Academic Emergency Medicine最新文献

Background: Ensuring follow up care can be a barrier to emergency department (ED) discharge for high-risk older adults. The US Dept of Veterans Affairs (VA) sought to address this challenge by creating an ED-based care transition program, SCOUTS (Supporting Community, Outpatient, Urgent care, and Telehealth Services). SCOUTS combines post ED care coordination and a home visit to assess home safety, geriatric syndromes, and unmet social needs and to provide a video visit with an ED provider. The purpose of this study is to evaluate the effects of the program on health care utilization.

Methods: Patients (aged ≥ 65 years) identified as high risk through geriatric emergency medicine care processes were offered a home visit with the program. SCOUTS patients were compared to a 1:1 propensity matched group of older ED patients. Primary outcomes for health care utilization included hospital admissions (from ED and 30- and 90-days after ED visit) and ED revisits (3 days and 30 days).

Results: During the first year of the program, there were 684 SCOUTS patients matched to 684 ED patients. SCOUTS patients were less likely to be admitted to the hospital from the ED (OR 0.12 (95% CI 0.07-0.02)) and had lower 30- and 90-day inpatient admissions (OR 0.33 (CI 0.24-0.45), OR 0.48 (CI 0.37-0.63)). Secondary matching of only discharged patients showed a decrease in 72-h ED revisit (OR 0.29 (CI 0.15, 0.6)), while maintaining an equivalent 30-day ED revisit rate and 30- and 90-day admissions as matched control. SCOUTS patients were significantly more likely to receive durable medical equipment orders (OR 1.94 (CI 1.54, 2.45)) and follow up with VA social work (OR 1.41 (CI 1.02, 1.95)).

Conclusions: An ED-based care transition program using home visits decreases admissions and ED revisits while increasing orders for durable medical equipment and referrals to follow up services.

Importance: Unsolicited peer review requests have increased with the expansion of academic publishing, raising concerns about reviewer fatigue. Peer review is a critical component in disseminating scientific discovery requiring time and expertise, often uncompensated.

Objective: We sought to quantify and analyze characteristics of the review solicitation burden on a group of senior faculty.

Methods: We conducted a prospective mixed-methods study of 6 senior academic physicians who are peer reviewers and editors. Each participant monitored their email inboxes (9/1-12/13, 2024) for peer review requests. We collected solicitation date, journal name, discipline, reviewer's existing relationship to journal, content relevance, response to request, immediate Plutchik Basic Emotions reaction, narrative comments, using hermeneutic phenomenology. We calculated descriptive statistics and performed a thematic analysis with a constructivist paradigm of narrative comments.

Results: Participants (5 institutions, 3 males) received 139 solicitations. Over half (52.5%, 73) were requests from a journal with whom the physician had no or unknown previous contact. Less than 1/3 of solicitations were directly relevant (28.1%, 39); 43.2% (60) partially relevant; 28.8% (40) irrelevant. Only 2.3% (3) of requests were accepted; 55.4% (77) were declined and 42.4% (59) were ignored. Of the Plutchik Basic Emotions, most were surprised (36%, 48) or disgusted (31%, 41). Qualitative analysis identified four themes: (1) issues with review process/journal quality, (2) time/effort demands, (3) relevancy to expertise, (4) technology/administrative barriers.

Conclusions: Academic faculty received copious peer review requests and declined or ignored many, citing frustration, surprise or disgust. Editors should optimize the review request process to avoid reviewer burnout.

Background: Status epilepticus (SE) is a medical emergency requiring rapid intervention. Despite treatment guidelines, delays in real-world SE management persist, potentially worsening outcomes. The Established Status Epilepticus Treatment Trial (ESETT), while comparing second-line antiseizure medications, also enabled analysis of treatment timelines in emergency settings.

Objectives: This study evaluates the timing of SE treatment steps in ESETT to assess adherence to guideline-recommended timeframes and identify factors contributing to delays.

Methods: This secondary analysis of ESETT included patients aged ≥ 2 years with generalized convulsive SE unresponsive to benzodiazepines, randomized to receive fosphenytoin, levetiracetam, or valproic acid. Key intervals analyzed included time from emergency department (ED) arrival to first benzodiazepine, initiation of second-line therapy, and other interventions (e.g., intubation, rescue meds). We used descriptive statistics and the Van Elteren test to compare timelines between those who achieved treatment success, defined as seizure cessation and improved mental status at 60 min, and those who did not.

Results: Among 487 patients (53% adults, 47% children; 57% male), 46% achieved treatment success. Nearly half did not receive any prehospital benzodiazepines. Median time from ED arrival to first benzodiazepine was 11 min (IQR 5-41), and to second-line antiseizure medications was 26 min (IQR 18-43), both generally aligning with guidelines. Earlier administration of second-line therapy was significantly associated with treatment success (p = 0.03).

Conclusions: Although many treatment steps occurred within recommended windows, considerable variability exists. Prehospital benzodiazepine use was often absent, and in-hospital treatment timing was inconsistent. Earlier delivery of second-line therapy correlated with improved outcomes. These real-world data provide a lens through which to better understand the causes and impact of practice variability in time to treatment and assess the extent to which current guidelines on timing may be important, but also how they may be ambiguous or unrealistic.

Objective: The Global Emergency Medicine Literature Review (GEMLR) identifies impactful research in global emergency care. This 20th annual edition reviews GEM literature published in 2024 and highlights the growth of GEMLR over the years.

Methods: We conducted a scoping review of 2024 GEM articles through structured PubMed and gray literature searches. Reviewers and editors from 10 countries screened abstracts using predefined criteria for three domains: disaster and humanitarian response (DHR), emergency care in limited-resource settings (ECLRS), and emergency medicine development (EMD). Duplicates and articles lacking authorship equity or ethical oversight were excluded. Remaining publications were scored using tailored rubrics for original research (OR), review articles (RE), and gray literature (GRAY). The top 5% in each category were selected for critical appraisal. A retrospective summary of 20 years of GEMLR reviews was also completed.

Results: The search identified 46,714 PubMed and 12,575 gray literature articles. A total of 473 met inclusion criteria and were scored; 33 were selected as the top 5%, a decrease from 55 in 2023. Although the search string was unchanged, 2024 yielded ~10,000 fewer articles. Common themes included trauma, pediatrics, and clinical/triage protocols, with a new focus on mental health among clinicians and disaster victims. Over 20 years, 230 individuals have contributed 810 service-years to GEMLR. Nearly 75% of members were from the USA, while 32 (13.9%) were from LMICs and 27 (11.7%) from non-USA high-income countries. In total, 398,904 articles have been screened, 8476 scored, and 517 top articles narratively reviewed since 2005.

Conclusions: Over two decades, GEMLR has evolved into a large-scale, multinational, methodologically rigorous initiative, highlighting more than 500 high-impact GEM publications. In 2024, despite fewer articles screened, 33 top studies were identified across key domains. GEMLR emphasizes equitable LMIC representation, rigorous quality standards, and authorship equity, aiming to help shape the future of emergency care research.

Background: Older adults are frequent users of the Emergency Department (ED), with a significant proportion presenting with pre-existing or acute cognitive impairment. While negative post-ED outcomes associated with cognitive status are well documented, their direct impact on care processes and resource allocation within the hospital remains poorly understood. This study aims to quantify how different cognitive profiles affect costs and care needs for acutely ill older adults.

Methods: We conducted a secondary analysis of a prospective cohort study at a single, tertiary care hospital. We included patients aged ≥ 65 years admitted to the hospital through the ED. They were stratified into three groups based on the brief Confusion Assessment Method (bCAM) and the 10-Point Cognitive Screener (10-CS): normal cognition, cognitive impairment without delirium, and delirium. Primary outcome was cost of care. Resource utilization, characterized by the number of medical specialties involved, geriatric consultation, type of inpatient bed allocated from the ED, time to hospitalization, and patient satisfaction, were explored as secondary outcomes. Multiple regression models were used to assess associations, adjusting for sociodemographic factors, clinical severity, and geriatric vulnerability.

Results: The sample comprised 824 patients: 429 (52.1%) with normal cognition, 165 (20.0%) with delirium, and 230 (27.9%) with cognitive impairment without delirium. Clinical severity, but not cognitive status, was independently associated with costs (B = 0.18; 95% CI: 0.08, 0.27). Delirium was independently associated with allocation to high-complexity bed and receiving a geriatric consultation. Cognitive impairment was independently associated with a greater number of specialties involved.

Conclusions: Clinical severity showed the strongest association with costs. In contrast, cognitive profiles were independently associated with the care pathway and complexity, with delirium linked to higher-acuity allocation and preexisting cognitive impairment without delirium to broader multidisciplinary involvement. Recognizing these distinct cognitive profiles is fundamental for anticipating care demands and optimizing resource allocation for this vulnerable population.