Academic Emergency Medicine最新文献

Background: Sepsis is a common, critical, time-sensitive medical emergency, with mortality rates of up to 56%. Early antibiotic administration is a cornerstone of sepsis management, yet prehospital antibiotic administration remains uncommon in the United States.

Methods: This prospective observational study evaluated the implementation of a prehospital sepsis protocol in an urban EMS system. Patients were eligible for prehospital antibiotic administration if they were ≥18 years old, hypotensive (SBP < 90 mm Hg), and febrile or hypothermic (<96.8°F or >100.4°F). Paramedics drew blood cultures and administered piperacillin/tazobactam or ceftriaxone. A report was generated to prospectively identify patients eligible for the study by hemodynamic data and/or if they were administered prehospital antibiotics. Demographic, operational, and clinical data were abstracted from patient care records and electronic health records. Outcomes were reported descriptively.

Results: A sample of 147 patients was included for encounters from December 1, 2019, to December 1, 2024 (mean age 72.8 years, 31.3% female). Antibiotics were administered to 132 patients (89.8%). Of encounters with antibiotic administrations, 127/132 (96.2%) complied with the clinical protocol, and five (3.8%) were protocol violations. Additionally, six patients (4.1%) were inappropriately not administered antibiotics, and nine patients (6.1%) had contraindications to the protocol, so antibiotics were withheld. Of 356 blood culture bottles that underwent laboratory analysis, nine (2.5%) were contaminated. The mean (±SD) time from patient contact to antibiotics was 32.7 (±8.2) min.

Conclusions: Prehospital clinicians can reliably and safely administer antibiotics for sepsis with hypotension and severe sepsis, observing high protocol adherence and low contamination rates while expediting time from recognition of sepsis to first antibiotics. These findings support the integration of prehospital antibiotics into broader sepsis care pathways. Expanding such protocols could improve compliance with sepsis care quality measures and enhance patient outcomes, particularly in resource-constrained environments.

Background: There is a high prevalence of acute pain in children cared for in the emergency care setting. However, there are still significant gaps in knowledge regarding optimal pain management. We aimed to develop a prioritized research agenda that identifies key questions for pediatric pain management in the emergency care setting that will guide future research and optimize care for children.

Methods: We used a modified Delphi approach to achieve consensus among a multidisciplinary and geographically diverse expert advisory group. An initial list of 108 research questions was identified, with successive rounds of questionnaires conducted until there was a convergence of opinion or a point of diminishing returns was reached. The list was iteratively refined each round by advisory group members who ranked research questions and provided suggestions for potential additional questions and feedback regarding questions considered.

Results: Twenty-nine advisory group members participated in the modified Delphi approach. Over the course of two rounds, we identified 10 research questions as the highest priority for future investigation. These questions included topics addressing short- and long-term outcomes related to inadequately assessed and treated pain, patient- and family-centered outcomes, optimizing analgesia in the emergency department (ED) and at home after discharge from the ED, nonpharmacologic/integrative treatments, novel analgesic treatments and strategies, children with difficult-to-treat pain, prehospital pain management, eliminating health disparities, opioid misuse/abuse, and dissemination and implementation.

Conclusions: The 10 research questions identified as highest priority can inform future work by researchers, funders, policy makers, and other key decision makers who aim to meaningfully advance the management of pain in children cared for in the emergency care setting.

Background: Care transitions from the emergency department (ED) to the community represent a critical period that can significantly impact clinical outcomes of older adults, yet there is a lack of standardized tools to measure patient-reported experiences and outcomes during this transition. Our objective was to develop and validate the Patient-Reported Outcome Measure-Older adult care Transitions in the ED (PROM-OTED) tool to measure care transition outcomes within 4-10 days after ED discharge.

Methods: Older adults (65+ years) discharged from four EDs were enrolled between November 2021 and April 2024 in a multiphase process: qualitative interviews, item generation, member checking, cognitive debriefing, technical expert panel review, and psychometric evaluation and validation. We employed descriptive statistics, item analysis, interitem correlation, and factor analyses to assess the tool's validity and reliability.

Results: Across all phases, we enrolled 290 older adults. The final 18-item PROM-OTED tool included items that addressed understanding of discharge instructions, medication management, follow-up care, and quality of life. The tool demonstrated feasibility with a mean (±SD) completion time of 4.97 (±3.04) min and was able to be administered electronically or via telephone. The tool additionally demonstrated excellent internal consistency (Cronbach's alpha 0.9376, McDonald's omega 0.9988) and good test-retest reliability (r = 0.8437). Exploratory factor analysis supported a robust factor structure and significant correlations between the PROM-OTED tool with the Care Transitions Measure-3, a general measure of hospital discharge quality of care, support its concurrent validity.

Conclusions: The PROM-OTED tool is a reliable and preliminarily valid instrument for use during the immediate post-ED period, with potential clinical applications in enhancing discharge practices and assessing care transition outcomes of older adults during observational or interventional studies.

The AACEM Chair Development Program (CDP) provides emergency medicine (EM)-focused leadership training for academic chairs and those interested in becoming EM chairs. The CDP began in 2014.This report describes the CDP second 5-year cohort from 2018 to 2023. A total of 102 participants completed the program during this time period with increased enrollment of women leaders. Seventeen participants who were not chairs at entry have become EM chairs. Quantitative and qualitative data based on a survey of participants demonstrate continued highly favorable assessment of the CDP and likelihood to recommend it to others. The CDP remains a popular and successful training experience to develop leadership skills, foster a leadership network, and prepare EM leaders for academic chair positions.