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

{"title":"Rapid outpatient evaluation for emergency department patients with intermediate risk chest pain safely reduces admissions","authors":"Quentin Reuter MD,&nbsp;Nicholas Lesh MD,&nbsp;Michelle Reyes DO,&nbsp;David Gothard BS,&nbsp;Michael Pallaci DO,&nbsp;Michael Weinstock MD","doi":"10.1002/emp2.13280","DOIUrl":"https://doi.org/10.1002/emp2.13280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to assess the safety of an outpatient chest pain pathway (OCPP) for patients presenting to the emergency department (ED) with chest pain and a HEART score of 4 or 5.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective, observational, non-inferiority study assessing the impact of the OCPP on the management and outcomes of ED patients with HEART score of 4 or 5. The study compared patients evaluated in the pre-OCPP (January‒May 2018) and the post-OCPP period (January‒October 2022). Data were collected via non-blinded chart review. The primary outcome was the rate of acute myocardial infarction (AMI) and death in patients utilizing the OCPP compared to patients with HEART score 4 or 5 in 2018. Secondary outcomes included admission rates before and after the implementation of this pathway. Non-inferiority of the post-intervention study epoch for the AMI/death composite outcome was assessed via the two one-sided tests (TOST), procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After implementing the OCPP, rates of patients with ED HEART score of 4 or 5 admitted from the ED decreased from 85.1% (605/711) to 74.1% (1239/1671) in 2022. Of the 432 total patients discharged in 2022, 237 (54.6%) patients were referred to emergent cardiology follow-up via the OCPP. The 30-day rate of AMI/death for patients discharged via the OCPP was 0.4% (1/237), as compared to 2.2% (8/368) in 2018. When compared to rates of AMI/death for all patients with HEART score 4 or 5 in 2018, outcomes for OCPP patients were found to be non-inferior.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The OCPP resulted in non-inferior rates of AMI/death in patients with HEART scores of 4 or 5 as compared to usual care.</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":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165747","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 forehead swelling","authors":"Madison C. Williams Chen MD,&nbsp;Sally M. Passons MD,&nbsp;John P. Gullett MD,&nbsp;Maxwell A. Thompson MD,&nbsp;David C. Pigott MD, RDMS,&nbsp;Samuel L. Burleson MD","doi":"10.1002/emp2.13256","DOIUrl":"https://doi.org/10.1002/emp2.13256","url":null,"abstract":"<p>A 60-year-old male presented to the emergency department with the complaint of “sinus infection and facial swelling.” The patient endorsed worsening symptoms for 1 month including nasal congestion, bloody nasal drainage, facial swelling and pain, and new onset diplopia. Physical examination was notable for forehead swelling extending to the periorbital area bilaterally (Figure 1). Point-of-care ultrasound was performed (Figures 2 and 3) and identified a heterogeneous highly vascular soft tissue mass with associated defect of the frontal bone. Computed tomography of the head and maxillofacial structures was obtained (Figure 4), confirming the diagnosis of a large anterior soft tissue mass with destruction of the frontal bone and mass effect on the orbits.</p><p>The patient underwent endoscopic biopsy, demonstrating squamous cell carcinoma originating from the skull base. In patients presenting with forehead swelling, point-of-care ultrasound (POCUS) provides a rapid imaging modality for superficial soft tissue masses.<span>^{1, 2}</span> Given the broad differential for this presentation, POCUS can facilitate the evaluation of skin and soft tissue infections, soft tissue, and bony or vascular pathology. Importantly, the use of Doppler ultrasound can prevent inadvertent incision of occult vascular structures.<span>³</span> POCUS has aided the diagnosis of Pott's puffy tumor, a rare disorder which may present with forehead swelling due to an underlying abscess associated with frontal bone osteomyelitis.<span>⁴</span> In evaluation of forehead masses, ultrasound can expedite further investigation by providing characterization of substance, vascularity, and compressibility.<span>⁵</span> POCUS examination in this patient rapidly facilitated appropriate additional imaging, consultation and diagnosis, and the avoidance of harmful bedside procedures.</p><p>The authors declare conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169827","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":"Unusual foreign body aspiration in a 4-year-old patient","authors":"Florian Merkle MD, BA,&nbsp;Travis D. Olives MD, MPH, MEd,&nbsp;Svatava Merkle MD,&nbsp;Adam Rieves MD, MACM","doi":"10.1002/emp2.13284","DOIUrl":"https://doi.org/10.1002/emp2.13284","url":null,"abstract":"<p>We present a case of a 4-year-old male child presenting with sudden onset of respiratory distress after aspirating a thumbtack. Prompt diagnostic evaluation with x-ray confirmed the presence of a radiodense foreign body at the level of the epiglottis, and the full size of the object was not clear on imaging. Visualization and retrieval of the object using video laryngoscopy resulted in a favorable outcome. This case underscores the unique anatomy of pediatric airways as well as the importance of timely recognition and intervention in cases of foreign body aspiration in pediatric patients to prevent respiratory compromise and ensure optimal clinical outcomes.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165239","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":"Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study","authors":"Jens Wretborn PhD,&nbsp;Samia Munir-Ehrlington MD,&nbsp;Erika Hörlin MSc,&nbsp;Daniel B. Wilhelms PhD","doi":"10.1002/emp2.13244","DOIUrl":"https://doi.org/10.1002/emp2.13244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Frailty, assessed with clinical frailty scale (CFS), alone or in combination with aggregated vital signs, has been proposed as a measure to better predict mortality of older patients in the emergency department (ED), but the added predictive value to conventional triage is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a secondary analysis of a prospective observational study in three EDs in Sweden that evaluated the prognostic performance of the CFS alone or in combination with the national early warning score (NEWS), triage early warning score (TEWS) or the rapid emergency triage and treatment system (RETTS) triage tool using logistic regression. The primary outcome was 30-day mortality with 7- and 90-day mortality and admission as secondary outcomes reported as area under the receiver operating curve (AuROC) scores with 95% confidence intervals (CIs). The sensitivity, specificity, accuracy, predictive values, and likelihood ratios are reported for all models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1832 patients were included with 17 (0.9%), 57 (3.1%), and 121 (6.6%) patients dying within 7, 30, and 90 days, respectively. The admission rate was 43% (795/1832). Frailty (CFS &gt; 4) was significantly associated with 30-day mortality (odds ratio 6, 95% CI 3‒12, <i>p</i> &lt; 0.01). Prognostication of 30-day mortality was similar for all CFS-based models and better compared with models without CFS. The AuROC (95% CI) improved for RETTS from 0.67 (0.61‒0.74) to 0.83 (0.79‒0.88) (<i>p</i> = 0.008), for NEWS from 0.53 (0.45‒0.61) to 0.82 (0.77‒0.87) (<i>p</i> &lt; 0.001), and for TEWS from 0.63 (0.55‒0.71) to 0.82 (0.77‒0.87) (<i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frailty measured with the CFS in combination with RETTS or structured vital sign assessment using NEWS or TEWS was better at prognosticating 30-day mortality compared to RETTS or early warnings score alone. Improved prognostication provides more realistic expectations and allows for informed discussions with patients and initiation of individualized treatment plans early in the ED process.</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":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165259","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 translational study evaluating a ruggedized portable oxygen concentrator versus an oxygen cylinder in simulated polytrauma intubation of swine","authors":"Craig Nowadly MD,&nbsp;Nola Shepard RLATg,&nbsp;Montane Silverman MD,&nbsp;Jason Rall PhD","doi":"10.1002/emp2.13294","DOIUrl":"https://doi.org/10.1002/emp2.13294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Portable oxygen concentrators (POCs) are medical devices that use filters to selectively remove nitrogen from ambient air to produce concentrated, medical-grade oxygen. This is the first study to evaluate a ruggedized POC's performance during simulated polytrauma intubation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-seven swine were intubated and anesthetized with ketamine. At <i>T</i> = 0, animals were extubated, received a chest wall injury, a tibia fracture, and 20% total blood volume controlled hemorrhage was initiated. At <i>T</i> = 10 min, the swine were pre-oxygenated using a bag-valve mask connected to one of three randomized oxygen sources: (1) a ruggedized POC, (2) a M-15 oxygen cylinder, or (3) room air (control). At <i>T</i> = 12 min, animals were re-intubated to simulate polytrauma intubation and connected to the test oxygen source for the remainder of the experiment. Surviving animals entered a 2-h period where partial pressure of oxygen (PaO₂), oxygen saturation (SpO₂), and regional oxygen saturation (rSO₂) were monitored. Groups were compared using analysis of variance (ANOVA), Fisher's exact, log-rank analysis, or mixed-effects model as appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All animals survived except one in the POC group. Mixed-effects models revealed differences between groups with regards to PaO₂ (<i>p</i> &lt; 0.0001) and SpO₂ (<i>p</i> = 0.006). Based on post hoc analysis, oxygen cylinder PaO₂ was superior to both POC and control, but there were no differences between POC and control PaO₂. There were statistically and clinically significant differences in SpO₂ during periods of pre-oxygenation (<i>T</i> = 10‒12 min), intubation (<i>T</i> = 12‒14 min), and immediately after intubation (<i>T</i> = 14‒20 min). The POC battery was consumed in 43 ± 13 min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our swine model, a single, ruggedized POC provided inferior amounts of oxygen supplementation compared to an oxygen cylinder and performed no better than room air.</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":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165260","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":"Age and racial and ethnic disparities in filled buprenorphine prescriptions post-emergency department visit in Nevada","authors":"Olufemi Ajumobi MD, PhD,&nbsp;Sarah Friedman PhD,&nbsp;John Westhoff MD,&nbsp;Michelle Granner PhD,&nbsp;Julie Lucero PhD,&nbsp;Brandon Koch PhD,&nbsp;Karla D. Wagner PhD","doi":"10.1002/emp2.13272","DOIUrl":"https://doi.org/10.1002/emp2.13272","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post-emergency department (post-ED) visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 1.5 years (July 1, 2020–December 31, 2021) of encounter-level Medicaid ED and retail pharmacy claims data obtained from the Nevada Department of Health and Human Services. We studied ED patients with an opioid use disorder (OUD) diagnosis who did not fill a prescription for OUD medications within 6 months before the ED encounter. Using logistic regression, we modeled the associations between the patient's demographic characteristics and the outcome, filling a buprenorphine prescription at a community pharmacy within 14 or 30 days of the ED encounter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2781 ED visits, representing 2094 patients, the median age was 39 years, 54% were male, 18.5% were Black, 11.7% were Hispanic, and 62.3% were White. Only 4% of the ED visits were followed by a filled buprenorphine prescription. Increasing age (14-day window: adjusted odds ratio (aOR) = 0.965, 95% confidence interval [CI]: 0.948–0.983) and being a Black patient (14-day window: aOR: 0.114, 95% CI 0.036–0.361) were both associated with lower odds of filled buprenorphine prescriptions. These results were similar within 30 days of an ED visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Initiation of buprenorphine following an ED visit remains low among Nevadan Medicaid patients and is less likely with increasing age and among Black patients, despite strong evidence supporting its use. Overburdened EDs, lack of attention from managers, and substance use stigma are among possible explanations. When ED clinicians do write buprenorphine prescriptions, peer recovery support could increase the fill rates.</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":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142152236","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 scrotal pain and swelling","authors":"Christopher W. Allen MD,&nbsp;Christina Liao MD,&nbsp;Christy Hill RDMS,&nbsp;Timothy J. Batchelor MD,&nbsp;Nicholas G. Ashenburg MD","doi":"10.1002/emp2.13289","DOIUrl":"10.1002/emp2.13289","url":null,"abstract":"<p>A 45-year-old male with type 2 diabetes presented to the emergency department (ED) with 1 week of testicular swelling. Despite receiving multiple antibiotics for cellulitis at another ED 3 days prior, he experienced increasing pain, swelling, fever, diaphoresis, and perineal desquamation accompanied by serosanguinous discharge. Initial vital signs were stable. Physical examination revealed scrotal swelling and erythema, two draining perianal lesions, and significant tenderness to touch without crepitus. Laboratory findings included leukocytosis, hyponatremia, hyperglycemia, and elevated inflammatory markers. Point-of-care-ultrasound (POCUS) performed in the ED confirmed scrotal edema (Figure 1, Video S1) and a phlegmonous perineal area concerning for abscess formation without subcutaneous emphysema (SE) (Figure 2, Video S2). Computed tomography (CT) imaging corroborated POCUS findings.</p><p>Given failed outpatient antibiotics, markedly elevated inflammatory markers, and POCUS findings, necrotizing soft tissue infection was suspected. The patient received intravenous broad-spectrum antibiotics and underwent surgical debridement.</p><p>Fournier gangrene (FG) is a necrotizing infection of the perineum that can rapidly extend to surrounding structures.<span>^1-3</span> Mortality with treatment ranges from 22% to 40%.<span>^2-5</span> Risk factors include obesity, alcoholism, diabetes, male gender, and so on.<span>¹</span> SE is regarded as a classic imaging finding. Yet in one systematic review of diagnostic POCUS in necrotizing fasciitis, SE was the least sensitive (6.3%) compared to fluid accumulation (85.4%), thickened fascia (66.7%), and cobblestoning (16.7%).<span>⁶</span> In this case, POCUS, in conjunction with clinical and laboratory findings, was a valuable component in diagnosis of FG, identifying a soft tissue region indicative of evolving infection requiring surgical intervention.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141943","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":"Use of artificial intelligence to support prehospital traumatic injury care: A scoping review","authors":"Jake Toy DO, MS,&nbsp;Jonathan Warren MD,&nbsp;Kelsey Wilhelm MD,&nbsp;Brant Putnam MD,&nbsp;Denise Whitfield MD,&nbsp;Marianne Gausche-Hill MD,&nbsp;Nichole Bosson MD, MPH,&nbsp;Ross Donaldson MD,&nbsp;Shira Schlesinger MD,&nbsp;Tabitha Cheng MD,&nbsp;Craig Goolsby MD, MEd","doi":"10.1002/emp2.13251","DOIUrl":"10.1002/emp2.13251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial intelligence (AI) has transformative potential to support prehospital clinicians, emergency physicians, and trauma surgeons in acute traumatic injury care. This scoping review examines the literature evaluating AI models using prehospital features to support early traumatic injury care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic search in August 2023 of PubMed, Embase, and Web of Science. Two independent reviewers screened titles/abstracts, with a third reviewer for adjudication, followed by a full-text analysis. We included original research and conference presentations evaluating AI models—machine learning (ML), deep learning (DL), and natural language processing (NLP)—that used prehospital features or features available immediately upon emergency department arrival. Review articles were excluded. The same investigators extracted data and systematically categorized outcomes to ensure consistency and transparency. We calculated kappa for interrater reliability and descriptive statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1050 unique publications, with 49 meeting inclusion criteria after title and abstract review (kappa 0.58) and full-text review. Publications increased annually from 2 in 2007 to 10 in 2022. Geographic analysis revealed a 61% focus on data from the United States. Studies were predominantly retrospective (88%), used local (45%) or national level (41%) data, focused on adults only (59%) or did not specify adults or pediatrics (27%), and 57% encompassed both blunt and penetrating injury mechanisms. The majority used machine learning (88%) alone or in conjunction with DL or NLP, and the top three algorithms used were support vector machine, logistic regression, and random forest. The most common study objectives were to predict the need for critical care and life-saving interventions (29%), assist in triage (22%), and predict survival (20%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A small but growing body of literature described AI models based on prehospital features that may support decisions made by dispatchers, Emergency Medical Services clinicians, and trauma teams in early traumatic injury care.</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":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134648","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":"Association of emergency department characteristics with presence of recommended pediatric-specific behavioral health policies","authors":"Ashley A. Foster MD,&nbsp;Jennifer A. Hoffmann MD, MS,&nbsp;Rachel Crady MS,&nbsp;Hilary A. Hewes MD,&nbsp;Joyce Li MD, MPH,&nbsp;Lawrence J. Cook PhD,&nbsp;Susan Duffy MD, MPH,&nbsp;Mark Johnson MPA,&nbsp;Merritt Schreiber PhD,&nbsp;Mohsen Saidinejad MD, MBA","doi":"10.1002/emp2.13266","DOIUrl":"10.1002/emp2.13266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.</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":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121273","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":"COVID-19 and coworker conflict among emergency medical service clinicians","authors":"Gennaro Di Tosto PhD,&nbsp;Halia Melnyk,&nbsp;Jonathan R. Powell MPA, NRP,&nbsp;Eben Kenah ScD,&nbsp;Christopher B. Gage MHS, NRP,&nbsp;Ashish R. Panchal MD, PhD,&nbsp;Ann Scheck McAlearney ScD, MS","doi":"10.1002/emp2.13282","DOIUrl":"10.1002/emp2.13282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Safety policies enacted in response to the emergence of coronavirus disease 2019 (COVID-19) have greatly affected the working environments of emergency medical service (EMS) clinicians. Our objective was to evaluate whether changes in the EMS environment during the COVID-19 pandemic were associated with increased workplace conflict.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This evaluation was a cross-sectional analysis of a random sample of 19,497 national certified EMS clinicians who were selected to receive an electronic survey in April 2022. The survey included an assessment of their level of stress using the Perceived Stress Scale instrument and examined changes in their working environment they perceived had occurred due to the emergence of COVID-19. Logistic regression modeling was used to evaluate the associations between workforce demographics, infrastructure, scheduling, and policies to and COVID-19-induced coworker conflict.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1686 responses were evaluated (response rate 10%). We found that COVID-19 was reported to have exacerbated conflict between coworkers in 51% of responses. Respondents who perceived an increase in coworker conflict due to COVID-19 self-reported higher levels of stress than the rest of the respondents. Perceptions of the impact of COVID-19 on conflict had also an association with the level of certification, indicating that national registered paramedics were more likely than emergency medical technicians to report coworker conflict due to COVID-19 (adjusted odds ratio [AOR] 1.30, 95% confidence interval [CI] 1.05–1.61). Multivariable analysis highlighted the impact of mandatory overtime policies, reported by 27% of the respondents and associated with higher odds of exacerbated coworker conflict in our model (AOR 2.05, 95% CI 1.62–2.60).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings indicate that conflict can be considered a potential indicator of high levels of stress in the EMS workforce and may be a reliable signal to monitor when implementing mandates that affect EMS clinicians and their workloads.</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":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121274","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}