Academic Emergency Medicine最新文献

{"title":"Chronic Hypertension in the ED: Physician Response When Hypertension Is or Is not a Reason for the ED Visit.","authors":"Adesuwa I Akhetuamhen, Tim P Moran, Daniel T Wu, Monique Smith, Michael R Frankel, Jonathan Rupp, David W Wright","doi":"10.1111/acem.70371","DOIUrl":"10.1111/acem.70371","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 6","pages":"e70371"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337271","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":"High-Risk Medication Prescribing Among Older Adults in the Emergency Department: A National Assessment.","authors":"Sarah E Follman, Maureen Canavan, Craig Rothenberg, Mark Iscoe, Arjun K Venkatesh, Reshma Ramachandran, Cameron J Gettel","doi":"10.1111/acem.70321","DOIUrl":"10.1111/acem.70321","url":null,"abstract":"<p><strong>Objectives: </strong>Potentially inappropriate medication prescribing remains a common and preventable source of adverse drug events among older adults, particularly during transitions of care such as ED discharge. We assessed the prevalence and trends of older adults with high-risk medication fills based on the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) list.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the 2017-2022 Merative™ MarketScan® Medicare Database. We included ED visits by older adults (65+ years of age) discharged from the ED. The primary outcome was met if a GEMS-Rx medication was filled within 3 days of ED discharge. Multivariable logistic regression estimated associations between patient- and system-level factors and GEMS-Rx fill after ED discharge.</p><p><strong>Results: </strong>Among 616,980 unique ED visits, 58,284 (9.4%; 95% CI: 9.4%-9.5%) had a GEMS-Rx medication filled within 3 days of discharge. In 2017, 13,746 (11%) ED encounters resulted in a GEMS-Rx medication fill within 3 days of ED discharge compared to 6,524 (7%) ED encounters in 2022. Medication fills declined over time, with each additional year associated with a lower odds of GEMS-Rx medication fills. Benzodiazepines (37%), first-generation antihistamines (22%), and skeletal muscle relaxants (11%) were the most frequently filled GEMS-Rx medication classes. Female sex (OR 1.43, 95% CI: 1.41-1.46) and younger age (75-84 years: OR 0.69, 95% CI: 0.68-0.71; ≥ 85 years: OR 0.47, 95% CI: 0.46-0.48) were associated with higher odds of receiving a GEMS-Rx medication.</p><p><strong>Conclusions: </strong>Nearly 1 in 10 older adults filled a high-risk GEMS-Rx medication within 3 days of ED discharge between 2017 and 2022. Despite a decline in GEMS-Rx medication fills over time, younger cohorts of older adults and females were more likely to fill a high-risk medication upon ED discharge. These findings highlight opportunities to continue improving geriatric medication safety through targeted education, decision support, and system-level interventions.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70321"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939748","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":"Lock and Protect, Reducing Access to Adolescent Means of Suicide: A Pilot Feasibility Study.","authors":"Ashley M Blanchard, Joandalys Tejada, Shekinah Pettway, Emma Cornell, Jennifer A Hoffmann, Sapana R Patel, Lauren S Chernick, Marian E Betz, Randy P Auerbach, Joan Asarnow, Peter S Dayan","doi":"10.1111/acem.70313","DOIUrl":"10.1111/acem.70313","url":null,"abstract":"<p><strong>Background: </strong>Providing lethal means counseling to caregivers is an underutilized component of emergency department (ED)-based suicide prevention. We assessed the feasibility and acceptability of Lock and Protect, a web-based lethal means counseling decision aid, among caregivers of adolescents who presented to the ED for self-injurious and/or suicidal thoughts and behaviors.</p><p><strong>Methods: </strong>We conducted a pilot feasibility study of caregiver-adolescent dyads in a pediatric ED. Adolescents were 13-17 years old with current suicidal ideation, suicide attempt, or non-suicidal self-injury. Caregivers received the Lock and Protect intervention plus usual care while their child was in the ED. Feasibility was measured via enrollment rates, duration of time caregivers interacted with Lock and Protect, and tool completion rates. Caregiver acceptability was measured with the Ottawa Acceptability Scale. Follow-up assessments measured changes in home storage at 2- and 4-weeks after enrollment.</p><p><strong>Results: </strong>Of 47 caregivers screened and eligible, 40 enrolled (85.1%), of whom 39/40 and 1/40 reported home access to medications and firearms, respectively. Caregivers found Lock and Protect respectful of their family values about medications (100%) and firearms (97.5%). Almost all caregivers (95.0%) reported the length was \"just right\" and 92.5% reported the amount of information was \"just right\". All caregivers completed the tool in the ED, using it for a mean of 8 min (SD = 3.4 min). All would recommend the tool to others. Ottawa Acceptability Scale scores demonstrated that 95.0% of caregivers found the options in Lock and Protect realistic, and 97.5% found the tool useful for changing home medication access. Follow-up was completed for 77.5% of caregivers, with 20/31 (64.5%) reporting safer home storage of medications.</p><p><strong>Conclusions: </strong>Lock and Protect, a web-based lethal means counseling decision aid, was feasible to administer in the pediatric ED and acceptable to caregivers of adolescents at risk for suicide.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70313"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832237","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":"Advanced Practice Providers Versus Physicians in Emergency Department Abdominal Pain: Comparison of Length of Stay and Return Visits.","authors":"Emad Awad, Shilpa Raju, Micah Ownbey, Paul Kim, Austin Johnson","doi":"10.1111/acem.70318","DOIUrl":"10.1111/acem.70318","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70318"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832167","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":"Voices From Diversity, Equity, and Inclusion Leaders in Emergency Medicine, Understanding Their Experiences.","authors":"Ryan E Tsuchida, Rebecca J Schwei, Dowin Boatright, Aasim I Padela","doi":"10.1111/acem.70322","DOIUrl":"10.1111/acem.70322","url":null,"abstract":"<p><strong>Background: </strong>While EM departments have designated new leadership roles to focus on diversity, equity, and inclusion (DEI) in recent years, the experiences of DEI leaders have not been thoroughly investigated. The purpose of this study was to describe the factors that impact the effectiveness of DEI leaders within EM.</p><p><strong>Methods: </strong>We conducted a national qualitative study of DEI leaders in EM. Participants participated in a 60-min semi-structured interview. An interview guide was pilot-tested and iteratively refined. The interview audio was recorded and professionally transcribed. Two team members developed a codebook, independently coded transcripts, and generated categories using content analysis. We analyzed the interview transcripts using inductive and deductive content analysis. Inductive analysis allowed us to identify emerging categories, while deductive analysis allowed us to overlay Camara Jones' Allegory of the Levels of Racism to our data.</p><p><strong>Results: </strong>We completed 24 interviews, representing 21 unique institutions in 14 states. In our adapted allegory, the DEI leader is represented centrally within the ecosystem. The effectiveness of the DEI leader is influenced by institutionally mediated, personally mediated, and internally mediated factors. Institutionally mediated factors included the macroenvironment, administrative positioning, and promotion pathways. Personally mediated factors included communication skills, ongoing leadership development, change management prowess, and seeking colleagues' support. Internally mediated factors included personal commitment to DEI work, as well as feelings of workplace inclusion, imposter syndrome, and tokenism.</p><p><strong>Conclusions: </strong>This qualitative analysis of EM DEI leaders highlights how factors at various levels influence their experience. Jones's allegory helps conceptualize how a DEI leader functions in a dynamic, continually evolving environment that is sometimes beyond the leader's control. Our research identifies opportunities at the personal, departmental, and institutional levels, such as maintaining a personal commitment to the work, supporting leadership development, and improving administrative positioning that can assist DEI leaders' effectiveness.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70322"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13174904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939791","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 Moment of Silence.","authors":"Rory Spiegel","doi":"10.1111/acem.70339","DOIUrl":"https://doi.org/10.1111/acem.70339","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70339"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969416","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":"Editors in Chief Introduction.","authors":"","doi":"10.1111/acem.70301","DOIUrl":"https://doi.org/10.1111/acem.70301","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 Suppl 1 ","pages":"S7"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969464","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":"Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED): Multicenter Derivation and Evaluation of a Task-Level Workload Measure.","authors":"Garth Meckler, Jeffrey N Bone, Tania Principi, Bruce Wright, Jocelyn Gravel, Ahmed Mater, Devin Singh, Matthias Görges, Tibor van Rooij, Katrina F Hurley, Quynh Doan","doi":"10.1111/acem.70314","DOIUrl":"10.1111/acem.70314","url":null,"abstract":"<p><strong>Background: </strong>Physician workload in pediatric emergency departments (PEDs) is associated with patient safety, quality of care, and clinician well-being, but is commonly inferred from proxy measures such as visit volume, acuity, or throughput metrics that incompletely capture the contextual and cognitive demands of clinical care. The Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED) was developed to quantify workload at the level of discrete clinical tasks. We derived workload estimates and evaluated the reliability, precision, and contextual responsiveness of SWAMPED.</p><p><strong>Methods: </strong>We conducted a multicenter cross-sectional study of PED physicians at tertiary children's hospitals within the Pediatric Emergency Research Canada network. Participants independently scored 46 care components using the NASA Task Load Index, a validated multidimensional instrument that measures perceived workload associated with a specific task (in this case a clinical care component) accounting for six domains of effort (mental, physical, time, effort, performance, and frustration). Six extrinsic patient and systems-level modifiers were assessed for their impact on component-level workload. We assessed score distributions, interrater agreement using intraclass correlation coefficients (ICC), precision of component estimates, and extrinsic modifiers' effects using mixed-effects models.</p><p><strong>Results: </strong>Sixty-two physicians from 11 sites participated. Interrater agreement across care components was good (ICC: 0.69, 95% CI: 0.60-0.78). Mean workload scores varied across care components (range 22.1-99.5) with high precision (95% CI margin of error of 2.5-6.5 points; relative margin 5%-10%). Most components demonstrated increased workload in the presence of extrinsic modifiers, while intrinsic physician characteristics were not associated with significant differences in workload scores.</p><p><strong>Conclusions: </strong>SWAMPED generated reliable and precise, task-specific workload estimates and demonstrated sensitivity to clinically relevant contextual modifiers. This approach enables quantitative assessment of physician workload at the task level and provides a foundation for future investigations linking workload to clinical outcomes, clinician performance, and health system planning.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70314"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832188","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":"Initial 12 mg Versus 6 mg Adenosine for Supraventricular Tachycardia in the Emergency Department.","authors":"Ekrem Taha Sert, Kamil Kokulu, Oğuz Yürük, Emin Hüseyin Akar, Muhammed Ali Topuz","doi":"10.1111/acem.70309","DOIUrl":"10.1111/acem.70309","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the efficacy and safety of an initial 12 mg versus 6 mg adenosine dose for sinus rhythm conversion in patients presenting with supraventricular tachycardia (SVT) in the emergency department (ED).</p><p><strong>Methods: </strong>This prospective observational study was conducted between February 2025 and January 2026. Adult patients (≥ 18 years) presenting to the ED with hemodynamically stable SVT confirmed by 12-lead electrocardiography (ECG) were included. Patients were categorized into two groups according to the initial adenosine dose administered (6 mg vs. 12 mg). To address potential selection bias, 1:1 propensity score matching (PSM) was performed. The primary outcome was successful first-dose sinus rhythm conversion. Secondary outcomes included adenosine-related adverse effects and SVT recurrence during the ED stay.</p><p><strong>Results: </strong>A total of 142 patients were analyzed (n = 71 per group). First-dose conversion was significantly higher with 12 mg compared with 6 mg (83.1% vs. 52.1%). In the PSM cohort (n = 104), the 12 mg dose maintained its superior efficacy (82.7% vs. 53.8%). The PSM-adjusted odds ratio for successful conversion was 4.12 (95% confidence interval [CI]: 1.85-9.14), with a number needed to treat (NNT) of 3.8 (95% CI: 2.5-8.3). SVT recurrence was numerically lower in the 12 mg group (1.4% vs. 9.9%). Adverse effects were similar between groups.</p><p><strong>Conclusions: </strong>An initial 12 mg adenosine dose was associated with higher first-dose sinus rhythm conversion than 6 mg, while adverse effects were similar between groups.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70309"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147758915","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":"Diagnostic Accuracy of Lung Ultrasound Findings for Pneumonia in Adults.","authors":"Caleb Bailie, Edem Adika, Christopher Hanuscin, Kelly Maurelus","doi":"10.1111/acem.70319","DOIUrl":"https://doi.org/10.1111/acem.70319","url":null,"abstract":"","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":"33 5","pages":"e70319"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832184","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}