CJEM最新文献

{"title":"Beyond the emergency department: the use of mobile health discharge interventions-a scoping review.","authors":"Courtney Price, Omar Anjum, Maxim Ben-Yakov, Ani Orchanian-Cheff, Venkatesh Thiruganasambandamoorthy","doi":"10.1007/s43678-025-00932-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00932-3","url":null,"abstract":"<p><strong>Objectives: </strong>Mobile health interventions can enhance post-emergency department (ED) care by improving care transitions and optimizing patient follow-up, yet their utility remains underexplored. Our objective was to review mobile health discharge interventions from the ED and to characterize these interventions by technology types, patient and clinical populations studied, and outcomes assessed.</p><p><strong>Methods: </strong>We performed a scoping review of mobile health interventions supporting post-ED care following Joanna Briggs Institute and PRISMA Extension for Scoping Reviews guidelines. Four databases (Medline, Embase, Cochrane Central and Systematic Reviews) were searched for studies in English from 2007 to 2024. Included studies were mobile health interventions administered within ED settings focused on the clinical encounter. Abstract and full-text screening were performed by two independent reviewers. Data were charted by technology type, intended clinical use, and outcomes.</p><p><strong>Results: </strong>Of 4,313 records identified, 43 studies were included. Most articles were published between 2021 and 2024 (28, 65%), were pilot studies (18, 42%) and in single academic site with adult patients. Technologies included text messaging (18, 42%), remote patient monitoring (16, 37%), and mobile phone applications (9, 21%). Common conditions studied included respiratory disease (12, 28%), general post-ED care across all presenting complaints (8, 19%), and infectious disease (6, 14%). Among primary outcomes, health systems outcomes were frequently assessed (18, 42%), followed by feasibility (13, 30%) and clinical outcomes (10, 23%). Across all outcomes, most studies reported improved outpatient follow-up adherence (78%, 7/9) and clinical disease states (54%, 6/11). ED revisit rates varied in the 17 studies that reported it (41% [7] no change, 29% [5] reduced, 29% [5] no comparator group).</p><p><strong>Conclusions: </strong>Mobile health interventions have been introduced to support post-ED care with emerging, yet limited evidence of their impact on ED revisit rates, follow-up care, and enhanced clinical outcomes.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in the 1-year outcomes of emergency department patients with alcohol withdrawal.","authors":"Frank Scheuermeyer, Skye Barbic, M Eugenia Socias, Amanda Slaunwhite","doi":"10.1007/s43678-025-00986-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00986-3","url":null,"abstract":"<p><strong>Background: </strong>Alcohol withdrawal is a common emergency department (ED) presentation, but differences in long-term outcomes between female and male patients are not clear.</p><p><strong>Methods: </strong>From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, British Columbia, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics and ED treatments. We linked with regional ED and provincial data to obtain the outcomes of 1-year return ED visits and mortality, respectively. The primary outcome was at least one return visit to the ED, and secondary outcomes included ED revisits and 1-week, 1-month, and 1-year mortality. We compared female patients with male patients using descriptive methods.</p><p><strong>Results: </strong>We identified 1,019 unique patients with 273 (26.8%) female. Median ages, ambulance arrival, initial withdrawal severity score, and index visit admission rates were similar. At 1 year, 186 (68.1%) female and 515 (69.0%) male patients reattended an ED, for a difference of 0.9%; (95% CI - 5.5 to 7.7%). A significantly greater proportion of male patients reattended at 1 week and 1 month, and the average number of male ED revisits was greater at 1 week, 1 month, and 1 year. By 1 year, a female patient (0.4%) and 19 males (2.6%) died, for a difference of 2.2% (95% CI 0.3-3.6%).</p><p><strong>Conclusion: </strong>Despite similar ED presentations, female patients with alcohol withdrawal had fewer 1-year ED visits and lower mortality. EDs may wish to incorporate sex-specific approaches to post-discharge management.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the geriatric-friendliness of emergency departments in the Canadian province with the oldest population.","authors":"Queen Jacques, Elise Thorburn, Jennifer Perry, David Bradbury-Squires, Susan Mercer, Michael Parsons, Kayla Furlong","doi":"10.1007/s43678-025-00974-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00974-7","url":null,"abstract":"<p><strong>Objectives: </strong>The number of older adults presenting to emergency departments (EDs) is rising. The care of older adults in the ED is challenged by atypical disease presentations and multimorbidity, among other factors. The geriatric ED guidelines-first developed in the United States in 2014-were developed to help EDs improve the care of older adults. However, little is known about Canadian EDs adherence to or implementation of these guidelines and geriatric-friendly ED principles. Our study aimed to describe the geriatric-friendliness of EDs and identify barriers to implementation in Newfoundland and Labrador, the Canadian province with the oldest population.</p><p><strong>Methods: </strong>A cross-sectional study was performed at EDs across Newfoundland and Labrador. We recruited ED site representatives through social media, email listservs, and word of mouth. ED site representatives were healthcare professionals familiar with the care of older adults in the ED. A 28-item questionnaire and a semi-structured interview via telephone were conducted. Proportions and percentages are reported for categorical data. Interview data were grouped into themes based on common patterns in participant responses.</p><p><strong>Results: </strong>Twenty-three EDs participated in the study. ED site representatives were physicians (n = 13), nurses (n = 5), and advanced care paramedics (n = 2). One site identified a physician with a focused education in geriatric emergency medicine. No sites had a nurse with a focused education in geriatric emergency medicine. Only one site tracked process and outcome measures. Most sites had wheelchair-accessible toilets and food and drink available. Barriers to making EDs more geriatric-friendly were identified and included challenges related to resources, infrastructure, education and training, the provision of adequate care, awareness of geriatric-friendly ED principles, and ability to implement change.</p><p><strong>Conclusion: </strong>This study demonstrates a lack of geriatric-friendly EDs in Newfoundland and Labrador. Barriers to implementation were widespread and similar between participating ED sites.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No room at the inn: pediatric psychiatric patients wait far longer for inpatient beds than their non-psychiatric counterparts; evidence of structural stigma.","authors":"Cassandra Chisholm, Xiaoming Wang, Kyle Guild, Conné Lategan, Zoe Hsu, Eddy Lang","doi":"10.1007/s43678-025-00984-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00984-5","url":null,"abstract":"<p><strong>Background: </strong>Pediatric emergency department (ED) boarding has considerable implications on patient care, safety, and outcomes. Few Canadian studies explore pediatric patients' boarding. Understanding which pediatric presentations are impacted by boarding is fundamental to informing psychiatric infrastructure, public policy, and system improvements. Our primary objective was to explore pediatric and adolescent ED median boarding time for psychiatric patients versus non-psychiatric patients while considering the impact of COVID-19 on boarding trends.</p><p><strong>Methods: </strong>We performed an observational study for 96 EDs in Alberta, Canada using the National Ambulatory Care Reporting System data from 2018-2023. Admitted patients aged 6-17 were included and classified as psychiatric or non-psychiatric using the International Statistical Classification of Diseases. Boarding was defined as the time from admission decision to patients departing the ED. Descriptive statistics summarized patient and ED visit characteristics and median (IQR) boarding time during three time periods to account for COVID-19. Semi-parametric interrupted time-series analysis compared psychiatric and non-psychiatric patient boarding trends.</p><p><strong>Results: </strong>A total of 38,821 pediatric and adolescent patients were admitted from an ED with psychiatric (25%) or non-psychiatric (75%) diagnoses. Psychiatric patients were predominantly female (70.6%) with an older median age of 15. The median (IQR) boarding time for psychiatric patients was 156% longer (241 min (88-1023)) than non-psychiatric patients (93 min (53-1590)). Comparing the initial and final study periods, psychiatric boarding increased by 52% (94 min), and non-psychiatric patient boarding increased by 7% (7 min).</p><p><strong>Conclusion: </strong>This is the largest and most recent comparison of pediatric and adolescent psychiatric and non-psychiatric boarding in Canada. Pediatric psychiatric patients experience substantially longer ED boarding times than non-psychiatric patients and worsened to a greater extent over the 5-year period. Our findings suggest substantial inequity in pediatric psychiatric patients' access to inpatient acute care beds and disparities in hospital-based psychiatric care.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: contrast allergy in the emergency department.","authors":"Derek Lanoue, Adam Byrne, D Blair Macdonald, Ariel Hendin","doi":"10.1007/s43678-025-00995-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00995-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic use of ketamine for severe agitation and violence.","authors":"Jonathan L Kwong, P Richard Verbeek, Yuen Chin Leong, Linda Turner, Maud Huiskamp, Ian R Drennan, Sarah Francom, Sarah Ropp, Sheldon Cheskes","doi":"10.1007/s43678-025-00963-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00963-w","url":null,"abstract":"<p><strong>Objectives: </strong>Safety of prehospital ketamine use for the management of violent and agitated patients remains controversial. In 2018, Ontario introduced a prehospital medical directive for ketamine use in emergency sedation. Our aim was to report the indications and adverse events of prehospital ketamine use.</p><p><strong>Methods: </strong>We completed a manual health records review of all electronic patient care records from three paramedic services (Peel, Simcoe and Halton) reporting ketamine administration from January 1, 2018 to May 31, 2022. Clinical indications, dosing, adverse events, and interventions to manage complications associated with ketamine administration were abstracted and analyzed using descriptive and bivariate statistics.</p><p><strong>Results: </strong>Of 332 cases identified, 19 cases were excluded (final sample = 313). The most common indication for ketamine use was for endogenous causes (e.g., drug-induced psychosis, agitation from brain injury, delirium) (82.1%), followed by procedural sedation (9.6%) and analgesia (8.3%). When ketamine was administered as the first sedative, it was most often given intramuscularly (81.5%) with an average dose of 4.2 mg/kg. There were no vital signs documented prior to administration in 34% of cases. 30.3% (N = 82) of cases had adverse events after ketamine was given. Hypoxia (15.4%), airway compromise (14.8%), and secretions/emesis (7.0%) were most common. When ketamine was used as the first sedative, 19.6% of patients received oxygen, 11.8% had an airway adjunct (oro- or nasopharyngeal airway) and 5.5% required bag-mask-ventilation. Advanced airways were inserted in six patients. There were three cardiac arrests after ketamine use.</p><p><strong>Conclusions: </strong>Prehospital ketamine is primarily used to sedate patients demonstrating severe violence or agitation related to various endogenous causes. Over 30% of patients develop adverse events after receiving ketamine. Although uncommon, we identified cases where patients required advanced airway placement and had cardiac arrest after ketamine administration. Paramedics should be prepared for the frequent number of adverse events after ketamine use.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: management of drug-induced seizures.","authors":"Jessica T Kent, Adrianna Rowe, Emily Austin","doi":"10.1007/s43678-025-00992-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00992-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the CJEM Editor: response to Dr. Kaplan.","authors":"James C Worrall, A Hendin, S Kanji","doi":"10.1007/s43678-025-00985-4","DOIUrl":"https://doi.org/10.1007/s43678-025-00985-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just the facts: calcium administration in trauma patients receiving massive blood transfusions.","authors":"Theodore Muth, Ian Ball, Raquel Oleksin, Alyssa Ball","doi":"10.1007/s43678-025-00994-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00994-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between prolonged emergency department (ED) wait times and short-term all-cause mortality: an analysis of multi-institutional administrative data in Alberta.","authors":"Niloofar Taghizadeh, Jeffrey Bakal, Patrick McLane, Marisa Vigna, Carina Vigna, Andrew D McRae, Shawn Dowling, Brian R Holroyd, Eddy Lang","doi":"10.1007/s43678-025-00964-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00964-9","url":null,"abstract":"<p><strong>Objective: </strong>ED wait times have been linked to adverse patient outcomes, including increased mortality. We sought to assess the consequences of ED wait times on patient outcomes.</p><p><strong>Methods: </strong>We conducted a cohort study using administrative data from the 14 Alberta highest-volume adult EDs (2017-2022). The relationships between different components of ED wait times and patient short-term all-cause mortality (primary outcome:7-day mortality, and secondary outcome: 30-day mortality) were assessed using Multi-level logistic regression with adjustment for age, gender, the Canadian Triage and Acuity Scale (CTAS), Deprivation Index, Charlson Comorbidity Index, disposition status, hospital EDs, and visit date.</p><p><strong>Results: </strong>Among 1,358,935 unique adult patient ED visits, 22,692 (1.7%) deaths occurred within 7 days, and 47,441 (3.5%) occurred within 30 days after leaving the EDs. Among the entire cohort, there were no associations between prolonged total length of stay, boarding time or time from arrival to physician initial assessment, and an increased risk of the primary outcome. However, in subgroup analyses, among discharged patients, total length of stay of more than 6 hours was associated with an increased risk of 7-day mortality, and demonstrated a dose-response association with an increased risk of 30-day mortality [odds ratio (OR), 95% confidence interval (CI), (reference<6 hrs.): 1.3 (1.2-1.5) at 6-10 h, 1.8 (1.6-2.0), at 10-19 h, and 2.2 (1.8-2.7) at ≥ 19 h].</p><p><strong>Conclusions: </strong>We did not observe an association between ED wait times and 7-day mortality across the overall patient population. Future work should identify specific patient groups that may be at risk of harm from ED wait times to tailor ED crowding and risk mitigation strategies to reduce adverse outcomes among the most at-risk patients.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}