Academic Emergency Medicine

BACKGROUND: Artificial intelligence of things (AIoT) may be a solution for predicting adverse outcomes in emergency department (ED) patients with pneumonia; however, this issue remains unclear. Therefore, we conducted this study to clarify it. METHODS: We identified 52,626 adult ED patients with pneumonia from three hospitals between 2010 and 2019 for this study. Thirty-three feature variables from electronic medical records were used to construct an artificial intelligence (AI) model to predict sepsis or septic shock, respiratory failure, and mortality...

We are all the same at night, inebriated on traumas and resuscitations-the good stuff- chest tubes, central lines, code blues and with a sharpie, we mark the cricothyroid membrane just in case.

BACKGROUND: Improving care transitions following emergency department (ED) visits may reduce post-ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital-to-home transitions; however, its effectiveness at improving post-ED outcomes is unknown. We tested the effectiveness of the CTI with community-dwelling older adult ED patients, hypothesizing it would reduce revisits and increase performance of self-management behaviors during the 30 days following discharge...

No abstract text is available yet for this article.

OBJECTIVE: To identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research and review articles in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature. METHODS: A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review team to identify those that met our criteria of original research or review articles in the domains of Disaster and Humanitarian Response, Emergency Care in Resource-Limited Settings, and Emergency Medicine Development...

BACKGROUND: Delayed diagnosis of cerebrovascular disease (CVD) among patients can result in substantial harm. If diagnostic process failures can be identified at Emergency Department (ED) visits that precede CVD hospitalization, interventions to improve diagnostic accuracy can be developed. METHODS: We conducted a nested case-control study using a cohort of adult ED patients discharged from a single medical center with a benign headache diagnosis from 10/1/2015-3/31/2018...

BACKGROUND: This study aimed to (1) examine the proportion of patients presenting to an emergency department (ED) for acute cardiac symptoms with comorbid mental health conditions (MHCs) comprising current depression, generalized anxiety disorder, and panic disorder; (2) compare cardiac patients with and without MHCs regarding sociodemographic, medical, and psychological characteristics; and (3) examine recognition and treatment rates of MHCs. METHODS: Multimorbid patients, aged ≥50 years, presenting to an inner-city ED with acute cardiac symptoms including chest pain, dyspnoea, and palpitations, completed validated self-report instruments assessing MHCs and a questionnaire collecting psychosocial and medical information...

It's tradition when the new interns begin their training for the outgoing seniors to share some wisdom and survival tips. When I started my residency, I was terrified that I wouldn't read enough or know enough or be the smartest person in the room. Today, on the other side of my training, I feel compelled to share some lessons that resonated, in the hope that those in my footsteps can avoid the gaping potholes I sometimes stumbled into.

This is a memento about the period of new coronavirus pneumonia. It's also the most precious gift I have ever received, and it's the best medicine for a doctor during that period.

BACKGROUND: In 2014, Maryland (MD) implemented a "global budget revenue" (GBR) program that prospectively sets hospital budgets. This program introduced incentives for hospitals to tightly control volume and meet budget targets. We examine GBR's effects on emergency department (ED) visits, admissions, and returns. METHODS: We performed an interrupted time series analysis with difference-in-differences (DiD) comparisons using 2012 to 2015 Healthcare Cost Utilization and Project data from MD, New York (NY), and New Jersey (NJ)...

Today is my third day in the ED. I feel more comfortable here, and I know my way around. You want a flush, the ultrasound machine, even some fresh linens? I'm your guy. I feel more confident in other ways, too. I watched several ultrasound-guided IV placements during the past couple days and I'm running over the steps in my head-I can definitely do this. A stellar physician's assistant walks me through the steps one more time, encourages me, brings me to the bedside of a patient who needs a peripheral line placed, and he patiently supervises my work...

BACKGROUND: Federal exception from informed consent (EFIC) procedures allow studies to enroll patients with time-sensitive, life-threatening conditions when written consent is not feasible. Our objective was to compare enrollment rates with and without EFIC in a trial of tranexamic acid (TXA) for children with hemorrhagic injuries. METHODS: We conducted a four-center randomized controlled pilot and feasibility trial evaluating TXA in children with severe hemorrhagic brain and/or torso injuries...

Emergency Medicine (EM) investigators lag in research funding from the National Institutes of Health (NIH) when compared to other specialties. NIH funding determinations are made in part by a process of NIH study section peer review. Low participation by EM investigators in NIH peer review could be one explanation for low levels of NIH funding by EM investigators. The objective of this study was to establish a current-state metric of EM faculty researchers serving on standing NIH study sections from 2019-2020...

There is a peculiarity in our emergency department: the conspicuous absence of any soda. Water? Orange juice? Even prune juice for those who desire. But not even a single off-brand soda will turn up in the patient nutrition refrigerator. And not for general lack of soda; all other units across eleven floors have cupboards overflowing with stacks of cans. This has found me trudging up and down the hospital floors over the years, seeking out the particular beverages my patients desire. I encourage custom orders at the conclusion of every patient encounter...

INTRODUCTION: Telehealth has the potential to significantly change the specialty of Emergency Medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS: Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic...

Neonatal lumbar punctures (LPs) are most often performed when a baby younger than 30 days of age presents with a fever.1,2,3 The procedure can be challenging, even for experienced providers.4 The challenge is compounded when the patient is having respiratory or other issues such that they cannot tolerate a sitting or lateral decubitus position. Various methods for optimizing of the success of neonatal LPs have been proposed and studied.5,6,7 Nevertheless, failure rates range up to 40% in some studies.2,4,5 Traditionally, neonatal LPs have been performed in the lateral decubitus position or the sitting position, both of which require firm holding to maintain proper spacing of the spinous processes, a distance that is widely regarded as crucial to successful LP...

BACKGROUND: Back pain is often benign but can be a harbinger for serious pathology. Little is known about the outcome in children with back pain but no serious diagnoses detected at the initial visit. We sought to estimate the rate of serious diagnoses at revisits among children initially discharged from the emergency department with back pain. METHODS: We performed a multicenter retrospective cohort study of patients from 45 pediatric hospitals in the Pediatric Health Information System database from October 1, 2015 to March 31, 2019...

BACKGROUND: Earlier initial antibiotic treatment for febrile neutropenia is associated with improved clinical outcomes. This study was conducted to evaluate the association of an emergency department (ED) intervention protocol with time to initial antibiotic treatment for febrile neutropenia patients. METHODS: We conducted a cohort study of adult ED febrile neutropenia patients before and after implementation of an intervention protocol. Analyses included comparison of means and medians, Kaplan-Meier estimates, multivariable regression analyses, interrupted time series analyses, and causal mediation analyses...

OBJECTIVE: To examine the association between clinicians' opioid-prescribing group and patients' outcomes among patients treated in the emergency department (ED). DESIGN: Retrospective cohort study. SETTING: EDs of the US Military Health System (MHS). PATIENTS: 181,557 Army active-duty opioid-naïve (no fill in past 180 days) patients with an index encounter to the ED between October 2010 and September 2016. EXPOSURE: Patients classified by opioid-prescribing tier of the treating ED clinician: top-, middle- or bottom-third relative to the clinician's peers in the same emergency department...

In February 2021, the U.S. Food and Drug Administration (FDA) provided Emergency Use Authorization for the Janssen vaccine- the first one-dose COVID-19 vaccine to become available in the U.S. The one-dose regimen expanded opportunity to vaccinate in settings that can reach vulnerable communities for which returning to a site for a second vaccine dose may prove difficult. With 139 million visits annually in the U.S.1 and a tendency to serve in a safety net capacity for underserved patients2 , the emergency department (ED) is one such setting...