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

Emergency department (ED) screening is an important strategy to address the persistent human immunodefiency virus (HIV) epidemic; however, ED screening rates remain low. This study describes the development of a quality measure to improve screening rates for HIV among ED patients. A panel of 10 emergency physicians with expertise in ED-based preventive health and quality measurement employed a 3-round modified Delphi process. The panel reviewed peer-reviewed literature and national guidelines to identify high-risk patient populations; participated in anonymous surveys to rank ED screening approaches based on the impact and feasibility of measurement and practice; and discussed survey rankings in consensus discussions. The highest impact and most feasible group to target for quality measurement were ED patients already undergoing testing for other sexually transmitted infections (ie, "co-screening"). This study successfully designed a quality measure to improve coscreening for HIV in the ED. Implementing this measure could enhance detection and subsequent linkage to care, ultimately contributing to the control of these epidemics. The focus on combining screening for HIV with diagnostic testing for patients with signs and symptoms of sexually transmitted infection aligns with an emerging approach in health care settings that balances expected health impact with feasibility challenges.

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.

Objectives: Artificial intelligence (AI) may improve many aspects of point-of-care ultrasound (POCUS) for physicians. However, adoption of AI relies on physician trust. Our study seeks to understand factors influencing physician trust in AI-augmented POCUS.

Methods: From November 2023 to April 2024, we conducted semistructured interviews with academic pediatric emergency medicine (PEM) physicians who use POCUS. The interview guide was sensitized by Yang's proposed framework for user trust in AI and explored participants' perspectives on AI-augmented POCUS. We used template analysis to identify themes. Interviews continued until thematic sufficiency was achieved.

Results: We interviewed 14 PEM physicians across career stages with varying POCUS experience. Participants named several specific aspects of POCUS where AI would be beneficial including image acquisition, image interpretation, and workflow enhancement. We identified themes related to 5 factors perceived as influential in physicians' trust in AI-augmented POCUS: (1) technological-AI-augmented POCUS must be reliable, accurate, transparent, and overridable by the physician; (2) contextual-The technology should be generalizable to the clinical population; (3) user-Each physician's clinical experience, comfort with POCUS, and experiences with technology affect their trust; (4) social/organizational-Endorsements by known colleagues, institutions, and national groups can engender trust although the organization or company creating the AI may have variable influence; (5) environmental-AI is everywhere, and there is subconscious use and acceptance.

Conclusion: Technological, contextual, user-related, social, organizational, and environmental factors influenced emergency physician trust in AI-augmented POCUS. Understanding these factors is important for developing AI-augmented POCUS tools.

Objectives: We evaluated factors associated with the need for full admission (greater than 2 days) for patients with skin and soft tissue infection (SSTI) placed in an emergency department (ED) observation unit (EDOU) in order to inform a new SSTI protocol.

Methods: Retrospective cohort study of adult ED patients assigned to the EDOU for treatment of a SSTI from 2017 to 2018. Data elements included demographics, vital signs, SSTI location and cause, procedures, consults, length of stay, and disposition. Significant relationships identified under univariable analysis were further examined in multivariable logistic regression.

Results: Four hundred eight patient charts were included, of which 100 (24.5%) were admitted. The mean age was 47.3 ± 17.5 years (range, 18-95 years), and 58.0% were men. SSTI complicated by intravenous drug abuse (odds ratio [OR], 1.47; 95% CI, 0.58-3.72) and diabetes (OR, 1.38; 95% CI, 0.41-4.60) had the highest univariable odds of admission for types of infection. Infections treated with a procedure such as incision and drainage had lower odds of admission (OR, 0.56; 95% CI, 0.32-0.98). On multivariate logistic regression, tachycardia (OR, 1.85; 95% CI, 1.09-3.13) was associated with higher odds of admission. SSTI on the torso (OR, 0.23; 95% CI, 0.06-0.80), plan for expert consultation (OR, 0.32; 95% CI, 0.19-0.54), and having a procedure (OR, 0.42; 95% CI, 0.22-0.76) were associated with lower odds of admission. Based on this information, the EDOU protocol for patients with SSTI was updated. In the year after update, admission rate among patients with SSTI was 22.4%.

Conclusion: Tachycardia in the ED may be an early sign of a more complicated SSTI that is more likely to require hospital admission. Adjusting an EDOU protocol to the local population may be helpful for improving EDOU patient selection.

Objectives: To evaluate the rate of return visits to the emergency department (ED) within 72 hours of discharge for patients evaluated in the waiting room. ED crowding challenges throughput, and we hypothesized that some patients may be suitable for the completion of evaluation without rooming.

Methods: This was a single-center retrospective analysis of a tertiary hospital ED. The primary outcome was 72-hour returns following discharge from the ED, stratified by location of initial physician evaluation and discharge: waiting room only, waiting room followed by treatment space, and treatment space only. Categorical data were compared using a chi-squared test and continuous data using a one-way analysis of variance with Bonferroni correction. The primary outcome was analyzed using a chi-squared test adjusting for age, biologic sex, Emergency Severity Index, primary language, time of day, and day of the week using logistic regression.

Results: There was a statistically significant overall difference in return visits within 72 hours of discharge based on the ED location where the evaluation occurred (P < .05; 5.0% in the waiting room only, 4.4% in the waiting room followed by treatment space, and 4.9% in the treatment space only). However, when comparing groups individually, there was a significantly lower rate of 72-hour return only for patients seen in the waiting room followed by a treatment space compared with treatment space only (P = .032). The patients evaluated and discharged from the waiting room tended to be younger, more likely to be male, with lower acuity Emergency Severity Index scores, and typically seen during an evening shift compared with the patients who were evaluated in a treatment space during their visit.

Conclusion: There was no significant increase in the rate of return for those patients seen primarily in the waiting room or for those where the initial work up started in the waiting room compared with those who were placed in a treatment space prior to a physician evaluation.