Academic Emergency Medicine最新文献

Introduction: Ketamine is the most common medication for procedural sedation and analgesia (PSA) of pediatric patients in the emergency department (ED). Since ketamine injection is painful, some studies have assessed the routes other than intravenous and intramuscular. Therefore, this systematic review aims to evaluate the details of noninjectable ketamine (NIK) administration.

Methods: The review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis for Systematic Review (PRISMA) guidelines. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection (SCIE and ESCI), and Scopus were searched for relevant studies from inception to 3 July 2025. All English original clinical research on PSA with NIK administration in pediatric populations in the ED was included. Risk of bias and certainty of evidence (COE) were also assessed.

Results: From 5617 identified records, 12 studies (7 interventional and 5 observational) with a total number of 1484 patients were included. Most of the studies evaluated laceration repair among children 2-12 years of age. Seven single-center double-blinded randomized controlled trials showed that oral ketamine (5-10 mg/kg) alone or in combination with other medications (mainly midazolam) provided the desirable level of sedation (COE: very low) relative to the oral comparators. It also resulted in faster onset of action (OA) (15-35 min) and shorter duration of action (DA) (60-265 min) (COE: low). Oral and nasal ketamine studies did not report any serious adverse event (SAE) associated with invasive interventions (COE: moderate to low).

Conclusion: Sedation with oral ketamine might have a desirable depth, faster OA, and shorter DA relative to the oral comparators. Furthermore, NIK probably showed no SAE during PSA. Nevertheless, the limited number of heterogeneous studies leaves uncertainty, highlighting the need for further research.

Background: Recent publications have shown that women are more likely to leave emergency medicine at a younger age than men. We aim to describe the prevalence of parental stress in academic emergency medicine and its association with scheduling practices and desire to leave medicine.

Methods: Blinded survey sent to eight geographically diverse academic sites. Survey included five domains: academic rank and perception of progress, child and childcare characteristics, clinical scheduling practices, plans to leave medicine, and validated psychometric measures including the Parental Stress Scale (PSS: normal population score 35-45). Likert scale responses were dichotomized as either moderate/extremely likely versus less than moderately likely/unsure. Descriptive statistics were calculated, and linear and multivariate regression analyses were performed using STATA 16.

Results: A total of 280 surveys were accessed, and 225 (80%) surveys had PSS completed. Of this cohort, there were 90 females, 123 men, 1 intersex, and 15 surveys had no sex reported. The median number of children was 2 (IQR 1-3), and the median age of the youngest child was 4 (IQR 1-9). The parental stress scale median score was 40 (IQR 35-46). There was no significant difference in the parental stress scale by sex. The number of children (B-coeff -1.88, p = 0.007), age of the youngest child (B-coeff -4.2, p = 0.000), use of daycare (B-coeff 3.8, p = 0.027), ability to preference times of shifts (day, swing, night shift) (B-coeff -2.4, p = 0.046), being a nocturnist (B-coeff 2.75, p = 0.006), and being able to completely set their own schedule in terms of days and times worked (B-coeff -2.19, p = 0.03) were associated with the PSS score. The parental stress scale was not associated with the likelihood to leave emergency medicine or leave the current job in 5 years.

Conclusion: Academic emergency physicians had parental stress scale scores similar to the general population. Parental stress scale score was not associated with a plan to leave emergency medicine.

Background: National studies report sustained gender-based differences in physician compensation, even after adjustment for workplace factors such as academic rank, specialty type, and work hours. This study examines differences in compensation among pediatric emergency medicine (PEM) fellows' first job after training.

Methods: Between May 2023 and June 2023, we distributed an electronic survey to all United States PEM fellowship program directors (FPDs), requesting they forward it to their graduating fellows. Survey completion was anonymous and voluntary, and included demographics, employment characteristics, and compensation package questions. We defined underrepresented in medicine (URiM) as individuals who self-identified as Black, Hispanic, Native American, Alaskan, or Pacific Islander.

Results: The survey was forwarded by 39 PEM FPDs to 107 eligible graduating PEM fellows, 80 (75%) of whom responded to the survey. Most respondents (71.3%) were women, 92.5% completed Pediatric residency, and 70.1% identified as White. The reported median base salary was $255,000 (IQR 222,000, 288,811). A high proportion of respondents were unaware of financial benefits beyond salary, such as employer retirement contributions. Compared to Pediatric hiring departments, Emergency Medicine (EM) departments had a significantly higher mean base salary (EM $277,079 vs. Pediatrics $239,540 p = 0.036) and annual clinical hours (EM 1393 vs. Pediatrics 1269, p = 0.035). While there were no statistical differences for base salary, annual clinical hours, sign-on bonus, or relocation stipend by gender or by underrepresented in medicine (URiM)-status, the mean difference in base salary for men was $25,628 higher than that of women (95% CI -$7903, $59,159). The mean difference in base salary for non-URiM versus URiM was $20,440 (95% CI -$22,000, $63,000).

Conclusion: While no statistically significant differences in salary by gender or race among PEM fellowship graduates were found, the difference in mean base salaries between genders is impactful over time. Transparency, financial education, and strategic action are important steps toward compensation equity.

Background: Which advanced imaging modality-computed tomography pulmonary angiography (CTPA) or lung scintigraphy-is optimal to evaluate for suspected pulmonary embolism (PE) in pregnancy is debated. Practice patterns, prevalence of indeterminate imaging, and clinician response in contemporary community hospitals are not well understood.

Methods: This retrospective cohort study included gravid adults in the emergency department (ED) and Labor and Delivery units (LDUs) who underwent advanced PE imaging 10/1/2021-3/31/2023. We excluded patients with COVID-19. Physician preferences were compared overall and in the subset of scintigraphy-eligible cases, i.e., those with imaging ordered when scintigraphy was available (7:00 a.m.-5:00 p.m.) and not contraindicated by abnormalities on chest radiography (CXR). We reported 48-h incidence of post-indeterminacy imaging and 90-day incidence of venous thromboembolism (VTE).

Results: Among 315 eligible cases, the median patient age was 31.0 years (IQR 26.5-35.5) with 164 (52.1%) in the third trimester. Index images included 288 (91.4%) CTPA and 27 (8.6%) scintigraphy, 25 of which were low-dose perfusion scans. PE was diagnosed in 5 (1.6%), all by CTPA. Among 116 scintigraphy-eligible cases, CTPA was favored: 82.8% versus 17.2%, with similar patterns between ED and LDU clinicians. CTPA diagnosed pneumonia in 6 cases (2.1% of 288) not previously identified on CXR and excluded pneumonia in 5 cases in which CXR suggested consolidation. Indeterminacy was more common with non-positive CTPA (24.7% [70/283]) than non-positive scintigraphy (0% [0/27]), p < 0.001. Only 7.1% (5/70) of patients with suboptimal non-positive CTPA received advanced imaging within 48 h, and none of the remaining 65 patients developed VTE or died within 90 days.

Conclusions: In this multicenter community setting with a low prevalence of PE, CTPA was preferentially ordered over lung scintigraphy in both the ED and LDU, even when both modalities were available and indicated. Indeterminate results were more prevalent with CTPA and often failed to trigger additional advanced imaging.