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

{"title":"Current and Desired Behavioral Health Resources for Children: A Survey of Illinois Emergency Departments.","authors":"Jennifer A Hoffmann, Kendall Arslanian, Cindy Durr, Jennifer Monti, Suhanee Mitragotri, Stephanie Atella, Ashley A Foster","doi":"10.1016/j.acepjo.2026.100446","DOIUrl":"10.1016/j.acepjo.2026.100446","url":null,"abstract":"<p><strong>Objectives: </strong>In the context of rising emergency department (ED) visits by children for behavioral health (BH) concerns, our objective was to understand current and desired resources for the care of children presenting to Illinois EDs with BH concerns.</p><p><strong>Methods: </strong>We surveyed nurse pediatric emergency care coordinators (PECCs) and nurse managers working in Illinois EDs participating in the Pediatric Facility Recognition Program from March 15 to June 30, 2025. We assessed ED characteristics, pediatric BH care practices, and current and desired BH resources.</p><p><strong>Results: </strong>Among 101 eligible EDs, 65 (64%) responded. Respondents included nurse PECCs (77%), nurse managers (17%), and nurses serving in both roles (6%). Most EDs (60%) were in hospitals without a pediatric inpatient unit, 22% were in critical access hospitals, and 67% had <4999 annual pediatric ED visits. On-site mental health professionals and telemental health services were available in 56% and 44% of EDs, respectively. Universal suicide risk screening was reported in 88% of EDs, most frequently using the Columbia-Suicide Severity Rating Scale Screen Version (87%) and starting at age 8 (36%). Among EDs, 56% reported always or often providing all elements of safety planning. Frequently desired resources included activity kits (82%) and a portal to view pediatric psychiatric inpatient bed availability (73%). High priority resources included a mechanism to escalate difficult cases (23%) and increased access to mental health professionals in the ED (23%).</p><p><strong>Conclusion: </strong>Survey findings inform opportunities to standardize and improve pediatric BH emergency care through the development and dissemination of desired resources.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100446"},"PeriodicalIF":1.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708784","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 Uterine Rupture in a Nonpregnant Patient: A Case Report.","authors":"Akinori Takeda, Junpei Komagamine, Tomohiro Kurihara","doi":"10.1016/j.acepjo.2026.100457","DOIUrl":"10.1016/j.acepjo.2026.100457","url":null,"abstract":"<p><p>Traumatic uterine rupture is a rare and easily overlooked condition. Most cases of traumatic uterine rupture have been reported to occur in pregnancy. Here, we reported the case of a 14-year-old nonpregnant girl who presented to the emergency department with hemorrhagic shock due to multiple traumatic injuries after falling from a height during a suicide attempt. Initial resuscitation stabilized the patient's vital signs. A whole-body computed tomography (CT) scan revealed bilateral pneumothorax, multiple rib fractures, a grade III renal injury, a liver injury, and an unstable pelvic fracture. Although a poorly enhancing area was identified in the anterior wall of the uterine body on the initial CT scan, uterine rupture was not included in the active differential diagnosis at that time, as clinical priorities were directed toward other life-threatening injuries. Persistent unexplained hemoperitoneum led to a repeat CT scan performed on hospital day 4 and prompted magnetic resonance imaging on hospital day 7, which confirmed complete full-thickness rupture of the anterior uterine wall. Laparoscopic uterine repair was performed on hospital day 14. This case highlighted the importance of not dismissing uterine CT scan findings as incidental in female patients with unstable pelvic fractures, even when pregnancy has been excluded, and of considering pelvic magnetic resonance imaging scans when hemoperitoneum persists without a fully identified source. We also discussed the cognitive processes-including anchoring bias, confirmation bias, and task fixation (search satisficing)-that contributed to the delayed recognition of this diagnosis.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100457"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426645","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":"\"Wait, What Is That in There?\" An Unexpected Airway Finding During Intubation.","authors":"Seth Lotterman, Natalie Fordjour, Irbert Vega","doi":"10.1016/j.acepjo.2026.100460","DOIUrl":"10.1016/j.acepjo.2026.100460","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100460"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426378","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":"Preparing Emergency Medical Services for Prehospital Buprenorphine: Examining a Train-the-Trainer Approach to Strengthening the Overdose Chain of Survival.","authors":"Maria E Paschke, Saad T Siddiqui, Joshua Wilson, Gerard Carroll, Melissa Kroll, Bradley Ray, Rachel P Winograd","doi":"10.1016/j.acepjo.2026.100452","DOIUrl":"10.1016/j.acepjo.2026.100452","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid-related overdoses remain the leading cause of accidental death in the US. Many jurisdictions are exploring emergency medical services (EMS)-initiated prehospital buprenorphine induction at overdose scenes to reduce subsequent risk. This study evaluated a training strategy preparing EMS agencies to implement these protocols by examining barriers and facilitators affecting their readiness to integrate buprenorphine into standard care.</p><p><strong>Methods: </strong>Leadership from 6 Missouri EMS agencies participated in a 6-month training program to support prehospital buprenorphine implementation. We described this evidence-informed frame-and-foster training approach and present findings from a readiness checklist and interviews with 8 trainees. Analysis followed a deductive, exploration, preparation, implementation, sustainment (EPIS)-guided framework approach to assess trainees' perceptions of the training and inner and outer barriers and facilitators to agency-wide implementation.</p><p><strong>Results: </strong>All agencies reported readiness, with (1) frontline staff training and (2) partnering with peer-linkage programs as areas for further preparation. Training increased confidence and clarified workflows. Remaining inner barriers within EMS agencies included stigma among paramedics toward people who use drugs, staff resistance, and burnout, while facilitators included clear protocols and integration into community paramedicine programs. Outer barriers included inconsistent community buprenorphine availability, while facilitators included continued training and state support.</p><p><strong>Conclusions: </strong>This evaluation provides early insights into how a structured training strategy can prepare EMS agencies to implement prehospital buprenorphine. Findings can inform future policy and practice to ensure EMS can effectively incorporate buprenorphine induction into overdose response and improve patient outcomes.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100452"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426673","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":"Don't Skip the Color: Emergency Department Neonatal Point-of-Care Ultrasound Diagnosis.","authors":"Joseph B Walsh, Tasha Desai","doi":"10.1016/j.acepjo.2026.100461","DOIUrl":"10.1016/j.acepjo.2026.100461","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100461"},"PeriodicalIF":1.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439208","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":"Detecting Adverse Events Following Acute Care Encounters among Veterans Prescribed Non-Steroidal Anti-Inflammatory Drugs.","authors":"Amber J Hackstadt, Amy M Perkins, Jesse O Wrenn, Thomas J Reese, Melissa D Rubenstein, Robert Winter, Chad A Dorn, Matthew R Martino, Jin H Han, Michael J Ward, Michael E Matheny","doi":"10.1016/j.acepjo.2026.100450","DOIUrl":"10.1016/j.acepjo.2026.100450","url":null,"abstract":"<p><strong>Objectives: </strong>To model the occurrence of adverse events (AEs) among Veterans prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) during emergency department and urgent care encounters within the Veterans Health Administration (VHA) care setting. NSAIDs can increase the risk for gastrointestinal, renal, and cardiovascular AEs, particularly in older adults, patients with chronic kidney disease (CKD), or patients with polypharmacy.</p><p><strong>Methods: </strong>We applied eXtreme Gradient Boosting (XGBoost) modeling and least absolute shrinkage and selection operator (LASSO) methods along with logistic regression to model the occurrence of AEs in a cohort of Veterans prescribed NSAIDs seen between January 1, 2017, and December 31, 2023. The outcome was defined as a composite of acute coronary syndrome, acute kidney injury, allergic reactions, gastrointestinal bleeding, or gastroesophageal reflux disease (GERD) within 2 to 30 days following the encounter. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) values and calibration plots. Observed-to-expected (OE) ratios for AEs were calculated.</p><p><strong>Results: </strong>We identified 1,112,819 acute care encounters for 736,677 unique patients and a total of 50,278 (4.5%) AEs. The XGBoost and LASSO regression models performed well across time, with AUC values ranging from 0.77 to 0.79. GERD and a diagnosis of CKD stage 4 or 5/dialysis were identified as having a harmful association with AEs. The OE ratios varied by VHA care site.</p><p><strong>Conclusions: </strong>The risk adjustment models had good discrimination performance across time and allowed us to identify significant risk-adjusted site variation. The models may be useful in clinical decision support and population health interventions with NSAIDs.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100450"},"PeriodicalIF":1.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439231","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":"An Older Adult With Abdominal Fullness.","authors":"Cheng-Yu Lai, Yu-Chin An","doi":"10.1016/j.acepjo.2026.100454","DOIUrl":"10.1016/j.acepjo.2026.100454","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100454"},"PeriodicalIF":1.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439285","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":"Documented Nicotine, Cannabis, and Co-Use Are Associated With More Intensive Emergency Department Care for Adolescent Asthma Exacerbations.","authors":"Hayes Stancliff, Anxhelo Mara, Sreyansh Rishabh, Stephen Sandelich","doi":"10.1016/j.acepjo.2026.100453","DOIUrl":"10.1016/j.acepjo.2026.100453","url":null,"abstract":"<p><strong>Objectives: </strong>Asthma exacerbations pose substantial risk to adolescents. We evaluated whether documented nicotine use, cannabis use, or concurrent use is associated with increased emergency department (ED) management intensity and adverse short-term outcomes during asthma exacerbations.</p><p><strong>Methods: </strong>Using the TriNetX database, we identified adolescents aged 11 to 21 years presenting to the ED with an acute asthma exacerbation from January 1, 2015, to January 1, 2025. Patients were categorized into nicotine-only, cannabis-only, or concurrent nicotine-cannabis cohorts based on documented International Classification of Diseases, 10th Revision (ICD-10) codes and matched to controls without such diagnoses. Outcomes were reported as risk ratios (RRs) with 95% CIs during 0 to 1-day and 1- to 30-day intervals.</p><p><strong>Results: </strong>After matching, cohorts included 4604 nicotine-only, 2679 cannabis-only, and 1045 co-use patients. During their ED encounter, co-use patients demonstrated the strongest associations with acute respiratory failure (RR, 4.63; 95% CI, 2.71-7.89), hospital admission (RR, 2.47; 95% CI, 1.80-3.38), and critical care services (RR, 1.92; 95% CI, 1.19-3.09). Nicotine-only and cannabis-only cohorts also showed increased pharmacologic escalation and diagnostic testing. Between 1 and 30 days, co-use patients had higher rates of repeat exacerbation (RR, 1.72; 95% CI, 1.36-2.17), ED revisits (RR, 1.54; 95% CI, 1.29-1.85), pneumonia (RR, 2.20; 95% CI, 1.05-4.62), and critical care use (RR, 2.07; 95% CI, 1.10-3.90); nicotine-only and cannabis-only cohorts additionally demonstrated this association to a lesser degree.</p><p><strong>Conclusion: </strong>Adolescents with documented nicotine or cannabis use, especially concurrent use, experience more intensive ED management and worse short-term outcomes during asthma exacerbations, supporting consideration of targeted acute care pathways.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100453"},"PeriodicalIF":1.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392667","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":"Counting the Cost: Examining Out-of-Pocket Spending on Emergency Care in Newfoundland and Labrador, Canada.","authors":"Noah Williams, Aswathy Geetha Manukumar, Hensley H Mariathas, Hai Van Nguyen, Christopher Patey, Shabnam Asghari","doi":"10.1016/j.acepjo.2026.100451","DOIUrl":"10.1016/j.acepjo.2026.100451","url":null,"abstract":"<p><strong>Objectives: </strong>To examine patient-reported non-disease-specific out-of-pocket costs (OOPCs) among emergency department (ED) visitors in a publicly funded health care system, including factors associated with OOPC and to explore patient experiences related to these costs.</p><p><strong>Methods: </strong>This convergent parallel mixed-method study used data collected through telephone surveys and semistructured interviews from March 1, 2021, to July 27, 2023. All patients who visited the 4 EDs (2 rural and 2 urban EDs) in Newfoundland and Labrador, Canada, were randomly selected to participate based on when they visited the ED (date and time). OOPC was defined as the total amount patients incurred from food, transportation, missed work hours, and other related expenses. Quantitative analyses included multivariable binomial and multinomial regression models adjusting for age, gender, ED location, and patient self-reported length of stay (LOS). Sensitivity analyses using multiple imputation assessed the impact of missing data. Qualitative data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Among the final sample of 818 patients, 24% (199/818) reported OOPC for an ED visit. An ED length of stay of 4+ hours was associated with higher odds of incurring OOPC (adjusted odds ratio [aOR], 2.26; 95% CI, 1.29-4.15) and OOPC of ≥$200 Canadian dollars (CAD; aOR, 3.68; 95% CI, 1.21-11.19). Patients who visited urban EDs were more likely to report OOPC of ≥$200 CAD (aOR, 2.55; 95% CI, 1.09-5.99). Qualitative analysis showed 4 OOPC themes: (1) ED visits are expensive; (2) missing work hours; (3) being forced to choose between care and necessities; and (4) ongoing costs of care.</p><p><strong>Conclusion: </strong>These findings demonstrate that OOPC persist even within a publicly funded health system and underscore the importance of improving ED efficiency to reduce the financial burden on individuals seeking care.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100451"},"PeriodicalIF":1.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392702","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":"Caught in a Web of Necrosis.","authors":"William Wanzor, Aakriti Bhargava","doi":"10.1016/j.acepjo.2026.100432","DOIUrl":"10.1016/j.acepjo.2026.100432","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100432"},"PeriodicalIF":1.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392715","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}