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The American journal of emergency medicine
Centrum Philadelphia]
The American journal of emergency medicine

Centrum Philadelphia]

0735-6757

The American journal of emergency medicine/Journal The American journal of emergency medicine
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    Motor vehicle-related electric scooter injuries in the US: A descriptive analysis of NEISS data

    Neuroth, Lucas M.Humphries, Kayleigh D.Wing, Jeffrey J.Smith, Gary A....
    5页
    查看更多>>摘要：Introduction: The introduction of scooter-share programs across the United States has led to an increased incidence of electronic scooter (e-scooter) injuries presenting to emergency departments (EDs). As legislation begins to push scooters from the sidewalk to the street, injuries resulting from collisions between e-scooters and motor vehicles are an important, but poorly characterized consideration. This study leverages data from a national injury surveillance system to characterize e-scooter versus motor vehicle collisions resulting in ED presentation. Methods: This study utilizes data from the National Electronic Injury Surveillance System(NEISS). NEISS was queried for e-scooter-related injuries from January 1st, 2015 through December 31st, 2019. Injuries were characterized as motor vehicle-related (MV-involved) or non-motor-vehicle-related (MV-uninvolved) based on a manual review by the study investigators. Weighted tabular analyses were used to characterize both types of e-scooter injuries across demographic, diagnostic, and event-related factors. Results: Over the study period an estimated 60,554 (95% CI: 37,525-84,594) injuries were treated in US EDs. Approximately 19% of these injuries involved motor vehicles. Those sustaining MV-involved injuries were significantly younger (p = 0.01), with a higher proportion of males injured (p = 0.01). Additionally, when compared to MV-uninvolved injuries, a significantly higher proportion of those with MV-involved injuries were admitted to the hospital for treatment (8.8% vs. 14.6%, p < 0.01). MV-involved injuries occurred primarily in the street (96.3%), while MV-uninvolved injuries were split across streets (44.0%), at one's home (similar to 20%), and on public property (similar to 20%) (p < 0.01). Conclusions: Electric scooter injuries involving a motor vehicle differed from those that did not across several key categories. As e-scooters and motor vehicles start to share the road more frequently, greater consideration should be made regarding how these two modes of transportation interact with each other. The promotion of thoughtful e-scooter legislation and infrastructure changes could help promote safer travel. (C) 2022 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Gender coding in job advertisements for academic, non-academic, and leadership positions in emergency medicine

    O'Brien, KellyPetra, VeronicaLal, DivyaKwai, Kim...
    5页
    查看更多>>摘要：Objectives: Gender disparities continue to exist in emergency medicine (EM) despite increasing percentages of women in medical school and residencies. Prior studies in other male dominated industries have shown using masculine or feminine-coded language in job advertisements affects the proportion of male versus female applicants who choose to apply for those jobs. The goal of this study was to determine if gender-coding exists in EM job advertisements, and to see if there were differences between academic vs. non-academic jobs or administrative vs. non-administrative jobs. Methods: This was a cross sectional study of EM jobs advertised in the United States on 13 academic and non-academic medical job databases from September 2020-February 2021. Using a gender decoder program based on prior research by Gaucher et al. on gendered wording in job advertisements, we analyzed each job to determine if the job advertisement was overall highly masculine, masculine, highly feminine, feminine, or neutral. Each job was categorized as academic, non-academic, administrative, or non-administrative. Data were analyzed using descriptive statistics and chi-square analysis. Results: Seventy-four EM job advertisements were posted during the study period. Forty-four (59.4%) of these coded out as masculine or strongly masculine, 18 (24.3%) coded out as feminine or strongly feminine, and 12 (16.2%) were neutral. Only one job advertisement contained no gender-coded words. There were no differences in the gender-coding of academic, non-academic, or administrative jobs. Conclusion: Job advertisements for EM physicians tend to contain more masculine-coded language. Almost all job advertisements for emergency medicine physicians in this study contained at least one gender-coded word. Further studies could explore whether changing the language of job advertisements in EM has an impact on the proportion of women who choose to apply to EM jobs. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Remote dielectric sensing for detecting pulmonary edema in the emergency department

    Rafique, ZubaidMcArthur, RobertSekhon, NavdeepMesbah, Heba...
    5页
    查看更多>>摘要：Background: Dyspnea is a common Emergency Department (ED) complaint of which acute pulmonary edema (APE) is a potentially life-threatening etiology. Remote Dielectric Sensing (ReDS (TM)) is a novel, non-invasive, radar based, rapid, point of care vest testing system used to objectively quantify lung fluid content and may be useful in the early diagnosis of APE. Objective: To determine the accuracy of ReDS to detect pathologic lung fluid in ED undifferentiated dyspneic patients. Methods: We performed a prospective convenience sample observation pilot study enrolling adult ED patients with a chief complaint of "shortness of breath." After informed consent, patients were fitted with the ReDS vest and a reading, blinded to the care team, was recorded. A gold standard diagnosis of pulmonary edema, determined by 2 physicians performing a chart review and blinded to ReDs data, was compared to the ReDS reading. Results: Overall, 123 patients were included; 59% (n = 73) were male, mean (SD) age 57.2 (+/- 12) years, 46.3% (n = 57) Hispanic, 34.1%(n = 42) African American, 13.0% (n = 16) Caucasian and 5.7% (n = 7) Asian. The gold standard diagnosis showed pulmonary edema in 38 (30.9%) patients, of which 30 were detected by ReDS. At an optimal cutoff (>= 37%), ReDS had a Sn of 79.5% (CI 63.5% - 90.5%), Sp of 72.6% (CI 61.8% - 81.8%), a PPV of 57.4% and a NPV of 88.4%. Conclusions: ReDS is moderately sensitive and specific with an accuracy of 74.8% for pulmonary edema. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Andexanet alfa effectiveness and safety versus four-factor prothrombin complex concentrate (4F-PCC) in intracranial hemorrhage while on apixaban or rivaroxaban: A single-center, retrospective, matched cohort analysis

    Parsels, Katie A.Seabury, Robert W.Zyck, StephanieMiller, Christopher D....
    4页
    查看更多>>摘要：Background: There is limited information directly comparing andexanet alfa (AA) versus four-factor prothrombin complex concentrate (4F-PCC) in intracranial hemorrhage (ICH) on apixaban or rivaroxaban. Objective: The objective of this study was to compare the effectiveness and safety of AA versus 4F-PCC in ICH on apixaban or rivaroxaban. Methods: This retrospective, matched, cohort analysis was conducted at a single healthcare system. Patients were matched based on baseline ICH volume. The primary outcome was good or excellent ICH hemostasis, which was defined as a 35% or less increase in ICH volume within 24 h following AA or 4F-PCC administration. The secondary outcome was thrombotic events within 14 days following AA or 4F-PCC administration. Results: In total, 26 AA and 26 4F-PCC patients were included in this matched cohort analysis. Both groups had comparable rates of good or excellent ICH hemostasis (AA: 92.3% vs. 4F-PCC: 88.5%, p = 1.000). Thrombotic events within 14-days were not significantly different (AA: 26.9% vs. 4F-PCC: 11.5%, p = 0.159). Conclusion and relevance: This study found no significant differences in good or excellent ICH hemostasis within 24-h or new thrombotic events within 14-days in a cohort given AA or 4F-PCC for ICH while on apixaban or rivaroxaban. However, this single-center analysis is underpowered due to sample size constraints, therefore further high-quality research comparing AA safety and effectiveness versus 4F-PCC is needed. (C) 2022 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Trends in upper extremity injuries presenting to emergency departments during the COVID-19 pandemic

    Albright, J. AlexTesta, Edward J.Hanna, JohnShipp, Michael...
    7页
    查看更多>>摘要：Introduction: During the emergence of the SARS-CoV-2 (COVID-19) pandemic, there were substantial changes in United States (US.) emergency department (ED) volumes and acuity of patient presentation compared to more recent years. Thus, the purpose of this study was to characterize the incidence of specific upper extremity (UE) injuries presenting to U.S. EDs during the COVID-19 pandemic and analyze trends across age groups and rates of hospital admission compared to years prior. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to US. EDs for an UE orthopaedic injury between 2016 and 2020. Chi-square analysis and logistic regression were used to assess for differences in ED presentation volume and hospital admissions between pre-pandemic (2016 through 2019) and during-pandemic (2020) times. Results: These queries returned 285,583 cases, representing a total estimate of 10,452,166 injuries presenting to EDs across the US. The mean incidence of UE orthopaedic injuries was 640.2 (95% CI, 6382-642.3) injuries per 100,000 person-years, with the greatest year to year decrease in incidence occurring between 2019 and 2020 (20.1%). The largest number of estimated admissions occurred in 2020, with a total 135,018 admissions (95% CI, 131,518-138,517), a 41.6% increase from the average number of admissions between 2016 and 2019. Conclusion: There was a 20.1% decrease in the incidence of UE orthopaedic injuries presenting to EDs after the start of the COVID-19 pandemic with a concomitant 412% increase in the number of hospital admissions from the ED in 2020 compared to recent pre-pandemic years. We speculate that at least some elective, semi-elective or urgent ambulatory surgeries were canceled or delayed due to the pandemic and were subsequently directed to the ED for admission. Regardless of the cause of increased UE orthopaedic admissions, policy planners and administrators should be aware of the additional stresses placed on already burdened ED and inpatient services. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Gender differences and survival after out of hospital cardiac arrest

    Pisinger, MichaelBelohlavek, JanRob, DanielKavalkova, Petra...
    5页
    查看更多>>摘要：Background: Published evidence regarding the effect of gender on outcome after out of hospital cardiac arrest (OHCA) is inconsistent. We aimed to investigate the association of gender to outcome and resuscitation characteristics in OHCA patients admitted to the cardiac arrest center. Methods: In this retrospective analysis of prospective registry data, all patients admitted for OHCA were included. The influence of gender on 30-day survival and good neurological outcome (cerebral performance category of 1 or 2) were examined using Kaplan-Meier estimates and multivariable logistic regression. Results: In total, 932 patients were analysed (239 women, 26%). Women were older (64 vs 60 years, p<0.001) and less commonly had a shockable rhythm(47% vs 65%, P<0.001) compared to men. Women were less likely to have a cardiac cause of arrest (54% vs. 75%, p<0.001), received less therapeutic hypothermia (74% vs 86%, p<0.001) and coronary angiography (63% vs. 79%, p<0.001). The overall 30-day survival was lower for women (45% vs. 53%, log-rank p = 0.005) as well as good neurological outcome (37% vs. 46%, p = 0.008). However, according to the multivariate logistic regression, gender was not associated with survival (OR 0.98, 95% CI 0.65-1.50, p = 0.94) nor with good neurological outcome (OR 0.91, 95% CI 0.59-1.40, p = 0.67). Conclusion: Women admitted for OHCA to a cardiac center had a different cause of arrest that had a different treatment and outcome compared to men. Survival and good neurological outcome were lower in women, however, after adjusting for baseline characteristics, gender was not associated with survival nor neurological outcome. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Impact of extended emergency department stay on antibiotic re-dosing delays and outcomes in sepsis

    Harpenau, Tara L.Bhatti, Samiyah N.Hoffman, Brian M.Kirsch, William B....
    6页
    查看更多>>摘要：Background: For patients with sepsis and septic shock, the initial administration of antibiotics should occur as soon as possible, preferably within one hour of sepsis recognition. While clinicians are focused on providing first-doses of antibiotics quickly upon presentation, re-dosing issues may arise in patients who have an extended emergency department (ED) length of stay (LOS). Limited studies have been conducted that assess the impact of re-dosing delays. The purpose of this study was to assess the association of an extended ED LOS >= 6 h with antibiotic re-dosing delays in patients with sepsis and examine outcomes. Methods: A retrospective cohort study comparing patients with sepsis with an ED LOS of <6 h to those with an ED LOS of >= 6 h was performed between March 2018 and February 2020. Patients >= 18 years old admitted from the ED with sepsis or septic shock were included. The primary outcome was incidence of delay to the second dose of antibiotics in those with an extended ED LOS compared to those without. Secondary outcomes included intensive care unit (ICU) LOS, hospital LOS, rate of transfer from non-ICU to ICU settings, incidence and duration of mechanical ventilation, and in-hospital mortality. An exploratory analysis compared outcomes in patients with and without a re-dosing delay. Results: Of the 128 patients included, 99 patients had an ED LOS < 6 h and 29 patients had an ED LOS >= 6 h. A delay to second dose of antibiotics occurred in 30 (30.3%) patients in the ED LOS < 6 h group versus 7 (24.1%) patients in the ED LOS >= 6 h group(p = 0.52). Secondary outcomes did not significantly differ between the two groups. Inhospital mortality was numerically higher in those with a re-dosing delay when compared to those without in the exploratory analysis (18.9% vs. 8.8%, p = 0.11). Conclusion: There was no statistically significant difference in the incidence of delays to the second dose of antibiotics among patients with sepsis with an ED LOS of <6 h versus those with an ED LOS of >= 6 h. The high incidence of antibiotic re-dosing delays in both groups, indicates an overall need for improved transitions of care in the ED sepsis population. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Andexanet alfa versus four-factor prothrombin complex concentrate for the reversal of apixaban- or rivaroxaban-associated intracranial hemorrhages

    Pham, HaithuyMedford, Whitney GibsonHorst, SpencerLevesque, Melissa...
    7页
    查看更多>>摘要：Background: Existing research recommends either andexanet alfa (AA) or four-factor prothrombin complex concentrate (4F-PCC) as an antidote for major bleeding events due to apixaban or rivaroxaban. Currently, there is limited published research that directly compares the risks and benefits of the two agents in patients with oral factor Xa inhibitor related traumatic and spontaneous intracerebral hemorrhages. Additional head-to-head data is needed to support favoring either AA or 4F-PCC when it comes to efficacy, safety, and cost. Methods: A retrospective chart review was conducted to assess patients admitted to a multi-center healthcare system and a stand-alone teaching hospital in central Florida from June 2016 to December 2020. Patients included in the study were at least 18 years of age, taking apixaban or rivaroxaban prior to admission, had radiographical evidence of an intracranial hemorrhage, and received either AA or 4F-PCC as a reversal agent. The primary outcome analyzed was the level of excellent hemostasis achieved, based on a standardized rating system for effective hemostasis defined by the International Society of Thrombosis and Hemostasis (ISTH), after administration of AA or 4F-PCC. Secondary outcomes analyzed included changes in the initial hemorrhage volume as reported on computed tomography (CT) scan and at 12 to 24 h post treatment, rate of thromboembolic events, rate of inpatient mortality, and total cost of treatment after AA or 4F-PCC administration. Results: A total of 109 patients were included in the study with 47 in the AA group (43.1%) and 62 in the 4F-PCC group (56.9%). There were no statistically significant differences between AA and 4F-PCC in terms of the primary and secondary outcomes with the exception of total cost of treatment. The level of excellent hemostasis achieved after reversal administration of AA was seen in 27 patients (71.1%) and 41 patients (70.7%) after 4F-PCC administration (p = 1, p adjusted = 0.654 after controlling for age, ICH score, regional mass effect, and midline shift). There was no statistically significant difference in the median percentage change in hemorrhagic volume from baseline to 12-24 h after reversal treatment (0 [-0.17-0.24] vs. 0 [-0.021-0.29], p = 0.439, adjusted p = 0.601) in the AA and 4F-PCC groups, respectively. The total incidence of thromboembolic events (4 [8.5%] vs. 6 [9.7%], p = 1, adjusted p = 0.973) and rate of inpatient mortality was similar between the two groups (16 [34.0%] vs. 13 [21.0%], p = 0.134, adjusted p = 0.283). A statistically significant difference was observed with the total cost of reversal treatment: $23,602 for treatment with AA and $6692 for treatment with 4F-PCC. Conclusions: No statistically significant differences were identified in primary or secondary outcomes between the two agents with the exception of total treatment cost. There is insufficient evidence based on this study to recommend AA over 4F-PCC for patients with intracranial hemorrhages associated with the use of apixaban or rivaroxaban. Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Implementation of a geriatric emergency medicine assessment team decreases hospital length of stay

    Keene, Sarah E.Cameron-Comasco, Lauren
    6页
    查看更多>>摘要：Background: Patients over the age of 65 who present to the Emergency Department (ED) are more likely to be admitted to the hospital and, if admitted, often have a longer length of stay (LOS) in the hospital than younger patients. Objectives: To determine if assessment and intervention by a Geriatric Emergency Medicine Assessment (GEMA) team would decrease the admission rate and reduce the hospital LOS for admitted geriatric patients. Methods: We conducted a case-control study of the impact of a GEMA team in a large ED. The team screened patients >= 65 years of age for functional decline to determine the need for targeted interventions. Potential interventions included: occupational therapy consultation in the ED, rehabilitation placement, geriatric clinic referral, and delirium management. Our control population was unassessed geriatric ED patients seen in the six months before and after GEMA team implementation. Results: A total of 815 patients were assessed between June and November 2019. Assessed patients were more likely to be discharged from the ED (54% vs 29%, OR 2.06). Mean ED LOS was nineteen minutes longer in assessed patients (4.94 vs 4.62 h, p<0.01). The mean hospital LOS was 25 h less in assessed patients (4.50 vs 5.54 days, p<0.01). Assessed and unassessed patients who were admitted to the hospital had the same baseline health status as measured by the Charlson Comorbidity Index (median score 2, p = 0.087). The reduction in hospital LOS resulted in an estimated savings of $1.7 million per year using the national average cost for 24 h of inpatient care. Conclusion: Patients who were assessed by the GEMA team were more likely to be discharged directly from the ED, and if admitted, hospital LOS was reduced by over 24 h. This indicates that a targeted intervention in the ED can help reduce hospital LOS in geriatric patients and therefore provide cost savings. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Disparities in cardiovascular outcomes among emergency department patients with mental illness

    Kumar, ShilpaDuber, Herbert C.Kreuter, WilliamSabbatini, Amber K....
    6页
    查看更多>>摘要：Background: Patients with mental illness have been shown to receive lower quality of care and experience worse cardiovascular (CV) outcomes compared to those without mental illness. This present study examined mental health-related disparities in CV outcomes after an Emergency Department (ED) visit for chest pain. Methods: This retrospective cohort included adult Medicaid beneficiaries in Washington state discharged from the ED with a primary diagnosis of unspecified chest pain in 2010-2017. Outcomes for patients with any mental illness (any mental health diagnosis or mental-health specific service use within 1 year of an index ED visit) and serious mental illness (at least two claims (on different dates of service) within 1 year of an index ED visit with a diagnosis of schizophrenia, other psychotic disorder, or major mood disorder) were compared to those of patients without mental illness. Our outcomes of interest were the incidence of major adverse cardiac events (MACE) within 30 days and 6 months of discharge of their ED visit, defined as a composite of death, acute myocardial infarction (AMI), CV rehospitalization, or revascularization. Secondary outcomes included cardiovascular diagnostic testing (diagnostic angiography, stress testing, echocardiography, and coronary computed tomography (CT) angiography) rates within 30 days of ED discharge. Only treat-and-release visits were included for outcomes assessment. Hierarchical logistic random effects regression models assessed the association between mental illness and the outcomes of interest, controlling for age, gender, race, ethnicity, Elixhauser comorbidities, and health care use in the past year, as well as fixed year effects. Results: There were 98,812 treat-and-release ED visits in our dataset. At 30 days, enrollees with any mental illness had no differences in rates of MACE (AOR 0.96; 95% CI, 0.72-1.27) or any of the individual components. At 6 months, enrollees with any mental illness (AOR 1.86; 95% CI, 1.11-3.09) and serious mental illness (AOR 2.60; 95% CI 1.33-5.13) were significantly more likely to be hospitalized for a CV condition compared to those without mental illness. Individuals with any mental illness had higher rates of testing at 30 days (AOR 1.16; 95% CI 1.07-1.27). Conclusion: Patients with mental illness have similar rates of MACE, but higher rates of certain CV outcomes, such as CV hospitalization and diagnostic testing, after an ED visit for chest pain. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier