Annals of emergency medicine最新文献

{"title":"Enhancing Emergency Department Triage Equity With Artificial Intelligence: Outcomes From a Multisite Implementation.","authors":"Jeremiah S Hinson, Scott R Levin, Benjamin D Steinhart, Christopher Chmura, Rohit B Sangal, Arjun K Venkatesh, R Andrew Taylor","doi":"10.1016/j.annemergmed.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.014","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680734","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":"Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study.","authors":"Jenny Koehl, Devin Spolsdoff, Briana Negaard, Alison Lewis, Ruben Santiago, James Krenz, Alyssa Polotti, Ryan Feldman, Giles Slocum, David Zimmerman, Gavin T Howington, Preeyaporn Sarangarm, Alicia E Mattson, Caitlin Brown, Anne Zepeski, Megan A Rech, Brett Faine","doi":"10.1016/j.annemergmed.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.013","url":null,"abstract":"<p><strong>Study objective: </strong>The primary objective of our study was to compare the effectiveness of oral cephalosporins versus fluroquinolones and trimethoprim/sulfamethoxazole (TMP-SMX) for the treatment of pyelonephritis in patients discharged home from the emergency department (ED).</p><p><strong>Methods: </strong>This was a multicenter, retrospective, observational cohort study of 11 geographically diverse US EDs. Patients aged ≥18 years diagnosed with pyelonephritis and discharged home from the ED between January 1, 2021 and October 31, 2023 were included. The primary outcome was treatment failure at 14 days defined as a composite outcome of the following: (1) recurrence of urinary symptoms, (2) repeat ED visit or hospitalization for a urinary tract infection, (3) receipt of a new antibiotic prescription for urinary tract infection. Secondary outcome was appropriateness of empiric treatment based on urine culture susceptibility.</p><p><strong>Results: </strong>Among the 851 patients who met inclusion criteria, 647 patients received a cephalosporin, and 204 patients received an Infectious Diseases Society of America guideline-endorsed first-line treatment (fluroquinolones, TMP-SMX). Overall, baseline characteristics were similar between the 2 cohorts. Rates of treatment failure were not significantly different in the cephalosporin group compared with the fluroquinolone/TMP-SMX groups (17.2% of cephalosporin vs 22.5% of fluroquinolone/TMP-SMX group, difference=5.3%, 95% confidence interval -0.118 to 0.01). After adjusting for potential confounders, cephalosporin use was not associated with treatment failure (odds ratio=0.22, 95% confidence interval 0.03 to 1.95). There was no difference in rates of appropriate empiric treatment based on urine culture susceptibility.</p><p><strong>Conclusion: </strong>Oral cephalosporins were associated with similar treatment failure rates compared with Infectious Diseases Society of America guideline-endorsed treatments for the treatment of pyelonephritis in ED patients discharged home.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680783","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":"Managing Acute Respiratory Failure With Facemask Noninvasive Ventilation.","authors":"Alexander Bracey, Brian J Wright","doi":"10.1016/j.annemergmed.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.012","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680753","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":"Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock.","authors":"Michael Gottlieb, Emily Wusterbarth, Tamara Amponsah","doi":"10.1016/j.annemergmed.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.011","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680786","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":"Where Are They Now? Attrition Rates of Emergency Medicine Residency Graduates by Gender.","authors":"Nikita A Salker, Andrea Fang, Michelle Lall, Michael Bond, Melissa White, Pooja Agrawal, Kinjal N Sethuraman","doi":"10.1016/j.annemergmed.2024.09.017","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.09.017","url":null,"abstract":"<p><strong>Study objective: </strong>Prior studies examined the retention of women emergency physicians through residency training, but their career paths on completing residency are less well understood. Our primary objective was to identify a difference in attrition rates between binary genders of practicing clinical emergency physicians within 10 to 30 years after residency graduation. Our secondary aims investigated gender differences in geographic practice location, academic, and community practice. We hypothesized that women emergency physicians have higher rates of attrition from clinical practice than men.</p><p><strong>Methods: </strong>In this cohort study, we tracked employment over 10 to 30 years of graduates from allopathic emergency medicine residency programs established before 2005 and those who graduated before 2010. We obtained graduate lists from 21 residency programs representing geographically diverse training programs in the United States. We utilized public databases to investigate current licensure, board certification, practice location, and occupation for graduates more than 10 years after residency graduation. Physicians who do not practice clinically in emergency medicine or an emergency medicine subspecialty were placed in the \"attrition\" category. \"Not available\" was defined as those individuals who did not have adequate information available online. We analyzed differences in attrition of women and men emergency physicians in clinical practice in 2020. We also noted whether they worked in an academic or community setting and assessed their geographic clinical practice region.</p><p><strong>Results: </strong>We identified a total of 4,170 graduates. Of those, 445 (10.6%) were excluded because of insufficient information. Of the 3,725 emergency medicine residency graduates, 71% were men. The attrition rate from clinical emergency medicine for men was 5.3% (95% confidence interval, 4.4% to 6.1%) and the attrition rate for women was 5.8% (95% confidence interval, 4.4% to 7.2%). The difference between the 2 proportions was -0.005 (95% confidence interval, -0.02 to 0.01). There were no gender differences in geographic location or practice type.</p><p><strong>Conclusion: </strong>We did not observe differences in attrition rates by gender in our sample from 21 programs over a 30-year period. The findings from this cohort are disparate from reports of recent emergency medicine graduates and identifying reasons for attrition of emergency physicians will be important to understanding the workforce needs of the future.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638247","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":"Self-Collection for Primary HPV Testing: Acceptability in a Large Urban Emergency Department.","authors":"Itunu O Sokale, Dick C Kuo, Claire M Hoppenot, Lorraine R Reitzel, Luis H Juarez, Katherine J Hernandez, Susan L Parker, Chris Amos, Maria Daheri, Kelly R Keene, Jane R Montealegre, Aaron P Thrift","doi":"10.1016/j.annemergmed.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.10.002","url":null,"abstract":"<p><strong>Study objective: </strong>Overdue cervical cancer screening increases the risk of invasive cervical cancer. It is important to identify settings where self-collection for primary human papillomavirus (HPV) testing can be implemented to have high effect on cervical cancer screening among hard-to-reach women with overdue screening. Herein, we examined the acceptability of HPV self-collection, including completion rates, attitudes, and experiences among women seeking noncritical care at a high-volume urban safety-net hospital emergency department (ED) in Houston, Texas, United States.</p><p><strong>Methods: </strong>In this single-arm intervention pilot study, we recruited women overdue for cervical cancer screening in the waiting areas of a safety-net hospital ED, seeking noncritical care from November 2023 to April 2024. Participants completed a preintervention survey and were offered an HPV self-collection kit. A postintervention survey followed immediately after HPV self-collection.</p><p><strong>Results: </strong>Nearly 30% (119 of 401) screened for eligibility were overdue for cervical cancer screening. Of these, 93% were enrolled and were predominantly Hispanic, non-US born, and uninsured, with a median age of 45 years (IQR: 37 to 53). HPV self-collection completion rate was 90% (95% CI 82.9% to 94.9%). More than a quarter (27%) of these women had never been screened, and 14% had a screening >10 years prior. Most women who completed the HPV self-collection had positive attitudes and experiences and reported that the kit was easy to use (97%) and would be very willing to use HPV self-collection for regular screening (88%).</p><p><strong>Conclusion: </strong>HPV self-collection for primary cervical cancer screening during noncritical ED visits is possible and highly acceptable among women overdue for cervical cancer screening.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638287","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":"Rapid-Sequence Intubation","authors":"","doi":"10.1016/s0196-0644(24)01209-5","DOIUrl":"https://doi.org/10.1016/s0196-0644(24)01209-5","url":null,"abstract":"[American College of Emergency Physicians: Rapid-sequence intubation. <ce:italic>Ann Emerg Med</ce:italic> April 1997;29:573.]","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"37 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142691129","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":"Interpretation of Diagnostic Studies","authors":"","doi":"10.1016/s0196-0644(24)01208-3","DOIUrl":"https://doi.org/10.1016/s0196-0644(24)01208-3","url":null,"abstract":"[American College of Emergency Physicians: Interpretation of diagnostic studies. <ce:italic>Ann Emerg Med</ce:italic> April 1997;29:572-573.]","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"59 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142691134","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":"HIV and Bloodborne Infections in Emergency Medicine","authors":"","doi":"10.1016/s0196-0644(24)01207-1","DOIUrl":"https://doi.org/10.1016/s0196-0644(24)01207-1","url":null,"abstract":"[American College of Emergency Physicians: HIV and bloodborne infections in emergency medicine. <ce:italic>Ann Emerg Med</ce:italic> 1997;29:571-572.]","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"236 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142691115","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 and Evaluation of a Novel Resuscitation Teamwork Model for Out-of-Hospital Cardiac Arrest in the Emergency Department.","authors":"Kah Meng Chong, Eric Hao-Chang Chou, Wen-Chu Chiang, Hui-Chih Wang, Yeh-Ping Liu, Patrick Chow-In Ko, Edward Pei-Chuan Huang, Ming-Ju Hsieh, Hao-Yang Lin, Wan-Ching Lien, Chien-Hua Huang, Cheng-Chung Fang, Shyr-Chyr Chen, Farhan Bhanji, Chih-Wei Yang, Matthew Huei-Ming Ma","doi":"10.1016/j.annemergmed.2024.09.008","DOIUrl":"10.1016/j.annemergmed.2024.09.008","url":null,"abstract":"<p><strong>Study objective: </strong>Cardiopulmonary resuscitation (CPR) is critical for out-of-hospital cardiac arrest patients but is prone to rapid changes and errors. Effective teamwork and leadership are essential for high-quality CPR. We aimed to introduce the Airway-Circulation-Leadership-Support (A-C-L-S) teamwork model in the emergency department (ED) to address these challenges.</p><p><strong>Methods: </strong>The study comprised 2 phases. The development phase involved reviewing CPR videos, categorizing problems, and formulating strategies using the Systems Engineering Initiative for Patient Safety model. Resuscitation tasks were organized into A-C-L-S domains using hierarchical task analysis. Equipment and environmental deficits were optimized ergonomically with a pit-crew style arrangement. Mnemonics enhanced teamwork and leadership. The evaluation phase assessed postimplementation ED resuscitation team performance, focusing on adherence, timeliness, and quality of A-C-L-S tasks.</p><p><strong>Results: </strong>The development phase produced a structured teamwork model, assigning tasks, tools, mnemonics, and positions based on A-C-L-S domains. The A-team manages the airway and optimizes end-tidal CO₂ levels; the C-team focuses on high-quality chest compressions and defibrillation. Leadership coordinates resuscitation efforts using goal-directed mnemonics (DABCD²E³), whereas the S-team handles medications, timekeeping, and recording. The evaluation phase showed improvements in adherence and timeliness of A-C-L-S tasks, with sustained increases in chest compression fraction before mechanical CPR, from 67.2% preimplementation to 83.0% postimplementation, 89.1% after 1 year, and 86.1% after 2 years. Overall, chest compression fraction also improved from 81.7% to 88.6%, peaking at 92.2% after 1 year and maintaining 90.8% after 2 years.</p><p><strong>Conclusion: </strong>The A-C-L-S teamwork model is feasible, applicable, and effective. Further research is needed to assess its influence on patient outcomes.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613922","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}