Academic Emergency Medicine最新文献

Background: Older adults are at high risk for severe injuries and death from falls. Physical therapist (PT) and occupational therapist (OT) evaluations have been introduced into Emergency Department (ED) care to assist with fall risk evaluation and fall prevention care. An evaluation of current evidence was undertaken to inform the Geriatric ED Guidelines 2.0.

Methods: Systematic review of physical and/or occupational therapy evaluation for fall prevention in the ED. The intervention was evaluation by a rehabilitation therapist (PT, OT, or both) for fall prevention, fall assessment, or mitigation of fall risk factors. Studies that did not perform the evaluation during the ED or ED Observation Unit visit were excluded, such as referrals for home consultation. The published literature was searched using strategies created by a medical librarian and was implemented in Embase and PubMed in March 2025. Covidence was used for article collation and review. Risk of bias was assessed using the Cochrane Risk of Bias v2 and the Ottawa-Newcastle scale.

Results: The search resulted in 387 articles with 52 duplicates, for 335 unique citations. Ten articles on 6 datasets were included (4 abstracts and 6 published manuscripts). One article was at high risk of bias as very few intervention patients received therapist evaluation. The remaining 5 datasets had varied co-interventions in addition to PT and/or OT evaluations. PT or OT evaluation in the ED was associated with reduced ED revisits at 1, 2, and 6 months. Evaluations in the ED were not associated with increased hospital admission rates or ED length of stay. A meta-analysis was infeasible due to varied outcome timeframes.

Conclusions: PT and/or OT evaluations for fall prevention were associated with reduced subsequent ED revisits for older adults. However, the impact of co-interventions and heterogeneity limits strong conclusions.

Objectives: Although robust evidence exists supporting opioid agonist treatment (OAT) as the best currently available treatment for opioid use disorder (OUD), many barriers prevent widespread access to the two most efficacious forms of OAT, buprenorphine and methadone. We sought to address interpersonal and knowledge-related barriers to OAT implementation by facilitating shared decision-making in the context of ED care. The objective of this study was to refine and evaluate an OUD treatment conversation aid in partnership with people with lived experience (PWLE).

Methods: We combined community-based participatory research principles, decision aid development guidelines, and qualitative methods. Via the longitudinal involvement of a multi-stakeholder Steering Committee (SC), interviews, and focus groups, we iteratively refined and evaluated a conversation aid, Talk About It (TAI). We performed beta-testing with ED patients with untreated OUD and clinicians and evaluated the aid via validated implementation measures of acceptability, appropriateness, and feasibility (3 scales, 4 questions each, range 1-5). Finally, TAI was translated into Spanish and Spanish-speaking patients and clinicians gave feedback.

Results: Over 100 people engaged in the refinement and evaluation of TAI. Of the 75 patient and community member participants, about half (34) reported using opioids within the past week. Refinements to TAI included changing content, simplifying language, and adding quotes, faces, and local resources. Validated acceptability, appropriateness, and feasibility measures demonstrated increasing scores. ED patients with untreated OUD gave the final version mean scores of 4.72, 4.70, and 4.67, respectively (range 1-5), indicating high agreement with implementation potential.

Conclusion: TAI's content and style were designed, refined, and approved by PWLE, ED clinicians, and addiction experts. Further testing will be needed to measure effectiveness.

Emergency physicians evaluate the full spectrum of traumatic brain injury (TBI) and generate the initial clinical descriptions that influence downstream care, follow-up, and patient expectations. Despite advances in neuroimaging, biomarker science, and systems of care, acute TBI is still commonly summarized using categorical labels: mild, moderate, and severe, derived from the Glasgow Coma Scale (GCS). In 2025, the National Institutes of Health-National Institute of Neurological Disorders and Stroke (NIH-NINDS) Traumatic Brain Injury Classification and Nomenclature Initiative proposed a multidimensional framework for acute TBI characterization incorporating Clinical, Biomarker, Imaging, and Modifier elements (CBI-M). The framework is intended to improve characterization and research rigor, and has generated broad interest and discussion across clinical disciplines. This special contribution introduced the CBI-M framework to the emergency medicine community and provides an interpretive, clinically grounded commentary on its relevance to emergency practice. The rationale for the framework is described, its core components are summarized, and its relevance to emergency department (ED) practice is discussed. Areas where CBI-M aligns with current emergency care, where important implementation questions remain, and how emergency physicians might engage with the framework as a shared language for describing injury rather than as a prescriptive management tool are highlighted. By situating CBI-M within the realities of emergency care and existing ED decision frameworks, this article aims to inform, contextualize, and encourage discussion within the emergency medicine community as this new approach to TBI characterization continues to evolve.

Study objectives: Significant variability exists in patient populations and diagnostic capabilities among hospital-based emergency departments (HBEDs) and freestanding emergency departments (FSEDs). While high sensitivity cardiac troponin (hs-cTn) research has focused on HBEDs, its application in FSEDs remains unexplored. This study assesses the comparative, real-world effectiveness of a 0/1-h accelerated protocol (AP) using hs-cTn between HBEDs and FSEDs.

Methods: We conducted a pre-planned, secondary analysis of a stepped-wedge cluster randomized trial involving nine EDs within an integrated health system, from July 2020 to March 2021, comprised of five HBEDs and four FSEDs. The trial implemented a 0/1-h AP utilizing hs-cTnI to evaluate acute myocardial infarction (AMI). Adult ED patients with an ECG and cardiac troponin ordered were eligible, excluding those with STEMI, hs-cTnI > 18 ng/L, or trauma-related symptoms. The primary outcome was safe ED discharge, defined as discharge without death or AMI within 30 days.

Results: The trial included 32,609 patients, 26,957 in HBEDs and 5652 in FSEDs. Safe discharge from HBED occurred 53.7% (5935/11,062) of the time in the standard care arm and 50.3% (7991/15895) under the AP (aOR 1.04, 95% CI 0.94-1.15, p = 0.50). Safe discharge from a FSED occurred 86.0% (2102/2443) of the time in the standard care arm and increased to 95.0% (3049/3209) under the AP (aOR 1.48, 95% CI 1.03-2.13, p = 0.033). Overall, the observed association between the AP and safe discharge was stronger in FSEDs than in HBEDs ( $\Delta$ log(aOdds) 1.05, 95% CI (0.82, 1.29), p < 0.001).

Conclusion: Implementing a 0/1-h AP using hs-cTnI to evaluate for AMI was associated with higher rates of safe discharge in FSEDs compared to HBEDs.