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

{"title":"Invited Editorial: Waiting Room Care is Not the Solution to Emergency Department Boarding.","authors":"Andrew J Bouland, Juan A March","doi":"10.1016/j.acepjo.2025.100161","DOIUrl":"10.1016/j.acepjo.2025.100161","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 3","pages":"100161"},"PeriodicalIF":1.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210347","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 Impact of an Educational Intervention to Improve Emergency Medicine Resident Treatment of Individuals With Opioid Use Disorder.","authors":"Corey S Hazekamp, Bernard P Chang, Anthony D Scoccimarro, Jason R West, Dana L Sacco","doi":"10.1016/j.acepjo.2025.100157","DOIUrl":"10.1016/j.acepjo.2025.100157","url":null,"abstract":"<p><strong>Objectives: </strong>Introducing evidence-based treatment strategies into education for emergency medicine (EM) residents might improve treatment for people with opioid use disorder (OUD). Our objective was to evaluate the impact of an educational initiative in treating OUD with emergency department (ED)-initiated buprenorphine.</p><p><strong>Methods: </strong>This was a retrospective analysis of an educational initiative using case-based discussions to train EM residents in the treatment of OUD, including ED-initiated buprenorphine, at a single EM residency program. Patients at the corresponding ED who were given an OUD-related diagnosis were screened for the initiation of buprenorphine. We calculated the odds of receiving ED-initiated buprenorphine among eligible patients 6 months before and 6 months after the educational initiative. Patients currently treated with buprenorphine or methadone were excluded from the analysis.</p><p><strong>Results: </strong>Before the educational initiative, 14% (26/186) of patients with OUD eligible for buprenorphine underwent a novel buprenorphine induction in the ED, which increased to 18% (33/183) after the educational initiative. Following the educational initiative, the odds of receiving ED-initiated buprenorphine compared with the pre-educational initiative was 1.35 (95% CI, 0.77-2.24).</p><p><strong>Conclusion: </strong>The total number of people with OUD treated with buprenorphine increased after our educational initiative, but the odds ratio was not statistically significant. Complementing educational initiatives, other factors are likely needed to significantly increase the likelihood that a person with OUD is treated with buprenorphine.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 3","pages":"100157"},"PeriodicalIF":1.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210349","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":"Four-Factor Prothrombin Complex Concentrate vs Plasma in Patients on Vitamin K Antagonists With Gastrointestinal Bleeding or Needing a Gastrointestinal Procedure: A Retrospective Analysis of 2 Randomized Controlled Trials.","authors":"Majed A Refaai, Joshua N Goldstein","doi":"10.1016/j.acepjo.2025.100142","DOIUrl":"10.1016/j.acepjo.2025.100142","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the efficacy of 4-factor prothrombin complex concentrate (4F-PCC) compared with plasma in vitamin K antagonist (VKA)-treated patients with gastrointestinal (GI) bleeding or requiring a GI surgical/invasive procedure.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on a subset of data from 2 prospective phase 3b randomized controlled trials of 4F-PCC or plasma for VKA reversal. Data from patients receiving VKA who experienced acute major GI bleeding or needed a GI surgical/invasive procedure within 24 hours were included in the analysis. Hemostatic efficacy, international normalized ratio (INR), and vitamin K-dependent coagulation factor (VKDF) restoration were analyzed.</p><p><strong>Results: </strong>In total, 171 patients were included in the analysis. Overall, hemostatic efficacy was rated excellent and good in 68 of 83 (81.9%) and 66 of 88 (75.0%) patients in the 4F-PCC and plasma treatment groups, respectively (odds ratio [OR], 1.52; 95% CI, 0.72-3.20). At 0.5 hours after infusion, 68.2% of patients treated with 4F-PCC achieved an INR of ≤1.3 compared with 0.0% of patients treated with plasma (68% difference; 95% CI, 57-79). Time to INR restoration from the start of infusion was significantly shorter for 4F-PCC than plasma (45 vs 1326 minutes, respectively; OR, 0.10; 95% CI, 0.07-0.14). All VKDF levels were significantly higher in the 4F-PCC group vs the plasma group within 3 hours from the start of infusion (all <i>P</i> < .002). Additional blood product use in the acute major bleeding study was comparable between both groups.</p><p><strong>Conclusion: </strong>4F-PCC was associated with a nearly immediate decrease in INR and rapid VKDF restoration compared with plasma in patients experiencing acute major GI bleeding or in need of GI surgery/invasive procedure. Yet, hemostatic efficacy was similar between the 2 groups, and therefore, larger studies might be needed to better understand patient outcomes.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 3","pages":"100142"},"PeriodicalIF":1.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310923","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":"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":"Artificial Intelligence in Emergency Medicine: A Primer for the Nonexpert.","authors":"Moira E Smith, C Christopher Zalesky, Sangil Lee, Michael Gottlieb, Srikar Adhikari, Mat Goebel, Martin Wegman, Nidhi Garg, Samuel H F Lam","doi":"10.1016/j.acepjo.2025.100051","DOIUrl":"10.1016/j.acepjo.2025.100051","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly being utilized to augment the practice of emergency medicine due to rapid technological advances and breakthroughs. AI applications have been used to enhance triage systems, predict disease-specific risk, estimate staffing needs, forecast patient decompensation, and interpret imaging findings in the emergency department setting. This article aims to help readers without formal training become informed end-users of AI in emergency medicine. The authors will briefly discuss the principles and key terminology of AI, the reasons for its rising popularity, its potential applications in the emergency department setting, and its limitations. Additionally, resources for further self-studying will also be provided.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"6 2","pages":"100051"},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544938","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}