BMC Emergency Medicine最新文献

{"title":"Impact of pediatric urgent care clinics on emergency department utilization and patient flow: a pre-post cohort study in Saudi Arabia.","authors":"Abdulhameed Al Khalaf, Alla Albisher, Ahmed Al Shams, Mohammed Al Khalaf, Jassem Althani, Jassim Al Essa, Ali Al Ali, Mohammed Alwabari, Haidar Alhassan","doi":"10.1186/s12873-026-01670-0","DOIUrl":"10.1186/s12873-026-01670-0","url":null,"abstract":"<p><strong>Background: </strong>Pediatric emergency departments (PEDs) frequently experience overcrowding, much of it related to low-acuity visits that may be manageable in outpatient settings. Pediatric Urgent Care Clinics (PUCCs) have been introduced to help accommodate such demand, but evidence from the Gulf region remains limited.</p><p><strong>Objectives: </strong>To evaluate changes in PED utilization, acuity mix, and patient-flow indicators following implementation of a PUCC at the Maternity and Children's Hospital in Alahsa, Saudi Arabia.</p><p><strong>Methods: </strong>We conducted a retrospective pre-post observational cohort study using electronic health record data from October 2023 to June 2024 (pre-implementation) and October 2024 to June 2025 (post-implementation). Variables included Canadian Triage and Acuity Scale (CTAS) level, timestamps for triage, physician start, and discharge, and demographic characteristics. Outcomes included PED visit volume, acuity distribution, door-to-doctor time, and length of stay (LOS). Continuous variables were summarized using medians with interquartile ranges (IQRs) and 5% trimmed means; categorical variables were compared using chi-square tests, and effect sizes for binary outcomes were expressed as risk ratios (RRs) with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 147,175 PED encounters were analyzed, including 84,595 in the pre-implementation period and 62,580 in the post-implementation period. In the post-implementation period, an additional 24,962 encounters were managed in the PUCC. The proportion of low-acuity PED visits (CTAS 4-5) decreased from 81.1% to 50.2% (RR 0.62; 95% CI 0.61-0.62; p < 0.001). Mean daily PED encounter volume declined from 308.7 to 229.2 encounters/day (incidence rate ratio 0.74; 95% CI 0.74-0.75; p < 0.001). Median door-to-doctor time was 37 min (IQR 22-63) before implementation and 39 min (IQR 22-65) after implementation, while median LOS increased from 62 min (IQR 34-112) to 76 min (IQR 43-131) (p < 0.001 for distributional comparisons).</p><p><strong>Conclusion: </strong>Implementation of a PUCC was associated with lower PED visit volume, a reduced proportion of low-acuity PED encounters, and a small absolute difference in door-to-doctor time, while PED LOS was longer in the post-implementation period. These findings suggest that a PUCC model may help redistribute lower-acuity pediatric encounters within a hospital-based urgent and emergency care system. Further studies are needed to evaluate safety outcomes and to better account for operational confounding.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148409955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early decision effect of withholding and/or withdrawing life-sustaining treatment on emergency department patients' short- and long-term outcomes: a retrospective analysis.","authors":"Joseph Sinoquet, Pradeebane Vaittinada Ayar, Prabakar Vaittinada Ayar","doi":"10.1186/s12873-026-01669-7","DOIUrl":"10.1186/s12873-026-01669-7","url":null,"abstract":"<p><strong>Background: </strong>In France, a significant proportion of end-of-life (EOL) decisions occur in emergency departments (EDs), where time constraints and limited resources may hinder optimal care. Although withholding or withdrawing life-sustaining treatments (WHWD) is common in this context, the impact of timing on patient outcomes remains unclear. The aim of this study was to assess the effect of WHWD decision timing on short- and long-term outcomes among adult emergency department patients.</p><p><strong>Methods: </strong>We conducted a retrospective, observational study at Beaujon Hospital's ED (Paris, France) between January 2020 and December 2021. We included all adult patients admitted to the observation unit with a WHWD decision. Patients were categorized into early (eWHWD) and late (lWHWD) groups based on the median time to decision. The primary endpoint was 28-day all-cause mortality. Cox regression was used for survival analysis, adjusting for age, sex, comorbidities, functional status, and severity of illness.</p><p><strong>Results: </strong>WHWD was decided in 354 patients. Patients in the eWHWD group (n = 176) were older, more functionally impaired, and had higher illness severity than those in the lWHWD group (n = 178). Early decisions occurred within a median of 2 h versus 7 h in the late group. Short-term mortality was significantly higher in the eWHWD group at 7 days (58% vs. 44%) and 28 days (76% vs. 65%). After adjustment, late WHWD remained independently associated with better survival at 7-days, 28-days, 90-days and 1-year. Respectively adjusted Hazard Ratios were equal to 0.71; 95% confidence interval (CI) (0.66 to 0.76), 0.73; 95% CI (0.68 to 0.78), 0.76; 95% CI (0.72 to 0.81) and 0.86; 95% CI (0.81 to 0.91).</p><p><strong>Conclusion: </strong>Early WHWD decisions reflect more severe patient conditions and are linked to poorer short and long-term outcomes. Enhancing advance care planning and integrating palliative care into ED practices may improve decision quality and align care with patient values.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of community paramedicine service on prehospital time intervals in rural Norway: a quasi-experimental study.","authors":"Odd Eirik Elden, Oddvar Uleberg, Emma Brulin, Bodil J Landstad, Maja Pålsdatter Lønvik, Øyvind Salvesen, Havard Dalen","doi":"10.1186/s12873-026-01642-4","DOIUrl":"10.1186/s12873-026-01642-4","url":null,"abstract":"<p><strong>Background: </strong>Community paramedicine service (CPS) may improve prehospital healthcare delivery in rural regions. As CPS does not provide patient transport, its introduction could prolong prehospital time intervals. Thus, we aimed to evaluate whether CPS implementation influenced prehospital time intervals for acute patients admitted to hospital.</p><p><strong>Methods: </strong>In this quasi-experimental study, we compared prehospital time intervals for acute missions resulting in hospital admission in two rural Norwegian municipalities with similar characteristics. Data were collected over four years before and two years after CPS implementation in one municipality (CPS_REGION). The second municipality served as a control (CONTROL_REGION).</p><p><strong>Results: </strong>Of 1,872 missions, 362 acute missions with hospital admission were included, of which 228 occurred in the CPS_REGION and 134 in the CONTROL_REGION. After CPS implementation, the median response interval was reduced from 19 to 11 min (p < 0.001), whereas no statistically significant changes were observed for the other prehospital time intervals in the CPS_REGION or for any prehospital time intervals in the CONTROL_REGION (all p > 0.12). Difference-in-differences analyses showed no statistically significant difference for total prehospital interval (-2 min, p = 0.850), while there were significantly shorter response- (-7 min, p < 0.001) and emergency medical service (EMS) on-scene intervals (-6 min, p = 0.003). Higher age was associated with longer total prehospital interval (p = 0.018).</p><p><strong>Conclusions: </strong>CPS implementation was not associated with changes of the total prehospital interval but was linked to shorter response interval and EMS on-scene intervals, which may indicate earlier arrival of prehospital personnel without evidence of delayed start of transport. However, given the observational design and the absence of clinical outcome data, the overall impact on patient safety and system performance remains uncertain.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective blinded interim evaluation of a portable radiofrequency device TES HT to support triage in emergency department patients with mild head trauma or acute neurological symptoms.","authors":"Adriana Modestina Conte, Fabrizio Alfieri, Angelo Localzo, Esaù Russo, Iole Cucinotto, Alessandro Trovato, Riccardo Gualtieri, Ettore Laccetti, Antonia Sorbo","doi":"10.1186/s12873-026-01676-8","DOIUrl":"10.1186/s12873-026-01676-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Emergency Department (ED) evaluation of patients presenting with mild head trauma or acute neurological symptoms is common and often requires rapid exclusion of intracranial pathology. Although computed tomography (CT) is the diagnostic reference standard, its widespread use raises concerns regarding radiation exposure, cost, and ED workflow efficiency. TES HT100 is a portable, non-invasive radiofrequency-based device intended to assist early triage decisions. We report the prespecified interim analysis of a prospective validation study conducted in an ED population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between December 2024 and January 2026, adult patients were enrolled at the Emergency Department of Pineta Grande Hospital, Castel Volturno, Italy. In this single-center, blinded diagnostic accuracy study, participants were included in two predefined cohorts: mild head trauma and non-traumatic acute neurological symptoms. TES HT100 provides a binary output and was compared with radiologist-interpreted head CT as the reference standard. Sensitivity, specificity, predictive values, likelihood ratios, accuracy, and balanced accuracy were calculated with 95% confidence intervals. Additional exploratory analyses stratified CT findings into acute clinically relevant abnormalities and chronic/incidental intracranial abnormalities without changing the prespecified primary endpoint. Robustness analyses assessed the impact of excluded or non-evaluable cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;ClinicalTrials.gov Identifier NCT07490418, registered on 23 March 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The interim analysis included 301 patients (151 trauma; 150 neurological symptoms). CT-positive prevalence was 52.2%, consistent with the CT-imaged Emergency Department population and the protocol-defined broad intracranial abnormality endpoint. Overall sensitivity was 96.2% (95% CI 91.9-98.2), specificity 82.6% (75.6-88.0), PPV 85.8%, NPV 95.2%, and accuracy 89.7%. The positive likelihood ratio was 5.54 and the negative likelihood ratio 0.05. Exploratory category-specific analyses showed sensitivity and NPV of 96.6% and 98.4%, respectively, for acute clinically relevant abnormalities, and 96.0% and 96.0%, respectively, for chronic/incidental abnormalities. Specificity was lower in the acute-target analysis (50.6%), supporting interpretation of TES HT100 as a structural-abnormality triage signal rather than a lesion-specific acute-pathology classifier.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this interim evaluation, TES HT100 demonstrated high sensitivity and a low negative likelihood ratio compared with CT in ED patients with head trauma or acute neurological symptoms. These findings support further evaluation of TES HT100 as a triage-support adjunct in CT-imaged ED populations. Exploratory acute/chronic analyses provide additional clinical context but should not be interpreted as evidence of lesion-specific performance for acute ab","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered mental status in cancer-related emergency hospitalizations: prevalence and recorded reasons for admission.","authors":"Lindun Ge, Yasufumi Gon, Yasuyoshi Kimura, Toshitaka Morishima, Tatsusada Okuno, Hideki Mochizuki, Isao Miyashiro","doi":"10.1186/s12873-026-01667-9","DOIUrl":"10.1186/s12873-026-01667-9","url":null,"abstract":"<p><strong>Background: </strong>Altered mental status is a critical clinical presentation in emergency departments, yet its frequency in cancer-related emergency hospitalizations and the clinical conditions recorded at presentation have not been well characterized.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study using data from the Cancer Registry-based Study on Cancer Care in Osaka (CanReCO), which links hospital-based cancer registry data with Diagnosis Procedure Combination (DPC) administrative data. The cohort included patients diagnosed between January 2019 and December 2022, and linked DPC hospitalization records available through June 2023 were used to identify first emergency hospitalizations after cancer diagnosis. We extracted cases presenting with altered mental status, defined as a Japan Coma Scale score ≥ 1. Recorded reasons for admission were described overall and according to cancer stage and cancer type.</p><p><strong>Results: </strong>Of 55,949 cancer-related emergency hospitalizations across 68 participating hospitals, 5,881 (10.5%) involved altered mental status. The most frequent reasons for admission among patients with altered mental status were index cancer (32.3%), stroke (8.6%), and pneumonia (6.9%). When analyzed by cancer stage at diagnosis, index cancer, CNS metastasis, and sepsis were more frequently recorded in later stages. When analyzed by cancer type, certain reasons were more frequent in specific malignancies, including CNS metastasis in lung and breast cancers; pneumonia in lung cancer; sepsis in hematologic, pancreatic, and biliary cancers; and hyperglycemia or diabetes mellitus in pancreatic cancer, among others.</p><p><strong>Conclusions: </strong>Altered mental status was commonly recorded among cancer patients requiring emergency hospitalization. The reasons for admission varied by cancer stage and cancer type, with neurological and infectious diagnoses frequently observed. These findings provide descriptive information that may help clinicians consider cancer-specific patterns when evaluating cancer patients presenting with altered mental status in emergency settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency training in medical practices and resuscitation quality: results from a regional study in Germany.","authors":"Lorenz Prinz, Vivian Lüdorf, Jan P Ehlers, Julia Nitsche","doi":"10.1186/s12873-026-01664-y","DOIUrl":"10.1186/s12873-026-01664-y","url":null,"abstract":"<p><strong>Background: </strong>High-quality cardiopulmonary resuscitation (CPR) is essential for improving outcomes in emergency patients treated in medical practices. Although regular emergency training is recommended, its measurable impact on resuscitation quality parameters in this setting has not been sufficiently investigated.</p><p><strong>Objective: </strong>The aim of this study was to examine the effects of emergency training on the quality of resuscitation measures in medical practices. Specifically, it sought to determine which resuscitation parameters could be influenced by the intervention and whether the quality of care was associated with emergency patient management.</p><p><strong>Methods: </strong>Seventeen medical practices participated. Each completed a 5-minute resuscitation simulation before (T1) and after (T2) emergency training. Quantitative data were collected on compression rate, compression depth, ventilation frequency, ventilation volume, no-flow time, incorrect hand position and missing defibrillation discharges. Due to small sample size and non-normal distribution, Wilcoxon signed-rank tests were applied. Spearman correlation analysis assessed the association between baseline performance and time since last emergency training.</p><p><strong>Results: </strong>Significant improvements were observed in ventilation frequency (p = 0.007), ventilation volume (p < 0.001), ventilation volume per minute (p = 0.003), compression depth (p < 0.001), and incorrect hand position (p = 0.001). Compression rate, no-flow time, and missing discharges did not change significantly. Compression depth increased from 31 [27.5-36.5] mm to 48 [45-56] mm, while ventilation frequency increased from 1.00 [0.00-3.50] to 3.00 [3.00-4.00]. Compression rate remained unchanged (p = 0.570). Time since last emergency training correlated with baseline performance (r_s = -0.516, p = 0.034).</p><p><strong>Conclusions: </strong>Emergency training significantly improves key resuscitation quality parameters in medical practices. Performance declines with increasing time since last training, underscoring the need for regular repetition. Structured, hands-on emergency training appears essential to maintain high-quality CPR performance.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of HINTS Plus test in the differential diagnosis of central and peripheral vertigo: a prospective, cross-sectional study.","authors":"Ahmet Coşkun, Alp Şener, Oğuzhan Oğuz, Burhan Burak Kuzucu, Hesna Bektaş","doi":"10.1186/s12873-026-01675-9","DOIUrl":"10.1186/s12873-026-01675-9","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the diagnostic accuracy of the HINTS Plus tool in differentiating central vertigo from peripheral vertigo in the emergency department, using neuroimaging as the reference standard.</p><p><strong>Methods: </strong>This cross-sectional study included adult patients with acute vestibular syndrome without focal neurological deficits. Crucially, all patients underwent neuroimaging with non-contrast brain tomography and magnetic resonance imaging to definitively exclude central pathology. Diagnostic accuracy of the HINTS Plus test was assessed by comparing bedside findings with neuroimaging results.</p><p><strong>Results: </strong>Of 298 patients enrolled, 62 had central and 236 peripheral vertigo patients. The sensitivity and specificity of the HINTS Plus for detecting central vertigo were 80.65% (95% CI: 68.63-89.58) and 82.63% (95% CI: 77.18-87.24), respectively. The Head Impulse Test demonstrated the highest sensitivity (70.97%) among individual components.</p><p><strong>Conclusion: </strong>HINTS Plus demonstrated moderate diagnostic accuracy in a real-world emergency department setting. Although useful as a bedside adjunct, the observed false-negative rate and LR- suggest that HINTS Plus should not be used as the sole strategy to exclude central causes of acute vestibular syndrome. Neuroimaging and overall clinical assessment remain essential components of diagnostic decision-making.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder perspectives on implementing ED time series forecasting: a qualitative interview study.","authors":"Luka Petravić, Kaja Gril Rogina, Janez Žibert, Tit Albreht, Andreja Kukec","doi":"10.1186/s12873-026-01671-z","DOIUrl":"10.1186/s12873-026-01671-z","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) around the globe are experiencing increasing patient attendance and staffing challenges, making it difficult for management to balance supply and demand. Time series forecasting (TSF) is a statistical technique that uses historical data and external variables to predict phenomena over time. Given the growing interest in TSF applications in emergency care, the aim of this study was to explore how these technologies could be aligned with everyday clinical demands to close the translational science gap.</p><p><strong>Methods: </strong>This was a prospective qualitative interview study. Through interviews with European emergency department directors, we collected and analysed perspectives on the practical applicability of time series forecasting in everyday emergency care. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).</p><p><strong>Results: </strong>We interviewed 26 ED directors in 19 countries. Over half had prior knowledge of time series forecasting technology. Only three countries had TSF implemented in daily practice. Most ED directors reported that their management decisions are informed by data and indicated openness to the adoption of additional decision-support tools, such as TSF. Novel, previously undescribed external variables were identified, including local primary care availability, fruit harvesting, and neighbouring hospital conditions (e.g. ED closures).</p><p><strong>Conclusions: </strong>We recommend that future TSF modelling studies in ED implement, at a minimum, both short- and long-term forecast horizons; conduct in-depth interviews with local senior staff to align models with operational needs; and validate models using real-world data from deployment sites. Through semi-structured interviews, we identified key directions for further TSF model development to enhance usability and support translation from academia into clinical practice.</p><p><strong>Study registration: </strong>This study was preregistered via Open Science Framework site ( https://doi.org/10.17605/OSF.IO/SGZH7 ).</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence as a second reader for pneumothorax detection: redirecting rather than reducing chest CT use.","authors":"Muhammed Fatih Cırıl, Ferhat Yıldız, Mustafa Akarca","doi":"10.1186/s12873-026-01673-x","DOIUrl":"10.1186/s12873-026-01673-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pneumothorax is a finding that is frequently missed in the emergency department, particularly in cases with subtle radiographic features, and can rapidly progress to tension pneumothorax when overlooked on the initial chest radiograph. Although artificial intelligence (AI)-assisted chest radiograph interpretation has been shown to improve diagnostic accuracy, its effect on the actual decision behaviour of emergency physicians - particularly on chest computed tomography (CT) ordering - remains insufficiently studied. This study evaluated the impact of AI-assisted chest radiograph interpretation on emergency physicians' pneumothorax diagnostic decisions and chest CT ordering behaviour, with a particular focus on the capacity of the AI alert to function as a second reader and capture diagnoses initially missed by the physician.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a nationwide, online, cross-sectional simulation study conducted between 1 and 15 April 2026. Emergency physicians practising in Türkiye were asked to interpret 20 standardised posteroanterior chest radiographs presented in a randomised order (10 pneumothorax-positive [5 overt and 5 subtle] and 10 pneumothorax-negative cases, all confirmed by chest CT). For each case, participants first indicated whether they suspected pneumothorax on the unannotated radiograph, and then - after being shown the same image annotated by a CE-certified, deep learning-based chest radiograph interpretation system - indicated whether they would order a chest CT. The primary endpoint was the paired pre-AI versus post-AI change in simulated CT-ordering intent, derived from a predefined survey coding scheme and analysed using the McNemar exact test. As the pre- and post-AI items do not capture CT-ordering intent identically, this endpoint reflects simulated imaging intent rather than observed CT-ordering behaviour.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 231 physicians (51.5% general practitioners, 25.5% emergency medicine residents, 22.9% emergency medicine specialists) completed the survey, yielding 4,620 physician-case response pairs. Simulated CT-ordering intent rose from 8.1% before AI exposure to 26.7% after AI exposure (absolute difference + 18.6% points; p &lt; 0.001). The increase was concentrated in pneumothorax-positive cases (+ 31.6 points; p &lt; 0.001) and remained limited in pneumothorax-negative cases (+ 5.7 points; p &lt; 0.001). In subtle pneumothorax cases, the integrated diagnostic capture rate rose from 54.8% to 85.0% (+ 30.2 points); among the 339 cases in which physicians had initially answered \"no pneumothorax,\" 211 (62.2%) were converted into a CT order after the AI alert. The effect was statistically significant across all professional titles and seniority strata (p &lt; 0.001 for all). The mean perceived usability score of the system was 8.1 out of 10 (interquartile range 7-10).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this simulation, AI-assisted chest radiograph","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling emergency department triage in everyday practice: An ethnographic study of underlying mechanisms across three Danish emergency departments.","authors":"Cecilie Blomberg Hvid, Michael Dan Arvig, Ove Andersen, Per Nilsen, Christina Østervang, Uswa Nissar Nomani Anjum, Jeanette Wassar Kirk","doi":"10.1186/s12873-026-01612-w","DOIUrl":"10.1186/s12873-026-01612-w","url":null,"abstract":"<p><strong>Background: </strong>Emergency department triage is commonly conceptualised as a standardised classification of patient urgency based on vital signs and presenting symptoms. However, research shows that triage is deeply shaped by the clinical context such as organizational structure, clinical uncertainty and subjective decision-making. This contextual complexity presents a challenge for the implementation of artificial intelligence decision-support in emergency care. While Artificial Intelligence-supported triage has demonstrated promising accuracy in controlled settings, these evaluations capture only a limited part of triage work and rarely account for the underlying mechanisms through which triage is sustained in everyday clinical practice. To address this gap, this study aimed to examine how triage unfolds in real-world emergency care and to understand the underlying generative mechanisms shaping triage practice.</p><p><strong>Methods: </strong>An ethnographic study was conducted across three Danish emergency departments with different organisational triage configurations. Data consisted of participant observations of triage practice and semi-structured interviews with nurses and physicians. Data were analysed using inductive qualitative content analysis. Findings were interpreted, informed by a critical realistic lens, to understand underlying generative mechanisms shaping triage practice.</p><p><strong>Results: </strong>Triage was not a standardized classification event but a dynamic, negotiated practice across the acute admission pathway. Two core generative mechanisms were identified: 1) Coherence work sustained continuity, safety, and flow through transitional coordination, gap compensation, situated judgement, and pragmatic prioritisation. 2) Interpretive reasoning enabled healthcare professionals to navigate clinical complexity through situated interpretive filtering and experience-driven judgement. Both mechanisms were activated by managing competing demands between safety, continuity, and flow within fragmented, resource-constrained organisational setups. Both mechanisms drew on tacit and embodied knowledge not routinely documented or available to artificial intelligence systems.</p><p><strong>Conclusions: </strong>These findings demonstrate that safe and effective triage depends not only on accurate classification but on largely invisible adaptive work embedded in everyday practice under conditions of clinical uncertainty and organisational fragmentation. For artificial intelligence-supported triage to achieve clinical impact, system design must recognise and support the coherence- and interpretive reasoning work through which continuity, safety, and flow are maintained in real-world emergency care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}