients. In total, 255/259 (98.5%) children with pARC ≥ 25% had pathology-proven appendicitis (95% CI 96.1-99.6) versus 39/68 (57.3%) with pARC < 25%; p < 0.0001. Probability of no appendicitis increased with decreasing pARC cut-offs from 0/230 (0%) for pARC ≥ 40% to 13/284 [4.6% (2.5-7.7)] for pARC ≥ 15%. The pARC ≥ 25% plus positive US combination had sensitivity 86.7% (82.3-90.4), specificity 87.9% (71.8-96.6), positive predictive value 98.5% (96.1-99.6), and negative predictive value 42.6% (30.7-55.2).</p><p><strong>Conclusions: </strong>In children with suspected appendicitis, a combination of positive US and pARC ≥ 25% carries a very high probability of appendicitis. Children with lower pARCs may be candidates for clinical re-evaluation or further imaging.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758917","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}