Academic Emergency Medicine

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BACKGROUND: Pulmonary embolism (PE) is a frequent diagnostic consideration in emergency department (ED) patients, yet diagnosis is challenging because symptoms of PE are nonspecific. Guidelines recommend the use of clinical decision tools to increase efficiency and avoid harms from over testing, including D-dimer screening in patients not at high risk for PE. Women undergo testing for PE more often than men yet have a lower yield from testing. Our study objective was to determine whether patient sex influenced the odds of received guideline-consistent care...

OBJECTIVES: Racial and ethnic minorities receive opioid prescriptions at lower rates and dosages than white patients. Though opioid stewardship interventions can improve or exacerbate these disparities, there is little evidence about these effects. We conducted a secondary analysis of a cluster-randomized controlled trial conducted among 438 clinicians from 21 emergency departments and 27 urgent care clinics. Our objective was to determine whether randomly allocated opioid stewardship clinician feedback interventions that were designed to reduce opioid prescriptions had unintended effects on disparities in prescribing by patient race and ethnicity...

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BACKGROUND: Amiodarone and lidocaine have not been shown to have a clear survival benefit compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. We sought to evaluate how timing from Emergency Medical Services (EMS) arrival on-scene to drug administration affects the efficacy of amiodarone and lidocaine compared to placebo. METHOD: This is a secondary analysis of the 10-site, 55 EMS agency double-blind randomized controlled Amiodarone, Lidocaine, or Placebo in OHCA Study...

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BACKGROUND: To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of RCT participants followed prospectively for 90 days after an E.D. visit for acute back or kidney stone pain. METHODS: One thousand three hundred-one individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool arm, a narrative-enhanced probabilistic risk tool arm, or a general risk information arm (control)...

BACKGROUND: Suicide is a leading cause of death in the United States (US), particularly among Veterans. Nonfatal firearm injuries may indicate subsequent risk of suicide and, thus, provide important opportunities for prevention in emergency departments and other healthcare settings. We used a retrospective cohort design to analyze associations between nonfatal firearm injuries and subsequent suicide among all Veterans who used US Department of Veterans Affairs (VA) healthcare, nationally, between 2010 and 2019...

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No abstract text is available yet for this article.

OBJECTIVES: Frailty is a clinical syndrome characterized by decreased physiologic reserve that diminishes the ability to respond to stressors such as acute illness. VA emergency departments (ED) are the primary venue of care for Veterans with acute illness and represents a key site for frailty recognition. As questionnaire-based frailty instruments can be cumbersome to implement in the ED, we examined two administratively-derived frailty scores for use among VA ED patients. METHODS: This national retrospective cohort study included all VA ED visits (2017-2020)...

BACKGROUND: The delivery and financing of healthcare services were altered in unprecedented ways by COVID-19 and subsequent policy responses. We estimated reimbursement losses to emergency physicians in 2020 as compared to 2019 related to shifting acute care utilization during COVID-19. METHODS: This was an observational analysis of the Clinical Emergency Department Registry (CEDR) and the Nationwide Emergency Department Sample (NEDS). Study sample included all ED visits from a sample of 214 emergency department (ED) sites in the CEDR in 2019 and 2020, as well as all ED visits in the NEDS in 2019...

BACKGROUND: While children discharged from the emergency department (ED) are frequently advised to follow up with ambulatory care providers, the extent to which this occurs is unknown. We sought to characterize the proportion of publicly insured children who have an ambulatory visit following ED discharge, identify factors associated with ambulatory follow-up, and evaluate the association of ambulatory follow-up with subsequent hospital-based healthcare utilization. METHODS: We performed a cross-sectional study of pediatric (<18 years) encounters during 2019 included in the IBM Watson Medicaid MarketScan claims database from 7 US states...

OBJECTIVES: Due to an increasing incidence of new cancer diagnoses in the United States and longer survivorship, a growing number of patients with cancer receive care in emergency departments (EDs). This trend places an increasing burden on already crowded EDs, and experts are concerned these patients do not receive optimal care. The purpose of this study is to describe the experiences of ED physicians and nurses who care for patients with cancer. This information can inform strategies to improve oncology care for patients in ED settings...

UNLABELLED: This study assessed the ability of end tidal carbon dioxide (ETCO2) in predicting in-hospital mortality and ICU admission compared to standard vital signs at ED triage as well as comparing to measures of metabolic acidosis. METHODS: This prospective study enrolled adult patients presenting to the ED of a tertiary care level 1 trauma center over 30 months. Patients had standard vital signs measured along with exhaled ETCO2 at triage. Outcome measures included in-hospital mortality, ICU admission and correlations with lactate, sodium bicarbonate (HCO3) and anion gap...