{"title":"Critical Insights on “Safety of Diltiazem for Acute Management of Atrial Fibrillation (AF) in Patients with Heart Failure and Reduced Ejection Fraction in the Emergency Department”","authors":"Junaid Imran MBBS , Saad Khan MBBS , Hiba Thasleem MD , Maryam Adnan MBBS , Fatima Sohail MBBS, FCPS","doi":"10.1016/j.jemermed.2025.02.027","DOIUrl":"10.1016/j.jemermed.2025.02.027","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 411-412"},"PeriodicalIF":1.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.jemermed.2025.07.029
Josef Finsterer MD, PhD
{"title":"The Rate of Covid-19 Positivity Should not be Calculated on the Basis of Self-Reporting in Questionnaires","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.jemermed.2025.07.029","DOIUrl":"10.1016/j.jemermed.2025.07.029","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 419-420"},"PeriodicalIF":1.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.jemermed.2025.07.055
Josef Finsterer MD, PhD
{"title":"Venous Sinus Thrombosis in High-Risk Patients Should Not be Misinterpreted as Conversion Disorder","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.jemermed.2025.07.055","DOIUrl":"10.1016/j.jemermed.2025.07.055","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 400-401"},"PeriodicalIF":1.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.jemermed.2025.10.013
Vadym Shapovalov MD , Quincy K. Tran MD, PhD , Babak Sarani MD , Mohammed Zohery BS , Amy Caggiula MD , Rahil Ashraf MS , Ali Pourmand MD, MPH, RDMS
Background
In many urban settings, police transport (PT) is increasingly used as an alternative to traditional Emergency Medical Services (EMS). PT follows a “scoop and run” strategy, aiming to minimize prehospital interventions to rapidly deliver patients to the nearest trauma center. Conversely, EMS teams typically provide stabilizing medical care on site before transport.
Objectives
This study aimed to compare outcomes, specifically rates of surgical intervention and mortality, for patients transported by police vs. EMS.
Methods
PubMed, Scopus, and Cochrane databases were searched from inception to January 1, 2025 for studies meeting inclusion criteria. A random-effects meta-analysis was performed to assess the primary outcome of mortality for PT vs. EMS, and the secondary outcome of surgical intervention in penetrating injuries. Study quality was evaluated using the Newcastle-Ottawa Scale; heterogeneity was assessed with Q-statistics and I² values.
Results
Ten studies met criteria, totaling 112,570 patients: 100,716 (89%) transported via EMS and 11,854 (11%) by police. All-cause mortality was 13% (12,742/100,716) for EMS patients vs. 25% (2922/11,854) for PT patients. Police transport was associated with a 1.5-fold higher mortality rate (odds ratio 1.50, 95% confidence interval 1.34–1.69, p < 0.001). No statistically significant difference was found in surgical intervention rates for penetrating injuries (odds ratio 1.19, 95% confidence interval 0.98–1.45, p = 0.082). Heterogeneity was significant for both mortality (I2 = 66%) and surgical interventions (I2 = 74%).
Conclusion
Police transport was associated with higher odds of all-cause mortality compared with EMS, with no difference in surgical intervention rates. Prospective, methodologically robust studies are needed to guide future practice.
{"title":"Comparative Clinical Outcomes of Trauma Transport: Emergency Medical Services vs. Police Transport, A Systematic Review and Meta-Analysis","authors":"Vadym Shapovalov MD , Quincy K. Tran MD, PhD , Babak Sarani MD , Mohammed Zohery BS , Amy Caggiula MD , Rahil Ashraf MS , Ali Pourmand MD, MPH, RDMS","doi":"10.1016/j.jemermed.2025.10.013","DOIUrl":"10.1016/j.jemermed.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>In many urban settings, police transport (PT) is increasingly used as an alternative to traditional Emergency Medical Services (EMS). PT follows a “scoop and run” strategy, aiming to minimize prehospital interventions to rapidly deliver patients to the nearest trauma center. Conversely, EMS teams typically provide stabilizing medical care on site before transport.</div></div><div><h3>Objectives</h3><div>This study aimed to compare outcomes, specifically rates of surgical intervention and mortality, for patients transported by police vs. EMS.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, and Cochrane databases were searched from inception to January 1, 2025 for studies meeting inclusion criteria. A random-effects meta-analysis was performed to assess the primary outcome of mortality for PT vs. EMS, and the secondary outcome of surgical intervention in penetrating injuries. Study quality was evaluated using the Newcastle-Ottawa Scale; heterogeneity was assessed with Q-statistics and <em>I</em>² values.</div></div><div><h3>Results</h3><div>Ten studies met criteria, totaling 112,570 patients: 100,716 (89%) transported via EMS and 11,854 (11%) by police. All-cause mortality was 13% (12,742/100,716) for EMS patients vs. 25% (2922/11,854) for PT patients. Police transport was associated with a 1.5-fold higher mortality rate (odds ratio 1.50, 95% confidence interval 1.34–1.69, <em>p</em> < 0.001). No statistically significant difference was found in surgical intervention rates for penetrating injuries (odds ratio 1.19, 95% confidence interval 0.98–1.45, <em>p</em> = 0.082). Heterogeneity was significant for both mortality (<em>I</em><sup>2</sup> = 66%) and surgical interventions (<em>I</em><sup>2</sup> = 74%).</div></div><div><h3>Conclusion</h3><div>Police transport was associated with higher odds of all-cause mortality compared with EMS, with no difference in surgical intervention rates. Prospective, methodologically robust studies are needed to guide future practice.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 8-19"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.jemermed.2025.10.007
Yuval Avidan MD, Razi Khoury MD, Ibrahim Naoum MD, Asaf Danon MD, MSc, Amir Aker MD
Background
The rise of smartwatches introduces a novel technology for detecting dysrhythmias. However, the diagnosis of ventricular dysrhythmias (VDs) usually requires automatic recording modes. There is a scarcity of literature on smartwatch-based VDs detection.
Objectives
We conducted a literature review to synthesize current evidence on the clinical profiles of smartwatch-detected VDs and to highlight their detectability in real-world settings.
Methods
PubMed, Embase, Scopus, and the Cochrane Library were searched from inception to May 2025 for studies reporting smartwatch-based detection of VDs, with availability of participant-level data. Two investigators independently extracted study data and quality.
Results
A total of 20 patients from 18 articles were included, with a mean age of 48 years; 35% were over 60 years of age, and 35% had a documented history of structural heart disease. Primary complaints were palpitations (70%) and syncope (20%). Sustained monomorphic ventricular tachycardia was the most common dysrhythmia (60%), followed by polymorphic ventricular tachycardia (25%). Vasospastic angina and idiopathic ventricular tachycardia were the leading diagnoses. Interventions included coronary angiography (25%), electrophysiology studies (35%), catheter ablation (35%), and implantable cardioverter defibrillators (45%). The rest received medical therapy.
Conclusions
Smartwatches may provide valuable outpatient data that support timely diagnosis and appropriate therapy across diverse clinical scenarios. As exemplified in this review, the detectability of VDs through smartwatches in real-world settings is feasible. Emergency department interrogation of smartwatch data may provide valuable information.
{"title":"Smartwatch-Based Detection of Ventricular Dysrhythmias: A Systematic Review of Literature","authors":"Yuval Avidan MD, Razi Khoury MD, Ibrahim Naoum MD, Asaf Danon MD, MSc, Amir Aker MD","doi":"10.1016/j.jemermed.2025.10.007","DOIUrl":"10.1016/j.jemermed.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>The rise of smartwatches introduces a novel technology for detecting dysrhythmias. However, the diagnosis of ventricular dysrhythmias (VDs) usually requires automatic recording modes. There is a scarcity of literature on smartwatch-based VDs detection.</div></div><div><h3>Objectives</h3><div>We conducted a literature review to synthesize current evidence on the clinical profiles of smartwatch-detected VDs and to highlight their detectability in real-world settings.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Scopus, and the Cochrane Library were searched from inception to May 2025 for studies reporting smartwatch-based detection of VDs, with availability of participant-level data. Two investigators independently extracted study data and quality.</div></div><div><h3>Results</h3><div>A total of 20 patients from 18 articles were included, with a mean age of 48 years; 35% were over 60 years of age, and 35% had a documented history of structural heart disease. Primary complaints were palpitations (70%) and syncope (20%). Sustained monomorphic ventricular tachycardia was the most common dysrhythmia (60%), followed by polymorphic ventricular tachycardia (25%). Vasospastic angina and idiopathic ventricular tachycardia were the leading diagnoses. Interventions included coronary angiography (25%), electrophysiology studies (35%), catheter ablation (35%), and implantable cardioverter defibrillators (45%). The rest received medical therapy.</div></div><div><h3>Conclusions</h3><div>Smartwatches may provide valuable outpatient data that support timely diagnosis and appropriate therapy across diverse clinical scenarios. As exemplified in this review, the detectability of VDs through smartwatches in real-world settings is feasible. Emergency department interrogation of smartwatch data may provide valuable information.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"79 ","pages":"Pages 610-618"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.jemermed.2025.10.011
Aria C. Shi MD , Kira L. Wang BA , Christopher Zeuthen BS , Christopher W. Baugh MD, MBA , Scott G. Weiner MD, MPH , Andrew D. Luo MD, MBA
Background
Opioid prescribing in U.S. emergency departments (EDs) declined over the past decade due to policy reforms and awareness of opioids-related harm. However, the impact of the recent policies and COVID-19 on ED pain management and prescribing patterns remains unexplored.
Objectives
To assess national trends in ED opioid and nonopioid analgesic use and prescribing from 2016 to 2022.
Methods
We conducted a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We examined the proportion of visits where opioids were administered in the ED, prescribed at discharge, or both. Survey-weighted analyses compared 2016 with 2022 and included subgroup analyses by demographics, opioid type, and chief concern.
Results
Across nearly one billion weighted ED visits, opioid administration declined from 22.4% in 2016 to 13.9% in 2022 (absolute difference: −8.5%, 95% CI −10.2 to −6.8; p < 0.001). The proportion of visits with opioids prescribed at discharge declined from 13.0% to 5.9% (absolute difference of 7.1%, 95% CI 5.6 to 8.5, p < 0.001). Nonopioid analgesic administration remained stable overall, with modest increases in select subgroups. Declines in opioid administration were observed across all demographic and hospital characteristics, though fentanyl administration increased slightly, particularly for abdominal pain.
Conclusion
Opioid prescribing in U.S. EDs declined significantly from 2016 to 2022. These reductions were seen across diverse patient populations and visit types, reflecting the impact of policy interventions and adoption of multimodal pain strategies. These findings highlight ongoing shifts in ED pain management and the need for continued monitoring to ensure effective pain management.
背景：在过去十年中，由于政策改革和对阿片类药物相关危害的认识，美国急诊科的阿片类药物处方有所下降。然而，最近的政策和COVID-19对ED疼痛管理和处方模式的影响仍未得到探讨。目的：评估2016年至2022年全国ED阿片类和非阿片类镇痛药使用和处方趋势。方法：我们使用全国医院门诊医疗调查（NHAMCS）的数据进行回顾性研究。我们检查了在急诊科使用阿片类药物、出院时开具处方或两者兼而有之的就诊比例。调查加权分析将2016年与2022年进行比较，并包括按人口统计学、阿片类药物类型和主要关注点进行的亚组分析。结果：在近10亿次加权急诊科就诊中，阿片类药物给药从2016年的22.4%下降到2022年的13.9%（绝对差异：-8.5%,95% CI -10.2至-6.8;p < 0.001）。出院时使用阿片类药物就诊的比例从13.0%下降到5.9%（绝对差异为7.1%,95% CI 5.6至8.5,p < 0.001）。非阿片类镇痛药总体上保持稳定，在选定的亚组中有适度的增加。阿片类药物的使用在所有人口统计学和医院特征中都有所下降，尽管芬太尼的使用略有增加，特别是对于腹痛。结论：2016年至2022年，美国急诊科阿片类药物处方明显下降。这些减少在不同的患者群体和就诊类型中都可以看到，反映了政策干预和采用多模式疼痛策略的影响。这些发现强调了ED疼痛管理的持续变化以及持续监测以确保有效疼痛管理的必要性。
{"title":"Decreasing Rates of Opioid Administration in the Emergency Department: Trends in National Opioid Prescribing Patterns From 2016 to 2022","authors":"Aria C. Shi MD , Kira L. Wang BA , Christopher Zeuthen BS , Christopher W. Baugh MD, MBA , Scott G. Weiner MD, MPH , Andrew D. Luo MD, MBA","doi":"10.1016/j.jemermed.2025.10.011","DOIUrl":"10.1016/j.jemermed.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Opioid prescribing in U.S. emergency departments (EDs) declined over the past decade due to policy reforms and awareness of opioids-related harm. However, the impact of the recent policies and COVID-19 on ED pain management and prescribing patterns remains unexplored.</div></div><div><h3>Objectives</h3><div>To assess national trends in ED opioid and nonopioid analgesic use and prescribing from 2016 to 2022.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We examined the proportion of visits where opioids were administered in the ED, prescribed at discharge, or both. Survey-weighted analyses compared 2016 with 2022 and included subgroup analyses by demographics, opioid type, and chief concern.</div></div><div><h3>Results</h3><div>Across nearly one billion weighted ED visits, opioid administration declined from 22.4% in 2016 to 13.9% in 2022 (absolute difference: −8.5%, 95% CI −10.2 to −6.8; <em>p</em> < 0.001). The proportion of visits with opioids prescribed at discharge declined from 13.0% to 5.9% (absolute difference of 7.1%, 95% CI 5.6 to 8.5, <em>p</em> < 0.001). Nonopioid analgesic administration remained stable overall, with modest increases in select subgroups. Declines in opioid administration were observed across all demographic and hospital characteristics, though fentanyl administration increased slightly, particularly for abdominal pain.</div></div><div><h3>Conclusion</h3><div>Opioid prescribing in U.S. EDs declined significantly from 2016 to 2022. These reductions were seen across diverse patient populations and visit types, reflecting the impact of policy interventions and adoption of multimodal pain strategies. These findings highlight ongoing shifts in ED pain management and the need for continued monitoring to ensure effective pain management.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"79 ","pages":"Pages 577-590"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.jemermed.2025.10.008
Samuel Gray BA , Grace Amadon MS , Nancy Temkin PhD , Marin Darsie MD , Joseph T. Giacino PhD , John D. Corrigan PhD , Frederick Korley MD, PhD , John Whyte MD, PhD , Murray B. Stein MD, MPH , Geoffrey T. Manley MD, PhD , Michael A. McCrea PhD , Lindsay D. Nelson PhD
Background
Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13–15 (“mild” TBI [mTBI]) in adult emergency departments (EDs). However, such assessment is not routine, partly due to limited guidance on interpreting symptom scores.
Objectives
Assess the utility of Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores, assessed in-hospital within 24 h of injury (day 1), in discriminating individuals with, vs. without, persistent TBI-related symptoms (persistent post-concussive symptoms [PPCS]) at 3 months post-injury, and provide interpretive guidance.
Methods
Adults with mTBI across three Level I trauma centers completed the RPQ at day 1 and 3 months post-injury. Using binary logistic regression models and fivefold internal cross-validation, we calculated the mean area under the curve (AUC) for day 1 RPQ total score in predicting 3-month PPCS. Clinical interpretation tables were provided.
Results
Two hundred fifty-two participants who completed a day 1 RPQ were included in the analysis. Inverse probability weighting was used to adjust for bias in attrition (n = 168 followed). The mean cross-validated AUC was 0.84 using day 1 RPQ score alone. Multivariable models, including those using previously validated sets of variables, did not outperform day 1 RPQ alone.
Conclusions
In adults presenting to Level I trauma centers for acute mTBI, symptom burden (RPQ total score) is robustly associated with 3-month symptom outcome. The RPQ, which can be completed in about 3 min, may support recognition of mTBI symptoms in the ED and risk stratification for triage into appropriate follow-up pathways.
{"title":"Use of In-Hospital Mild Traumatic Brain Injury Symptom Checklist Within 24 Hours of Injury to Predict 3-Month Symptom Outcome","authors":"Samuel Gray BA , Grace Amadon MS , Nancy Temkin PhD , Marin Darsie MD , Joseph T. Giacino PhD , John D. Corrigan PhD , Frederick Korley MD, PhD , John Whyte MD, PhD , Murray B. Stein MD, MPH , Geoffrey T. Manley MD, PhD , Michael A. McCrea PhD , Lindsay D. Nelson PhD","doi":"10.1016/j.jemermed.2025.10.008","DOIUrl":"10.1016/j.jemermed.2025.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13–15 (“mild” TBI [mTBI]) in adult emergency departments (EDs). However, such assessment is not routine, partly due to limited guidance on interpreting symptom scores.</div></div><div><h3>Objectives</h3><div>Assess the utility of Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores, assessed in-hospital within 24 h of injury (day 1), in discriminating individuals with, vs. without, persistent TBI-related symptoms (persistent post-concussive symptoms [PPCS]) at 3 months post-injury, and provide interpretive guidance.</div></div><div><h3>Methods</h3><div>Adults with mTBI across three Level I trauma centers completed the RPQ at day 1 and 3 months post-injury. Using binary logistic regression models and fivefold internal cross-validation, we calculated the mean area under the curve (AUC) for day 1 RPQ total score in predicting 3-month PPCS. Clinical interpretation tables were provided.</div></div><div><h3>Results</h3><div>Two hundred fifty-two participants who completed a day 1 RPQ were included in the analysis. Inverse probability weighting was used to adjust for bias in attrition (n = 168 followed). The mean cross-validated AUC was 0.84 using day 1 RPQ score alone. Multivariable models, including those using previously validated sets of variables, did not outperform day 1 RPQ alone.</div></div><div><h3>Conclusions</h3><div>In adults presenting to Level I trauma centers for acute mTBI, symptom burden (RPQ total score) is robustly associated with 3-month symptom outcome. The RPQ, which can be completed in about 3 min, may support recognition of mTBI symptoms in the ED and risk stratification for triage into appropriate follow-up pathways.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 211-219"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.jemermed.2025.10.004
Riley Westein, Lauren Nickel, Mary Beth Phelan
Background
Phantom scanning, defined as the use of point-of-care ultrasound (POCUS) without image archiving, occurs frequently in cardiac arrest and carries clinical, legal, and quality improvement consequences. Its association with clinical presentation following out-of-hospital cardiac arrest (OHCA) remains understudied.
Objectives
To evaluate the prevalence of phantom scanning in OHCA, stratified by clinical presentation and emergency department (ED) disposition.
Methods
We conducted a retrospective, single-center study of adult patients presenting with atraumatic OHCA. The primary outcome was phantom scanning among patients presenting with cardiopulmonary resuscitation (CPR) in progress versus return of spontaneous circulation (ROSC). The secondary outcome compared phantom scanning between admitted patients versus those who died in the ED. Descriptive statistics, chi-square tests, and odds ratios with 95% confidence intervals evaluated associations.
Results
Of 306 patients reviewed, 244 met inclusion criteria. POCUS was more likely with CPR in progress (OR = 3.58, 95% CI [2.08, 6.26], p < 0.001). Among patients who underwent POCUS, phantom scanning was more frequent with CPR in progress (OR = 3.15, 95% CI [1.49, 6.84], p = 0.002). POCUS was less likely among admitted patients (OR = 0.37, 95% CI [0.21, 0.66], p < 0.001), and phantom scanning was less common in this group (OR = 0.23, 95% CI [0.11, 0.47], p < 0.001). Differences in POCUS use and phantom scanning were significant by both presentation and disposition (p < 0.001).
Conclusion
Phantom scanning occurred more often in OHCA patients with CPR in progress and in those who died in the ED. Future research should focus on strategies to reduce phantom scanning and promote adherence to POCUS best practices.
背景：幻像扫描，定义为使用无图像存档的即时超声（POCUS），经常发生在心脏骤停中，并具有临床、法律和质量改善的后果。其与院外心脏骤停（OHCA）后临床表现的关系仍未得到充分研究。目的：评估幻影扫描在OHCA中的流行程度，并根据临床表现和急诊科（ED）处理进行分层。方法：我们对出现非外伤性OHCA的成年患者进行了回顾性、单中心研究。主要结果是在正在进行心肺复苏（CPR）的患者与恢复自然循环（ROSC）的患者中进行幻肢扫描。次要结果比较了住院患者和急诊死亡患者的幻影扫描。描述性统计、卡方检验和95%置信区间的比值比评估了相关性。结果：306例患者中，244例符合纳入标准。心肺复苏术进行时POCUS发生的可能性更大（OR = 3.58, 95% CI [2.08, 6.26], p < 0.001）。在接受POCUS的患者中，正在进行心肺复苏的患者更频繁地进行幻肢扫描（OR = 3.15, 95% CI [1.49, 6.84], p = 0.002）。入院患者的POCUS发生率较低（OR = 0.37, 95% CI [0.21, 0.66], p < 0.001），且本组患者的幻像扫描发生率较低（OR = 0.23, 95% CI [0.11, 0.47], p < 0.001）。POCUS的使用和幻影扫描在表现和处置上都有显著差异（p < 0.001）。结论：幻像扫描在正在进行CPR的OHCA患者和死于ED的患者中更常见。未来的研究应侧重于减少幻像扫描的策略，并促进对POCUS最佳实践的遵守。
{"title":"Phantom Scanning in Point-of-Care Ultrasound After Out-of-Hospital Cardiac Arrest: Impact of Clinical Presentation in a Single-Center Analysis","authors":"Riley Westein, Lauren Nickel, Mary Beth Phelan","doi":"10.1016/j.jemermed.2025.10.004","DOIUrl":"10.1016/j.jemermed.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Phantom scanning, defined as the use of point-of-care ultrasound (POCUS) without image archiving, occurs frequently in cardiac arrest and carries clinical, legal, and quality improvement consequences. Its association with clinical presentation following out-of-hospital cardiac arrest (OHCA) remains understudied.</div></div><div><h3>Objectives</h3><div>To evaluate the prevalence of phantom scanning in OHCA, stratified by clinical presentation and emergency department (ED) disposition.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center study of adult patients presenting with atraumatic OHCA. The primary outcome was phantom scanning among patients presenting with cardiopulmonary resuscitation (CPR) in progress versus return of spontaneous circulation (ROSC). The secondary outcome compared phantom scanning between admitted patients versus those who died in the ED. Descriptive statistics, chi-square tests, and odds ratios with 95% confidence intervals evaluated associations.</div></div><div><h3>Results</h3><div>Of 306 patients reviewed, 244 met inclusion criteria. POCUS was more likely with CPR in progress (OR = 3.58, 95% CI [2.08, 6.26], <em>p</em> < 0.001). Among patients who underwent POCUS, phantom scanning was more frequent with CPR in progress (OR = 3.15, 95% CI [1.49, 6.84], <em>p</em> = 0.002). POCUS was less likely among admitted patients (OR = 0.37, 95% CI [0.21, 0.66], <em>p</em> < 0.001), and phantom scanning was less common in this group (OR = 0.23, 95% CI [0.11, 0.47], <em>p</em> < 0.001). Differences in POCUS use and phantom scanning were significant by both presentation and disposition (<em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Phantom scanning occurred more often in OHCA patients with CPR in progress and in those who died in the ED. Future research should focus on strategies to reduce phantom scanning and promote adherence to POCUS best practices.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 187-193"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Disparities in emergency care for acute coronary syndrome (ACS) have been reported across sex and race/ethnicity. Evidence-based decision tools may help reduce these gaps if their components are objective. The history, electrocardiogram (ECG), age, risk factors, troponin levels (HEART) Score is a validated tool for cardiac risk stratification that may support more equitable care.
Objectives
To assess whether HEART Score implementation in a large, urban, safety-net emergency department (ED) increased referral for guideline-recommended cardiac testing, and whether effects differed by sex or race/ethnicity.
Methods
We conducted a secondary analysis of a pre–post quasi-experiment evaluating HEART Score-based ACS guideline implementation. Adults (≥18 years) were included if they had a troponin completed and an ICD-10 code for chest pain or ACS. The primary outcome was appropriate referral, defined as HEART Score ≥4, no normal objective testing within the year, and receipt of ED testing, urgent outpatient testing ordered, or inpatient admission for testing. We calculated descriptive statistics and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).
Results
Among 1170 patients (521 preimplementation; 649 postimplementation), 498 had a HEART Score ≥4 and were included in the primary model. Implementation was associated with higher odds of appropriate referral (adjusted OR 2.74, 95% CI: 1.87–4.03). Sex and race/ethnicity were not independently associated with referral in either period (p = 0.23–0.76).
Conclusions
Implementation of the HEART Score was associated with increased odds of appropriate referrals for cardiac testing, with no observed disparities by sex, race, or ethnicity. Standardized risk stratification using the HEART Score may support more equitable ACS evaluation in the ED.
{"title":"Associations Between Sex, Race/Ethnicity, and HEART Score Guideline Implementation for Cardiac Testing in the Emergency Department","authors":"Evangelia Murray MD, MPH , Kristina Munoz MD , Emily Hopkins MSPH , Stephanie Gravitz MPH , Jason Haukoos MD,MSc , Stacy Trent MD, MPH","doi":"10.1016/j.jemermed.2025.10.006","DOIUrl":"10.1016/j.jemermed.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in emergency care for acute coronary syndrome (ACS) have been reported across sex and race/ethnicity. Evidence-based decision tools may help reduce these gaps if their components are objective. The history, electrocardiogram (ECG), age, risk factors, troponin levels (HEART) Score is a validated tool for cardiac risk stratification that may support more equitable care.</div></div><div><h3>Objectives</h3><div>To assess whether HEART Score implementation in a large, urban, safety-net emergency department (ED) increased referral for guideline-recommended cardiac testing, and whether effects differed by sex or race/ethnicity.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of a pre–post quasi-experiment evaluating HEART Score-based ACS guideline implementation. Adults (≥18 years) were included if they had a troponin completed and an ICD-10 code for chest pain or ACS. The primary outcome was appropriate referral, defined as HEART Score ≥4, no normal objective testing within the year, and receipt of ED testing, urgent outpatient testing ordered, or inpatient admission for testing. We calculated descriptive statistics and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Among 1170 patients (521 preimplementation; 649 postimplementation), 498 had a HEART Score ≥4 and were included in the primary model. Implementation was associated with higher odds of appropriate referral (adjusted OR 2.74, 95% CI: 1.87–4.03). Sex and race/ethnicity were not independently associated with referral in either period (<em>p</em> = 0.23–0.76).</div></div><div><h3>Conclusions</h3><div>Implementation of the HEART Score was associated with increased odds of appropriate referrals for cardiac testing, with no observed disparities by sex, race, or ethnicity. Standardized risk stratification using the HEART Score may support more equitable ACS evaluation in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 53-63"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.jemermed.2025.10.012
Stephen Alerhand MD , Linda Qiu MD , Robert James Adrian MD
Background
An acute Stanford Type A aortic dissection (ATAAD) carries a high in-hospital mortality rate that increases with delays to surgical intervention. Early diagnosis is therefore critical for improving outcomes. Unfortunately, ATAAD is often misdiagnosed initially. Moreover, definitive diagnosis with computed tomography angiography (CTA) requires time to obtain and may not be feasible in an unstable patient. Fortunately, emergency physicians can use transthoracic cardiac point-of-care ultrasound (POCUS) to make a quicker diagnosis, prompt earlier CTA, initiate goal-directed therapy, and reduce time-to-operative intervention.
Objective
This narrative review reports four echocardiographic findings that suggest the presence of ATAAD. For each finding, we describe the associated pathophysiology and summarize the literature evaluating diagnostic utility. We also use high-quality media to provide step-by-step tutorials and advanced pearls and pitfalls for translation to the bedside.
Discussion
The echocardiographic findings that suggest ATAAD are: aortic intimal flap, aortic root enlargement, aortic regurgitation, and pericardial effusion.
Conclusion
The use of cardiac POCUS can rule in or strongly suggest the diagnosis of ATAAD. Although cardiac POCUS on its own should not be used to rule out ATAAD, the lack of any suggestive echocardiographic findings may lower suspicion for this diagnosis.
{"title":"What Echocardiographic Findings Suggest Acute Type A Aortic Dissection?","authors":"Stephen Alerhand MD , Linda Qiu MD , Robert James Adrian MD","doi":"10.1016/j.jemermed.2025.10.012","DOIUrl":"10.1016/j.jemermed.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>An acute Stanford Type A aortic dissection (ATAAD) carries a high in-hospital mortality rate that increases with delays to surgical intervention. Early diagnosis is therefore critical for improving outcomes. Unfortunately, ATAAD is often misdiagnosed initially. Moreover, definitive diagnosis with computed tomography angiography (CTA) requires time to obtain and may not be feasible in an unstable patient. Fortunately, emergency physicians can use transthoracic cardiac point-of-care ultrasound (POCUS) to make a quicker diagnosis, prompt earlier CTA, initiate goal-directed therapy, and reduce time-to-operative intervention.</div></div><div><h3>Objective</h3><div>This narrative review reports four echocardiographic findings that suggest the presence of ATAAD. For each finding, we describe the associated pathophysiology and summarize the literature evaluating diagnostic utility. We also use high-quality media to provide step-by-step tutorials and advanced pearls and pitfalls for translation to the bedside.</div></div><div><h3>Discussion</h3><div>The echocardiographic findings that suggest ATAAD are: aortic intimal flap, aortic root enlargement, aortic regurgitation, and pericardial effusion.</div></div><div><h3>Conclusion</h3><div>The use of cardiac POCUS can rule in or strongly suggest the diagnosis of ATAAD. Although cardiac POCUS on its own should not be used to rule out ATAAD, the lack of any suggestive echocardiographic findings may lower suspicion for this diagnosis.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 224-240"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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