Urinary stone disease is common, recurrent, and increasingly managed through imaging-driven pathways, yet standard-dose CT of the kidneys, ureters, and bladder (CT KUB) raises concerns about cumulative radiation exposure and the limited use of quantitative imaging information for risk stratification. This review synthesizes contemporary evidence on dose-optimized CT, advanced spectral technologies, and artificial intelligence (AI)-enabled analytics that are reshaping diagnosis, treatment selection, and triage. This review summarizes data supporting low-dose and ultra-low-dose CT protocols that preserve diagnostic accuracy while substantially reducing dose, and discusses how dual-energy CT, photon-counting CT, and radiomics facilitate noninvasive stone characterization and extraction of imaging biomarkers beyond size and location. It also reviews AI approaches for automated detection, segmentation, and volumetric quantification across CT, KUB, and ultrasounds, highlighting their potential to standardize stone-burden metrics. It further examines predictive models, including logistic regression, nomograms, and machine learning, for perioperative infectious complications, emergency department admission or intervention, procedure success, and long-term recurrence, and outlines reporting and validation frameworks and implementation considerations, including software as a medical device regulation and human oversight. In contrast to prior reviews that consider imaging and AI separately, this review integrates dose reduction, spectral characterization, and AI-driven analytics within real-world clinical pathways to distinguish established clinical applications from those that remain investigational. Integrating advanced CT and AI outputs into well-validated prediction models embedded in real-world workflows may enable safer imaging, more consistent triage, and more personalized follow-up for urinary stone disease.

Stimulant-involved overdose deaths have increased sharply in the United States, largely driven by adulteration of the stimulant drug supply with fentanyl and other high-potency synthetic opioids. Individuals with stimulant use disorder (StUD) who do not intentionally use opioids remain at elevated risk for unintentional opioid overdose. Pharmacologic strategies for overdose prevention in this population remain limited. We describe a 32-year-old woman with severe stimulant use disorder who smoked crack cocaine and denied intentional opioid use but experienced 2 nonfatal opioid overdoses attributed to fentanyl-adulterated cocaine. After emergency department treatment with naloxone, we initiated daily oral naltrexone off-label as a harm-reduction strategy to reduce the risk of future opioid overdose. The patient tolerated naltrexone well after brief nausea and reported consistent adherence without reduction in stimulant effects or cravings. She continued daily cocaine use but experienced no further opioid overdoses during 5 months of follow-up. This case highlights the potential role of naltrexone as pre-exposure prophylaxis (PrEP) for unintentional opioid overdoses. Framing naltrexone use around unintentional opioid overdose prevention may enhance acceptability and adherence in patients not seeking a decrease or cessation of stimulant use. This strategy does not prevent non-opioid-involved stimulant deaths and should complement, not replace, naloxone distribution and other first-line overdose prevention measures. Oral naltrexone may represent a novel harm-reduction intervention to mitigate opioid-related morbidity and mortality in the setting of an increasingly adulterated stimulant supply. Further research is needed to evaluate efficacy and implementation.

Sepsis is a leading cause of preventable death in low-resource settings, where delays in recognition and emergency department (ED) treatment are common. Limited access to training also contributes to poor outcomes. We hypothesized that a contextualized telesimulation and debriefing program would be associated with better sepsis-related outcomes and time-critical care processes in children presenting to our center in Kumasi, Ghana. We also determined the program's acceptability and feasibility in our clinical providers. We conducted a 12-month mixed-method quasi-experimental (before vs. after implementation) study at Komfo Anokye Teaching Hospital, 2023-2024. Pediatric ED providers completed 30-minute, low-bandwidth telesimulation sessions using culturally-adapted real patient videos, filmed in the local Ghanaian hospital. Clinical outcomes and care processes were evaluated pre- and post-intervention. Trained observers recorded time-critical interventions: shock recognition, oxygen use, IV access, fluid bolus, reassessment, blood cultures, and antibiotics. Acceptability and feasibility were assessed using validated surveys. Tertiary academic hospital with 1200 beds, including 15 pediatric ED beds and 4 PICU beds. ED healthcare providers as well as clinical data from patients 2 months to 14 years old, screened at triage for suspected sepsis or septic shock. None. Post- vs pre-implementation care periods had mortality of 7 of 67 (10%) vs. 25 of 70 (36%), which represents an associated decrease in odds ratio (OR) of death 0.2 (95% CI, 0.1-0.5; p = 0.001). The post- vs pre-implementation changes in care characteristics, included: greater odds of supplemental oxygen use (OR 2.4 [95% CI, 1.0-5.7] p = 0.044) and IV placement (OR 3.8 [95% CI, 1.3-13.1] p = 0.012). Also, among trainees, 44/45 agreed that the program was acceptable and feasible. In our 2023-2024 pre- vs. post-implementation study, we found that contextualized telesimulation and debriefing were associated with lower odds of mortality, improved characteristics of care, and were acceptable and feasible to the healthcare team.

Outcomes Associated With an Age-Friendly Emergency Department Intervention.

This report presents a series of 16 patients who were admitted to the emergency department following confirmed intake of the potent synthetic cannabinoid ADB-CHMINACA. The cases are drawn from a prospective observational study following the recreational use of synthetic cannabinoids. The clinical and analytical data were combined and submitted to a Poison Centre. The severity of poisoning was evaluated on the basis of clinical data, including follow-up information. The present analysis was conducted exclusively on patients with analytically confirmed intake of ADB-CHMINACA and treatment in emergency departments for acute adverse effects. Cases with additional relevant serum concentrations of other drugs of abuse that suggested relevant interactions were excluded. Common clinical manifestations included panic attacks, tachycardia, agitation, vomiting and seizures. Most of the patients experienced these symptoms within minutes after inhaling this new psychoactive substance. Serum concentrations of ADB-CHMINACA varied widely and ranged from 0.2-31 ng/mL, without a clear correlation between severity of the poisoning and drug concentration. Severity of poisoning was moderate to severe, but all patients recovered. Notably, 1 of the patients developed a posterior reversible encephalopathy syndrome, a rare but serious neurological complication characterised by usually transient symptoms like headaches, seizures and altered mental state, often accompanied by brain oedema. In this case, the patient recovered after 4 days. Clinical presentations exhibited by patients with analytically confirmed intake of ADB-CHMINACA showed similarities to previous reports; neuropsychiatric and cardiovascular symptoms were most prominent. Notable distinctions include the prevalence of panic attacks and trembling.

People with dementia and preferred language other than English (PLOE) in the United States may face communication-related barriers to high-quality end-of-life care. Compare end-of-life care characteristics among people with dementia and PLOE versus those preferring English. Retrospective cohort study. Decedents with dementia (2011-2021). (1) Documentation of a goals-of-care discussion, (2) presence of advance care planning (ACP) documents, (3) hospital-based healthcare utilization, (3) palliative care consultation, (4) in-hospital death. Among 7777 decedents, 725 (9%) had PLOE and 7052 (91%) preferred English. The median age at death was 84years and about half of patients were female. Those with PLOE were more likely to have a documented goals-of-care discussion in the 6months preceding death compared to those preferring English (62% versus 45%, adjusted risk difference 0.08; 95% CI 0.04-0.13). In the last 30days of life, those with PLOE were more likely to visit the Emergency Department (ED), be admitted to the hospital or intensive care unit, and die in-hospital (adjusted risk difference 0.09 95% CI 0.04-0.14, 0.06 95% CI 0.01-0.11, 0.06 95% CI 0.02-0.09, 0.11 95% CI 007-0.14 respectively). Differences in frequency of ACP documentation and palliative care consultation were not detected. Decedents with dementia and PLOE were more likely to have documented goals-of-care discussions and similarly likely to have ACP documents and palliative care consultation, yet had higher hospital-based healthcare utilization near end-of-life. Future studies should investigate whether high healthcare utilization is goal-discordant for this group. Future efforts to improve end-of-life care for those with PLOE might prioritize ED and hospital-based interventions, recognizing their critical safety-net functions, as well as ensure that people with dementia and PLOE and their families have sufficient cultural and linguistic support to engage in high-quality end-of-life communication with their healthcare providers.

Hypertensive crises, encompassing emergencies and urgencies, are acute, severe blood pressure elevations associated with significant morbidity and mortality. Despite available guidelines, variability in clinical practice persists. This systematic review aims to synthesise evidence on pharmacological management strategies for hypertensive crises, focusing on efficacy, safety, and setting-specific considerations. Following thePreferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library was conducted for studies published between January 2020 and December 2025. Studies evaluating pharmacological interventions in adult patients with hypertensive crises were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). A narrative synthesis was performed due to clinical and methodological heterogeneity. The search yielded 629 records, of which six studies met the inclusion criteria, with two randomised controlled trials, two retrospective cohort studies, and two cross-sectional studies conducted across India, Taiwan, the United States, Ethiopia, the Netherlands, and Europe. All studies demonstrated low risk of bias, with NOS scores ranging from 7 to 9 stars. Continuous intravenous infusion achieved the fastest blood pressure reduction, while intravenous bolus alone was associated with the shortest intensive care unit (ICU) stay. One study found no significant difference in time to blood pressure control between treated and untreated emergency department patients, but observed reduced three-year and five-year mortality in treated patients. Overall mortality among ICU patients was 8%, with higher rates in those presenting with acute coronary syndrome. Both phenoxybenzamine and doxazosin were effective in preventing intraoperative haemodynamic instability during pheochromocytoma resection, with zero 30-day mortality. Acute kidney injury occurred in 20-30% of patients with hypertensive emergencies complicated by heart failure. Guidelines recommended against routine early intensive blood pressure lowering in acute ischaemic stroke due to the absence of proven mortality benefit and potential harm. Factors associated with better outcomes included polypharmacy approaches, formal end-organ damage evaluation, and absence of target organ damage. Multiple pharmacological strategies are effective in hypertensive crises, with choice guided by clinical context and target organ damage. Continuous infusion offers the fastest reduction, and bolus strategies reduce ICU utilisation. Target organ damage, especially acute coronary syndrome, predicts worse outcomes. Emergency department intervention confers long-term mortality benefits. Standardised definitions and larger trials are needed, particularly in resource-limited settings.

Intragastric balloon (IGB) therapy is a minimally invasive endoscopic intervention primarily utilized for weight reduction in patients with Class I and II obesity. While less frequently utilized in individuals with Class III obesity (BMI ≥ 40 kg/m²), IGB placement may be considered as a bridge to bariatric surgery or when surgery is contraindicated or declined. However, data regarding short-term safety outcomes in this higher-risk population remain limited. This study aims to compare 30-day safety outcomes after IGB placement in patients with BMI ≥ 40 kg/m² versus BMI < 40 kg/m². This was a retrospective cohort study of 4,555 patients undergoing primary IGB placement from 2016 to 2023 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Primary outcomes included hospital length of stay and 30-day rates of outpatient intravenous (IV) treatments, emergency department (ED) visits, readmissions, reoperations, interventions, and mortality. Patients were stratified by BMI ≥ 40 kg/m² and BMI < 40 kg/m² for comparative analysis using propensity score-matching (PSM). 962 pairs were identified for PSM. Patients with BMI ≥ 40 kg/m² were younger on average and more likely to be male and non-Hispanic Black. This group exhibited a higher prevalence of associated medical problems, including diabetes, obstructive sleep apnea, hypertension, renal insufficiency, immunosuppressant use, thromboembolic events, and therapeutic anticoagulation use. After adjustment for baseline differences, patients with BMI ≥ 40 kg/m² were more likely to require a postoperative hospital length of stay longer than one day (p = 0.003). No significant differences in 30-day outpatient IV treatments, ED visits, readmissions, reoperations, interventions, or mortality, were observed. Patients with BMI ≥ 40 kg/m² exhibited a greater burden of associated medical problems and longer hospital length of stay, but otherwise demonstrated comparable short-term safety outcomes to those with BMI < 40 kg/m². These findings suggest comparable 30-day hospital-based safety outcomes after IGB placement in patients with BMI ≥ 40 kg/m² compared with BMI < 40 kg/m².

Diagnosis and treatment of sexually transmitted infections among emergency department patients.

Introduction: Medical and disaster-related incidents associated with mass gatherings are increasingly recognized as important issues. Understanding the nature of these gatherings and implementing thorough disaster preparedness and well-planned response strategies are essential for mitigating potential impacts. Taiwan’s Mazu pilgrimage is one of the largest mass gatherings worldwide, involving rituals and processions spanning over 300 kilometers in 8 to 10 days. Few studies have examined the health impacts and influencing factors associated with such prolonged and long-distance pilgrimage movements. This study aims to assess the health impacts and associated factors of these events to inform future preparedness and response planning. Methods: We conducted a retrospective observational study of patients visiting the emergency department during the Mazu pilgrimage from 2018 to 2024, utilizing data from the Emergency Medical Resources Management System (EMRM), Ministry of Health and Welfare. The dataset includes variables such as date of emergency visit, gender, age, primary diagnosis, mode of transportation to the emergency department, triage level, and medical interventions. The primary outcome measured was the frequency of emergency department visits. Results: A total of 1,637 patients visited the ED during the Mazu pilgrimages from 2018 to 2024. The mean age of all patients was 49.1 years, with 813 (49.7%) being male. Among these patients, 819 (50.0%) were transported to the ED by ambulance, and 177 (10.8%) were triaged as TTAS level I or II. Regarding patient disposition, 1,469 patients (89.7%) were discharged without admission, and 132 (8.1%) were admitted to the general ward. Conclusion: For the Mazu pilgrimages in Taiwan, most patients visiting the ED presented with mild cases. Furthermore, the health impacts extended beyond EDs to the emergency medical service (EMS), which had to respond to the increased demand for ambulance transportation. Therefore, it is critical to effectively manage both prehospital EMS and emergency services in EDs to bridge potential treatment gaps.

Pessimistic repetitive thought, goal-oriented repetitive thought, and positive indulging about the future as predictors of suicide ideation among treatment-seeking adolescents.

Impact of early blood testing on emergency department length of stay during overcrowding.

Summary: Emergency Department (ED) evaluation of suspected Viral Hemorrhagic Fever (VHF) patients can significantly disrupt an institution’s ED operations. Given the significant risk of contamination, best practice is to close off areas where the patient has been present. While designed to protect healthcare workers and other patients, this can have unintended consequences, such as closing off access to critical areas and supplies. A full-scale disaster drill was conducted at a New York City (NYC) designated Ebola Receiving Center. A fictitious patient suspected of VHF was taken to the designated VHF treatment area through EMS and walk-in triage. The impact on normal patient/staff flow and access to critical resources was documented by trained observers. The following areas were unintentionally blocked due to patient transport to the designated VHF treatment room: 1. Arrival via EMS: a) critical elevators to OR, MICU, SICU, and Labor and Delivery, b) ED Radiology including X-Ray, CT, and ultrasound. 2. Arrival via walk-in: a) waiting room, b) triage area, c) the entirety of the non-critical adult emergency department, approximately 81 patient treatment locations. This drill highlighted the potential for significant disruptions to ED operations when managing VHF patients, even when using a pre-identified VHF treatment room. By identifying feasible access to appropriate care areas, hospitals can mitigate these challenges and ensure the continuity of daily operations. EDs should consider similar strategies when developing their VHF response plan. The Division of Disaster Preparedness &amp; ED administrators assessed the ED’s architectural blueprint to locate areas of entry/egress and the ED’s treatment/diagnostic areas. Multiple attempts to find a space within the emergency department to care for VHF patients without closing the ED proved difficult. However, after reviewing the blueprint, an ideal area outside the ED treatment areas was identified.

Summary: A 2021 drill evaluating a patient under investigation for Ebola Virus Disease (EVD) revealed a significant vulnerability in the Emergency Department (ED) workflow, resulting in a loss of access to critical elevators, ED radiology, and ED treatment areas. This report describes the development and implementation of a new treatment area and process to care for patients with concerns for Viral Hemorrhagic Fevers (VHF). ED Administration and the Division of Disaster Preparedness performed a Gemba walk to evaluate ED Viral Hemorrhagic Fever workflows and assess treatment areas that minimally impact the ER flow. For Walk-ins: The Gemba walk identified an underutilized triage room outside the main ED. This room was converted to a “Hot Triage” room, where high-risk patients are cared for outside the ED. This allows other patients to navigate the entire ED without crossing the VHF patient’s path. For EMS: The Gemba walk identified that EMS patients should not proceed past ambulance triage, otherwise significant closures would occur. Therefore, EMS should transport patients into the decontamination showers directly from outside the building. If patients make it into ambulance triage, the door to that area can be secured, and a team will manage the patient there. A just-in-time training document was created that describes the novel workflows above and delineates the preparation that must be taken before entering the patient’s room. A PPE cart was developed that included pre made kits for VHF patient evaluation. Medical equipment listed in the document and found in the cart included telemonitor, resuscitation supplies, POC blood gas and malaria PCR cards, baby monitor, and critical contact numbers. Identifying appropriate care areas is crucial to a comprehensive VHF response plan. By isolating and evaluating potential VHF patients early and outside the department, EDs can minimize the risk of transmission and maintain hospital operations.

The role of demographic factors of individuals with seizures in emergency care delivery.

ABSTRACTBackgroundTransitions of care are high‐risk periods for patient safety in the emergency department (ED), particularly for patients who are still in the diagnostic process and are discharged with diagnostic uncertainty. Care transitions must be improved for these patients, as one third of discharged ED patients have diagnostic uncertainty. Yet there are no validated measures that assess the quality of care transitions from the ED, limiting the ability to assess the impact of interventions. Thus, we developed and validated the ED Transitions (EDT) measure.MethodsThis mixed methods study was conducted across a large healthcare system in three phases: item generation, cognitive interviewing, and large‐scale validation. Scale items were generated by experts and then iteratively refined using feedback from cognitive interviews (n = 11). The measure was then validated on a large sample of patients (n = 301) recently discharged from the ED. Exploratory structural equation modeling (ESEM) was employed to assess factor structure. Bivariate correlations were used to assess discriminant and convergent validity using the Care Transition Measure (CTM‐3) and the Communication Assessment Tool‐Teams (CAT‐T).ResultsThe measure was iteratively refined by way of an expert panel and cognitive interviews which resulted in a 15‐item measure to be used for validation. The validation sample (n = 301) was 62% women, 49% White, and the majority having Medicare and/or Medicaid (68%). Sequential comparisons between confirmatory factor analyses and ESEM resulted in a final 10‐item two‐factor structure. Reliability was excellent (0.93), and bivariate correlations indicated positive correlations between the EDT, CTM‐3, and CAT‐T.ConclusionThe EDT measure demonstrates content validity, structural validity, convergent validity, discriminant validity, and high internal consistency (i.e., reliability). This newly developed patient reported outcome measure can be used in future clinical and research work to better understand the impact of ED interventions on quality‐of‐care transitions for patients with diagnostic uncertainty.

This study examines the financial burden of the opioid crisis on the United States healthcare system using a system-oriented, multivariate empirical framework. Drawing on survey data from 387 healthcare facilities and professionals, the study models Financial Cost Pressure as a function of opioid-related demand, emergency department burden, treatment capacity and access, hospital response strategies, reporting and surveillance timeliness, workforce and operational strain, drug market complexity, community and social determinants, and analytics and early warning readiness. Results indicate that opioid-related demand and emergency department burden are the strongest drivers of cost pressure, while workforce strain, reporting challenges, drug market complexity, and adverse social conditions further amplify financial burden. In contrast, greater treatment capacity, stronger hospital response strategies, and improved analytic readiness significantly mitigate system-level costs. The model explains 63 per cent of financial cost pressure. By integrating epidemic dynamics and institutional capacity, the study provides evidence on sustained healthcare costs.

Background: Trauma is a leading cause of morbidity and mortality in low- and middle-income countries, yet large multicenter descriptions of emergency department (ED) trauma epidemiology from Nepal remain limited. Accurate, multi-site data are essential to prioritise injury prevention, prehospital services, resource allocation and trauma system development.Objective: To describe the epidemiology, injury characteristics, care processes and in-hospital outcomes of trauma patients presenting to tertiary emergency departments across four major Nepalese hospitals over one year.Materials and Methods: We performed a multicenter, retrospective cross-sectional study of consecutive trauma patients presenting to the EDs of the National Trauma Center (Mahankal/Bir Hospital network), Tribhuvan University Teaching Hospital (TUTH), Dhulikhel Hospital and Pokhara Academy of Health Sciences between 1 January and 31 December 2024. We extracted standardised variables from ED registries and hospital records: demographics, mechanism of injury, injury intent, arrival mode and time, vital signs and triage category, injury severity proxies (Glasgow Coma Scale, anatomical injury categories), prehospital interventions, ED interventions, disposition (admitted, operated, ICU, death), and in-hospital mortality. We cleaned and harmonized datasets across sites, applied descriptive statistics for frequencies and rates, and constructed multivariable logistic regression models to identify independent predictors of in-hospital mortality and ICU admission, adjusting for age, sex, mechanism, arrival time, vital signs and transfer status.Results: (Summary to be filled with actual dataset.) We expect to report patient volumes, age/sex distribution, leading mechanisms (road traffic collisions, falls, and interpersonal violence), proportion arriving by ambulance, median time from injury to ED arrival, triage acuity distribution, proportion requiring surgery and ICU, and in-hospital mortality. Multivariable models will estimate adjusted odds ratios (aOR) for mortality with 95% confidence intervals; we will present subgroup analyses for head injury, pediatric (

Atopic dermatitis (AD) and hidradenitis suppurativa (HS) are two inflammatory skin conditions characterized by intermittent flares that may lead some patients to seek treatment in urgent care or emergency departments (ED). At our institution, we implemented a walk-in appointment process for patients seen in the ED for urgent dermatologic concerns. After implementation of this program, patients received treatment by a pediatric dermatologist faster: 75.7 days versus 19.1 days for AD pre- and post-implementation, respectively, and 89.9 days versus 9.33 days for HS pre- and post-implementation, respectively (p < 0.01). Our work demonstrates that walk-in visits for urgent dermatologic concerns facilitate timely access for pediatric patients with chronic dermatologic conditions.

Emergency departments (EDs) serve patients at high risk for overdose. There is increasing interest in peer-delivered ED interventions for substance use but little rigorous research on their effectiveness. To examine the effectiveness of an initiative (Relay) operated by the New York City Health Department that dispatches trained peer wellness advocates (WAs) to support ED patients after a nonfatal opioid overdose. This randomized clinical trial compared Relay and site-directed care (SDC) at 4 EDs in New York, New York. Adult patients presenting after opioid-involved overdose were enrolled from October 6, 2020, to June 30, 2022, with 12 months of outcome follow-up. Statistical analysis was performed from November 4, 2024, to May 6, 2025. ED workers (generally physicians) called the Relay hotline for patients presenting after a suspected opioid-involved overdose. WAs met patients in the ED to provide peer support and brief overdose risk reduction education. WAs attempted to contact patients for 90 days to provide ongoing support, education, and referrals using a harm reduction framework. Opioid-related adverse events (any opioid-involved overdose [fatal or nonfatal] or any other substance use-related ED visit) in the 12 months after enrollment were identified using health care administrative data plus self-report. Among a total of 253 participants randomized, 127 were randomized to the Relay arm and 126 to the SDC arm. A total of 247 participants, 125 in the Relay arm and 122 in the SDC arm (190 [76.9%] men; 80 [32.4%] Black, 126 [51.0%] Hispanic or Latinx, 76 [30.8%] White, and 91 other race [36.8%]), were included in the intention-to-treat analyses. No statistically significant differences between arms were observed for the primary outcome (mean [SD] opioid-related adverse events, 3.29 [4.52] in the Relay arm and 4.10 [9.36] in the SDC arm; rate ratio, 1.02; 95% CI, 0.72-1.45; P = .90). By 12 months after enrollment, 24 participants (9.7%) had died (17 [70.8%] due to overdose). Relay participants reported high satisfaction with the ED intervention. This randomized clinical trial examining the impact of an ED peer navigator intervention on subsequent opioid-related adverse events did not find significant outcome differences for Relay vs SDC participants. These findings highlight the importance of intervening to save lives in this high-risk population and suggest potential refinements to future ED peer intervention research. ClinicalTrials.gov Identifier: NCT04317053.