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

{"title":"First Responders Have Lower COVID-19 Vaccination Rates Than Other Healthcare Providers.","authors":"Mirela Anghelina, Valerie Sircelj, Jennifer A Frey, John Rider, Daniel J Bachmann, Soledad Fernandez, Ashish R Panchal","doi":"10.1016/j.acepjo.2026.100416","DOIUrl":"10.1016/j.acepjo.2026.100416","url":null,"abstract":"<p><strong>Objectives: </strong>COVID-19 vaccination status varies widely among first responders. We sought to understand whether similar vaccination rates exist for first responders and healthcare providers (nurses/physicians) and if this rate changed over time.</p><p><strong>Methods: </strong>This is a secondary analysis of a prospective longitudinal study of first responders and healthcare providers recruited starting in January 2021 and followed until April 2024. Following enrollment, participants completed surveys concerning personal demographics (age, sex, race, professional role [first responder, healthcare worker], use of personal protective equipment (PPE), and number of household members under age 18), and medical history (COVID-19 vaccination status, previous COVID-19 infection, and history of comorbidities). Participant vaccination status was confirmed at least every 6 months. Descriptive statistics were calculated, followed by logistic regression models (OR, 95% CI) to describe the associations between vaccination, demographics, and work characteristics. The cumulative incidence was visually described using a Kaplan-Meier plot.</p><p><strong>Results: </strong>Across 190 study participants, 61.1% were first responders, and 38.9% were healthcare providers. First responders were older, predominantly male, and reported more prior exposure to COVID-19. Although the odds of vaccination varied greatly within healthcare providers (OR 8.26, 95% CI 2.42-28.18), their odds of vaccination were higher than those of first responders (referent). Kaplan-Meier plots demonstrated that vaccination rates for both groups plateaued after 1 year.</p><p><strong>Conclusions: </strong>This study noted differential rates of vaccination between first responders and healthcare professionals and that these rates plateaued, demonstrating fixed perspectives on vaccination. Focused efforts to understand diverse perspectives on vaccination concerns may enhance the protection and maintenance of these workforces.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100416"},"PeriodicalIF":1.8,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201402","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":"Painless Buccal Abscess With Intraoral Fistula in an Older Woman.","authors":"Kyoko Yamamoto, Yoshihiro Aoki, Hiromasa Harada, Kensuke Takahashi, Shuhei Yamano, Koichi Hayakawa, Osamu Tasaki","doi":"10.1016/j.acepjo.2026.100420","DOIUrl":"10.1016/j.acepjo.2026.100420","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100420"},"PeriodicalIF":1.8,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159164","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 Man With Acute Painless Visual Loss.","authors":"Chavin Triganjananun, Apichaya Monsomboon, Tanyaporn Nakornchai","doi":"10.1016/j.acepjo.2026.100422","DOIUrl":"10.1016/j.acepjo.2026.100422","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100422"},"PeriodicalIF":1.8,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159035","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":"Development of a Predictive Model for Identifying High-Risk Older Adults for Geriatric Emergency Department Screening.","authors":"Karen A Hauser, Jeremy Swartzberg, David Schlessinger, Nasrin Samady, Karin Dove, Michelle Donnelly, Cristina D Perkins, Dana Sax, Marlena Tang, Vincent X Liu","doi":"10.1016/j.acepjo.2026.100414","DOIUrl":"10.1016/j.acepjo.2026.100414","url":null,"abstract":"<p><strong>Objective: </strong>Geriatric emergency department (GED) programs face challenges in risk-stratifying older adults. Existing tools, like the identification of seniors at risk (ISAR) score model, have modest predictive accuracy and are difficult to implement sustainably. We undertook a quality improvement initiative to develop, evaluate, and validate a screening score (SS) within a large, integrated health care system. This score, which can be deployed and automated at emergency department (ED) triage, identifies older adults at risk of subsequent ED or hospital use and short-term mortality.</p><p><strong>Methods: </strong>The GED-SS score model was developed from a multicenter cohort of ED patients aged ≥70 years with an Emergency Severity Index > 1 from January 1, 2018, until December 31, 2019. The composite outcome was ≥3 days of acute care (ED, observation, or inpatient) or death within 90 days. The GED-SS score model was prospectively validated in 1313 ED patients and then compared with the nurse-performed ISAR score screenings.</p><p><strong>Results: </strong>The GED-SS score model showed better discrimination with an area under the curve (AUC) value of 0.73 vs 0.66 for the ISAR score model identification. At a 43% sensitivity threshold (based on an ISAR score model cutoff value of ≥ 3), the GED-SS score model had higher specificity (86% vs 78%) and positive predictive value (59% vs 47%), while also flagging fewer patients (23.3% vs 29.1%).</p><p><strong>Conclusion: </strong>We developed and validated a GED-SS score model to identify older adult ED patients at increased risk of short-term mortality and acute care utilization. The model, which uses structured data facilitating automatic calculation, was prospectively validated and performed comparably to or better than the ISAR score model.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100414"},"PeriodicalIF":1.8,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140125","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":"Long-Term Outcomes of Trauma Patients After Treatment With Prehospital Tranexamic Acid: A Subgroup Analysis From the PATCH-Trauma Trial.","authors":"Biswadev Mitra, Sara MacKenzie, Elyssia M Bourke, Rumer Aldous, Abby Grant, Stephen Bernard, Dashiell Gantner, David J Read, Michael C Reade, Tony Trapani, Paul S Myles, Peter A Cameron, Russell L Gruen","doi":"10.1016/j.acepjo.2026.100417","DOIUrl":"10.1016/j.acepjo.2026.100417","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to assess 24-month functional outcomes of patients randomly assigned to prehospital tranexamic acid (TXA) compared with those assigned to placebo.</p><p><strong>Methods: </strong>The PATCH-Trauma trial assessed administration of TXA by prehospital clinicians and demonstrated greater survival at 28 days from injury among patients allocated to receive TXA, but no difference in favorable functional outcomes at 6 months.This was a subgroup analysis of patients enrolled in the PATCH-Trauma trial. The primary outcome measure was the 8-point Glasgow Outcome Scale-Extended (GOS-E) at 24 months after injury, dichotomized to favorable functional outcomes (GOS-E 5-8) and dead or unfavorable functional outcomes (GOS-E 1-4). We also assessed mortality at 24 hours, 28 days, 6 months, and 24 months after injury.</p><p><strong>Results: </strong>There were 584 patients eligible for inclusion, and 516 patients had data on 24-month outcomes available. Baseline characteristics were comparable. At 24 months, a favorable outcome was reported in 167 (64.0%; 95% CI: 57.8-69.8) patients in the TXA group and 149 (58.4%; 95% CI: 52.1-64.5) in the placebo group (<i>P</i> = .20). There was no difference in the change in GOS-E profile from 6 to 24 months (coeff -0.06; 95% CI: -0.30 to 0.19; <i>P</i> = .64). There was no difference in mortality at any timepoint.</p><p><strong>Conclusion: </strong>Prehospital treatment and ongoing hospital infusion of TXA did not result in improved survival or statistically significant functional outcomes at 24 months compared to placebo. Consideration of longer-term outcomes after trauma is recommended for evidence to practice decisions.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100417"},"PeriodicalIF":1.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038563","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 Preschool-Aged Child in Tenwek, Kenya, With Limb Pain.","authors":"Victor M Karomo, Eric K Langat, Samuel Burleson, Luke Bishop, Ariane Kubena","doi":"10.1016/j.acepjo.2026.100361","DOIUrl":"10.1016/j.acepjo.2026.100361","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100361"},"PeriodicalIF":1.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038530","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":"Impact of the First Basic Emergency Care Training Course in Ethiopia.","authors":"Tirsit Makonnen, Alegnta Gebreyesus, Bethlehem Workeye, Chelsea McCullough, Gellila Mengistu, Menbeu Sultan, Ahlam Awad Mohammed, Fatuma Ebrahim, Nejat Ibrahim, Shama Patel, Tsion Firew","doi":"10.1016/j.acepjo.2026.100401","DOIUrl":"10.1016/j.acepjo.2026.100401","url":null,"abstract":"<p><strong>Objectives: </strong>In Ethiopia, there is a significant unmet need for basic emergency care. The World Health Organization (WHO), in collaboration with the International Committee of the Red Cross (ICRC), developed the Basic Emergency Care (BEC) course to assist in essential acute, time-sensitive health training for frontline providers in resource-constrained settings. Recognizing the urgency of this issue, the Federal Ministry of Health (FMOH) of Ethiopia prioritized the implementation of the BEC course. The objective of this study is to evaluate the first implementation of the BEC training in Ethiopia.</p><p><strong>Methods: </strong>A quasiexperimental study was conducted to assess whether Ethiopia's BEC training implementation would lead to improved baseline knowledge as a foundational step toward enhancing emergency services delivery. The study followed 2 cohorts of participants who completed the WHO's 5-day BEC Training of Trainers (ToT) course. Owing to resource constraints requiring the training of multiple participants in a short period, a cascading peer-teaching model was used. Expert instructors first administered the BEC ToT course to cohort A, who then subsequently trained cohort B. To evaluate changes in knowledge, pretest and posttest assessments were used. The pretest assessment was administered to both cohorts on the first day of the course, prior to the start of the training. The posttest assessment was administered to both cohorts on the last day of the course, after the completion of the training. The assessment, which was standardized into the course by WHO, covered topics such as identifying emergencies, skills application, and qualitative feedback.</p><p><strong>Results: </strong>A total of 111 participants completed both pretraining and posttraining assessments. In cohort A, the average pretest score was 89%, and the average posttest score was 92%. The pass rate decreased from 96% to 91%. In cohort B, the average pretest score was 58%, and the average posttest score was 80%. The pass rate increased from 37% to 80%, demonstrating an increase of 43%. Strategic recommendations for future training include adapting course materials to better align with country-specific needs and allocating more time and resources for practical skills training.</p><p><strong>Conclusion: </strong>The BEC training was successfully introduced in Ethiopia in an efficient and structured manner. With specific modifications, future BEC training sessions should continue to maintain and strengthen foundational emergency care training in Ethiopia.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100401"},"PeriodicalIF":1.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044922","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 Child With Abnormal Ocular Ultrasound After Out-of-Hospital Cardiac Arrest.","authors":"Vladimir L Cousin, Emmanuel Barreau, Ramy Charbel","doi":"10.1016/j.acepjo.2026.100419","DOIUrl":"10.1016/j.acepjo.2026.100419","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100419"},"PeriodicalIF":1.8,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044929","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":"Novel Technologies for Identifying Treatment Assignment in a Prehospital Pediatric Emergency Care Clinical Trial.","authors":"Travis P Sharkey-Toppen, Jay Mendpara, Kim Moeller, Jennifer A Frey, John M VanBuren, Marianne Gausche-Hill, Manish I Shah, Nichole Bosson, Matthew Hansen, Barbara Wendelberger, Henry E Wang","doi":"10.1016/j.acepjo.2026.100399","DOIUrl":"10.1016/j.acepjo.2026.100399","url":null,"abstract":"<p><p>Clinical trials are essential for generating evidence-based knowledge to support clinical practice. In the prehospital setting, particular challenges exist in clinical trial design that have a large impact on the quality of the results, including the appropriate and systematic allocation of assigned treatment arm. The Pediatric Prehospital Airway Resuscitation Trial is a multicenter clinical trial evaluating different paramedic airway management strategies on critically ill and injured children in the prehospital setting. The trial assigns airway management strategy using odd-even day pseudo-randomization, which pragmatically balances the rigor of a statistical design that minimizes bias with the complexities of operationalizing a clinical trial in the prehospital setting. We describe the development of 2 technologies to aid in treatment assignment adherence during the trial: (1) a quick response code-linked web application, and (2) a self-contained portable reminder device. These technologies offer novel approaches to support treatment allocation in acute care clinical trials.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100399"},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870445","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 Use of Lights and Sirens in Stroke Is Associated With Faster Door-to-CT Times but Not Door-to-Thrombolysis or Door-to-Endovascular Therapy Times.","authors":"Courtney D Wham, Daria Nicke, Ian S Espinoza, Logan Murphy, Geoffrey Sowitz, Stefan Sillau, Andra M Farcas, Michelle Leppert, Elizabeth Molina Kuna, Layne Dylla","doi":"10.1016/j.acepjo.2026.100415","DOIUrl":"10.1016/j.acepjo.2026.100415","url":null,"abstract":"<p><strong>Objectives: </strong>Lights and sirens (L&S) during Emergency Medical Services (EMS) transport may shorten transport times and improve outcomes in acute stroke but carry significant roadway risk. This study assesses L&S and in-hospital stroke care, including door-to-CT, door-to-intravenous thrombolysis (IVT), door-to-endovascular thrombectomy (EVT), and discharge disposition.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 2020 to 2022, including adult patients identified by EMS as having suspected stroke and who had a final diagnosis of stroke or transient ischemic attack. Data were collected from the IMPACT network (70 EMS agencies, 30 hospitals, 2 states). Multivariable regression modeled the association between L&S and door-to-CT, door-to-IVT, and door-to-EVT times, controlling for confounders. Logistic regression modeled the association between L&S and discharge disposition, adjusting for confounders and in-hospital intervention.</p><p><strong>Results: </strong>Of 3,161 patients, 75.4% (n = 2384) were transported with L&S. Transport time with L&S was shorter than without (geometric mean 8.9 minutes [95% CI 8.7-9.1] vs 11.6 minutes [95% CI 11.0-12.1], <i>p</i> < .001). L&S were associated with shorter door-to-CT (ratio estimate, 0.51; 95% CI, 0.46-0.56), but not with door-to-IVT (ratio estimate, 0.94; 95% CI, 0.82-1.08) nor door-to-EVT (ratio estimate, 1.03; 95% CI, 0.76-1.39). L&S were not associated with improved discharge outcomes.</p><p><strong>Conclusion: </strong>While L&S were associated with faster door-to-CT times, they did not shorten time to IVT or EVT or improve discharge outcomes. These findings suggest that perceived urgency of L&S may prompt quicker imaging, but transport time savings are minimal and may not improve outcomes. Alternative EMS prenotification and hospital activation strategies merit consideration.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 3","pages":"100415"},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935950","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}