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

{"title":"Pandemic-Associated Dental Office Closures Associated With Increased Use of Emergency Departments for Dental Conditions in Publicly Insured Children In New York State.","authors":"Shulamite Sian Huang, Scarlett Wang, Heather T Gold","doi":"10.1016/j.acepjo.2025.100094","DOIUrl":"10.1016/j.acepjo.2025.100094","url":null,"abstract":"<p><strong>Objectives: </strong>All traditional dental clinics were closed from March to May 2020 due to the COVID-19 shutdown, potentially causing additional strain on hospital emergency departments (EDs) to care for patients with dental conditions. We evaluated the impact of pandemic-associated dental office closures on the share of dental conditions managed in EDs among children on Medicaid.</p><p><strong>Methods: </strong>We quantified the change in the dental-related ED burden among publicly insured children before, during, and after pandemic dental office closures across NY using 2018-2020 New York State (NY) Medicaid claims data among children under age 19 using a difference-in-differences approach.</p><p><strong>Results: </strong>After controlling for seasonality, dental practice closures in 2020 in NY led to a 2.31 percentage point increase in the share of dental conditions seen in EDs (<i>P</i> < .01) among children on Medicaid, representing a 62% increase over 2019 levels. This was sustained even after reopening in May 2020 (1.26 percentage point increase in the reopening phase, <i>P</i> < .01). The increases in the dental-related ED burden during dental office closures were due to the increased use of EDs for dental conditions.</p><p><strong>Conclusion: </strong>Lack of access to dental care during a time of significant health care system strain was associated with an increased burden on EDs from dental conditions among publicly insured children. Health care systems should consider alternatives to referral programs to dental offices to ensure publicly insured children do not fall through the dental safety net, such as by providing limited dental services on-site or incorporating urgent dental care clinics within hospitals.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 2","pages":"100094"},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702530","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":"Traumatic Forehead Mass: An Ultrasound Lens.","authors":"Mayra Gonzalez-Torres, Waleed Aldadah, Nicole Aviles","doi":"10.1016/j.acepjo.2024.100039","DOIUrl":"https://doi.org/10.1016/j.acepjo.2024.100039","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 2","pages":"100039"},"PeriodicalIF":1.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054797","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":"Viscoelastic Hemostatic Assays are Associated With Mortality and Blood Transfusion in a Multicenter Cohort.","authors":"Shyam Murali, Eric Winter, Nicolas M Chanes, Allyson M Hynes, Madhu Subramanian, Alison A Smith, Mark J Seamon, Jeremy W Cannon","doi":"10.1016/j.acepjo.2024.100042","DOIUrl":"https://doi.org/10.1016/j.acepjo.2024.100042","url":null,"abstract":"<p><strong>Objectives: </strong>Trauma-induced coagulopathy (TIC) carries significant risks, including increased mortality. Traditional TIC definitions rely on laboratories that result slowly and do not highlight therapeutic targets. We hypothesized that a TIC score, based on thromboelastography (TEG) and rotational thromboelastometry (ROTEM), collectively termed viscoelastic hemostatic assays, is associated with in-hospital mortality and packed red blood cell (pRBC) transfusion.</p><p><strong>Methods: </strong>This retrospective cohort study used a database of adult patients undergoing institutional massive transfusion at seven level 1 trauma centers (2013-2018). A \"TIC score\" was developed, with 1 point assigned for abnormal TEG R-time (≥ 9 min) or ROTEM clot time (≥ 80 sec), ɑ-angle (< 65^o), or maximum amplitude (< 55 mm). TIC+ patients (TIC score 1-3) were compared with TIC- patients (TIC score 0). TIC Score composition and abnormal cutoff values were adjusted to investigate optimal weighting and thresholds. Multiple logistic and negative binomial regression was used to control confounders while evaluating the association between abnormal TIC values, in-hospital mortality, and 24-hour pRBC transfusion.</p><p><strong>Results: </strong>Of 1499 patients in the final analysis, 591 (39.4%) were TIC+. Each 1-point increase in TIC score was associated with a 53% increase in the odds of mortality (odds ratio [OR], 1.53, 95% CI, 1.33-1.76, <i>P</i> < .001) and a 25% increase in pRBC transfusion volumes (incidence rate ratio, 1.25, 95% CI, 1.16-1.34, <i>P</i> < .001). Abnormal maximum amplitude was associated with both mortality (OR 1.50, 95% CI, 1.03-2.19, <i>P</i> = .034) and pRBC transfusion volumes (<i>P</i> < .001), whereas abnormal ɑ-angle was associated with mortality (OR, 1.59, 95% CI, 1.09-2.32, <i>P</i> = .015). The unequal weighting of TIC score components and adjustments to normal/abnormal cutoff thresholds were maintained but did not improve the model's predictive power.</p><p><strong>Conclusion: </strong>A viscoelastic hemostatic assay-based TIC score is independently associated with mortality and pRBC transfusion volumes. This association persists with unequal weighting and adjustment of normal/abnormal cutoff thresholds of TEG components.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 2","pages":"100042"},"PeriodicalIF":1.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047352","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":"Prehospital Blood Administration in Traumatic Hemorrhagic Shock.","authors":"Bryan McNeilly, Kathleen Samsey, Seth Kelly, Andre Pennardt, Francis X Guyette","doi":"10.1016/j.acepjo.2024.100041","DOIUrl":"https://doi.org/10.1016/j.acepjo.2024.100041","url":null,"abstract":"<p><p>Following the military's advancement of prehospital blood into the field, civilian prehospital blood programs are becoming more prevalent. However, there are significant differences between civilian and military prehospital operations that should be considered. Civilian prehospital systems also vary widely in terms of resources, transport times, and patient types. Given these variations and the logistical challenges associated with establishing a prehospital blood program, careful consideration of the state of the science is warranted. Although blood is the preferred fluid for patients in hemorrhagic shock, there have only been a few high-quality studies that have examined the efficacy of administering blood in the prehospital setting. Given the conflicting results of these studies, individual medical directors must determine whether the risk-benefit analysis for their system warrants establishing such a resource-intensive operation. Efforts to establish a prehospital blood program should not supersede attempts to optimize the fundamental components of trauma operations and management.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 2","pages":"100041"},"PeriodicalIF":1.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052616","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":"Syncope After a Run.","authors":"Olivia Bowles, Daniel Natkiel, Jeffrey Gardecki","doi":"10.1016/j.acepjo.2024.100038","DOIUrl":"10.1016/j.acepjo.2024.100038","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100038"},"PeriodicalIF":1.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517280","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":"Occult Ventricular Fibrillation Visualized by Echocardiogram During Cardiac Arrest: A Retrospective Observational Study From the Real-Time Evaluation and Assessment for Sonography-Outcomes Network (REASON).","authors":"Romolo Gaspari, Srikar Adhikari, Timothy Gleeson, Monica Kapoor, Robert Lindsay, Vicki Noble, Jason T Nomura, Anthony Weekes, Dan Theodoro","doi":"10.1016/j.acepjo.2024.100028","DOIUrl":"10.1016/j.acepjo.2024.100028","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiac arrest patients with a shockable rhythm are more likely to survive an out-of-hospital cardiac arrest (OHCA) compared with a nonshockable rhythm. An electrocardiogram (ECG) is the most common way to identify a shockable rhythm, but it can miss patients with clinically significant ventricular fibrillation (vfib). We sought to determine the percentage of nonshockable OHCA patients that demonstrated vfib on echo.</p><p><strong>Methods: </strong>Secondary analysis of echo images recorded from a prior study from our group, Real-Time Evaluation and Assessment for Sonography-Outcomes Network (REASON), a multicenter, observational study of OHCA patients presenting to the emergency department with nonshockable rhythms. Using ECG and echocardiogram images recorded during the initial cardiopulmonary resuscitation (CPR) pause, 2 independent emergency physicians determined the presence of vfib. Two experienced emergency physicians (R.G. and T.G.) reviewed echo images with adjudication by a third if necessary. ECG interpretation was unblinded to patient information. The primary outcome was the proportion of patients in occult vfib.</p><p><strong>Results: </strong>During the first CPR pause, reviewers noted occult vfib in 22/685 (3.2%; 95% CI, 2.1%-4.8%) subjects. Patients with ECG vfib (n = 55) were defibrillated immediately during the first pause in CPR, but no patients with occult vfib during the first pause in CPR were defibrillated. Subsequently, 50% (11 of 22) of occult vfib patients were defibrillated when ECG vfib was recognized during an ensuing pause in CPR.</p><p><strong>Conclusion: </strong>One in 33 OHCAs with a nonshockable ECG rhythm exhibits VF on echocardiogram. Patients presenting to the emergency department in a presumed nonshockable rhythm following OHCA may benefit from prompt defibrillation if personnel recognize occult vfib on echo.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100028"},"PeriodicalIF":1.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517369","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 Novel Way to Rescue a Woman Stuck in a Chair.","authors":"Kenichiro Iga, Tomoyuki Shirahige, Sunao Yamauchi","doi":"10.1016/j.acepjo.2024.100029","DOIUrl":"10.1016/j.acepjo.2024.100029","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100029"},"PeriodicalIF":1.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517549","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":"Methicillin-resistant <i>Staphylococcus aureus</i> and Vancomycin Prescribing in the Emergency Department: A Single-center Study Assessing Antibiotic Prescribing.","authors":"Joshua D Niforatos, Jeremiah S Hinson, Richard E Rothman, Sara E Cosgrove, Kate Dzintars, Eili Y Klein","doi":"10.1016/j.acepjo.2024.100021","DOIUrl":"10.1016/j.acepjo.2024.100021","url":null,"abstract":"<p><strong>Objectives: </strong>Given the support for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) antimicrobial stewardship in the 2021 Surviving Sepsis Campaign Guidelines, we sought to measure the use of vancomycin in the emergency department (ED) in the years preceding these recommendations.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of all patients aged ≥ 18 years presenting to 5 emergency departments within a university-based health system who were given intravenous (IV) vancomycin during their ED index visit. The primary outcome assessed the proportion of patients with MRSA-positive blood cultures who received IV vancomycin in the ED. We also measured associations between clinical attributes associated with any MRSA infection.</p><p><strong>Results: </strong>Of the 20,212 unique ED visits for patients who received IV vancomycin, 63% (n = 12,755) had at least 1 MRSA risk factor. Only 2.4% (n = 494) and 14.1% (n = 2850) of patients receiving IV vancomycin in the ED were found to have MRSA bacteremia or any MRSA-positive culture, respectively. A total of 3160 patients met Sepsis-3 criteria and received IV vancomycin, though 65% (n = 2064) had no MRSA risk factors. For any patient with culture-proven MRSA, 63.8% (n = 315) and 43.4% (n = 1236) received an MRSA antimicrobial in the ED. MRSA risk factors were not associated with MRSA bacteremia (≥1 MRSA risk factor: odds ratio, 1.3, 95% CI, 0.9-1.8) or an MRSA-positive culture of any type (odds ratio, 0.9, 95% CI, 0.7-1.1).</p><p><strong>Conclusion: </strong>Within our hospital system, MRSA was an infrequent cause of bacteremia for patients presenting to the ED with sepsis or septic shock. Although vancomycin is frequently used in the ED, many patients with culture-proven MRSA did not receive MRSA antimicrobials. Notably, one-third of patients with culture-proven MRSA had no MRSA risk factors. MRSA risk factors were not predictive of culture-proven MRSA, thus highlighting the complexity of antimicrobial stewardship in the ED without validated clinical decision rules.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100021"},"PeriodicalIF":1.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517356","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":"Man With an Itchy Back.","authors":"Katherine Schaffer, Nevin Adamski, Brittany Ambrose, Kathleen Anderson","doi":"10.1016/j.acepjo.2024.100032","DOIUrl":"10.1016/j.acepjo.2024.100032","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100032"},"PeriodicalIF":1.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517339","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":"Addressing Note Bloat: Solutions for Effective Clinical Documentation.","authors":"Nicholas Genes, Joseph Sills, Heather A Heaton, Bradley D Shy, Jean Scofi","doi":"10.1016/j.acepjo.2024.100031","DOIUrl":"10.1016/j.acepjo.2024.100031","url":null,"abstract":"<p><p>Clinical documentation in the United States has grown longer and more difficult to read, a phenomenon described as \"note bloat.\" This issue is especially pronounced in emergency medicine, where high diagnostic uncertainty and brief evaluations demand focused, efficient chart review to inform decision-making. Note bloat arises from multiple factors: efforts to enhance billing, mitigate malpractice risk, and leverage electronic health record tools that improve speed and completeness. We discuss best practices based on available evidence and expert opinion to improve note clarity and concision. Recent E/M coding reforms aim to streamline documentation by prioritizing medical decision-making over details of historical and physical examination, though implementation varies. New technologies such as generative artificial intelligence present opportunities and challenges for documentation practices. Addressing note bloat will require ongoing effort from clinical leadership, electronic health record vendors, and professional organizations.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 1","pages":"100031"},"PeriodicalIF":1.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517563","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}