Academic Emergency Medicine

Posterior circulation strokes represent 20% of all acute ischemic strokes. Posterior circulation stroke patients are misdiagnosed twice as often compared to those with anterior events. Misdiagnosed patients likely have worse outcomes than correctly diagnosed patients because they are at risk for complications of the initial stroke, as well as recurrent events due to lack of secondary stroke prevention and failure to treat the underlying vascular pathology. Understanding important anatomic variants, the clinical presentations, relevant physical examination findings, and the limitations of acute brain imaging may help reduce misdiagnosis...

We acknowledge that Dr. Dara Kass is the founder and CEO of FemInEM, LLC.1 The failure to disclose this was an oversight.2 This research study was not supported in any way financially by FemInEM; we as authors take joint responsibility for this oversight of nondisclosure. We also fully stand by the findings and conclusions of our study. This article is protected by copyright. All rights reserved.

I read with interest the March issue devoted to gender issues in Emergency Medicine and was struck by what I see as a disturbing trend in the emerging literature on gender issues in Emergency Medicine: the lack of disclosure of ideological and financial conflicts of interest. Multiple authors in this issue have founded or currently work as advisors for an advocacy organization addressing gender issues in Emergency Medicine. This article is protected by copyright. All rights reserved.

OBJECTIVES: Community consultation is required for clinical trials considering federal exception from informed consent (EFIC) procedures. Questions remain about the value of the community consult process and whether it adds intended protections to study subjects. Public deliberation methods that provide baseline participant education and elicit values and opinions about consent options is a novel approach for community consultation. This study evaluated the use of structured public deliberation methods to assess a community's values and opinions about informed consent procedures for a pediatric trauma trial...

OBJECTIVE: To describe the incidence, nature and risk factors for adverse events (AEs) among patients who received parenteral sedation for acute agitation in an emergency department (ED) setting. METHODS: We undertook a prospective observational study and a clinical trial of parenteral sedation for the management of acute agitation. We included agitated adult patients who required parenteral sedation from 2014 to 2017 in twelve Australian EDs, excluding those with incomplete information or aged under 18 years...

Frailty is a state of vulnerability to impairments in mobility, balance, muscle strength, motor processing, physical function, disability, cognition, nutrition, endurance, and physical activity. Prevalence estimates vary widely from 4.0 to 59.1% (weighted estimate 10.9%), with prevalence increasing with age. The risk of adverse outcomes for frail older adults including falls, delirium, disability and death is increased compared to similarly aged individuals without frailty, and may be a more important predictor of death than age for older adults...

Endotracheal intubation is a common procedure in emergency medicine, and recognizing a potentially difficult intubation is imperative in planning for the procedure. While the "can't intubate, can't ventilate" scenario is rare, it is catastrophic if the airway operator is not prepared.1-3 Thus, predicting factors associated with difficult endotracheal intubation is important for emergency clinicians, with consideration of airway adjuncts such as video laryngoscopy, supraglottic airway devices, and cricothyrotomy...

In this issue of Academic Emergency Medicine, Winkels et al. publish a study where patients in the University of Michigan Emergency Department (ED) were asked about decisions to forgo head CT in minor traumatic brain injury. Participants were given a clinical scenario: their theoretical CT had a 1 in 100 or 1 in 1000 chance of showing an intracranial bleed, but also carried similar risks of developing cancer from CT radiation. Patients also were asked about how a cash incentive paid to them (either $0 or $100) would impact their decision to forgo testing...

BACKGROUND: Nitrous oxide (N2O) is an inhalational medication with few side effects that has anxiolytic, amnestic, potent venodilatory and mild-to-moderate analgesic properties commonly used in the emergency department (ED) setting. Priapism is a serious complication of sickle cell disease (SCD) with few treatment options and an adverse impact on quality of life. Although a 50:50 nitrous oxide/oxygen mix is commonly used in France to enhance analgesia in patients with SCD and vaso-occlusive pain events (VOE) there are no reports of its use to treat priapism...

OBJECTIVES: Guidelines recommend chest radiography (CR) in the workup of suspected acute aortic syndromes (AASs) if the pre-test clinical probability is low. However, the diagnostic impact of CR integration for the rule-in and rule-out of AASs is unknown. METHODS: We performed a secondary analysis of the ADvISED multicenter study. Emergency Department (ED) outpatients were eligible if an AAS was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD-RS)...

BACKGROUND: Antibiotics are commonly prescribed during emergency department (ED) and urgent care center (UCC) visits for viral acute respiratory infection (ARI). We evaluate the comparative effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings (adapted intervention) to a stewardship intervention that additionally incorporates behavioral nudges (enhanced intervention) in reducing inappropriate prescriptions. METHODS: This study was a pragmatic, cluster-randomized clinical trial conducted in three academic health systems comprising five adult and pediatric EDs and four UCCs...

BACKGROUND: Childhood pneumonia is a leading cause of mortality worldwide. Growing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic alternative to chest x-ray (CXR) for childhood pneumonia. However, it is unclear whether sonographer experience affects the diagnostic accuracy of LUS. We summarize the diagnostic accuracy of LUS for pneumonia and compare the performance between novice and advanced sonographers with a systematic review and meta-analysis. METHODS: We searched PubMed and EMBASE from inception to February 2018 for eligible studies that evaluated the utility of LUS in children suspected of having pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory and imaging results...

The Office of the Inspector General has the authority to levy fines relating to violations of the Emergency Medicine Treatment and Labor Act (EMTALA) for both medical and psychiatric care. Terp et al. have described the incidence of violations and penalties levied for psychiatric cases and compared them to that for medical. This article reviews that article and the podcast recorded with Dr. Terp and the ensuing discussion in the podcast and online.

OBJECTIVES: The objective was to determine the prevalence of compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) and identify potential personal and professional predictors of these phenomena in pediatric emergency medicine (PEM) physicians. METHODS: A modified Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of personal and professional characteristics were distributed electronically to PEM physicians nationally...

No abstract text is available yet for this article.

BACKGROUND: Resuscitation with crystalloid fluid is a cornerstone of pediatric septic shock treatment. However, the optimal type of crystalloid fluid is unknown. We aimed to determine the feasibility of conducting a pragmatic randomized trial to compare balanced (lactated Ringer's [LR]) with 0.9% normal saline (NS) fluid resuscitation in children with suspected septic shock. METHODS: Open-label pragmatic randomized controlled trial (RCT) at a single academic children's hospital from January - August 2018...

BACKGROUND: Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few Emergency Departments (ED) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive yet brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED, and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks post-injury...

Posterior vitreous detachment (PVD) or separation of the posterior vitreous from the retina, is usually due to degeneration and age. PVD may present with floaters and/or flashes or may be asymptomatic for years.1 The incidence of PVD increases with age, from 25% in those 50-59 years to 87% in those 80-89 years.2 This condition sets the stage for further ophthalmologic pathologies, including a retinal tear. This article is protected by copyright. All rights reserved.

Sexual harassment is a serious threat to a safe and productive workplace. The emergency department (ED) environment poses unique threats, including stress, time constraints, working in close physical proximity, and frequent personal contacts with staff, colleagues, consultants, and difficult patients. Sexual harassment must be recognized and addressed in individual cases, in policy and in law, to protect staff members and patients. This article addresses the scope of the problem of sexual harassment known to date...

OBJECTIVES: Repeat visits (revisits) to Emergency Departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of Community Health Centers (CHCs)-which provide regional, low-cost primary care-correspond with fewer repeat psychiatric-related ED visits (PREDVs). METHODS: We obtained repeated cross-sectional time series data for 7.8 million PREDVs from the State Emergency Department Database for four populous US states (California, Florida, North Carolina and New York) from 2006 to 2011...