Academic Emergency Medicine

Patient satisfaction has evolved into a standard measure for quality and value in health care. Given the importance of patient satisfaction to overall hospital quality measures, a growing literature has investigated a number of variables that affect satisfaction in the emergency department (ED). For instance, studies have demonstrated that certain objective visit-related metrics, such as reduced wait time to see a provider, shorter length of stay, and a higher number of administered treatments, underlie higher patient satisfaction in the ED...

Cautious optimism suggests the COVID-19 pandemic in the United States (U.S.) has reached a turning point. Cases have declined precipitously from their heights in the early winter months and vaccine distribution and administration has moved ahead at an accelerated pace. As of late-March, more than 140 million doses of COVID-19 vaccine had been administered in the U.S., with more than 27% of the population receiving at least one dose.1 Nevertheless, challenges with COVID-19 remain. Rates are increasing in select parts of the country, as non-pharmaceutical interventions such as mask mandates and capacity limits are relaxed; more transmissible variants now represent a greater proportion of new cases; and, vaccine hesitancy persists in many sectors of the population...

OBJECTIVES: Emergency department (ED) patients with serious skin and soft tissue infections (SSTI) are often hospitalized to receive intravenous (IV) antibiotics. Appropriate patients may avoid admission following a single-dose, long-acting IV antibiotic. METHODS: We conducted a pre- vs. post-intervention design trial at 11 US EDs comparing hospitalization rates under usual care to those using a clinical pathway that included a single IV dalbavancin dose. We enrolled adults with cellulitis, abscess, or wound infection with an infected area of ≥75 cm2 without other indications for hospitalization...

Analgesia and sedation for patients who are mechanically ventilated may improve endotracheal tube tolerance, alleviate pain, reduce agitation, and facilitate other aspects of care including imaging, procedures, and travel to different parts of the hospital. Notwithstanding these benefits, lighter levels of sedation are associated with improved patient outcomes in intensive care unit (ICU) settings, including decreased duration of mechanical ventilation and length of stay.

Pain management is one of the primary tenets of emergency department care. Oligoanalgesia is a frequent occurrence in the ED and earlier administration of analgesic results in improved patient outcomes. Patients may wait hours to receive analgesia in the ED and thus, triage administration of an inhaled analgesic is a novel and potentially effective strategy. We discuss a randomized controlled trial by Brichko et al published in Academic Emergency Medicine, February 2021, comparing inhaled methoxyflurane to standard analgesia at ED triage...

INTRODUCTION: Rapid sequence intubation (RSI) is used to secure the airway of traumatic brain injury (TBI) patients, with ketamine frequently used for induction. Studies show that ketamine induction RSI might cause lower blood pressures when compared to etomidate. It is not clear if the results from that research can be extrapolated to systems that use different dosing regimens for ketamine RSI. Ambulance Victoria authorised the use of ketamine 1.5mg/kg in January 2015 for head injury RSI induction by road-based paramedics...

BACKGROUND: Acute gastroenteritis (AGE) is a common pediatric diagnosis in emergency medicine, accounting for 1.7 million visits annually. Little is known about racial/ethnic differences in care in the setting of standardized care models. METHODS: We used quality improvement data for children 6 months to 18 years presenting to a large, urban pediatric emergency department (ED) treated via a clinical pathway for AGE/dehydration between 2011 and 2018. Race/ethnicity was evaluated as a single variable (non-Hispanic [NH]-White, NH-Black, Hispanic, and NH-other) related to ondansetron and intravenous fluid (IVF) administration, ED length of stay (LOS), hospital admission, and ED revisits using multivariable regression...

OBJECTIVE: Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of non-fatal firearm injuries on utilization and expenditures. Our objective was to compare healthcare encounters and expenditures one year before and one year following a non-fatal firearm injury. METHODS: Retrospective cohort study of children 0-18 years with ICD-9/ICD-10 diagnosis codes for firearm injury in the emergency department or inpatient setting from 2010-2016 in the Medicaid MarketScan claims database...

The use of advanced practice providers (APPs) in emergency departments (EDs) has increased over the past two decades. As APPs have truncated training compared with emergency physicians, some have raised the concern that some APPs may compensate for training gaps through increased testing. We discuss an observational study by Pines et al published in Academic Emergency Medicine, January 2021, comparing test utilization and hospital admissions in patients with chest pain and abdominal pain by APPs and emergency physicians...

Otitis media with effusion (OME), one of the most common diseases in early childhood, is a self-limited illness1 with an estimated recurrence rate of 50% within 24 months2 . OME is characterized by an accumulation of fluid in the middle ear without symptoms or signs of acute infection.3 In most cases OME causes mild hearing impairment for a short period. OME in the pediatric population can lead to diminished hearing which in theory could hinder early learning. Some studies have shown an association with adult hearing loss as well...

BACKGROUND: Patients with COVID-19 can present to the emergency department (ED) at any point during the spectrum of illness, making it difficult to predict what level of care the patient will ultimately require. Admission to a ward bed, which is subsequently upgraded within hours to an intensive care unit (ICU) bed, represents an inability to appropriately predict the patient's course of illness. Predicting which patients will require ICU care within 24 hours would allow admissions to be managed more appropriately...

As the COVID-19 pandemic continues to rage across the United States and Europe, attention has been diverted from the toll the virus is taking in India. India is currently home to the second largest COVID-19 outbreak in the world, with more than 10 million confirmed cases and over 150,000 confirmed deaths1 .

INTRODUCTION: Seizures are one of the most common neurological reasons for emergency department (ED) visits. The benefit of ED-initiated, short-course outpatient Benzodiazepine (BZD) treatment to prevent early recurrent seizure is unknown. This study assesses the risk of early seizure recurrence in patients that were or were not started with outpatient BZD in the ED. METHODS: Multicenter retrospective study conducted in 8 French EDs between January 1st and December 31st 2019...

The global prevalence of migraine headaches is estimated to be about 15%, consisting mostly of young and middle-aged adults.1 Migraine headaches not only cause a burden of pain and suffering, but also result in significant loss of productivity. For example, in the European Union migraines are estimated to cost nearly 50 billion Euros in lost productivity in terms of aggregate direct and indirect costs to society annually.2 A reliable method of preventing symptoms would be beneficial in terms of quality of life as well as societal productivity...

Between 2000 and 2010, there were 2.6 million hospitalizations for hip fractures in the United States among women over 55 years of age alone.1 This is nearly as many hospitalizations as those for myocardial infarction or stroke among that same population and outnumbered hospitalizations for all other fractures combined.1 Studies have also demonstrated an increased risk for mortality in the months after hip fracture.

No abstract text is available yet for this article.

Neuraminidase inhibitors (NAIs) are commonly used in the prevention and treatment of influenza. Previous studies and reviews have demonstrated a questionable and modest benefit of their use while demonstrating potential adverse effects.1,2 .

OBJECTIVES: To evaluate the effects of direct access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS: We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18-80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention...

In patients with suspected acute aortic syndrome (AAS), standardized clinical risk assessment following the American Heart Association (AHA) and European Society of Cardiology (ESC) recommendations, is based on twelve risk-markers summarized in the aortic dissection detection (ADD) risk score (1, 2). However, additional risk factors and conditions have been associated with AASs. These include autoimmune diseases, immunosuppressive or glucocorticoid treatment, and use of fluoroquinolones (3-5).

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19 has infected more than 25 million Americans, leading to over 420,000 deaths.1 The Centers for Disease Control and Prevention (CDC) reports over 378,000 cases of COVID-19 in US health care personnel (HCP) with 1,286 deaths.2 By summer 2020, an estimated 4.6% of academic emergency department (ED) HCP had contracted COVID-19.3 In mid-December 2020 Emergency Use Authorization COVID-19 vaccines were administered to US HCP as a priority group...