Academic Emergency Medicine

BACKGROUND: History and physical exam are key features to narrow the differential diagnosis of central versus peripheral causes in patients presenting with acute vertigo. We conducted a systematic review and meta-analysis of the diagnostic test accuracy of physical exam findings. METHODS: Patient-intervention-control-outcome (PICO) question, (P) adult ED patients with vertigo/dizziness; (I) presence/absence of specific physical exam findings; (O) central (ischemic stroke, hemorrhage, others) versus peripheral etiology...

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BACKGROUND: Dexmedetomidine (DEX), a centrally acting alpha-2 agonist, is increasingly used for sedation in multiple clinical settings. Evidence from the intensive care unit and operative settings suggests DEX may have significant advantages over traditional GABAergic sedatives such as benzodiazepines. There has been limited research on the use of DEX in the emergency department (ED). METHODS: We performed a systematic review of the medical literature to identify all published evidence regarding the use of DEX in the ED...

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OBJECTIVES: To conduct a systematic review and qualitative evidence synthesis (QES) to identify best practices, benefits, harms, facilitators and barriers to the routine collection of sociodemographic variables in Emergency Departments (EDs). DESIGN: A systematic review and QES. DATA SOURCES: We conducted a comprehensive search of Medline (Ovid), CINAHL (Ebsco), Cochrane Central (OVID), EMBASE (Ovid) and the multidisciplinary Web of Science Core database using peer-reviewed search strategies, complemented by a grey literature search...

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BACKGROUND: Point-of-care ultrasound (US) has been suggested as the primary imaging in evaluating patients with suspected diverticulitis. Discrimination between simple and complicated diverticulitis may help to expedite emergent surgical consults and determine the risk of complications. This study aimed to: (1) determine the accuracy of an US protocol (TICS) for diagnosing diverticulitis in the Emergency Department (ED) setting and (2) assess the ability of TICS to distinguish between simple and complicated diverticulitis...

BACKGROUND: Advanced practice providers (APPs) comprise an increasing proportion of the emergency medicine (EM) workforce, particularly in rural geographies. With little known regarding potential expanding practice patterns, we sought to evaluate trends in independent emergency care services billed by APPs from 2013 to 2019. METHODS: We performed a repeated cross-sectional analysis of emergency clinicians independently reimbursed for at least 50 Evaluation & Management (E/M) services [99281-99285, 99291] from Medicare Part B, with high acuity services including codes 99285 and 99291...

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OBJECTIVES: Fentanyl test strips (FTS) are increasingly used to address fentanyl contamination of the illicit drug supply by testing a drug for the presence of fentanyl, allowing people who use drugs to engage in overdose prevention. While emergency departments (EDs) have implemented various harm reduction strategies for people who use drugs, to date distribution of FTS in EDs is limited and not evaluated. Thus, we sought to explore ED staff experiences distributing FTS. METHODS: Twenty-one staff serving different roles (e...

BACKGROUND: Delirium, altered mental status or confusion among older adults are common presentations to the emergency department (ED). We aimed to report the proportion of older ED patients presenting with delirium who have acute abnormal findings on head imaging. We also assessed whether anticoagulation, neurological deficits, trauma or headache were associated with head imaging abnormalities in these patients. METHODS: A systematic review was performed using Ovid Medline, Embase, Clinicaltrials...

OBJECTIVE: To evaluate the comparative effectiveness and safety of pharmacological and non-pharmacological management options for Atrial Fibrillation/Atrial Flutter with Rapid Ventricular Response (AFRVR) in patients with Acute Decompensated Heart Failure (ADHF) in the acute care setting. METHODS: A systematic review of observational studies or randomized clinical trials of adult patients with AFRVR and concomitant ADHF in the ED, ICU, or step-down unit. The primary effectiveness outcome was successful rate or rhythm control...

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OBJECTIVES: Efforts to promote COVID-19 vaccine acceptance must consider the critical role of the emergency department (ED) in providing healthcare to underserved patients. Focusing on patients who lacked primary care, we sought to elicit the perspectives of unvaccinated ED patients regarding COVID-19 vaccination concerns and potential approaches that might increase their vaccine acceptance. METHODS: We conducted this qualitative interview study from August to November 2021 at four urban EDs in San Francisco, California; Seattle, Washington; Durham, North Carolina; and Philadelphia, Pennsylvania...

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