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Western Journal of Emergency Medicine
Journal Prestige (SJR): 0.664

Citation Impact (citeScore): 1
Number of Followers: 11

This is an Open Access Journal

Open Access journal
ISSN (Print) 1936-900X - ISSN (Online) 1936-9018
Published by eScholarship

[73 journals]

CORD Abstracts 2025
- Authors: Saucedo; Cassandra , Kawaguchi, Isabelle
  Abstract: n/a
  PubDate: Tue, 10 Jun 2025 00:00:00 +000
Beyond Efficiency: Considering the Benefits of Residents in the Emergency
Department
- Authors: Armstrong; Rachel Elizabeth
  PubDate: Sat, 31 May 2025 00:00:00 +000
Developing Machine-Learning Models to Predict Bacteremia in Febrile Adults
Presenting to the Emergency Department: A Retrospective Cohort Study from
a Large Center
- Authors: Fu; Chia-Ming , Ngo, Ike , Lau, Pak Sheung , Ivanchuk, Yaroslav , Chou, Fan-Ya , Wang, Chih-Hung , Lin, Chien-Yu , Tsai, Chu-Lin , Chen, Shey-Ying , Lu, Tsung-Chien , Wei, Hung-Yu
  Abstract: Introduction: Bacteremia, a common disease but difficult to diagnose early, may result in significant morbidity and mortality without prompt treatment. We aimed to develop machine-learning (ML) algorithms to predict patients with bacteremia from febrile patients presenting to the emergency department (ED) using data that is readily available at the triage.Methods: We included all adult patients (≥18 years of age) who presented to the emergency department (ED) of National Taiwan University Hospital (NTUH), a tertiary teaching hospital in Taiwan, with the chief complaint of fever or measured body temperature more than 38°C, and who received at least one blood culture during the ED encounter. We extracted data from the Integrated Medical Database of NTUH from 2009–2018.The dataset included patient demographics, triage details, symptoms, and medical history. The positive blood culture result of at least one potential pathogen was defined...
  PubDate: Sat, 31 May 2025 00:00:00 +000
Beyond Efficiency: Considering the Benefits of Residents in the Emergency
Department
- Authors: Valentine; Jake , Poulson, Johnathan
  Abstract: N/A
  PubDate: Sat, 31 May 2025 00:00:00 +000
WestJEM Full-Text Issue
- Authors: Saucedo; Cassandra , Kawaguchi, Isabelle
  Abstract: n/a
  PubDate: Fri, 30 May 2025 00:00:00 +000
Comparing Prehospital Time Among Pediatric Poisoning Patients in Rural and
Urban Settings
- Authors: Phillips; Aaron T. , Denning, Michael , Long-Mills, Em , Tumin, Dmitry , Parker-Cote, Jennifer , Bryant, Kathleen
  Abstract: Objectives: Barriers to healthcare in rural areas can delay treatment in pediatric patients who have experienced poisoning. We compared emergency medical services (EMS) response times and EMS-reported delays in responding to pediatric poisoning incidents between rural and urban settings using the 2021 National Emergency Medical Services Information System (NEMSIS). Methods: The NEMESIS defines rural areas as locations with a population of <50,000, not part of metropolitan areas, while all other locations are classified as urban (metropolitan) areas. In this study we included 11,911 patients (12% rural) <18 years of age who were transported by EMS with a first-responder primary impression of poisoning. We compared study variables using rank-sum tests and chi-square tests. Multivariable analysis of outcomes included quantile regression and logistic regression for continuous data and categorical data, respectively.Results:...
  PubDate: Fri, 23 May 2025 00:00:00 +000
Validation of a Methodology to Investigate Care Inequities for Transgender
Patients
- Authors: Engstrom; Kellyn , Bellolio, Fernanda https://orcid.org/0000-0002-1632-4750 , Jeffery, Molly Moore , Sutherland, Sara C. , Carpenter, Kayla P. , Jackson, Gia , Cole, Kristin , Chedid, Victor , Davidge-Pitts, Caroline J. , Sunga, Kharmene L. , Gonzalez, Cesar , Brown, Caitlin
  Abstract: Introduction: Pain is a common chief complaint in the emergency department (ED), and there are known disparities in the management of pain among racial/ethnic minorities, women, and older adults. Transgender and gender diverse (TGD) individuals comprise another under-represented patient population in emergency medicine and are also at risk of disparities in care. To measure and evaluate the magnitude of care inequities among TGD individuals, first we need to be able to accurately identify the right cohort and comparison groups. The primary objective of this study was to establish an accurate and generalizable process for identifying TGD patients through the electronic health record (EHR). Secondary objectives included creating and validating a method for matching and comparing of TGD patients to cisgender patients. Methods: This was a retrospective, observational cohort study that included patients presenting to Mayo Clinic EDs...
  PubDate: Tue, 20 May 2025 00:00:00 +000
Coronary Artery Bypass Grafting Is Rarely Done in the Acute Care of
ST-elevation Myocardial Infarction Patients Treated by Emergency Medical
Services
- Authors: Toy; Jake , Lauer, Caroline , Kaji, Amy H. , Thomas, Joseph L. , Megowan, Nichelle , Bosson, Nichole , Gausche-Hill, Marianne , Dhawan, Puneet , Kloner, Robert A. , Rasnake, Sara , French, William , Schlesinger, Shira
  Abstract: Introduction: The use of coronary artery bypass grafting (CABG) for primary revascularization during the acute care of ST-elevation myocardial infarction (STEMI) patients has declined significantly in the past decade; but there is little data to determine whether there has been a change in the use of CABG for STEMI patients treated by emergency medical services (EMS). In this study we described the incidence of urgent or emergent CABG for STEMI patients treated in a large, regionalized cardiac care system.Methods: We obtained data obtained for patients transported by EMS between January 2011– December 2022 who were diagnosed with acute STEMI on prehospital or emergency department (ED) electrocardiogram and taken for primary diagnostic catheterization. All STEMI patients were transported by EMS to one of 34 STEMI receiving centers (SRC) in a regionalized cardiac care system, all of which are required to maintain onsite cardiac surgery...
  PubDate: Tue, 20 May 2025 00:00:00 +000
Non-invasive Monitor of Effective Chest Compressions with Carotid and
Femoral Artery Ultrasound in the Emergency Department
- Authors: Yang; Feihong , Zou, Hao , Gan, Jiaohong , Zhao, Xia , Tu, Xiaopeng , Jiang, Cheng , Xia, Jian https://orcid.org/0009-0007-8883-8762
  Abstract: Background: End-tidal carbon dioxide (EtCO2) has been regarded as the gold standard for assessing the effectiveness of cardiopulmonary resuscitation (CPR). However, the clinically observed limitations of EtCO2 influenced by ventilation during CPR suggest the need to implement a new, non-invasive hemodynamic monitoring method to evaluate and optimize CPR effectiveness in real time.Methods: For this prospective study we enrolled 31 cardiac arrest (CA) patients who presented to the emergency department (ED) and 13 healthy volunteers as point-of-care ultrasound (POCUS) controls. Two physicians not involved in the resuscitation team performed POCUS of the bilateral carotid and femoral arteries during chest compression within the first 10 minutes of CPR. The clinical data and presumed CA cause were recorded. We observed the arterial pulse and measured the peak systolic velocity (PSV). The EtCO2 values during POCUS were also recorded. We explored...
  PubDate: Tue, 20 May 2025 00:00:00 +000
Real-time Ultrasound-guided Lumbar Puncture: A Comparison of Two
Techniques Using Simulation
- Authors: Samsel; Kara , Wasiak, David , Situ-LaCasse, Elaine , Adhikari, Srikar , Acuna, Josie
  Abstract: Introduction: The current literature on the use of real-time ultrasound-guidance for lumbar punctures (LP) is limited. Two techniques have been described: the paramedian sagittal oblique (PSO); and the transverse interlaminar (TL) approach. Our objectives in this study were to compare the procedure outcomes between these two techniques and assess the ability of emergency physicians to perform ultrasound-guided LPs.Methods: This was a prospective study whose participants included emergency physicians. Participants were randomized into either Group P (PSO technique) or Group T (TL technique). After a didactic session, participants then performed an ultrasound-guided LP on a training manikin, during which we collected procedure data. A survey was administered after completion of the procedure. Results: A total of 31 participants were included, 16 in Group P and 15 in Group T. Most participants (90.3%)...
  PubDate: Tue, 20 May 2025 00:00:00 +000
Evaluation of Point-of-Care Ultrasound Use in Emergency Medicine
Residents: An Observational Study
- Authors: Fareri; Michael , VandeHei, Matthew , Schnapp, Ben , Jewell, Corlin , Lasarev, Michael R. , Alexandridis, Roxana , Resop, Dana , Damewood, Sara , Kuttab, Hani I. https://orcid.org/0000-0001-9776-8929
  Abstract: Introduction: Point-of-care ultrasound (POCUS) is integral to emergency medicine (EM) training. It is unclear how EM residents use POCUS and how these skills are maintained as they progress in residency training. The purpose of this study was to evaluate resident use of POCUS at various timepoints in EM training.Methods: This was a retrospective cohort study of EM residents at a single, three-year training program between July 1, 2014–June 30, 2022. Residents were included if they had completed three consecutive years of training and an ultrasound rotation in their postgraduate year (PGY)-1. The following time points were assessed: PGY-1 rotation and 3-, 6-, 12-, 18-, and 24-months post-rotation. Number of scans, accuracy of interpretation, acceptability for credit, and percentage of technically limited studies (TLS) were collected at each point. We analyzed performance characteristics using mixed-effects binomial logistic regression...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Civil Monetary Penalties from Violations of the Emergency Medical
Treatment and Labor Act for Patients Arriving or Leaving with Law
Enforcement
- Authors: Ahmed; Sameer https://orcid.org/0000-0003-3194-199X , Reichert, Zach , Santillanes, Genevieve , Toomer, Carmen , Tyler-Mills, Sandra , Vontela, Neha , Hsia, Jasmine , Axeen, Sarah https://orcid.org/0000-0002-1538-0013 , Kashani, Saman , Nakagawa, Joe , Menchine, Michael , Terp, Sophie
  Abstract: Introduction: The Emergency Medical Treatment and Labor Act (EMTALA), a federal law enacted in 1986, is intended to prevent inadequate, delayed, or denied treatment of emergency medical or emergency psychiatric conditions by Medicare-participating hospitals when individuals present to dedicated emergency departments (EDs). EMTALA requires all patients seeking evaluation for an emergency medical condition (EMC) at a dedicated ED to have an appropriate medical screening exam (MSE), stabilization of identified EMCs, and an appropriate transfer if specialized services are needed for stabilization.Methods: We obtained summaries of all EMTALA-related civil monetary penalties (CMPs) between 2002–2023 from the Office of the Inspector General (OIG) and reviewed them for instances where patients arrived or departed with law enforcement officers (LEOs). In this article, we describe the characteristics of these CMPs. Results:...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Moving Beyond “Check A Box”: Shifting Physician Perceptions and
Culture with an Antiracism and Equity Curriculum
- Authors: Barber Doucet; Hannah https://orcid.org/0000-0003-0552-2863 , Lin, Timmy , Wilson, Taneisha
  Abstract: Objectives: The purpose of this study was to evaluate the impact of the Discussing Anti-Racism and Equity (DARE) curriculum on individual physician knowledge and practice, as well as on perceptions of group culture.Methods: DARE was a longitudinal multimodal curriculum targeted at pediatric and adult emergency medicine (EM) trainees and faculty, made up of 12 lectures/workshops, three simulations, five book clubs, and two movie screenings. We used a multiphase, parallel convergent mixed-methods approach. Focus groups before and after DARE explored prior education, antiracism attitudes and behaviors, perceived impact of intervention curriculum, and perceptions of departmental medical culture. We elucidated themes using thematic analysis. Surveys of trainees and attendings evaluated individual attitudes and practices related to equity and antiracism.Results: We held nine focus groups with a total of 52 participants....
  PubDate: Mon, 19 May 2025 00:00:00 +000
Age-stratified Association Between Plasma Adiponectin Levels and Mortality
in Septic Patients
- Authors: Wang; Hui , Ma, Ming , Dong, Jinfeng , Duan, Jun
  Abstract: Background: Plasma adiponectin (APN) levels might be affected by age. In this study we aimed to study the association between plasma APN levels and age and the effects of APN levels on mortality in age-stratified septic patients.Methods: We conducted this single-center, retrospective study with 173 patients with sepsis and 57 controls. Physical and demographic characteristics were recorded, and blood samples were collected to measure plasma APN levels. Using this data, we determined the association between plasma APN levels and age, and the effect of plasma APN levels on mortality in age-stratified septic patients.Results: We stratified patients into three age groups: < 60 years (middle age); 60-80 years (advanced age); and elderly (≥ 80 years). Plasma APN levels increased with increasing age in both the control group and the sepsis group. Mortality also increased with age: 12.3% in the < 60 group; 24.6%...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Descriptive Analysis of Resources Used to Learn About Residency Programs
Since Transition to Virtual Interviews
- Authors: Bounds; Richard , Priester, John , Lewis, Benjamin , King, Roz , Lentz, Skyler
  Abstract: Introduction: The transition to virtual interviews over the past four years has been associated with changes to the ways that applicants collect information on residency programs. Methods: Our program collected free-response data from questionnaires completed by applicants prior to their virtual interview days over the course of four recruitment cycles. We performed a descriptive analysis of these responses to identify the frequency with which students have been accessing various resources to learn about programs, and to learn how that has changed over time. Results: Our findings over four years and 322 applicants (of 391 surveyed, response rate 82%) indicated that the three most common sources of information were individual program websites, the Emergency Medicine Resident’s Association (EMRA) Match website, and Instagram. These sources were reported more frequently than personal experience, word...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Dispatch Decisions and Emergency Medical Services Response in the
Prehospital Care of Status Epilepticus
- Authors: McInnis; Robert P. , Wood, Andrew J. , Shay, Courtney L. , Haggart, Anna A. , Crowe, Remle P. https://orcid.org/0000-0001-9733-9294 , Guterman, Elan L.
  Abstract: Objective: Emergency medical dispatch is intended to ensure that emergency medical services (EMS) allocate appropriate resources for the treatment of patients with status epilepticus (SE). However, it is unclear whether dispatch algorithms accurately identify those patients having a seizure-related medical emergency and how dispatch algorithms influence what prehospital resources are allocated for the encounter.Methods: We performed a cross-sectional analysis of prehospital encounters for SE using data from the 2019 ESO Data Collaborative. We included patients who were ≥18 years of age, had an EMS diagnostic impression of SE, and did not have a cardiac arrest. We examined the dispatch-determined complaint designated by the emergency medical dispatch (EMD) code, dispatch-determined level of acuity (A, B, C, D), ambulance response, and training level of the responding prehospital professional.Results: Of the 18,515...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Ultrasound-guided Emergency Pericardiocentesis Simulation on Human
Cadavers: A Scoping Review
- Authors: Ünlü; Luca https://orcid.org/0000-0002-0670-5840 , Margenfeld, Felix , Zendehdel, Adib , Griese, Johannes , Poilliot, Amélie , Müller-Gerbl, Magdalena , Nickel, Christian H. , Dedic, Mirza
  Abstract: Objectives: Emergency pericardiocentesis is a critical but infrequently performed procedure in emergency medicine, necessitating effective training modalities for emergency physicians. In this scoping review we aimed to identify existing literature on simulation of ultrasound-guided pericardiocentesis in human cadavers. Methods: We carried out a scoping review based on a search on the use of sonography on human cadavers. The following databases were searched: MEDLINE; EMBASE; CENTRAL; BIOSIS Previews; and Web of Science Core Collection. Additionally, we performed a gray literature search. Title and abstract screening were done by a single reviewer, and full-text review was performed by two independent reviewers. Studies included were limited to those published in English or German, focusing specifically on ultrasound-guided pericardiocentesis training models in human cadavers, with no restrictions on publication year or outcomes.Results:...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Ending Nuclear Weapons, Before They End Us
- Authors: Abbasi; Kamran , Ali, Parveen , Barbour, Virginia , Birch, Marion , Blum, Inga , Doherty, Peter , Haines, Andy , Helfand, Ira , Horton, Richard , Juva, Kati , Lapena, Jose F. , Mash, Robert , Mironova, Olga , Mitra, Arun , Monteiro, Carlos , Naumova, Elena N. , Onazi, David , Ruff, Tilman , Sahni, Peush , Tumwine, James , Umaña, Carlos , Yonga, Paul , Zielinski, Chris
  Abstract: n/a
  PubDate: Mon, 19 May 2025 00:00:00 +000
Association of Heat Index and Patient Presentation Rate at a Stadium
- Authors: Wolin; Jennifer , Wolf, Daniel , Su, John , Quinn, Eric https://orcid.org/0000-0001-7261-7235 , Eng, David , Ali, Humaira , Lobel, David , Friedman, Matt Saul
  Abstract: Introduction: A mass gathering is defined as an event that has the potential to strain the resources of the local health system. An onsite physician for mass gatherings can mitigate the strain on the local health infrastructure. One factor affecting onsite medical usage and patient presentation rates is the heat index, which is a calculated value of perceived heat exposure that combines air temperature and relative humidity. In this study we asked whether there was a positive association between heat index and patient presentation rates for onsite medical care at a bounded (large event in an enclosed location) professional stadium sporting event. We hypothesized that a positive correlation exists between these two variables and assess whether it might surpass current onsite resources.Methods: We performed a prospective observational study with patients seeking medical care at a baseball stadium in a large northeastern city in the United...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Practical Status and Social Background of Current Mobile Stroke Units
Worldwide: A Survey and Investigation
- Authors: Hiroki; Masahiko , Kohno, Mototsugu , Kohno, Yutaka , Misawa, Masaki
  Abstract: Background: We aimed to clarify the current challenges involved in introducing and operating mobile stroke units (MSU) in new regions, considering the social background of regions with MSUs.Methods: We conducted a questionnaire survey on the operational and financial status of all active MSU programs worldwide as of March 2023, and investigated the demographic, economic, and healthcare backgrounds of areas with and without active MSUs. We compared the data for the two groups at the country, state, or city level. We then correlated data gathered from the survey and the investigation.Results: Of the 33 MSU programs contacted, 19 (59%) responded. The responding programs treated a range of 52-1,663 (median 781) patients at an MSU per year. The most commonly reported hours of operation were eight hours every weekday (5, 26%). The majority had four staff on board (11, 58%). No physicians were on board in six...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Emergency Medical Service Responders’ Perspectives on Transgender,
Intersexual, and Non-Binary Patients in Germany
- Authors: Brod; Torben , Afshar, Kambiz , Schroeder, Christoph , Stoetzer, Carsten , Stiel, Stephanie
  Abstract: Introduction: Gender minorities, including transgender, intersexual and non-binary (TIN) individuals, are at risk of receiving suboptimal care in emergency departments due to clinicians’ limited knowledge and formal training in TIN-specific needs. Little evidence is available regarding emergency medical service (EMS) responders, including paramedics (EMT-P), emergency medical technicians (EMT) ,and prehospital emergency physicians (EP). Therefore, in this study we aimed to explore the experiences and knowledge, attitudes, and education/training needs of EMS professionals in Germany regarding the care of TIN patients.Methods: In April 2023, we electronically surveyed EMTs, EMT-Ps and prehospital EPs from ambulance stations across Germany. Participants completed a questionnaire consisting of 15 closed-ended items assessing their experience and knowledge, attitudes, and education/training needs regarding the care of TIN patients. We used...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Field vs. Emergency Department Intubation: A Retrospective Review of
Hospital Outcomes of Trauma Patients
- Authors: Vorce; Mitchell https://orcid.org/0000-0002-8313-9256 , Galwankar, Sagar , Shuck, Jarrod , Agrawal, Amit
  Abstract: Introduction: Definitive airway management is crucial for severely injured trauma patients when basic pre-hospital interventions fail to provide adequate oxygenation and ventilation. Endotracheal intubation by emergency medical service (EMS) personnel is often necessary before reaching the emergency department (ED). While some studies suggest that advanced airway protocols in the pre-hospital setting improve survival in patients with severe head injuries, others indicate potential complications and adverse outcomes associated with pre-hospital intubation. In this study we aimed to evaluate whether trauma patients who underwent intubation by EMS in the field experienced different hospital outcomes compared to those intubated by physicians in the ED. Specifically, it assessed the impact of pre-hospital intubation on the number of days requiring mechanical ventilation, intensive care unit length of stay (ICU LOS), and overall hospital LOS.Methods:...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Patient Sociodemographic Factors Are Associated with Receiving
Point-of-care Ultrasound in the Emergency Department
- Authors: Wubben; Brandon M. , Spolsdoff, Devin , Harland, Karisa K. , Del Rios, Marina
  Abstract: Background: Point-of-care ultrasound (POCUS) is widely used in emergency medicine (EM) and increasingly throughout healthcare. Prior studies have revealed disparities in the use of imaging in the emergency department (ED) based on sociodemographic factors; however, the association between these factors and POCUS use is unknown. Our aim was to compare the odds of receiving POCUS in the ED based on patient race and ethnicity, language, sex, and type of insurance.Methods: We reviewed electronic health records (EHR) matched to a departmental POCUS database from November 2021–June 2023 at an academic Level I trauma center. We included ED patients diagnosed with an International Classification of Diseases code mapped to chest or flank pain, who had a cardiac troponin obtained, or had been evaluated as a trauma activation or alert. Our primary outcome was whether a patient received transthoracic echocardiography (cardiac), renal, or focused...
  PubDate: Mon, 19 May 2025 00:00:00 +000
Exposure to Community Violence and Adverse Childhood Experiences in the
Emergency Department
- Authors: Cachola; Leslie , Guevara, Yanina , Ansari, Sobia
  Abstract: Introduction: Adverse childhood experiences (ACEs) and exposure to community violence are public health issues linked to negative mental and physical health outcomes. The emergency department (ED) can play a critical role in the care of patients with a history of trauma exposure. Unfortunately, patients’ experiences often go unidentified, leading to missed opportunities to address and prevent further harm. Methods: We administered a 22-question survey of trauma exposure in ED patients to 1) identify the prevalence of exposure to community violence and ACEs and resulting post-traumatic stress disorder (PTSD) symptoms, and 2) determine perceived social service needs. This self-administered survey study was conducted on a convenience sample of 267 adult patients at one academic hospital in Chicago, IL, between July 2018–December 2019. This ED sees approximately 70,000 patients annually. These were fluent English-speaking patients...
  PubDate: Sun, 18 May 2025 00:00:00 +000
Post-Concussion Syndrome Following Blast Injury: A Cross-Sectional Study
of Beirut Blast Casualties
- Authors: Anan; Hind , Al Hariri, Moustafa , Hitti, Eveline , Kobeissy, Firas , Mufarrij, Afif
  Abstract: Introduction: The massive 2020 blast in Beirut, Lebanon, caused by improperly stored ammonium nitrate, was one of the most powerful non-nuclear explosions in history, Following the blast, head injuries emerged as a predominant presentation to the emergency department (ED). Blast-induced head injuries can lead to mild traumatic brain injuries (mTBI) mediated via primary blast overpressure without direct head trauma. The recovery process from mTBIs can be prolonged and affected by several factors. If symptoms persist for more than three months, patients should be evaluated for post-concussion syndrome (PCS). While clinical blast-injury studies have focused on repetitive blast exposure, this study evaluates a cohort exposed to a single blast. We hypothesized that a single blast exposure is sufficient to induce PCS symptoms similar to those exposed to repetitive blasts.Methods: This cross-sectional study explores PCS in patients presenting...
  PubDate: Sun, 18 May 2025 00:00:00 +000
A Systematic Review of Guidelines for Emergency Department Care of Sexual
Minorities: Implementable Actions to Improve Care
- Authors: Kruse; Michael I. https://orcid.org/0000-0001-9519-9873 , Karabelas-Pittman, Sawyer , Northrop, Grace https://orcid.org/0000-0003-0391-5882 , Stuart, Joanna , Upadhye, Suneel https://orcid.org/0000-0002-6380-161X , Bigham, Blair L. https://orcid.org/0000-0002-9280-473X
  Abstract: Introduction: Sexual minorities, including lesbian, gay, bisexual, asexual, pansexual, and others make up 4.0 to 5.4% of the North American population. Stigmatization and minority stress can lead to poorer health status in sexual minorities, and a previous scoping review showed gaps in the emergency medicine (EM) literature for care of sexual minorities. In this review we sought to examine existing guidelines for the care of sexual minorities that made recommendations relevant to care in the emergency department (ED).Methods: Using the PRISMA criteria, we performed a systematic search of OVID Medline, EMBASE, CINAHL, and the grey literature for clinical practice guidelines (CPG) and best practice statements (BPS) published until July 31, 2022. Articles were included if they were in English, included medical care of sexual minority populations of any age, in any setting, region, or nation, and were of national or international scope. Exclusion criteria included primary...
  PubDate: Fri, 16 May 2025 00:00:00 +000
Emergency Medicine Residency Website Wellness Pages: A Content
Analysis
- Authors: Sappington; Alexandra , Milman, Brian
  Abstract: Introduction: The COVID-19 pandemic impacted the way medical students seek residency positions. In 2020, the Accreditation Council for Graduate Medical Education advocated for virtual interviews. Most emergency medicine (EM) interviews in 2023 remained virtual, and this format will persist for the foreseeable future. Since students are not evaluating programs in person in most cases, residency websites are crucial for prospective residents. Resident wellness is critical for resident training and important to prospective residents; it follows that programs must be transparent about resident wellness on websites. In this study we aimed to quantify the number of EM programs with wellness pages on their websites and identify themes portrayed on those pages. Methods: We analyzed residency website wellness pages from EM websites based on the 2022 directory of the Electronic Residency Application Service. We independently coded wellness...
  PubDate: Fri, 16 May 2025 00:00:00 +000
Trends in Studies on Transesophageal Echocardiography in Emergency
Medicine: A Scoping Review
- Authors: Tseng; Bor-Yuan , Yang, Chih-Jui , Sun, Jen-Tang https://orcid.org/0000-0003-2628-9917 , Liu, Yiju Teresa , Yadav, Kabir , Hsieh, Yu-Lin , Chu, Sheng-En , Lee, Chen-Wei , Lee, Yi-Kung , Tsai, Tou-Yuan https://orcid.org/0000-0003-0071-9069
  Abstract: Background: Transesophageal echocardiography (TEE) has been introduced in resuscitative scenarios in recent decades, with a growing number of emergency physicians learning, performing, and studying resuscitative TEE.Objective: Our goal was to characterize publishing trends regarding TEE use in emergency medicine (EM) and to investigate the increasing interest in potential applications of TEE in emergency departments (ED).Methods: We retrieved published research associated with the use of TEE in EM from the Web of Science database from inception to December 31, 2023. We analyzed trends based on the number of articles published annually. To systematically map trends related to TEE in emergency medicine (EM), we extracted data on the number of unique EM TEE practitioners, institutions performing EM TEE, study topics, and other characteristics from research articles and case reports. To better reflect research trends,...
  PubDate: Wed, 14 May 2025 00:00:00 +000
Development and Evaluation of a Novel Curriculum for Whole Blood
Transfusion by Paramedics in the Prehospital Environment
- Authors: Garfinkel; Eric , May, Robby , Margolis, Asa , Cohn, Eric , Colburn, Steven , Grawey, Tom , Levy, Matthew
  Abstract: Introduction: Resuscitation with low-titer O+ whole blood improves the outcomes of patients with hemorrhagic shock. Recently, some emergency medical services (EMS) agencies have started to carry blood in the field. However, there exists no standardized training program to teach paramedics the fundamentals of blood administration. This study describes one EMS system’s experience with implementing a novel, whole blood educational curriculum. Methods: We used Kern’s six-step framework to develop a novel curriculum to provide paramedics the requisite knowledge to safely administer blood in the field. The course included an asynchronous component as well as an in-person, skills competency verification. The asynchronous portion was open to any paramedic, but only paramedic supervisors were eligible for the in-person skills check as they are the ones tasked with administering blood in the field. The course was evaluated through survey...
  PubDate: Tue, 13 May 2025 00:00:00 +000
Evaluation of Disparities in Emergency Department Admission and Wait Times
for Non-English Preferred Patients
- Authors: Wong-Castillo; John https://orcid.org/0000-0002-3497-1169 , Berger, Daniel , Montoy, Juan Carlos , Alwan, Riham
  Abstract: Introduction: Patients who prefer to communicate in a language other than English are vulnerable to the consequences of medical communication barriers. Studies of non-English language preferred (NELP) and English language preferred (ELP) patients have shown differences in rates of hospital admission and wait times—factors known to be related to increased costs and lower patient satisfaction. However, few studies include languages other than Spanish or account for patient acuity level. Methods: We performed a retrospective cohort study at an urban, Level I trauma center from January–December 2020. Patients were grouped by language preference, with NELP languages grouped into three categories: Spanish; Chinese (Mandarin, Cantonese, Taishanese, Taiwanese, and Zhongshan-Chinese dialect); and other (all other remaining languages). We extracted age, sex, race, ethnicity, language preference, emergency department (ED) discharge disposition,...
  PubDate: Mon, 12 May 2025 00:00:00 +000
Emergency Department Blood Pressure Management in Type B Aortic
Dissection: An Analysis with Machine Learning
- Authors: Chen; Nelson , Downing, Jessica V. , Epstein, Jacob , Mudd, Samira , Chan, Angie , Kuppireddy, Sneha , Tehrani, Roya , Vashee, Isha , Hart, Emily , Esposito, Emily , Chasm, Rose , Tran, Quincy K. https://orcid.org/0000-0002-7774-154X
  Abstract: Background: Acute aortic dissections (AAD) have a high morbidity and mortality rate. Treatment for type B aortic dissection includes strict systolic blood pressure (SBP) and heart rate (HR) control per the American Heart Association (AHA) guidelines. However, predictors of successful emergency department (ED) management of SBP have not been well studied. Methods: We retrospectively analyzed the records of adult patients presenting to any regional ED with type B AAD between 2017–2020 with initial SBP >120 mmHg and HR >60 beats per minute (bpm) and were subsequently transferred to our quaternary center. Primary outcome was SBP <120 mmHg based on both the 2010 and 2022 AHA guidelines and HR <60 bpm (based on the 2010 guideline), or HR <80 (2022 guideline). We used random forest (RF) algorithms, a machine-learning tool that uses clusters of decision trees to predict a categorical outcome, to identify predictors of achieving...
  PubDate: Mon, 12 May 2025 00:00:00 +000
Evaluating the Implementation of a “COVID-19 Test” Chief Concern in
the Emergency Department
- Authors: Michels; Collin , Hekman, Daniel J. , Schwei, Rebecca J. , Tsuchida, Ryan E. , Gauger, Joshua , Hurst, Irene , Glazer, Joshua , Brink, Jenna , Barclay-Buchanan, Ciara , Shah, Manish N. , Hamedani, Azita G. , Pulia, Michael
  Abstract: Background: During the COVID-19 pandemic, rapid, at-home testing for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was inconsistently available. Consequently, for some patients, emergency departments (ED) became the preferred site to access COVID-19 testing. To improve operational efficiency, our ED implemented a “COVID-19 Test” chief concern (CC). Our primary objective in this analysis was to broadly assess the utilization of the new “COVID-19 Test” CC and associated clinical care. Methods: We conducted a retrospective analysis of ED encounters from an academic ED and an affiliated, community-based ED of all patients after the establishment of a CC of “COVID-19 Test” from October 11, 2021–July 31, 2022. The data were extracted from the electronic health record. We calculated descriptive demographic statistics and ran a univariate and multivariate logistic regression with additional diagnostic or therapeutic interventions...
  PubDate: Fri, 2 May 2025 00:00:00 +0000
Harnessing Residents’ Practice-based Inquiries to Enhance Research
Literacy: The Thoughtful Reading of Evidence into Clinical Settings
(T-RECS) Initiative
- Authors: Worley; Emmagene , Suh, Edward H. https://orcid.org/0000-0001-6888-3119 , Abrukin, Liliya , Defilippo, Michael , Kamler, Jonathan J. , Polavarapu, Mahesh , Wyer, Peter C.
  Abstract: Introduction: Research literacy is an important competency for all clinicians, but developing resident enthusiasm for it is difficult. At one academic emergency medicine (EM) residency program, we designed an innovative program to help residents improve literacy skills within a community of practice and use research literature to address clinical problems. Methods: A six-member faculty core team surveyed residents to assess their baseline experience with evidence-based medicine (EBM) and level of engagement with the medical literature. Interested residents joined an iterative curriculum development process that drew on previous EBM pedagogical experience and literacy theory. We developed a semi-structured approach that prioritizes using the reference frame of clinical applicability rather than research methodology. We held 90-120 minute sessions three times a year as part of the regular residency didactic conference; post-session...
  PubDate: Tue, 29 Apr 2025 00:00:00 +000
Randomized Controlled Trial of Atorvastatin in Acute Influenza in the
Emergency Department
- Authors: Chase; Maureen https://orcid.org/0000-0003-2451-122X , Cocchi, Michael N. , Grossestreuer, Anne V. , Liu, Xiaowen , Vine, Jacob , Moskowitz, Ari L. , Donnino, Michael W.
  Abstract: Objectives: We sought to determine whether atorvastatin administration attenuates the inflammatory response and improves clinical outcomes in acute influenza.
  Methods: We conducted a randomized double-blind trial administering atorvastatin 40 milligrams or placebo to adults with confirmed influenza for five days between December 2013–May 2018. Patients were primarily enrolled in the emergency department (ED) at an urban, tertiary-care center. Serum was obtained at enrollment and 72 hours for the primary outcome, change in interleukin (IL-6). Patients reported severity of influenza symptoms over 10 days. We used linear mixed-effects models for the primary comparisons. Results: Of the 116 enrolled patients, 59 received atorvastatin and 57 received placebo. Groups were well-matched including baseline influenza symptom scores and receipt of an antiviral medication. There was no difference between groups in the change...
  PubDate: Tue, 29 Apr 2025 00:00:00 +000
Emergency Physician Assessment of Productivity and Supervision Practices
- Authors: Schreyer; Kraftin https://orcid.org/0000-0001-8955-2060 , Kuhn, Diane , Norton, Vicki
  Abstract: Introduction: Despite a lack of data guiding safe standards for physician productivity and supervision of non-physician practitioners (NPP), legislation dictating supervision ratios for emergency physicians (EP) has been enacted in Florida and elsewhere across the country. To inform future legislation, we aim to identify current productivity and supervision practices among practicing EPs as well as those physicians’ safety assessments of their current practices. Methods: We conducted a cross-sectional observational study regarding EPs’ perspectives on safe staffing and supervision models. A survey, consisting of 14 questions examining different variables affecting supervision and productivity, was used to determine physicians’ opinions on the safety of productivity and supervision models across a range of annual volumes, employers, and years of experience. We coded safety assessments as binary (yes/no) and measured productivity...
  PubDate: Tue, 1 Apr 2025 00:00:00 +0000
Epidemiology of 911 Calls for Opioid Overdose in Nogales, Arizona
- Authors: Glenn; Melody , Stratton, Darien , Primeau, Keith , Rice, Amber
  Abstract: Objective: Drug overdose is the leading cause of unintentional death in the United States, and individuals identifying as BIPOC (Black, indigenous and people of color) and those of low socioeconomic status are over-represented in this statistic. The US-Mexico border faces several unique challenges when it comes to healthcare and the drug overdose crisis, due in large part to health inequities. Although the US Centers for Disease Control and Prevention recommends that overdose prevention programs address health inequities, little is known about opioid overdoses in this rural, primarily Spanish-speaking region. As emergency medical services (EMS) records collect countywide data, they represent a high-quality source for epidemiologic surveillance.Methods: We conducted a retrospective chart review based on a local quality assurance program in which two years of EMS records were reviewed with the primary objective of characterizing patients...
  PubDate: Mon, 31 Mar 2025 00:00:00 +000
Social Determinants of Health and Health Literacy in Emergency Patients
with Diabetic Ketoacidosis
- Authors: Suarez; Daniel F. , Schneider, Ryan M. , Girardi, Margo , LaRossa, Gina , Yeary, Julianne , Kaser, Taylor , Ancona, Rachel , Cruz Bravo, Paula , Griffey, Richard T.
  Abstract: Introduction: Social determinants of health (SDoH) and health literacy have been demonstrated to significantly impact health outcomes. As part of a study of diabetic ketoacidosis (DKA) treatment from the emergency department (ED), we assessed the burden of SDoH and health literacy among patients with DKA to identify potentially modifiable risk factors in the development of DKA. Methods: This was an exploratory, prospective, cross-sectional study of adult patients with DKA in a large urban academic ED from March 2023–March 2024. We administered the Centers for Medicare & Medicaid Services Accountable Health Communities Health-Related Social Needs Screening Tool (SNST) and the Brief Health Literacy Screen (BHLS).Results: Of 126 identified ED patients with confirmed DKA, 57 completed the SNST and 72 completed the BHLS. Nearly all patients (56 patients, 98%) reported at least one unmet SDoH need, and 32...
  PubDate: Mon, 31 Mar 2025 00:00:00 +000
Caught Unprepared: The Urgent Need for Reproductive Health Training in
Emergency Medicine
- Authors: Yun; Peter Sangeyup https://orcid.org/0000-0001-9598-8848 , Saxena, Monica
  Abstract: N/A
  PubDate: Mon, 24 Mar 2025 00:00:00 +000
Characteristics of Alcohol-based Hand Sanitizer Ingestions in Florida
Before and During the Coronavirus-2019 Pandemic
- Authors: Arnold; Justin , Athanasios, Amira , Nguyen, Diep , Mhaskar, Rahul
  Abstract: Introduction: Hand sanitizer use and media coverage increased throughout the coronavirus-2019 pandemic. In this study our goal was to examine and compare the incidence, demographics, and clinical outcomes of exposures to alcohol-based hand sanitizers (ABHS) before and during the COVID-19 pandemic in the state of Florida.Methods: We analyzed statewide data on all ABHS exposures in adults collected by the Florida Poison Information Network from March 1, 2015–February 28, 2020 (“pre-COVID-19” cohort) and during the COVID-19 pandemic from March 1, 2020–May 5, 2023 (“COVID-19” cohort). We performed descriptive, univariable, and multivariable analyses to assess changes in sex, age, medical outcome, and intentionality of the exposure in the pre-COVID-19 vs COVID-19 study periods, and we examined the factors associated with medical outcomes. Results: We identified 876 single-substance ingestions of ABHS, 414 in...
  PubDate: Mon, 24 Mar 2025 00:00:00 +000
Legislating Fear: How Immigration Status Mandates Threaten Public Health
- Authors: Yun; Peter Sangeyup https://orcid.org/0000-0001-9598-8848 , Williams, Lindsey , Blanchard, Janice
  Abstract: N/A
  PubDate: Mon, 24 Mar 2025 00:00:00 +000
Effects of Emergency Department Training on Buprenorphine Prescribing and
Opioid Use Disorder-Associated ED Revisits: Retrospective Cohort Study
- Authors: Torchiano; Anna , Roberts, Brian , Haroz, Rachel , Milburn, Christopher , Baston, Kaitlan , Heil, Jessica , Ganetsky, Valerie , Salzman, Matthew
  Abstract: Introduction: Prescribing patients buprenorphine from the emergency department (ED) is recommended by multiple organizations. However, it is unclear how best to encourage physicians to prescribe buprenorphine from the ED. Our objectives in this study were to examine the effects of a departmental-wide training initiative for emergency physicians to prescribe buprenorphine, increase buprenorphine prescribing, and decrease ED re-utilization for opioid use disorder (OUD) complications.Methods: We performed this retrospective cohort study at an academic medical center. Beginning May 1, 2018, the ED started a buprenorphine-education initiative and tracked the proportion of clinicians who obtained buprenorphine-prescribing certification over the following 16 months. We identified adult patients referred to an addiction clinic from the ED during this period. Our primary outcome was the proportion of patients who received a buprenorphine prescription...
  PubDate: Mon, 24 Mar 2025 00:00:00 +000
Case Study of How Alleviating “Pebbles in the Shoe” Improves
Operations in the Emergency Department
- Authors: Savitzky; Diana , Chavda, Yash https://orcid.org/0000-0002-6966-9103 , Datta, Suchismita , Reens, Alexandra , Conklin, Elizabeth , Scott, Matthew , Caspers, Christopher
  Abstract: Objectives: Addressing minor yet significant frustrations, or “pebbles,” in the workplace can reduce physician burnout, as noted by the American Medical Association. These “pebbles” are small workflow issues that are relatively easy to fix but can significantly improve the workday when resolved. This quality improvement project aimed to enhance clinician well-being in an emergency department (ED) affiliated with an academic institution through human-centered design by actively engaging clinicians to identify these “pebbles” and for a dedicated team to address them.Methods: A task force comprised of three emergency physicians collaborating with emergency medicine leadership was established. After educating clinicians about “pebbles,” clinicians were able to anonymously submit pebbles based on recall of frustrations in a baseline survey at the start of the project, as well as submit pebbles in real time by a QR code that was placed in...
  PubDate: Mon, 24 Mar 2025 00:00:00 +000
Predictive Factors and Nomogram for 30-Day Mortality in Heatstroke
Patients: A Retrospective Cohort Study
- Authors: anxin; Li https://orcid.org/0000-0002-0682-7178 , Zhang, Yuchen , Zhang, Xiaoshi , Duan, Zixiao , Chen, Yan , Jiang, Xiaoyan , Deng, Wuquan
  Abstract: Objective: Heatstroke (HS) is a severe condition associated with significant morbidity and mortality. In this study we aimed to identify early risk factors that impacted the 30-day mortality of HS patients and establish a predictive model to assist clinicians in identifying the risk of death.Methods: We conducted a retrospective cohort study, analyzing the clinical data of 203 HS patients between May 2016–September 2024. The patients were divided into two groups: those who had died within 30 days of symptom onset; and those who had survived. We analyzed the risk factors affecting 30-day mortality. A nomogram was drawn to visualize the clinical model. We used the receiver operating characteristic (ROC) curve and calibration curve to verify the accuracy of the nomogram. A decision curve analysis was also performed to evaluate the clinical usefulness of the nomogram.Results: Within a 30-day period, 57 patients...
  PubDate: Sat, 22 Mar 2025 00:00:00 +000
Simulation-based Training Changes Attitudes of Emergency Physicians Toward
Transesophageal Echocardiography
- Authors: Danta; Michael https://orcid.org/0009-0009-1800-5946 , Nguyen-Phuoc, Alyssa Y. , Gupta, Suman , Sakhpara, Aneri , Kurbedin, Jeanette , Khordipour, Errel , Likourezos, Antonios , Haines, Lawrence , Aghera, Amish , Drapkin, Jefferson , Lin, Judy
  Abstract: Objective: The American College of Emergency Physicians recommends that transesophageal echocardiography (TEE) be used to “maintain the standard of ultrasound-informed resuscitation” in cardiac arrest. To date, no standards exist on how to train emergency physicians (EP) on TEE use in the emergency department (ED). We propose a novel educational paradigm using simulation to train EPs on the use of TEE in cardiac arrest.Methods: A total of 63 EPs at a single-center academic teaching hospital participated in a 90-minute simulation-based education session to summarize the use of TEE in cardiac resuscitation and practice related procedural skills. The session consisted of a simulated cardiac arrest scenario using both transthoracic echocardiography (TTE) and TEE and hands-on practice on a high-fidelity TEE task trainer. Participants filled out anonymous surveys before and after the training session, which evaluated their subjective attitudes...
  PubDate: Sat, 15 Mar 2025 00:00:00 +000
Feasibility of an Emergency Department-based Food Insecurity Screening and
Referral Program
- Authors: Cisneros; Victor , Olliffe, Ian Dennis Capo , Esteban, Marco Santos , Bui, Joseph , Takallou, Armin , Lotfipour, Shahram , Chakravarthy, Bharath
  Abstract: Introduction: Food insecurity (FI) remains a pervasive issue in the United States, affecting over 12.8% of households. Marginalized populations, particularly those in urban areas, are disproportionately impacted. The emergency department (ED) holds potential as a vital outreach hub, given its diverse patient population and extensive service coverage. In this study we explore the feasibility of implementing an ED-based FI screening and referral program at an urban, academic teaching hospital. We aimed to assess the prevalence of FI among ED patients and evaluate the feasibility of a three- and six-week follow-up to assess patients’ FI and related barriers to resource referral utilization.Methods: This single-center, observational study was conducted at an urban, academic ED from 2018-2024. Initial FI screening was performed using a validated two-question survey adapted from the Hunger Vital Sign screening tool. Participants who screened...
  PubDate: Sat, 15 Mar 2025 00:00:00 +000
Variations in Out-of-Hospital Cardiac Arrest Resuscitation Performance and
Outcomes in Ohio
- Authors: Nassal; Michelle M.J. , Wang, Henry E. , Powell, Jonathan R. , Benoit, Justin L. , Panchal, Ashish R.
  Abstract: Introduction: Understanding characteristics of top-performing emergency medical service (EMS) agencies and hospitals can be an important tool for improving community out-of-hospital cardiac arrest (OHCA) care. We compared deidentified EMS and hospital-level variations in OHCA performance and outcomes in Ohio.Methods: We analyzed adult OHCA data from the 2019 Ohio Cardiac Arrest Registry to Enhance Survival (Ohio CARES). We limited the analysis to EMS agencies and receiving hospitals with ≥10 OHCA episodes. The primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge. We compared OHCA outcomes between EMS agencies using linear mixed models, with EMS agency as a random effect and adjusting for Utstein variables. We repeated the analysis by receiving hospital. We compared EMS agency population demographics, response times, and resuscitation characteristics of the top 10% of agencies against remaining...
  PubDate: Sat, 15 Mar 2025 00:00:00 +000
National Study of Firearm Presence and Storage Practices in Homes of Rural
Adolescents
- Authors: Linden; Benjamin , Sinik, Megan , Wetjen, Kristel , Hoogerwerf, Pam , Liao, Junlin , Jennissen, Charles
  Abstract: Introduction: Firearm-related unintentional and suicide death rates in adolescents are higher in rural areas. In 2020, the overall rural firearm death rate was 28% higher than the urban rate. Firearm access significantly increases the risk. The study objective was to evaluate firearm exposure and storage practices in the homes of rural adolescents. Methods: We conducted a cross-sectional, anonymous survey of attendees at the 2021 National FFA (formerly Future Farmers of America) Convention & Exposition. Descriptive, bivariate, and multivariable logistic regression analyses were performed.Results: A total of 3,296 adolescents 13-18 years of age participated in our survey. Overall, 87% of respondents reported having rifles/shotguns, 71% had handguns, and 69% had both rifles/shotguns and handguns in their homes. The odds of those living on farms having rifles/shotguns and handguns were 7.5 and 2 times...
  PubDate: Sat, 15 Mar 2025 00:00:00 +000
WestJEM Full-Issue Text
- Authors: Valenzi; Nicole
  PubDate: Thu, 13 Mar 2025 00:00:00 +000
Emergency Department Comprehensive Social Risk Screening and Resource
Referral Program
- Authors: Stillman; Kaytlena , Dahut, Alex , Caudill, Antonina , Hren, Katie , Green, Krystal , Lauzon, Marie , Jackman, Susan , Lawton, Alexander , Chopra, Tananshi , Geiderman, Joel , Torbati, Sam
  Abstract: Introduction: The emergency department (ED) is an appropriate location to screen for and address social risks among patients; however, a standardized process does not currently exist. Our objective in this study was to describe the implementation and findings of a social risk screening and resource referral program using a comprehensive screening questionnaire. Methods: We conducted a prospective, cohort study between July 2022–April 2023 at a single academic, urban ED in Los Angeles, CA. Trained staff on rotating shifts recruited ED patients between 6 am to midnight, with an average of 40 hours of coverage per week including weekends. Patients were excluded if they were <18 years of age, could not provide informed consent, or were deemed too medically unstable. Trained staff screened eligible consenting patients at ED bedside for social risks within 12 different domains of social determinants of health using a 19-question survey....
  PubDate: Wed, 5 Mar 2025 00:00:00 +0000
Risk Factors for Hospital Admissions Among Emergency Department Patients:
From Triage to Admission
- Authors: Koh; Jemima , Hong Choon, Oh , Zeyen, Seah , Lim, Steven
  Abstract: Introduction: Healthcare systems typically provide multiple channels to access acute inpatient care, with the emergency department (ED) as the main route of access. The ED faces multifaceted demand and supply challenges, which implicate resource allocation and patient flow. In this study we aimed to identify factors associated with hospital admissions among ED patients in a Singapore tertiary-care hospital.Methods: Using a retrospective cohort study of all eligible visits to a Singapore ED between January 1–December 31, 2019, we conducted a multivariable, mixed-effect logistic regression model to study the factors associated with hospital admissions. The model accounted for patients’ demographics; triage category; arrival mode; referral source; time of ED visit; discharge diagnosis; and ED occupancy levels. Results: In 2019, there were 141,719 visits to the ED, with 42,238 (30%) of these visits resulting in hospital admissions. Factors associated...
  PubDate: Wed, 5 Mar 2025 00:00:00 +0000
Creation and Implementation of an EMS Elective for Final-Year Medical
Students: A 5-year Evaluation
- Authors: Peralta; Edder , Evers, Christopher , Gonell, Toniann , Hodges, Megan , Cohen, David , Maloney, Lauren M. https://orcid.org/0000-0001-7073-055X
  Abstract: Introduction: Emergency medical services (EMS) professionals interact with nearly every type of physician and are key stakeholders across the healthcare spectrum. However, no formal national recommendations exist for medical student education about EMS. When looking for institution-level resources to assist in writing the educational objectives and curricular content for an EMS elective for medical students, limited examples are available for guidance. We designed, implemented, and evaluated a two-week EMS elective for final-year medical students. A pragmatic description of how to create an EMS elective is detailed. Methods: The EMS elective involves an introductory session, an operational orientation, and six ambulance shifts. Self-directed activities and checklists encourage interdisciplinary learning between calls. Additionally, students deliver a case presentation including an example for improved interdisciplinary communication....
  PubDate: Fri, 28 Feb 2025 00:00:00 +000
Images in Black and White: Disparities in Utilization of Computed
Tomography and Ultrasound for Older Adults with Abdominal Pain
- Authors: Unachukwu; Ijeoma , Adjei-Poku, Michael N. , Sailors, Olivia C. , Gonzales, Rachel , South, Eugenia , Meisel, Zach , Kelz, Rachel R. , Cappola, Anne R. , Friedman, Ari B.
  Abstract: Introduction: Abdominal pain is the leading emergency department (ED) chief complaint in older (≥65 years of age) adults, accounting for 1.4 million ED visits annually. Ultrasound and computed tomography (CT) are high-yield tests that offer rapid and accurate diagnosis for the most clinically significant causes of abdominal pain. In this study we used nationally representative data to examine racial/ethnic differences in cross-sectional imaging for older adults presenting to the ED with abdominal pain. Methods: We performed a retrospective, cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to assess differences in the rate of imaging between White and Black older adults presenting to the ED for abdominal pain. Our primary outcome was the receipt of abdominal CT and/or ultrasound imaging. Results: Across 1,656 older adult ED visits for abdominal pain,...
  PubDate: Fri, 28 Feb 2025 00:00:00 +000
Unlocking Cardiac Insights: Displacement of Aortic Root for Calculation of
Ejection Fraction in Emergency Department in India
- Authors: Manu; Sudhi https://orcid.org/0000-0003-4149-5022 , Vivek, Gopinathan https://orcid.org/0000-0002-9949-1158 , Sanjan, Asanaru Kunju https://orcid.org/0000-0002-8507-5698 , Ajay, A. https://orcid.org/0000-0001-9095-5596 , Nisarg, S. https://orcid.org/0000-0001-8621-092X , Jayaraj, Mymbilly Balakrishnan , Aishwarya, T.R. https://orcid.org/0000-0002-0314-0549 , Khalid, Mohammad https://orcid.org/0000-0002-9282-5450 , Chetana, S. https://orcid.org/0000-0002-0570-3261
  Abstract: Introduction: Assessing cardiac function is crucial for managing acute dyspnea. In this study we aimed to evaluate displacement of the aortic root (DAR) as a method for calculating ejection fraction (EF) in patients with undifferentiated dyspnea presenting to the emergency department (ED). The primary objective was to compare EF values obtained through DAR with the modiﬁed Simpson method, which is considered the criterion reference, within an Indian academic ED.Methods: We conducted a prospective, cross-sectional study spanning two years (December 2019–December 2021). The study enrolled 110 consecutive ED patients ≥18 years of age, presenting with undifferentiated dyspnea and normal sinus rhythm. Ultrasound-trained investigators measured DAR using M-mode ultrasonography. Experienced echocardiographers, blinded to DAR, determined EF using the modiﬁed Simpson method. Statistical analyses included the Shapiro-Wilk test, McNemar test, and...
  PubDate: Tue, 25 Feb 2025 00:00:00 +000
A Review of Sports-Related, Life-Threatening Injuries Presenting to
Emergency Departments, 2009-18
- Authors: Ibiebele; Abiye , Mannix, Rebekah , Meehan, William
  Abstract: Introduction: In the United States, 3.7 million people present to an emergency department (ED) annually with an injury related to sports or athletic activity. A prior study a decade ago revealed that 14% of life-threatening injuries presenting to EDs were sports related, with this percentage being higher in the pediatric population. However, with changes in sports participation and regulatory changes over the past decade, it is unclear whether the proportion of life-threatening sports-related injuries has changed. Methods: We conducted a cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS), consisting of patients from years 2009–2018. Life-threatening injuries were defined as International Classification of Diseases 9 and 10 codes for skull fracture, cervical spine fractures, intracranial hemorrhage, traumatic pneumothorax/hemothorax, liver lacerations, spleen lacerations, traumatic aortic aneurysm...
  PubDate: Mon, 24 Feb 2025 00:00:00 +000
Diagnostic Delays Are Common, and Classic Presentations Are Rare in Spinal
Epidural Abscess
- Authors: Durant; Edward J. , Copos, Sarabeth , Folck, Bruce F. , Anderson, Meredith , Ghiya, Meena S. , Hofmann, Eric R. , Vuong, Peter , Shan, Judy , Kene, Mamata
  Abstract: Introduction: Spinal epidural abscess (SEA) is a rare surgical emergency of the spine that can result in permanent neurological injury if not diagnosed and treated in a timely manner. Because early presentation can appear similar to benign back or neck pain, delays in diagnosis may be relatively common. We sought an improved understanding of the characteristics associated with SEA and frequency of delays in SEA diagnosis. Methods: We conducted a retrospective cohort study of adult patients with new magnetic resonance imaging-confirmed SEA from January 1, 2016–December 31, 2019 in an integrated healthcare system. We applied electronic data abstraction and focused manual chart review to describe potentially SEA-related ambulatory and emergency visits in the 30 days prior to SEA diagnosis, and patient characteristics including comorbidities, potential risk factors, and presenting signs and symptoms. We described the frequency of potential...
  PubDate: Mon, 24 Feb 2025 00:00:00 +000
Analysis of the Highest Altmetrics-scored Articles in Emergency Medicine
Journals
- Authors: Bayram; Başak , Çetin, Murat https://orcid.org/0000-0002-0667-7966 , Limon, Önder , Long, Brit , Gottlieb, Michael https://orcid.org/0000-0003-3276-8375
  Abstract: Introduction: Alternative metrics (altmetrics) have emerged as invaluable tools for assessing the inﬂuence of scholarly articles. In this study we aimed to evaluate correlations between Altmetric Attention Scores (AAS), and sources and actual citations in articles displaying the highest AAS within emergency medicine (EM) journals.Methods: We conducted an analysis of EM journals listed in the Science Citation Index Expanded (SCIE) using the Altmetric Explorer tool. We analyzed the journals that received the highest number of mentions, the sources of AAS, the regions most frequently mentioned, and the geographical distribution of mentions. In the subsequent stage of our analysis, we conducted an examination of the 200 top-ranked articles that had received high AAS and were published in SCIE EM journals from January 1, 2013–January 1, 2023. We sought to determine the correlations between the AAS and the citation counts of articles on Google...
  PubDate: Fri, 14 Feb 2025 00:00:00 +000
Push and Pull: What Factors Attracted Applicants to Emergency Medicine and
What Factors Pushed Them Away Following the 2023 Match
- Authors: Kiemeney; Michael , Morris, James , Lamparter, Lauren , Weizberg, Moshe , Little, Andrew , Milman, Brian
  Abstract: Introduction: Emergency medicine (EM) historically enjoyed a nearly 100% match rate. A rapid change saw 46% of EM programs with one or more unﬁlled positions after the 2023 Match. Much has been discussed about potential causes, and characteristics of unﬁlled programs have been investigated. We surveyed recent applicants to EM to further understand what continues to draw them to EM and what concerns deter them from choosing a career in EM.Methods: A cross-sectional, mixed methods survey was distributed in the summer of 2023 to a convenience sample of respondents via the listservs of national EM resident and student organizations as well as clerkship directors in EM. We did not calculate response rate due to listserv convenience sampling. A total of 213 responses were received, representing 7.7% of the total number of EM applicants (2,765) in 2023. Applicants were asked to rank from 1 to 5 their experiences with EM and the characteristics...
  PubDate: Fri, 14 Feb 2025 00:00:00 +000
Validating an Electronic Health Record Algorithm for Diabetes Screening
Eligibility in the Emergency Department
- Authors: Smart; Mary H. https://orcid.org/0000-0002-7303-6579 , Lin, Janet Y. , Layden, Brian T. , Eisenberg, Yuval , Danielson, Kirstie K. , Pobee, Ruth , Tang, Chuxian , Rydzon, Brett , Maheswaran, Anjana Bairavi , Pickard, A. Simon , Sharp, Lisa K. , Kong, Angela
  Abstract: Objective: While the American Diabetes Association (ADA) screening guidelines have been used widely, the way they are implemented and adapted to a particular setting can impact their practical application and usage. Our primary objective was to validate a best practice advisory (BPA) screening algorithm informed by the ADA guidelines to identify patients eligible for hemoglobin a1c (HbA1c) testing in the emergency department (ED). Methods: This cross-sectional study included adults presenting to a large urban medical center’s ED in May 2021. We used sensitivity, specificity, likelihood ratios, and predictive values to estimate the algorithm’s ability to correctly identify patients eligible for diabetes screening, with manual chart review as the reference standard. Eligibility criteria targeted patients at risk for diabetes who were likely unaware of their elevated HbA1c. We also calculated the area under the receiver operating...
  PubDate: Thu, 13 Feb 2025 00:00:00 +000
“Oh, Another Overdose, for the Love of Pete”: First Responder
Perspectives on Overdose Response Technology
- Authors: Rioux; William , Jones, Stephanie , Ghosh, S. Monty
  Abstract: Background: Overdose response applications and hotlines are novel overdose response technologies (ORT)/virtual harm reduction strategies that have recently emerged as a strategy to reduce the harms associated with the ongoing opioid epidemic. First responders are often the first point of contact for people who have overdosed and play a significant role in responses enacted by these services. In this study our aim was to explore the attitudes and perceptions of first responders on these novel technologies. Methods: We recruited 17 participants using purposive sampling through the province of Alberta between February–April 2023 including 11 paramedics, two firefighters, and five emergency communications operators. To be included in the study, participants were required to be older than 18 years of age, have the ability to communicate effectively in English, provide verbal informed consent, and work in an emergency responder role....
  PubDate: Wed, 12 Feb 2025 00:00:00 +000
Response to the Letter to the Editor Regarding “Bicarbonate and Serum
Lab Markers as Predictors of Mortality in the Trauma Patient”
- Authors: Talbott; Matthew M. , Jehle, Dietrich , Paul, Krishna
  Abstract: N/A
  PubDate: Wed, 12 Feb 2025 00:00:00 +000
Immune Checkpoint Inhibitor-associated Pneumonitis: A Narrative Review
- Authors: Li; Chang , Faiz, Saadia A. , Boysen-Osborn, Megan , Sheshadri, Ajay , Wattana, Monica K.
  Abstract: Immune checkpoint inhibitors (ICI), such as pembrolizumab, nivolumab, durvalumab and ipilimumab, have signiﬁcantly enhanced survival rates for multiple cancer types such as non-small cell lung cancer, melanoma, Hodgkin lymphoma, and breast cancer, and they have emerged as an adjunct or primary therapy for malignant disease. Approximately 40% of patients with cancer on ICI therapy experience side effects called immune-related adverse events (irAE). While not the most common, pulmonary toxicities can be rapidly progressive, potentially fatal, and pose a three-fold increased risk for requiring intensive care unit-level of care. Pneumonitis is a focal or diffuse inﬂammation of the lung parenchyma, and clinical manifestations may be highly variable. While the onset is generally observed 6–12 weeks after the initiation of therapy, drug toxicity can develop rapidly within days after the ﬁrst infusion or many months into therapy. Pneumonitis symptoms can be subtle or non-speciﬁc; therefore,...
  PubDate: Fri, 7 Feb 2025 00:00:00 +0000
Effort During Ethanol Breath Testing Impacts Correlation with Serum
Ethanol Concentration
- Authors: Stellpflug; Samuel J. , Menton, William H. https://orcid.org/0000-0002-0151-712X , Westgard, Bjorn C. https://orcid.org/0000-0003-1275-753X , Johnsen, Ryan D. https://orcid.org/0000-0001-8438-1071 , Coomes, Alexander M. https://orcid.org/0000-0003-2878-6917 , Lefevere, Robert C. https://orcid.org/0000-0003-4816-4437 , Zwank, Michael D.
  Abstract: Introduction: The gold standard for quantifying ethanol intoxication in patients is serum testing. However, breath testing is faster, less expensive, and less invasive. It is unknown whether perceived effort during a breath ethanol test impacts the accuracy of the test and the correlation with serum concentration. In this study we analyzed whether perceived “poor” effort during breath ethanol testing would result in worse correlation than perceived “normal” breath-testing effort with respect to serum ethanol concentration.Methods: Subjects were identiﬁed retrospectively over a 49-month period if they had both a breath ethanol test and a serum ethanol test obtained during the same ED visit within 60 minutes of each other, if they had their effort during the breath test recorded as “normal” or “poor” by the person administering the test, and had non-zero breath and serum ethanol concentrations. We completed descriptive and correlation...
  PubDate: Thu, 6 Feb 2025 00:00:00 +0000
Virtual Interviews Correlate with Home and In-State Match Rates at One
Emergency Medicine Program
- Authors: Motzkus; Christine , Frey, Casey , Humbert, Aloysius
  Abstract: Introduction: Incorporating virtual interviews into residency recruitment may help diversify access to residency programs while reducing the cost involved with travel and lodging. Programs may be more likely to rank students they have met in person at an interview when compared to unknown virtual applicants. Our objective was to characterize home institution, in-state, and in-region match rates to emergency medicine (EM) residency programs for fourth-year medical students.Methods: We used National Residency Matching Program data available to the program director to identify medical school and match location of fourth-year medical students who interviewed at a large EM residency program in the Midwest from 2018–2023. Students’ medical schools and ultimately matched programs were mapped to Electronic Residency Application Service geographic regions; subgroup analyses evaluated allopathic and osteopathic medical students separately. We...
  PubDate: Wed, 5 Feb 2025 00:00:00 +0000
Productivity and Efficiency Growth During Emergency Medicine Residency
Training
- Authors: Singh; Matthew T. , Austin, David M. , Mullennix, Stephanie C. , Reynolds, Joshua C. , Oostema, J. Adam
  Abstract: Introduction: Throughout training, an emergency medicine (EM) resident is required to increase efﬁciency and productivity to ensure safe practice after graduation. Multitasking is one of the 22 Accreditation Council for Graduate Medical Education (ACGME) EM milestones and is often measured through evaluations and observation. Providing quantitative data to both residents and residency administration on patients seen per hour (PPH) and efﬁciency could improve a resident experience and training in many ways. Our study was designed to analyze various throughput metrics and productivity trends using applied mathematics and a robust dataset. Our goals were to deﬁne the curve of resident PPH over time, adjust for relevant confounders, and analyze additional efﬁciency metrics related to throughput such as door-to-decision time (DTDT).Methods: We used a retrospective, observational design in a single, tertiary-care center emergency department...
  PubDate: Wed, 5 Feb 2025 00:00:00 +0000
Modeling Hourly Productivity of Advanced Practice Clinicians in the
Emergency Department
- Authors: Stenson; Bryan A. https://orcid.org/0000-0003-2212-164X , Antkowiak, Peter S. , Chiu, David T. , Sanchez, Leon D. https://orcid.org/0000-0002-8807-0913 , Joseph, Joshua W.
  Abstract: Introduction: Advance practice clinicians (APC) play signiﬁcant roles in academic and community emergency departments (ED). In attendings and residents, prior research demonstrated that productivity is dynamic and changes throughout a shift in a predictable way. However, this has not been studied in APCs. The primary outcome of this study was to model productivity for APCs in community EDs to determine whether it changes during a shift similar to the way it does for attendings and residents.Methods: This was a retrospective, observational analysis of 10-hour APC shifts at two suburban hospitals, worked by 14 total individuals. We examined the number of patients seen per hour of the shift by experienced APCs who see all acuity and staff all patients with an attending. We used a generalized estimating equation to construct the model of hour-by-hour productivity change.Results: We analyzed 862 shifts over one year...
  PubDate: Fri, 31 Jan 2025 00:00:00 +000
Harder, Better, Faster, Stronger' Residents Seeing More Patients Per
Hour See Lower Complexity
- Authors: Jewell; Corlin M. , Bai, Guangyu (Anthony , Hekman, Dann J. , Nicholson, Adam M. , Lasarev, Michael R. , Alexandridis, Roxana , Schnapp, Benjamin H.
  Abstract: Introduction: Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efﬁciency, although it is likely insufﬁcient for encapsulating overall efﬁciency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efﬁciency.Methods: We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their ﬁnal year of training who graduated between 2017–2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (ﬁnal) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU).Results: A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from ﬁrst to second year...
  PubDate: Fri, 31 Jan 2025 00:00:00 +000
Injuries and Outcomes of Ground-level Falls Among Older Patients: A
Retrospective Cohort Study
- Authors: Kan; Vincent , Huang, Wilson , Steigauf-Regan, Gretta , Anderson, Jill , Dang, Ivy , Darling, Chad
  Abstract: Study Objective: We sought to determine the overall rates of traumatic injuries and whether the rates of traumatic injuries and various clinical outcomes differed among older patients presenting to a tertiary-care emergency department (ED) after a ground-level fall (GLF) and who underwent whole-body computed tomography.Methods: We conducted a retrospective cohort study of patients ≥65 years of age who presented to the ED with a GLF and received a whole-body CT from January 1–December 31, 2021. Age was stratiﬁed into age groups: 65–74; 75–84; and 85+. We presented a descriptive analysis of traumatic injuries, intensive care unit (ICU) admissions, and all-cause mortality rates. We used multivariable logistic regression to determine the association between increasing age, traumatic injuries, and clinical outcomes.Results: Of 638 patients in the cohort, 120 (18.9%) sustained thoracic injuries and 80 (12.5%) sustained...
  PubDate: Thu, 30 Jan 2025 00:00:00 +000
Critical Time Intervals in Door-to-Balloon Time Linked to One-Year
Mortality in ST-Elevation Myocardial Infarction
- Authors: Tsai; Shin-Ho , Hsiao, Yu-Ting , Yeh, Ya-Ni , Lin, Jih-Chun , Zhang, Shi-Quan , Tsai, Ming-Jen https://orcid.org/0000-0002-2662-1206
  Abstract: Background: Timely activation of primary percutaneous coronary intervention (PCI) is crucial for patients with ST-segment elevation myocardial infarction (STEMI). Door-to-balloon (DTB) time, representing the duration from patient arrival to balloon inﬂation, is critical for prognosis. However, the speciﬁc time segment within the DTB that is most associated with long-term mortality remains unclear. In this study we aimed to identify the target time segment within the DTB that is most associated with one-year mortality in STEMI patients.Methods: We conducted a retrospective cohort study at a tertiary teaching hospital. All patients diagnosed with STEMI and activated for primary PCI from the emergency department were identiﬁed between January 2013–December 2021. Patient demographics, medical history, triage information, electrocardiogram, troponin-I levels, and coronary angiography reports were obtained. We divided the DTB time into door-to-electrocardiogram...
  PubDate: Thu, 30 Jan 2025 00:00:00 +000
Development of a Reliable, Valid Procedural Checklist for Assessment of
Emergency Medicine Resident Performance of Emergency Cricothyrotomy
- Authors: Loke; Dana E. , Rogers, Andrew M. , McCarthy, Morgan L. , Leibowitz, Maren K. , Stulpin, Elizabeth T. , Salzman, David H.
  Abstract: Introduction: Emergency cricothyrotomy is a rare but potentially life-saving procedure performed by emergency physicians. A comprehensive, dichotomous procedural checklist for emergency cricothyrotomy for emergency medicine (EM) resident education does not exist.Objectives: We aimed to develop a checklist containing the critical steps for performing an open emergency cricothyrotomy, to assess performance of EM residents performing an open emergency cricothyrotomy using the checklist on a simulator, and to evaluate the reliability and validity of the checklist for performing the procedure.Curricular Design: We developed a preliminary checklist based on literature review and sent it to experts in EM and trauma surgery. A modiﬁed Delphi approach was used to revise the checklist and reach consensus on a ﬁnal version of the checklist. To assess usability of the checklist, we assessed EM residents using a cricothyrotomy...
  PubDate: Thu, 30 Jan 2025 00:00:00 +000
Use and Outcomes of Sugammadex for Neurological Examination after
Neuromuscular Blockade in the Emergency Department
- Authors: Hallisey; Stephen D. https://orcid.org/0009-0004-1479-7601 , Prucnal, Christiana K. , Ilg, Annette M. , Seethala, Raghu R. , Jansson, Paul S.
  Abstract: Introduction: Non-depolarizing agents such as rocuronium and vecuronium are frequently used in the emergency department (ED) to facilitate intubation but may lead to delay in neurologic examination and intervention. Sugammadex is used for reversal of neuromuscular blockade by non-depolarizing agents but its role in the reversal of neuromuscular blockade for neurologic examination in the ED is poorly deﬁned.Methods: This was a multicenter cohort study using retrospective chart review. We reviewed all ED encounters from June 21, 2016–February 9, 2024 of the electronic health record of Mass General Brigham, a large multistate health system, and abstracted all ED administrations of sugammadex to facilitate neurologic examination. We calculated descriptive statistics and assessed outcomes.Results: In 3,080,338 ED visits during the study period, 48 patients received sugammadex to facilitate neurologic examination....
  PubDate: Thu, 30 Jan 2025 00:00:00 +000
Personality Traits and Burnout in Emergency Medicine Residents
- Authors: Freeman; Brendan , Cygan, Lukasz , Melville, Laura , Gaeta, Theodore
  Abstract: Background: Burnout is prevalent in medical training, and some data indicates certain personality types are more susceptible. The criterion reference for measurement of burnout is the Maslach Burnout Inventory (MBI), which scores three factors: emotional exhaustion (EE); depersonalization (DP); and personal accomplishment (PA). Emotional exhaustion most closely correlates with burnout. Studies have yet to evaluate a link between burnout markers and certain personality traits in emergency medicine (EM) residents. The personality traits of openness, agreeableness, extraversion, conscientiousness, and neuroticism can be measured with a 50-item International Personality Item Pool (IPIP) Big 5 survey. Our goal in this study was to be the ﬁrst to examine the relationship between personality traits and burnout among EM residents and guide future research on potential predictors of burnout and targeted interventions for resident well-being.Methods:...
  PubDate: Thu, 30 Jan 2025 00:00:00 +000
CDEM CORD Special Issue on Educational Research and Practice
- Authors: Saucedo; Cassandra
  Abstract: n/a
  PubDate: Mon, 27 Jan 2025 00:00:00 +000
Special Issue on Substance Misuse and Addiction Disorders
- Authors: Saucedo; Cassandra
  Abstract: n/a
  PubDate: Tue, 21 Jan 2025 00:00:00 +000
Substance Use and Addiction Disorders : A Call for Increased Screening and
Treatment in the Emergency Department
- Authors: Wilkerson; R. Gentry , LaPietra, Alexis M.
  Abstract: n/a
  PubDate: Mon, 20 Jan 2025 00:00:00 +000
WestJEM Full Issue Text
- Authors: Valenzi; Nicole
  PubDate: Thu, 16 Jan 2025 00:00:00 +000
Associations of Individual and Neighborhood Factors with Disparities in
COVID-19 Incidence and Outcomes
- Authors: Samuels-Kalow; Margaret E. , Cash, Rebecca E. , Zachrison, Kori S. , Rodney Fassinou, Auriole Corel , Harris II, Norman , Camargo, Carlos A.
  Abstract: Introduction: The disproportionate impact of coronavirus 2019 (COVID-19) on Black and Hispanic communities has been widely reported. Many studies have used neighborhood racial/ethnic composition to study such disparities, but less is known about the interplay between individual race/ethnicity and neighborhood racial composition. Therefore, our goal in this study was to assess the relative contributions of individual and neighborhood risk to disparities in COVID-19 incidence and outcomes.Methods: We performed a cross-sectional study of patients with emergency department (ED) and inpatient visits to an academic health system (12 hospitals; February 1–July 15, 2020). The primary independent variable was race/ethnicity; covariates included individual age, sex, comorbidity, insurance and neighborhood density, poverty, racial/ethnic composition, education and occupation. The primary outcome was severe acute respiratory syndrome coronavirus...
  PubDate: Wed, 15 Jan 2025 00:00:00 +000
Food and Housing Insecurity, Resource Allocation, and Follow-up in a
Pediatric Emergency Department
- Authors: Assaf; Raymen R. , Knudsen-Robbins, Chloe , Heyming, Theodore , Bacon, Kellie , Shelton, Shelby K. , Chakravarthy, Bharath , Saadat, Soheil , Douglas, Jason A. , Cisneros, Victor
  Abstract: Introduction: Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efﬁcient screening tools or most effective interventions for ED use.Objective: In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED.Methods: During the study period (March 1–December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children’s hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic,...
  PubDate: Wed, 15 Jan 2025 00:00:00 +000
Cardiac Computed Tomography Measurements in Pulmonary Embolism Associated
with Clinical Deterioration
- Authors: Weekes; Anthony J. https://orcid.org/0000-0001-9309-7910 , Pikus, Angela M. https://orcid.org/0000-0002-2048-2081 , Hambright, Parker L. https://orcid.org/0009-0006-0942-3722 , O’Connell, Nathaniel https://orcid.org/0000-0002-3827-5152
  Abstract: Introduction: Most pulmonary embolism response teams (PERT) use a radiologist-determined right ventricle to left ventricle ratio (RV:LV) cut-off of 1.0 to risk-stratify pulmonary embolism (PE) patients. Continuous measurements from computed tomography pulmonary angiograms (CTPAs) may improve risk stratiﬁcation. We assessed associations of CTPA cardiac measurements with acute clinical deterioration and use of advanced PE interventions.Methods: This was a retrospective study of a PE registry used by eight afﬁliated emergency departments. We used an artiﬁcial intelligence (AI) algorithm to measure RV:LV on anonymized CTPAs from registry patients for whom the PERT was activated (2018–2023) by institutional guidelines. Primary outcome was in-hospital PE-related clinical deterioration deﬁned as cardiac arrest, vasoactive medication use for hypotension, or rescue respiratory interventions. Secondary outcome was advanced intervention use....
  PubDate: Wed, 15 Jan 2025 00:00:00 +000
Procedural Sedation in the Emergency Department – An Observational
Study: Does Nil Per Os Status Matter'
- Authors: Peterson; Brendan , Nowacki, Amy S. , Ulintz, Alexander , Mace, Sharon E.
  Abstract: Introduction: Procedural sedation (PS) is commonly performed in the emergency department (ED). Nil per os (nothing by mouth) (NPO) guidelines extrapolated from standards for patients undergoing elective procedures in the operating room have been applied to ED PS patients. There has been no large study of ED PS patients comparing differences in adverse events and PS success rates based on NPO status.Methods: From a cohort of consecutive ED PS patients of all ages in the 20 EDs of one hospital system—one quaternary ED, four tertiary EDs, six community hospital EDs, one rural ED, two pediatric EDs, and six freestanding EDs in two states in the Midwest and South—we conducted a retrospective analysis on a prospective database over 183 months from April 2000–June 2015. Primary outcome was the incidence of side effects and complications, which comprised the adverse effects. The side effects were nausea, vomiting, itching/rash, emergence...
  PubDate: Wed, 15 Jan 2025 00:00:00 +000
Combining Immersive Simulation with a Collaborative Procedural Training on
Local Anesthetic Systemic Toxicity and Fascia Iliaca Compartment Block: A
Pilot Study
- Authors: Griesmer; Katherine B. , Thompson, Maxwell , Miller, Briana , Zhai, Guihua , Raper, Jaron , Bloom, Andrew
  Abstract: Introduction: Readiness to perform a wide variety of procedures or manage nearly any patient presentation remains an essential aspect of emergency medicine training and practice. Often, simulation is needed to supplement real-life exposure to provide comfort and knowledge, particularly with rarer pathology and procedures. As the scope of practice continues to grow, newer procedures, such as ultrasound (US)-guided nerve blocks (UGNB), are becoming integrated into resident training, building on previously established skills. The fascia iliaca compartment block (FICB) is performed on patients with speciﬁc femoral fractures and is a now a component of standard multimodal pain regimens, with US-guidance limiting adverse events. Given the need for high volumes of local anesthetic to perform the block it is imperative for clinicians to understand dosing as well as recognize and treat local anesthetic systemic toxicity (LAST). With sparse literature on sequential immersive...
  PubDate: Wed, 15 Jan 2025 00:00:00 +000

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