Annals of emergency medicine最新文献

{"title":"Trends in Nonresearch Industry Payments to Emergency Physicians Between 2016 and 2023.","authors":"Dalia Owda,Constantin Radu,Joseph S Ross,Craig Rothenberg,Arjun K Venkatesh","doi":"10.1016/j.annemergmed.2025.08.019","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.019","url":null,"abstract":"STUDY OBJECTIVETo characterize the prevalence, value, and nature of nonresearch industry payments made to emergency physicians in the United States between 2016 and 2023.METHODSThis was a repeated cross-sectional analysis of Open Payments data, which is annually released by the Centers for Medicare and Medicaid Services, from 2016 to 2023. We examined nonresearch industry payments to emergency physicians. The primary outcome was the annual proportion of emergency physicians receiving industry payments. The secondary outcomes were the total value of payments, payment regularity, and the distribution of payments by form, nature, and associated drug product. We used descriptive statistics to summarize trends.RESULTSA total of 27,970/80,270 (35%) emergency physicians received industry payments at least once during the study period of 2016-2023. The proportion of emergency physicians receiving payments decreased from 10,410/67,070 (16%) in 2016 to 8,770/79,600 (11%) in 2023, with an absolute difference between the 2 years of 4.5% (95% confidence interval: 4.2%, -4.9%). The total payment value decreased by 45% from $9.820 million in 2016 to $5.373 million in 2020 and then subsequently increased by 87% to $10.074 million in 2023. Only 0.8% of emergency physicians received payments every year they were eligible. Consulting fees became the highest-value payment in 2023, making up 50% of all payment value.CONCLUSIONThe proportion of emergency physicians receiving payments has decreased since 2016, whereas the overall value of payments has remained stable due to increasing concentration among a small group of recipients. These findings suggest evolving influence of industry and raise important questions about the influence of high-value relationships on clinical practice.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"8 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261450","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":"Efficacy of Adding Intravenous Saline Solution to Nonsteroidal Anti-Inflammatory Drug-Based Treatment of Acute Migraine in the Emergency Department.","authors":"Yusuf Turan,Haldun Akoglu,Emir Unal,Emre Kudu,Erhan Altunbas,Melis Efeoglu Sacak,Cigdem Ozpolat,Erkman Sanri,Sinan Karacabey,Ozge Ecmel Onur,Arzu Denizbasi","doi":"10.1016/j.annemergmed.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.013","url":null,"abstract":"STUDY OBJECTIVEIntravenous fluid administration is frequently used alongside nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of acute migraine in emergency departments (EDs), despite a lack of clear evidence supporting its benefit. The objective of this study was to evaluate whether the addition of 1,000 mL intravenous normal saline solution to standard NSAID-based treatment improves clinical outcomes in adults presenting to the ED with acute migraine.METHODSIt was a double-blind, parallel-group, randomized controlled trial in single tertiary care academic ED (June 2020 to June 2021). Adults aged ≥18 years with migraine per International Classification of Headache Disorders, 3rd edition criteria, presenting with an acute attack. Patients with dehydration, recent intravenous fluid use, or contraindications were excluded. Of 955 screened patients, 128 were randomized; 125 were analyzed. All patients received 75 mg intramuscular diclofenac. The intervention group received 1,000 mL intravenous saline solution over 1 hour; the control group received 10 mL intravenous saline solution over 1 hour. The primary outcome was change in headache severity (100-mm visual analog scale [VAS]) at 2 hours. Secondary outcomes included rescue medication use, ED length of stay, adverse events, and functional disability.RESULTSMedian VAS reduction was 62.0 mm (IQR 37.5-82.0) in the intervention group vs 48.0 mm (26.0-74.0) in controls; the Hodges-Lehmann estimated between-group difference was 10.0 mm (95% CI -2.0 to 20.0). We found no between-group differences in nausea VAS or functional disability across time points. Rescue medication use was lower in the intervention group (23.8%) than in controls (42.5%) (absolute difference 18.6%, 95% CI 2.1% to 35.0%). Median ED length of stay was shorter in the intervention group (150 vs 168 minutes; difference 19 minutes, 95% CI 0 to 39). No serious adverse events occurred; 24-hour survey outcomes were similar between groups.CONCLUSIONAdding 1,000 mL intravenous saline solution to NSAID-based therapy did not produce a clear improvement in pain relief at 2 hours. Lower rescue medication use and shorter ED length of stay in the intervention group are secondary findings that may be influenced by unblinded administering staff and should be interpreted cautiously. Routine intravenous fluids should be considered selectively, particularly for patients with clinical signs of dehydration.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"88 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261220","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":"Learning Curves and Laryngoscopes: The Influence of Experience on Airway Management.","authors":"Michael Gottlieb,Stephanie C DeMasi","doi":"10.1016/j.annemergmed.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.008","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"49 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235896","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":"Rates of Recommended Shingles Vaccination and Interest Among Emergency Department Patients: A Multicenter Study.","authors":"Michael Gottlieb,Giles Slocum,Shwetha Sekar,Brian Chinnock,Stephanie A Eucker,Vijaya Arun Kumar,Melanie F Molina,Kristin L Rising,Jesus R Torres,Robert M Rodriguez","doi":"10.1016/j.annemergmed.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.09.001","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"11 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203708","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":"Feasibility and Acceptability of a Large Language Model-Based Motivational Interviewing Agent in the Emergency Department.","authors":"Brian Suffoletto,Carl Prieksaitis,Christian Rose,David Kim,Nikhil Pillai,Vanessa Pitre","doi":"10.1016/j.annemergmed.2025.08.021","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.021","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"38 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203710","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":"Examining Agreement Between Binary Hispanic or Latino Ethnicity Variable With Country of Origin.","authors":"Rama A Salhi,Melissa A Meeker,Kori S Zachrison,Margaret E Samuels-Kalow","doi":"10.1016/j.annemergmed.2025.08.008","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.008","url":null,"abstract":"STUDY OBJECTIVESDemographic data are critical in identifying and addressing disparities but are challenged by data classification issues, particularly for Hispanic or Latino patients. Ethnicity data are typically collected through (1) binary Hispanic or Latino response and/or (2) country-of-origin checklist; however, there is no consensus on which populations are represented by the term Hispanic or Latino. Our objective was to examine the agreement between the commonly collected binary ethnicity variable and country-of-origin-based definitions.METHODSWe conducted a cross-sectional study among patients in a regional health care system (January 1, 2021 to November 16, 2023). The primary outcome was agreement between the binary Hispanic or Latino ethnicity and country of origin. Given the variation in countries represented by the term Hispanic or Latino, we used multiple definitions including from the US Office of Management and Budget.RESULTSAmong the 2,919,810 patients identified, 83.1% had completed responses to the binary Hispanic or Latino ethnicity question and 75.1% had completed responses to the country-of-origin ethnicity variable. Using the binary variable, 241,391 were documented as Hispanic or Latino and of these, 169,731 (70%) had countries of origin identified in the Office of Management and Budget definition. An expanded definition additionally including Brazil, Haiti, Belize, and Guyana had increased agreement (n=176,048; 73%).CONCLUSIONOur findings highlight the limitations of using only the binary Hispanic or Latino ethnicity variable, specifically in that it may lead to underestimation. Efforts to improve data quality and nuance, particularly in the emergency department, are critical as inaccurate assessment of disparities may lead to misdirection of interventions, and, ultimately, missed opportunities to decrease disease burden.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"73 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153486","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":"Serious Cardiac Outcomes and Physician Estimation of Risk in Emergency Department Patients With Presyncope Versus Syncope.","authors":"Edward H Suh,Dana L Sacco,Carolyn Winskill,John DeAngelis,Daniel Nishijima,Jonathan Schimmel,Alan Storrow,Venkatesh Thiruganasambandamoorthy,Robert E Weiss,Nancy Wood,Marc A Probst","doi":"10.1016/j.annemergmed.2025.08.014","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.014","url":null,"abstract":"STUDY OBJECTIVEPrevious research suggests that the short-term incidence of adverse events is similar in emergency department (ED) patients with presyncope and syncope. However, admission rates for presyncope are lower, which could imply clinicians underestimate its risk. We sought to compare physician risk estimates and the 30-day rate of serious cardiac outcomes between patients with syncope and presyncope.METHODSWe conducted a secondary analysis of a prospective, observational, multicenter study of patients aged ≥40 years presenting to ED with presyncope or syncope. Patients with serious ED diagnoses were excluded. Descriptive statistics and multivariable regression analyses were used to compare the physician-estimated risk, ED disposition, and 30-day rate of adverse outcomes.RESULTSOf the 1,263 patients analyzed, 721 (57%) had syncope and 542 (43%) had presyncope. Baseline characteristics were similar between groups. At 30 days, 34 (4.7%) syncope patients and 28 (5.2%) presyncope patients experienced a serious cardiac outcome; logistic regression showed no difference in the odds (odds ratio 1.13; 95% confidence interval 0.66 to 1.79) of serious cardiac outcomes between syncope and presyncope patients. The mean physician-estimated risk of serious cardiac outcomes was 7.6% in syncope, versus 5.3% in presyncope (risk difference 2.3% [0.89%, 3.7%]); this difference remained significant after adjustment for clinical characteristics. Admission rate was lower in presyncope, 38.2% versus 49.5% (risk difference 11.3% [1.2%, 21.5%]).CONCLUSIONPatients with unexplained presyncope and syncope had similar rates of 30-day serious cardiac outcomes after ED visit. Patients with presyncope were less likely to be admitted and had a lower mean physician-estimated risk of adverse outcomes.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"16 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127259","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":"Cool Running Water as a First Aid Treatment for Burn Injuries.","authors":"Maleea D Holbert,Yvonne Singer,Tina Palmieri,John Rose,Kevin Mackey,Sonia Singh,Nathan Kuppermann,Fiona Wood,Victor Joe,Tanesha A Dimanopoulos,Cody Frear,Steven M McPhail,Roy Kimble,Leila Cuttle,Robert Katzer,Bronwyn Griffin","doi":"10.1016/j.annemergmed.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.003","url":null,"abstract":"STUDY OBJECTIVEThe application of 20 minutes of cool running water within 3 hours of a burn injury significantly improves patient burn-related outcomes. To facilitate the integration of 20 minutes of cool running water into clinical practice in the United States, this investigation aimed to determine barriers and facilitators to implementing 20 minutes of cool running water in out-of-hospital emergency medical services (EMS) and in-hospital emergency departments (EDs) and to codesign tailored strategies for its routine use in acute burn first aid.METHODSUsing a sequential mixed-methods design, we identified barriers and facilitators to 20 minutes of cool running water implementation and codesigned strategies to enhance its implementation. EMS and ED clinicians completed an online questionnaire assessing perceived barriers and facilitators, with responses coded using the Consolidated Framework for Implementation Research. Semistructured interviews with a convenience sample of participants further examined determinants and codesigned implementation strategies.RESULTSA total of 371 (210 EMS, 161 ED) clinicians participated in the questionnaire, and 22 (14 EMS, 8 ED) participated in interviews. Twelve key determinants were identified across 4 Consolidated Framework for Implementation Research domains. Implementation barriers included a lack of resources, challenges adapting 20 minutes of cool running water to local clinical settings, and the absence of external policies incorporating burn first aid cooling, whereas facilitators included high clinician motivation, strong professional networks, and a supportive clinical culture. Codesigned strategies to enhance 20 minutes of cool running water uptake included portable irrigation equipment, nursing-driven protocols, and policy updates.CONCLUSIONAlthough clinicians appear motivated to implement 20 minutes of cool running water, infrastructure, workflow, and policy challenges hinder widespread adoption. Addressing these barriers through targeted codesigned 20 minutes of cool running water implementation strategies will facilitate integration into EMS and ED settings, improving burn care outcomes.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"40 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117167","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":"Accuracy of Published Screening Tools for Large Vessel Occlusion in Patients With Suspected Acute Ischemic Stroke: A Prospective Cohort Study.","authors":"Francis Desmeules,Marcel Emond,Alexandra Nadeau,Pierre-Gilles Blanchard,Pier-Alexandre Tardif,Axel Benhamed,Nicolas Capolla-Daneau,Marie-Christine Camden,Eric Mercier","doi":"10.1016/j.annemergmed.2025.07.030","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.07.030","url":null,"abstract":"STUDY OBJECTIVETo identify the most accurate screening tool for predicting a large vessel occlusion in patients with a suspected acute ischemic stroke.METHODSBetween January 2022 and April 2023, adult patients with a suspected acute ischemic stroke for whom an emergency physician activated the stroke code (indicating potential eligibility for thrombolysis and/or thrombectomy) at the emergency department (ED) of l'Hôpital de l'Enfant-Jésus-CHU de Québec, a tertiary care center for neurologic diseases, were prospectively included. Demographic data and variables included in 8 screening tools were collected by the emergency physician prior to the head computed tomography using a standardized data collection form. The performance of each tool to identify patients with a large vessel occlusion was assessed using the accuracy with 95% confidence intervals (CIs) and the McNemar test was used to compare the performance of the tools.RESULTSA total of 390 patients were included in the study (mean age: 72.3 years; men: 48.2%). Acute ischemic strokes was the final diagnosis in 259 patients (66.4%) of which 111 (28.5%) had a large vessel occlusion. The accuracy of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) was 0.76 (95% CI 0.72 to 0.81), which was not significantly different from that of Rapid Arterial Occlusion Evaluation Scale (0.75, 95% CI 0.71 to 0.80), Los Angeles Motor Scale (0.75, 95% CI 0.71 to 0.79), or Large ARtery Intracranial Occlusion stroke scale (0.72, 95% CI 0.68 to 0.77). However, it was significantly higher than the accuracy of Conveniently-Grasped FAST, Ambulance Clinical Triage-FAST, Vision, Aphasia, Neglect assessment, and Face-Arm-Speech-Time plus severe arm or leg motor deficit. Cincinnati Prehospital Stroke Scale, when performed by either the emergency physicians or paramedics, demonstrated poor accuracy, with values of 0.34 (95% CI 0.29 to 0.39) and 0.37 (95% CI 0.32 to 0.34), respectively.CONCLUSIONThis study provides valuable insights into the accuracy of various large vessel occlusion screening tools for patients in our ED setting with FAST-ED, Rapid Arterial Occlusion Evaluation Scale, and Los Angeles Motor Scale showing the highest levels of accuracy. These findings will contribute to the development of evidence-based care pathways for improving stroke diagnosis and management.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"38 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089855","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":"Development of a Unified Geriatric Emergency Department Database, 2022.","authors":"Darya M Herscovici,Krislyn M Boggs,Maeve Swanton,Janice A Espinola,Margaret E Samuels-Kalow,Ashley F Sullivan,Cameron J Gettel,Anita N Chary,Maura Kennedy,Carlos A Camargo","doi":"10.1016/j.annemergmed.2025.08.011","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.08.011","url":null,"abstract":"STUDY OBJECTIVERecent initiatives have aimed to improve emergency care for older adults by supporting the recognition of geriatric emergency departments (GEDs). Our objective was to create a unified database of GEDs to understand the distribution and growth of US GEDs.METHODSWe identified United States emergency departments (EDs) that were members of the Geriatric ED Collaborative (GEDC) or accredited by the Geriatric ED Accreditation (GEDA) program by December 31, 2022. For completeness, we also identified hospitals recognized by the Age Friendly Health Systems (AFHS), although this recognition is not ED-specific. We collected the year each facility first received recognition and incorporated the combined list into the 2022 National ED Inventory-US database.RESULTSWe identified 324 GEDs (5.8%) among 5,622 nonfederal EDs in 2022. An additional 202 hospitals were recognized by AFHS, yielding 526 (9.4%) potential GEDs (pGEDs). GEDs (and pGEDs) were disproportionally located in urban areas. From 2017 to 2019, 110 (69%) of 160 pGEDs were in nonteaching hospitals, and from 2020 to 2022, 316 (86%) of 366 were. This rise in nonteaching hospital pGEDs was driven largely by AFHS hospitals, but a similar pattern was observed among GEDs (GEDC and GEDA). Attainment of GEDA was more likely among EDs in GEDC (odds ratio 13.56, 95% confidence interval 6.14 to 29.96) than AFHS-recognized hospitals (odds ratio 3.26, 95% confidence interval 2.15 to 4.95).CONCLUSIONSThe different requirements of GEDC, GEDA, and AFHS-along with current findings-support inclusion of GEDC or GEDA only in the unified national GED database. Furthermore, there was an increase in the number of pGEDs in nonteaching hospitals since 2017. We encourage further efforts to expand these 2 ED-based programs into nonurban, community EDs.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"5 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089854","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}