Annals of emergency medicine最新文献

{"title":"Managing Analgesia for Hip Fractures.","authors":"Brit Long, Michael Shalaby, Michael Gottlieb","doi":"10.1016/j.annemergmed.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.04.007","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967819","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":"Application-Based Education for Corneal Foreign Body Removal in an Emergency Medicine Residency.","authors":"Viran Jayanetti,James Miers,Angela L Chiew","doi":"10.1016/j.annemergmed.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.03.031","url":null,"abstract":"STUDY OBJECTIVETo assess whether Emergency Procedures App (EPApp) use among emergency physicians improves knowledge and skill in performing corneal foreign body removal compared with usual practice.METHODSThis single-blinded, multicenter, randomized trial involved emergency physicians assessing their knowledge and performance in corneal foreign body removal. Participants were randomized into 2 groups (crossover and EPApp) and completed written and procedural assessments. The crossover group was initially prepared using usual methods, whereas the EPApp group reviewed the EPApp. Both groups used the EPApp for the second attempt. Performance scores from both attempts were compared, with subgroup analyses based on postgraduate years (PGYs) experience less than 4 or more than or equal to 4).RESULTSThirty physicians were recruited, including 14 with PGYs less than 4. The crossover group had 16 participants, with 8 PGYs less than 4. Initial mean test scores were lower in the crossover arm (53%, standard deviation [SD]: 26%) compared with the EPApp arm (72%, SD:15%) (mean difference 18.9%; 95% confidence interval [CI] 2.8, 35). Both groups improved on their second attempt, with larger improvement in the crossover group (25.4%; SD:15.6%; 95% CI 17.14, 33.73) compared with the EPApp arm (13.4%; SD:10.3%; 95% CI 7.45, 19.26). The greatest improvements were seen in participants with PGYs less than 4.CONCLUSIONEPApp use improved knowledge and procedural skills in corneal foreign body removal, especially for junior physicians. Further research into its effectiveness for other procedures and with broader participant groups is warranted.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"115 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914985","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":"Housing Status and Longitudinal Care Patterns After Injury.","authors":"Hannah Decker,Jennifer Evans,Dave Graham Squire,Sara Colom,Kenneth Perez,Maria Raven,Rebecca Plevin,Hemal K Kanzaria,Anne Stey","doi":"10.1016/j.annemergmed.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.03.024","url":null,"abstract":"STUDY OBJECTIVEInjury is a leading cause of hospitalization in people experiencing homelessness, yet post-injury care use is unknown. We sought to understand care use patterns in the 12 months after injury in people experiencing homelessness versus housed low-income Medicaid beneficiaries.METHODSWe conducted a retrospective cohort study examining injured Medicaid beneficiaries in San Francisco from 2015 to 2022. Our primary exposure was housing status at the time of injury, obtained from linking the county's only Level 1 Trauma Center's Trauma Registry to the county-wide Coordinated Care Management System integrated data system. The primary outcome was emergency department (ED) visits in the 12 months after injury. Secondary outcomes were hospital admissions, outpatient visits, and mental health encounters. We adjusted for demographic, clinical, and injury variables as well as preinjury care use.RESULTSAmong 5,998 people, 32.9% (N=1,926) were experiencing homelessness at injury. Approximately 76.9% were men, 82.3% spoke English, and 26.9% were Black. Thirty-four percent of people experiencing homelessness had 4 or more ED visits in the 12 months following injury. People experiencing homelessness had a 0.99 greater adjusted increase in ED visits after injury compared with before injury versus housed low-income Medicaid beneficiaries (95% confidence interval 0.64 to 1.33; P<.001). This pattern was observed for inpatient admissions, outpatient visits, and mental health encounters. ED visits and mental health encounters persisted above preinjury levels for 12 months following injury for people experiencing homelessness.CONCLUSIONThe 12 months following injury had higher health-sector use among those experiencing homelessness than housed low-income Medicaid beneficiaries.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"56 3 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914993","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":"Formative Evaluation to Inform Implementation of Sepsis Bundles in Emergency Departments.","authors":"Hannah E Frank,Nima Sarani,Jacqueline F Hayes,Ruben G Martinez,Jessyca Goldstein,Laura Evans,Gary Phillips,R Phillip Dellinger,David Portelli,Christa Schorr,Kathleen M Terry,Lori Harmon,Sean Townsend,Mitchell M Levy","doi":"10.1016/j.annemergmed.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.04.005","url":null,"abstract":"STUDY OBJECTIVESepsis bundles are effective in reducing mortality for sepsis, the leading cause of admissions to intensive care units. However, little is known about factors that hinder and facilitate the delivery of sepsis bundles in emergency departments. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, the objective of the present study was to characterize determinants of implementing sepsis bundles in emergency departments in the United States.METHODSA formative evaluation guided by the EPIS was conducted with nurses, physicians, and pharmacists using qualitative interviews (N=66 interviews) and quantitative surveys (N=86 surveys). Qualitative interviews were analyzed using a matrix-guided rapid analytic approach. Quantitative surveys were analyzed descriptively.RESULTSScores on quantitative measures indicated that participants perceived evidence-based interventions positively and had moderately positive perceptions of implementation climate and organizational readiness for change. Qualitative results indicate barriers aligned with the EPIS constructs of outer context (eg, perceived rigidity related to Centers for Medicare & Medicaid Services bundle requirements), inner context (eg, alert fatigue), bridging factors (eg, staffing shortages), and innovation factors (eg, concerns about fluid overload). Participants reported facilitators including nurse-driven protocols (inner context) and bundles being straightforward (innovation factors).CONCLUSIONSFindings highlight areas that warrant attention during sepsis bundle implementation efforts in emergency departments, including staff turnover, hesitancy in initiating bundles, competing or misaligned priorities related to bundle implementation, and developing hospital cultures that promote sepsis bundle compliance. These findings will be used to tailor implementation strategies that will support bundle compliance in a hybrid type II effectiveness-implementation trial.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"72 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903047","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":"Is Short-Course Antibiotic Therapy as Effective as Long-Course Therapy for Treatment of Pediatric Community-Acquired Pneumonia?","authors":"Summer Villa,Michael Gottlieb,Brit Long","doi":"10.1016/j.annemergmed.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.04.001","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"54 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902884","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":"Emergency Medicine: A Career or Just a Pit Stop?","authors":"Michelle P. Lin MD, MPH, MS ,&nbsp;Richelle J. Cooper MD, MSHS","doi":"10.1016/j.annemergmed.2025.03.022","DOIUrl":"10.1016/j.annemergmed.2025.03.022","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 6","pages":"Pages 489-490"},"PeriodicalIF":5.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871986","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 Role of Emergency Medicine in Hospital-at-Home.","authors":"Austin S Kilaru,Hashem E Zikry","doi":"10.1016/j.annemergmed.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.03.020","url":null,"abstract":"Hospital-at-home is an evidence-based model for delivering care in patient homes in lieu of a traditional hospital admission. Recent policy changes and technological advancement have spurred growth in hospital-at-home programs across the United States. The role of emergency medicine in hospital-at-home programs has not been clearly defined. We argue that emergency medicine should contribute to the design, implementation, and leadership of these programs, as experts in management of acute illness and patient disposition. Further growth of hospital-at-home is likely to have important implications for the practice of emergency medicine, prompting adaptation and innovation. Finally, hospital-at-home offers a novel strategy to address emergency department boarding, although there is little evidence to suggest that these programs will meaningfully alleviate boarding in either the short term or long term.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"156 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872056","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":"Can the Association of the Biomarkers GFAP and UCH-L1 Predict Intracranial Injury After Mild Traumatic Brain Injury in Adults? A Systematic Review and Meta-Analysis.","authors":"Antoine Puravet,Charlotte Oris,Bruno Pereira,Samy Kahouadji,Ben A Dwamena,Vincent Sapin,Damien Bouvier,","doi":"10.1016/j.annemergmed.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.03.018","url":null,"abstract":"STUDY OBJECTIVESBrain biomarkers have been used to predict intracranial injury in both adults and children following mild traumatic brain injury (mTBI). Several biomarkers have been evaluated, including S100B, NfL, Tau, glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1). The combined measurement of GFAP and UCH-L1 has recently been recommended by scientific societies, but no meta-analysis on the topic has been performed yet.METHODSA meta-analysis was performed to assess the prognostic value of the association of GFAP and UCH-L1 blood levels in predicting intracerebral lesions in adults after mTBI. A protocol was designed and registered with PROSPERO (CRD42024562587). Studies were chosen if they included adults with mTBI who underwent GFAP and/or UCH-L1 measurement and cranial computed tomography scans. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 criteria. Three databases (Medline, Embase, and the Cochrane Central Register of Controlled Trials) were consulted.RESULTSOf the 379 articles screened, 16 were selected for inclusion. The overall pooled sensitivity (Se) and specificity (Spe) were 100% (95% confidence interval [CI] 99% to 100%) and 31% (95% CI 26% to 36%), respectively, for the association of GFAP and UCH-L1. For GFAP alone, the overall pooled Se and Spe were 94% (95% CI 91% to 97%) and 40% (95% CI 34% to 46%), respectively. For UCH-L1 alone, the overall pooled Se and Spe were 83% (95% CI 69% to 94%) and 51% (95% CI 40% to 63%), respectively. The areas under the curve were 88, 67, and 97%, respectively, for GFAP, UCH-L1, and the association GFAP/UCH-L1.CONCLUSIONThe combined measurement of GFAP and UCH-L1 allows the exclusion of intracranial injury after mTBI in adults with 100% Se and negative predictive value. Its routine use can theoretically reduce the number of cranial computed tomography scans by 31%. The different sampling times and techniques used in the studies did not allow us to make specific recommendations.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"21 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872057","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 Qualitative Study Exploring Adolescent and Caregiver Perspectives of Emergency Department Response After a Positive Suicide Screen.","authors":"Rachel Cafferty,Anastasia Klott,Ashley Dafoe,Chloe Glaros,Brooke Dorsey,Maya Haasz,Bruno J Anthony,Sean T O'Leary","doi":"10.1016/j.annemergmed.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.03.019","url":null,"abstract":"STUDY OBJECTIVEAs a safety net for adolescents, the emergency department (ED) is considered an opportune setting for suicide screening and response (ie, safety assessments, brief interventions, and referrals). This study explored adolescent and caregiver perspectives on the ED's response when nonacute suicide risk was identified during universal screening.METHODSThis was a qualitative study of adolescents who completed the Ask Suicide-Screening Questions (ASQ) in the ED and/or their caregiver. Our institution performs universal suicide screening with the ASQ for all ED patients aged 10 or more years. We conducted semistructured interviews with adolescents (13 to 17 years) who had a \"nonacute positive\" ASQ (defined as \"yes\" to questions 1 to 4 on the ASQ without current thoughts of suicide), and/or their caregiver. Interviews were scheduled after ED discharge and occurred from October 2023 to June 2024. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti. Content analysis was used to identify salient themes. The analytic team diagrammed each participant's story to augment the analysis.RESULTSWe completed 17 interviews (8 adolescents and 9 caregivers). Three primary themes were identified: (1) responses by ED clinicians are lacking, confusing, and inconsistent; (2) ED responses should be tailored, well timed, private, and autonomous; and (3) resources provided by the ED should empower adolescents and caregivers moving forward. Participants recommended resources that overcome barriers to care and standardized ED interventions to better support patients and families.CONCLUSIONIn this study, the ED response to nonacute suicide risk was described as inadequate. Participants recommended additional resources to safely manage suicidal thoughts and navigate mental health treatment.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"23 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866987","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":"Upper Respiratory Infections and Respiratory Adverse Events and Interventions in Emergency Department Sedation of Children.","authors":"Daniel S Tsze,Nick Barrowman,Maala Bhatt","doi":"10.1016/j.annemergmed.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.03.016","url":null,"abstract":"STUDY OBJECTIVEChildren with upper respiratory infections (URIs) have an increased risk of respiratory adverse events when undergoing operative anesthesia and in general populations of children receiving procedural sedation. It is unclear if children with URI undergoing emergency department (ED) sedation share the same increased risk. We aimed to determine if the presence of a URI in children undergoing ED sedation is associated with increased risk of respiratory adverse events and serious respiratory interventions.METHODSWe conducted a secondary analysis of a prospective cohort study of children aged 17 years or younger who received parenteral sedation for a painful procedure in 1 of 6 pediatric EDs. A multivariable regression model was used to identify potential associations between URI and respiratory adverse events, serious respiratory adverse events (ie, complete airway obstruction, apnea, laryngospasm, clinically apparent pulmonary aspiration, and death), and serious respiratory interventions (ie, bag-valve-mask ventilation and endotracheal intubation).RESULTSWe analyzed 6,292 children; 444 (7.1%) had a URI. The risk of respiratory adverse events, serious respiratory adverse events, or serious respiratory interventions was adjusted odds ratio (aOR) 1.00 (95% confidence interval [CI] 0.78 to 1.29), 0.53 (95% CI 0.18 to 1.58), and 1.08 (95% CI 0.68 to 1.71), respectively.CONCLUSIONIn this study, we found no increase in risk of any respiratory adverse events or serious respiratory interventions associated with URI in children undergoing ED sedation.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"11 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866778","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}