American Journal of Emergency Medicine最新文献_第7页

Virtual nursing's effect on ED efficiency and quality of care

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-17 DOI: 10.1016/j.ajem.2025.02.024

Saif Khairat , Jennifer Morelli , Qiyao Qin , Xiaoyu Wu , Randy Fakhreddin , Barbara S. Edson , Mauri Williams

Importance

Nursing shortages lead to longer emergency department (ED) wait times and incomplete documentation. US health systems are rapidly implementing virtual nursing, a new care delivery model, to improve care and alleviate nursing burden by providing nursing care and expertise via telehealth.

Objective

To evaluate the association of using virtual nursing for patients admitted via the ED with quality outcomes, namely, wait time, admission assessment duration, documentation completeness, and number of interruptions.

Materials and methods

Non-randomized retrospective cohort study of adult patients over the age of 18 seen in the ED and subsequently admitted to one of six hospitals.

Results

Patients who had in-person admission assessments median wait time was 525.5 min (IQR: 332.9–969.8), while the median wait time for patients using virtual nursing for admission assessments was 429.5 min (IQR: 292.6–954.5). In-person admissions had a median duration of 24.0 min (IQR: 15.0–36.0), while virtual nursing admissions median duration was 29.0 min (IQR: 18.0–42.0). The average number of uncompleted documentation fields for in-person admissions was 0.4 ± 1.5, while the average for virtual nursing admissions was 0.2 ± 0.5. Finally, the average number of interruptions during admission for in-person was 1.8 ± 1.5 interruptions, while virtual nursing admissions averaged 1.4 ± 1.3 interruptions.

Discussion

Virtual nursing was associated with shorter wait times, more complete nursing documentation, and fewer interruptions during admission assessments for patients admitted via the ED.

Conclusion

Virtual nursing is a promising care delivery model that may lead to reduced nursing burnout and enhanced patient care coordination.

{"title":"Virtual nursing's effect on ED efficiency and quality of care","authors":"Saif Khairat , Jennifer Morelli , Qiyao Qin , Xiaoyu Wu , Randy Fakhreddin , Barbara S. Edson , Mauri Williams","doi":"10.1016/j.ajem.2025.02.024","DOIUrl":"10.1016/j.ajem.2025.02.024","url":null,"abstract":"<div><h3>Importance</h3><div>Nursing shortages lead to longer emergency department (ED) wait times and incomplete documentation. US health systems are rapidly implementing virtual nursing, a new care delivery model, to improve care and alleviate nursing burden by providing nursing care and expertise via telehealth.</div></div><div><h3>Objective</h3><div>To evaluate the association of using virtual nursing for patients admitted via the ED with quality outcomes, namely, wait time, admission assessment duration, documentation completeness, and number of interruptions.</div></div><div><h3>Materials and methods</h3><div>Non-randomized retrospective cohort study of adult patients over the age of 18 seen in the ED and subsequently admitted to one of six hospitals.</div></div><div><h3>Results</h3><div>Patients who had in-person admission assessments median wait time was 525.5 min (IQR: 332.9–969.8), while the median wait time for patients using virtual nursing for admission assessments was 429.5 min (IQR: 292.6–954.5). In-person admissions had a median duration of 24.0 min (IQR: 15.0–36.0), while virtual nursing admissions median duration was 29.0 min (IQR: 18.0–42.0). The average number of uncompleted documentation fields for in-person admissions was 0.4 ± 1.5, while the average for virtual nursing admissions was 0.2 ± 0.5. Finally, the average number of interruptions during admission for in-person was 1.8 ± 1.5 interruptions, while virtual nursing admissions averaged 1.4 ± 1.3 interruptions.</div></div><div><h3>Discussion</h3><div>Virtual nursing was associated with shorter wait times, more complete nursing documentation, and fewer interruptions during admission assessments for patients admitted via the ED.</div></div><div><h3>Conclusion</h3><div>Virtual nursing is a promising care delivery model that may lead to reduced nursing burnout and enhanced patient care coordination.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 59-66"},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471344","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}

引用次数: 0

High risk and low incidence diseases: Pediatric intussusception

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-17 DOI: 10.1016/j.ajem.2025.02.020

Brit Long MD , Joshua Easter MD, MSc , Alex Koyfman MD

Introduction

Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality.

Objective

This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Discussion

Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10–25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms.

Conclusion

An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.

{"title":"High risk and low incidence diseases: Pediatric intussusception","authors":"Brit Long MD , Joshua Easter MD, MSc , Alex Koyfman MD","doi":"10.1016/j.ajem.2025.02.020","DOIUrl":"10.1016/j.ajem.2025.02.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality.</div></div><div><h3>Objective</h3><div>This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.</div></div><div><h3>Discussion</h3><div>Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10–25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms.</div></div><div><h3>Conclusion</h3><div>An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 37-45"},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465075","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}

引用次数: 0

Artificial intelligence for the diagnosis of pediatric appendicitis: A systematic review

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-17 DOI: 10.1016/j.ajem.2025.02.023

Mariam Chekmeyan, Shao-Hsien Liu

Background

While acute appendicitis is the most frequent surgical emergency in children, its diagnosis remains complex. Artificial intelligence (AI) and machine learning (ML) tools have been employed to improve the accuracy of various diagnoses, including appendicitis. The purpose of this study was to systematically review the current body of evidence regarding the efficacy of AL and ML approaches for the diagnosis of acute pediatric appendicitis.

Methods

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles from Pubmed, Scopus, and iEEE Xplore. Study information, methodological details, and outcome metrics were extracted and summarized across studies. Quality of reporting was appraised using The Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis (TRIPOD) statement.

Results

Fourteen studies were included in the final analysis of which ten were published after 2019. Two studies originated in the United States while half were carried out in Europe. Artificial Neural Network and Random Forest AI methods were the most commonly used modeling approaches. Commonly used predictors were pain and laboratory blood findings. The average area under the curve that was reported among the fourteen studies was greater than 80 %.

Conclusions

AI and ML technologies have the potential to improve the accuracy of acute appendicitis diagnosis in pediatric patients. Further investigation is needed to identify barriers to adoption of these technologies and to assess their efficacy in real world usage once integrated into clinical workflows.

{"title":"Artificial intelligence for the diagnosis of pediatric appendicitis: A systematic review","authors":"Mariam Chekmeyan, Shao-Hsien Liu","doi":"10.1016/j.ajem.2025.02.023","DOIUrl":"10.1016/j.ajem.2025.02.023","url":null,"abstract":"<div><h3>Background</h3><div>While acute appendicitis is the most frequent surgical emergency in children, its diagnosis remains complex. Artificial intelligence (AI) and machine learning (ML) tools have been employed to improve the accuracy of various diagnoses, including appendicitis. The purpose of this study was to systematically review the current body of evidence regarding the efficacy of AL and ML approaches for the diagnosis of acute pediatric appendicitis.</div></div><div><h3>Methods</h3><div>This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles from Pubmed, Scopus, and iEEE Xplore. Study information, methodological details, and outcome metrics were extracted and summarized across studies. Quality of reporting was appraised using The Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis (TRIPOD) statement.</div></div><div><h3>Results</h3><div>Fourteen studies were included in the final analysis of which ten were published after 2019. Two studies originated in the United States while half were carried out in Europe. Artificial Neural Network and Random Forest AI methods were the most commonly used modeling approaches. Commonly used predictors were pain and laboratory blood findings. The average area under the curve that was reported among the fourteen studies was greater than 80 %.</div></div><div><h3>Conclusions</h3><div>AI and ML technologies have the potential to improve the accuracy of acute appendicitis diagnosis in pediatric patients. Further investigation is needed to identify barriers to adoption of these technologies and to assess their efficacy in real world usage once integrated into clinical workflows.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 18-31"},"PeriodicalIF":2.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552696","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}

引用次数: 0

Pediatric emergency 2024 updates

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-16 DOI: 10.1016/j.ajem.2025.02.019

Emily Rose MD , Joshua S. Easter MD

Most children receive emergency care by general emergency physicians and not in designated children's hospitals. There are unique considerations in the care of children that differ from the care of adults. Many management principles can be extrapolated from adult studies, but the unique pathophysiology of pediatric disease requires specialized attention and management updates.

This article highlights ten impactful articles from the 2024 whose findings can improve the care of children in the Emergency Department (ED). These studies address pediatric cervical spine injury, resuscitation, infant fever, appendicitis, direct admissions, mental practice, and hypothermia.

引用次数: 0

Racial inequities in point-of-care ultrasound for pregnancy

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-15 DOI: 10.1016/j.ajem.2025.02.014

Justin Moher MD, MPH , Krithika Muruganandan MD , Megan M. Leo MD , Emily Cleveland Manchanda MD, MPH , Judith Linden MD , Vonzella Bryant MD , Ijeoma M. Okafor MPH , Joseph R. Pare MD MHS

Study objective

Racial inequities are pervasive throughout healthcare. We sought to assess if race and ethnicity are associated with emergency department (ED) point-of-care ultrasound (POCUS) usage compared with radiology-ordered ultrasounds as our primary outcome and a secondary outcome of nurse-driven ultrasound ordering for early pregnancy.

Methods

In this retrospective, observational cohort study between June 2015 and December 2021, we assessed ED physician POCUS use in relation to Radiology (RADUS) ultrasound for first trimester pregnancy with race and ethnicity as our primary variable. A secondary outcome assessed if race and ethnicity impacted nursing-driven ultrasound ordering. Univariate and multivariate logistic regression models were created to test relationships and interactions with clinical variables. Given the overlap of language and race/ethnicity, a multivariate model with language as the primary variable was included.

Results

No significant differences based on race and ethnicity were found for the selection of POCUS versus RADUS (n = 2337: χ2 = 5.25, p = 0.155). For the secondary outcome, 1694 of 7662 (22.1 %) patients received a nurse ultrasound order. Hispanic/Latino patients had increased odds of receiving a nurse-driven order (aOR 1.25, 95 % CI 1.009–1.549) and those of other or unknown race/ethnicity (aOR 1.357, 95 %CI 1.043–1.765) when language was excluded; in addition to Non-English speakers (OR 1.213, 95 %CI 1.072–1.372) with race excluded.

Conclusions

For first trimester pregnancy complaints, race and ethnicity did not alter POCUS usage by ED physicians. Secondary analysis showed race and ethnicity differences in nurse-driven orders, however collinearity between the primary outcome and language makes it difficult to assess the magnitude of these factors.

{"title":"Racial inequities in point-of-care ultrasound for pregnancy","authors":"Justin Moher MD, MPH , Krithika Muruganandan MD , Megan M. Leo MD , Emily Cleveland Manchanda MD, MPH , Judith Linden MD , Vonzella Bryant MD , Ijeoma M. Okafor MPH , Joseph R. Pare MD MHS","doi":"10.1016/j.ajem.2025.02.014","DOIUrl":"10.1016/j.ajem.2025.02.014","url":null,"abstract":"<div><h3>Study objective</h3><div>Racial inequities are pervasive throughout healthcare. We sought to assess if race and ethnicity are associated with emergency department (ED) point-of-care ultrasound (POCUS) usage compared with radiology-ordered ultrasounds as our primary outcome and a secondary outcome of nurse-driven ultrasound ordering for early pregnancy.</div></div><div><h3>Methods</h3><div>In this retrospective, observational cohort study between June 2015 and December 2021, we assessed ED physician POCUS use in relation to Radiology (RADUS) ultrasound for first trimester pregnancy with race and ethnicity as our primary variable. A secondary outcome assessed if race and ethnicity impacted nursing-driven ultrasound ordering. Univariate and multivariate logistic regression models were created to test relationships and interactions with clinical variables. Given the overlap of language and race/ethnicity, a multivariate model with language as the primary variable was included.</div></div><div><h3>Results</h3><div>No significant differences based on race and ethnicity were found for the selection of POCUS versus RADUS (<em>n</em> = 2337: χ2 = 5.25, <em>p</em> = 0.155). For the secondary outcome, 1694 of 7662 (22.1 %) patients received a nurse ultrasound order. Hispanic/Latino patients had increased odds of receiving a nurse-driven order (aOR 1.25, 95 % CI 1.009–1.549) and those of other or unknown race/ethnicity (aOR 1.357, 95 %CI 1.043–1.765) when language was excluded; in addition to Non-English speakers (OR 1.213, 95 %CI 1.072–1.372) with race excluded.</div></div><div><h3>Conclusions</h3><div>For first trimester pregnancy complaints, race and ethnicity did not alter POCUS usage by ED physicians. Secondary analysis showed race and ethnicity differences in nurse-driven orders, however collinearity between the primary outcome and language makes it difficult to assess the magnitude of these factors.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 46-54"},"PeriodicalIF":2.7,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464799","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}

引用次数: 0

Stroke at the Hairdresser's chair: A scoping review of the beauty parlor stroke syndrome

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-15 DOI: 10.1016/j.ajem.2025.02.016

Georgios Mavrovounis , Konstantinos Drivas , Argyro Syrakouli , Evangelia Syrakouli , Maria Mermiri , Panagiotis Papanagiotou , Ioannis Pantazopoulos

Background

Beauty Parlor Stroke Syndrome (BPSS), can present after neck hyperextension during activities like hair shampooing.

Purpose

To examine BPSS in the context of activity-induced cerebrovascular accidents, focusing on diagnostic challenges, therapeutic interventions, and implications for emergency care.

Materials and methods

Literature searches were performed in PubMed, Scopus, and Google Scholar using keywords related to BPSS and neck hyperextension. Inclusion criteria targeted studies with original data on neurological deficits linked to neck hyperextension.

Results

The review identified 22 studies, comprising 54 BPSS cases (79.63 % female, age 13–85). Most cases occurred during beauty parlor visits (42/54), followed by dental visits (8/54) and other settings (4/54). Symptoms varied widely, with dizziness, equilibrium disturbances, and headache being common. Imaging was performed in most cases, with MRI and angiography frequently used. Mechanical impingement and cervical artery dissection were common etiologies. Therapeutic interventions included antiplatelet therapy, anticoagulants, stent revascularization and surgical operations, according to the underlying etiology. Outcomes ranged from full recovery to persistent symptoms and death. Follow-up data was sparse.

Conclusions

BPSS, while rare, can result from hyperextension during routine activities like salon visits. Its symptoms overlap with those of a classic stroke, emphasizing the importance of thorough history-taking and advanced neuroimaging. Pathophysiology is linked to vascular impingement or dissection, with factors like atherosclerosis and vertebral artery hypoplasia contributing. Treatment is tailored to the underlying cause, ranging from conservative measures to surgical interventions. Emergency physicians should consider BPSS in patients with recent neck hyperextension and acute neurological symptoms.

{"title":"Stroke at the Hairdresser's chair: A scoping review of the beauty parlor stroke syndrome","authors":"Georgios Mavrovounis , Konstantinos Drivas , Argyro Syrakouli , Evangelia Syrakouli , Maria Mermiri , Panagiotis Papanagiotou , Ioannis Pantazopoulos","doi":"10.1016/j.ajem.2025.02.016","DOIUrl":"10.1016/j.ajem.2025.02.016","url":null,"abstract":"<div><h3>Background</h3><div>Beauty Parlor Stroke Syndrome (BPSS), can present after neck hyperextension during activities like hair shampooing.</div></div><div><h3>Purpose</h3><div>To examine BPSS in the context of activity-induced cerebrovascular accidents, focusing on diagnostic challenges, therapeutic interventions, and implications for emergency care.</div></div><div><h3>Materials and methods</h3><div>Literature searches were performed in PubMed, Scopus, and Google Scholar using keywords related to BPSS and neck hyperextension. Inclusion criteria targeted studies with original data on neurological deficits linked to neck hyperextension.</div></div><div><h3>Results</h3><div>The review identified 22 studies, comprising 54 BPSS cases (79.63 % female, age 13–85). Most cases occurred during beauty parlor visits (42/54), followed by dental visits (8/54) and other settings (4/54). Symptoms varied widely, with dizziness, equilibrium disturbances, and headache being common. Imaging was performed in most cases, with MRI and angiography frequently used. Mechanical impingement and cervical artery dissection were common etiologies. Therapeutic interventions included antiplatelet therapy, anticoagulants, stent revascularization and surgical operations, according to the underlying etiology. Outcomes ranged from full recovery to persistent symptoms and death. Follow-up data was sparse.</div></div><div><h3>Conclusions</h3><div>BPSS, while rare, can result from hyperextension during routine activities like salon visits. Its symptoms overlap with those of a classic stroke, emphasizing the importance of thorough history-taking and advanced neuroimaging. Pathophysiology is linked to vascular impingement or dissection, with factors like atherosclerosis and vertebral artery hypoplasia contributing. Treatment is tailored to the underlying cause, ranging from conservative measures to surgical interventions. Emergency physicians should consider BPSS in patients with recent neck hyperextension and acute neurological symptoms.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 29-36"},"PeriodicalIF":2.7,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464801","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}

引用次数: 0

Are we prepared to care for the children? An assessment of pediatric-specific pre-deployment training provided by non-governmental organizations operating in disaster zones

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-14 DOI: 10.1016/j.ajem.2025.02.018

Lea Ohana Sarna Cahan MD , Derrick Tin MBBS , Jamla Rizek RN , Debra L. Weiner MD, PhD , Gregory R. Ciottone MD

Introduction

Children have specific vulnerabilities during crises that necessitate specialized care. This study assessed the adequacy of pediatric-specific pre-deployment training provided by Non-Governmental Organizations (NGOs) operating in crisis zones.

Method

To identify NGOs active in disaster response, a list of organizations that responded to the 2023 Turkey-Syria earthquake were selected from Charity Watch's top-rated NGOs in the International Relief & Development category. A comprehensive analysis of their public websites was performed, and the NGOs were contacted for information on their pediatric-specific training. NGO response rates and the content of the programs were analyzed to evaluate the current state of pediatric pre-deployment training.

Findings

Twelve of the 23 (52.1 %) NGOs responded to inquiries. Of the responding NGOs, only one required any pediatric-specific training: a baseline minimum requirement for both pediatric and neonatal life support certificates (or the equivalent) for all clinical staff. The NGO stipulated that its staff also receive mandatory training on safeguarding child welfare, as well as Integrated Management of Neonatal and Childhood Illness training. The non-pediatric specific courses offered by this specific NGO include Personal Safety and Security, Psychological First Aid and Hostile Environment Awareness Training.

Conclusion

There is a critical lack of pediatric training provided by NGOs. This underscores the crucial need for standardized and comprehensive pre-deployment training for healthcare personnel in disaster zones, with a particular focus on pediatric care. The analysis of NGO responses and practices revealed inconsistencies in training content, strategies and programs. Establishing best practices and collaboration between NGOs, healthcare experts, and authorities is vital to ensuring the proper care of pediatric patients in disaster zones.

{"title":"Are we prepared to care for the children? An assessment of pediatric-specific pre-deployment training provided by non-governmental organizations operating in disaster zones","authors":"Lea Ohana Sarna Cahan MD , Derrick Tin MBBS , Jamla Rizek RN , Debra L. Weiner MD, PhD , Gregory R. Ciottone MD","doi":"10.1016/j.ajem.2025.02.018","DOIUrl":"10.1016/j.ajem.2025.02.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Children have specific vulnerabilities during crises that necessitate specialized care. This study assessed the adequacy of pediatric-specific pre-deployment training provided by Non-Governmental Organizations (NGOs) operating in crisis zones.</div></div><div><h3>Method</h3><div>To identify NGOs active in disaster response, a list of organizations that responded to the 2023 Turkey-Syria earthquake were selected from Charity Watch's top-rated NGOs in the International Relief & Development category. A comprehensive analysis of their public websites was performed, and the NGOs were contacted for information on their pediatric-specific training. NGO response rates and the content of the programs were analyzed to evaluate the current state of pediatric pre-deployment training.</div></div><div><h3>Findings</h3><div>Twelve of the 23 (52.1 %) NGOs responded to inquiries. Of the responding NGOs, only one required any pediatric-specific training: a baseline minimum requirement for both pediatric and neonatal life support certificates (or the equivalent) for all clinical staff. The NGO stipulated that its staff also receive mandatory training on safeguarding child welfare, as well as Integrated Management of Neonatal and Childhood Illness training. The non-pediatric specific courses offered by this specific NGO include Personal Safety and Security, Psychological First Aid and Hostile Environment Awareness Training.</div></div><div><h3>Conclusion</h3><div>There is a critical lack of pediatric training provided by NGOs. This underscores the crucial need for standardized and comprehensive pre-deployment training for healthcare personnel in disaster zones, with a particular focus on pediatric care. The analysis of NGO responses and practices revealed inconsistencies in training content, strategies and programs. Establishing best practices and collaboration between NGOs, healthcare experts, and authorities is vital to ensuring the proper care of pediatric patients in disaster zones.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 25-28"},"PeriodicalIF":2.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464800","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}

引用次数: 0

Clinical outcomes of admitted patients with COVID and an opioid overdose

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-12 DOI: 10.1016/j.ajem.2025.02.015

Benjamin Gerstein , Kori L. Brewer PhD , Dmitry Tumin PhD , Jason B. Hack MD

Objectives

To date, research on opioid overdose during the COVID-19 pandemic has focused on rates of Emergency Department (ED) visits related to opioids but has not considered how interaction with concurrent COVID-19 infection may have influenced clinical outcomes. We hypothesized that COVID-19 infection increased the need for respiratory support, prolonged hospital stays, and increased mortality among ED patients admitted to the hospital after presenting with opioid overdose.

Methods

The 2020 National Emergency Department Sample (NEDS) was used to identify patients admitted to the hospital after presenting to the ED with opioid overdose, and whose COVID-19 infection status could be determined. The primary outcome was the use of respiratory support, and secondary outcomes were hospital length of stay (LOS) and mortality.

Results

Among the 5913 eligible patients, 3 % had a COVID-19 infection diagnosis. Among all included patients, 28 % received respiratory support, in-hospital mortality was 4 %, and the mean hospital length of stay was 3.9 days. After multivariable adjustment, COVID-19 was not associated with the use of respiratory support (odds ratio [OR]: 0.98; 95 % confidence interval [CI]: 0.67, 1.44; p = 0.938). COVID-19 was associated with higher odds of in-hospital mortality (OR: 2.22; 95 % CI: 1.20, 4.11; p = 0.011) and longer hospital stay (incidence rate ratio: 1.57, 95 % CI: 1.22, 2.01; p < 0.001).

Conclusion

This data suggests that COVID-19 infection in patients admitted to the hospital with opioid overdose results in higher morbidity and longer hospital stay, but had no association with the use of respiratory support. The physiologic cause deserves future study.

{"title":"Clinical outcomes of admitted patients with COVID and an opioid overdose","authors":"Benjamin Gerstein , Kori L. Brewer PhD , Dmitry Tumin PhD , Jason B. Hack MD","doi":"10.1016/j.ajem.2025.02.015","DOIUrl":"10.1016/j.ajem.2025.02.015","url":null,"abstract":"<div><h3>Objectives</h3><div>To date, research on opioid overdose during the COVID-19 pandemic has focused on rates of Emergency Department (ED) visits related to opioids but has not considered how interaction with concurrent COVID-19 infection may have influenced clinical outcomes. We hypothesized that COVID-19 infection increased the need for respiratory support, prolonged hospital stays, and increased mortality among ED patients admitted to the hospital after presenting with opioid overdose.</div></div><div><h3>Methods</h3><div>The 2020 National Emergency Department Sample (NEDS) was used to identify patients admitted to the hospital after presenting to the ED with opioid overdose, and whose COVID-19 infection status could be determined. The primary outcome was the use of respiratory support, and secondary outcomes were hospital length of stay (LOS) and mortality.</div></div><div><h3>Results</h3><div>Among the 5913 eligible patients, 3 % had a COVID-19 infection diagnosis. Among all included patients, 28 % received respiratory support, in-hospital mortality was 4 %, and the mean hospital length of stay was 3.9 days. After multivariable adjustment, COVID-19 was not associated with the use of respiratory support (odds ratio [OR]: 0.98; 95 % confidence interval [CI]: 0.67, 1.44; <em>p</em> = 0.938). COVID-19 was associated with higher odds of in-hospital mortality (OR: 2.22; 95 % CI: 1.20, 4.11; <em>p</em> = 0.011) and longer hospital stay (incidence rate ratio: 1.57, 95 % CI: 1.22, 2.01; <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>This data suggests that COVID-19 infection in patients admitted to the hospital with opioid overdose results in higher morbidity and longer hospital stay, but had no association with the use of respiratory support. The physiologic cause deserves future study.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 8-12"},"PeriodicalIF":2.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444225","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}

引用次数: 0

Compassionate care in the emergency department: A narrative review and blueprint for future inquiry

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-11 DOI: 10.1016/j.ajem.2025.02.012

Clifford M. Marks , Amanda Scudder , Brian W. Roberts , Adrian D. Haimovich , Stephen W. Trzeciak , Nathan I. Shapiro

While compassion has long been accepted conceptually as a vital part of patient care, few rigorous studies have focused on its provenance or impact until quite recently. A growing body of literature gives early evidence that compassion can substantially impact health outcomes, and critically, that compassionate behaviors may be fostered by didactics or clinical environment. Only a few studies have yet addressed compassion in the emergency department (ED) setting, but there are already indications that the perception of compassionate care during medical emergencies can have a meaningful and enduring impact on health. This review aims to assess the current research on compassion as it relates to ED care and proposes a framework for future inquiry. In particular, we assess the current evidence surrounding 1) measurement of compassion, 2) the impact of compassion on patient outcomes, and 3) the efficacy of compassion education for providers. We also highlight several understudied areas in the compassion literature, including potential effect on overall cost of care, how delivery of compassionate care might influence provider burnout, and how social determinants of health, race, gender, and other factors mediate either the provision of or the perception of compassionate care. In an era of competing demands on emergency providers' time, it is vitally important to better understand both the teaching of compassion and its myriad potential impacts if we are to make informed decisions about how to prioritize this aspect of medical care.

{"title":"Compassionate care in the emergency department: A narrative review and blueprint for future inquiry","authors":"Clifford M. Marks , Amanda Scudder , Brian W. Roberts , Adrian D. Haimovich , Stephen W. Trzeciak , Nathan I. Shapiro","doi":"10.1016/j.ajem.2025.02.012","DOIUrl":"10.1016/j.ajem.2025.02.012","url":null,"abstract":"<div><div>While compassion has long been accepted conceptually as a vital part of patient care, few rigorous studies have focused on its provenance or impact until quite recently. A growing body of literature gives early evidence that compassion can substantially impact health outcomes, and critically, that compassionate behaviors may be fostered by didactics or clinical environment. Only a few studies have yet addressed compassion in the emergency department (ED) setting, but there are already indications that the perception of compassionate care during medical emergencies can have a meaningful and enduring impact on health. This review aims to assess the current research on compassion as it relates to ED care and proposes a framework for future inquiry. In particular, we assess the current evidence surrounding 1) measurement of compassion, 2) the impact of compassion on patient outcomes, and 3) the efficacy of compassion education for providers. We also highlight several understudied areas in the compassion literature, including potential effect on overall cost of care, how delivery of compassionate care might influence provider burnout, and how social determinants of health, race, gender, and other factors mediate either the provision of or the perception of compassionate care. In an era of competing demands on emergency providers' time, it is vitally important to better understand both the teaching of compassion and its myriad potential impacts if we are to make informed decisions about how to prioritize this aspect of medical care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"91 ","pages":"Pages 1-7"},"PeriodicalIF":2.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428886","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}

引用次数: 0

Pain out of plane: Lumbar erector spinae block redefining analgesia for acute soft tissue injury in emergency department.

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2025-02-11 DOI: 10.1016/j.ajem.2025.02.009

Satyendra Meena, Jyothiswaroop Bhaskararayuni, Sanjeev Bhoi

Introduction: Soft tissue injuries resulting from trauma (motor vehicle collisions, falls, etc.) are frequently present to the Emergency Department. While opioid analgesia is commonly used, its side effects and dependence potential underscore the need for alternative approaches (1). The erector spinae plane block (ESPB) is a regional anesthesia technique that involves the injection of local anesthetic into the fascial plane deep to the erector spinae muscles. This case report highlights the effective use of lumbar ESPB in a patient with severe soft tissue pain who was unresponsive to opioids, showcasing its potential as a safe, rapid, and non-opioid alternative for acute pain management in the ED.

Case: A 32-year-old man presented to the ED with complaints of intense lower back pain radiating to the left lower quadrant after a history of fall from height. The patient was found to have soft tissue injury on imaging. The only concern the patient had was severe pain, which was unresponsive to opioids. Erector spinae plane block was given at L1. The patient experienced rapid and substantial pain relief within 10 min of ESPB administration, with a Defense Veteran Pain Rating Scale (DVPRS) score reduction of 2/10 and then 0/10 within an hour. This was the first time, to the best of our knowledge, that ESPB was given at the lumbar vertebrae for soft tissue injuries in the emergency department.

Conclusion: The Erector Spinae Plane Block (ESPB) is a minimally invasive, effective alternative for managing acute soft tissue pain in emergency care, reducing opioid use, and enabling early mobilization. This case highlights its potential as a regional anesthetic in soft tissue injury and underscores the need for further research to expand its applications in acute care. Lumbar ESPB may serve as an alternative intervention for acute, intractable soft tissue pain in emergency care, especially in cases where standard analgesics are insufficient. When performed correctly and with suitable patient selection, it serves as an important tool in the arsenal of regional anesthesia practitioners anesthesia.

{"title":"Pain out of plane: Lumbar erector spinae block redefining analgesia for acute soft tissue injury in emergency department.","authors":"Satyendra Meena, Jyothiswaroop Bhaskararayuni, Sanjeev Bhoi","doi":"10.1016/j.ajem.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.02.009","url":null,"abstract":"<p><strong>Introduction: </strong>Soft tissue injuries resulting from trauma (motor vehicle collisions, falls, etc.) are frequently present to the Emergency Department. While opioid analgesia is commonly used, its side effects and dependence potential underscore the need for alternative approaches (1). The erector spinae plane block (ESPB) is a regional anesthesia technique that involves the injection of local anesthetic into the fascial plane deep to the erector spinae muscles. This case report highlights the effective use of lumbar ESPB in a patient with severe soft tissue pain who was unresponsive to opioids, showcasing its potential as a safe, rapid, and non-opioid alternative for acute pain management in the ED.</p><p><strong>Case: </strong>A 32-year-old man presented to the ED with complaints of intense lower back pain radiating to the left lower quadrant after a history of fall from height. The patient was found to have soft tissue injury on imaging. The only concern the patient had was severe pain, which was unresponsive to opioids. Erector spinae plane block was given at L1. The patient experienced rapid and substantial pain relief within 10 min of ESPB administration, with a Defense Veteran Pain Rating Scale (DVPRS) score reduction of 2/10 and then 0/10 within an hour. This was the first time, to the best of our knowledge, that ESPB was given at the lumbar vertebrae for soft tissue injuries in the emergency department.</p><p><strong>Conclusion: </strong>The Erector Spinae Plane Block (ESPB) is a minimally invasive, effective alternative for managing acute soft tissue pain in emergency care, reducing opioid use, and enabling early mobilization. This case highlights its potential as a regional anesthetic in soft tissue injury and underscores the need for further research to expand its applications in acute care. Lumbar ESPB may serve as an alternative intervention for acute, intractable soft tissue pain in emergency care, especially in cases where standard analgesics are insufficient. When performed correctly and with suitable patient selection, it serves as an important tool in the arsenal of regional anesthesia practitioners anesthesia.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473265","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}

引用次数: 0