Annals of emergency medicine最新文献

{"title":"Adoption of Outpatient Management of Acute Low-Risk Pulmonary Embolism.","authors":"Colin F Greineder, Valerie Mefford, Connor O'Hare, Elizabeth Joyce, Shriya Ejanthker, Karan Desai, Thomas Basala, Geoffrey D Barnes","doi":"10.1016/j.annemergmed.2026.08.738","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.738","url":null,"abstract":"<p><strong>Study objective: </strong>To assess longitudinal outcomes of a multicomponent intervention designed to address key barriers to the outpatient management of low-risk pulmonary embolism (PE), and to define the most appropriate target population and metric for evaluating adoption.</p><p><strong>Methods: </strong>We implemented a multicomponent intervention in the emergency department (ED) of a quaternary academic medical center. Outcomes were evaluated using the RE-AIM framework, comparing a 3-year preimplementation period (2016-2019) with active implementation (year I), postimplementation (year II), and maintenance (year III) periods. The primary outcome (adoption) was the proportion of low-PESI (≤85) patients discharged from the ED. Following implementation, the charts of all hospitalized low-PESI patients were reviewed to determine reasons for admission.</p><p><strong>Results: </strong>Among 1,810 patients with acute PE, 705 (39.0%) had low-PESI scores. Adoption rose from 5.1% preimplementation to 16.1% (odds ratio [OR] 3.43, 95% confidence interval [CI] 1.77 to 6.63), 24.0% (OR 5.98, 95% CI 3.04 to 11.78), and 33.3% (OR 9.24, 95% CI 5.04 to 16.92) in years I to III. There were no recurrent venous thromboembolism or deaths within 30 days of any ED discharge. Bleeding complications were rare (0%-4.3%) and none required hospitalization. Hospitalization decreased primarily among low-PESI patients without Hestia criteria, whereas admission of low-PESI Hestia-positive patients remained relatively constant. Excluding Hestia-positive cases, adoption increased from 9.0% preimplementation to 75% in the maintenance phase.</p><p><strong>Conclusion: </strong>In this single-center implementation study, a multicomponent intervention guided by RE-AIM resulted in a sustained increase in outpatient management of low-risk PE. Both the PESI score and Hestia criteria could be incorporated into the definition of the target population and future quality metrics.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190900","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":"Final Diagnoses and Outcomes After Paramedic-Suspected ST-Segment Elevation Myocardial Infarction.","authors":"Malanka Lankaputhra, Andrew Bishop, Jesslyn Wijaya, Riley Batchelor, Tegwyn McManamny, David Anderson, Emily Nehme, Karen Murdoch, Ashanti Dantanarayana, Ben Meadley, Jocasta Ball, Ziad Nehme, Dion Stub","doi":"10.1016/j.annemergmed.2026.07.027","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.07.027","url":null,"abstract":"<p><strong>Study objective: </strong>Emergency medical services activate ST-segment elevation myocardial infarction (STEMI) pathways before biomarkers, imaging, or angiography are available. We sought to describe final hospital diagnoses, inhospital care, and outcomes among patients attended by paramedics for suspected STEMI in a statewide ambulance registry.</p><p><strong>Methods: </strong>We conducted a retrospective statewide registry cohort study using the Victorian Ambulance STEMI Quality Initiative, with hospital follow-up data from January 2020 to June 2025. Principal International Classification of Diseases, 10th Revision, Australian Modification (ICD-10-AM) discharge diagnoses were grouped as STEMI; non-ST-elevation acute coronary syndrome or other coronary syndromes; other cardiac diagnoses; noncardiac diagnoses; and symptom-based diagnoses. Outcomes included out-of-hospital management, coronary angiography, percutaneous coronary intervention, complications, hospital length of stay, inhospital death, 30-day death, and mortality during follow-up. Associations were estimated with multivariable logistic and Cox regression and are reported as odds ratios or hazard ratios with 95% confidence intervals.</p><p><strong>Results: </strong>Among 8,077 suspected STEMI visits with hospital follow-up data, 7,205 (89.2%) had a recorded discharge diagnosis and formed the primary analytic cohort; 872 (10.8%) had no recorded discharge diagnosis. Among the 7,205 with a recorded diagnosis, STEMI was confirmed in 4,330 (60.1%); 824 (11.4%) had non-ST-elevation acute coronary syndrome or other coronary syndromes, 760 (10.5%) other cardiac diagnoses, 613 (8.5%) noncardiac diagnoses, and 678 (9.4%) symptom-based diagnoses. Coronary angiography occurred in 4,836 (67.1%) and percutaneous coronary intervention in 3,200 (44.4%). Inhospital mortality was 8.6%, 30-day mortality 6.5%, and mortality during follow-up 17.5% (median follow-up 2.8 years). Compared with confirmed STEMI, adjusted mortality during follow-up was higher for noncardiac diagnoses (hazard ratio [HR] 1.75, 95% confidence interval [CR], 1.47 to 2.09); other cardiac (HR 1.14, 95% CI, 0.93 to 1.39), NSTE-ACS or other coronary (HR 1.16, 95% CI, 0.98 to 1.38), and symptom-based diagnoses (HR 1.09, 95% CI, 0.89 to 1.34) did not differ materially from STEMI after adjustment.</p><p><strong>Conclusion: </strong>Within this statewide pathway population, paramedic-suspected STEMI identified a diagnostically heterogeneous, high-acuity group, in which approximately 60% of patients with a recorded discharge diagnosis had confirmed STEMI. These findings describe the suspected STEMI pathway population and should not be generalized to all confirmed STEMI or to all chest pain presentations. Emergency medical services and emergency department STEMI systems should preserve rapid access to reperfusion while supporting early diagnostic refinement and risk stratification for serious alternative diagnoses.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126208","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":"DO Generations MAtter for Treatment of Outpatient Pyelonephritis With Cephalosporins in the Emergency Department? DOGMA-ED Study.","authors":"Alicia E Mattson, Devin Spolsdoff, Caitlin S Brown, Ana Avram Fletcher, Spencer Laehn, Lance Ray, Alyssa B Polotti, Ryan Feldman, Giles W Slocum, Ruben Santiago, James Krenz, David E Zimmerman, Jordan A Woolum, Gavin T Howington, Preeyaporn Sarangarm, Anne Zepeski, Briana Negaard, Alison Lewis, Jenny Koehl, Megan A Rech, David Talan, Brett Faine","doi":"10.1016/j.annemergmed.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.001","url":null,"abstract":"<p><strong>Study objective: </strong>The primary objective of this study was to compare the effectiveness between first-, second-, and third-generation oral cephalosporins for the treatment of pyelonephritis in adult patients discharged from the emergency department (ED).</p><p><strong>Methods: </strong>This was a multicenter, retrospective, observational cohort study of 11 geographically distributed academic US EDs. Patients aged ≥18 years who were diagnosed with pyelonephritis and discharged home on an oral cephalosporin from the ED between August 1, 2023 and January 1, 2025 were included. The primary outcome was treatment failure at 14 days between the cephalosporin generations. The composite outcome was defined as one of the following: (1) recurrence of symptoms, (2) repeat ED/urgent care visit due to urinary tract infection, (3) receipt of a new antibiotic prescription for urinary symptoms, or (4) hospitalization due to urinary tract infection. Secondary outcomes included the need to modify the patient's initial antimicrobial regimen based on culture and susceptibility.</p><p><strong>Results: </strong>A total of 1,147 patients met inclusion, with 618 (53.9%) receiving a first-generation, 91 (7.9%) a second-generation, and 438 (38.2%) a third-generation cephalosporin. Baseline characteristics were similar across cohorts, with women comprising over 85% of the study population. The most prescribed agents were cephalexin (85% of first generation), cefuroxime (100% of second generation), and cefdinir (79% of third generation). There was no statistically significant difference in 14-day treatment failure rates across generations (first versus second: 19.6% versus 17.6%, difference 2.0%, 95% confidence interval (CI) -7.1 to 11.1; first versus third: 19.6% versus 18.0%, difference 1.6%, 95% CI -3.4 to 6.5).</p><p><strong>Conclusion: </strong>First-, second-, and third-generation oral cephalosporins demonstrated comparable 14-day treatment failure rates for the treatment of acute pyelonephritis in patients discharged from the ED.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126200","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":"645 Healthcare Worker Perception of a Large Language Model Sepsis Alert in the Emergency Department","authors":"M. Self, Claire Allison, Gabriel Wardi","doi":"10.1016/j.annemergmed.2026.08.661","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.661","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"1 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086901","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":"644 Why Is Pericardial Fat Anechoic? A Clinicopathologic Correlation","authors":"P. Koscumb, K. Paul, Michael Schreck, James Woytash, Torsten Behrens, John Cotter, Jeremy Carter, Dietrich Jehle","doi":"10.1016/j.annemergmed.2026.08.660","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.660","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"11 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086902","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":"626 A Provider-in-Triage and Continuous Flow Tract Model Improves Left Without Being Seen Rate in a Veterans Affairs Emergency Department","authors":"B. Bales, Jonathan Andereck, William Stubblefield, Michael Ward, Jesse Wrenn, James Jordan, Jonathan Gerwien, J. Champion, Andrew Neck","doi":"10.1016/j.annemergmed.2026.08.642","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.642","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"60 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086912","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":"624 Impact of a Visual Identity Tool on Provider-Nursing Communication","authors":"A. Hembree, Jacqueline Tran, Justine Sweeney, Dina Saba, Marly Sam, Chris Reisig","doi":"10.1016/j.annemergmed.2026.08.640","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.640","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"1 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086914","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":"617 A Cross-Sectional Survey of Workplace Violence Prevention Policies and Reporting Practices in Healthcare Settings","authors":"H. Schindler, Austin Hanrahan, Nadiya Persaud, Tiffany Brown, Michelle Wallen","doi":"10.1016/j.annemergmed.2026.08.633","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.633","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"7 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086919","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":"609 Applying Lean Strategy and Hoshin Kanri in a County Hospital: A Framework for Organization-Wide Improvement in Patient Flow and Access","authors":"M. Feldmeier, Christopher Peabody, Radha Rai, Christopher Ross, William Huen, Susan Ehrlich, Gabriel Ortiz, Gillian Otway, Angelica Almeida, Hemal Kanzaria","doi":"10.1016/j.annemergmed.2026.08.625","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.625","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"171 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086928","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":"602 Postpartum Emergency Department Utilization in a High-Risk Urban Maternal Population","authors":"S. Hay, Shaveta Khosla, Rachel Caskey, Sage Kim, Anne Elizabeth Glassgow","doi":"10.1016/j.annemergmed.2026.08.618","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2026.08.618","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"23 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086933","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}