Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine

The authors' stated objective is to describe characteristics of EMTALA civil monetary penalties (CMPs) levied by the Office of Inspector General (OIG) between 2002 and 2018. [ 1 ] However, the description provided is just the government's version of the 'description', it leaves out the affected hospitals' side of the story; and the authors' statistical analysis of the penalties assessed overlooks known critical factors which could substantively undermine their conclusions. This article is protected by copyright...

BACKGROUND: Depression is one of the most common illnesses in the U.S., with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the Emergency Department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a non-psychiatric emergency department (ED) population and its association with subsequent ED visits and hospitalizations. METHODS: This prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015 and September 21, 2015...

OBJECTIVES: Early identification of geriatric patients at high risk for mortality is important to guide clinical care, medical decision-making, palliative discussions, quality assurance, and research. We sought to identify injured older adults at highest risk for 30-day mortality using an empirically derived scoring system from available data, and to compare it with current prognostic scoring systems. METHODS: This was a retrospective cohort study of injured adults ≥ 65 years transported by 44 emergency medical services (EMS) agencies to 49 emergency departments in Oregon and Washington from 1/1/2011 through 12/31/2011, with follow-up through 12/31/2012...

BACKGROUND: Ketamine is an emerging drug used in the management of undifferentiated, severe agitation in the prehospital setting. However, prior work has indicated that ketamine may exacerbate psychotic symptoms in patients with schizophrenia. The objective of this study was to describe psychiatric outcomes in patients who receive prehospital ketamine for severe agitation. METHODS: This is a retrospective cohort study, conducted at two tertiary academic medical centers, utilizing chart review of patients requiring prehospital sedation for severe agitation from 01/01/2014 - 06/30/2016...

OBJECTIVES: An adverse event (AE) is a physical harm experienced by a patient due to health care, requiring intervention. Describing and categorizing AEs is important for quality and safety assessment and identifying areas for improvement. Safety science suggests that improvement efforts should focus on preventing and mitigating harm rather than on error, which is commonplace but infrequently leads to AEs. Most taxonomies fail to describe harm experienced by patients (e.g. hypoxia, hemorrhage, anaphylaxis), focusing instead on errors, and use categorizations that are too broad to be useful (e...

BACKGROUND: The optimal order of drug administration (sedative first versus neuromuscular blocking agent first) in rapid sequence intubation (RSI) is debated. STUDY OBJECTIVE: We sought to determine if RSI drug order was associated with the time elapsed from administration of the first RSI drug to the end of a successful first intubation attempt. METHODS: We conducted a planned secondary analysis of a randomized trial of adult ED patients undergoing emergency orotracheal intubation that demonstrated higher first attempt success with bougie use compared to a tracheal tube + stylet...

Trauma is a major cause of morbidity and mortality, representing one of the top ten causes of both death and disability-adjusted life years by the World Health Organization. Point-of-care ultrasound (POCUS) is commonly performed during or after the primary survey to identify whether significant thoracic injuries or abdominal free fluid are present, particularly when patients are unstable or cannot receive a computed tomogram (CT). However, it is important to determine the accuracy of this modality to ensure proper application in trauma patients...

BACKGROUND AND OBJECTIVES: Emergency departments are essential providers of compassionate, immediate treatment and referral for women experiencing intimate partner violence. Intimate partner violence, largely perpetrated by men against women, exerts a substantial burden on the health systems and economies of all nations. There is little known about how staff in Australian emergency departments respond to the challenges such violence generates. We therefore examined the clinical team response to women experiencing intimate partner violence in two large Australian metropolitan hospital emergency departments...

Atrial fibrillation is the most common cardiac dysthrymia. Several rate-control strategies have been used, and magnesium sulfate has been investigated as an adjunct. In this review, we look at a trial by Bouida et al in which magnesium sulfate was studied in two different doses for rate control in atrial fibrillation. In addition, we review the social media commentary in response to the Skeptics Guide of Emergency Medicine Hot of the Press podcast. This article is protected by copyright. All rights reserved...

Patients, clinicians, and policymakers need to trust that conflicts of interest (COI) are appropriately disclosed in all forms of disseminated science, whether it's in the form of a research study, an expert editorial, a review article, or a meeting presentation. Recent high-profile events have renewed the public's attention to the basic procedure and reasons for disclosing COI.1 Honest and mutually-beneficial partnerships with industry or other funding agencies are vital for the advancement of medicine. Conflicts are inevitable and "could never possibly be eliminated" according to Jeffrey Flier,2 but a better understanding of the procedure for disclosing COI could reduce misunderstandings associated with COI and change the perception that COI is a dirty word...

The authors thank Dr. XYZ and colleagues for an insightful response to our recent meta-analysis on the prognostic accuracy of the HEART score for prediction of major adverse cardiac events (MACE) in patients presenting with chest pain [1]. The authors make excellent points related to the evaluation of prognostic scores, particularly as it relates to clinical decision-making. We feel that their editorial does highlight important complementary discussion points to our article. This article is protected by copyright...

In this issue, Fernando et al present a systematic review and meta-analysis assessing the prognostic accuracy of the HEART score for prediction of major adverse cardiac events (MACE) in adult patients presenting with chest pain at the emergency department (ED).1 The authors conclude that the HEART score has excellent performance for prediction of MACE (particularly mortality and myocardial infarction) in chest pain patients and should be the primary clinical decision instrument used for risk-stratification of this patient population...

No abstract text is available yet for this article.

Now is the critical time to consider the pipeline of women in medicine: for the past two years, 51% matriculants into medical school were women (1) - a milestone - and increasing data demonstrates the value of women in terms of providing high quality healthcare, innovative leadership, bottom line financial results, and groundbreaking research. And yet, disturbingly, gender disparities in compensation (2, 3), promotion (4), and leadership (5) in medicine have been persistently observed, even after accounting for a wide variety of potential explanatory factors, and these data are in parallel with common narratives of on-the-ground discouraging and demoralizing gender-based experiences among women physicians (6)...

The current state of physician burnout has become an increasingly popular topic of discussion and concern. Depending on how it is defined and measured by researchers, the prevalence of physician burnout ranges anywhere from 0 to 80%.1 Emergency medicine is often cited as the specialty with some of the highest reported levels of physician burnout.2 Regardless of what the "true" prevalence of physician burnout may be, most of these studies suggest the presence of a crisis. The detrimental impact of burnout on physicians is certainly of interest to physicians...

OBJECTIVE: The main objective of this study was to evaluate the accuracy of emergency physician-performed point-of-care ultrasound (POCUS) for the diagnosis of small bowel obstruction (SBO) compared to computed tomography (CT). METHODS: We performed a prospective, multicenter, observational study examining a convenience sample of adult patients with potential SBO presenting to the emergency department (ED) between July 2014 and May 2017. Each emergency physician-performed POCUS was interpreted at the bedside and retrospectively by an expert reviewer...

Despite the steady increase in female medical students and female faculty in the US, there has been little change in the distribution of women across the ranks of assistant, associate, and full professor over the past 30 years.1,2,3 Women are substantially less likely than men to be full professors even after accounting for age, experience, specialty, and measures of research and clinical productivity.4,5 From 2009 to 2017, the percentage of female faculty in emergency medicine dropped from 3% to 1.8%, while it stayed relatively stable for men (9% to 8...

This is a prospective observational study looking to validate a previously derived decision rule designed to help safely discharge opioid overdose patients from the emergency department after 1 hour.4 They included a convenience sample of 538 adult patients who had received naloxone pre-hospital and compared the Hospital Observation Upon Reversal (HOUR) rule with clinical judgement. The primary outcome of interest was a broadly defined composite of adverse events. The HOUR rule had a sensitivity of 84.1% (95% CI 76...

No abstract text is available yet for this article.

OBJECTIVE: An estimated 1.2 million annual emergency department (ED) visits for syncope/ near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and Natriuretic Peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/ serious cardiac outcomes in adult patients presenting with syncope...