Academic Emergency Medicine最新文献

Background: Emergency physicians have the highest rates of burnout among all specialties. Existing burnout tools include the Copenhagen Burnout Inventory (CBI) and single-item measures from the Maslach Burnout Inventory (MBI). While both were designed to measure burnout, how they conceptualize this phenomenon differs and their agreement is unclear. Given the close conceptual relationship between emotional regulation strategies such as distancing and distraction with the MBI subscale of depersonalization, we examined agreement between the two inventories and association with emotional regulation strategies as a lens to explore the conceptualization of burnout.

Methods: We conducted a cross-sectional survey of adult and pediatric emergency physicians and trainees in Canada. Survey questions were pretested using written feedback and cognitive interviews. "Frequent use" of an emotional regulation strategy was "most" or "all" shifts (≥4 on 5-point Likert scale). Burnout was defined as mean ≥50/100 on the CBI and scoring ≥5 (out of 7) on at least one of the single-item measures from the MBI. Associations with burnout were examined using multivariable logistic regression.

Results: Of 147 respondents, 44.2% were positive for burnout on the CBI and 44.9% on the single-item measures from the MBI. Disagreement was 21.1% overall, ranging from 12.5% for older (≥55 years) physicians to 30.2% for younger (<35 years) physicians. Use of distraction and use of distancing were strongly associated with burnout on the single-item measures (adjusted odds ratio [aOR] 14.4, 95% confidence interval [CI] 3.4-60.8]) and CBI (aOR 10.1, 95% CI 2.5-39.8, respectively.

Conclusions: Despite near-equal rates of burnout, agreement between the CBI and single-item measures from the MBI varies and was lower for younger emergency physicians/trainees. While emotional regulation strategies were felt to be important in supporting a career in emergency medicine, they were strongly associated with burnout. Future research is needed to better understand this phenomenon and which tools to use to measure burnout.

Background: Disparities in health outcomes, including increased chronic disease prevalence and decreased life expectancy for Indigenous people, have been shown across settings affected by white settler colonialism including Canada, the United States, Australia, and New Zealand. Emergency departments (EDs) represent a unique setting in which urgent patient need and provider strain interact to amplify inequities within society. The aim of this scoping review was to map the ED-based interventions aimed at improving equity in care for Indigenous patients in EDs.

Methods: This scoping review was conducted using the procedures outlined by Arksey and O'Malley and guidance on conducting scoping reviews from the Joanna Briggs Institute. A systematic search of MEDLINE, CINAHL, SCOPUS, and EMBASE was conducted.

Results: A total of 3636 articles were screened by title and abstract, of which 32 were screened in full-text review and nine articles describing seven interventions were included in this review. Three intervention approaches were identified: the introduction of novel clinical roles, implementation of chronic disease screening programs in EDs, and systems/organizational-level interventions.

Conclusions: Relatively few interventions for improving equity in care were identified. We found that a minority of interventions are aimed at creating organizational-level change and suggest that future interventions could benefit from targeting system-level changes as opposed to or in addition to incorporating new roles in EDs.

Objectives: Up to 50% of ultrasounds (USs) for suspected pediatric appendicitis are nondiagnostic. While the validated low-risk clinical pediatric Appendicitis Risk Calculator (pARC) score < 15% and the low-risk US with nonvisualized appendix and no periappendiceal inflammation carry relatively low appendicitis risks, the contribution of the combination of both characteristics to this risk has never been assessed. The primary objective was to determine the proportion of children with the low-risk US-low-risk pARC combination with appendicitis. We hypothesized that this proportion would be 2.5% (upper 95% CI ≤ 5%).

Methods: A retrospective cohort study of 448 previously healthy children 4-17 years old at a pediatric ED with suspected appendicitis, nondiagnostic US, and persistent clinical concern about appendicitis. Two investigators abstracted demographic, clinical, and imaging data. Based on published criteria, USs were classified as low-risk or high-risk. The pARC includes seven demographic, clinical, and laboratory variables and is quantified according to the published formula. The primary outcome was appendicitis, based on the histological evidence. All nonoperated patients underwent a 1-month-follow-up to exclude delayed appendicitis diagnoses.

Results: Sixty of the 448 (13.4%) patients had appendicitis; 269 (60%) had low-risk US, 262 (58.4%) had low-risk pARC, and 163 (36.4%) had both characteristics. The appendicitis rates with low-risk pARC alone and low-risk US alone were 14/262 (5.4%) and 21/269 (7.8%), respectively. A total of 2/163 children (1.2%) with low-risk pARC and low-risk US had appendicitis (95% CI 0%-4.4%). Higher-risk US increased the appendicitis odds 5 (95% CI 1.54-20.55) to 11 times (95% CI 2.41-51.10) across pARC levels. The low-risk combination had sensitivity of 96.7% (95% CI 88.5%-99.6%), specificity of 41.5%, positive predictive value of 20.4%, and negative predictive value of 98.8% (95% CI 95.6%-99.9%).

Conclusions: The children with low-risk pARC and low-risk US combination are unlikely to have appendicitis and can be discharged home. The presence of higher-risk US-pARC score combinations substantially increases the appendicitis risk and warrants reassessment or interval imaging.