Journal of the American College of Emergency Physicians open最新文献

Objective: To determine the effect of live environmental music therapy (EMT), prerecorded music (same music as EMT), and a control condition on state anxiety, stress, pain, and well-being levels in patients and caregivers in the emergency department (ED) waiting areas of 2 general hospitals in Colombia, South America.

Methods: This was a pragmatic, multicenter randomized clinical trial with 3 arms: standard care + EMT, standard care + prerecorded music, and standard care only. Participants included 256 adult patients and 174 caregivers. Primary outcome was the six-item State-Trait Anxiety Inventory. Secondary outcomes were stress and pain levels, assessed with Visual Analog Scales (Visual Analog Stress Scale and Visual Analog Pain Scale), and well-being, assessed with the Well-Being Numerical Rating Scales.

Results: Results indicated that both music therapy interventions were associated with statistically significant reductions in anxiety, stress, and pain levels in patients and caregivers. Improvements in psychologic well-being were observed primarily in the group receiving live music therapy. Overall, live EMT showed better improvements across the emotional and physical outcomes.

Conclusion: The results of this study indicate that live EMT and prerecorded music implemented by trained music therapists can be effective strategies for improving mental health and reducing pain in patients and caregivers in the ED waiting area.

Objectives: This study aimed to characterize emergency department (ED)-based policies related to documentation of adverse social drivers of health (aSDOH) among a national sample of US EDs.

Methods: We conducted a cross-sectional survey of ED leaders from a 5% stratified random sample of US EDs (n = 280) from January to October 2023. For EDs reporting written screening policies for core aSDOH (housing, food, transportation, and utilities) or regulatory requirement-driven screening (intimate partner violence, other violence, substance use, and mental health), we assessed documentation policies, including personnel responsible and documentation methods. Using survey-weighted analyses and multivariable logistic regression, we examined associations between documentation policies and ED characteristics (practice setting, urbanicity, visit volume, and 24/7 social work availability).

Results: Of 232 responding EDs (83% response rate), 213 (93.2%, 95% CI, 89.3-95.7) reported screening for at least 1 risk factor. Among these, 196 (93.8%, 95% CI, 87.9-96.9) had policies requiring documentation of positive screens. Documentation requirements were higher for regulatory requirement-driven screening (84-93.5) compared with core aSDOH screening (56.8-68.9). Clinical providers most commonly documented findings (97.8%, 95% CI, 94.8-99.1), followed by social workers/care coordinators (52.6%, 95% CI, 42.4-62.6). All documentation occurred in the electronic health record. In adjusted analyses, 24/7 social work availability was associated with greater odds of having at least 1 aSDOH documentation policy (odds ratio, 2.86; 95% CI, 1.09-7.52).

Conclusion: Although most EDs with screening policies required documentation of positive screens, requirements varied by domain. Future research should focus on standardizing documentation practices and developing systems to effectively translate documented social needs into meaningful interventions.

Objectives: Older adults are vulnerable to infection and are difficult to diagnose. This study assessed the performance of MeMed BV (MMBV), a host-protein test for differentiating bacterial from viral infection, in adults ≥65 years.

Methods: Post hoc pooled and meta-analysis of adults with suspected acute infections enrolled in 3 prospective studies. MMBV results were interpreted as bacterial/viral/equivocal per manufacturer's instructions. Reference standard infection etiology was adjudicated by experienced physicians who were blinded to MMBV. Diagnostic accuracy for bacterial infection was calculated for MMBV results (area under the receiver operating characteristic curve [AUC], bin analysis) and for unequivocal MMBV results (sensitivity/specificity). MMBV's potential impact on antibiotic use was estimated by comparing MMBV-guided decisions to actual practice.

Results: A total of 754 younger (18-64 years) and 248 older (≥65 years) adults were included. Among older adults, the median age was 75.0 years (IQR, 69.0, 82.0), 53.2% were male, 68.1% were hospitalized, and 79.0% had ≥3 comorbidities. Respiratory tract infections were common (76.2%), and 85.1% were prescribed antibiotics. A total of 111 patients were assigned a bacterial reference standard infection etiology, 77 a viral etiology, and 60 an indeterminate etiology. In pooled analysis, MMBV attained comparable AUC in older (0.95; 95% CI, 0.92-0.98) vs younger adults (0.95; 0.93-0.97). Focusing on older adults, 96.2% (90.3-98.8) sensitivity and 85.7% (74.8-92.5) specificity with 10.6% equivocal results were observed. MMBV could reduce potentially unwarranted antibiotic prescriptions 2.5-fold (from 62.3% to 24.7%; P < .0001). Using a bivariate model, MMBV similarly attained AUC 0.92 (0.81-0.97).

Conclusions: MMBV demonstrated high diagnostic accuracy in older adults, supporting its potential to optimize antibiotic use in this population. Further studies are needed to evaluate real-world utility.

Objectives: This systematic review aims to evaluate the diagnostic accuracy of artificial intelligence (AI) algorithms in acute coronary syndrome (ACS) detection using 12-lead electrocardiograms (ECGs).

Methods: Adhering to Preferred Reporting Items for Systematic Reviews guidelines, Ovid MEDLINE, Ovid Embase, Cochrane Central, and Cochrane Database of Systematic Reviews were searched up to June 15, 2023. Eligible studies involved adults with suspected ACS and employed AI for 12-lead ECG interpretation. The primary outcomes were sensitivity and specificity, with secondary outcomes including positive predictive value (PPV), negative predictive value (NPV), and accuracy. Risk of bias was evaluated using Prediction model Risk Of Bias Assessment Tool (PROBAST).

Results: From 2051 records, 24 studies were included. The sensitivity of AI-based diagnosis for ACS among the 24 studies varied from 68% to 98%, and the specificity varied from 41% to 98%. For subgroup analysis of ST-elevated myocardial infarction/occlusion myocardial infarction, sensitivity ranged from 68% to 97% and specificity from 68% to 99%. AI models outperformed clinicians interpreting ECGs retrospectively without knowledge of outcomes in sensitivity (90% of studies) and PPV (100% of studies), whereas clinicians had better NPV (70% of studies). One study compared AI with real-time emergency department physician interpretations. Three studies reported code availability. Thirty-eight percentage of studies showed a high risk of bias, with 50% showing unclear risk, although applicability concerns were minimal.

Conclusion: AI models show high diagnostic accuracy for ACS using 12-lead ECGs, with potential to enhance early diagnosis. However, variability in performance, transparency challenges with limited code availability, a high risk of bias in some studies, and minimal real-time comparisons underscore the necessity for standardized reporting and open-access practices.

Objectives: Neck injuries in warfare are critical due to the concentration of vital structures within a relatively unprotected anatomical region. This study aims to provide a comprehensive analysis of the epidemiology, severity, and outcomes of neck injuries during Military operations under "Operation Swords of War," leveraging data from the Israeli National Trauma Registry.

Methods: Data were retrospectively collected for casualties from October 7, 2023, through December 31, 2023. Injury characteristics, time to surgical exploration, and in-hospital outcomes were analyzed.

Results: A total of 1815 trauma casualties were recorded, with 147 (8.1%) suffering from neck injuries. The majority of these injuries were due to penetrating trauma (89.8%), with a significant number leading to surgical exploration (45.0%). The study highlighted the extensive use of resources for managing these severe injuries, including operating rooms and intensive care units.

Conclusion: The findings underscore the high prevalence and severity of neck injuries in military conflicts and the critical need for rapid assessment and intervention. Comparisons with previous conflicts suggest an improvement in survival rates due to enhanced medical response and triage efficiency. In conclusion, neck injuries remain a significant concern in combat settings, necessitating specialized trauma care and rapid intervention strategies. The results from this study provide vital insights that can help improve trauma care protocols and outcomes in future conflicts.