Emergency Department Management Research Articles

Spontaneous Hemothorax from Pulmonary Intralobar Sequestration: A Case Report.

Pulmonary sequestration is a rarely reported phenomenon where aberrant lung tissue exists independently from the rest of the tracheobronchial network. Complications may include hemothorax; however, there is a paucity of descriptions of this condition in the literature. We describe a case of a pulmonary intralobar sequestration resulting in atraumatic tension hemothorax. A 73-year-old woman presented to our facility in extremis and with complaints of acute-onset flank pain. Her evaluation was notable for a large pulmonary sequestration with a presumed, moderate-sized effusion; however, initial review did not reveal an obvious underlying cause for her symptoms. Shortly after her arrival to the emergency department (ED) she experienced a cardiac arrest. On secondary review of her computed tomographic angiography, it was determined that what was previously thought to be a pleural effusion was a large hemothorax. Following this finding, a finger thoracostomy was performed, which resulted in the immediate evacuation of hemothorax. The thoracostomy was then converted into an ED thoracotomy to assess for active hemorrhage with brief return of spontaneous circulation. Prior to proceeding with emergent operative intervention, the patient's spouse requested that all further resuscitative efforts cease, and the patient was allowed to expire. In a review of the case, it was determined that the patient suffered from cardiac arrest due to a spontaneous hemothorax secondary to a large intralobar pulmonary sequestration. Pulmonary intralobar sequestration can result in spontaneous hemorrhage with fatal results. Early and correct interpretation of imaging and surgical intervention are crucial in ED management.

Evolutionary Game Analysis of Government–Enterprise Collaboration in Coping with Natech Risks

The synergistic interaction between emergency management departments and enterprises constitutes a fundamental mechanism for mitigating the risks of technological accidents caused by natural disasters (Natech). The efficacy of this collaborative approach is impacted by comprehensive risk analyses and the game between government and enterprise. Predicated on these premises, the evolutionary game analysis of government–enterprise collaboration in coping with Natech risk was carried out. Firstly, an evolutionary game model of government–enterprise collaboration in coping with Natech risk was constructed. Secondly, the evolutionary stability strategy (ESS) was developed. Finally, these strategies were substantiated through numerical simulations. The findings revealed that at lower levels of Natech risk, enterprises will choose low investment in coping capacity building, and emergency management departments will choose delayed disposal. Under moderate Natech risk, enterprises will increase their investments if emergency management departments persist with delayed strategies, and emergency management departments will react proactively if enterprises persist with low investment. Under a high Natech risk, a pattern of strategic misalignment emerges between the two entities. This study contributes a theoretical basis for the optimization of government–enterprise collaboration in coping with Natech risks.

Two-stage evolutionary game model on complex networks for emergency logistics based on blockchain platform

Enhancing the efficiency of emergency logistics is essential to reinforce the response capacity to emergencies. It requires collaborative efforts from both the emergency management departments and logistics enterprises. However, the capability for information docking between these organizations substantially influences the efficiency of emergency materials transportation. Blockchain, as an emerging information technology, has the potential to substantially enhance the efficiency and security of information docking through its unique characteristics. Additionally, logistics enterprises share information and resources based on the blockchain platform, aiming to ensure fast, efficient, and reliable collaborative transportation of emergency materials to impacted regions. Therefore, we propose a two-stage evolutionary game analysis of emergency materials collaborative transportation based on this platform. First, we develop a first-stage evolutionary game model to analyze the challenges associated with building a blockchain platform among emergency management departments and logistics enterprises. Subsequently, a second-stage evolutionary game model is devised to bolster the willingness of logistics enterprises based on this platform for collaborative transportation of emergency materials. Third, to validate the theoretical findings of the two-stage game model, two scale-free networks are employed for numerical simulations. As those networks evolve, the edges among nodes and the strategy choices of nodes in those networks likewise change. Numerical simulations are performed based on those networks to scrutinize the sensitivity of factors influencing strategic choice among game stakeholders. Ultimately, certain management insights gleaned from the findings can assist emergency management departments and logistics enterprises in making more informed decisions in the future.

Fracture pain in children in the emergency department: the impact of a new pain management procedure

PurposeTo compare compliance with the French national guidelines before and after the implementation (in 2018) of a new protocol on acute fracture pain management in the pediatric emergency department of a French university medical center.MethodsWe conducted a retrospective, before-after study in patients aged below 16 years presenting at the pediatric emergency department with a fracture. We compared pain management before (in 2017) and after (in 2019 and 2020) implementation of the new procedure. The primary endpoint was appropriate pain management, defined as (i) an appropriate initial assessment of pain, (ii) appropriate treatment with analgesic drugs (acetaminophen for mild pain, acetaminophen and ibuprofen for moderate pain, ibuprofen and morphine for severe pain) and (iii) reassessment of the pain intensity.Results572 patients were included (mean age: 6.5 years; male: 60%). 190 in 2017 and 382 in 2019–2020. Pain management was appropriate for 40% of the patients in 2017 and 52% in 2019–2020 (p = 0.004). Pain was rated for 98% of patients in 2017 vs. 100% in 2019–2020 (p = 0.04). The frequency of appropriate treatment for mild pain and moderate pain increased significantly from 52 to 76% and from 0 to 44%, respectively. The administration of ibuprofen increased by 26% points (from 3 to 20 patients treated) and the administration of morphine increased by 29% points (from 1 to 17 patients treated). Pain reassessment rose significantly from 21 to 43%. Levels of compliance with the guidelines were similar in 2019 and 2020. Analgesia was significantly more effective in 2019–2020 than in 2017 (in 20% vs. 14% of the patients, respectively; p = 0.005).ConclusionAfter the implementation of a new protocol for the management of acute fracture pain, we observed an increase in compliance with the guidelines. Although the use of ibuprofen and morphine rose significantly as did the frequency of pain reassessment, further improvements are required.

Survey on health literacy and related factors among firefighters of emergency management departments in Southwest China

ObjectiveAlthough health literacy (HL) has emerged as a critical public health concern, research on HL in emergency management departments is limited. This study aimed to investigate the awareness of HL and associated factors among firefighters of emergency management departments in southwest China to provide a basis for carrying out targeted health education.MethodsA cross-sectional convenience sample of 1,742 firefighters from an emergency management department in southwestern China was surveyed from February to April 2023 using the Chinese Citizen’s Health Literacy Questionnaire (2019 version). The chi-square test, linear trend chi-square test, Fisher’s test, rank sum test, and multifactorial logistic regression model were used to identify influential factors associated with HL.ResultsThe HL level of the 1742 respondents was 34.3%. Age, ethnicity, education level, length of service, type of job, smoking status, types of parental jobs, annual household income, time of daily internet use, etc. (P < 0.05). The results of multivariate logistic regression analysis indicate that type of job (OR = 0.648, 95%CI:0.426–0.985), length of service (OR = 0.496, 95%CI:0.251–0.981), household income (OR = 1.900, 95%CI:1.443–2.502), daily internet usage time (OR = 0.726, 95%Cl:0.588–0.896), health status (OR = 0.750, 95%Cl:0.585–0.962) and frequency of organizing HL sessions (OR = 1.603, 95%Cl:1.101–2.330) were influencing factors affecting the HL of the officers and soldiers.ConclusionThe health literacy level of firefighters in the Emergency Management Department in Southwest China was 34.3%. Lower levels were found in the health-related skills dimension (HRS, 30.1%) and in infectious disease control (ID, 30.7%). Health information literacy (HI, 34.3%) was lower than the national level. The type of urban and rural areas, literacy level, and household income level may be the factors affecting the level of health literacy among the respondents. Therefore, health education and promotion interventions should target high priority dimensions (HRS, HI, and ID) and should focus on strengthening health literacy levels of firefighters with rural types, low education levels, and low household income to improve their health.

Comparing intravenous lidocaine and pethidine for pain management in emergency department patients with femoral bone fracture: a randomized controlled trial

BackgroundIntravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied.ObjectiveThis study compared intravenous lidocaine to pethidine for femoral bone fracture pain management.MethodsThis double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18–70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS.ResultsSeventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics.ConclusionThe administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids.Trial RegistrationIRCT20231213060355N1 (https://irct.behdasht.gov.ir/trial/74624) (30/12/2023).

Brain Metastasis in the Emergency Department: Epidemiology, Presentation, Investigations, and Management.

Brain metastases (BMs) are the most prevalent type of cerebral tumor, significantly affecting survival. In adults, lung cancer, breast cancer, and melanoma are the primary cancers associated with BMs. Symptoms often result from brain compression, and patients may present to the emergency department (ED) with life-threatening conditions. The goal of treatment of BMs is to maximize survival and quality of life by choosing the least toxic therapy. Surgical resection followed by cavity radiation or definitive stereotactic radiosurgery remains the standard approach, depending on the patient's condition. Conversely, whole brain radiation therapy is becoming more limited to cases with multiple inoperable BMs and is less frequently used for postoperative control. BMs often signal advanced systemic disease, and patients usually present to the ED with poorly controlled symptoms, justifying hospitalization. Over half of patients with BMs in the ED are admitted, making effective ED-based management a challenge. This article reviews the epidemiology, clinical manifestations, and current treatment options of patients with BMs. Additionally, it provides an overview of ED management and highlights the challenges faced in this setting. An improved understanding of the reasons for potentially avoidable hospitalizations in cancer patients with BMs is needed and could help emergency physicians distinguish patients who can be safely discharged from those who require observation or hospitalization.

Dynamic changes and improvement paths of China's emergency logistics response capabilities under public emergencies-research based on the entropy weight TOPSIS method.

Due to global industrialization and urbanization, natural disasters, accidents, and public health emergencies happen frequently. These events cause significant loss of life and property damage to countries worldwide. In the context of frequent public emergencies, enhancing emergency logistics response capabilities is crucial, ensuring rapid supply of rescue materials and support for rescue personnel, thereby saving lives and reducing economic losses. In order to identify the changes and enhancement paths of the emergency logistics response capability of Chinese regions under the shocks of public emergencies, this paper innovatively constructs emergency logistics response capability measurement indicators. This paper uses the entropy weight TOPSIS method and panel quantile regression model to quantify the change and enhancement paths of China's regional emergency logistics response capability under different events. It is found that: (1) The gap in emergency logistics response capability among Chinese regions is widening, with the internal difference in the eastern region higher than that in the west, while the difference in the central region is relatively low. (2) China's emergency management department can effectively transform social logistics into emergency logistics, thereby promoting the improvement of emergency logistics response capabilities. (3) Sudden geological disasters break through the limits of social logistics resources when they cross lower scales, resulting in the failure of emergency logistics response capabilities. This paper expands research on assessing emergency logistics capabilities, addressing issues in existing assessments such as reliance on single indicators and subjective measurement methods. Additionally, it quantifies the dynamic changes in China's regional emergency logistics response capabilities under public emergencies by extending the study of event content, types, and impacts. This enhances discussions on the effects of public emergencies. Finally, from an empirical perspective, the paper explores pathways to enhance regional emergency logistics response capabilities in China. In practice, this paper assists countries worldwide in assessing whether different regions of China can effectively provide emergency support for various resources in direct investments, thus providing a scientific basis for investment decisions.

Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country.

This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.

Pediatric sport and nonsport concussions presenting to emergency departments: injury circumstances, characteristics, and clinical management.

The aim of this study was to compare injury circumstances, characteristics, and clinical management of emergency department (ED) presentations for sports-related concussion (SRC) and non-SRC. This multicenter prospective observational study identified patients 5-17 years old who presented to EDs within 24 hours of head injury, with one or more signs or symptoms of concussion. Participants had a Glasgow Coma Scale score of 13-15 and no abnormalities on CT (if performed). Data were stratified by age: young children (5-8 years), older children (9-12 years), and adolescents (13-17 years). Of 4709 patients meeting the concussion criteria, non-SRC accounted for 56.3% of overall concussions, including 80.9% of younger child, 51.1% of older child, and 37.0% of adolescent concussions. The most common mechanism of non-SRC was falls for all ages. The most common activity accounting for SRC was bike riding for younger children, and rugby for older children and adolescents. Concussions occurring in sports areas, home, and educational settings accounted for 26.2%, 21.8%, and 19.0% of overall concussions. Concussions occurring in a sports area increased with age, while occurrences in home and educational settings decreased with age. The presence of amnesia significantly differed for SRC and non-SRC for all age groups, while vomiting and disorientation differed for older children and adolescents. Adolescents with non-SRC were admitted to a ward and underwent CT at higher proportions than those with SRC. Non-SRC more commonly presented to EDs overall, with SRC more common with increasing age. These data provide important information to inform public health policies, guidelines, and prevention efforts.

Emergency Material Prediction in South China Based on Case Analysis Method

After the occurrence of flood disasters, timely and rapid emergency response is one of the important tasks to improve the efficiency of emergency rescue and reduce disaster losses, and the prediction of material demand, which is the premise and basis of emergency response in disaster areas after disasters, is one of the key problems that need to be solved urgently. Considering the characteristics of poor information in the post-disaster disaster area, a post-disaster material demand forecasting technology based on fuzzy case reasoning was introduced. Firstly, on the basis of the analysis and summary of the existing case database, the key feature attributes of flood disasters that affect the demand for materials after the disaster are extracted, and the fuzzy set of flood disaster characteristics is established by introducing the concept of fuzzy sets, and then the membership degree of the specific feature attribute values of the new and old cases to the fuzzy set is calculated, in order to measure the similarity between the new and old cases, and the corrected measure closeness based on the weight of the feature attributes of the new and old cases is calculated, and the one with the largest closeness represents the best match between the new and old cases. Finally, an actual case is used to show the specific application process of the technology, and the existing reference cases that are closest to the new case are obtained, which can provide reference for post-disaster emergency rescue. The results show that the proposed method can provide a scientific prediction of the demand for emergency supplies and provide a basis for decision-making for the relevant emergency management departments in an actual flood disaster case in South China.

Vulnerability Assessment and Spatial Pattern Analysis of Earthquake Disaster in Hebei Province

To evaluate the vulnerability of earthquake disaster in Hebei Province and analyze the spatial pattern, the aim is to provide theoretical basis for emergency management departments to prevent and respond to disasters. This study uses the subjective and objective evaluation mechanism, through the integration of analytic hierarchy process and entropy weight method to determine the weight distribution of each index. The assessment model is used to assess the vulnerability of earthquake disasters, and the spatial pattern characteristics are studied by global spatial autocorrelation analysis and LISA clustering analysis.The main conclusions are as follows: (1) The area with the greatest vulnerability to earthquake disaster is Shijiazhuang High-tech Zone (0.761); The lowest value is 0.243 in Qian 'an City, Tangshan City, and there are great differences among some regions. (2) The vulnerability of all counties (cities and districts) in Hebei Province has a positive correlation and aggregation with their spatial locations, and the spatial distribution is low in the whole province, high in the local area, high in the southeast and low in the northwest. (3) It is found that measures such as training health workers and expanding professional emergency management team can reduce the overall level of earthquake disaster vulnerability in Hebei Province.

Approach to chest trauma management in emergency department: Systematic review

Approach to chest trauma management in emergency department: Systematic review

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department.

The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a "take home message" is stated.

Emergency department mental health presentations in young children: a retrospective chart review

AimTo characterise key features of young people presenting to the emergency department (ED) with a mental health complaint when comparing children (aged 7 to 12 years) and teenagers (13 years and greater).MethodsRetrospective review of all ED mental health presentations in children aged 7–17 years presenting over a 12‐month period in 2018 to a tertiary children's hospital in Victoria, Australia. Univariate analyses were carried out to examine the relationship between children and teenagers and a number of key presentation variables. Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated for ED management outcomes.ResultsThere were 1691 ED mental health presentations in 2018. Of these presentations, 407 (24%) were children aged 12 years or less. The remaining 76% (1284) were teenagers. The younger aged cohort were more likely to be male (OR 2.43, CI 1.92–3.08) and have a past history of autism spectrum disorder (OR 1.92, CI 1.45–1.84). They were more likely to have a presenting complaint of acute behavioural disturbance (OR 2.03, CI 1.59–2.60), be physically restrained (OR 2.01, CI 1.18–3.37) and have sedative medication provided (OR 2.87, CI 1.63–5.04). The older aged cohort were more likely to have a past history of depression (OR 0.19, CI 0.12–0.29) and a presenting complaint of intentional self‐poisoning (OR 0.33, CI 0.15–0.65).ConclusionsChildren aged 12 years or less represent one‐quarter of all young people presenting to the ED with a mental health concern. They experience high rates of acute behavioural disturbance and are more likely to require restrictive interventions during their presentation.

Multimarkers approach in chest pain management in Emergency department: a focus on the prognostic role of sST2 and suPAR

Chest pain is one of the most prevalent causes of Emergency Department (ED) admission and could be a presenting symptom of Acute Coronary Syndrome (ACS). The aim of this review was to provide an overview of the research about troponin and its limitations and new biomarkers used in patients with cardiovascular diseases, with a special focus on soluble Suppression of Tumorigenicity 2 (sST2) and Soluble Urokinase Plasminogen Activator Receptor (suPAR). In January 2024, a PubMed and Reviews in Cardiovascular Medicine (RCM) search was carried out to identify all relevant papers in the past five years. 80 articles were included in the final review. ssT2 and suPAR are involved in both acute and chronic cardiovascular disease and can predict the risk of adverse events. sST2 and suPAR are promising biomarkers that, in combination with troponin, could help in the management of patients with chest pain in the ED. Further studies are needed to validate their role in management of ACS in this specific setting.

Knowledge Management Model for Urban Flood Emergency Response Based on Multimodal Knowledge Graphs

Recently, frequent flood disasters in China have seriously threatened economic development and public safety. This paper addresses the need for a dynamic urban flood emergency knowledge management system in emergency management departments and the lack of systematic knowledge among emergency managers regarding urban flood control. A multimodal knowledge graph-based urban flood emergency knowledge management model was constructed to enhance the decision-making capabilities of emergency management departments, improve the efficiency of public emergency evacuation, and reduce losses from urban flood disasters by analyzing the shortcomings of the existing emergency management system. An intelligent and dynamic flood emergency knowledge management model was built. This paper integrates multimodal knowledge graph technology to establish a multimodal emergency knowledge management framework for urban flood control. It develops and simulates the proposed model’s application scenarios for urban flood emergency evacuation using the Flocking algorithm on the NetLogo platform. Through simulation experiments, the practicality and effectiveness of the model in real flood disaster situations were examined, particularly in simulating crowd evacuation behavior. The study found that the model significantly improves the accuracy of information and decision-making speed during emergency responses and supports emergency management departments in conducting targeted and personalized emergency decisions. This research provides a scientific basis for emergency management departments to optimize their emergency response strategies to flood disasters and serves as a reference and example for the application of multimodal knowledge graph technology in emergency management.

Systematic Review of Emergency Department Management of Vaso-occlusive Crisis

Systematic Review of Emergency Department Management of Vaso-occlusive Crisis

Study on the integration of emergency IPAs in Nord-Pas-de-Calais: supervisors' perspectives

In the context of the introduction of advanced practice nurses in emergency departments (APNs), the Collège de Médecine d'Urgence du Nord-Pas-de-Calais teamed up with the Unité de Formation et de Recherche des Sciences de la Santé et du Sport at the University of Lille to conduct a survey of emergency department management teams, with the aim of gaining a better understanding of their needs. The results revealed a number of obstacles and levers to the implementation of APNs, and led to a better understanding of the patient pathways in these departments. As a result, the content of the university teaching program could be reviewed with a view to meeting the needs expressed in the field.

Evaluation of the quality of emergency department management for patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is associated with exacerbations and high risk of serious outcomes. Our goal was to determine the appropriateness of the emergency department (ED) management of COPD exacerbations. This observational cohort study incorporated a health records review and included COPD exacerbation cases seen at two large academic EDs. We included all patients with the primary diagnosis of COPD exacerbation. From the electronic medical record, demographic and clinical data were abstracted, and the Ottawa COPD Risk Score (OCRS) was calculated for each. Short-term serious outcomes included intensive care unit admission, intubation, myocardial infarction, noninvasive positive pressure ventilation (NIV), and death at 30 days. Cases were judged for appropriateness of treatment according to explicit indications and standards developed a priori. We enrolled 500 cases with mean age of 71.9 years, 51.2% female patients, 50.2% admitted, and 4.4% death. The calculated OCRS score was >2 for 70.8% of patients. The treatments provided were inhaled β-agonists (82.6%), inhaled anticholinergics (76.6%), corticosteroids (75.2%), antibiotics (71.0%), oxygen (63.8%), NIV (8.8%), and intubation (0.6%). Overall, 50.0% of cases were judged to have had inadequate management due to missing treatments. Specifically, the proportion of missing treatments were inhaled β-agonist (17.0%), inhaled anticholinergic (22.6%), corticosteroids (24.4%), antibiotics (12.8%), and NIV (2.0%). Adequate treatment of COPD exacerbation was lacking in 50.0% of patients in these two large academic EDs. Concerning were the number of patients not receiving corticosteroids or antibiotics. Implementation of explicit treatment standards should lead to improved patient care of this common and serious condition.