Pub Date : 2025-12-18DOI: 10.1016/j.annemergmed.2025.09.030
Abriana Tasillo MD (Commentator), Puja Patel MD (Commentator), Matthew L. Wong MD, MPH (Commentator), Derek L. Isenberg MD, MS (Commentator)
{"title":"West Nile Virus and Other Nationally Notifiable Arboviral Diseases—United States, 2023","authors":"Abriana Tasillo MD (Commentator), Puja Patel MD (Commentator), Matthew L. Wong MD, MPH (Commentator), Derek L. Isenberg MD, MS (Commentator)","doi":"10.1016/j.annemergmed.2025.09.030","DOIUrl":"10.1016/j.annemergmed.2025.09.030","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 1","pages":"Pages 103-106"},"PeriodicalIF":5.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766042","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 : 2025-12-18DOI: 10.1016/j.annemergmed.2025.11.011
{"title":"Global Research Highlights","authors":"","doi":"10.1016/j.annemergmed.2025.11.011","DOIUrl":"10.1016/j.annemergmed.2025.11.011","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 1","pages":"Pages 1-3"},"PeriodicalIF":5.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765649","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 : 2025-12-18DOI: 10.1016/j.annemergmed.2025.06.608
American College of Emergency Physicians Clinical Policies Subcommittee on Cannabis Consumption, Benjamin W. Hatten MD, MPH (Writing Chair), Caitlin Bonney MD, Stephen P. Wall MD, MSc, MAEd (Methodologist), Deborah B. Diercks MD, MSc (Committee Chair), Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee), Deborah B. Diercks MD, MSc (Co-Chair 2021-2022, Chair 2022-2024, Co-Chair 2024-2025), Scott M. Silvers MD (Co-Chair 2024-2025), John D. Anderson MD, Richard Byyny MD, MSc (Methodologist), Christopher R. Carpenter MD, John T. Finnell MD (Board Liaison 2020-2024), Benjamin W. Friedman MD (Methodologist), Seth R. Gemme MD, Charles J. Gerardo MD, MHS, Joshua Gibson RN, MSN (ENA Representative), Steven A. Godwin MD, Benjamin W. Hatten MD, MPH, Jason S. Haukoos MD, MSc (Methodologist), Amy Kaji MD, MPH, PhD (Methodologist) , Kaeli Vandertulip MBA, MSLS, AHIP (Staff Liaison, Clinical Policies Committee and Subcommittee on Cannabis Consumption)
This clinical policy from the American College of Emergency Physicians is a novel document. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: Are people who have recently or chronically consumed marijuana at increased risk of cardiovascular effects requiring a visit to the emergency department compared with the overall population of emergency department visits? Evidence was graded and
{"title":"Clinical Policy: Critical Issues Related to Harms of Cannabis Exposure in Adult Patients Presenting to the Emergency Department, Cardiovascular Considerations","authors":"American College of Emergency Physicians Clinical Policies Subcommittee on Cannabis Consumption, Benjamin W. Hatten MD, MPH (Writing Chair), Caitlin Bonney MD, Stephen P. Wall MD, MSc, MAEd (Methodologist), Deborah B. Diercks MD, MSc (Committee Chair), Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee), Deborah B. Diercks MD, MSc (Co-Chair 2021-2022, Chair 2022-2024, Co-Chair 2024-2025), Scott M. Silvers MD (Co-Chair 2024-2025), John D. Anderson MD, Richard Byyny MD, MSc (Methodologist), Christopher R. Carpenter MD, John T. Finnell MD (Board Liaison 2020-2024), Benjamin W. Friedman MD (Methodologist), Seth R. Gemme MD, Charles J. Gerardo MD, MHS, Joshua Gibson RN, MSN (ENA Representative), Steven A. Godwin MD, Benjamin W. Hatten MD, MPH, Jason S. Haukoos MD, MSc (Methodologist), Amy Kaji MD, MPH, PhD (Methodologist) , Kaeli Vandertulip MBA, MSLS, AHIP (Staff Liaison, Clinical Policies Committee and Subcommittee on Cannabis Consumption)","doi":"10.1016/j.annemergmed.2025.06.608","DOIUrl":"10.1016/j.annemergmed.2025.06.608","url":null,"abstract":"<div>This clinical policy from the American College of Emergency Physicians is a novel document. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: Are people who have recently or chronically consumed marijuana at increased risk of cardiovascular effects requiring a visit to the emergency department compared with the overall population of emergency department visits? Evidence was graded and</div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 1","pages":"Pages e1-e9"},"PeriodicalIF":5.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765974","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 : 2025-12-18DOI: 10.1016/j.annemergmed.2025.05.029
Camille Gerlier MD, Jonathan A. Edlow MD, PhD
{"title":"Clinical Risk Scores to Stratify for Serious Causes of Vertigo","authors":"Camille Gerlier MD, Jonathan A. Edlow MD, PhD","doi":"10.1016/j.annemergmed.2025.05.029","DOIUrl":"10.1016/j.annemergmed.2025.05.029","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 1","pages":"Pages 124-125"},"PeriodicalIF":5.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765768","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 : 2025-12-18DOI: 10.1016/j.annemergmed.2025.07.036
Gustavo C. Machado PhD, Chris G. Maher DMedSc
{"title":"Cohort Definitions on Estimates of Opioid Use for Low Back Pain in Emergency Departments","authors":"Gustavo C. Machado PhD, Chris G. Maher DMedSc","doi":"10.1016/j.annemergmed.2025.07.036","DOIUrl":"10.1016/j.annemergmed.2025.07.036","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 1","pages":"Pages 126-127"},"PeriodicalIF":5.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765770","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 : 2025-12-18DOI: 10.1016/j.annemergmed.2025.08.001
Robert Ohle MA, MSc, MBBCh (on behalf of the authors)
{"title":"","authors":"Robert Ohle MA, MSc, MBBCh (on behalf of the authors)","doi":"10.1016/j.annemergmed.2025.08.001","DOIUrl":"10.1016/j.annemergmed.2025.08.001","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 1","pages":"Pages 125-126"},"PeriodicalIF":5.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765769","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}
STUDY OBJECTIVESThe Limit of Detection in the Emergency Department (LEGEND) rule-out strategy integrates high-sensitivity cardiac troponin assay concentrations with shared decision making to rapidly assess emergency patients with suspected acute coronary syndrome (ACS). We hypothesized that the LEGEND rule-out strategy would reduce length of stay (LOS), increase the proportion of patients safely discharged within 4 hours, reduce cardiac testing, and decrease hospital representations, while maintaining patient safety.METHODSWe conducted a stepped-wedge cluster randomized controlled trial in 4 Australian emergency departments from August 2019 to July 2020. We included adult patients presenting with suspected ACS. We randomized sites to implement the LEGEND strategy. The primary outcome was LOS. Secondary outcomes included discharge from hospital within 4 hours, cardiovascular tests, representations, index, and 30-day events.RESULTSThe study included 9,944 patients, 5,347 in the standard care and 4,597 in the intervention arm. For patients in the LEGEND cohort (presentation troponin ≤2 ng/L), the mean LOS was 3.6 hours shorter in the intervention arm than the standard care arm (95% confidence interval [CI] 2.5 to 4.6 hours). The proportion of patients safely discharged within 4 hours increased by 22.9% (95% CI 19.5% to 26.3%), and cardiac testing decreased by 7.8% (95% CI 4.6% to 11.1%). There were no differences in representations, index events, or 30-day events.CONCLUSIONThe LEGEND rule-out strategy safely ruled out acute myocardial infarction, reduced hospital LOS, increased the proportion of patients discharged within 4 hours, and reduced cardiac testing.
研究目的急诊科检测限（LEGEND）排除策略将高灵敏度心肌肌钙蛋白检测浓度与共同决策相结合，以快速评估疑似急性冠脉综合征（ACS）的急诊患者。我们假设LEGEND排除策略将减少住院时间（LOS），增加4小时内安全出院的患者比例，减少心脏检查，减少医院就诊，同时保持患者安全。方法2019年8月至2020年7月，我们在澳大利亚4个急诊科开展了一项楔形聚类随机对照试验。我们纳入了疑似ACS的成年患者。我们随机化站点来实施LEGEND策略。主要结果是LOS。次要结局包括4小时内出院、心血管检查、表现、指数和30天事件。结果研究纳入9944例患者，标准治疗组5347例，干预组4597例。LEGEND队列（呈现肌钙蛋白≤2 ng/L）的患者，干预组的平均LOS比标准护理组短3.6小时（95%可信区间[CI] 2.5至4.6小时）。4小时内安全出院的患者比例增加了22.9% (95% CI 19.5% ~ 26.3%)，心脏检查减少了7.8% （95% CI 4.6% ~ 11.1%）。在表征、指数事件或30天事件方面没有差异。结论LEGEND排除策略安全地排除了急性心肌梗死，降低了医院LOS，增加了4小时内出院的患者比例，减少了心脏检查。
{"title":"The Limit of Detection in the Emergency Department Trial (LEGEND): A Stepped-Wedge Cluster Randomized Trial to Rule Out Acute Myocardial Infarction and Reduce Hospital Length of Stay for Patients Presenting to the Emergency Department.","authors":"Jaimi Greenslade,William Parsonage,Laura Stephensen,Rex Parsons,Siegfried Perez,Katrina Starmer,Gregory Starmer,Niranjan Gaikwad,Steven M McPhail,Emma Hall,Emily Brownlee,Ellyse McCormick,Louise Cullen, ","doi":"10.1016/j.annemergmed.2025.10.014","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.10.014","url":null,"abstract":"STUDY OBJECTIVESThe Limit of Detection in the Emergency Department (LEGEND) rule-out strategy integrates high-sensitivity cardiac troponin assay concentrations with shared decision making to rapidly assess emergency patients with suspected acute coronary syndrome (ACS). We hypothesized that the LEGEND rule-out strategy would reduce length of stay (LOS), increase the proportion of patients safely discharged within 4 hours, reduce cardiac testing, and decrease hospital representations, while maintaining patient safety.METHODSWe conducted a stepped-wedge cluster randomized controlled trial in 4 Australian emergency departments from August 2019 to July 2020. We included adult patients presenting with suspected ACS. We randomized sites to implement the LEGEND strategy. The primary outcome was LOS. Secondary outcomes included discharge from hospital within 4 hours, cardiovascular tests, representations, index, and 30-day events.RESULTSThe study included 9,944 patients, 5,347 in the standard care and 4,597 in the intervention arm. For patients in the LEGEND cohort (presentation troponin ≤2 ng/L), the mean LOS was 3.6 hours shorter in the intervention arm than the standard care arm (95% confidence interval [CI] 2.5 to 4.6 hours). The proportion of patients safely discharged within 4 hours increased by 22.9% (95% CI 19.5% to 26.3%), and cardiac testing decreased by 7.8% (95% CI 4.6% to 11.1%). There were no differences in representations, index events, or 30-day events.CONCLUSIONThe LEGEND rule-out strategy safely ruled out acute myocardial infarction, reduced hospital LOS, increased the proportion of patients discharged within 4 hours, and reduced cardiac testing.","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"8 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765493","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 : 2025-12-13DOI: 10.1016/j.annemergmed.2025.11.004
J. Adam Oostema
{"title":"Spin Control: Reframing Dizziness Evaluation in the Emergency Department","authors":"J. Adam Oostema","doi":"10.1016/j.annemergmed.2025.11.004","DOIUrl":"https://doi.org/10.1016/j.annemergmed.2025.11.004","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"46 1","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730712","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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