JEM reports最新文献_第7页

Gastric ultrasound-guided noninvasive ventilation for altered hypertensive cardiogenic pulmonary edema: A case report 超声引导下无创通气治疗高血压心源性肺水肿1例

JEM reports Pub Date : 2025-06-01 Epub Date: 2025-03-03 DOI: 10.1016/j.jemrpt.2025.100157

Sasikumar Mahalingam , Gunaseelan Rajendran , Anitha Ramkumar , Kumaresh Pillur Tamilarasu , Aswin Kumaran , Surendar Ravipragasam , Tharun kumar Ganesan , Shivakumar Somannavar , Vijayalakshmi Padmanaban , Vinay Yareshimi , Nedurumalli Naga Vaishnavi , Nirmala Subbamanda Dinesh

{"title":"Gastric ultrasound-guided noninvasive ventilation for altered hypertensive cardiogenic pulmonary edema: A case report","authors":"Sasikumar Mahalingam , Gunaseelan Rajendran , Anitha Ramkumar , Kumaresh Pillur Tamilarasu , Aswin Kumaran , Surendar Ravipragasam , Tharun kumar Ganesan , Shivakumar Somannavar , Vijayalakshmi Padmanaban , Vinay Yareshimi , Nedurumalli Naga Vaishnavi , Nirmala Subbamanda Dinesh","doi":"10.1016/j.jemrpt.2025.100157","DOIUrl":"10.1016/j.jemrpt.2025.100157","url":null,"abstract":"<div><h3>Background</h3><div>Gastric ultrasound is mainly used in the preoperative evaluation of patients for aspiration risk assessment. This is accomplished by assessing the gastric antrum, which can be used to calculate the total gastric volume (TGV). We extrapolated this concept to our emergency department to manage cardiogenic pulmonary edema.</div></div><div><h3>Case report</h3><div>Here, we report a case of a 65-year-old man with comorbidities, namely, hypertension and coronary artery disease, who presented to the emergency department with acute cardiogenic pulmonary edema (ACPE) and had a drop in sensorium after a few minutes of hospital arrival, for whom we resorted to gastric ultrasound-guided noninvasive ventilation (G-NIV) under a sedation cover rather than intubation. We achieved excellent outcomes, and the patient was discharged healthy.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Although noninvasive ventilation (NIV) is a class 1 indication for ACPE, its role may be limited in altered sensorium or irritable patients. Ideally, these patients should be intubated and mechanically ventilated. However, in resource-limited settings where ventilators are not available, G-NIVs can be used. However, another advantage of G-NIV is that intubation-related complications can be avoided, resulting in early discharge and less morbidity.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Spontaneous peroneal pseudoaneurysm in the young athlete 年轻运动员自发性腓骨假性动脉瘤

JEM reports Pub Date : 2025-06-01 Epub Date: 2025-03-20 DOI: 10.1016/j.jemrpt.2025.100162

Nina C. Lund, Jennifer L. Hemberg

{"title":"Spontaneous peroneal pseudoaneurysm in the young athlete","authors":"Nina C. Lund, Jennifer L. Hemberg","doi":"10.1016/j.jemrpt.2025.100162","DOIUrl":"10.1016/j.jemrpt.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoaneurysm represents an unusual cause of unilateral extremity pain in the acute care setting. However, a growing body of literature supports its inclusion in the standard differential for acute-onset extremity pain. Consideration for pseudoaneurysm is particularly justified in management of pediatric patients, who may bear undiagnosed syndromes conferring increased risk of vascular injury.</div></div><div><h3>Case report</h3><div>We present an unusual case of acute onset unilateral extremity pain in an otherwise healthy 17-year-old male resulting from spontaneous peroneal artery rupture with pseudoaneurysm identified on emergent angiography. In this case, pseudoaneurysm was complicated by compartment syndrome necessitating four compartment fasciotomy and washout with delayed closure.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Our discussion reviews current evidence for emergent vascular imaging in the pediatric population. If there is a high suspicion for pseudoaneurysm or other vascular emergency, providers should prioritize computed tomography with angiography over magnetic resonance. Prompt diagnosis is critical to avert progression to compartment syndrome and/or disability. We also discuss the known causes of pseudoaneurysm and conclude that the finding of spontaneous pseudoaneurysm should trigger evaluation for related genetic and rheumatologic disorders with the aim of mitigating morbidity and mortality related to the underlying disease process.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A nerve block supply cart and nerve block champions program associated with increased fascia iliaca block use 神经阻滞供应推车和神经阻滞冠军计划与筋膜髂阻滞使用增加有关

JEM reports Pub Date : 2025-06-01 Epub Date: 2025-03-22 DOI: 10.1016/j.jemrpt.2025.100164

Joseph R. Brown , Michael Heffler , Peter Alsharif , Brigit Noon , Justin Inman , Eric Bustos , Juliana Wilson , Ryan Tucker

{"title":"A nerve block supply cart and nerve block champions program associated with increased fascia iliaca block use","authors":"Joseph R. Brown , Michael Heffler , Peter Alsharif , Brigit Noon , Justin Inman , Eric Bustos , Juliana Wilson , Ryan Tucker","doi":"10.1016/j.jemrpt.2025.100164","DOIUrl":"10.1016/j.jemrpt.2025.100164","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound-guided nerve blocks (UGNBs) are a vital component of a multimodal approach to managing pain in the Emergency Department (ED). However, implementation has not been universally adopted due to their time-consuming nature and provider discomfort with the procedure.</div></div><div><h3>Objectives</h3><div>The primary outcome of this study was to deploy a new UGNB cart and group of nerve block “champions” and evaluate whether the rate of infrainguinal fascia iliaca compartment block (IFICB) use increased in geriatric hip fractures. Secondary outcomes included length of stay in the ED, complications associated with the UGNB and Morphine Equivalents used compared to patients who did not receive the IFICB.</div></div><div><h3>Methods</h3><div>This was a prospective, observational cohort study performed at a single urban, academic site. Inclusion criteria was based on institutional coding of a hip fracture. Each chart was reviewed as to whether the patient received an IFICIB as well as secondary outcomes like ED length of stay (LOS). Finally, the treating physician was surveyed regarding their decision to perform an IFICB.</div></div><div><h3>Results</h3><div>Of the 146 eligible patients, 15.8 % received an IFICB, an increase from 2.6 % in 2019. 55 physicians were enrolled with a 96 % response rate. Commonly cited reasons for not performing the block were controlled pain and lack of training. Of the 23 UGNBs performed, 14 involved a champion. Despite length of time being cited 10.6 % of the time for not performing the IFICB, patients who received a IFICB had a shorter ED LOS.</div></div><div><h3>Conclusion</h3><div>This study showed that the creation of nerve block “champions” and implementation of an UGNB cart was associated with an increase in their utilization of the IFICB.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dystonic reaction to haloperidol causing severe tongue swelling requiring cricothyroidotomy 氟哌啶醇的张力障碍反应引起严重的舌肿，需要环甲状腺切开术

JEM reports Pub Date : 2025-06-01 Epub Date: 2025-04-24 DOI: 10.1016/j.jemrpt.2025.100172

Carmen Estrada Huerta, Emily White

{"title":"Dystonic reaction to haloperidol causing severe tongue swelling requiring cricothyroidotomy","authors":"Carmen Estrada Huerta, Emily White","doi":"10.1016/j.jemrpt.2025.100172","DOIUrl":"10.1016/j.jemrpt.2025.100172","url":null,"abstract":"<div><h3>Background</h3><div>Haloperidol is a widely used drug in both the prehospital setting and the emergency department (ED) for agitation. Though rare, haloperidol can lead to severe dystonic reactions that can cause traumatic tongue swelling. Severe tongue swelling can lead to airway compromise.</div></div><div><h3>Case Report</h3><div>A 31-year-old female was given haloperidol in the pre-hospital setting by EMS for agitation to allow for transport and medical evaluation. She had a delayed dystonic reaction that led to tongue protrusion, jaw clenching, and subsequent traumatic oral swelling. The severe tongue swelling caused airway compromise requiring an emergency cricothyroidotomy. She recovered in the ICU with removal of airway support on day five.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Agitation in patients needing emergency care is not infrequent. Haloperidol is a common medication to treat agitation in both the pre-hospital and emergency department settings. A key to the safe administration of this drug is awareness of life-threatening adverse reactions such as severe dystonic reactions. It is important for emergency providers to be aware that dystonic reactions can cause tongue protrusion, tongue biting, and resultant traumatic tongue swelling. Anti-cholinergic medications are a critical intervention as the first line treatment of dystonia. It is also essential that emergency providers look for medical bracelets prior to giving medications if the patient is unable to communicate allergies. It was discovered in the ED that the patient had a bracelet noting her prior reactions to haloperidol.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Systemic sclerosis with associated endometrial squamous metaplasia, liver mass, adrenal lesion and bilateral breast masses: Case report 系统性硬化症伴子宫内膜鳞状皮化生、肝脏肿块、肾上腺病变及双侧乳房肿块：1例报告

JEM reports Pub Date : 2025-06-01 Epub Date: 2025-03-21 DOI: 10.1016/j.jemrpt.2025.100165

Ariella Gartenberg , Capwell Taylor , Arvind Haran , Alexander Petrie

{"title":"Systemic sclerosis with associated endometrial squamous metaplasia, liver mass, adrenal lesion and bilateral breast masses: Case report","authors":"Ariella Gartenberg , Capwell Taylor , Arvind Haran , Alexander Petrie","doi":"10.1016/j.jemrpt.2025.100165","DOIUrl":"10.1016/j.jemrpt.2025.100165","url":null,"abstract":"<div><h3>Background</h3><div>Systemic sclerosis is a rare and chronic autoimmune connective tissue disease that involves widespread vascular dysfunction, as well as fibrosis of the skin and internal organs. With the development of organ-based treatment, including ACE-inhibitors for renal crisis and goal directed therapy for heart failure, the mortality associated with renal and cardiac involvement has decreased significantly. Consequently, the increased risk of malignancy in patients with systemic sclerosis has become a topic of concern. Once the diagnosis of systemic sclerosis is made, various associated disease processes, including malignancy, must be screened for.</div></div><div><h3>Case report</h3><div>This case report details a 44 year old female presenting to the Emergency Department with abdominal pain, vaginal bleeding, pruritic rash, and two syncopal episodes. The patient was ultimately diagnosed with systemic sclerosis with extensive “salt and pepper” skin pigmentation and tightening over the arms, chest, and back, with associated bilateral breast masses, an adrenal lesion, liver mass, and endometrial squamous metaplasia.</div><div><strong>Why should an emergency physician be aware of this?</strong> A chief complaint as common as “syncope” can be an atypical presentation of less common, difficult to diagnose conditions in the emergency department, such as systemic sclerosis. While systemic sclerosis is not a diagnosis readily made in the emergency department, prompt recognition and appropriate consulting services or referrals can prevent long-term devastating complications and associated morbidity and mortality.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Compressive neuropathy following intermittent pneumatic compression device: A case report 间歇性气动压缩装置后压缩性神经病变1例报告

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-02-10 DOI: 10.1016/j.jemrpt.2025.100150

Tyler D'Ovidio , Abhishek Mogili , Simeret Genet , Charles R. Litchfield , Rachel E. Solnick

{"title":"Compressive neuropathy following intermittent pneumatic compression device: A case report","authors":"Tyler D'Ovidio , Abhishek Mogili , Simeret Genet , Charles R. Litchfield , Rachel E. Solnick","doi":"10.1016/j.jemrpt.2025.100150","DOIUrl":"10.1016/j.jemrpt.2025.100150","url":null,"abstract":"<div><h3>Background</h3><div>Compression neuropathy is a relatively common neurological condition that affects many individuals. Common etiologies include tight clothing, trauma, overuse, and obesity; however, iatrogenic causes such as improper positioning during surgical procedures are not commonly reported.</div></div><div><h3>Case report</h3><div>We present a case of a 57-year-old female who presented to the emergency department (ED) with posterior left calf and foot sensory loss with gait instability. She recently underwent surgery, during which she recalled having a tight and uncomfortable intermittent pneumatic compression device placed on her left calf. Her workup was largely unremarkable and supported the diagnosis of peripheral nerve compression, most likely of tibial origin.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Peripheral neuropathies are common causes of ED presentations and have a wide variety of etiologies. One less common factor that emergency physicians should consider is recent surgery during which an intermittent pneumatic compression device (IPCD) was used.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

3D-augmentation of 2D ultrasound for appendicitis diagnosis: A cross-sectional pilot study 三维增强二维超声诊断阑尾炎：横断面试点研究

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-02-01 DOI: 10.1016/j.jemrpt.2025.100149

Rebecca G. Theophanous , Elias Jaffa , Matthew R. Morgan , Carl D. Herickhoff , Erica Peethumnongsin , Joao Ricardo Nickenig Vissoci , Joshua S. Broder

{"title":"3D-augmentation of 2D ultrasound for appendicitis diagnosis: A cross-sectional pilot study","authors":"Rebecca G. Theophanous , Elias Jaffa , Matthew R. Morgan , Carl D. Herickhoff , Erica Peethumnongsin , Joao Ricardo Nickenig Vissoci , Joshua S. Broder","doi":"10.1016/j.jemrpt.2025.100149","DOIUrl":"10.1016/j.jemrpt.2025.100149","url":null,"abstract":"<div><h3>Background</h3><div>Two-dimensional ultrasound (2DUS) is first-line imaging for pediatric appendicitis but is often nondiagnostic. Computed tomography (CT) is expensive with ionizing radiation. Three-dimensional ultrasound (3DUS) can capture multiplanar images using volume acquisition without radiation exposure.</div></div><div><h3>Objective</h3><div>We hypothesized that bedside-performed 3DUS would be feasible, with rapid image acquisition times, and good image quality comparable to 2DUS and CT.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional pilot study on emergency department patients being evaluated for appendicitis. An emergency physician captured 3DUS images using a Sonosite M-Turbo machine equipped with an inertial measurement unit and customized software. Our primary outcome was 3DUS acquisition times compared to 2DUS and CT. Secondary outcomes were 3DUS image quality, with visual demonstrations of appendicitis findings compared to clinical imaging.</div></div><div><h3>Results</h3><div>20 subjects underwent an experimental 3DUS between October 2015 and March 2017. Mean age was 11.6 years (4.6–30.4 years). Five patients (25 %) had clinical appendicitis (2 by 2DUS and 3 by CT). Mean 3DUS acquisition and reconstruction times were 10.3 and 14.5 s, compared to 2DUS (41 min) and CT (22 min). Mean 3DUS pixels were 320.5 PPI depth, 388 PPI width, mean total frame number 344, and field of view 78.8°. Finally, we demonstrated two appendicitis complications on 3DUS: abscess and a dilated noncompressible appendix with appendicoliths.</div></div><div><h3>Conclusion</h3><div>Our study suggests 3DUS is fast with good image quality. We presented 3DUS images of acute appendicitis comparable to 2DUS and CT as visual demonstrations of feasibility. Future studies with larger cohorts are needed to assess diagnostic accuracy.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143308002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rare case of yellow nail syndrome in the emergency room setting: A case report 急诊室中罕见的黄指甲综合征1例：1例报告

JEM reports Pub Date : 2025-03-01 Epub Date: 2024-11-30 DOI: 10.1016/j.jemrpt.2024.100130

Jordan S. Elmowitz , Michael E. Nelson

引用次数: 0

Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia 胰岛素-葡萄糖治疗高钾血症后的低血糖和监测实践

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-25 DOI: 10.1016/j.jemrpt.2025.100142

Samuel Ford , Julian Williams , Ian Coombes , Adam La Caze

{"title":"Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia","authors":"Samuel Ford , Julian Williams , Ian Coombes , Adam La Caze","doi":"10.1016/j.jemrpt.2025.100142","DOIUrl":"10.1016/j.jemrpt.2025.100142","url":null,"abstract":"<div><h3>Background</h3><div>Hypoglycaemia is commonly encountered following insulin-dextrose therapy (IDT) for hyperkalaemia. This retrospective study aimed to assess the local incidence of hypoglycaemia following IDT for hyperkalaemia in the Emergency Department (ED).</div></div><div><h3>Objectives</h3><div>Describe the local incidence of hypoglycaemia and BGL monitoring practices following IDT for hyperkalaemia in the ED.</div></div><div><h3>Methods</h3><div>Adult patients with hyperkalaemia (>5.5 mmol/L) who received IDT in a large metropolitan ED were included. The primary outcome was the incidence of hypoglycaemia, defined as a BGL less than 70 mg/dL (3.9 mmol/L), within 5 h post-administration. Secondary outcomes included hypoglycaemia severity, time to hypoglycaemia, risk factors for hypoglycaemia, blood glucose and potassium monitoring. Data collection spanned January 1, 2019 to May 1, 2020.</div></div><div><h3>Results</h3><div>Among 90 patients, 51 % were receiving chronic renal replacement therapies and the incidence of hypoglycaemia and severe hypoglycaemia was 30 % and 6.7 % respectively. Risk factors for hypoglycaemia were lower pre-treatment blood glucose (p=<0.001), absence of diabetes (p=<0.001) and not being prescribed insulin prior to presentation (p = 0.0026). Approximately 50 % of patients received ≤2 blood glucose measurements within 5 h post IDT. Only 44 % of patients had a potassium sample taken in the 1st hour post IDT and 24 % in hour 3.</div></div><div><h3>Conclusions</h3><div>This study demonstrates a higher incidence of hypoglycaemia post-IDT for hyperkalaemia than reported in the general population and estimates the incidence of severe hypoglycaemia in an Australian population. Monitoring of both blood glucose levels (BGL) and potassium was suboptimal. Strategies to improve BGL monitoring and prospective studies to define the optimal dose of insulin-glucose for hyperkalaemia are needed.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient acceptance of emergency department-initiated buprenorphine and reasons for declining 急诊科患者对丁丙诺啡的接受程度及其下降的原因

JEM reports Pub Date : 2025-03-01 Epub Date: 2025-01-18 DOI: 10.1016/j.jemrpt.2025.100141

Lindsey K. Jennings , Allison Smith , Angela Moreland , Ralph Ward , Sarah Gainey , Suzanne Lane , Olivia Holodnik , Katherine Scarpino , Karen Hartwell , Louise Haynes , Kathleen T. Brady , Kelly Barth

{"title":"Patient acceptance of emergency department-initiated buprenorphine and reasons for declining","authors":"Lindsey K. Jennings , Allison Smith , Angela Moreland , Ralph Ward , Sarah Gainey , Suzanne Lane , Olivia Holodnik , Katherine Scarpino , Karen Hartwell , Louise Haynes , Kathleen T. Brady , Kelly Barth","doi":"10.1016/j.jemrpt.2025.100141","DOIUrl":"10.1016/j.jemrpt.2025.100141","url":null,"abstract":"<div><h3>Background</h3><div>Medication for Opioid Use Disorder (MOUD) reduces morbidity and mortality for patients with opioid use disorder (OUD). Emergency department-initiated buprenorphine (EDIB) doubles retention in treatment at 30 days compared to outpatient referral alone. Little is known about acceptance rates of EDIB and reasons why patients decline this life-saving intervention.</div></div><div><h3>Objectives</h3><div>The aim of this study was to quantify the number of patients who initiate and decline buprenorphine in the ED and determine reasons for declination.</div></div><div><h3>Methods</h3><div>Seven SC EDs implemented EDIB programs that included ED-based peer recovery specialists (PRSs) to provide a brief intervention and assist with referral to outpatient treatment. The PRSs recorded patient interactions in a database including medical eligibility, if EDIB was provided, and the reason(s) why eligible patients declined EDIB. All eligible EDIB patients were entered in the PRS database and included in the study. Reasons for declining buprenorphine in eligible patients were analyzed with both fixed and free-text response options.</div></div><div><h3>Results</h3><div>A total of 2205 patients were eligible for EDIB. Of those, 963 (43.6 %) patients accepted buprenorphine and 1242 (56.3 %) declined. The most common reasons for declination were 1) the “patient preferring non-MOUD treatment” (53.4 %), 2) “Not ready/would like to think about it and/or check with other treatment providers or case workers” (16.7 %).</div></div><div><h3>Conclusions</h3><div>Over half of patients with OUD who were eligible for EDIB declined treatment, with the most common reason being preference for non-MOUD treatment. Given the success of MOUD for treatment of OUD, this topic requires further exploration.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0