Pub Date : 2026-03-01Epub Date: 2025-10-10DOI: 10.1016/j.annemergmed.2025.09.010
Scott G. Weiner MD, MPH , Arjun K. Venkatesh MD, MHS , Prateek B. Sharma MBA, MS , Craig Rothenberg MPH , Sam Shahid MD, MBBS, MPH , Megan Sambell MPH , Pawan Goyal MD, MHA , Kathryn F. Hawk MD, MHS
Study objective
This study aimed to assess practices surrounding opioid use disorder (OUD), specifically provision of naloxone and medication for OUD (MOUD), in a large sample of emergency departments (EDs) participating in a quality improvement initiative.
Methods
Data were obtained from EDs participating in the American College of Emergency Physicians’ Emergency Quality Network substance use disorder program, a national practice-based quality improvement initiative. ED sites abstracted data elements from a random sample of discharged visits with diagnosis codes for opioid overdose or OUD. Data were reported in May and October 2023 for visits that occurred up to 6 months prior to the reporting period. The percentages of visits for which naloxone was prescribed or dispensed and MOUD was administered or prescribed were determined.
Results
There were 6,749 included visits for overdose or OUD reported from 300 unique EDs. Naloxone was either dispensed or prescribed in 1,874 (27.8%) of visits. There were 752 visits (11.1%) in which it was reported that the patient was already taking MOUD. Excluding those visits, MOUD was either administered in the ED or prescribed at discharge 438 times, representing 7.3% of potentially eligible visits.
Conclusion
In this large sample of visits for OUD and overdose, just over a quarter of patients with visits related to opioids were prescribed or dispensed naloxone, and administration or prescription of MOUD to patients not already on it was also low. These findings indicate opportunity for improvement in ED OUD care.
{"title":"Treatment of Opioid Use Disorder Across a National Emergency Department Practice Improvement Network","authors":"Scott G. Weiner MD, MPH , Arjun K. Venkatesh MD, MHS , Prateek B. Sharma MBA, MS , Craig Rothenberg MPH , Sam Shahid MD, MBBS, MPH , Megan Sambell MPH , Pawan Goyal MD, MHA , Kathryn F. Hawk MD, MHS","doi":"10.1016/j.annemergmed.2025.09.010","DOIUrl":"10.1016/j.annemergmed.2025.09.010","url":null,"abstract":"<div><h3>Study objective</h3><div>This study aimed to assess practices surrounding opioid use disorder (OUD), specifically provision of naloxone and medication for OUD (MOUD), in a large sample of emergency departments (EDs) participating in a quality improvement initiative.</div></div><div><h3>Methods</h3><div>Data were obtained from EDs participating in the American College of Emergency Physicians’ Emergency Quality Network substance use disorder program, a national practice-based quality improvement initiative. ED sites abstracted data elements from a random sample of discharged visits with diagnosis codes for opioid overdose or OUD. Data were reported in May and October 2023 for visits that occurred up to 6 months prior to the reporting period. The percentages of visits for which naloxone was prescribed or dispensed and MOUD was administered or prescribed were determined.</div></div><div><h3>Results</h3><div>There were 6,749 included visits for overdose or OUD reported from 300 unique EDs. Naloxone was either dispensed or prescribed in 1,874 (27.8%) of visits. There were 752 visits (11.1%) in which it was reported that the patient was already taking MOUD. Excluding those visits, MOUD was either administered in the ED or prescribed at discharge 438 times, representing 7.3% of potentially eligible visits.</div></div><div><h3>Conclusion</h3><div>In this large sample of visits for OUD and overdose, just over a quarter of patients with visits related to opioids were prescribed or dispensed naloxone, and administration or prescription of MOUD to patients not already on it was also low. These findings indicate opportunity for improvement in ED OUD care.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 313-320"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.annemergmed.2025.10.017
Shakir Ullah MBBS, Muhammad Yaseen PharmD, Fida Muhammad MBBS
{"title":"Cephalosporins for Outpatient Pyelonephritis in the Emergency Department","authors":"Shakir Ullah MBBS, Muhammad Yaseen PharmD, Fida Muhammad MBBS","doi":"10.1016/j.annemergmed.2025.10.017","DOIUrl":"10.1016/j.annemergmed.2025.10.017","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 399-400"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.annemergmed.2026.01.007
{"title":"Global Research Highlights","authors":"","doi":"10.1016/j.annemergmed.2026.01.007","DOIUrl":"10.1016/j.annemergmed.2026.01.007","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 289-291"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146777343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-23DOI: 10.1016/j.annemergmed.2025.07.008
Alexander T. Clark MD , Wade Brown MD , Michael J. Ward MD, MBA, PhD , Jason C. Brainard MD , Joseph M. Brewer DO , Brian E. Driver MD , John P. Gaillard MD , Sheetal Gandotra MD , Shekhar Ghamande MD, FCCP , Kevin W. Gibbs MD , Adit A. Ginde MD , Joanne W. Hudson MSc, PA-C FCCP , Christopher G. Hughes MD, MS FCCM , David R. Janz MD , Aaron M. Joffe DO , Akram Khan MD , Aaron J. Lacy MD , Andrew J. Latimer MD , Steven H. Mitchell MD , David B. Page MD, MSPH , Jonathan D. Casey MD, MSc
Study objectives
Complications are common during emergency tracheal intubation. Although graduate medical education in emergency medicine and critical care mandate competency in this procedure, thresholds for proficiency are poorly defined. We evaluated the relationship between the operator performing intubation and complications of emergency tracheal intubation.
Methods
We performed a secondary analysis of data from 8 multicenter randomized trials of critically ill adults undergoing emergency tracheal intubation in an emergency department or ICU in the United States. We examined the relationship between an operator’s prior intubating experience and procedural outcomes, including successful intubation on the first attempt and lowest oxygen saturation.
Results
Among 2,839 intubations with data on prior intubating experience of the operator, 1,863 (65.6%) were by critical care medicine clinicians and 739 (26.0%) by emergency medicine clinicians. The median number of reported previous intubations by clinicians was 56.0 (interquartile range, 32 to 100). Greater intubation experience was associated with an increased odds of successful intubation on the first attempt (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.30 to 2.36; P<.001) and increased lowest oxygen saturation (OR 1.45; 95% CI, 1.21 to 1.73; P<.001). Learning curves suggested a plateau effect between 35 and 50 intubations.
Conclusion
For tracheal intubations performed in an emergency department or ICU, intubating experience is associated with improved procedural outcomes, reaching a plateau outcome after a mean 35 to 50 previous intubations.
{"title":"Association Between Operator Experience and Procedural Outcomes of Tracheal Intubation in the Emergency Department and ICU","authors":"Alexander T. Clark MD , Wade Brown MD , Michael J. Ward MD, MBA, PhD , Jason C. Brainard MD , Joseph M. Brewer DO , Brian E. Driver MD , John P. Gaillard MD , Sheetal Gandotra MD , Shekhar Ghamande MD, FCCP , Kevin W. Gibbs MD , Adit A. Ginde MD , Joanne W. Hudson MSc, PA-C FCCP , Christopher G. Hughes MD, MS FCCM , David R. Janz MD , Aaron M. Joffe DO , Akram Khan MD , Aaron J. Lacy MD , Andrew J. Latimer MD , Steven H. Mitchell MD , David B. Page MD, MSPH , Jonathan D. Casey MD, MSc","doi":"10.1016/j.annemergmed.2025.07.008","DOIUrl":"10.1016/j.annemergmed.2025.07.008","url":null,"abstract":"<div><h3>Study objectives</h3><div>Complications are common during emergency tracheal intubation. Although graduate medical education in emergency medicine and critical care mandate competency in this procedure, thresholds for proficiency are poorly defined. We evaluated the relationship between the operator performing intubation and complications of emergency tracheal intubation.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of data from 8 multicenter randomized trials of critically ill adults undergoing emergency tracheal intubation in an emergency department or ICU in the United States. We examined the relationship between an operator’s prior intubating experience and procedural outcomes, including successful intubation on the first attempt and lowest oxygen saturation.</div></div><div><h3>Results</h3><div>Among 2,839 intubations with data on prior intubating experience of the operator, 1,863 (65.6%) were by critical care medicine clinicians and 739 (26.0%) by emergency medicine clinicians. The median number of reported previous intubations by clinicians was 56.0 (interquartile range, 32 to 100). Greater intubation experience was associated with an increased odds of successful intubation on the first attempt (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.30 to 2.36; <em>P</em><.001) and increased lowest oxygen saturation (OR 1.45; 95% CI, 1.21 to 1.73; <em>P</em><.001). Learning curves suggested a plateau effect between 35 and 50 intubations.</div></div><div><h3>Conclusion</h3><div>For tracheal intubations performed in an emergency department or ICU, intubating experience is associated with improved procedural outcomes, reaching a plateau outcome after a mean 35 to 50 previous intubations.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 321-327"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-16DOI: 10.1016/j.annemergmed.2025.07.020
Michael F. Barton MD, MPH , Kailynn M. Barton BS , Mark Chottiner MD , Mathew A. Saab MD, MPH
Compression ultrasonography is the bedside standard for diagnosing lower-extremity deep venous thrombosis. Probe-induced thrombus dislodgement, though rare, can precipitate pulmonary embolism, as well as strokes and other end-organ infarcts in patients with patent foramen ovales. We report a 65-year-old woman whose noncompressible mid-femoral deep venous thrombosis detached during routine point-of-care ultrasound—captured in real time—and resulted in bilateral subsegmental pulmonary emboli (PE) noted on computed tomography pulmonary angiography. The case highlights the possibility of compression-induced embolization, the need for controlled compression pressure, and immediate PE assessment when embolization is observed.
{"title":"Real-Time Capture of Thrombus Embolization During Point-of-Care Lower-Extremity Compression Ultrasonography","authors":"Michael F. Barton MD, MPH , Kailynn M. Barton BS , Mark Chottiner MD , Mathew A. Saab MD, MPH","doi":"10.1016/j.annemergmed.2025.07.020","DOIUrl":"10.1016/j.annemergmed.2025.07.020","url":null,"abstract":"<div><div>Compression ultrasonography is the bedside standard for diagnosing lower-extremity deep venous thrombosis. Probe-induced thrombus dislodgement, though rare, can precipitate pulmonary embolism, as well as strokes and other end-organ infarcts in patients with patent foramen ovales. We report a 65-year-old woman whose noncompressible mid-femoral deep venous thrombosis detached during routine point-of-care ultrasound—captured in real time—and resulted in bilateral subsegmental pulmonary emboli (PE) noted on computed tomography pulmonary angiography. The case highlights the possibility of compression-induced embolization, the need for controlled compression pressure, and immediate PE assessment when embolization is observed.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 374-376"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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