Emergency Department Setting Research Articles

Improving benign paroxysmal positional vertigo management in the emergency department: A longitudinal study post-GRACE-3.

Vertigo is a priority for training and decision support in emergency departments (ED). Benign paroxysmal positional vertigo (BPPV), though manageable at bedside, remains frequently underdiagnosed and undertreated. This study assessed the effectiveness of a two-tiered educational intervention on posterior and horizontal BPPV management in the ED setting. Longitudinal program evaluation study conducted over a year in a French ED, following GRACE-3 guidelines, involving patients with triggered episodic vestibular syndrome or brief vertigo without nystagmus. Two 6-month periods were compared: before (control cohort) and after (intervention cohort) an educational intervention of standardized training and an online decision support tool. The primary outcome was the prevalence of evidence-based BPPV diagnoses. Of the 382 patients included, 166 were in the control cohort (43.5%) and 216 were in the intervention cohort (56.5%). The intervention cohort had a higher rate of evidence-based BPPV diagnoses compared to the control cohort (38.0% vs. 16.9%), with an effect size of 21.1 (95% confidence interval [CI] 11.5-29.6, p < 0.0001). Canalith repositioning maneuvers were performed more frequently in the intervention cohort (90.2% vs. 57.7%), with an effect size of 33.1 (95% CI 13.2-53.1). Posttreatment tests showed a nonsignificant difference of 79.5% of intervention cohort patients testing negative versus 75.0% in the control cohort. ED length of stay was shorter in the intervention cohort (137 min vs. 247 min), with an effect size of -109.5 (95% CI -154.0 to -65.0). ED revisits within 1 month were similar (2.3% vs. 1.2%). During the intervention period, clinicians' satisfaction was correlated with the effectiveness of their clinical management. A standardized educational intervention demonstrated enhancing BPPV screening and improved evidence-based diagnosis, showing promise of more efficient treatment in the ED. Further multicenter studies are warranted to evaluate impacts on patient-reported outcomes and resource optimization.

The ethics of proximity: Enrolling patients in emergency department hallway beds for suicide research.

Suicide is the 10th leading cause of death in the United States. Prior research suggests that 10% of people who died by suicide received some form of emergency department (ED) treatment in the 2 months preceding death. The risk of attempted suicide is high during transition back to the community after discharge from the ED, so this is an important opportunity to develop effective empirically validated prevention methods. However, the physical layout and crowded nature of most contemporary EDs, resulting in high rates of "hallway bed" assignments, presents some ethical challenges to conducting the requisite behavioral health research in ED settings. In this report, we illustrate the clinical/research ethics controversy through the example of a specific ED-based suicide prevention research protocol, in which the proposed hallway bed recruitment was initially rejected by the institutional review board (IRB) based on concerns about privacy, data confidentiality, and related considerations. Through a consultation process that involved the IRB representatives, the research team (including ethicists), and ED personnel, along with the collection of data to evaluate the risk of compromised confidentiality in hallway bed settings, a viable and ethically grounded approach was reached. This example illustrates the ethical considerations when enrolling patients who occupy a hallway bed into research and the value of a collaborative/problem solving focused dialogue between investigators, ethicists, and IRB personnel.

Emergency department utilization by youth before and after firearm injury.

Emergency department (ED) visits may serve as opportunities for firearm injury prevention and intervention efforts. Our objective was to determine ED utilization by youth before and after firearm injury. We performed a retrospective cohort study of ED encounters by youth (0-18 years old) with firearm injury from eight states using the 2019 State ED and Inpatient Databases. Our primary outcome was an ED encounter (1) 90 days before or (2) 90 days after index injury. We used generalized estimating equations, accounting for hospital clustering, to determine associations between ED utilization and ED type (pediatric vs. general), youth age, sex, race and ethnicity, urbanicity, and insurance status. We identified 1035 ED encounters for firearm injury (median [IQR] age 17 (15-18) years, 85.3% male, 63.3% non-Hispanic Black, 68.6% publicly insured, 90.5% living in a metropolitan area, 52.8% general ED). In the 90 days before an index injury, 12.8% of youth had an ED encounter; of these, 68.2% occurred in general EDs, and 18.2% were for trauma. In the 90 days after an index injury, 22.1% of youth had an ED encounter; of these, 50.0% occurred in general EDs, and 22.6% were for trauma. We found no significant association between ED type and ED utilization patterns. Few youths changed ED type across longitudinal encounters. Youth have high rates of ED utilization before and after firearm injury. Half of firearm-injured youth receive their emergency care exclusively in general EDs. Implementing firearm injury prevention and intervention efforts in all ED settings is critical.

Laboratory confirmation of respiratory syncytial virus infection is not associated with increased risk of death in adults with acute respiratory illness

Abstract Background Limited data have described the testing patterns and outcomes of adults (≥18 years) with acute respiratory illness (ARI) in the emergency department (ED) setting. Methods This prospective cohort study includes ARI patients from the CDC-sponsored Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) program from August 2021 until March 2024 (n=91 hospitals). Patients with ARIs were identified weekly by electronic surveillance for one or more of 130 ICD-10 codes that defined ARI. Patients were followed for 30 days for the primary outcomes of hospitalization and mortality. Testing for RSV with nasopharyngeal swabbing followed by was done as part of usual care. Risk of 30-day mortality RSV positivity was tested in a generalized estimating equation (GEE). Findings From 1,210,394 patients with ARI, 345,185 (28.5%) adults underwent RSV testing, which was positive in 2.4%. In RSV+ adults the overall mortality rate was 1.9% compared with a mortality rate of 2.9% in RSV- adults. Mortality with RSV+ increased with age ≥65 years: 3.8% (95% CI: 3.1 to 4.5%). However, in the GEE, RSV+ status was not associated with higher rate of hospitalization (adjusted Odds 0.79, 0.75-0.84), or 30-day mortality (odds 0.62, 0.53-0.74) relative to those who were RSV-. Age ≥65 years, incremental worsening of vital signs, male sex and heart failure were independently associated with death. Conclusion Among adults with ARI presenting to an ED and who were tested for RSV as part of their usual care, laboratory-confirmed RSV positivity was not associated with increased risk, including hospitalization, ICU requirement, or death.

The Prevalence and Predictors of Atrioventricular Blocks in Syrian Patients Reporting to the Emergency Department During the Ongoing Conflict: A Cross-Sectional Study.

Atrioventricular block (AVB) is a cardiac conduction disorder that can lead to significant clinical outcomes, particularly in resource-limited and conflict-affected regions. In Syria, healthcare infrastructure has been severely impacted by ongoing conflict, potentially affecting the prevalence and management of AVB. We conducted a cross-sectional study at Tishreen University Hospital in Latakia, Syria, with patients > 40 who presented to the emergency department (ED) from June 1 to August 1, 2024. Routine 12-lead ECGs were performed, with AVB diagnoses confirmed by two independent cardiology consultants. Exclusion criteria included pre-existing AVB, pacemaker presence, hemodynamic instability, and ECG diagnostic discrepancies. Patient demographics and comorbidities were assessed, and logistic regression analyses identified predictors of AVB. The final analysis included 692 patients, of which AVB was detected in 7% of the cohort. Patients with AVB were significantly older (median age 76 vs. 54 years, p < 0.001) and had higher rates of ischemic heart disease (IHD) (62% vs. 14%, p < 0.001) and diabetes (56% vs. 21%, p = 0.01). Logistic regression showed older age (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.6-5.6, p < 0.001), IHD (OR: 1.9, 95% CI: 1.4-4.5, p < 0.001), and DM (OR: 3.9, 95% CI: 2.9-8.3, p < 0.001) were independently associated with AVB. AVB prevalence in the Syrian ED setting is high, with age, IHD, and diabetes as significant predictors. Routine ECG screening in EDs may facilitate early AVB detection in at-risk populations, especially in conflict-affected regions with limited healthcare resources. This approach could improve outcomes by enabling timely intervention in high-risk patients.

Prolonged length of stay among individuals presenting to the emergency department with psychosis: Associations with sociodemographic and visit-level characteristics.

Individuals experiencing psychosis commonly initiate and engage in treatment within an emergency department (ED) setting. Understanding factors contributing to adverse ED experiences is critical for improving psychosis-related treatment. Prolonged ED length of stay (LOS), which can be conversely associated with treatment quality, is not well explored among individuals experiencing psychosis. In this retrospective analysis of 2129 ED visits for psychosis, we examined sociodemographic characteristics associated with prolonged ED LOS. Among these visits, which occurred from March 1, 2019-February 28, 2021, we also examined the risk of physical restraint, parenteral medication administration, disposition to inpatient psychiatric hospitalization, and substance use positivity by prolonged ED LOS status. Females, compared to males, were more likely to have prolonged ED LOS; no other sociodemographic characteristics were significantly associated with prolonged ED LOS. Visits with physical restraint, parenteral medication administration, and disposition to inpatient psychiatric hospitalization had a greater risk of prolonged ED LOS compared to visits without these factors. These findings provide critical insight on approaches to reduce ED LOS among individuals experiencing psychosis and improve treatment engagement.

Emergency department and inpatient interhospital transfers for patients with status epilepticus.

Interhospital transfers for status epilepticus (SE) are common, and some are avoidable and likely lower yield. The use of interhospital transfer may differ in emergency department (ED) and inpatient settings, which contend with differing clinical resources and financial incentives. However, transfer from these two settings is understudied, leaving gaps in our ability to improve the hospital experience, cost, and triage for this neurologic emergency. We aimed to describe interhospital transfer for SE and examine the relationship between the site of transfer and hospital length of stay. We performed a cross-sectional study of adult patients with SE who underwent interhospital transfer using data from the State Emergency Department Databases and State Inpatient Databases of Florida (2016-2019) and New York (2018-2019). The primary outcome was discharge after undergoing transfer. Secondary outcomes were discharge within 1 day, discharge after 30 days, receipt of electroencephalography (EEG), and discharge disposition. There were 10 461 encounters for SE. Of 1790 ED encounters without admission to the same hospital, 324 (18.1%) resulted in transfer. Of 8671 hospitalizations, 629 (7.3%) resulted in transfer. Patients transferred from the ED were younger, more likely were White, more likely were in a metro area, and had fewer medical comorbidities than patients transferred from the inpatient setting. The median time to discharge was 5 days (interquartile range [IQR] = 2.0-9.0) after ED transfer and 10 days (IQR = 4.0-20.0) after inpatient transfer. There were 58 (17.9%) patients who were discharged within 1 day after undergoing transfer from an ED. ED transfers had higher rates of discharge at 30 days and higher likelihood of undergoing EEG at the receiving hospital and being discharged home. A high proportion of patients with SE are discharged shortly after undergoing interhospital transfer, particularly those transferred from the ED. Understanding reasons for transfer is a crucial next step in triaging limited inpatient epilepsy resources and reducing costs associated with interhospital transfer.

Illnesses Associated With Increased Length of Stay for Individuals Experiencing Homelessness: A Retrospective Cohort Study of Emergency Department Visits and Hospitalisations.

Individuals experiencing homelessness (IEH) tend to have increased length of stay (LOS) in acute care settings, which negatively impacts health care costs and resource utilisation. It is unclear however, what specific factors account for this increased LOS. This study attempts to define which diagnoses most impact LOS for IEH and if there are differences based on their demographics. A retrospective cohort study was conducted looking at ICD-10 diagnosis codes and LOS for patients identified as IEH seen in Emergency Departments (ED) and also for those admitted to hospital. Data were stratified based on diagnosis, gender, and age. Statistical analysis was conducted to determine which ICD-10 diagnoses were significantly associated with increased ED and inpatient LOS for IEH compared to housed individuals. Homelessness was associated with increased LOS regardless of gender or age group. The absolute mean difference of LOS between IEH and housed individuals was 1.62 h [95% CI 1.49-1.75] in the ED and 3.02 days [95% CI 2.42-3.62] for inpatients. Males age 18-24 years spent on average 7.12 more days in hospital, and females aged 25-34 spent 7.32 more days in hospital compared to their housed counterparts. Thirty-one diagnoses were associated with increased LOS in EDs for IEH compared to their housed counterparts; maternity concerns and coronary artery disease were associated with significantly increased inpatient LOS. Homelessness significantly increases the LOS of individuals within both ED and inpatient settings. We have identified several diagnoses that are associated with increased LOS in IE; these should inform the prioritisation and development of targeted interventions to improve the health of IEH.

Socio-Demographic and Clinical Characteristics of Patients with Substance Intoxication Receiving a Psychiatric Assessment in the Emergency Department of the Maggiore Della Carita Hospital, Novara, Italy.

Patients intoxicated with alcohol or other substances are often assessed and assisted in the context of the Emergency Department (ED) by emergency physicians, who usually require a psychiatric assessment. This study aims to analyse the characteristics of a sample of patients receiving a psychiatric consultation in the ED setting of the Maggiore della Carità University Hospital in Novara, Italy, in the period from 1 January 2021 to 31 December 2023, to find out whether and how patients screening positive for alcohol/drugs differ from those screening negative. Socio-demographic and clinical history information and clinical data related to the ED psychiatric consultations were extracted from the PsNet database, a collection of data extracted from the application that serves as the electronic medical record for patients accessing the ED. Statistical analyses were performed using SAS 9.4 and STATA version 17 software. Chi-square/Fisher tests, t-tests, and both univariate and multivariate logistic models were employed. Most of the findings regarding socio-demographic characteristics, symptoms observed during the 1362 psychiatric consultations, and treatments received by a total of 922 patients in the ED were consistent with the literature on this topic. However, some results only partially aligned with previous studies, particularly concerning the higher frequency of anxiety and psychotic symptoms, as well as cognitive impairments, observed in consultations for patients who tested negative for alcohol or substances. Interpreting these findings is complex and raises important questions, which may be addressed more effectively by expanding the sample size (extending the research to other EDs) and analysing its characteristics in greater detail. In this regard, improving diagnostic methods for detecting substance use through laboratory tests would also be beneficial.

Performance of A-DROP, NEWS2, and REMS in predicting in-hospital mortality and mechanical ventilation in pneumonia patients in the emergency department: a retrospective cohort study

BackgroundPneumonia is a potentially life-threatening respiratory tract infection. Many Early Warning Scores (EWS) were developed to detect patients with high risk for adverse clinical outcomes, but few have explored the utility of these EWS for pneumonia patients in the Emergency Department (ED) setting. We aimed to compare the prognostic utility of A-DROP, NEWS2, and REMS in predicting in-hospital mortality and the requirement for mechanical ventilation among ED patients with pneumonia.MethodsA retrospective study was conducted at the ED of Siriraj Hospital, Thailand. Adult patients diagnosed with non-COVID-19 pneumonia between June 1, 2021, and May 31, 2022, were included. We calculated and analyzed their EWS at ED arrival. The primary outcome was all-cause in-hospital mortality. The secondary outcome was mechanical ventilation.ResultsWe enrolled 735 patients; 272 (37%) died at hospital discharge, and 75 (10.2%) required mechanical ventilation. A-DROP had the highest discrimination capacity for in-hospital mortality (AUROC: 0.698, 95% CI 0.659–0.737) compared to NEWS2 (AUROC 0.657; 95%CI 0.617, 0.698) and REMS (AUROC 0.637; 95%CI 0.596, 0.678). A-DROP also had superior performances than NEWS2 and REMS in terms of calibration, overall model performance, and balanced diagnostic accuracy indices at its optimal cut point (A-DROP ≥ 2). No EWS could perform well in predicting mechanical ventilation.ConclusionA-DROP had the highest prognostic utility for predicting in-hospital mortality in non-COVID-19 pneumonia patients in the ED compared to NEWS2 and REMS.

Procedural sedation in the emergency department by Italian emergency physicians: results of the SEED SIMEU registry

Background and importance Effective and safe procedural sedation is pivotal for the quality of care in the emergency department (ED). Objectives The aim of this work is to evaluate the feasibility, effectiveness, and safety procedural sedation performed by emergency physicians in the ED setting in Italy. Design/setting and participants/intervention Following a specific training of the staff and with the adoption of a standardized protocol, a registry of procedural sedations performed on adult patients in 10 Italian EDs was compiled from 2019 to 2022; the following basic data were recorded: demographic and clinical information, procedure’s indication, administered drugs, predefined, and actual sedation level. Outcome measures and analysis Effectiveness was evaluated considering three parameters: successful completion of the procedure, absence of procedural pain, and no memory of the procedure; adverse events were classified according to the World Society of Intravenous Anaesthesia criteria and evaluated taking into account clinical and procedural variables. Main results The study included 1349 patients (median age 68 years, male 64%). Sedation was performed for electrical cardioversion (66.3%), orthopedic procedures (23.2%), or other procedures (10.5%). Propofol (67%) and midazolam (24.2%) were the two most frequently used sedatives and 70.6% of the patients achieved a deep level of sedation. Procedural failure occurred in 4.6% of cases, with no significant differences between procedure types or drugs used. Recall of the procedure and procedural related pain were reported by 2.9% and 2.6% of patients, respectively, and were more frequently related to orthopedic procedures, midazolam use – if compared with propofol, and lower levels of sedation. A total of 135 adverse events were observed, with an overall incidence of 10%: 38 minimal adverse events (2.8%), 38 minor adverse events (2.8%), and 59 moderate adverse events (4.4%). There were no adverse events requiring unplanned hospital admission or escalation of care, and no sentinel adverse events were observed. All adverse events were resolved with simple and noninvasive treatments. The incidence of adverse events was greater with higher American Society of Anesthesiologists class, intermediate/difficult airway, and deeper sedation levels. Conclusion Procedural sedation performed in Italian EDs by emergency physicians, with propofol as main sedative, was effective and safe, and has comparable adverse event rates with previous international studies.

Extension of an ICU-based noninvasive model to predict latent shock in the emergency department: an exploratory study

BackgroundArtificial intelligence (AI) has been widely adopted for the prediction of latent shock occurrence in critically ill patients in intensive care units (ICUs). However, the usefulness of an ICU-based model to predict latent shock risk in an emergency department (ED) setting remains unclear. This study aimed to develop an AI model to predict latent shock risk in patients admitted to EDs.MethodsMultiple regression analysis was used to compare the difference between Medical Information Mart for Intensive Care (MIMIC)-IV-ICU and MIMIC-IV-ED datasets. An adult noninvasive model was constructed based on the MIMIC-IV-ICU v3.0 database and was externally validated in populations admitted to an ED. Its efficiency was compared with efficiency of testing with noninvasive systolic blood pressure (nSBP) and shock index.ResultsA total of 50,636 patients from the MIMIC-IV-ICU database was used to develop the model, and a total of 2,142 patients from the Philips IntelliSpace Critical Care and Anesthesia (ICCA)-ED and 425,087 patients from the MIMIC-IV-ED were used for external validation. The modeling and validation data revealed similar non-invasive feature distributions. Multiple regression analysis of the MIMIC-IV-ICU and MIMIC-IV-ED datasets showed mostly similar characteristics. The area under the receiver operating characteristic curve (AUROC) of the noninvasive model 10 min before the intervention was 0.90 (95% CI: 0.84–0.96), and the diagnosis accordance rate (DAR) was above 80%. More than 80% of latent shock patients were identified more than 70 min earlier using the noninvasive model; thus, it performed better than evaluating shock index and nSBP.ConclusionThe adult noninvasive model can effectively predict latent shock occurrence in EDs, which is better than using shock index and nSBP.

C‐reactive protein diagnostic value for bacterial infections in the paediatric emergency department setting

AimC‐reactive protein (CRP) is commonly used to assess the probability of bacterial infection and the need for empiric antibiotic treatment. We assessed the relationship between CRP levels and bacterial infection in the paediatric emergency room (PER) setting.MethodsA retrospective cohort study. Relative risks (RRs) were calculated for the relation between CRP levels and various demographic, clinical and diagnosis parameters. Additionally, the sensitivity and specificity of different CRP levels (2, 5, 7 and 10 mg/dL) for bacterial infection diagnosis was calculated.ResultsOverall, 13 092 cases were recorded. Fever, leucocytosis, hospitalisation and bacterial infection diagnosis were associated with elevated CRP levels, while lower CRP levels were associated with young age. Gender, ethnicity, hypoxemia and neutrophilia were not associated with CRP levels. The sensitivity of CRP ≥2 mg/dl for bacterial disease was 65%–70%, declining to &lt;50% in CRP ≥5 mg/dL. The specificity of CRP ≥2 mg/dL for bacterial disease was ~60%, increasing to &gt;80% in CRP ≥5 mg/dL.ConclusionsCRP levels of ≥5 mg/dl high specificity for bacterial disease, allow for its use as an indicator to start empiric antibiotic treatment, while the low sensitivity of various CRP levels probably excludes the possibility of withholding empiric antibiotic treatment, based only on CRP level.

Nonfatal Strangulation Injuries: Improving Physician Knowledge and Attitudes

In the emergency department, physicians evaluate patients who have experienced nonfatal strangulation resulting from sexual assault or intimate partner violence. Given the prevalence and potential consequences of nonfatal strangulation injuries, physicians need confidence in their decision-making for these patients. Previous educational interventions effectively improved physician knowledge of sexual assault and intimate partner violence patients; however, no studies have been conducted with the goal of improving physician knowledge about nonfatal strangulation injuries in this population. Pre- and post-intervention surveys were administered to physicians from four different south-central Indiana emergency departments. These surveys assessed comfort and knowledge regarding the treatment of survivors of sexual assault, intimate partner violence, and nonfatal strangulation. Additionally, six vignette-style questions designed to evaluate knowledge in clinical scenarios were also administered. A 15-min, interactive, educational presentation was delivered prior to the post-survey. Post-intervention participants tended to rate awareness of imaging recommendations and resources, decision-making, history taking, and use of trauma-informed care higher than pre-intervention participants. The post-intervention group ( n = 12) answered more clinical vignette questions correctly with an average of 92% correct compared with the pre-intervention group ( n = 22), which had an average of 76% correct. Based on these results a 15-min educational intervention was effective in improving physician knowledge, confidence, and comfort in treating patients who have experienced nonfatal strangulation in small community-based emergency department settings. In the future, similar interventions may be implemented in other emergency departments to increase awareness about the evaluation and treatment of nonfatal strangulation injuries.

Key Aspects of Recovery-Oriented Practice in Caring for People With Mental Ill-Health in General Emergency Departments: A Modified Delphi Study.

To identify key aspects of recovery-oriented practice in caring for people with mental ill-health in general emergency departments. A modified Delphi study with three rounds. A 24-member expert panel was recruited consisting of people with lived experience of mental ill-health, registered nurses working in emergency care, registered nurses specialised in psychiatric and mental health nursing and mental health recovery researchers. In the initial round, important aspects of recovery-oriented practice were identified through focus group interviews. Thematic analysis generated statements that were then reformulated as a questionnaire for subsequent rounds. The experts rated each statement's perceived importance on a 5-point Likert scale. The consensus level was set at ≥ 80%. Descriptive statistics were used to analyse the data. Consensus was reached on the importance of 39 of 73 statements, with ≥ 80% deemed 'very important' in recovery-oriented practice in general emergency departments. The study emphasises the delicate balance between the essential elements of recovery-oriented practice, their practical feasibility and the predominant biomedical perspective in general emergency department care. It proposes strategies to empower nursing staff and managers to adopt recovery-oriented practices that enhance the quality of care for people with mental ill-health. Enabling staff by providing the necessary prerequisites and a care environment that supports reflective practices is crucial. The responsibility for facilitating these changes needs to be a shared commitment between nursing staff and managers. The identified issues can serve as a framework for interventions, education and training to support the integration of recovery-oriented practice in general emergency care. They can also be used to develop tools for evaluating emergency care environments and promoting alignment with recovery-oriented principles. Problem addressed: People with mental ill-health are at risk of being neglected, judged and dismissed in general emergency department care, creating obstacles to their mental health recovery. The Delphi study identified 39 key aspects of recovery-oriented practice in general emergency departments, emphasising person-centred, strength-based, collaborative and reflective care. The research seeks to establish a foundation for developing training programmes, education and interventions and for the integration of recovery-oriented practices in general emergency care. It thus has the potential to enhance the quality and equality of care for patients with mental ill-health in emergency care. The impact extends to nursing staff and managers as it seeks to empower them to systematically reflect on and reevaluate established emergency department practices to ensure that every person, irrespective of their health condition, is treated with dignity and respect in emergency department settings. The CREDES guidance on conducting and reporting Delphi studies. The authors have nothing to report.

Ultrasonography can be more informative than computed tomography for diagnosing radial head fractures: An illustrative case series.

Ultrasonography is increasingly being discussed as an alternative to X-rays in emergency department settings. Systematic comparisons of the 2 modalities are often based on the use of computed tomography as a reference. When diagnosing patients with elbow trauma, the physicians at our emergency department experienced that ultrasonography can be more informative than cone beam computed tomography for identifying radial head fractures. Our goal is to share this experience with the scientific community.All patients diagnosed with a radial head fracture in our emergency department between January 2021 and November 2022 were identified. The images of 18 cases in which both point-of-care ultrasonography and cone beam computed tomography had been used were reviewed by us. Eight examples were selected illustrating the variation in coincidence or discrepancy between ultrasonography and computed tomography.The 8 examples illustrate that ultrasonography can be more informative than cone beam computed tomography or vice versa.The joint application of ultrasonography and computed tomography is advisable if a correct diagnosis of the extent and components of radial head fractures is of uttermost importance.

Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings.

The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened version, for its efficacy compared with NIHSS-11 in an emergency department setting. A cohort study was conducted from May 2018 to May 2019 at Imam Reza Hospital, Tabriz, Iran. Patients with suspected acute stroke were assessed using both NIHSS-11 and NIHSS-8. The modified Rankin Scale (mRS) was used to evaluate patient outcomes at discharge. Correlations between NIHSS-8, NIHSS-11, and mRS were analyzed, and diagnostic performance metrics were calculated. The study included 292 patients with a mean age of 70.40 years. Approximately 68.5% of patients were categorized as having moderate stroke severity using NIHSS-11, with a similar 67.1% using NIHSS-8. The correlation between NIHSS-11 and NIHSS-8 scores was high (intraclass correlation coefficient of 0.970). Both scales showed strong relationships with mRS at discharge but were not significantly correlated with long-term outcomes. NIHSS-8 demonstrated a sensitivity of 97.5% and specificity of 96.9%, while NIHSS-11 showed 100% sensitivity and 96.9% specificity. NIHSS-8 is a reliable and efficient alternative to NIHSS-11 for assessing stroke severity in emergency departments. It provides high sensitivity and specificity while being less time-consuming, making it suitable for rapid stroke assessment and triage.

A Novel Training Modality for Providers in the Emergency Department Using a Computer-Based Scenario: A Pilot Study.

Individuals with substance use disorders (SUD) are increasingly admitted in emergency departments (EDs) nationwide. However, ED providers often have limited knowledge about and lack confidence in treating SUDs. This limited knowledge often results in poor treatment outcomes among patients with SUD in the ED setting. The aims of this pilot study were to (a) assess the desirability, applicability, and acceptability of a computer-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) education scenario and (b) examine changes in SUD knowledge scores among ED providers before and after engaging in the computer-based SBIRT education scenario. A tailored computer-based education scenario was developed based on the SBIRT framework for ED providers in an academic medical center. Participants (N = 15) evaluated the desirability, applicability, and acceptability of the education tool. Also, a single-group pre-/post-design was used to examine changes in participants' SUD knowledge and proficiency scores. Participants rated the computer-based SBIRT education scenario as desirable, applicable, and acceptable based on 4.0/5.0 or greater evaluation scores for each component. Overall knowledge scores increased from 3.5 to 3.8, albeit non-significantly. Proficiency score percentages increased by 25%. Computer-based SBIRT education scenario training may be acceptable by ED providers and may improve proficiency in addressing SUD for patients. Future studies should evaluate this training method with a larger sample size.

Implementation of a Child Maltreatment Screening Tool in the Prehospital Setting

ABSTRACT OBJECTIVES Emergency Medical Services (EMS) clinicians are in a unique position to screen for child maltreatment as they are often the first point of contact with the health care system and they may encounter children in their home environment. However, EMS training regarding the signs of child maltreatment is lacking. Although several child maltreatment screening tools have been developed for the primary care and Emergency Department (ED) settings, there appears to be no published literature describing or evaluating a prehospital screening aid. The objective of this study was to develop, implement, and examine the effectiveness and acceptability of a prehospital child maltreatment screening tool. METHODS We completed a mixed methods qualitative and quantitative study, with data collection spanning June 2021-June 2022. We developed a child maltreatment screening tool “Shield” for the prehospital setting by adapting Pittsburgh Child Abuse Screening Tool (P-CAST), a screening tool developed at the University of Pittsburgh for use in the ED. Shield was integrated into the EMS electronic Patient Care Report (ePCR) for three participating fire agencies. Data, including demographics, ED evaluation, and outcomes, were collected for patients who underwent Shield evaluation. The EMS clinicians completed self-assessment surveys and participated in focus groups to provide feedback on their experience using Shield. RESULTS Participating EMS agencies evaluated 1,054 eligible patients (children <15 years old) during the study period, June 2021-June 2022. Of these, Shield screenings were initiated on 948 patients and completed on 753. Among all patients for whom a Shield evaluation was started, 32 (3.4%) screened positive for findings and/or histories concerning for possible maltreatment. Of these, 20 patients were transported to the primary study institution; in the ED 10 patients underwent additional child maltreatment evaluation. Pre-implementation surveys suggested a majority (77.2%) of EMS clinicians desired a child abuse screening tool integrated into the ePCR and post-implementation focus group data demonstrated EMS clinicians found Shield to be well integrated into their ePCR. CONCLUSIONS Shield screens were initiated on nearly 90% of pediatric patients evaluated by EMS during the study period, suggesting that this tool has the potential to help standardize child maltreatment screening in the prehospital setting.

How Close Are We to Patient-Side Troponin Testing?

Laboratory-based high-sensitivity cardiac troponin testing has been the pillar for emergency stratification of suspected acute coronary syndrome for well over a decade. Point-of-care troponin assays achieving the requisite analytical sensitivity have recently been developed and could accelerate such assessment. This review summarises the latest assays and describes their potential diverse clinical utility in the emergency department, community healthcare, pre-hospital, and other hospital settings. It outlines the current clinical data but also highlights the evidence gap, particularly the need for clinical trials using whole blood, that must be addressed for safe and successful implementation of point-of-care troponin analysis into daily practice. Additionally, how point-of-care troponin testing can be coupled with advances in biosensor technology, cardiovascular screening, and triage algorithms is discussed.