Academic Emergency Medicine

Patient-Reported Outcomes (PROs) are of increasing importance in clinical research because they capture patients' experience with well-being, illness, and their interactions with health care. Because PROs tend to focus on specific symptoms (e.g., pain, anxiety) or general assessments of patient functioning and quality of life that offer unique advantages compared to traditional clinical outcomes (e.g., mortality, emergency department revisits), emergency care researchers may benefit from incorporation of PRO measures into their research design as a primary or secondary outcome...

Out of hospital cardiac arrest (OHCA) and opioid overdose (OD) are two emergencies where prompt recognition and response-typically by untrained bystanders-are critical to ensure positive outcomes. The median incidence of EMS-treated OHCA across ten urban centres in North America is 52 per 100 000, (1) while the US incidence of fatal OD is around 14 per 100 000. (2).

OBJECTIVE: It is unclear if trauma center care is associated with improved outcomes in older adults with traumatic brain injury (TBI) compared to management at non-trauma centers. Our primary objectives were to describe the long-term outcomes of older adults with TBI and to evaluate the association of trauma center transport with long-term functional outcome. METHODS: This was a prospective, observational study at 5 EMS agencies and 11 hospitals representing all 911 transfers within a county...

Stress ulceration is a term coined to explain a form of upper gastrointestinal (GI) bleeding seen in critically ill patients, who are commonly defined as individuals admitted to an intensive care unit. Stress ulceration was first noted in the 1960s when a series of post-mortem examinations performed on critically ill individuals revealed gastric mucosal lesions.

BACKGROUND: Risk of respiratory depression is increased when opioids are added to sedative agents. In our recent multi-center emergency department (ED) procedural sedation cohort we reported a strong association between pre-procedural opioids and sedation-related adverse events. We sought to examine the association between timing of opioids and the incidence of adverse sedation outcomes. METHODS: We conducted a secondary analysis of a prospective cohort of children aged 0-18 years who received sedation for a painful procedure in six Canadian pediatric EDs from July/2010-Feb/2015...

The Federal Bureau of Investigation (FBI) defines an active shooter as "an individual actively engaged in killing or attempting to kill people in a confined and populated area".1 A study of newspaper articles and press releases identified 154 active shooter incidents (ASIs) in hospitals in the United States in the 12-year period 2000-2011.2 ASIs were more common in larger hospitals, with 29% taking place in the emergency department (ED) and 19% in patient rooms. In 50% of the ASIs in an ED, the perpetrator used a security officer's gun...

Traditionally, authors will present a manuscript at a conference prior to submitting the subsequent manuscript for consideration in a journal. While peer-reviewed publications are typically considered to be the gold standard in research,1 presentation of abstracts at conferences have several distinct advantages. First, presentation of abstracts at a conference offers an opportunity for early feedback and review, which can help identify issues prior to submission. This can allow authors the ability to refine their study question or revise their study design prior to completion of the project...

Pulmonary embolism (PE) is commonly suspected in patients presenting to the emergency department, however the gold-standard diagnostic test of CTA of the pulmonary arteries cannot always be performed rapidly. Focused cardiac ultrasound (FOCUS) has been studied previously as a diagnostic test for PE, with mixed results. We review a study by Daley et al in which the authors evaluated the diagnostic utility of FOCUS for PE in patients with unstable vital signs. We provide critical analysis of the article, as well as summarize the social media discussion and feedback of a podcast in which the authors discuss their work...

BACKGROUND: Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non-low-risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non-low-risk patients with syncope in the ED. METHODS: This prospective multicenter observational study included adult patients presenting to the ED after syncope...

BACKGROUND: Elderly patients presenting to the emergency department (ED) with nonspecific complaints (NSCs) often undergo troponin testing to assess for atypical acute coronary syndrome (ACS). However, the rate of ACS and utility of troponin testing in this population is unknown. We sought to determine the rate of ACS and diagnostic yield of troponin testing in elderly patients with NSCs. METHODS: We retrospectively identified all patients aged ≥ 65 years triaged in the ED with NSCs from January 1, 2017, to June 30, 2017...

Frailty is a state of vulnerability arising from multiple medical and psychosocial problems primarily affecting older people. It is associated with adverse outcomes including mortality, prolonged hospitalization, and functional dependence after discharge. Identifying frailty early may help concentrate resources on patients at high risk of iatrogenesis, functional decline, and death. Despite the growing number of emergency department (ED) visits by older people, frailty is relatively underexamined in the ED setting...

Syncope is a common and costly chief complaint among patients presenting to the emergency department (ED), accounting for 740,000 ED visits annually with an estimated annual cost of $2.4 billion per year in the United States.1,2 Syncope presents a diagnostic dilemma for clinicians in the ED since differentiating serious and benign causes of syncope can be challenging, particularly in the older adult. Routine laboratory testing with complete blood count (CBC) and basic metabolic panel (BMP) is commonly ordered for patients presenting to the ED with syncope...

As a military EM physician, it's fulfilling to care for a unit and getting to know your troops day in and day out on deployment. Yet it's tough to differentiate them as your patients versus your teammates. The emotions of military providers caring for their own near death are indefinable. While we can wash the blood out, we can never completely wash out the emotional scars it leaves behind.

A component of patient-centered care is effective, clear, and timely communication.1 Communication has been linked to improved outcomes,2,3 compliance with recommendations,4 and higher patient satisfaction.5,6 Despite this, emergency departments (EDs) are challenging environments where providers may struggle with consistently updating patients7 ED providers find themselves caring for a wide variety of concerns, acuity, constraints on physical work space, interruptions and ambient noise.

Cardiac arrest occurs in over 550,000 patients every year in the United States. Survival to hospital discharge occurs in only 12% of arrests, regardless of rhythm, and many survivors experience complications such as anoxic brain injury and poor neurologic function after cardiac arrest. Post cardiac arrest hyperthermia is associated with poor outcomes, including increased mortality and rates of neurologic injury.

Fifty one percent of the US population is female.1 Thirty six percent of professionally active physicians are female.2 Twenty seven percent of active emergency medicine physicians are female.

Acute esophageal variceal bleeding is an important cause of morbidity and mortality in patients with cirrhosis. Pharmacological agents used to treat such hemorrhages include somatostatin, a vasoactive agent that reduces splanchnic blood flow and thus portal pressure.1 .

BACKGROUND: In the era of frequent head-to-pelvis CT for adult blunt trauma evaluation, we sought to update teachings regarding aortic injury by determining 1) the incidence of aortic injury; 2) the proportion of patients with isolated aortic injury (without other concomitant thoracic injury); 3) the clinical implications of aortic injury (hospital mortality, length of stay, and rate of surgical interventions); and 4) the screening value of traditional risk factors/markers (such as high-energy mechanism and widened mediastinum on chest x-ray [CXR]) for aortic injury, as compared to newer criteria from the recently developed NEXUS Chest CT decision instrument...

OBJECTIVES: Patients with low back pain (LBP) are often treated with non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are modestly effective for LBP, but many patients with LBP continue to suffer despite treatment with these medications. We compared pain and functional outcomes one week after ED discharge among patients randomized to a one-week course of ibuprofen + acetaminophen versus ibuprofen + placebo. METHODS: This was a randomized, double-blind study conducted in two urban EDs...

Upper gastrointestinal bleeding (UGIB) is common, with an annual incidence of approximately 67 to 150 per 100,000, with estimated mortality rates between 6% and 15%.1 Many patients require hospital admission and ultimately endoscopic evaluation for diagnosis and treatment of the hemorrhage. It is standard practice to start patients with undifferentiated UGIB on acid suppression therapy with an intravenous proton-pump inhibitor (PPI) in the emergency department prior to admission or endoscopy.2 This practice is based on data that the most common cause of UGIB is peptic ulcer disease...