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

{"title":"Rationale and development of a prehospital goal-directed bundle of care to prevent rearrest after return of spontaneous circulation","authors":"David G. Dillon MD, PhD,&nbsp;Juan Carlos C. Montoy MD, PhD,&nbsp;Nichole Bosson MD, MPH,&nbsp;Jake Toy DO, MS,&nbsp;Senai Kidane MD,&nbsp;Dustin W. Ballard MD, MBE,&nbsp;Marianne Gausche-Hill MD,&nbsp;Joelle Donofrio-Odmann DO,&nbsp;Shira A. Schlesinger MD, MPH,&nbsp;Katherine Staats MD,&nbsp;Clayton Kazan MD, MS,&nbsp;Brian Morr BS, MICP,&nbsp;Kristin Thompson RN,&nbsp;Kevin Mackey MD,&nbsp;John Brown MD, MPA,&nbsp;James J. Menegazzi PhD,&nbsp;the California Resuscitation Outcomes Consortium","doi":"10.1002/emp2.13321","DOIUrl":"10.1002/emp2.13321","url":null,"abstract":"<p>In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585254","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 sudden unilateral vision loss","authors":"Areeba Abid MD,&nbsp;Michelle P. Lin MD,&nbsp;Elizabeth Cox MD,&nbsp;Timothy J. Batchelor MD","doi":"10.1002/emp2.13337","DOIUrl":"https://doi.org/10.1002/emp2.13337","url":null,"abstract":"&lt;p&gt;A 60-year-old female with a history of breast cancer in remission presented to the emergency department with 1 day of acute onset left eye visual changes, which she described as “shadows” and “tunnel-like.” She reported mild pain and “stinging” with extraocular movements of the left eye. Physical exam demonstrated relative afferent pupillary defect in the left eye, with visual field defects in the infranasal and supratemporal regions. The patient had normal intraocular pressure (IOP) and 20/20 corrected central vision. Ocular point-of-care ultrasound of the left eye was performed, demonstrating “spot sign” (Figure 1, Video 1). The presumptive diagnosis was corroborated by a comprehensive ocular examination by ophthalmology. She was ultimately discharged to outpatient follow up on dual-antiplatelet therapy.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Central retinal artery occlusion&lt;/i&gt; (CRAO) typically presents with painless loss of vision,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; resulting from sudden blockage of the central retinal artery. This is an ocular emergency and a stroke equivalent, with retinal hypoperfusion causing rapidly progressive retinal damage and vision loss.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;“Spot sign” is a hyperechoic focus sometimes seen posterior to the globe within the optic nerve sheath, indicative of a calcified embolus from atherosclerotic plaques. Transbulbar ultrasound is valuable for the initial diagnosis and workup of CRAO because it helps to elucidate whether occlusion is secondary to thrombus or calcified embolus, with positive spot sign associated with decreased effectiveness of thrombolysis. The absence of spot sign may help to identify patients more likely to benefit from thrombolytic treatment.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing, we confirm that we have followed the regulations of our institutions concerning intellectual property and patient confidentiality. We understand that the corresponding author is the sole contact for the editorial process (including editorial manager and direct communications with the office). She is responsible for communicating with the other authors about progress, submissions of revisions, and final approval of proofs.&lt;/p&gt;&lt;p&gt;We confirm that we have provided a current, correct email address which is accessible ","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540829","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":"Factors influencing emergency medicine worker shift satisfaction: A rapid assessment of wellness in the emergency department","authors":"Brooke Senken MD,&nbsp;Julie Welch MD,&nbsp;Elisa Sarmiento MSPH,&nbsp;Elizabeth Weinstein MD,&nbsp;Emma Cushman,&nbsp;Heather Kelker MD","doi":"10.1002/emp2.13315","DOIUrl":"https://doi.org/10.1002/emp2.13315","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In emergency medicine (EM), the interplay of wellbeing and burnout impacts not only patient care, but the health, productivity, and job satisfaction of EM healthcare workers. The study objective was to use a rapid assessment tool to identify factors that impact EM worker satisfaction, or “wellness,” while on shift in the emergency department (ED) and the association with role and level of satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective descriptive study utilized a QR-code-based electronic survey instrument that included a 7-point Likert shift satisfaction score. A voluntary response sampling was obtained from EM workers at five EDs. Respondents self-reported role and work site. Association and logistic regression analysis were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 755 responses, 467 were dissatisfied (score ≤ 5) and 288 were satisfied (score ≥ 6) with their shifts. Physicians reported higher satisfaction on shift than nurses (OR 2.77, 95% CL 2.01–3.81, <i>p</i> &lt; 0.01). Factors associated with dissatisfied responses included: admission or transfer process (OR 0.40, CL 0.21–0.77, <i>p</i> &lt; 0.01), boarding patients (OR 0.13, CL 0.06–0.27, <i>p</i> &lt; 0.01), tools to do my job (OR 0.65, CL 0.46–0.90, <i>p</i> = 0.01), and patient flow (OR 0.72, CL 0.53–0.98, <i>p</i> = 0.04). Factors linked to a satisfied response included: teaching/learning (OR 2.85, CL 1.86–4.37, <i>p</i> &lt; 0.01) and team/coworker interaction (OR 8.92, CL 6.14–12.96, <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Satisfaction on shift for EM physicians, nurses, and staff differ and are associated with multiple identifiable factors. Focused attention to work environment and operations could help mitigate on-shift dissatisfaction. Endeavors aimed at cultivating and enhancing a supportive teaching and learning environment with an emphasis on team member and coworker interaction could positively impact and improve wellness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142541098","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":"Passage of vaginal tissue in an non-pregnant adolescent","authors":"Brenda N. Martinez MD,&nbsp;Dharshana Krishnaprasadh MD, FAAP","doi":"10.1002/emp2.13309","DOIUrl":"https://doi.org/10.1002/emp2.13309","url":null,"abstract":"<p>A 16-year-old female, with a history of spontaneous abortion 2 years ago, presented to the emergency department immediately after tissue expulsion vaginally (Figure 1). The patient had been placed on a high-dose depot of medroxyprogesterone acetate (DMPA) 4 weeks prior to presentation. Additionally, she had abdominal cramping and denied recent sexual activity, fever, or vaginal discharge. Her vital signs were normal. Complete Blood Count (CBC) and Comprehensive metabolic panel (CMP) were normal and serum human chorionic gonadotropin was &lt;1 MIU/mL. Pelvic ultrasound demonstrated trace non-specific fluid (Figure 2). The diagnosis was confirmed histologically.</p><p>Decidual cast (DC) is a gynecological phenomenon in which the entire lining of the uterine cavity is shed in one piece, resembling the shape of the uterus.<span>^{1, 2}</span> This condition can be quite alarming due to its dramatic presentation and can be accompanied by significant pain and heavy bleeding. Women may report cramping similar to or more intense than typical menstrual cramps, alongside the expulsion of a fleshy mass. The pathology involves excessive buildup and subsequent detachment of the decidualized endometrial lining under the influence of progesterone.<span>^{2, 3}</span> Hormonal contraceptives, particularly those containing progesterone such as DMPA can predispose to DC.<span>^{1, 4, 3}</span> Diagnosis is clinical, supported by history and physical examination, and may be confirmed by histological examination if the cast is retained for analysis. Our patient's histology showed benign decidualized endometrial tissue with exogenous progesterone effects. Treatment focuses on pain control for abdominal cramping, and patient may continue to use the contraceptive method without further episodes of DC formation.2,5</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540828","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 Dunning‒Kruger effect in resident predicted and actual performance on the American Board of Emergency Medicine in-training examination","authors":"Theodore J. Gaeta DO, MPH,&nbsp;Earl Reisdorff MD,&nbsp;Melissa Barton MD,&nbsp;Kim M. Feldhaus MD,&nbsp;Marianne Gausche-Hill MD,&nbsp;Deepi Goyal MD,&nbsp;Kevin Joldersma PhD,&nbsp;Chadd K. Kraus DO, DrPH,&nbsp;Felix Ankel MD","doi":"10.1002/emp2.13305","DOIUrl":"10.1002/emp2.13305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The Dunning–Kruger effect (DKE) is a cognitive bias wherein individuals who are unskilled overestimate their abilities, while those who are skilled tend to underestimate their capabilities. The purpose of this investigation is to determine if the DKE exists among American Board of Emergency Medicine (ABEM) in-training examination (ITE) participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective, cross-sectional survey of residents in Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine (EM) residency programs. All residents who took the 2022 ABEM ITE were eligible for inclusion. Residents from international programs, residents in combined training programs, and those who did not complete the voluntary post-ITE survey were excluded. Half of the residents taking the ITE were asked to predict their self-assessment of performance (percent correct), and the other half were asked to predict their performance relative to peers at the same level of training (quintile estimate). Pearson's correlation (<i>r</i>) was used for parametric interval data comparisons and a Spearman's coefficient (<i>ρ</i>) was determined for quintile-to-quintile comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7568 of 8918 (84.9%) residents completed their assigned survey question. A total of 3694 residents completed self-assessment (mean predicted percentage correct 67.4% and actual 74.6%), with a strong positive correlation (Pearson's <i>r</i> 0.58, <i>p</i> &lt; 0.001). There was also a strong positive correlation (Spearman's <i>ρ</i> 0.53, <i>p</i> &lt; 0.001) for the 3874 residents who predicted their performance compared to peers. Of these, 8.5% of residents in the first (lowest) quintile and 15.7% of residents in the fifth (highest) quintile correctly predicted their performance compared to peers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EM residents demonstrated accurate self-assessment of their performance on the ABEM ITE; however, the DKE was present when comparing their self-assessments to their peers. Lower-performing residents tended to overestimate their performance, with the most significant DKE observed among the lowest-performing residents. The highest-performing residents tended to underestimate their relative performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514253","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":"Asynchronous education improves emergency medical services clinician confidence and knowledge in caring for patients near the end-of-life","authors":"David H. Wang MD,&nbsp;Charles Dunn BS, EMT,&nbsp;Justin K. Brooten MD,&nbsp;Brian Gacioch MD, EMT-P,&nbsp;Michael Taigman MA, NREMT-P,&nbsp;Zili He MS,&nbsp;James Dziura PhD,&nbsp;Amelia M. Breyre MD, NREMT-P","doi":"10.1002/emp2.13331","DOIUrl":"10.1002/emp2.13331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of a nationally available continuing education online curriculum on Emergency Medical Services (EMS) clinician confidence and knowledge in caring for end-of-life (EOL) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective observational study of EMS clinicians (emergency medical technicians [EMTs], advanced EMTs [AEMTs], and paramedics). EMS clinicians and physicians with both EMS and palliative care expertise developed two 20-min modules regarding: (1) communication skills (including death notification) and (2) hospice knowledge. EMS clinicians’ subject confidence (modified Likert-scale) and knowledge were assessed electronically immediately before and after each module. Data analysis compared before and after module improvements in knowledge and confidence. Linear regressions analyzed baseline EOL skill confidence scores based on EMS agency, level of certification, and years of experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed completed datasets for 1825 EMS clinicians (979 EMTs, 112 AEMTs, and 734 paramedics) representing a heterogeneous cohort across different EMS agencies (617 private, 545 fire-based, 298 hospital-based, 61 third service, and 304 other) and all 50 states and the District of Columbia. After the communication module, the number of EMS clinicians who reported confidence in delivering bad news increased from 62% (1131/1825) to 80% (1468/1825) (<i>p</i> &lt; 0.001). After the hospice module, the number of EMS clinicians who reported confidence in knowing what services hospice provides increased from 51% (925/1825) to 75% (1375/1825) (<i>p</i> &lt; 0.001) and confidence in knowing what active dying patients look like from 57% (1033/1825) to 78% (1429/1835) (<i>p</i> &lt; 0.001) in knowing what active dying patients look like. Linear regression demonstrated that before modules, EMS clinicians with more monthly EOL calls, those with more years of experience, and paramedics were more confident in their EOL skills than their peers. After module completion, those with the fewest years of experience (0–3 years) and EMTs gained significantly more confidence in communication skills than their peers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Asynchronous, online continuing education improves EMS clinician knowledge and confidence in caring for patients near the EOL. The greatest benefit in improved confidence was for EMTs and those with the fewest years of EMS experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514250","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 multicenter randomized control trial: Point-of-care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness","authors":"Andrew C. Meltzer MD MS,&nbsp;Aditya Loganathan BS,&nbsp;Seamus Moran BS, MS,&nbsp;Soroush Shahamatdar BS,&nbsp;Luis W. Dominguez MD, MPH,&nbsp;Joel Willis DO,&nbsp;Wei Zhang PhD,&nbsp;Xinyi Zhang PHD,&nbsp;Yan Ma PhD","doi":"10.1002/emp2.13306","DOIUrl":"10.1002/emp2.13306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Syndromic assessment with multiplex polymerase chain reaction (mPCR) testing in patients with acute respiratory illness (ARI) allows for simultaneous identification of multiple possible infectious etiologies. Point-of-care (POC) syndromic assessment can be conducted in a clinical setting, such as an urgent care center (UCC), without requiring certified laboratories. The primary objective of this study was to determine whether POC syndromic assessment improved patient satisfaction for patients seen at an UCC with ARI; secondary objectives included whether syndromic assessment reduced self-isolation time, increased diagnostic confidence, and reduced overall antibiotic utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an unblinded multicenter randomized controlled trial on UCC patients with an ARI. Patients were randomized to either SC (defined as standard UCC testing for ARI) or syndromic assessment with POC mPCR. Patients were surveyed for patient satisfaction, self-isolation plans, diagnostic confidence, and overall antibiotic utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 360 patients enrolled, those in the syndromic assessment group were more satisfied with the time required to communicate the results (98.4% vs. 42.4%, <i>p</i> &lt; 0.001) on day of treatment, more likely to resume normal activities sooner (83.3% vs. 69.4%, <i>p</i> = 0.039), and more confident in their illness cause (60.7% vs. 29.6%, <i>p</i> &lt; 0.001); however, the rate of antibiotic utilization did not differ (33.5% vs. 26%, <i>p</i> = 1.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, our study provides evidence supporting the use of syndromic assessment in UCCs for ARI diagnosis, including patient-centered outcomes such as greater confidence in diagnosis and more efficient isolation strategies. This study did not show a difference in more clinically oriented outcomes, such as a change in antibiotic utilization. Future studies should identify clinical care pathways to improve antibiotic stewardship for likely viral syndromes and whether the increased initial cost of syndromic assessment is offset by the clinical benefits and subsequent cost savings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514249","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":"Buprenorphine, oxycodone, hydrocodone, and methadone mortality in the United States (2010‒2017)","authors":"Karilynn M. Rockhill PhD,&nbsp;Gabrielle E. Bau MS,&nbsp;Angela DeVeaugh-Geiss PhD,&nbsp;Howard Chilcoat ScD,&nbsp;Richard Dart MD, PhD,&nbsp;Janetta Iwanicki MD,&nbsp;Joshua C. Black PhD","doi":"10.1002/emp2.13338","DOIUrl":"10.1002/emp2.13338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Opioid overdose survivors present to emergency departments (EDs) and many EDs have developed programs to initiate buprenorphine. The impact of the increasing use of buprenorphine in ED and by other providers is unknown while opioid mortality continues to rise. Public mortality data do not distinguish buprenorphine from other prescription opioids. Our objective was to determine when changes in overdose mortality trends occurred comparing deaths involving buprenorphine to oxycodone, hydrocodone, and methadone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational study utilized the drug-involved mortality database including US death certificates (2010‒2017) in which buprenorphine, oxycodone, hydrocodone, or methadone were contributing causes of death (determined through textual analysis). Population- and drug utilization-adjusted mortality rates were examined using disjointed linear regression. Buprenorphine-involved deaths were stratified by polysubstance involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The population-adjusted mortality rates for buprenorphine-involved deaths were lowest compared to other opioids; however, the change in rate for buprenorphine increased faster than oxycodone, hydrocodone, and methadone at 8.9% each quarter-year (95% confidence interval [CI]: 8.0, 9.8) from 2010 to mid-2016 when it stabilized. After adjusting for changes in dispensing over the study period, buprenorphine-involved mortality rates were increasing at 5.3% (95% CI: 4.6, 6.1) each quarter-year. In 2017, 94% buprenorphine-involved deaths had at least one other drug contributing to the cause of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given the low mortality, high proportions of polysubstance mortality, and the mixed agonist/antagonist mechanism of action, use of buprenorphine alone likely presents a lower risk for overdose than comparators. Mortality rose faster than dispensing, signaling need to ensure people understand buprenorphine risks, particularly polysubstance use, balanced against importance for treating opioid use disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514251","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":"Evaluation of an emergency department-based approach to reduce subsequent opioid overdoses","authors":"Eric N. Reed MD,&nbsp;Joan Papp MD,&nbsp;Yesol Oh MD,&nbsp;Kellie LeVine MD,&nbsp;Yasir Tarabichi MD,&nbsp;Estella Bastian BA,&nbsp;Kailee Pollock PharmD,&nbsp;Lance D. Wilson MD,&nbsp;Jonathan Siff MD,&nbsp;Joseph S. Piktel MD","doi":"10.1002/emp2.13304","DOIUrl":"10.1002/emp2.13304","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this study was to determine the association of a multi-pronged treatment program in emergency department (ED) patients with an acute presentation of opioid use disorder (OUD) on the rate of subsequent opioid overdose (OD). This approach included ED-initiated take-home naloxone, prescription buprenorphine, and an ED-based peer support and recovery program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective observational analysis of adult patients presenting to the ED at a large urban hospital system from November 1, 2017 to March 17, 2023. Patients with an ED discharge diagnosis of OD or OUD were included. Outcomes determined were subsequent 90-day OD and 180-day OD death. Post hoc analyses were performed to identify intervention utilization throughout the study period including the COVID-19 pandemic as well as ED characteristics associated with subsequent OD and OD death. Statistical comparisons were made using logistic regression and chi-squared test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2634 patients presented to the ED with an opioid OD or diagnosis of OUD. Subsequent 90-day OD decreased significantly over time (11.5%–2.3%, odds ratio [OR] 0.85, confidence interval [CI] 0.82–0.89). No single intervention was independently associated with 90-day OD or 180-day OD death. Resource utilization was stable during the COVID-19 pandemic and increased afterward. A higher buprenorphine fill-rate among all patients and the Back race subgroup was associated with a decrease in 90-day OD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Subsequent OD and OD death decreased over time after implementation of a multi-pronged treatment program to ED patients with OUD. No single intervention was associated with a decrease of subsequent OD or OD death.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514252","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":"Young infant with umbilical protrusion","authors":"Yuto Otsubo MD,&nbsp;Ryoichi Yamaki MD,&nbsp;Yuho Horikoshi MD","doi":"10.1002/emp2.13323","DOIUrl":"10.1002/emp2.13323","url":null,"abstract":"<p>A 1-month-old male infant presented to a pediatric emergency department with a fever and poor activity. Physical examination revealed tachycardia, slightly mottled skin, abdominal distension, and an umbilical protrusion (Figure 1).</p><p>The symptom of umbilical protrusion raised the suspicion of a HPeV3 infection, polymerase chain reaction was performed, and HPeV was detected in the cerebrospinal fluid. A type analysis revealed HPeV3. His general condition, including the umbilical protrusion, resolved after a few days.</p><p>HPeV3 can cause a severe infection, such as sepsis or a central nervous system infection, in a young infant.<span>¹</span> Early diagnosis, though difficult, can enable the discontinuation of unnecessary antibiotic therapy and help predict the clinical course of the infection.</p><p>Umbilical protrusion is one of the characteristic symptoms of early infantile HPeV3 infection. In a previous study, eight of 43 young infants with HPeV3 (19%) presented with an umbilical protrusion.<span>²</span> Umbilical protrusion is typically observed in the presence of abdominal distention.<span>³</span> Abdominal distension caused by HPeV3 is sometimes severe and may be confused with a surgical condition.<span>⁴</span> The mechanism of umbilical protrusion is thought to be an increased abdominal pressure and the insufficient development of the umbilical ring in young infants. In young infantile cases of abdominal distention and umbilical protrusion accompanied by sepsis-like symptoms, HPeV3 should be considered in a differential diagnosis.</p><p>The authors declare no conflicts of interest.</p><p>There were no sources of funding for this study.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482482","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}