Introduction: Acute abdomen is a common emergency presentation with variable causes and outcomes. The clinical profile, aetiologies, and outcome predictors vary from region to region. Understanding regional patterns of disease enables protocolised care and improves efficiency and decision-making in Emergency Departments (ED). Aim: To study the clinical profile and predictors of outcomes in acute abdomen in the emergency department. Materials and Methods: This prospective cohort study was conducted over three months (June 2024- August 2024) in a tertiary-care ED in Northern India. Consecutive adults (>18 years) with acute abdominal pain were enrolled. Demographic, clinical, laboratory, and imaging data were collected in a structured proforma. Outcomes were classified as favourable (ED discharge or hospital stay ≤7 days) or unfavourable (surgical intervention, hospital stay >7 days, High Dependency Units (HDU) /Intensive Care Units (ICU) admission, or death). Data were analysed using appropriate parametric and non parametric tests, and multivariable logistic regression was used to identify independent predictors of various outcomes (p-value <0.05). Results: Of 499 screened patients, 198 were analysed (mean age 43.3±17.2 years; 54% male). Co-morbidities were present in 26.3%, most commonly hypertension (9.6%) and diabetes (8.1%); 33.8% reported substance use. The most frequent provisional ED diagnosis was non specific “acute abdomen” (39.9%). Common definitive diagnoses were ureteric colic (13.2%), pancreatitis (8.8%), and acid peptic disorders (10%). Favourable outcomes occurred in 44.4%. Unfavourable outcomes included prolonged hospital stay (19.7%), HDU admission (17.7%), ICU admission (6.1%), surgical intervention (9.1%), and in-hospital mortality (1%). Hypoalbuminaemia was independently associated with reduced odds of ED discharge (OR 0.03, 95% CI 0.00-0.45; p-value=0.012), prolonged stay (OR 0.34, 95% CI 0.17-0.67; p-value=0.002), and HDU/ ICU admission (OR 0.33, 95% CI 0.16-0.67; p-value=0.002). Abnormal abdominal examination predicted prolonged stay (OR 1.07, 95% CI 1.01-1.13; p-value=0.021) and HDU/ICU admission (OR 1.07, 95% CI 1.01-1.14; p-value=0.033). Fluid resuscitation predicted HDU/ICU admission (OR 3.71, 95% CI 1.15-11.94; p-value=0.028). Conclusion: Hypoalbuminaemia independently predicted unfavourable outcomes in adults presenting with acute abdominal pain and may represent a simple, low-cost marker for early risk stratification in the ED.

Evaluating the Performance of Large Language Models for Generating Emergency Department Discharge Instructions.

Automated auditing of emergency department documentation using large language models.

Hemoptysis is a potentially life-threatening symptom that often prompts emergency department (ED) evaluation and hospitalization. Reliable prognostic tools to guide clinical decision-making and optimize resource use are currently lacking. To prospectively validate the Florence Hemoptysis Assessment Score (FLHASc) in patients presenting with hemoptysis to the ED, and to eventually derive and validate an improved version of the score (FLHASc2). We analyzed data from the POPEIHE study (NCT06067997), a multicenter prospective cohort of 546 consecutive adult patients presenting with hemoptysis to 9 Italian EDs. The primary outcome was a composite of in-hospital death, need for ventilatory support, intensive care unit (ICU) admission, blood transfusion, or invasive hemostatic procedures. We evaluated the prognostic performance of the original FLHASc, then derived a new model (FLHASc2) using multivariate logistic regression in a randomly selected derivation cohort (n=321) and validated it in the remaining cohort (n=225). A simplified version of the score was also tested. The original FLHASc demonstrated moderate discriminatory ability (AUC 0.71; 95% CI: 0.65-0.76) and suboptimal calibration. The FLHASc2 showed improved performance (AUC 0.79, 95% CI: 0.73-0.87 in derivation and 0.81, 95% CI: 0.73-0.88, in validation cohorts; Brier score<0.10 in both). The simplified FLHASc2 (sFLHASc2), assigning one point per variable, maintained comparable accuracy (AUC 0.80, 95% CI: 0.72-0.87) and identified 47.8% of patients as low risk (2.7% event rate). When combined with a negative chest X-ray, the observed event rate in this subgroup dropped to 0.87%, with a negative predictive value of 99.1% (CI 95%, 96.5-100%). The FLHASc2 and its simplified version are accurate prognostic tools for identifying hemoptysis patients at low risk of short-term adverse outcomes. Use of the sFLHASc2 combined with chest X-ray may allow safe ED discharge in nearly half of cases. A prospective management trial is warranted to confirm its clinical impact. NCT06067997.

An Emergency Department Nudge-Based Strategy to Screen and Treat Patients With Alcohol Misuse.

We characterized emergency department (ED) gout visits and identified patient characteristics and health services patterns contributing to ED presentations. We conducted a population-based study of ED gout visits in Ontario, Canada between 2014 and 2023. We assessed patient characteristics, encounter rate trends (cumulatively and stratified by age and sex), and healthcare use surrounding ED visits. Among individuals aged ≥66 years, gout-related medication use was examined. From 2014 to 2023, 125,505 ED gout visits occurred, including 86,824 (69.2%) incident ED cases. Mean age was 59.7 years, with 77.5% male. Individuals with ED gout visits were more likely to live in materially marginalized and less racially diverse neighborhoods. Comorbidity burden was high, driven by hypertension (57.7%) and diabetes (24.0%). ED gout encounters peaked in 2018, with an annual crude rate of 0.99 visits per 1,000 persons (95% CI: 0.97-1.01) and a male-specific rate of 1.56 (95% CI: 1.53-1.59). Older adults (aged 75-84) had the highest rates at 3.01 (95% CI: 2.89-3.15) visits per 1000-persons in 2015 across study years. Within 30-days of ED discharge, 21.3% had gout-specific follow-up visits, 28.3% of patients aged ≥66 years received flare medications, and 10.3% filled an opioid prescription. By 6-months, 38.1% underwent outpatient serum urate testing. Within 90-days, repeat ED visits occurred in 29.9%, with 9.4% specifically for gout. Gout contributes to a high burden of ED visits, with sub-optimal treatment, poor follow-up and frequent representations. Quality improvement efforts are needed to prevent acute care presentations for gout and improve post-ED management.

Safety net primary care for emergency physicians: Diagnosis and treatment of asymptomatic hypertension.

Children with acute gastroenteritis-associated vomiting discharged from emergency departments (EDs) have improved outcomes when provided with ondansetron for home use. However, only one-third of children who present with significant vomiting experience ongoing vomiting after discharge. To identify characteristics associated with 3 or more vomiting episodes among pediatric patients within 24 hours of ED discharge. This nonprespecified secondary analysis of a randomized clinical trial of children aged 6 months to less than 18 years presenting to EDs between September 14, 2019, and June 27, 2024, with acute gastroenteritis-associated vomiting and who were followed up for 7 days. A prognostic score was derived using generalized linear mixed models across 10 imputed datasets. Data analysis was performed between May 9, 2025, and February 13, 2026. The primary outcome was 3 or more episodes of vomiting within 24 hours of ED discharge. Secondary outcomes included unscheduled health care revisits, intravenous fluid administration, and hospitalization within 7 days after the ED visit. Of 1030 children enrolled, 977 had follow-up data available and were included in this analysis (median age, 47.0 months [IQR, 22.1-80.1 months]; 493 [50.5%] girls; 925 [89.8%] with complete follow-up data). Eighty of 927 children (8.6%) had 3 or more episodes of vomiting in the 24 hours after ED discharge. In unadjusted analysis, only age 6 months to less than 2 years was associated with ongoing vomiting after discharge (odds ratio [OR], 2.17; 95% CI, 1.37-3.43). In multivariable regression analysis, variables associated with postdischarge vomiting included age 6 months to less than 2 years, symptom duration of 24 to 48 hours, or 10 or more vomiting episodes in the 24 hours preceding the ED visit. In a predictive model, a score of 4 points or more was associated with a 13.6% (95% CI, 9.9%-18.1%) probability of 3 or more vomiting episodes within 24 hours of ED discharge, with a sensitivity of 0.50 (95% CI, 0.39-0.61) and specificity of 0.70 (95% CI, 0.67-0.73). Children with 3 or more vomiting episodes within 24 hours of discharge, compared with those without, were more likely to have an unscheduled health care visit (33 of 80 [41.3%] vs 65 of 846 [7.7%]; difference, 33.6%; 95% CI, 22.6%-44.5%), receive intravenous fluids (9 of 80 [11.3%] vs 15 of 846 [1.8%]; difference, 9.5%; 95% CI, 2.5%-16.5%), and be hospitalized (5 of 80 [6.2%] vs 9 of 846 [1.1%]; difference, 5.2%; 95% CI, -0.2% to 10.5%) within 7 days of discharge. In this analysis of children presenting for ED care with vomiting, younger children and those unwell for 24 to 48 hours with 10 or more episodes of vomiting at presentation were more likely to have persistent vomiting after discharge. Based on these findings, these children are most likely to benefit from being provided ondansetron for home administration. ClinicalTrials.gov Identifier: NCT03851835.

Physician awareness of a patient's social and functional barriers to effective and safe care after discharge from the emergency department (ED) is crucial. Yet, limited data exist evaluating the ability of resident physicians to identify these barriers. We performed a prospective cohort study of patients age ≥ 18 at a single urban ED with an emergency medicine (EM) residency program from 10/2024 to 5/2025. A research team member assessed barriers with each patient, including transportation access, difficulty affording medications, need for assistance with activities of daily living (ADL), and lack of a primary care provider. We measured health literacy and cognitive function with the Rapid Estimate of Adult Literacy in Medicine-Revised and Mini-Cog, respectively. Patient report or measurement of barriers (criterion standard) was matched to written survey data completed by the EM resident caring for the patient. We calculated sensitivity of resident identification of barriers and measured agreement using Cohen's kappa. The sample included 234 patients with complete barrier data cared for by 40 EM residents. Patients consistently reported barriers at higher rates than physicians. Physicians had poor sensitivity for accurate identification of patient barriers. For example, 20.4% of patients reported they had no primary care physician (PCP) and 9.8% of residents reported their patient had no PCP [sensitivity 26.1% (95% CI 14.3-41.1), κ = 0.25]. Limited health literacy was identified in 59.0% of patients and reported by 37.6% of residents [sensitivity 44.7% (95% CI 35.7-53.9), 57.7% agreement]. Abnormal cognition was present in 53.6% of adults age ≥ 65 and reported by 16.7% of residents [sensitivity 27.3% (95% CI 13.3-45.5), 58.6% agreement]. Patients report barriers to effective care transitions after ED discharge at higher rates than resident physicians identify these barriers. Poor agreement between patient-reported and physician-identified challenges suggests a need for enhanced training, systematic screening, and interdisciplinary collaboration.

Risk Factors for Pediatric Deep Neck Infection Revisit After Emergency Department Discharge for Pharyngitis or Localized Neck Symptoms.

Firearm injury in the United States disproportionately affects marginalized and disadvantaged communities and results in high rates of functional limitations, mobility impairments, and chronic pain. Despite the high rates of firearm injury and impact on function, few studies have examined access to rehabilitation care after firearm injury. This study analyzed the use of physical therapy after firearm injuries compared to other traumatic injuries. A retrospective cohort study was performed using medical claims data from a statewide All Payer Claims Database linked with an institutional trauma registry (2013-2022). The setting was a Level I trauma center. Patients were identified from our institution's trauma registry to obtain initial injury information, and trauma registry data were linked to the Washington State All Payer Claims Database to identify physical therapy service use. The exposure was mechanism of injury (firearm vs other trauma). The main outcome was the use of physical therapy services in any setting in the year after hospital or emergency department discharge, and the secondary outcome was the total number of physical therapist visits. Covariates included sociodemographic factors (race, ethnicity, insurance, age, and gender) and clinical characteristics indicating the need for physical therapy (injury region, injury severity, and hospital length of stay). Multivariable Poisson regression with robust SEs was used to evaluate the effect of firearm mechanism on outcomes. Among 25,404 patients, the overall rate of physical therapist service use was 37.2%. Firearm injury survivors were less likely to use physical therapy services than survivors of other trauma (21.3% vs 38.4%; adjusted relative risk = 0.79; 95% CI = 0.71-0.88). Firearm injury survivors had fewer total physical therapy visits (8.0 [SD = 11.4] vs 11.9 [SD = 13.8]; adjusted relative risk = 0.79; 95% CI = 0.76-0.82). Despite a high incidence of serious and disabling physical conditions after firearm injury, there was less use of physical therapy services after firearm injury than after other mechanisms of injury in this single-institution sample. Insufficient use of physical therapy services after firearm injury may affect recovery and long-term outcomes among firearm injury survivors, and interventions are needed to support improved access to rehabilitation in this population.

This study aimed to evaluate whether a single dose of intravenous dexamethasone, when added to standard abortive therapy, reduces relapse of migraine after emergency department (ED) discharge in children and adolescents. Migraine is a leading cause of headache presentations to the ED for children and adolescents. Although corticosteroids have been suggested to reduce relapse in adults with acute migraine, their efficacy in children remains unknown. We conducted a randomized, double blind, placebo-controlled trial at the tertiary pediatric ED of the CHU Sainte-Justine in Montréal, Canada. Patients 8-17 years old with acute migraine attack requiring intravenous rescue therapy (metoclopramide with diphenhydramine) were randomized to receive dexamethasone (0.6 mg/kg iv, max 15 mg) or placebo before discharge. All participants were discharged on oral naproxen for 48 h. The primary outcome was relapse within 48 h, defined as recurrence or worsening of headache after initial improvement. Secondary outcomes included pain scores, return to school and activities, health care revisits, and adverse events. Analyses were performed using a modified intention-to-treat approach including all children who provided data for the primary outcome. Between July 2013 and February 2025, 116 patients were enrolled, and 87 patients (75%) provided outcome data at 48 h. Median age was 14 years, and 85 patients (73%) were female. Relapse occurred in 39% (16 of 41) of the dexamethasone group versus 44% (20 of 46) of the placebo group (risk difference: -4%; 95% confidence interval, -32% to 24%). Pain scores, return to school, functional recovery, and health care consultations did not differ significantly between groups. Adverse events were infrequent and mild in both arms. In this small clinical trial of children and adolescents with acute migraine attack treated in the ED, adjunctive dexamethasone did not reduce relapse rates nor improve functional outcomes compared with placebo. Although limited by low statistical power, these findings raise questions about the routine use of dexamethasone in migraine management of children and adolescents.

The time following emergency department (ED) discharge is a high-risk period for suicidal behavior. This study examined correlates of suicidal behavior patterns over one-year follow-up among adults presenting to the ED with active suicidal thoughts and behaviors. Participants were n = 863 adults presenting to the ED with active suicidal thoughts and behaviors followed for one year post-discharge. Participants were categorized into four suicidal behavior groups: none (no suicidal behavior at baseline or follow-up), worsening (no suicidal behavior at baseline but at follow-up), improving (suicidal behavior at baseline but not follow-up), or persistent (suicidal behavior at both timepoints). We used binary logistic regression models to compare persistent versus improving and worsening versus none groups to examine factors that distinguished groups with the same baseline but different follow-up suicidal behavior. The most common suicidal behavior patterns were none (52.7%, n = 455) or improving (24.7%, n = 213). Risky alcohol use and previous psychiatric inpatient hospitalization distinguished participants in the worsening group from the none group. None of the factors distinguished the improving from the persistent group. Individuals with active suicidal ideation, alcohol use, and past psychiatric inpatient hospitalization may require additional support following ED discharge to prevent future suicide attempts.

Patients with limited English proficiency (LEP) face disproportionate risks at emergency department (ED) discharge. Professional interpretation improves outcomes, but real-time written translations remain difficult to provide in many EDs. Modern transformer-based large language models (LLMs) may offer improved translation quality compared with older systems, yet their performance on ad hoc provider-written ED discharge instructions is not well established. We conducted a blinded cross-sectional non-inferiority study of English-language ED discharge instructions translated into Spanish, Brazilian Portuguese, and Simplified Chinese comparing Google Translate and ChatGPT-4o versus professional medical interpreters. Fifty-three randomly selected provider-written instructions (100-500 words, preserving spelling/grammar errors) were translated, yielding 477 unique translations. Professional medical interpreters, blinded to translation method, independently scored each translation on fluency, adequacy, meaning, and severity on a five-point Likert scale. Inter-rater reliability between the professional interpreter evaluations was calculated. A 0.5-point non-inferiority margin was pre-specified, and adjusted mean Likert rating differences generated by mixed effects models for each accuracy dimension were compared between translation methods for each language. The proportion of clinically significant translation errors was compared between methods, as was the ability of evaluators to guess the translation method. Inter-rater reliability was high across languages. Both machine translation methods were non-inferior to professional interpreters for adequacy, meaning, and severity in Spanish and Portuguese, and for all four domains in Chinese. For fluency, Google Translate and ChatGPT-4o were inferior in Spanish and Portuguese but non-inferior in Chinese. The frequency of clinically significant errors did not differ significantly by translation method. Evaluators, blinded to method, frequently misidentified machine translations as professional. In this multi-language evaluation of real-world ED discharge instructions, Google Translate and ChatGPT-4o were non-inferior to professional interpreters for most domains of translation accuracy.

Older adults represent a growing proportion of emergency department (ED) visits, with an increased risk of adverse outcomes following discharge, particularly when frailty is present. Access to post-ED geriatric follow-up is often delayed, leaving patients without timely support and increasing their risk of ED revisits and subsequent hospital admissions. This study evaluates a novel Geriatric Rapid Access Clinic (Geri-RAC) designed to provide expedited, specialized follow-up for high-risk older adults discharged from the ED. A retrospective chart review was conducted of all patients who attended the Geri-RAC at a large academic hospital in Toronto from January 2023 to July 2024. Older adults identified as high-risk in the ED were referred to the clinic. Patient outcomes included ED revisit rates and anticipated hospital admission avoidance; data on clinic performance indicators, patient characteristics, and accessed supports were also measured. Thirty-three patients attended the Geri-RAC during the 19-month pilot. Mean age was 82.6 years, with 81.8% having a Clinical Frailty Scale score ≥ 4. Functional limitations were present in 69.7% of patients. Median wait time from ED referral to appointment was 7 days. Cognitive testing was conducted in 78.7% of attendees and medication de-prescribing was initiated in 48.5%. Most patients (87.9%) were newly connected to support services, averaging 2.6 ± 2.1 service linkages per patient. 45.5% of patients received new specialist referrals. The 7-, 30-, and 90-day ED revisit rates were 0%, 12.1%, and 24.2%, respectively. Admission avoidance was anticipated in 42.4% of cases. The Geri-RAC provided timely access to post-ED follow-up and multidisciplinary care for frail older adults. Early findings highlight the potential for this model to enhance ED discharge planning, facilitate structured care transitions, and decrease reliance on emergency services in this high-risk population.

Diagnosis-specific patterns for direct ED discharge after physician-staffed HEMS transport in Japan: A nationwide registry study.

Cumulative Incidence of Stroke Disability and Mortality Following Emergency Department Discharge for Dizziness: A Cohort Study.

Medications for alcohol use disorder, or "anti-craving medications", are effective yet underutilized treatments for alcohol use disorder. This study examined whether a pre-printed prescription embedded in a printable order set could "nudge" clinicians to increase prescribing for medications for alcohol use disorder. We conducted a prescription database review comparing prescribing rates at baseline to those at monthly intervals up to 12months following implementation of a new provincial pre-printed order set for alcohol withdrawal syndrome in Saskatchewan. Patients were included if they had an alcohol-related emergency department (ED) visit, were discharged home, had a prescription for a medication for alcohol use disorder filled within 3days of ED discharge, and did not have a previous prescription for a medication for alcohol use disorder filled within a washout window prior to the ED visit. The review captured all provincial prescriptions of naltrexone and acamprosate-the two medications available on the pre-printed prescription-for patients who fit the inclusion criteria. A total of 5740 pre-implementation and 6021 post-implementation patients met inclusion criteria. Baseline demographics and comorbidities were similar across groups. The rate of ED visits with a filled prescription increased from 1.8% pre-implementation to 3.4% post-implementation. Naltrexone prescribing rose from 1.6 to 2.7%, and acamprosate from 0.2 to 0.7%. Interrupted time-series and logistic regression analyses confirmed a statistically significant increase in prescribing post-implementation (adjusted OR 1.9; 95% CI 1.5-2.5). Introducing an order set incorporating pre-printed prescriptions for medications for alcohol use disorder effectively increased prescribing rates for physicians treating patients with alcohol-related ED visits, validating use of a "nudge" to effect behavioural change. While promising, sustaining these gains may require reinforcement. In resource-constrained EDs, nudges offer a feasible strategy to improve alignment with evidence-based treatment for alcohol use disorder.

Teaching hospitals are vital for training future physicians, yet there is concern that the presence of learners may increase unscheduled emergency department (ED) return visits. Previous studies of this phenomenon are limited to a sample of EDs in a region. Our study aimed to address this gap using a comprehensive regional dataset and multiple academic years of routinely collected electronic medical record data. Our objective was to determine whether ED patients seen by supervised learners had higher rates of unscheduled return visits within 72hours compared to those seen by attending physicians alone. Secondary outcomes were return visits resulting in hospital admission and the impact of learner training level. We conducted a cohort study of over 1 million ED discharges across nine linked hospitals in a large Canadian health region between July 1, 2015, and June 30, 2018. The primary outcome was the rate of unscheduled return visits within 72hours. Secondary outcomes included return visits with hospital admission and critical care admission. Logistic regression models were adjusted for patient demographics, acuity, and site characteristics. Among 1,033,026 patient visits, 7.4% returned within 72hours. There was no statistically significant difference in unscheduled return visits between supervised learners and attending physicians alone (adjusted RR 0.98, 95% CI 0.96-1.00, p = 0.054). Return visit admissions were slightly higher among patients seen by learners (adjusted RR 1.06, 95% CI 1.01-1.13), primarily those seen by medical students and off-service residents. Emergency medicine residents in mid-training had lower return visit rates than attendings. Patients seen by supervised learners in a regional ED network did not have increased rates of unscheduled return visits. Further research is warranted to explore factors underlying return visit admissions in learner-involved care.

Background/Objectives: Traumatic brain injury (TBI) affects more than 50 million people annually worldwide. Challenges in managing moderate-to-severe TBI include high rates of hospital-acquired infections and substantial variability in discharge disposition, and these combined challenges contribute significantly to the cost and trajectory of health recovery. Although current strategies such as antibiotic-impregnated external ventricular drains (EVDs) offer some benefit in controlling infections, they remain limited by high cost and inconsistent implementation. A clearer understanding of clinical and demographic factors associated with infection risk and discharge disposition are essential for improving care pathways. This study aims to identify and quantify key determinants of infection and discharge outcomes in patients with TBI. Methods: The National Trauma Database (NTDB) was queried using structured query language (SQL) based on predefined inclusion criteria (adult patients with ICD-coded TBI), input variables (basic demographics, injury location and severity, and vital signs), and specified outcome variables (emergency department discharge disposition, infection, and sepsis) to identify and filter the eligible patient cohort. A set of machine learning models were trained for each outcome (e.g., Emergency Department (ED) discharge, types of infections, and sepsis). Results: Data from 310,494 patients were extracted. The prediction model we developed, the Predictive TBI-Disposition Model (PTDM), was able to predict the outcome of a patient’s discharge with 96% accuracy. The accuracy of the models for infection and sepsis was 93% and 94%, respectively. Conclusions: Demographic and clinical factors significantly influence the discharge disposition and infection risk among TBI patients. Machine learning models demonstrated strong predictive performance, suggesting their utility in early risk stratification and targeted clinical decision-making.