首页 > 最新文献

Annals of emergency medicine最新文献

英文 中文
Comparing the Canadian Syncope Risk Score to the Final Emergency Department Diagnosis and the Model Without It: A Secondary Analysis.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-28 DOI: 10.1016/j.annemergmed.2024.12.010
Hadi Mirfazaelian, Ian G Stiell, Venkatesh Thiruganasambandamoorthy
{"title":"Comparing the Canadian Syncope Risk Score to the Final Emergency Department Diagnosis and the Model Without It: A Secondary Analysis.","authors":"Hadi Mirfazaelian, Ian G Stiell, Venkatesh Thiruganasambandamoorthy","doi":"10.1016/j.annemergmed.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.010","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078514","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}
引用次数: 0
Ethanol and the Limitations of the Osmol Gap.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-24 DOI: 10.1016/j.annemergmed.2024.12.022
Ryan Marino, Alexander Sidlak, Anthony Scoccimarro, Kathryn Flickinger, Anthony Pizon

Study objective: The osmol gap can help detect and manage those with toxic alcohol exposure, and it is altered by all alcohols including ethanol. The optimal correction for ethanol that would allow accurate detection of an alternative alcohol is unclear.

Methods: We conducted a prospective cohort study to assess baseline variations in osmol gap, and then to assess the validity of 2 commonly used coefficients (correction factors) for ethanol. Twenty-two healthy volunteers received a body mass-based dose of oral ethanol that targeted an estimated peak blood ethanol concentration >200 mg/dL. We measured laboratory values prior to ethanol administration and at 2, 4, and 6 hours after ingestion. We considered an osmol gap >10 or <-10 abnormal and an osmol gap of >10 after correction as a false positive.

Results: Four of the 22 subjects (18%) had an osmol gap >10 at baseline. Following ethanol ingestion and across 66 timepoints (N=66), there were 14 abnormal osmol gap tests (21%) when corrected with an ethanol coefficient of 4.6, and 31 (47%) abnormal tests when corrected using the Purssell ethanol coefficient of 3.7. The mean difference between the baseline and the post-ethanol corrected osmol gap was lower with the molecular weight correction factor of 4.6 compared with the Purssell correction factor of 3.7 (0.2 versus 11.0; P<.001).

Conclusion: Our data show that the osmol gap is occasionally elevated absent ingestion of any alcohol, and using an ethanol correction coefficient of 4.6 produced a better clinical osmol gap input albeit still with some variation.

{"title":"Ethanol and the Limitations of the Osmol Gap.","authors":"Ryan Marino, Alexander Sidlak, Anthony Scoccimarro, Kathryn Flickinger, Anthony Pizon","doi":"10.1016/j.annemergmed.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.022","url":null,"abstract":"<p><strong>Study objective: </strong>The osmol gap can help detect and manage those with toxic alcohol exposure, and it is altered by all alcohols including ethanol. The optimal correction for ethanol that would allow accurate detection of an alternative alcohol is unclear.</p><p><strong>Methods: </strong>We conducted a prospective cohort study to assess baseline variations in osmol gap, and then to assess the validity of 2 commonly used coefficients (correction factors) for ethanol. Twenty-two healthy volunteers received a body mass-based dose of oral ethanol that targeted an estimated peak blood ethanol concentration >200 mg/dL. We measured laboratory values prior to ethanol administration and at 2, 4, and 6 hours after ingestion. We considered an osmol gap >10 or <-10 abnormal and an osmol gap of >10 after correction as a false positive.</p><p><strong>Results: </strong>Four of the 22 subjects (18%) had an osmol gap >10 at baseline. Following ethanol ingestion and across 66 timepoints (N=66), there were 14 abnormal osmol gap tests (21%) when corrected with an ethanol coefficient of 4.6, and 31 (47%) abnormal tests when corrected using the Purssell ethanol coefficient of 3.7. The mean difference between the baseline and the post-ethanol corrected osmol gap was lower with the molecular weight correction factor of 4.6 compared with the Purssell correction factor of 3.7 (0.2 versus 11.0; P<.001).</p><p><strong>Conclusion: </strong>Our data show that the osmol gap is occasionally elevated absent ingestion of any alcohol, and using an ethanol correction coefficient of 4.6 produced a better clinical osmol gap input albeit still with some variation.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036212","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}
引用次数: 0
Finding My Voice by Advocating for Others: The Case for a Chief Resident of Diversity, Equity, and Inclusion in Emergency Medicine.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-24 DOI: 10.1016/j.annemergmed.2024.12.017
Fahad Ali, Anita Knopov, Taneisha Wilson, Almaz Dessie
{"title":"Finding My Voice by Advocating for Others: The Case for a Chief Resident of Diversity, Equity, and Inclusion in Emergency Medicine.","authors":"Fahad Ali, Anita Knopov, Taneisha Wilson, Almaz Dessie","doi":"10.1016/j.annemergmed.2024.12.017","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.017","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036216","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}
引用次数: 0
Goals of Care: Not Just a Patient-Centric Conversation, a Hospital Flow Intervention.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-24 DOI: 10.1016/j.annemergmed.2024.12.021
Yoga Kammili, Molly McCann-Pineo, Landon R Witz, Timmy Li, Matthew Hatchell, Payal Sud
{"title":"Goals of Care: Not Just a Patient-Centric Conversation, a Hospital Flow Intervention.","authors":"Yoga Kammili, Molly McCann-Pineo, Landon R Witz, Timmy Li, Matthew Hatchell, Payal Sud","doi":"10.1016/j.annemergmed.2024.12.021","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.021","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036221","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}
引用次数: 0
Dissociative and Deep Sedations Administered by Trained Unsupervised Pediatric Residents in Israeli Emergency Departments.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-22 DOI: 10.1016/j.annemergmed.2024.12.020
Neta Cohen, Nitai Levy, Jordanna H Koppel, Layah Alkoby-Meshulam, Nir Friedman, Gidon Test, Nachshon Buchshtav, Giora Weiser, Adi Klein, Irena Chistyakov, Itai Shavit

Study objective: To cover pediatric emergency physicians' off-hours, third-year pediatric residents in Israel are trained for unsupervised administration of emergency department (ED) dissociative and deep sedation. We assessed the frequency of critical sedation events associated with resident-performed sedations.

Methods: We conducted a retrospective chart review on all patients receiving intravenous sedation across 10 pediatric EDs between January 2018 and September 2022. We defined a critical sedation event as one or more of the following: chest compressions, tracheal intubation, neuromuscular blockers, vasopressors, atropine for bradycardia, aspiration syndrome, death, or unplanned hospital admission due to sedation. We liaised with the Ministry of Health's reporting department and ED directors to verify complete identification of all sentinel events.

Results: Pediatric residents and pediatric emergency physicians performed 12,733 and 10,845 sedations, respectively, most frequently for fracture reduction (44.4%) and laceration repair (25.6%). Patients' mean (SD) age was 6.9 (4.4) years. Residents and emergency physicians administered ketamine or propofol alone in 6,473 and 3,465 cases, respectively, with drug combinations for the remainder. We identified 6 critical sedation events, of which 3 were resident-performed sedations. The frequency of critical sedation events among pediatric residents and emergency physicians was 0.024% (95% CI, 0.005% to 0.069%) and 0.028% (95% CI, 0.006% to 0.080%), respectively.

Conclusion: We observed a low frequency of critical sedation events in this large sample of dissociative and deep sedations performed by pediatric residents and pediatric emergency physicians. Our findings suggest that ED sedation by unsupervised, trained pediatric residents is a safe practice in Israel.

{"title":"Dissociative and Deep Sedations Administered by Trained Unsupervised Pediatric Residents in Israeli Emergency Departments.","authors":"Neta Cohen, Nitai Levy, Jordanna H Koppel, Layah Alkoby-Meshulam, Nir Friedman, Gidon Test, Nachshon Buchshtav, Giora Weiser, Adi Klein, Irena Chistyakov, Itai Shavit","doi":"10.1016/j.annemergmed.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.020","url":null,"abstract":"<p><strong>Study objective: </strong>To cover pediatric emergency physicians' off-hours, third-year pediatric residents in Israel are trained for unsupervised administration of emergency department (ED) dissociative and deep sedation. We assessed the frequency of critical sedation events associated with resident-performed sedations.</p><p><strong>Methods: </strong>We conducted a retrospective chart review on all patients receiving intravenous sedation across 10 pediatric EDs between January 2018 and September 2022. We defined a critical sedation event as one or more of the following: chest compressions, tracheal intubation, neuromuscular blockers, vasopressors, atropine for bradycardia, aspiration syndrome, death, or unplanned hospital admission due to sedation. We liaised with the Ministry of Health's reporting department and ED directors to verify complete identification of all sentinel events.</p><p><strong>Results: </strong>Pediatric residents and pediatric emergency physicians performed 12,733 and 10,845 sedations, respectively, most frequently for fracture reduction (44.4%) and laceration repair (25.6%). Patients' mean (SD) age was 6.9 (4.4) years. Residents and emergency physicians administered ketamine or propofol alone in 6,473 and 3,465 cases, respectively, with drug combinations for the remainder. We identified 6 critical sedation events, of which 3 were resident-performed sedations. The frequency of critical sedation events among pediatric residents and emergency physicians was 0.024% (95% CI, 0.005% to 0.069%) and 0.028% (95% CI, 0.006% to 0.080%), respectively.</p><p><strong>Conclusion: </strong>We observed a low frequency of critical sedation events in this large sample of dissociative and deep sedations performed by pediatric residents and pediatric emergency physicians. Our findings suggest that ED sedation by unsupervised, trained pediatric residents is a safe practice in Israel.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021926","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}
引用次数: 0
Incidental Findings on Computed Tomography in Children With Blunt Abdominal Trauma.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-22 DOI: 10.1016/j.annemergmed.2024.12.012
Irma T Ugalde, Kenneth Yen, Grant Tatro, Paul Ishimine, Nisa S Atigapramoj, Pradip P Chaudhari, Kevan A McCarten-Gibbs, Mohamed Badawy, Jeffrey S Upperman, Nathan Kuppermann, James F Holmes

Study objective: Nontraumatic, incidental findings on computed tomography (CT) may be discovered after blunt abdominal trauma in children; however, the rate and importance of these findings are not well known. The objective of this study was to determine the prevalence and types of incidental CT findings among injured children undergoing abdominal/pelvic CT.

Methods: This was a planned secondary analysis of a multicenter prospective cohort study of children (<18 years) who underwent abdominal/pelvic CT after blunt trauma. We abstracted radiology reports for nontraumatic findings. We assessed and classified findings by their clinical urgency.

Results: Of 7,581 children enrolled, 2,500 (33%) underwent abdominal/pelvic CT. The mean patient age was 10.1±4.8 years, and 1,446 (58%) were boys. A total of 988 (39.5%, 95% CI 37.6 to 41.5%) children had 1,552 incidental findings with a mean patient age of 10.6±4.8 years, of whom 59% were boys. Fifty-five (3.5%) incidental findings were considered to need immediate evaluation/treatment, and 84 (5.4%) were considered to require outpatient follow-up within 4 weeks. Most incidental findings, however, were considered less urgent regarding follow-up: 552 (36%) were routine, 574 (37%) were considered to have a potential need, and 287 (18%) did not need follow-up.

Conclusions: Forty percent of children undergoing CT scanning after abdominal trauma have incidental findings, few of which are clinically important and require timely follow-up. CT scans should be obtained only when necessary, and clinicians must be prepared to address incidental findings and ensure proper management.

{"title":"Incidental Findings on Computed Tomography in Children With Blunt Abdominal Trauma.","authors":"Irma T Ugalde, Kenneth Yen, Grant Tatro, Paul Ishimine, Nisa S Atigapramoj, Pradip P Chaudhari, Kevan A McCarten-Gibbs, Mohamed Badawy, Jeffrey S Upperman, Nathan Kuppermann, James F Holmes","doi":"10.1016/j.annemergmed.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.012","url":null,"abstract":"<p><strong>Study objective: </strong>Nontraumatic, incidental findings on computed tomography (CT) may be discovered after blunt abdominal trauma in children; however, the rate and importance of these findings are not well known. The objective of this study was to determine the prevalence and types of incidental CT findings among injured children undergoing abdominal/pelvic CT.</p><p><strong>Methods: </strong>This was a planned secondary analysis of a multicenter prospective cohort study of children (<18 years) who underwent abdominal/pelvic CT after blunt trauma. We abstracted radiology reports for nontraumatic findings. We assessed and classified findings by their clinical urgency.</p><p><strong>Results: </strong>Of 7,581 children enrolled, 2,500 (33%) underwent abdominal/pelvic CT. The mean patient age was 10.1±4.8 years, and 1,446 (58%) were boys. A total of 988 (39.5%, 95% CI 37.6 to 41.5%) children had 1,552 incidental findings with a mean patient age of 10.6±4.8 years, of whom 59% were boys. Fifty-five (3.5%) incidental findings were considered to need immediate evaluation/treatment, and 84 (5.4%) were considered to require outpatient follow-up within 4 weeks. Most incidental findings, however, were considered less urgent regarding follow-up: 552 (36%) were routine, 574 (37%) were considered to have a potential need, and 287 (18%) did not need follow-up.</p><p><strong>Conclusions: </strong>Forty percent of children undergoing CT scanning after abdominal trauma have incidental findings, few of which are clinically important and require timely follow-up. CT scans should be obtained only when necessary, and clinicians must be prepared to address incidental findings and ensure proper management.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021929","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}
引用次数: 0
Intervention With Concentrated Albumin for Undifferentiated Sepsis in the Emergency Department (ICARUS-ED): A Pilot Randomized Controlled Trial.
IF 5 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-22 DOI: 10.1016/j.annemergmed.2024.12.016
Julian M Williams, Jaimi H Greenslade, Angela Z Hills, Mercedes T Ray

Study objectives: Concentrated albumin early in sepsis resuscitation remains largely unexplored. Objectives were to determine 1) feasibility of early intervention with concentrated albumin in emergency department (ED) patients with suspected infection and hypoperfusion and 2) whether early albumin therapy improves outcomes.

Methods: ED patients with suspected infection and hypoperfusion (systolic blood pressure [SBP]<90 mmHg or lactate ≥4.0 mmol/L) were randomized to receive either 400 mL 20% albumin over 4 hours or no albumin. All patients were treated with crystalloids, antibiotics, and other therapies at the treating team's discretion. Primary outcome was SBP at 24 hours; secondary outcomes included SBP at 6 hours, fluid and organ support requirements, organ dysfunction, and mortality. Quantile and logistic regressions were used to calculate differences (and 95% CI) between study groups.

Results: Compliance with study protocol was more than 95%, and infection was confirmed in 95% of the 464 study patients enrolled. SBP at 24 hours did not differ between intervention (110.5 mmHg) and standard care arms (110 mmHg). In patients treated with albumin, SBP was higher at 6 hours, less total fluid was infused at 72 hours, fewer patients required vasopressor therapy at 24 and 72 hours, and organ function was improved. Mortality was not significantly different.

Conclusions: Early identification, trial enrollment, and intervention in ED patients with sepsis is feasible. In this pilot study, concentrated albumin given early in resuscitation did not improve SBP at 24 hours. Albumin was associated with less total fluid and vasopressor requirements and improved organ dysfunction. A multicenter study is indicated.

{"title":"Intervention With Concentrated Albumin for Undifferentiated Sepsis in the Emergency Department (ICARUS-ED): A Pilot Randomized Controlled Trial.","authors":"Julian M Williams, Jaimi H Greenslade, Angela Z Hills, Mercedes T Ray","doi":"10.1016/j.annemergmed.2024.12.016","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.016","url":null,"abstract":"<p><strong>Study objectives: </strong>Concentrated albumin early in sepsis resuscitation remains largely unexplored. Objectives were to determine 1) feasibility of early intervention with concentrated albumin in emergency department (ED) patients with suspected infection and hypoperfusion and 2) whether early albumin therapy improves outcomes.</p><p><strong>Methods: </strong>ED patients with suspected infection and hypoperfusion (systolic blood pressure [SBP]<90 mmHg or lactate ≥4.0 mmol/L) were randomized to receive either 400 mL 20% albumin over 4 hours or no albumin. All patients were treated with crystalloids, antibiotics, and other therapies at the treating team's discretion. Primary outcome was SBP at 24 hours; secondary outcomes included SBP at 6 hours, fluid and organ support requirements, organ dysfunction, and mortality. Quantile and logistic regressions were used to calculate differences (and 95% CI) between study groups.</p><p><strong>Results: </strong>Compliance with study protocol was more than 95%, and infection was confirmed in 95% of the 464 study patients enrolled. SBP at 24 hours did not differ between intervention (110.5 mmHg) and standard care arms (110 mmHg). In patients treated with albumin, SBP was higher at 6 hours, less total fluid was infused at 72 hours, fewer patients required vasopressor therapy at 24 and 72 hours, and organ function was improved. Mortality was not significantly different.</p><p><strong>Conclusions: </strong>Early identification, trial enrollment, and intervention in ED patients with sepsis is feasible. In this pilot study, concentrated albumin given early in resuscitation did not improve SBP at 24 hours. Albumin was associated with less total fluid and vasopressor requirements and improved organ dysfunction. A multicenter study is indicated.</p>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021931","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}
引用次数: 0
FASTER-But Not Fast Enough: Bridging the Gap Between Data Collection and Injury Prevention in Firearm Injury Surveillance. 更快——但还不够快:在枪支伤害监测中弥合数据收集和伤害预防之间的差距。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-18 DOI: 10.1016/j.annemergmed.2024.12.011
Lois K Lee,Fahd A Ahmad
{"title":"FASTER-But Not Fast Enough: Bridging the Gap Between Data Collection and Injury Prevention in Firearm Injury Surveillance.","authors":"Lois K Lee,Fahd A Ahmad","doi":"10.1016/j.annemergmed.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.011","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"74 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991721","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}
引用次数: 0
Use of Hallway Beds, Radiology Studies, and Patients in Pain on Arrival to the Emergency Department Are Associated With Patient Experience. 走廊床的使用、放射学研究和到达急诊科时疼痛的患者与患者的经历有关。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-18 DOI: 10.1016/j.annemergmed.2024.11.020
Diane Kuhn,Peter S Pang,Olena Mazurenko,Nancy K Glober,Thomas A Lardaro,Xiaochun Li,Christopher A Harle,Paul I Musey
STUDY OBJECTIVEPatient experience is an essential measure of patient-centered emergency care. However, emergency department (ED) patient experience scores may be influenced by patient demographics as well as clinical and operational characteristics unrelated to actual patient-centeredness of care. This study aimed to determine whether there are characteristics associated with patient experience scores that have not yet been proposed for risk adjustment by the Centers for Medicare and Medicaid Services (CMS).METHODSThis is a cross-sectional study of patient visits for 13 EDs across a regional health system from January 1, 2022, to December 31, 2023. We used a multivariable mixed-effects regression with physician-site random effects to examine the relationship between patient, clinical, and operational characteristics and ED patient experience scores. The dependent variable was a patient's likelihood to recommend rating (0-10 scale), treated as a continuous variable. The independent variables included patient (age, race, gender, ethnicity, interpreter need, and payer type), clinical (radiology and laboratory studies, opioid administration, patient acuity, and initial pain score), and operational characteristics (door-to-doc times, hallway bed placement, and National Emergency Department Overcrowding Scale [NEDOCS] level).RESULTSA total of 58,622 unique patient visits were included in the analysis. The patient experience survey response rate was 7.1% of discharged ED patients during the study period. Black or African American patients, those with Medicaid insurance, and adults aged younger than 40 years were underrepresented relative to the expected proportions based on population data. Several clinical and operational characteristics were significantly associated with experience ratings, including hallway bed placement (-0.38 [95% confidence interval, -0.53 to -0.23]), receiving radiology studies (0.27 [0.20 to 0.35]), initial pain scores (-0.08 [-0.09 to -0.06]), and NEDOCS level.CONCLUSIONWe found several clinical and operational characteristics associated with patient experience scores, which CMS does not currently use for risk adjustment. Our findings raise concerns that there are elements of care associated with patients' overall experience ratings which have an unclear relationship with patient-centered constructs such as communication and coordination of care.
研究目的:患者体验是以患者为中心的急诊护理的重要指标。然而,急诊科(ED)患者体验得分可能受到患者人口统计学以及与实际以患者为中心的护理无关的临床和操作特征的影响。本研究旨在确定是否存在与患者经验评分相关的特征,这些特征尚未被医疗保险和医疗补助服务中心(CMS)提出用于风险调整。方法:这是一项横断面研究,研究了从2022年1月1日到2023年12月31日,整个地区卫生系统中13个急诊科的患者就诊情况。我们使用多变量混合效应回归和医生现场随机效应来检验患者、临床和手术特征与急诊科患者体验评分之间的关系。因变量是患者推荐评分的可能性(0-10分),作为连续变量处理。自变量包括患者(年龄、种族、性别、民族、翻译需求和付款人类型)、临床(放射学和实验室研究、阿片类药物给药、患者视力和初始疼痛评分)和操作特征(从门到医生的时间、走廊床位的放置和国家急诊科过度拥挤程度[NEDOCS]水平)。结果共有58,622例独立患者就诊被纳入分析。研究期间出院急诊科患者的患者体验调查应答率为7.1%。与基于人口数据的预期比例相比,黑人或非裔美国人患者、有医疗补助保险的患者以及年龄小于40岁的成年人的比例偏低。一些临床和操作特征与经验评分显著相关,包括走廊床放置(-0.38[95%置信区间,-0.53至-0.23]),接受放射学检查(0.27[0.20至0.35]),初始疼痛评分(-0.08[-0.09至-0.06])和NEDOCS水平。结论:我们发现了一些与患者体验评分相关的临床和操作特征,而CMS目前并未将其用于风险调整。我们的研究结果引起了人们的关注,即与患者整体体验评级相关的护理要素与以患者为中心的结构(如护理的沟通和协调)之间存在不明确的关系。
{"title":"Use of Hallway Beds, Radiology Studies, and Patients in Pain on Arrival to the Emergency Department Are Associated With Patient Experience.","authors":"Diane Kuhn,Peter S Pang,Olena Mazurenko,Nancy K Glober,Thomas A Lardaro,Xiaochun Li,Christopher A Harle,Paul I Musey","doi":"10.1016/j.annemergmed.2024.11.020","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.11.020","url":null,"abstract":"STUDY OBJECTIVEPatient experience is an essential measure of patient-centered emergency care. However, emergency department (ED) patient experience scores may be influenced by patient demographics as well as clinical and operational characteristics unrelated to actual patient-centeredness of care. This study aimed to determine whether there are characteristics associated with patient experience scores that have not yet been proposed for risk adjustment by the Centers for Medicare and Medicaid Services (CMS).METHODSThis is a cross-sectional study of patient visits for 13 EDs across a regional health system from January 1, 2022, to December 31, 2023. We used a multivariable mixed-effects regression with physician-site random effects to examine the relationship between patient, clinical, and operational characteristics and ED patient experience scores. The dependent variable was a patient's likelihood to recommend rating (0-10 scale), treated as a continuous variable. The independent variables included patient (age, race, gender, ethnicity, interpreter need, and payer type), clinical (radiology and laboratory studies, opioid administration, patient acuity, and initial pain score), and operational characteristics (door-to-doc times, hallway bed placement, and National Emergency Department Overcrowding Scale [NEDOCS] level).RESULTSA total of 58,622 unique patient visits were included in the analysis. The patient experience survey response rate was 7.1% of discharged ED patients during the study period. Black or African American patients, those with Medicaid insurance, and adults aged younger than 40 years were underrepresented relative to the expected proportions based on population data. Several clinical and operational characteristics were significantly associated with experience ratings, including hallway bed placement (-0.38 [95% confidence interval, -0.53 to -0.23]), receiving radiology studies (0.27 [0.20 to 0.35]), initial pain scores (-0.08 [-0.09 to -0.06]), and NEDOCS level.CONCLUSIONWe found several clinical and operational characteristics associated with patient experience scores, which CMS does not currently use for risk adjustment. Our findings raise concerns that there are elements of care associated with patients' overall experience ratings which have an unclear relationship with patient-centered constructs such as communication and coordination of care.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"32 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991723","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}
引用次数: 0
Anti-Amyloid Therapies for Alzheimer's Disease and Amyloid-Related Imaging Abnormalities: Implications for the Emergency Medicine Clinician. 抗淀粉样蛋白治疗阿尔茨海默病和淀粉样蛋白相关影像学异常:对急诊医学临床医生的启示。
IF 6.2 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2025-01-17 DOI: 10.1016/j.annemergmed.2024.12.002
Megan A Rech,Christopher R Carpenter,Neelum T Aggarwal,Ula Hwang
Alzheimer's disease is the neurodegenerative disorder responsible for approximately 60% to 70% of all cases of dementia and is expected to affect 152 million by 2050. Recently, anti-amyloid therapies have been developed and approved by the Food and Drug Administration as disease-modifying treatments given as infusions every 2 to 5 weeks for Alzheimer's disease. Although this is an important milestone in mitigating Alzheimer's disease progression, it is critical for emergency medicine clinicians to understand what anti-amyloid therapies are and how they work to recognize, treat, and mitigate their adverse effects. Anti-amyloid therapies may be underrecognized contributors to emergency department visits because they carry the risk of adverse effects, namely amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities are observed as abnormalities on magnetic resonance imaging as computed tomography is not sensitive enough to detect the microvasculature abnormalities causing vasogenic edema (amyloid-related imaging abnormalities-E) microhemorrhages and hemosiderin deposits (amyloid-related imaging abnormalities-H). Patients presenting with amyloid-related imaging abnormalities may have nonspecific neurologic symptoms, including headache, lethargy, confusion, and seizures. Anti-amyloid therapies may increase risk of hemorrhagic conversion of ischemic stroke patients receiving thrombolytics and complicate the initiation of anticoagulation. Given the novelty of anti-amyloid therapies and limited real-world data pertaining to amyloid-related imaging abnormalities, it is important for emergency medicine clinicians to be aware of these agents.
阿尔茨海默病是一种神经退行性疾病,约占所有痴呆症病例的60%至70%,预计到2050年将影响1.52亿人。最近,抗淀粉样蛋白疗法被开发出来,并被食品和药物管理局批准为治疗阿尔茨海默病的疾病改善疗法,每2至5周注射一次。尽管这是减缓阿尔茨海默病进展的一个重要里程碑,但对于急诊临床医生来说,了解抗淀粉样蛋白疗法是什么以及它们如何识别、治疗和减轻其不良反应是至关重要的。抗淀粉样蛋白疗法在急诊就诊中可能被低估,因为它们有不良反应的风险,即淀粉样蛋白相关的成像异常。淀粉样蛋白相关成像异常表现为磁共振成像异常,因为计算机断层扫描不够灵敏,无法发现引起血管源性水肿(淀粉样蛋白相关成像异常- e)的微血管异常、微出血和含铁血黄素沉积(淀粉样蛋白相关成像异常- h)。表现为淀粉样蛋白相关影像学异常的患者可能有非特异性神经系统症状,包括头痛、嗜睡、精神错乱和癫痫发作。抗淀粉样蛋白治疗可能增加接受溶栓治疗的缺血性脑卒中患者出血转化的风险,并使抗凝治疗的开始复杂化。鉴于抗淀粉样蛋白疗法的新颖性和与淀粉样蛋白相关的成像异常有关的有限的现实数据,对急诊医学临床医生来说,了解这些药物是很重要的。
{"title":"Anti-Amyloid Therapies for Alzheimer's Disease and Amyloid-Related Imaging Abnormalities: Implications for the Emergency Medicine Clinician.","authors":"Megan A Rech,Christopher R Carpenter,Neelum T Aggarwal,Ula Hwang","doi":"10.1016/j.annemergmed.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2024.12.002","url":null,"abstract":"Alzheimer's disease is the neurodegenerative disorder responsible for approximately 60% to 70% of all cases of dementia and is expected to affect 152 million by 2050. Recently, anti-amyloid therapies have been developed and approved by the Food and Drug Administration as disease-modifying treatments given as infusions every 2 to 5 weeks for Alzheimer's disease. Although this is an important milestone in mitigating Alzheimer's disease progression, it is critical for emergency medicine clinicians to understand what anti-amyloid therapies are and how they work to recognize, treat, and mitigate their adverse effects. Anti-amyloid therapies may be underrecognized contributors to emergency department visits because they carry the risk of adverse effects, namely amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities are observed as abnormalities on magnetic resonance imaging as computed tomography is not sensitive enough to detect the microvasculature abnormalities causing vasogenic edema (amyloid-related imaging abnormalities-E) microhemorrhages and hemosiderin deposits (amyloid-related imaging abnormalities-H). Patients presenting with amyloid-related imaging abnormalities may have nonspecific neurologic symptoms, including headache, lethargy, confusion, and seizures. Anti-amyloid therapies may increase risk of hemorrhagic conversion of ischemic stroke patients receiving thrombolytics and complicate the initiation of anticoagulation. Given the novelty of anti-amyloid therapies and limited real-world data pertaining to amyloid-related imaging abnormalities, it is important for emergency medicine clinicians to be aware of these agents.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"23 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988613","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}
引用次数: 0
期刊
Annals of emergency medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1