Academic Emergency Medicine最新文献

{"title":"The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients.","authors":"Ula Hwang, Natalia Sifnugel, Inessa Cohen, Ling Han, Katy Araujo, Luann M Bianco, Cynthia A Brandt, Sandra Capelli, Christopher R Carpenter, Daniel S Cruz, Scott M Dresden, Ivy L Fishman, Katrina Gipson, S Nicole Hastings, William W Hung, Raymond Kang, Mechelle Lockhart, Daniella Meeker, Ugochi Ohuabunwa, Sierra Ottilie-Kovelman, Caitlin Partridge, Timothy F Platts-Mills, Jacqueline Sandoval, Zachary Taylor, Debra F Tomasino, Camille P Vaughan","doi":"10.1111/acem.70101","DOIUrl":"10.1111/acem.70101","url":null,"abstract":"<p><strong>Objectives: </strong>Multicenter research of geriatric emergency department (GED) care remains limited. Our objectives were to: 1. Prospectively collect data prioritized by the Geriatric Emergency care Applied Research (GEAR) network, a transdisciplinary taskforce for GED care, and create a multicenter GED research repository of prospective and electronic health record (EHR) data, 2. Assess concordance between prospective and EHR data.</p><p><strong>Methods: </strong>The GEAR Standardization Study (GEARSS) is a multicenter, prospective study of older emergency department (ED) patients (65+) focusing on the 4Ms of age-friendly care (mobility, medication safety, mentation, what matters) and elder mistreatment. Demographic and clinical data were collected via interviews by trained research assistants (RA) on Days 0, 4, 30, and 90 and linked to EHR. Prevalence of chronic comorbidities and incident delirium were measured and reported using descriptive statistics. Prospective and EHR data concordance was assessed with Cohen's Kappa.</p><p><strong>Results: </strong>999 participants were recruited from 5 EDs (3/25/2021-6/30/2022) across 3 institutions: Grady Health System, Northwestern Memorial Hospital, and Yale New Haven Health. The cohort was 57.0% female, 55.2% White, 39.1% Black, and 3.4% Hispanic, and the mean age was 75.1 years. For rheumatologic disease, peptic ulcer disease, diabetes, renal disease, and cancer, prevalence differed between prospective and EHR data by > 10%. About two-thirds of participants were at risk for falls. Concordance between prospective and EHR data was good for ethnicity (K = 0.73); excellent for sex (K = 1.00), age (K = 1.00), and race (K = 0.98); fair for disposition (K = 0.53); slight for ED observation status (K = 0.33) and dementia diagnosis (K = 0.24); poor for delirium presence (K = 0.07).</p><p><strong>Conclusion: </strong>In GEARSS, demographic variables aligned strongly between prospective and EHR data, while diagnosis, disposition, and mentation factors did not. This multicenter data source provides preliminary findings for common geriatric syndromes and conditions. Choice of measures using these data should be driven by GED research questions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615782","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":"Telling Women to \"Lean in\" Isn't Going to Cut It.","authors":"Laura E Walker, Moon O Lee, Andrea Fang, Tala Elia, Elizabeth M Schoenfeld","doi":"10.1111/acem.70105","DOIUrl":"https://doi.org/10.1111/acem.70105","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615781","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":"First Trimester Point of Care Ultrasound: Imaging Features and Review Behaviors Associated With Diagnostic Accuracy.","authors":"Gillian Sheppard, Lori Stolz, Jeremy S Boyd, Martin Pusic, Jessica Baez, Patrick Minges, Matthew Swarm, Megan Hilbert, Marisa O'Brien, Katie Harris, Catherine Varner, Constance LeBlanc, Kathy Boutis","doi":"10.1111/acem.70094","DOIUrl":"https://doi.org/10.1111/acem.70094","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify the most diagnostically challenging features in first-trimester point-of-care ultrasound (FT-POCUS) images. We also sought to determine the physician image review behaviors associated with increased diagnostic accuracy.</p><p><strong>Methods: </strong>We conducted a multicenter prospective cross-sectional study in a convenience sample of emergency physicians in the United States and Canada. The web-based intervention included 400 FT-POCUS cases acquired via the transabdominal or transvaginal approach. Participants reviewed FT-POCUS cases to identify pregnancy-related imaging findings. We captured clickstream-level data with each case encounter, including the correctness of a participant's response and physician image review behaviors.</p><p><strong>Results: </strong>We enrolled 317 participants, who collectively generated 16,295 case interpretations. The most diagnostically challenging imaging findings included eccentrically located gestational sac and endometrial collection/heterogeneous uterine material (p < 0.001 for all comparisons). Participants who reported \"definite\" certainty, as opposed to \"probable,\" demonstrated a significantly higher odds of getting the diagnosis of intrauterine pregnancy (IUP) present or absent correct (OR = 4.48; 95% CI 4.00, 5.01) and a lower odds of time spent reviewing cases (OR = 0.46; 95% CI 0.40, 0.51). Those who reviewed a higher proportion of available views per case were more likely to accurately identify a fetal heartbeat (OR = 1.51; 95% 1.34, 1.69), multiple IUPs (OR = 1.33; 95% CI 1.10, 1.61), and adnexal structures (OR = 1.11; 95% CI 1.04, 1.17), but less likely to correctly identify an IUP (OR = 0.93; 95% CI 0.88, 0.99) and endometrial fluid collection/heterogeneous uterine material (OR = 0.96; 95% CI 0.92, 0.99).</p><p><strong>Conclusions: </strong>Emergency physicians interpreting FT-POCUS images encountered specific diagnostic challenges that may increase risks to patient safety. We found that higher diagnostic confidence correlated with greater diagnostic accuracy and efficiency. Reviewing a larger proportion of available images improved diagnostic accuracy for some findings, but not for others.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607098","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":"Emergency Physician Versus Telemedicine Neurologist Assessment for Thrombolytic Indication in the Treatment of Acute Ischemic Stroke (AIS).","authors":"Nicholas Linares, John Cambron, Tom Xu, Brook Danboise, Peter Richman","doi":"10.1111/acem.70096","DOIUrl":"https://doi.org/10.1111/acem.70096","url":null,"abstract":"<p><strong>Background and objectives: </strong>Through the advent of telemedicine, ED patients in many smaller and rural hospitals have gained access to input from neurologists for the decision to provide thrombolytics (tPA) for AISCVA. We evaluated the interrater agreement between teleneurologists and emergency physicians (EP) for the indication to give thrombolytic tPA to ED patients with symptoms suggestive of AISCVA.</p><p><strong>Methods: </strong>This was a prospective, observational study conducted at an urban, community teaching hospital. A convenience sample of adult ED patient encounters for possible AISCVA symptoms < 4.5 h duration was included for analysis. Immediately following bedside evaluations, EPs filled out a structured form regarding their history, exam, and assessment of indications for thrombolytic tPA therapy. Subsequently, each patient was evaluated by a teleneurologist, and their assessment was recorded. Multivariate logistic regression was performed. Interrater agreement was assessed by 𝜅.</p><p><strong>Results: </strong>A total of 92 patients were enrolled; mean age 61 ± 15 years, 47% female, mean NIHSS 7 ± 6, 11% prior AISCVA past 3 months, intracranial hemorrhage on CT 5%, 8% discharged home from ED, 10% neurointerventional procedure. Thrombolytic tPA was received by 18 patients (20%). Agreement between EPs and teleneurologist for ± thrombolytic tPA indicated was moderate (86% agreement; 𝜅 = 0.58) and the reason for thrombolytic tPA ineligibility substantial (83% agreement; 𝜅 = 0.77). In five (5.4%) cases, the EP determined that thrombolytic tPA was indicated, the teleneurologist disagreed and the patient did not receive thrombolytic tPA. On the other hand, in nine (9.8%) cases, the EP felt thrombolytic tPA was not indicated and the teleneurologist assessed that it should be administered. For three cases, patients did not receive thrombolytic tPA despite the + teleneurologist impression that it was indicated, including one where the EP dissented.</p><p><strong>Conclusion: </strong>Within our study group of patients evaluated for possible AISCVA, agreement between EP and teleneurologists for thrombolytic tPA indication was moderate and their agreement for thrombolytic tPA ineligibility reasons was substantial.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558777","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":"Pathway for a Diverse and Sustainable Emergency Medicine Clinician-Scientist Workforce: Recommendations From the 2024 SAEM Consensus Conference.","authors":"Robert W Neumar, Dowin Boatright, Melissa McMillian, Theodore Corbin, Marquita S Norman, Jody Vogel, Clifton W Callaway, Lynne Holden, Ava E Pierce, Linda Regan, Lynne D Richardson, Caitlin R Ryus, Opeolu Adeoye, Andra Blomkalns, Charles J Gerardo, Nathan Kuppermann, Gail D'Onofrio","doi":"10.1111/acem.70076","DOIUrl":"https://doi.org/10.1111/acem.70076","url":null,"abstract":"<p><strong>Objectives: </strong>The 2024 Society for Academic Emergency Medicine Consensus Conference focused on developing a pathway to build and support a diverse and sustainable emergency medicine (EM) clinician-scientist workforce. The underlying premise is that the specialty of EM needs a robust clinician-scientist workforce to fulfill its research mission of creating new knowledge to improve patient care and outcomes.</p><p><strong>Methods: </strong>Preconference workgroups assessed existing pathways to develop and support EM clinician-scientists and generated unranked lists of strategies to holistically and comprehensively grow the clinician-scientist workforce. These strategies were refined and prioritized during a one-day, in-person conference, which was followed by a virtual conference to reach consensus on metrics, goals, and timelines for implementation.</p><p><strong>Results: </strong>Overarching strategies included fostering a departmental culture that values research, addressing barriers to recruiting and retaining a diverse research work force, and enhancing the national reputation of EM research. At the undergraduate and medical school stage, creating a portfolio of medium- and long-term research training opportunities with EM faculty mentors was the highest priority. At the resident and fellow stage, top priorities were dedicated research training built into EM residencies and clinical fellowships. Early-career faculty strategies prioritized departmental support for federally funded K awards. Mid-career faculty strategies prioritized securing federal support for research mentoring, leading institutional training grants, and building research teams that include PhD scientists. At all stages, we addressed recruitment and retention of trainees and faculty from disadvantaged and underserved groups.</p><p><strong>Conclusions: </strong>These prioritized strategies with respective metrics, goals, timelines, and responsible parties provide a roadmap for EM to build a broadly inclusive and sustainable clinician-scientist workforce, capable of creating the new knowledge needed to advance emergency medical care. Successful implementation will require substantial commitment and investment from national EM organizations and academic department chairs. The result will be improved care and outcomes for the patients and communities we serve.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558779","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.","authors":"Samuel A Boes, Brian E Driver","doi":"10.1111/acem.70102","DOIUrl":"https://doi.org/10.1111/acem.70102","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558778","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":"Diagnostic Accuracy and Application of Subarachnoid Hemorrhage Decision Rules Among Patients With Non-Traumatic Acute Headache: A Systematic Review and Meta-Analysis.","authors":"Mahdi Roostaei, Nadia Saniee, Seyyed Amir Yasin Ahmadi, Mahdi Rezai, Arash Tehrani-Banihashemi, Hamid Reza Baradaran, Farzaneh Barzkar","doi":"10.1111/acem.70087","DOIUrl":"https://doi.org/10.1111/acem.70087","url":null,"abstract":"<p><strong>Background: </strong>The Ottawa and Emerald rules were developed to aid in the diagnosis of subarachnoid hemorrhage (SAH) and to determine whether a CT scan is necessary for patients presenting with non-traumatic acute headaches in the emergency department. Numerous studies have been conducted to validate these clinical decision rules. In this study, we aimed to investigate the pooled diagnostic accuracy of these rules and their impact on imaging utilization.</p><p><strong>Methods: </strong>In this PRISMA-DTA-compliant systematic review, a comprehensive search was done in databases including PubMed, Scopus, Embase, and Web of Science. Then, screening, selection of studies, and data extraction were performed and the QUADAS-2 tool was used for critical appraisal. The true positives (TP), false negatives (FN), false positives (FP), and true negatives (TN) were extracted to calculate pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and Diagnostic Odds Ratio (DOR) with 95% CIs. The effect of Ottawa rule on CT scan utilization was assessed by calculating pooled odds ratios for the number of CT scans in SAH and non-SAH groups before and after applying the rule.</p><p><strong>Results: </strong>The pooled sensitivity, specificity, negative LR, and positive LR for the Ottawa SAH rule were 99% (95% CI: 92%-100%), 23% (95% CI: 16%-32%), 0.025 (95% CI: 0.003%-0.193%), and 1.29 (95% CI: 1.16%-1.42%) respectively. Similarly, these measures for the Emerald SAH rule were 99% (95% CI: 71%-100%), 27% (95% CI: 15%-43%), 0.065 (95% CI: 0.004%-1.072%), and 1.34 (95% CI: 1.1%-1.62%), respectively. The pooled odds ratio for CT scan utilization for the Ottawa rule was 1.15 (95% CI: 0.62%-2.13%).</p><p><strong>Conclusion: </strong>Both rules are highly sensitive for excluding SAH in patients with non-traumatic acute headaches presenting to the emergency department but have low specificity and do not significantly reduce CT scan utilization.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD42023476444.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551685","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 \"Reevaluating biomarker accuracy in alcohol-intoxicated TBI patients\" by Drs. Sathian and Al Hamad.","authors":"Frederick K Korley","doi":"10.1111/acem.70064","DOIUrl":"10.1111/acem.70064","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"815"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207356","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":"Improving benign paroxysmal positional vertigo management in the emergency department: A longitudinal study post-GRACE-3.","authors":"Camille Gerlier, Linda Mehenni, Gilles Chatellier, Marine Cachanado, Olivier Ganansia","doi":"10.1111/acem.15115","DOIUrl":"10.1111/acem.15115","url":null,"abstract":"<p><strong>Background: </strong>Vertigo is a priority for training and decision support in emergency departments (ED). Benign paroxysmal positional vertigo (BPPV), though manageable at bedside, remains frequently underdiagnosed and undertreated. This study assessed the effectiveness of a two-tiered educational intervention on posterior and horizontal BPPV management in the ED setting.</p><p><strong>Methods: </strong>Longitudinal program evaluation study conducted over a year in a French ED, following GRACE-3 guidelines, involving patients with triggered episodic vestibular syndrome or brief vertigo without nystagmus. Two 6-month periods were compared: before (control cohort) and after (intervention cohort) an educational intervention of standardized training and an online decision support tool. The primary outcome was the prevalence of evidence-based BPPV diagnoses.</p><p><strong>Results: </strong>Of the 382 patients included, 166 were in the control cohort (43.5%) and 216 were in the intervention cohort (56.5%). The intervention cohort had a higher rate of evidence-based BPPV diagnoses compared to the control cohort (38.0% vs. 16.9%), with an effect size of 21.1 (95% confidence interval [CI] 11.5-29.6, p < 0.0001). Canalith repositioning maneuvers were performed more frequently in the intervention cohort (90.2% vs. 57.7%), with an effect size of 33.1 (95% CI 13.2-53.1). Posttreatment tests showed a nonsignificant difference of 79.5% of intervention cohort patients testing negative versus 75.0% in the control cohort. ED length of stay was shorter in the intervention cohort (137 min vs. 247 min), with an effect size of -109.5 (95% CI -154.0 to -65.0). ED revisits within 1 month were similar (2.3% vs. 1.2%). During the intervention period, clinicians' satisfaction was correlated with the effectiveness of their clinical management.</p><p><strong>Conclusions: </strong>A standardized educational intervention demonstrated enhancing BPPV screening and improved evidence-based diagnosis, showing promise of more efficient treatment in the ED. Further multicenter studies are warranted to evaluate impacts on patient-reported outcomes and resource optimization.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":"739-747"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031690","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":"\"Pending Trauma Workup\".","authors":"Anant Shukla, Michelle Izmaylov","doi":"10.1111/acem.70100","DOIUrl":"https://doi.org/10.1111/acem.70100","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537678","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}