American Journal of Emergency Medicine最新文献

{"title":"Utilizing an ultrasound-guided nerve block for management of sciatica in the ED: A national simulation-based cost savings analysis","authors":"Lachlan Driver ,&nbsp;Carrie D. Walsh ,&nbsp;Caroline Schissel ,&nbsp;David A. Meguerdichian ,&nbsp;Nicole M. Duggan ,&nbsp;Christopher W. Baugh ,&nbsp;Andrew J. Goldsmith","doi":"10.1016/j.ajem.2025.12.045","DOIUrl":"10.1016/j.ajem.2025.12.045","url":null,"abstract":"<div><h3>Objectives</h3><div>Acute sciatica is a frequent cause of emergency department (ED) visits and hospital admissions. We evaluated the potential national cost savings of using ultrasound-guided transgluteal sciatic nerve block (TGSNB) in patients with acute sciatica who would otherwise be admitted.</div></div><div><h3>Methods</h3><div>We performed a Monte Carlo simulation with 10,000 iterations to compare the costs of usual care versus TGSNB targeted to patients who would otherwise require admission. Model inputs included national ED visits for acute sciatica, pre-block admission rates, admission costs, and procedural costs. The primary outcomes were per-patient savings among admitted patients and projected annual national savings.</div></div><div><h3>Results</h3><div>Targeted use of TGSNB in admission-eligible patients yielded mean per-patient savings of $11,974 (95 % UI: $6702–$18,527). Extrapolated nationally, this corresponds to $45.8 M (95 % UI $22.9 M–$74.0 M) in annual savings. Block costs were modest ($0.67 M (95 % UI: $0.46 M–$0.93 M)), and sensitivity analysis identified admission rates and costs as the main drivers of savings.</div></div><div><h3>Conclusions</h3><div>Adoption of TGSNB for severe sciatica in the ED may reduce admissions and generate meaningful healthcare savings. Prospective studies are needed to confirm clinical efficacy and implementation feasibility.</div><div>Capsule Summary:<ul><li><span>1.</span><span><div>What is already known on this topic:</div><div>Ultrasound-guided transgluteal sciatic nerve block (TGSNB) can rapidly relieve radicular pain; ED adoption is limited.</div></span></li><li><span>2.</span><span><div>What question this study addressed:</div><div>What national cost savings could result if EDs target TGSNB to patients with acute sciatica who would otherwise be admitted?</div></span></li><li><span>3.</span><span><div>What this study adds to our knowledge:</div><div>A Monte Carlo model (10,000 iterations) projects $11,974 per-treated-patient savings and $45.8 M annual national savings, with admission rate and admission cost as primary drivers.</div></span></li><li><span>4.</span><span><div>How this is relevant to clinical practice:</div><div>Targeted ED TGSNB could reduce admissions and overall costs while supporting opioid-sparing pain management.</div></span></li></ul></div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 135-140"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of sexually transmitted infections among emergency department patients","authors":"Michael Gottlieb MD ,&nbsp;Eric Moyer MD ,&nbsp;Kevin G. Buell MBBS, MS ,&nbsp;Melissa Fleegler MD ,&nbsp;Supriya Mehta MHS, PhD ,&nbsp;Kyle J. Popovich MD, MS ,&nbsp;Richard E. Rothman MD, PhD ,&nbsp;Yu-Hsiang Hsieh PhD ,&nbsp;Kyle Bernard MD ,&nbsp;Jason Haukoos MD, MSc","doi":"10.1016/j.ajem.2025.12.037","DOIUrl":"10.1016/j.ajem.2025.12.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Sexually transmitted infections (STIs) remain a major public health concern, with emergency departments (EDs) serving as key sites for evaluation and treatment. Despite their importance, contemporary national-level data describing ED testing and treatment practices for patients presenting with symptoms suggestive of STI are limited.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of ED encounters from 2016 to 2024 using Cosmos, a large geographically diverse electronic health record database. Patients aged ≥15 years with symptoms suggestive of an STI were included. We examined diagnostic testing for <em>Neisseria gonorrhoeae</em>/<em>Chlamydia trachomatis</em> (NG/CT), <em>Trichomonas vaginalis</em>/bacterial vaginosis (TV/BV), syphilis, and HIV. Pregnancy testing was assessed among females aged 15–55 years. Empiric antibiotic treatment patterns were evaluated over time.</div></div><div><h3>Results</h3><div>Among 5,566,966 unique ED encounters, only 37.8 % underwent STI testing. NG/CT was the most frequently ordered test (34.1 %), followed by TV/BV (21.7 %), HIV (4.1 %), and syphilis (3.9 %). Among those tested for NG/CT, co-testing was 56.0 % for TV/BV, 9.3 % for syphilis, and 8.5 % for HIV. Pregnancy testing occurred in 68.5 % of eligible females. Nearly half (46.2 %) of NG/CT-tested patients received empiric treatment. Among TV/BV-tested patients, 13.4 % were empirically treated in the ED and 32.4 % were prescribed outpatient treatment.</div></div><div><h3>Conclusion</h3><div>Most ED patients who presented for conditions suggestive of STI did not undergo STI testing, and co-testing for other STIs was also uncommon. Empiric antibiotic therapy remains very common, occurring in approximately half of patients. These findings highlight opportunities to improve STI detection and treatment in EDs through standardized protocols and expanded use of co-testing.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 124-128"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation","authors":"Alexander Bracey ,&nbsp;Aaron J. Lacy ,&nbsp;Scott D. Weingart ,&nbsp;Ashar Ata ,&nbsp;Alexander S. Giuliano ,&nbsp;John C. Lewis ,&nbsp;James Mantas ,&nbsp;Benjamin Bayly ,&nbsp;Michael Doyle ,&nbsp;Ryan N. Barnicle","doi":"10.1016/j.ajem.2025.12.041","DOIUrl":"10.1016/j.ajem.2025.12.041","url":null,"abstract":"<div><h3>Background</h3><div>Video laryngoscopy (VL) is now ubiquitous in emergency airway management. Hyperangulated video laryngoscopy (HAVL) differs from standard geometry VL (SGVL) in blade design, technique, and required microskills, yet the two are often regarded similarly. Despite widespread use, no comprehensive taxonomy of HAVL-specific performance errors exists.</div></div><div><h3>Methods</h3><div>We conducted an observational study of video-recorded endotracheal intubations (ETIs) performed in an urban academic emergency department (2020–2024). Fifty HAVL videos were first analyzed to derive 20 performance errors, followed by 100 additional recordings to confirm findings and assess incidence. Two independent emergency physicians evaluated each recording for performance errors. Interrater reliability and correlations among errors, procedure duration, and intubation success were assessed using Cohen's κ, Gwet's AC, and Pearson's correlation.</div></div><div><h3>Results</h3><div>We identified 20 discrete performance errors associated with HAVL. All 100 recordings contained at least one performance error (pooled κ = 0.53, 95 % CI 0.48–0.58). The most common error was failure to engage the midline vallecula (56 %), and the least common was bougie delivery issues (1 %). Each additional performance error added approximately 3 s to intubation duration. Strong correlations were observed among several errors.</div></div><div><h3>Conclusions</h3><div>Performance errors during HAVL are common and interrelated. This novel taxonomy provides a framework for structured feedback, targeted training, and future investigation of HAVL technique and clinical outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 152-158"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult scarlet fever: Case report and epidemiology","authors":"Nina Prieto MD,&nbsp;Mai Tantawy MD,&nbsp;Swathi Bhuma MD, MS,&nbsp;Siu Fai Li MD","doi":"10.1016/j.ajem.2025.12.040","DOIUrl":"10.1016/j.ajem.2025.12.040","url":null,"abstract":"<div><div>A 30-year-old woman presented to the ED with a generalized rash, fever, and tachycardia. A detailed review of systems and physical examination revealed symptoms and signs of streptococcal pharyngitis. PCR testing confirmed the diagnosis of streptococcal infection and scarlet fever. Scarlet fever is generally a disease of children, but episodic outbreaks are associated with the disease in adults, sometimes with significant complications. It is important for Emergency Medicine clinicians to be aware of this childhood illness presenting in adults.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 121-123"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A CT-based multimodal fusion model for predicting outcomes in blunt chest trauma: A multicenter study","authors":"Tingting Zhao MD ,&nbsp;Dong Li PhD ,&nbsp;Mengshan Wu MD ,&nbsp;Chenyuan Zhang MD ,&nbsp;Xiaoyuan Qu MD ,&nbsp;Xin Tian MD ,&nbsp;Yixi Zhang MD ,&nbsp;Chunlin Song MD ,&nbsp;Xiaoran Wang PhD ,&nbsp;Xianghong Meng PhD ,&nbsp;Zhi Wang MD","doi":"10.1016/j.ajem.2025.12.038","DOIUrl":"10.1016/j.ajem.2025.12.038","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to develop a multimodal predictive model that integrates clinical variables, radiomic features (RFs), and deep learning–based features (DLFs) to improve prognostic accuracy in patients with blunt chest trauma (BCT).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 337 patients with BCT from three medical centers. Clinical and CT imaging data, including emergency and follow-up scans, were obtained. Features including radiomic (RF) and deep learning-based (DLF) descriptors along with delta features representing temporal changes were extracted. After sequential feature selection, the least absolute shrinkage and selection operator (LASSO) regression was applied to identify optimal features. Model development included clinical-only, imaging-only, and fused models, with performance evaluated using AUC, calibration curves, and decision curve analysis.</div></div><div><h3>Results</h3><div>Rib fracture count, multiple injuries, and hemopneumothorax-to-lung ratio (HPR) were identified as independent prognostic factors. The fusion model, particularly the delta-clinical-DLR model, achieved AUCs of 0.85 (95 % CI: 0.80–0.90) and 0.86 (95 % CI: 0.77–0.95) in the training and test sets, respectively. Significant improvements in net reclassification (NRI up to 0.76) and integrated discrimination (IDI up to 0.26) were observed compared to the clinical models alone.</div></div><div><h3>Conclusions</h3><div>Integrating multi-timepoint CT imaging with clinical variables through a multimodal fusion model significantly enhances the prognostic performance of BCT, providing a robust tool for individualized risk prediction and clinical decision-making.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 71-77"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maggot infestation leading to Ignatzschineria larvae bacteremia and bladder outlet obstruction","authors":"Stephen Gamboa MD, MPH ,&nbsp;Christopher Parsons MD ,&nbsp;Christina Shenvi MD, PhD, MBA","doi":"10.1016/j.ajem.2025.12.035","DOIUrl":"10.1016/j.ajem.2025.12.035","url":null,"abstract":"<div><div>We report a case of a 61-year-old man with a history of alcoholic cirrhosis and impaired mobility who presented to the Emergency Department (ED) with hepatic encephalopathy, cellulitis, sepsis, and extensive maggot infestation (myiasis). Maggots were recovered from the patient's skin, urethra, and rectum, and the burden of maggots in the urethra had led to bladder outlet obstruction. Blood cultures revealed polymicrobial bacteremia, including <em>Ignatzschineria larvae</em>.</div><div><em>Ignatzschineria larvae</em> is a commensal bacterium that resides in the digestive tract of maggots. The organism is rarely pathogenic to humans, and case reports of <em>Ignatzschineria larvae</em> bacteremia are rare. This case demonstrates two uncommon complications of wound myiasis: bacteremia and bladder infestation, causing outlet obstruction and urinary retention. Patients who present to the Emergency Department with myiasis are at risk for bacteremia from both typical skin pathogens related to their wounds and pathogens associated with the maggots themselves.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 129-130"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute solar and atmospheric shifts preceding emergency department presentations for intentional drug overdose","authors":"Yalcin Golcuk MD (Assoc. Prof.) ,&nbsp;Fulden Cantaş Türkiş PhD (Assoc. Prof.) ,&nbsp;Meltem Derya Şahin MD (Assoc. Prof.) ,&nbsp;Ömer Yasir Boz MD ,&nbsp;Sevilay Yerlikaya Boz MD","doi":"10.1016/j.ajem.2025.12.042","DOIUrl":"10.1016/j.ajem.2025.12.042","url":null,"abstract":"<div><h3>Background</h3><div>Intentional drug overdose (IDO) is a major cause of emergency department (ED) presentations. While psychiatric and psychosocial factors are established contributors, many events occur without identifiable triggers. Emerging evidence suggests that rapid environmental changes may act as acute behavioral stressors influencing self-harm risk. This study investigates whether short-term increases in solar insolation and related atmospheric conditions are associated with IDO presentations, using a 15-day harmonic mean (HM15) model to detect individualized environmental deviations.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults presenting with IDO to a tertiary ED in Muğla, Türkiye between July 1, 2019 and July 1, 2024. Environmental data—including solar insolation, temperature at 2 m (T2M), ultraviolet (UV) radiation, and humidity—were obtained from the NASA POWER database. For each case, index-day values were compared to the individual's preceding HM15 baseline.</div></div><div><h3>Results</h3><div>Among 515 IDO patients, solar insolation, T2M, and UV radiation on the index day were significantly higher than HM15 baselines (all <em>P</em> &lt; 0.001). These deviations were most pronounced in spring and early summer, aligning with established peaks in suicide risk. In spring, a 15.6 % surge in solar insolation was observed, alongside significant increases in T2M and UV exposure. Similar abrupt shifts were noted in summer, while autumn and winter demonstrated mixed environmental patterns.</div></div><div><h3>Conclusions</h3><div>Acute rises in solar insolation, temperature, and UV radiation are temporally associated with increased IDO risk. The HM15 model may support real-time, meteorologically informed, AI-enhanced risk stratification in ED-based suicide prevention and merits evaluation for integration into clinical decision support systems.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 114-120"},"PeriodicalIF":2.2,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages A3-A10"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146619750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 507-509"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146619754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 510-514"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146619755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}