Annals of emergency medicine最新文献

{"title":"Cardiac Arrest Management in United States Emergency Departments During the First Year of the COVID-19 Pandemic, 2020.","authors":"Jesus R Torres, James H Paxton, Eliezer Santos León, Kari K Harland, Anusha Krishnadasan, Nicholas M Mohr, Richard Rothman, William R Mower, Kelli Wallace, David A Talan","doi":"10.1016/j.annemergmed.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.02.005","url":null,"abstract":"<p><strong>Study objective: </strong>The COVID-19 pandemic posed exposure risk for health care personnel, potentially affecting the care for patients with cardiac arrest. We compare emergency department (ED) cardiac arrest management in patients who were suspected and not suspected of COVID-19 early in the pandemic in 2020.</p><p><strong>Methods: </strong>This was a multicenter prospective observational cohort study of cardiac arrest patients conducted at 20 geographically diverse United States academic EDs from May 2020 to December 2020. We used percentage point differences, proportion tests, and 95% confidence intervals (CIs) to analyze cardiac arrest management-chest compressions, defibrillation/cardioversion, airway management-by suspected COVID-19 status.</p><p><strong>Results: </strong>We identified 1,143 cardiac arrest events managed by 437 participating physicians or advanced practice providers. Of 183 (16%) patients suspected of COVID-19, 34 (19%) had laboratory confirmation, whereas 149 (81%) were suspected by clinical impression. Comparing COVID-19 suspected and not suspected patients, proportions who received chest compressions (16.4% versus 13.5%, respectively; difference 2.9% [95% CI, -3.3 to 9.0]) and defibrillation/cardioversion (7.1% versus 5.3%, respectively; difference 1.8% [95% CI -2.5 to 6.1]) were similar. The proportion not achieving return of spontaneous circulations was also similar between the groups (62.3% versus 67.1%, respectively, difference -4.8% [95% CI -12.7 to 3.2]). Full-barrier personal protective equipment was used more often in those suspected of COVID-19 (61.8% versus 54.9%, respectively, difference of 8.1% [95% CI 0.7% to 15.5]).</p><p><strong>Conclusion: </strong>Despite potential exposure risks to ED personnel early in the pandemic, cardiac arrest management of patients suspected and not suspected of COVID-19 was similar.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762905","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}

{"title":"The Implementation of Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage.","authors":"Amy D Costigan, Laurel C O'Connor, Christopher Slocum, Kimberly Barry, Maureen M Canellas, Alexandra M Sanseverino, Erin Proudman, Karen Plainte, Mathew Shatsky, Janell Forget, Martin A Reznek","doi":"10.1016/j.annemergmed.2025.02.023","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.02.023","url":null,"abstract":"<p><strong>Study objective: </strong>Violence in health care settings is a growing threat to patients and clinicians. This study's objective was to describe the demographic distribution of the Dynamic Appraisal of Situational Aggression (DASA) score at emergency department (ED) triage, identifying patterns in score variability across different patient groups and exploring associations with demographic factors.</p><p><strong>Methods: </strong>From January 11, 2023 to December 31, 2023, patients aged 18 years and older were assigned a DASA score during triage at 5 EDs as part of a systemwide strategy to mitigate increasing workplace violence. Scores were used to stratify patients into established risk categories of aggressive behavior (low, moderate, high, or imminent). Subjects' DASA scores and demographic characteristics were abstracted from the electronic health record. Findings were reported descriptively with 95% confidence intervals for counts and proportions.</p><p><strong>Results: </strong>There were 192,947 ED encounters during the study period, of which 159,154 (80.3%) had a DASA score assigned at triage (mean age, 51.5 years; 53.5% women). The data set comprised 98,751 unique patients. Male sex, younger age, high-acuity Emergency Severity Index, and arrival with police, by ambulance, or by aircraft were most associated with a high-risk DASA score assignment.</p><p><strong>Conclusion: </strong>The use of the DASA instrument score at ED triage was highly adopted by staff. The demographic makeup of patients with a high-risk DASA score was concordant with prior literature describing patients at risk for committing violence against health care workers. Further research should investigate the predictive value of triage DASA assessment for aggressive patient behavior.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762929","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}

{"title":"Abnormal Placement of Flow Directed Balloon Pacemaker.","authors":"Alfred Sacchetti, Monika Smith, Allyson Raymond","doi":"10.1016/j.annemergmed.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.02.020","url":null,"abstract":"<p><p>Blind placement of a transvenous pacemaker is a core emergency medicine resuscitative procedure. The commonly used balloon-tipped pacing wire is designed to allow the flow of blood returning to the heart to carry the pacer wire through the tricuspid valve and into the right ventricle. Presented here is a case of misdirection of such a pacemaker into the left pericardiophrenic vein.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727357","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}

{"title":"Predictors of Emergency Physician Productivity in a National Emergency Medicine Group.","authors":"Jonathan J Oskvarek, Mark S Zocchi, Bernard S Black, Laura G Burke, Marika Kachman, Andrew Leubitz, Ali Moghtaderi, Dhimitri A Nikolla, Nishad Rahman, Jesse M Pines","doi":"10.1016/j.annemergmed.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.02.002","url":null,"abstract":"<p><strong>Study objectives: </strong>We sought to identify physician and environmental factors (eg, crowding) associated with emergency physician productivity, measured as patients per hour. We also assessed whether physician productivity is associated with higher emergency department (ED) return rates.</p><p><strong>Methods: </strong>We used data from 184 EDs in 24 states staffed by a national ED group from January 2021 to December 2022. Clinical outcomes were 72-hour returns and returns with admission. We performed multivariable linear regression models that included physician, shift, and facility characteristics.</p><p><strong>Results: </strong>We examined 234,146 shifts among 2,099 physicians. The mean number of patients per hour was 1.94 (SD = 0.57). Physician factors associated with a higher number of patients per hour included younger age and longer tenure at a site, with the number of patients per hour increasing even after 60+ months at a site. Longer tenure at a site was associated with a higher number of patients per hour (0.06 [95% confidence interval {CI} 0.02 to 0.09] at 6 months and 0.11 [95% CI 0.07 to 0.15] at 12 months). The number of patients per hour was weakly associated with shifts worked in the prior 3 to 30 days (0.003 number of patients per hour [95% CI 0.002 to 0.004] for each additional shift). Overnight shifts, non-Monday shifts, more physicians working on shift, and longer shift lengths were associated with a lower number of patients per hour. The number of patients with ED length of stay more than 6 hours (boarding patients) was negatively associated with the number of patients per hour. The higher number of patients per hour, both within site and within physician, was associated with slightly decreased 72-hour returns but no meaningful difference in returns with admission.</p><p><strong>Conclusion: </strong>Both physician- and shift-level factors are associated with emergency physician number of patients per hour. Higher number of patients per hour is not associated with increased 72-hour returns with admission.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727441","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}

{"title":"Clindamycin Should Remain the Toxin-Neutralizing Antibiotic of Choice for Necrotizing Soft Tissue Infections","authors":"Jennifer Koehl PharmD,&nbsp;Gavin T. Howington PharmD","doi":"10.1016/j.annemergmed.2024.10.022","DOIUrl":"10.1016/j.annemergmed.2024.10.022","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 4","pages":"Pages 359-361"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642283","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}

{"title":"Between the Curtains of Noise and Grief","authors":"Brittany Ellis MBChB, MSc","doi":"10.1016/j.annemergmed.2024.12.009","DOIUrl":"10.1016/j.annemergmed.2024.12.009","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 4","pages":"Pages 372-373"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644670","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}

{"title":"Inferolateral ST-Elevation in a Patient Presenting With Abdominal Pain","authors":"Jose Reyes MD,&nbsp;Kyle T. Ackerman MD,&nbsp;Tarlan Hedayati MD,&nbsp;Joseph S. Palter MD,&nbsp;Joseph Weber MD","doi":"10.1016/j.annemergmed.2024.08.005","DOIUrl":"10.1016/j.annemergmed.2024.08.005","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 4","pages":"Pages 341-343"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644662","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}

{"title":"Woman With Unilateral Facial Paleness","authors":"Kristian Damke MD ,&nbsp;Anna Lowinski ,&nbsp;Maike Friederich MD ,&nbsp;Gerrit M. Grosse MD ,&nbsp;Christian H. Nickel MD","doi":"10.1016/j.annemergmed.2024.10.009","DOIUrl":"10.1016/j.annemergmed.2024.10.009","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 4","pages":"Pages 364-365"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Man With Eye Pain and Lateral Gaze Palsy","authors":"Benjamin A. Johnson MD, MSc,&nbsp;Timothy J. Batchelor MD,&nbsp;Marc Gabriel Berenson MD","doi":"10.1016/j.annemergmed.2024.10.019","DOIUrl":"10.1016/j.annemergmed.2024.10.019","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 4","pages":"Pages 370-371"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644669","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}

{"title":"A Young Man With an Unusual Presentation of a Well-Known Entity","authors":"Ezhilkugan Ganessane MD ,&nbsp;András Vereckei MD ,&nbsp;Aswin Kumaran MD ,&nbsp;Balamurugan Nathan MD ,&nbsp;Vishwanath Balassoundaram MD ,&nbsp;Anuusha Subathra Sadasivam MD ,&nbsp;Anas Mohammed Muthanikkatt MD","doi":"10.1016/j.annemergmed.2024.08.511","DOIUrl":"10.1016/j.annemergmed.2024.08.511","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 4","pages":"Pages 344-348"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644663","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}