Journal of the American College of Emergency Physicians open最新文献

{"title":"Emergency Department Visits in the United States for Paroxysmal Supraventricular Tachycardia Are Increasing Among Adults: An Analysis from the Nationwide Emergency Department Sample.","authors":"Nihar R Desai, Charles V Pollack, Arjun K Venkatesh, Xiaohui Jiang, Naomi C Sacks, Anita Holz, David B Bharucha, Sean D Pokorney","doi":"10.1016/j.acepjo.2026.100343","DOIUrl":"https://doi.org/10.1016/j.acepjo.2026.100343","url":null,"abstract":"<p><strong>Objectives: </strong>Paroxysmal supraventricular tachycardia (PSVT) is an arrhythmia that may be challenging to diagnose because of its sudden and episodic nature and its presentation, which may be confused with acute anxiety, especially after spontaneous resolution. Prevalence of PSVT in the United States (US), based on projections to the 2018 US Census, was estimated to be as high as 2.1 million patients with an annual incidence of nearly 300,000. Prior studies report significant rates of health-care resource use among newly diagnosed patients with PSVT, but likely do not reflect contemporary acute care utilization in a population with increased PSVT prevalence. In this study, we quantified annual US emergency department (ED) visits for PSVT and examined temporal trends in PSVT across time among adults aged ≥18 years old.</p><p><strong>Methods: </strong>We used the Nationwide Emergency Department Sample data to identify adults who visited the ED with a primary diagnosis of PSVT (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM]: I47.1) from 2016-2019. We used Agency for Healthcare Research and Quality-provided sampling weights to estimate annual ED visit counts in the US overall and by the presence or absence of comorbid atrial fibrillation (AFib)/atrial flutter (AFl). We examined demographic characteristics, calculated annual visit rates per 10,000 US population, and assessed visit trends 2016-2019. Sensitivity analyses were conducted in which ED visits were defined primarily for PSVT when PSVT was the primary diagnosis and the ED visit resulted in hospitalization or when PSVT was the diagnosis in any position, and the visit resulted in discharge. We used Poisson regression, based on 2016-2019 visit increases, to project estimates of PSVT visits through 2030.</p><p><strong>Results: </strong>ED visits for PSVT increased 8.3% over the study period (from 129,219 to 139,992; <i>P</i> < .0001); ED visit rates per 10,000 also increased, from 5.16 ( 95% CI, 4.87-5.45) to 5.46 ( 95% CI, 5.18-5.73; <i>P</i> = .0029). ED visits for PSVT as a proportion of all ED visits also increased significantly (<i>P</i> < .0001). The majority of ED visits in 2019, the final study year (N = 139,992; 95% CI, 132,913-147,070), were for females (59.3%) and individuals aged <65 years (62.6%). Most visits involved patients without secondary diagnoses of AFib/AFl (86.0%; 120,377/139,992); 24.2% resulted in inpatient hospitalizations, and 10.1% incurred observation stays. Sensitivity analyses, including diagnosis in any position, identified an additional 119,914 visits in 2019, for a total of 259,916 ED visits for PSVT, with similar characteristics, but larger proportions of observation stays (19.9%). Based on the rate of change from 2016-2019, annual US ED visits with a primary diagnosis of PSVT are projected to reach nearly 180,000 among adults by 2030.</p><p><strong>Conclusion: </strong>ED visits due to PSVT in the US ","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 2","pages":"100343"},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13055564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640603","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}

{"title":"Analysis of Pediatric Cervical Spine Injury Evaluation Workflow in the Emergency Department.","authors":"Annie J Truelove, Megan E Gregory, Fahd A Ahmad, Sean P Pajak, Nicole C Hammer, Daniel Corwin, Leah Tzimenatos, Scott O King, Matthew Szadkowski, Martin J Herman, Julie C Leonard","doi":"10.1016/j.acepjo.2025.100295","DOIUrl":"10.1016/j.acepjo.2025.100295","url":null,"abstract":"<p><strong>Objectives: </strong>The decision to image children for cervical spine injuries (CSI), an uncommon injury with high associated morbidity and mortality, is complex. X-rays and computed tomography are often used to screen for CSI; however, radiation exposure increases lifetime cancer risk. We recently developed a CSI prediction rule to inform pediatric imaging decisions. To guide implementation, we conducted a workflow analysis of CSI screening in children after blunt trauma.</p><p><strong>Methods: </strong>We interviewed emergency departments (ED) and trauma clinicians at 21 hospitals following the applied cognitive task analysis task diagram, knowledge audit, and simulation interview approaches. Interviews were coded using a combined deductive-inductive approach to construct a workflow diagram and identify critical decisions with associated workflow junctures, decision makers, physical locations, and cognitive demands. We noted areas of high, medium, and low variability.</p><p><strong>Results: </strong>We interviewed 48 participants (emergency medicine physicians and advanced practice providers [n = 22], nurses [n = 14], and surgeons [n = 12]) across 21 hospitals located in the Western (n = 15), Northeastern (n = 5), and Midwestern (n = 1) USA. Critical decisions within the pediatric CSI imaging decision workflow included trauma triaging, spinal motion restriction application, clinical clearance, decision to image, and imaging type. There was moderate-to-high variability between hospitals for most workflow junctures and decision makers. However, more consistent patterns emerged, such as a high level of ED and trauma attending involvement throughout the process. The knowledge audit revealed a heavy cognitive load associated with decision making. \"Big picture,\" \"past and future,\" \"noticing\", \"job smarts,\" and \"equipment\" were highly relevant cognitive demands.</p><p><strong>Conclusion: </strong>Moderate-to-high between-hospital variability in workflow for decision making around CSI evaluation for pediatric trauma patients could potentially complicate CSI prediction rule implementation.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 1","pages":"100295"},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936636","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}

{"title":"Trends and Predictors of Emergency Department Outcomes in Atrial Fibrillation: A Statewide Analysis from North Carolina-2016 to 2023.","authors":"Shantanu Srivatsa, Parsa Pazooki, Benjamin K Lau, Anna Waller, Anna Bess Brown, Kimberly McDonald, Anil Gehi, Wayne Rosamond","doi":"10.1016/j.acepjo.2025.100279","DOIUrl":"10.1016/j.acepjo.2025.100279","url":null,"abstract":"<p><strong>Objectives: </strong>The population burden of atrial fibrillation (AF) continues to rise, leading to significant implications for emergency departments (EDs) managing acute presentations and complications. In this study, we aimed to characterize statewide trends in ED visits, admissions, and mortality related to AF, evaluate the association of AF outcomes with heart failure (HF) subtypes, and identify demographic and clinical predictors of these outcomes.</p><p><strong>Methods: </strong>This retrospective statewide analysis utilized ED data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) from 2016 to 2023. AF encounters were identified using ICD-10-CM diagnosis codes (I48.0-I48.2). Multivariable logistic regression was performed to evaluate predictors of hospital admission and mortality.</p><p><strong>Results: </strong>Among 39,445,680 ED visits, 517,722 (1.3%) had a diagnosis of AF. AF-related visits peaked in 2018 and declined significantly during the COVID-19 pandemic but recovered to previous levels by 2023. Hospital admission rates remained consistently high (63.7%-73.3%), whereas intra-encounter mortality was low but increased after 2020 (0.2% [pre-2020] to 0.6% [post-2020]). Patients with concomitant HF had increased odds of admission (HfpEF, OR 2.16; 95% CI [2.11-2.21]; HfrEF, OR 2.43; 95% CI [2.36-2.50]). In models evaluating intra-encounter mortality, AF + HFrEF (OR, 1.30; 95% CI [1.05-1.60]) but not AF + HFpEF (OR, 1.13; 95% CI [0.92-1.37]) was significantly associated with increased mortality; in subanalyzes excluding infectious presentations, AF + HFrEF was still associated with increased mortality (OR, 1.56; 95% CI [1.20-2.03]).</p><p><strong>Conclusion: </strong>These findings highlight continued clinical complexity and disparities in AF management in a large statewide syndromic surveillance database, particularly the association of comorbid HF and AF in emergent settings. Population-wide surveillance of AF can help assess the need for improved outpatient care, especially in populations with comorbid HF or high-risk and underserved populations.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 1","pages":"100279"},"PeriodicalIF":1.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12702206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764780","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}

{"title":"The Effect of Live Environmental Music Therapy and Prerecorded Music on State Anxiety, Stress, Pain, and Well-Being Levels of Patients and Caregivers in the Emergency Department Waiting Room: A Multicenter Randomized Clinical Trial.","authors":"Mark Ettenberger, Angélica Hernández, Moshé Amarillo, Raúl Suarez, Ana María Díaz, Ornella Fiorillo Moreno, Ana María Moreno Quintero, Bryan Alonso Ríos Suarez, Lina Marcela Gómez González, Guiselle Alexandra Cristancho Olaya","doi":"10.1016/j.acepjo.2025.100268","DOIUrl":"10.1016/j.acepjo.2025.100268","url":null,"abstract":"<p><strong>Objective: </strong>To determine the effect of live environmental music therapy (EMT), prerecorded music (same music as EMT), and a control condition on state anxiety, stress, pain, and well-being levels in patients and caregivers in the emergency department (ED) waiting areas of 2 general hospitals in Colombia, South America.</p><p><strong>Methods: </strong>This was a pragmatic, multicenter randomized clinical trial with 3 arms: standard care + EMT, standard care + prerecorded music, and standard care only. Participants included 256 adult patients and 174 caregivers. Primary outcome was the six-item State-Trait Anxiety Inventory. Secondary outcomes were stress and pain levels, assessed with Visual Analog Scales (Visual Analog Stress Scale and Visual Analog Pain Scale), and well-being, assessed with the Well-Being Numerical Rating Scales.</p><p><strong>Results: </strong>Results indicated that both music therapy interventions were associated with statistically significant reductions in anxiety, stress, and pain levels in patients and caregivers. Improvements in psychologic well-being were observed primarily in the group receiving live music therapy. Overall, live EMT showed better improvements across the emotional and physical outcomes.</p><p><strong>Conclusion: </strong>The results of this study indicate that live EMT and prerecorded music implemented by trained music therapists can be effective strategies for improving mental health and reducing pain in patients and caregivers in the ED waiting area.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 6","pages":"100268"},"PeriodicalIF":1.9,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12744334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859526","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}

{"title":"A Woman With Abdominal Pain.","authors":"Fu Chi, Cheng-Han Chen","doi":"10.1016/j.acepjo.2025.100267","DOIUrl":"10.1016/j.acepjo.2025.100267","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 6","pages":"100267"},"PeriodicalIF":1.9,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12641217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607708","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}

{"title":"Documentation of Adverse Social Drivers of Health in US Emergency Departments.","authors":"Melanie F Molina, Rebecca E Cash, Janice A Espinola, Krislyn M Boggs, Carlos A Camargo, Margaret E Samuels-Kalow","doi":"10.1016/j.acepjo.2025.100272","DOIUrl":"10.1016/j.acepjo.2025.100272","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to characterize emergency department (ED)-based policies related to documentation of adverse social drivers of health (aSDOH) among a national sample of US EDs.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of ED leaders from a 5% stratified random sample of US EDs (<i>n</i> = 280) from January to October 2023. For EDs reporting written screening policies for core aSDOH (housing, food, transportation, and utilities) or regulatory requirement-driven screening (intimate partner violence, other violence, substance use, and mental health), we assessed documentation policies, including personnel responsible and documentation methods. Using survey-weighted analyses and multivariable logistic regression, we examined associations between documentation policies and ED characteristics (practice setting, urbanicity, visit volume, and 24/7 social work availability).</p><p><strong>Results: </strong>Of 232 responding EDs (83% response rate), 213 (93.2%, 95% CI, 89.3-95.7) reported screening for at least 1 risk factor. Among these, 196 (93.8%, 95% CI, 87.9-96.9) had policies requiring documentation of positive screens. Documentation requirements were higher for regulatory requirement-driven screening (84-93.5) compared with core aSDOH screening (56.8-68.9). Clinical providers most commonly documented findings (97.8%, 95% CI, 94.8-99.1), followed by social workers/care coordinators (52.6%, 95% CI, 42.4-62.6). All documentation occurred in the electronic health record. In adjusted analyses, 24/7 social work availability was associated with greater odds of having at least 1 aSDOH documentation policy (odds ratio, 2.86; 95% CI, 1.09-7.52).</p><p><strong>Conclusion: </strong>Although most EDs with screening policies required documentation of positive screens, requirements varied by domain. Future research should focus on standardizing documentation practices and developing systems to effectively translate documented social needs into meaningful interventions.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 6","pages":"100272"},"PeriodicalIF":1.9,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12641213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607770","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}

{"title":"A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0.","authors":"Satheesh Gunaga, Christopher R Carpenter, Maura Kennedy, Lauren T Southerland, Alexander X Lo, Sangil Lee, Kirby Swan, Fabrice Mowbray, Rachel M Skains, Teresita M Hogan, Martin F Casey, Kei Ouchi, Naomi R George, Kerstin de Wit, Cameron J Gettel, Katherine Selman, Luna C Ragsdale, Anita N Chary, James D van Oppen, Glenn Arendts, Charles L Maddow, Katherine M Hunold, Katren R Tyler, Danya Khoujah, Ula Hwang, Shan Liu","doi":"10.1016/j.acepjo.2025.100247","DOIUrl":"10.1016/j.acepjo.2025.100247","url":null,"abstract":"<p><p>The original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, formalized evidence grading, and consensus building grounded in systematic reviews and meta-analyses. We describe the identification, recruitment, and collaboration of multidisciplinary clinical and academic experts working together to improve the care of older adults in the emergency department. Through this multidisciplinary effort, key geriatric domains were selected, priority topics identified, and systematic reviews and meta-analyses conducted to generate a robust evidence base for future guideline and policy development. The GED Guidelines 2.0 represents the first emergency medicine (EM) subspecialty guideline effort to fully adopt the GRADE framework, offering a novel blueprint for future EM guideline development.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 6","pages":"100247"},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187741","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}

{"title":"Wrongful Migration: A Hidden Culprit Behind Flank Pain.","authors":"Ryan Miller, Anjeza Cipi, Emma Pierce","doi":"10.1016/j.acepjo.2025.100248","DOIUrl":"10.1016/j.acepjo.2025.100248","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 5","pages":"100248"},"PeriodicalIF":1.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331076","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}

{"title":"A Host-Protein Test for Differentiating Bacterial From Viral Infection: Diagnostic Accuracy in Elderly Patients.","authors":"Tanya M Gottlieb, Yaly Orr, Hagai Hamami, Roy Navon, Lior Kellerman, Eran Eden, Daniel Haber, Neta Petersiel, Ami Neuberger, Adam J Singer, Mical Paul, Richard E Rothman","doi":"10.1016/j.acepjo.2025.100245","DOIUrl":"10.1016/j.acepjo.2025.100245","url":null,"abstract":"<p><strong>Objectives: </strong>Older adults are vulnerable to infection and are difficult to diagnose. This study assessed the performance of MeMed BV (MMBV), a host-protein test for differentiating bacterial from viral infection, in adults ≥65 years.</p><p><strong>Methods: </strong>Post hoc pooled and meta-analysis of adults with suspected acute infections enrolled in 3 prospective studies. MMBV results were interpreted as bacterial/viral/equivocal per manufacturer's instructions. Reference standard infection etiology was adjudicated by experienced physicians who were blinded to MMBV. Diagnostic accuracy for bacterial infection was calculated for MMBV results (area under the receiver operating characteristic curve [AUC], bin analysis) and for unequivocal MMBV results (sensitivity/specificity). MMBV's potential impact on antibiotic use was estimated by comparing MMBV-guided decisions to actual practice.</p><p><strong>Results: </strong>A total of 754 younger (18-64 years) and 248 older (≥65 years) adults were included. Among older adults, the median age was 75.0 years (IQR, 69.0, 82.0), 53.2% were male, 68.1% were hospitalized, and 79.0% had ≥3 comorbidities. Respiratory tract infections were common (76.2%), and 85.1% were prescribed antibiotics. A total of 111 patients were assigned a bacterial reference standard infection etiology, 77 a viral etiology, and 60 an indeterminate etiology. In pooled analysis, MMBV attained comparable AUC in older (0.95; 95% CI, 0.92-0.98) vs younger adults (0.95; 0.93-0.97). Focusing on older adults, 96.2% (90.3-98.8) sensitivity and 85.7% (74.8-92.5) specificity with 10.6% equivocal results were observed. MMBV could reduce potentially unwarranted antibiotic prescriptions 2.5-fold (from 62.3% to 24.7%; <i>P</i> < .0001). Using a bivariate model, MMBV similarly attained AUC 0.92 (0.81-0.97).</p><p><strong>Conclusions: </strong>MMBV demonstrated high diagnostic accuracy in older adults, supporting its potential to optimize antibiotic use in this population. Further studies are needed to evaluate real-world utility.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 5","pages":"100245"},"PeriodicalIF":1.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331102","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}

{"title":"The Accuracy of Artificial Intelligence-Based Models Applied to 12-Lead Electrocardiograms for the Diagnosis of Acute Coronary Syndrome: A Systematic Review.","authors":"Aly Fawzy, Aleena Malik, Juan Pablo Diaz-Martinez, Ani Orchanian-Cheff, Sameer Masood","doi":"10.1016/j.acepjo.2025.100240","DOIUrl":"10.1016/j.acepjo.2025.100240","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review aims to evaluate the diagnostic accuracy of artificial intelligence (AI) algorithms in acute coronary syndrome (ACS) detection using 12-lead electrocardiograms (ECGs).</p><p><strong>Methods: </strong>Adhering to Preferred Reporting Items for Systematic Reviews guidelines, Ovid MEDLINE, Ovid Embase, Cochrane Central, and Cochrane Database of Systematic Reviews were searched up to June 15, 2023. Eligible studies involved adults with suspected ACS and employed AI for 12-lead ECG interpretation. The primary outcomes were sensitivity and specificity, with secondary outcomes including positive predictive value (PPV), negative predictive value (NPV), and accuracy. Risk of bias was evaluated using Prediction model Risk Of Bias Assessment Tool (PROBAST).</p><p><strong>Results: </strong>From 2051 records, 24 studies were included. The sensitivity of AI-based diagnosis for ACS among the 24 studies varied from 68% to 98%, and the specificity varied from 41% to 98%. For subgroup analysis of ST-elevated myocardial infarction/occlusion myocardial infarction, sensitivity ranged from 68% to 97% and specificity from 68% to 99%. AI models outperformed clinicians interpreting ECGs retrospectively without knowledge of outcomes in sensitivity (90% of studies) and PPV (100% of studies), whereas clinicians had better NPV (70% of studies). One study compared AI with real-time emergency department physician interpretations. Three studies reported code availability. Thirty-eight percentage of studies showed a high risk of bias, with 50% showing unclear risk, although applicability concerns were minimal.</p><p><strong>Conclusion: </strong>AI models show high diagnostic accuracy for ACS using 12-lead ECGs, with potential to enhance early diagnosis. However, variability in performance, transparency challenges with limited code availability, a high risk of bias in some studies, and minimal real-time comparisons underscore the necessity for standardized reporting and open-access practices.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 5","pages":"100240"},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331128","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}