Annals of emergency medicine最新文献

Trends in Care and Outcomes Among Emergency Department Patients With Chest Pain Without Myocardial Infarction. 急诊科无心肌梗死胸痛患者的护理趋势和结局

IF 6.5 1区医学

Annals of emergency medicine Pub Date : 2026-11-06 DOI: 10.1016/j.annemergmed.2026.08.743

Shih-Chuan Chou, J Frank Wharam, Renee Y Hsia

{"title":"Trends in Care and Outcomes Among Emergency Department Patients With Chest Pain Without Myocardial Infarction.","authors":"Shih-Chuan Chou, J Frank Wharam, Renee Y Hsia","doi":"10.1016/j.annemergmed.2026.08.743","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.743","url":null,"abstract":"Study objective: To characterize trends in hospitalization, downstream care, and outcomes among emergency department (ED) patients with chest pain without acute myocardial infarction (AMI) diagnosis.Methods: We analyzed claims data from a large national commercial insurer (2007-2021) and identified ED visits with a principal diagnosis of chest pain. We excluded visits with secondary diagnoses of AMI or other significant cardiopulmonary conditions and those preceded by cardiac testing, coronary procedures, AMI admissions, or chest pain ED visits within 6 months. Usage outcomes included index hospitalization (principal), 7-day cardiac testing, and 30-day coronary revascularization. The principal clinical outcome was 180-day postindex AMI hospitalization. Adjusted annual rates were estimated using generalized estimating equations, and trends were assessed using inverse-variance-weighted linear regression.Results: We included 773,250 index chest pain ED visits (mean age 54.2 years; 54.3% women). Adjusted hospitalization rates declined from 42.7% to 18.6%, and 7-day noninvasive testing decreased from 26.7% to 9.1%. Revascularization within 30 days declined from 5.8% to 3.6%. Overall, 180-day postindex AMI hospitalization showed no significant temporal trend, ranging from 0.8% to 1.2%. However, a modest increasing trend was observed among patients aged 70 years and older.Conclusion: Among ED patients with chest pain without AMI diagnosis, hospitalization, cardiac testing, and revascularization declined substantially from 2007 to 2021. Overall, downstream AMI hospitalization remained stable, although those in older adults experienced modest rises. Although efforts continue to identify additional low-risk patients for safe discharge, future research should quantify the potential benefits of hospitalization and cardiac testing, particularly for older adults and high-risk patients.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149369883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Concepts in Practice: Understanding and Addressing Name-Based Microaggressions in Health Care. 实践中的概念：理解和解决卫生保健中基于名称的微侵犯。

IF 6.5 1区医学

Annals of emergency medicine Pub Date : 2026-11-06 DOI: 10.1016/j.annemergmed.2026.08.744

Peace Odiase, Ayomide Osunjimi, Stephen J Huot, Inginia Genao, Emmanuel C Ohuabunwa

{"title":"Concepts in Practice: Understanding and Addressing Name-Based Microaggressions in Health Care.","authors":"Peace Odiase, Ayomide Osunjimi, Stephen J Huot, Inginia Genao, Emmanuel C Ohuabunwa","doi":"10.1016/j.annemergmed.2026.08.744","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.744","url":null,"abstract":"Names are important markers of identity, culture, and belonging. In health care settings, individuals with ethnically distinct names may experience repeated mispronunciations, unsolicited nicknames, or avoidance of their names. Repeated mispronunciations without sincere efforts to learn or improve, as well as the avoidance, dismissal, or replacement of names with unsolicited nicknames, may function as name-based microaggressions and can negatively affect psychological safety, professional identity formation, and workplace inclusion. In this manuscript, we discuss the effect of name-based microaggressions on health care professionals and trainees, with particular focus on the emergency department. We review the 3 major categories of microaggressions-microassaults, microinsults, and microinvalidations-and use clinical vignettes to demonstrate how these behaviors may appear in both interpersonal and institutional settings. We also propose practical interpersonal and institutional strategies to promote more inclusive workplaces and foster respectful engagement with ethnically distinct names. By encouraging greater awareness, curiosity, humility, and intentionality around names, health care organizations can help cultivate clinical environments where individuals feel respected, included, and valued.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149369880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is a Minute Saved More Than a Minute Earned? Ambient Scribes and the Work Behind the Note. 节约一分钟比挣一分钟更重要吗？环境抄写员和笔记背后的工作。

IF 6.5 1区医学

Annals of emergency medicine Pub Date : 2026-11-06 DOI: 10.1016/j.annemergmed.2026.09.029

Christian Rose, Carl Preiksaitis

引用次数: 0

Youth Suicide Prevention Is Core Emergency Care. 青少年自杀预防是核心的紧急护理。

IF 6.5 1区医学

Annals of emergency medicine Pub Date : 2026-11-06 DOI: 10.1016/j.annemergmed.2026.09.021

Polina Krass, Bijan Ketabchi

引用次数: 0

A High-Yield Solution to the Emergency Medicine Resident Scholarly Activity Requirement. 急诊医学住院医师学术活动需求的高产解决方案。

IF 6.5 1区医学

Annals of emergency medicine Pub Date : 2026-11-06 DOI: 10.1016/j.annemergmed.2026.08.739

Jace C Bradshaw, Harry Lambert, A C Castro, McKenzie Warshel, Jed Wolpaw, Laeben Lester, Michael Ehmann

引用次数: 0

Live Versus Delayed Video-Based TEAM Assessment During Real-World Cardiac Arrest: Agreement and Exploratory Differences by Rater Experience. 真实世界心脏骤停期间的实时与延迟视频团队评估：由评分者经验得出的一致性和探索性差异。

IF 6.5 1区医学

Annals of emergency medicine Pub Date : 2026-11-06 DOI: 10.1016/j.annemergmed.2026.09.032

Chun-Ju Lien, Ping-Hsun Yu, Shou-Kuen Huang, Jia-How Chang, Edward Pei-Chuan Huang

{"title":"Live Versus Delayed Video-Based TEAM Assessment During Real-World Cardiac Arrest: Agreement and Exploratory Differences by Rater Experience.","authors":"Chun-Ju Lien, Ping-Hsun Yu, Shou-Kuen Huang, Jia-How Chang, Edward Pei-Chuan Huang","doi":"10.1016/j.annemergmed.2026.09.032","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.09.032","url":null,"abstract":"Study objective: To evaluate agreement between immediate live and delayed video-based assessment of nontechnical skills during real-world adult cardiac arrest resuscitation, and whether agreement differed by rater experience.Methods: We conducted a prospective observational study of adult cardiac arrest resuscitations in a tertiary emergency department in Taiwan in 2024. For each event, one trained physician or nurse who participated in the resuscitation completed the Team Emergency Assessment Measure (TEAM) immediately afterward and re-rated the same event from video approximately 30 days later. Live-video agreement was assessed using intraclass correlation coefficients and Bland-Altman analysis.Results: Of 105 recorded resuscitations, 80 had complete paired assessments. Mean global ratings were similar between modalities (8.25 versus 8.22; mean paired difference, -0.03; 95% confidence interval [CI] -0.25 to 0.20), whereas teamwork scores were modestly lower on video review (mean paired difference, -1.00; 95% CI -1.77 to -0.23). Event-level agreement was limited: intraclass correlation coefficients were 0.21 (95% CI 0.00 to 0.41) for total TEAM score and 0.16 (95% CI -0.06 to 0.37) for global rating. Total TEAM video ratings averaged 1.24 points lower than live ratings, with limits of agreement from -12.28 to 9.80. Agreement was higher among senior raters.Conclusion: Delayed video-based TEAM assessment produced similar group-level scores but limited event-level agreement during real-world cardiac arrest. Agreement appeared higher among senior raters. Video review may support debriefing and monitoring, but appraisal of a specific resuscitation or other higher stakes use likely requires experienced raters and structured safeguards.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149369882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fatal Opioid-Like Toxidrome Associated With a 7-Hydroxymitragynine Kratom Product 与7-羟米特拉甘碱Kratom产品相关的致命阿片样毒物症

IF 6.2 1区医学

Annals of emergency medicine Pub Date : 2026-10-27 DOI: 10.1016/j.annemergmed.2026.08.746

Roy Gerona PhD, Ross Ellison BS, Ronda Conners MS, Randall Bissessar MD

{"title":"Fatal Opioid-Like Toxidrome Associated With a 7-Hydroxymitragynine Kratom Product","authors":"Roy Gerona PhD, Ross Ellison BS, Ronda Conners MS, Randall Bissessar MD","doi":"10.1016/j.annemergmed.2026.08.746","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.746","url":null,"abstract":"Kratom (<ce:italic>Mitragyna speciosa</ce:italic>) use has increased in the United States, with the market shifting from traditional leaf preparations to concentrated products containing concentrated or chemically processed alkaloids such as 7-hydroxymitragynine (7-HMG) and mitragynine pseudoindoxyl. These formulations may deliver supraphysiologic opioid-receptor agonist doses with poorly characterized toxicity. A 42-year-old man was found dead at home after reportedly ingesting 3 tablets of a commercial “7-HMG” product and several beers. Postmortem examination revealed purge fluid at the mouth and nose, severe bilateral pulmonary edema, distended bladder, and no evidence of trauma or injection drug use. Quantitative analysis of the remaining tablet showed 29 mg 7-HMG and 0.58 mg mitragynine pseudoindoxyl, with minimal mitragynine. Postmortem blood contained 37.3 ng/mL 7-HMG and 76 ng/mL mitragynine pseudoindoxyl, whereas gabapentin and other medications were present at subtherapeutic concentrations. Compared with an estimated 1 to 4.5 mg 7-HMG in a typical high dose of dried kratom leaf powder, this ingestion delivered approximately 87 mg 7-HMG (19-fold to 87-fold greater 7-HMG exposure than a high-dose botanical leaf preparation). Given the high μ-opioid receptor activity of 7-HMG and its in vivo conversion to the even more potent opioid agonist mitragynine pseudoindoxyl, the postmortem findings are most consistent with a fatal opioid-like toxidrome associated with exposure to concentrated kratom alkaloids. This case illustrates the emerging risk posed by new kratom-branded products containing purified or chemically enriched alkaloids at doses far exceeding traditional preparations.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"6 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Did Long Waits in English Emergency Departments Cause 15,860 Excess Deaths in 2025? 2025年，英国急诊科的长时间等待是否导致了15860人死亡？

IF 6.2 1区医学

Annals of emergency medicine Pub Date : 2026-10-27 DOI: 10.1016/j.annemergmed.2026.08.003

Carl Marincowitz BA MB BChir MSc PhD, Fiona Lecky MBChB DA MSc PhD

引用次数: 0

Associations Between Diagnostic Blood-Based Biomarkers and Neuroimaging Findings in Mild Traumatic Brain Injury 轻度创伤性脑损伤诊断血液生物标志物与神经影像学表现之间的关系

IF 6.2 1区医学

Annals of emergency medicine Pub Date : 2026-10-27 DOI: 10.1016/j.annemergmed.2026.08.731

Shraddha Pandey BA, Yanying Chen BA, John K. Yue MD, Sonia Jain PhD, Xiaoying Sun MS, Shawn R. Eagle PhD, Christopher B. Colwell MD, Alan H.B. Wu PhD, Geoffrey T. Manley MD PhD, Debbie Y. Madhok MD

引用次数: 0

Ambient Artificial Intelligence Scribe Use and Objective Documentation Effort Among Emergency Physicians 急诊医师环境人工智能记录仪的使用和客观记录工作

IF 6.2 1区医学

Annals of emergency medicine Pub Date : 2026-10-27 DOI: 10.1016/j.annemergmed.2026.08.737

Wayne A. Martini MD, Heather Heaton MD, Laura Walker MD, Andrej Urumov MD, Douglas Rappaport MD, Nicole Hodgson MD

引用次数: 0