Emergency Department Management Research Articles

Comparison of body mass index level by triage level in the emergency department

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED. MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study. RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6–11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98; 28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma. CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management.

Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine

Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine

Utilisation and Management of an Emergency Department in a Tertiary Hospital in the Philippines During the COVID-19 Pandemic

The Emergency Department (ED) plays the role of providing efficient and quality healthcare services to patients. During the COVID-19 pandemic, there were observed changes in the ED’s utilisation and management reflecting the underlying challenges faced by most tertiary hospitals in the Philippines. This study aims to describe the changes in the utilisation and management of ED in a major COVID-19 hospital in the Philippines, its implications for inpatient admissions, and effect on ED staff. Patient data from 2019 (pre-pandemic) and 2020 (pandemic) were compared. In addition, this study administered a COVID-19-specific psychometric tool to assess the pandemic’s effect on ED staff. Comparing the pre-pandemic and pandemic census, this study found a 59.0% and 67.6% decrease in ED consultations and hospital admissions, respectively. ED consultations significantly shifted to older patients, with longer length of stay, increased out-of-pocket payment, and mostly presenting with respiratory-related chief complaints. There is a decrease in general hospital unit utilisation, and the addition of a COVID-19 ward and an ICU. Despite the changes, 63.6% of the ED staff exhibited good emotional adjustment to the stress brought by the pandemic. This study reported the situation of Philippine ED amid the pandemic and indicated the important management changes in ED.

The study of nurses’ knowledge and attitudes regarding pain management and control in emergency departments

BackgroundGiven the importance and pivotal role of nurses in pain management and control, this study was conducted to determine the nurses’ knowledge and attitudes toward in emergency departments.MethodsThis study was designed and conducted as a descriptive-analytical cross-sectional study. Nurses’ attitude and knowledge towards pain management and control and relationship between their demographic characteristics have been assessed. Nurse Attitude Survey (NAS) and Pain management and control principles assessment Test (PMPAT) questionnaires were used.ResultsTotally 400 volunteers, including 148 (37.2%) male and 250 (62.8%) female nurses recruited from 23 hospitals in East Azerbaijan, Iran, with a mean age of 30.88 years (± 6.04 SD) and age range between 22 and 53 years old. The crude mean score of participants’ knowledge of pain management and control was 12.51 (± 2.77 SD), and standardized mean score was 40.34 (± 8.92 SD), which was low at 84.8% and moderate in 15.3% of the participants. Older nurses and nurses who previously participated in pain retraining courses had significantly less knowledge about pain management and control (r= -0.104, P = 0.038), and (r= -0.148, P = 0.003) respectively. The crude mean score of participants’ attitudes toward pain control and management was 15.22 (± 2.56 SD), and standardized mean score was 60.87 (± 10.26 SD). Nurses’ attitudes have become more negative with the increase of their work experience (r = -0.168, P = 0.001), and previously participation in pain retraining courses (r =-0.207, P < 0.001). Older nurses and highly educated nurses had significantly more negative attitudes towards pain control and management (r = -0.153, P = 0.002), and (r= -0.126, P = 0.005), respectively.ConclusionsThe current study revealed that pain management and control knowledge in most emergency nurses was low, and most of them had a moderate attitude. We need more scientific and comprehensive pain management and control training courses to improve knowledge and attitude among health workers and nurses.

How to build the fractal emergency organization under the disaster response for coastal cities of China?

It is necessary to construct a dynamic emergency response organization that adapts to disaster scenarios and has the ability of rapid response. From a systematic point of view, fractal theory is introduced into the emergency organization construction of coastal cities in China, and a virtual network fractal emergency organization structure and reconstruction idea with self-organization, self-optimization and self-affine characteristics is proposed. Taking the emergency target as the construction purpose of the virtual network fractal emergency organization, the hierarchical relationship of the virtual network fractal emergency organization and the downward propagation relationship of the parent fractal emergency unit are established according to the task supply-demand relationship, the “Commission implementation” relationship and the collaborative relationship through the target decomposition and task analysis; Furthermore, we regard the changes of disaster scenarios and “Resource-Target-Constraint” as the motivation of virtual network fractal emergency organization reconstruction. This paper designs the virtual network fractal emergency organization reconstruction mechanism of coastal cities, and realizes the systematic research from the establishment of organizational structure to dynamic reconstruction, and provides theoretical guidance and method reference for the emergency management department of coastal cities government. Finally, taking typhoon “Lichma” as an example, the construction of virtual network fractal emergency organization is analyzed and the dynamic reconstruction process is verified, and the result shows that the virtual network fractal emergency organization is efficient, dynamic and open to adapt to the changes of disaster scenarios.

Population-level trends in emergency general surgery presentations and mortality over time.

Emergency general surgery (EGS) refers to the treatment of a subset of general surgical disease necessitating emergency evaluation and management (operative or non-operative)1. The majority of these disorders relate to the abdomen and gastrointestinal tract, with a range of severity. Operations for EGS conditions have higher rates of perioperative complications and death than comparable elective procedures, and many of these deaths are thought to be preventable2,3. There are limited population-level data regarding the impact of EGS. Existing studies4–6 suggest a trend towards decreased mortality with time. Many of these studies relied on incomplete population data that were weighted to estimate more comprehensive regional or national information5,6. Additionally, previous evaluations were largely limited to admitted patients. Emergency department (ED) overcrowding is a worsening public health problem, with potential effects on timely access to care and clinical outcomes7. Patients may be diverted to outpatient surgery, develop complications that change their admitting diagnosis, or even die. Therefore, evaluating EGS-related ED presentations and management even without admission is important. The contribution of individual EGS diagnoses to overall trends in ED presentations, admissions, and mortality is also largely unexplored, yet this information will be essential in anticipating the future needs of the EGS workforce and associated distribution of resources. The objective of this study was to determine the population-level trends in ED presentations, hospital admissions, and mortality from EGS conditions over 17 years in Ontario, Canada.

Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey.

There is a paucity of information on pediatric traumatic brain injury (TBI) care in Asia and Latin America. In this study, the authors aimed to describe the clinical practices of emergency departments (EDs) participating in the Saline in Asia and Latin-America Neurotrauma in the Young (SALTY) study, by comparing designated trauma centers (DTCs) and nontrauma centers (NTCs) in their networks. The authors performed a site survey study on pediatric TBI management in the EDs in 14 countries. Two European centers joined other participating sites in Asia and Latin America. Questions were formulated after a critical review of current TBI guidelines and published surveys. The authors performed a descriptive analysis and stratified centers based on DTC status. Of 24 responding centers (70.6%), 50.0% were DTCs, 70.8% had academic affiliations, and all centers were in urban settings. Patients were predominantly transferred to DTCs by centralized prehospital services compared to those sent to NTCs (83.3% vs 41.7%, p = 0.035). More NTCs received a majority of their patients directly from the trauma scene compared to DTCs (66.7% vs 25.0%, p = 0.041). Ten centers (41.7%) reported the use of a TBI management guideline, and 15 (62.5%) implemented CT protocols. Ten DTCs reported implementation of intervention strategies for suspected raised intracranial pressure (ICP) before conducting a CT scan, and 6 NTCs also followed this practice (83.3% vs 50.0%, p = 0.083). ED management for children with TBI was comparable between DTCs and NTCs in the following aspects: neuroimaging, airway management, ICP monitoring, fluid resuscitation, anticoagulant therapy, and serum glucose control. Hyperventilation therapy for raised ICP was used by 33.3% of sites. This study evaluated pediatric TBI management and infrastructure among 24 centers. Limited differences in prehospital care and ED management for pediatric patients with TBI were observed between DTCs and NTCs. Both DTCs and NTCs showed variation in the implementation of current TBI management guidelines. There is an urgent need to investigate specific barriers to guideline implementation in these regions.

Assessment of the Explosion Accident Risk in Non-Coal Mining by Hasse Diagram Technique

The aim of is paper is to address the problem of identifying critical factors in the analysis of non-coal mine explosion accidents as well as to improve the rationality and accuracy of the risk analysis results. Hence, we developed a risk identification method for non-coal mine explosion accidents, combining the Systems-Theoretic Accident Model and Process (STAMP) and the Rank-order Centroid (ROC) method based on the Poset decision-making theory. The proposed method was applied to identify risk in engineering cases. Findings showed that four main dangerous events (out of twelve identified ones) were the primary culprits of related accidents, which were the events “Blasters without licenses and illegal operation” at the basic level, the event of “the confusion about the safety management system of non-coal mine companies” at the control level, and the event of “the failure about the emergency management departments” and “public security departments” at the supervision level. The approximate values of the average rank of the four events are 11.56, 10.4, 4.33, 4.33. The results of risk identification of non-coal mine explosion accidents based on Poset were consistent with the results obtained by the method used in the case study. This study extends the methods for identifying risks of non-coal mine explosion accidents and facilitates the formulation of effective preventive measures.

Safety of nurse-directed triage intranasal fentanyl protocol for acute pain management in a European pediatric emergency department: A retrospective observational analysis.

Nurse-directed pain protocols for intranasal fentanyl administration are not widely implemented in European (EU) pediatric emergency departments (PED). Barriers include perceived safety concerns for intranasal (IN) fentanyl. The aim of this study is to describe our experience with a nurse-directed triage IN fentanyl protocol with a focus on safety in a tertiary EU PED. We conducted a retrospective analysis of patient records of children aged 0-16 years who received nurse-directed IN fentanyl between January 2019 and December 2021 at the PED of the University Children's Hospital of Bern, Switzerland. Extracted data points included demographics, presenting complaint, pain score, IN fentanyl dosage, concomitant pain medication use, and adverse events. A total of 314 patients were identified with ages ranging from 9 months to 15 years. The main indication for nurse-directed fentanyl administration was musculoskeletal pain due to trauma (n = 284, 90%). Mild adverse events (vertigo) were reported in two patients (0.6%), without a correlation to concomitant pain medication or protocol violation. The only reported severe adverse event of syncope and hypoxia in a 14-year-old adolescent occurred in a setting where the institutional nurse-directed protocol was violated. In accordance with previous studies outside of Europe, our data support the case that when appropriately used, nurse-directed IN fentanyl is a safe potent opioid analgesic for pediatric acute pain management. We strongly encourage the introduction of nurse-directed triage fentanyl protocols Europe-wide in order to provide effective and adequate acute pain management in children.

Australian emergency department care for older adults diagnosed with low back pain of lumbar spine origin: a retrospective analysis of electronic medical record system data (2016–2019)

BackgroundIn Australian emergency departments, 30% of all back pain presentations are for older adults. Relatively little is known about the care that this population receives during an emergency department stay, including admission to hospital. The aim of this study is to describe emergency department management of older adults diagnosed with a lumbar spine condition and to determine predictors of healthcare use in this population.MethodsA retrospective analysis of electronic medical record data of adults aged ≥ 65 years with a lumbar spine discharge diagnosis. Demographic, clinical care (date and time of presentation and discharge, length of stay in the emergency department, mode of arrival, triage category, re-presentations to the emergency department (within 48 h), discharge mode, the administration of pain-relieving medicines, lumbar imaging, and laboratory tests) and costs data were extracted from the electronic medical record system. Descriptive analyses and multilevel mixed-effects logistic regression models were performed.ResultsOver the period January 2016 to December 2019 there were 4,093 presentations to emergency departments by older adults with a lumbar spine discharge diagnosis (82.0% were non-specific low back pain). Most were female (58.3%), 39.9% had some form of lumbar imaging, and 34.1% were admitted to hospital. The most administered pain medicines were opioid analgesics (67.1%), followed by paracetamol (63.9%) and NSAIDs (33.0%). Predictors of healthcare use and hospital inpatient admission were receiving a laboratory test and receiving any opioid. For the financial period 2019-20, the mean (SD) total cost of care per presentation was $5,629 ($11,982).ConclusionIn the emergency department, more than two thirds of older adults with a lumbar spine condition received opioid analgesics. They often received imaging and laboratory tests, had high costs and were admitted to hospital. Alternative pathways of care are needed to support older adults with low back pain, to receive guideline-concordant emergency department care and have good health outcomes.

Comparative Evaluation of Dermatological Emergency Consultations in the Coronavirus Pandemic Era: Tertiary Clinic Experience.

Due to the increase in COVID-19 patients during the pandemic, the workload of emergency departments has increased. The profile of patients seeking non-COVID medical care has changed significantly because of the pandemic; this includes dermatological emergencies. The aim was to evaluate and compare adult dermatological emergency consultations during the COVID-19 period with the pre-pandemic period. Consulted patients from ED to dermatology between March 11, 2019, and March 11, 2021 were included (Pre-pandemic and pandemic). Age, gender, zone of triage, consultation hour, consultation date, consultation response time, ICD-10 codes were recorded. The total number of consultations was 639. The mean age of the patients was 44.4 in the pre-pandemic period and 46.1 in the pandemic period. The mean consultation response time was 44.4 minutes in the pre-pandemic period and 60.3 minutes in the pandemic. In the pre-pandemic period, the most common consulted diseases were herpes zoster, urticaria, and allergic contact dermatitis. During the pandemic, the most common consulted diseases were herpes zoster, other dermatitis, and urticaria. There was a statistically significant difference in the incidence of other dermatitis, impetigo/folliculitis, cutaneous vasculitis, and pruritus (p<0.05) CONCLUSIONS: Emergency departments are the busiest and fastest areas of the hospital. Pandemics such as COVID-19 may also occur in the coming years. Informing society about dermatological emergencies and adding adequate dermatology training to the training of emergency physicians will facilitate appropriate patient management in emergency departments.

Emergency Department Preparedness toward a Future Pandemic: Safety Management Response Pyramid

Background: Hospitals and other healthcare facilities play a crucial role in national and local responses to emergencies, such as communicable disease outbreaks. In our region, hospital management has established mechanisms for developing and implementing a hospital emergency safety management program, which is designed to ensure the effective management of the risks of internal and external emergencies, including pandemics. Aim: To assess and explore the preparedness of the emergency departments in Saudi Arabia at tertiary hospitals toward a future pandemic. Methods: A cross-sectional survey was conducted at tertiary hospitals. One hundred forty healthcare providers who are working in the emergency department were surveyed, and the response rate was 75% (105). Results: Participants were predominately female (60 (57.1%)), with a bachelor’s degree (72 (68.6%)) and had more than 10 years of experience in their profession (46 (43.8%)). The study revealed that, namely, the junior emergency department staff were poorly trained on average all areas of pandemic preparedness. Healthcare providers reported that the highest implemented measures related to safety/ infection control, emergency department management, and response were, respectively: support N95 respirator fit testing (2.77 (SD = 0.44)), infection prevention techniques (2.85 (SD = 0.39)) and provide criteria for patient assessment (2.72 (SD = 0.51)). On the other hand, the lowest implemented measures were for a unit pandemic safety plan, palliative care, and determined alternate transport resources with a mean of 2.04 (SD = 0.75), 2.22 (SD = 0.83), and 2.19 (SD = 0.80) respectively. Conclusion: The findings of this study support the need for formalized pandemic preparedness training, developing a pandemic safety plan to protect the community and healthcare professionals, improving palliative care during and after the pandemic, and defining strategies to allocate healthcare resources.

Predictors for hospital admission in emergency department patients with benign paroxysmal positional vertigo: A retrospective review.

This study aims to assess the incidence of Emergency Department (ED) visits for benign paroxysmal positional vertigo (BPPV), describe patient characteristics, management practices and predictors of inpatient admission of BPPV patients. This was a retrospective chart review of patients presenting with BPPV to a single ED between November 2018 and August 2020. Patients' characteristics, ED management, discharge medications, disposition and unscheduled return visits were determined. In total, 557 patients were included. Average age was 49 years, 54.2% were females and 12.4% required hospital admission. In the ED, 51.1% received intravenous hydration, 33.8% received anti-emetics, 10.1% received benzodiazepines, 31.8% underwent canalith repositioning maneuvers (CRMs) and 56.7% were discharged on acetyl-leucine. Of discharged patients, 2.5% had unscheduled return visits. A higher likelihood of admission was associated with age above 54 years (aOR = 4.86, p<0.001, 95% CI [2.67, 8.86]), home use of proton pump inhibitors (PPIs) (aOR = 2.44, p = 0.03, 95% CI [1.08, 5.53]), use of anti-emetics and benzodiazepines in the ED (aOR = 2.34, p = 0.003, 95% CI [1.34, 4.07]) and (aOR = 2.18, p = 0.04, 95% CI [1.03, 4.64]), respectively. While BPPV is a benign diagnosis, a significant number of patients presenting to the ED require admission. Predictors of admission include older age, PPIs use and ED treatment with anti-emetics and benzodiazepines. Although CRMs are the gold standard for management, CRMs usage did not emerge as protective from admission, and our overall usage was low.

Interhospital Variability in Utilization of Cardioversion for Atrial Fibrillation in the Emergency Department

The role for direct current cardioversion (DCCV) in the management of atrial fibrillation (AF) in the emergency department (ED) is unclear. Factors associated with DCCV in current practice are not well described, nor is the variation across patients and institutions. All ED encounters with a primary diagnosis of AF were identified from the Nationwide Emergency Department Sample from 2006 to 2017. The independent association of patient and hospital factors with use of DCCV was assessed using multivariable hierarchical logistic regression. The relative contributions of patient, hospital, and unmeasured hospital factors were assessed using reference effect measures methods. Among 1,280,914 visits to 3,264 EDs with primary diagnosis of AF, 31,422 patients (2.4%) underwent DCCV in the ED. History of stroke (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.09 to 0.22, p <0.001) and dementia (OR 0.14, 95% CI 0.10 to 0.19, p <0.001) was associated with lowest odds of DCCV. Comparing patients more likely to receive DCCV (ninety-fifth percentile) with patients with median risk, the influence of unmeasured hospital factors (OR 14.13, 95% CI 12.55 to 16.09) exceeded the contributions of patient (OR 5.66, 95% CI 5.28 to 6.15) and measured hospital factors (OR 3.89, 95% CI 2.87 to 5.60). In conclusion, DCCV use in the ED varied widely across institutions. Disproportionately large unmeasured hospital variation suggests that presenting hospital is the most determinative factor in the use of DCCV for ED management of AF. Clarification is needed on best practices for management of AF in the ED, including the use of DCCV.

A Rare Cause of Headache and an Unorthodox Transfer: A Case Report.

Emergency department (ED) crowding and hospital diversion times are increasing nationwide, with negative effects on patient safety and an association with increased mortality. Crowding in referral centers makes transfer of complex or critical patients by rural emergency physicians (EP) more complicated and difficult. We present a case requiring an unorthodox transfer method to navigate extensive hospital diversion and obtain life-saving neurosurgical care. We present the case of a previously healthy 21-year-old male with two hours of headache and rapid neurologic decompensation en route to and at the ED. Computed tomography revealed obstructive hydrocephalus recognized by the EP, who medically managed the increased intracranial pressure (ICP) and began the transfer process for neurosurgical evaluation and management. After refusal by six referral centers in multiple states, all of which were on diversion, the EP initiated an unorthodox transfer procedure to the institution at which he trained, ultimately transferring the patient by air. Bilateral external ventricular drains were placed in the receiving ED, and the patient ultimately underwent neurosurgical resection of an obstructive colloid cyst. First, our case illustrates the difficulties faced by rural EPs when attempting to transfer critical patients when large referral centers are refusing transfers and the need for improvements in facilitating timely transfers of critically ill, time-sensitive patients. Second, EPs should be aware of colloid cysts as a rare but potentially catastrophic cause of rapid neurologic decline due to increased ICP, and the ED management thereof, which we review.

Variability in opioid use disorder clinical presentations and treatment in the emergency department: A mixed-methods study

BackgroundThere is strong evidence for emergency department (ED)-initiated treatment of opioid use disorder (OUD). However, implementation is variable, and ED management of OUD may differ by clinical presentation. Our aim was to use mixed methods to explore variation in ED-based OUD care by patient clinical presentation and understand barriers and facilitators to ED implementation of OUD treatment across scenarios. MethodsWe analyzed treatment outcomes in OUD-related visits within three urban, academic EDs from 12/2018 to 7/2020 following the implementation of interventions to increase ED-initiated OUD treatment. We assessed differences in treatment with medications for OUD (MOUDs) by clinical presentation (overdose, withdrawal, others). These data were integrated with results from 5 focus groups conducted with 28 ED physicians and nurses January to April 2020 to provide a richer understanding of clinician perspectives on caring for ED patients with OUD. ResultsOf the 1339 total opioid-related visits, there were 265 (20%) visits for overdose, 123 (9%) for withdrawal, and 951 (71%) for other OUD-related conditions. 23% of patients received MOUDs during their visit or at discharge. Treatment with MOUDs was least common in overdose presentations (6%) and most common in withdrawal presentations (69%, p < 0.001). Buprenorphine was prescribed at discharge in 15% of visits, including 42% of withdrawal visits, 14% of other OUD-related visits, and 5% of overdose visits (p < 0.001). In focus groups, clinicians highlighted variation in ED presentations among patients with OUD. Clinicians also highlighted key aspects necessary for successful treatment initiation including perceived patient receptivity, provider confidence, and patient clinical readiness. ConclusionsED-based treatment of OUD differed by clinical presentation. Clinician focus groups identified several areas where targeted guidance or novel approaches may improve current practices. These results highlight the need for tailored clinical guidance and can inform health system and policy interventions seeking to increase ED-initiated treatment for OUD.

Pediatric Emergency Department Management in Acute Poisoning-A 2-Year Retrospective Study.

(1) Background: Poisonings in children are common reasons for addressing ED and can potentially have serious complications. Our research aims to review risk factors leading to poisoning in children. (2) Methods: A retrospective review of all pediatric poisoning cases addressing the Children's emergency department of St Mary Hospital over a two-year period was performed. (3) Results: We collected data on 797 children admitted for acute poisoning. The highest incidence identified was in the 12-18 and 1-3-year-old age groups. The distribution of voluntary versus unintentional poisonings was relatively balanced: 50.19% versus 47.43% (for some cases the type of intoxication remained unknown). Exposure to the toxic substance by ingestion was significant compared to the other routes, with an incidence of 87.1%. Acute poisoning happened at home in 70.4% of cases. A known risk factor before reaching the ED was present in 13.04%. (4) Conclusions: Our study showed a greater risk for acute poisoning in children between 1-3 years of age, and adolescents over 12 years. Identifying and documenting epidemiological aspects and other variables is important for establishing preventive measures and for therapeutic conduct. Adequate risk stratification and preventive measures involving closer supervision of minors or cognitive-behavioral programs can prevent voluntary intoxication.

Abuse: emergency department management

Abuse has many forms. Its societal impact is substantial. Abused patients are insufficiently identified as such. Mistreatment represents a real challenge for our societies and for the medical profession in particular. The emergency physician is on the front line to identify, assess and refer the abused patients. Knowledge of the typology of abuse, the legal framework and the local resources at his disposal allows him to treat and guide safely the victim.

The Aspects of Running Artificial Intelligence in Emergency Care; a Scoping Review.

Artificial Inteligence (AI) application in emergency medicine is subject to ethical and legal inconsistencies. The purposes of this study were to map the extent of AI applications in emergency medicine, to identify ethical issues related to the use of AI, and to propose an ethical framework for its use. A comprehensive literature collection was compiled through electronic databases/internet search engines (PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC) and reference lists. We considered studies published between 1 January 2014 and 6 October 2022. Articles that did not self-classify as studies of an AI intervention, those that were not relevant to Emergency Departments (EDs), and articles that did not report outcomes or evaluations were excluded. Descriptive and thematic analyses of data extracted from the included articles were conducted. A total of 137 out of the 2175 citations in the original database were eligible for full-text evaluation. Of these articles, 47 were included in the scoping review and considered for theme extraction. This review covers seven main areas of AI techniques in emergency medicine: Machine Learning (ML) Algorithms (10.64%), prehospital emergency management (12.76%), triage, patient acuity and disposition of patients (19.15%), disease and condition prediction (23.40%), emergency department management (17.03%), the future impact of AI on Emergency Medical Services (EMS) (8.51%), and ethical issues (8.51%). There has been a rapid increase in AI research in emergency medicine in recent years. Several studies have demonstrated the potential of AI in diverse contexts, particularly when improving patient outcomes through predictive modelling. According to the synthesis of studies in our review, AI-based decision-making lacks transparency. This feature makes AI decision-making opaque.

Characteristics and outcomes of older patients in the emergency department

Background: Less is known about patients classified as &amp;quot;less acute&amp;quot; during triage, although elderly patients in the emergency department (ED) are a high-risk population. Our study concentrated on the outcomes of patients 65 and older with low acuity triage evaluations. Methods: This health records study assessed emergency department (ED) patients and controls with a Canadian Triage Acuity Scale score of 4 or 5 and age 65 or older. The information collected covered patient demographics, ED management, disposition, and a subsequent visit or hospital admission after 14 days. Chi-square testing and descriptive analysis of the data were both performed. Results: A stratified analysis plan was performed on patients 65 to 74, 75 to 84, and 85 years or older. The elder cohort had an average age of 77.4 years (range 64 to 99), while the control group of adults aged 39 to 54 had a mean age of 46.2 years. Most patients (86.3% older, 93.8% control) were prioritised and sent to the ED&amp;apos;s ambulatory care unit. 11.1% of patients in the older cohort were triaged and then sent to an isolated stretcher area. Emergency medical services brought an elderly patient who had fallen and was being transferred on a backboard to the acute monitored area of the department. The elder cohort&amp;apos;s likelihood of hospital admission was considerably higher (p=0.017). Conclusion: The present study shows that even &amp;quot;low acuity&amp;quot; older individuals risk returning and being admitted within 14 days after visiting the ED.