Emergency Department Research Articles

Disparities in Pediatric Emergency Department Revisits Within 7 Days by Disease Process.

To identify disease processes in which patients experienced the greatest rates of emergency department (ED) revisit disparities by race, ethnicity, language, insurance, and Childhood Opportunity Index. We performed a retrospective, cross-sectional study of ED visits at a comprehensive pediatric health system encompassing three EDs. We included all pediatric (0 to 18y) ED encounters that led to a discharge home (2018 to 2022). The primary outcome was ED revisit within 7 days of the index encounter. We performed multivariable logistic regression to assess the relationship between diagnoses, patient demographics, and 7-day ED revisit. There were 1,008,651 total ED encounters included [53% (n = 529,960) were male]. Of all encounters, 52,176 (5.2%) had a 7-day ED revisit within the system. Patients who identified as black/African American (adjusted odds ratio [aOR]: 1.14, 95% CI: 1.11-1.17), multiracial (aOR: 1.14, 95% CI: 1.06-1.22), Hispanic (aOR: 1.21, 95% CI: 1.17-1.26), and those with public insurance (aOR: 1.19, 95% CI: 1.16-1.23) had greater odds of ED revisit. Disparities in ED revisits among Hispanic patients were concentrated in a few high-volume diagnoses, particularly within ear, nose, throat (ENT)/dental/mouth diseases (aOR: 1.11, 95% CI: 1.01-1.21) such as upper respiratory infections and infectious ear diseases. Conversely, disparities in ED revisits for black/African American patients were widespread across a broader range of diagnoses. Disease-focused interventions are needed to reduce disparities in ED return visits. Focusing on upstream determinants of health may better reduce the burden of ED revisits for minoritized populations at risk of ED revisits.

Abstract 4893: Who falls through the cracks?: Characteristics of women successfully and unsuccessfully navigated to breast cancer screening from the emergency department

Abstract Screening mammography has contributed to decreased breast cancer mortality, but screening disparities exist among racial/ethnic minority populations. Emergency departments (EDs) serve in a safety net capacity for underserved patients and are a novel place for cancer screening education and navigation. We implemented an intervention at two EDs in New Jersey where students recruited patients overdue for breast cancer screening and connected them to patient navigators. This analysis describes participants who were reached by a navigator to make a mammogram appointment versus those not reached, as well as women who attended their appointment versus not. Of 415 ED patients eligible for breast cancer screening (women 40-74 years old), 152 (37%) were eligible for the study (last mammogram >1 year ago), of which 101 agreed to participate. When contacted, 14 (14%) participants were reached and made a mammogram appointment. Women reached were more likely to: be in their 40s (71% vs. 49%), Hispanic (77% vs. 47%), Spanish-speaking (64% vs. 38%), not have private insurance (33% vs. 49%), and have Medicaid (22% vs. 10%) than women not reached. Nine women (9% total, 64% of those reached) attended a mammogram appointment. Women who attended their appointment had similar characteristics as women reached but were more likely to have a primary care provider (PCP) (78% vs 64%) and Medicaid (33% vs 22%) compared to all women who made an appointment. (See table.)Follow-up care is vital to an ED cancer screening intervention. Surprisingly, English speaking and patients with private insurance were less likely to be reached for a mammogram appointment. Patients without a PCP were less likely to attend their appointment. Adapting interventions to target women who “fall through the cracks” is imperative to improving breast cancer equity. More work is needed to strengthen the follow-up process for breast cancer screening for ED patients. Characteristics of Study Participants by Follow-Up Status % Attended Appointment (n=9) Made Appointment (n=14) Was Not Reached (n=87) All (n=101) Age Mean (SD) 48.7 (7.4) 47.8 (6.2) 51.1 (8.1) 50.6 (8.0) 40-49 years 67 71 49 53 50-59 years 22 21 31 29 60-69 years 11 7 19 17 70-74 years 0 0 1 1 Race/ Ethnicity Asian 0 0 6 5 Black 22 23 30 29 Hispanic 78 77 47 51 White 0 0 10 8 Other 0 0 7 6 Language English 33 36 60 56 Spanish 67 64 38 42 Other 0 0 2 2 Insurance Type Private 33 33 49 47 Medicaid 33 22 10 12 Medicare 0 0 8 7 No Insurance 33 33 27 28 Other 0 11 6 7 PCP (Y/N) Yes 78 64 52 54 Highest Level of Education Less than HS degree 38 42 38 38 HS degree or GED 38 33 40 39 Associate’s degree 13 8 5 5 Bachelor’s degree 13 17 10 11 Master’s degree 0 0 7 6 Citation Format: Sara Heinert, John Hemphill, Gabrielle Gracias, Maya Iglesias, Jessica Kim, Hrithika Ravuri, Antonia Sames, Alexandra Sobocinski, Ana Natale-Pereira, Erin Muckey, Pamela Ohman-Strickland, Vince Silenzio, Jonathan McCoy, Amanda Esposito, Ethan Halm, Mary O'Dowd, Humaira Chaudhry. Who falls through the cracks?: Characteristics of women successfully and unsuccessfully navigated to breast cancer screening from the emergency department [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4893.

Evaluation of a text message + pedometer intervention to increase steps after emergency department discharge: a pilot study.

Older adults face increased risk of functional impairments after Emergency Department (ED) discharge, yet no evidence-based interventions exist for this population. To evaluate the feasibility, safety, and effectiveness of Safe Steps, a text message + pedometer intervention designed to motivate individuals to meet step count goals. We recruited ED patients aged ≥ 60 with low physical activity. Participants received a pedometer in the ED, daily text messages to report steps, and weekly prompts to set step goals over 4 weeks. We assessed step count reporting rates, falls, and change in steps over time. Among analyzed participants (n = 40), daily step reporting was high (95% of weeks with 2 + readings). No participants had falls due to the intervention. Step count increased by a mean of 359 steps per week (95% confidence interval 182-536). Safe Steps appears feasible, safe, and may be effective for promoting activity after ED discharge.

Dengue-Associated Acute Demyelinating Polyradiculoneuropathy: A Case Report

Dengue is a viral disease endemic in tropical and subtropical regions. Four serotypes have been identified, with types 2 and 3 most frequently associated with neurological manifestations, including Guillain-Barré syndrome (GBS). A 51-year-old male patient with a history of dengue infection without severity criteria. He later develops asthenia, adynamia, and progressive weakness in the lower extremities, rapidly evolving into ascending paralysis and respiratory failure. He arrives at the emergency department with severe headache, nausea, and vomiting, presenting as hemodynamically stable but with progressive neurological deterioration. A cranial CT scan shows no relevant findings. Neurology evaluates the patient, and immunoglobulin therapy is initiated due to suspected GBS. Laboratory tests reveal hyperglycemia (302 mg/dL) and mild hyponatremia (132 mmol/L), with a normal complete blood count and coagulation parameters. However, the patient’s condition deteriorates rapidly, leading to neurological decline and respiratory collapse. Despite therapeutic measures, the patient dies on the same day of admission. This case highlights the lethality of Guillain-Barré syndrome secondary to dengue and the importance of timely diagnosis and management. The rapid progression to respiratory failure and lack of response to treatment emphasize the need for a high index of suspicion and intensive monitoring in these patients.

Hospital experiences and medical traumatic stress in adults with spina bifida.

PurposeThis study examined hospital and emergency department (ED) experiences of adults with spina bifida (SB). It investigated the association between medical traumatic stress (MTS) and participant characteristics, anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and resiliency scores.MethodsAdults with SB who had a hospital or ED encounter within the last five years were recruited from a medical home clinic and completed a structured interview and validated questionnaires. Interview responses were characterized using qualitative theme analysis, questionnaires were scored using published guidelines, and MTS scores were reported per participant characteristic and emotional health questionnaire score counts and percentages.ResultsTwenty-five adults with SB were recruited, representing 37% of eligible patients. A majority of participants scored positive for at least one symptom cluster of MTS. No trends were noted within the demographic or SB data when compared to MTS scores. There was a trend of increased MTS symptom clusters associated with increased depression, anxiety, and PTSD, and a trend of decreased MTS symptom clusters associated with increased resilience. The narrative analysis yielded three distinct themes: negative hospital environment (sub-themes: feeling unheard, insufficient communication, care delays, and an uncomfortable adult healthcare environment), SB-related condition concerns and complications (sub-themes: adult providers lacking SB knowledge, multiple hospitalizations, pain, urology concerns, skin/bone infections, shunt/neurosurgery care, anxiety about needed procedures and illness severity, and MTS symptom clusters), and positive supports when in the hospital (sub-themes: self-advocacy, resilience, family support, positive patient/provider communication, and positive care outcome).ConclusionFurther research with a larger study population is necessary to draw significant conclusions about relationships between demographic and SB data, emotional health, and MTS. However, this study identified opportunities for improving healthcare experiences for this patient population, including facilitating communication, inquiring about potentially traumatic medical experiences, and promoting self-advocacy, self-efficacy, resilience, and familial support.

Abstract 5957: A real-world study for cost-effectiveness analysis of nanoliposomal irinotecan in patients with pancreatic adenocarcinoma

Abstract Background: Systemic chemotherapy plays a crucial role in pancreatic adenocarcinoma (PAC), not only as palliative chemotherapy for unresectable PAC, but also as (neo-)adjuvant chemotherapy for (borderline) resectable PAC. Recently, nano-liposomal irinotecan plus 5-fluorouracil/leucovorin (nal-IRI/5-FU/LV) showed a survival benefit in the global phase 3 NAPOLI-1 trial. However, there is a paucity of studies that have evaluated the effectiveness and cost analysis of nal-IRI in the entire treatment course of PAC. Therefore, this study aimed to evaluate the effectiveness and cost of treatment according to exposure to nal-IRI in the management of PC using an electronic health record data. Methods: We analyzed the effectiveness and cost according to the exposure of nal-IRI/5-FU/LV treatment during follow-up. Effectiveness was assessed by overall survival (OS) and direct medical costs including costs of imaging or laboratory tests, administration of chemotherapy, surgery, or radiotherapy, supportive care, management of adverse events during inpatient, outpatient, and emergency department were included in this study. Propensity score matching was used to adjust for potential differences in patient characteristics between nal-IRI group and non-liposomal irinotecan group. We defined the incremental cost-effectiveness ratio as the difference in mean total medical costs (per patient) divided by the difference in median OS between two groups. Results: A total of 1, 734 patients diagnosed with PAC were screened, and 705 patients who received at least one cycle of chemotherapy were included in the analysis. Median OS was significantly longer in the nal-IRI group compared to the non-liposomal irinotecan group (28.0 months vs. 18.3 months, P = 0.011). Patients in the nal-IRI group had more hospital visits and admissions during follow-up, the average total cost per patient was was higher in the nal-IRI group ($61, 430 vs $39, 129). The incremental cost-effectiveness ratio was $2, 787 per month of median survival gained ($33, 285 per life-year gained). Conclusions: In this real-world retrospective study, patients treated with nal-IRI/5-FU/LV showed longer OS and the incremental cost-effectiveness ratio was acceptable given the poor prognosis of PAC. Funding: This work was supported in part by Servier No. 2152460) and in part by the National Cancer Center, Korea (No. 2310280). Citation Format: Jung Won Chun, Jang Won Lee, Dong Kee Jang, Yoon Suk Lee, Jong-Chan Lee, Jin-Hyeok Hwang, Byeong-Gon Kim, Sung Jun Kim, Gyuryang Park, Tae Young Kim, Young Ae Kim, Sang Myung Woo. A real-world study for cost-effectiveness analysis of nanoliposomal irinotecan in patients with pancreatic adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5957.

Ultrasound evaluation of the optic nerve in patients with severe symptomatic hyponatremia.

Severe hyponatremia can precipitate significant neurological symptoms due to osmotic imbalances that induce intracranial hypertension (ICH). This study investigates the correlation between serum sodium levels and optic nerve sheath diameter (ONSD), measured by ultrasound, in patients presenting with symptomatic severe hyponatremia in the Emergency Department. Sixty-four patients with severe hyponatremia (Na+ < 125mmol/L) and neurological symptoms were enrolled and compared to a matched control group. Serial measurements of serum sodium and ONSD were obtained at 3, 12, and 24h post-correction. Results demonstrated a significant inverse correlation between sodium levels and ONSD, with ONSD decreasing as sodium levels were corrected (r = -0.71). ROC analysis confirmed ONSD as a sensitive and specific indicator of elevated intracranial pressure in these patients. This study highlights ultrasound ONSD measurement as a valuable non-invasive tool for monitoring ICH in severe hyponatremia, supporting its role in emergency settings to enhance diagnostic accuracy and therapeutic monitoring. Further research is needed to validate these findings and elucidate prognostic implications.

Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use Disorder: A Randomized Clinical Trial.

Alcohol use disorder (AUD) is common in hospital patients. AUD medications are not typically initiated in that setting. The comparative effectiveness between initiation of oral naltrexone and extended-release injectable naltrexone in the hospital is not known. To compare the effectiveness of initiating oral naltrexone vs extended-release injectable naltrexone on reduction in alcohol use and health care utilization among medical inpatients with AUD. The Alcohol Disorder Hospital Treatment (ADOPT) study is a randomized clinical trial conducted at an urban teaching hospital in the US, with enrollment between June 2016 and March 2020. Inpatients were screened for eligibility, and those with AUD and recent heavy drinking (defined as 5 or more drinks for men and 4 or more drinks for women) were enrolled. Outcomes were assessed at 3-month follow-up; assessors were not blinded to treatment assignment. Data were analyzed from May 2021 to September 2023. Participants received either daily oral naltrexone or monthly extended-release injectable naltrexone. All received medical management with a research nurse who specialized in addiction. The primary outcome was change in percentage of heavy drinking days (HDDs) over the past 30 days from baseline to 3-month follow-up, assessed by validated instrument. The secondary outcome was any acute health care utilization (emergency department or hospitalization) at 3-month follow-up over the past 90 days. Of 248 participants, 199 (80.2%) were male, and the mean (SD) age was 49.4 (10.4) years. The baseline median (IQR) percentage of HDDs in the past 30 days was 80.0% (43.3-100). At 3-month follow-up, the mean percentage of HDDs in the past 30 days was reduced in both groups (oral naltrexone: baseline, 66.7% HDDs; 3-month follow-up, 27.4% HDDs; difference, -38.4 percentage points; 95% CI, -125.0 to 48.2; extended-release injectable naltrexone: baseline, 70.7% HDDs; 3-month follow-up, 23.8% HDDs; difference, -46.4 percentage points; 95% CI, -123.4 to 30.6; P = .14). At follow-up, 59 of 109 in the oral naltrexone arm (54.1%) and 66 of 108 in the extended-release injectable naltrexone arm (61.1%) reported acute health care utilization in the prior 3 months; the odds of this utilization were not significantly different between groups (adjusted odds ratio, 1.34; 95% CI, 0.77-2.33). In this randomized clinical trial, when initiated at hospital discharge, oral and extended-release injectable naltrexone did not differ in effectiveness. Participants had substantial reductions in HDDs in both treatment groups; however, there was not a significant difference in the reduction of percentage of HDDs in the past 30 days or acute health care utilization between groups. Hospitalization represents an opportunity to start AUD pharmacotherapy; choice of oral naltrexone vs extended-release injectable naltrexone should be directed by factors such as patient preference and insurance. ClinicalTrials.gov Identifier: NCT02478489.

Medetomidine-Associated Opioid Overdoses in Chicago, Illinois: A Report of 3 Cases.

Medetomidine has recently emerged as an adulterant in street-level opioids and stimulants in North America, complicating opioid overdose presentations and resisting reversal with naloxone. Medetomidine is an alpha-2 adrenergic receptor agonist used in veterinary medicine as an anesthetic, analgesic, anxiolytic, and muscle relaxant and is not approved for human use by the Food and Drug Administration. Medetomidine's pharmacological profile resembles xylazine, another medication of the same class, but demonstrates higher potency and longer sedative effects in canine models. We present 3 cases of opioid overdoses involving medetomidine at the same emergency department, which are part of a larger series of at least 12 confirmed, 26 probable, and 140 suspected cases in Chicago between May 11 and May 17, 2024. Each presented with sinus bradycardia, hypertension, and prolonged sedation, which persisted after naloxone administration. Laboratory results confirmed medetomidine, fentanyl, and other substances in their systems. Management involved symptomatic treatment, including cardiorespiratory support and antihypertensive therapy. Given the severity of their opioid use disorders and social vulnerabilities, patients received extended-release buprenorphine injections. Despite different clinical courses, the cases shared a constellation of features and presenting symptoms likely attributed to medetomidine-associated toxicity. These cases underscore the clinical challenges of recognizing and managing medetomidine as an emerging drug adulterant. Unlike typical opioid overdoses, medetomidine intoxication may require different management strategies due to prolonged sedation, bradycardia, and hypertension despite standard-of-care overdose treatment. Improved access to testing for medetomidine and research into alpha-2-antagonist reversal options are crucial for optimizing treatment outcomes.

Perceptions of an Electronic Patient Symptom Reporting Tool by Clinicians.

Prior to implementing an electronic health record-integrated patient-reported outcomes system, eSyM, the perceived facilitators and barriers to implementation from multiple stakeholder perspectives were sought. The purpose is to report the findings of the perceived facilitators and barriers to implementation of eSyM from multiple clinician stakeholder perspectives. Stakeholders included administrators, clerical staff, information technology professionals, support staff, physicians, providers, and nurses from six Symptom Management Implementation of Patient-Reported Outcomes in Oncology health systems, a diverse mix of academic/community, rural/metropolitan, and Northeastern and Southern community-based cancer centers. Site information, participant information, perceived effectiveness, and perceived patient barriers to use were collected from 173 stakeholders. RNs were the most represented participants, followed by physicians, physician assistants, and nurse practitioners. Stakeholders felt that eSyM would be effective in improving patient symptom management, keeping patients out of the hospital and emergency department, and improving clinic efficiency. Clinician stakeholders perceived eSyM as necessary and effective for improving symptom management. Most stakeholders felt that their colleagues would be supportive of using eSyM. Stakeholders perceived minor patient barriers were access to technology, distrust of technology, and English language proficiency. Computer literacy was perceived as a major barrier. Future longitudinal mixed-methods design that combines quantitative findings with qualitative observations is needed. Understanding the contextual factors that influence the facilitation or barriers of implementing eSyM is needed to scale and spread the intervention to other institutions. As a nursing intervention, the assessment of the perceptions of improvement of eSyM workflow would be especially useful.

Disseminated Tuberculosis Complicated with Disseminated Intravascular Coagulation (DIC) in an Immigrant Patient

Disseminated tuberculosis (TB) is rare, can affect any organ system, and predominantly presents in immunocompromised populations. While pulmonary tuberculosis (TB) is prevalent in developing countries, it is an uncommon cause of disseminated TB. In pediatric populations, particularly in the first and second decades of life, disseminated TB is often secondary to lung infections. However, there have been few reports of disseminated TB complicated by disseminated intravascular coagulation (DIC). Disseminated TB is defined as the involvement of two or more noncontiguous sites due to the lymphohematogenous spread of Mycobacterium tuberculosis. Extrapulmonary involvement occurs in one-fifth of all TB cases and may present without histological or radiological evidence of pulmonary infection. An eleven-year-old girl presented to the emergency department (ED) with complaints of weight loss and abdominal pain. She had no history of immunodeficiency but had been in contact with TB patients. On admission, she exhibited refractory coagulopathy, necessitating transfer to the pediatric intensive care unit (PICU). In the PICU, intravenous vitamin K, fresh frozen plasma (FFP), and packed red blood cells (PRBCs) were administered on the 14th day of admission, following the initiation of antibiotics and a combination of standard anti-tuberculous drugs. It can be speculated that many pediatric cases of TB-induced pneumonia leading to acute respiratory distress syndrome (ARDS) remain unreported in the literature. More robust data on the epidemiology of childhood TB are necessary to better understand its contribution to ARDS and to develop pediatric-specific therapeutic strategies. Some risk factors for disseminated TB include young age, recent measles infection, immunodeficiency, malnutrition, and malignancies. Children, especially infants and immunocompromised patients, are at higher risk of developing miliary and disseminated TB. However, none of these contributing factors were identified in this child. In the present case, the patient had no HIV infection or immunodeficiency but was an immigrant from an endemic country and had a history of contact with TB patients. The onset of her symptoms closely resembled those of inflammatory bowel disease (IBD), and she later developed coagulation disorders and DIC. We successfully treated disseminated TB complicated by DIC using antibiotics, FFP, PC, vitamin K, and anti-tuberculous therapy. The follow-up indicated an improvement in her condition and the resolution of symptoms.

Removable Boot vs Casting of Toddler's Fractures: A Randomized Clinical Trial.

Toddler's fractures (TF) of the tibia are commonly treated with casts and fracture clinic follow-up. However, a prefabricated removable boot might be sufficient and reduce unnecessary follow-up. To determine whether pain in children with TF treated with a removable boot is not worse than those managed with a circumferential cast at 4 weeks postinjury. This pragmatic, multicenter, assessor-blinded, noninferiority randomized clinical trial was conducted between October 2019 and February 2024 at 4 urban, tertiary care, pediatric Canadian emergency departments. Children aged between 9 months and 4 years with a radiograph-visible TF were eligible for inclusion. Prefabricated walking boot for up to 3 weeks (removable at caregivers' discretion) vs circumferential cast immobilization (site standard of care) for 3 weeks. The primary outcome was pain score, measured with the Evaluation Enfant Douleur (EVENDOL) scale (maximum score: 15). Additional outcomes included return to baseline activities, complications, parental satisfaction and care burden. In 129 enrolled children, the mean (SD) age was 2.2 (0.8) years, and 56 children (43%) were female. Of these, 118 children (92%) completed the 4-week follow-up, and the boot (n = 64) vs cast (n = 54) groups demonstrated mean (SD) EVENDOL pain scores of 1.21 (1.54) and 1.76 (2.13), respectively (difference, -0.55; 95% CI, -1.23 to 0.13). The percentage of participants who returned to baseline activities "almost all of the time" was 49 of 64 children (77%) in the boot group and 22 of 54 (41%) in the cast group (difference, 36%; 95% CI, 9%-63%). Skin complications occurred in both groups (boot: 46 total complications [72%], with 5 stage 1 pressure sores; cast: 27 total complications (50%), with 1 pressure sore]; difference, 22%; 95% CI, -6% to 50%). There was no statistically significant difference in the percentage of caregivers who were satisfied or very satisfied with the treatment (difference, 9%; 95% CI, -24% to 43%). Fewer caregivers reported bathing care burden (difference, -32%; 95% CI, -47% to -18%) and challenges with carrying the child (difference, -21%; 95% CI, -27% to -15%) in the boot vs cast group. In this multicenter randomized clinical trial examining the management of children with TF, a removable boot without physician follow-up was noninferior to circumferential casting with respect to pain recovery. While there was a clinically relevant but not statistically significant trend toward more skin complications in the boot group, there was no difference in caregiver satisfaction, and the boot strategy demonstrated reduced childcare-related challenges. ClinicalTrials.gov Identifier: NCT03971448.

Corrosive Substance Ingestion: When to Perform Endoscopy?

Ingestion of corrosive substances is a difficult and important medical problem to manage. The aim of this study is to present an algorithm that will regulate the treatment and follow-up of paediatric patients with corrosive ingestion. Children who were admitted to the paediatric emergency department with corrosive substance ingestions between July 2015 and December 2021 were included. Between July 2015 and January 2020, endoscopy was performed on all patients. After January 2020, endoscopy was performed only for patients presenting with hypersalivation and dysphagia. 172 patients were followed up and treated in our clinic due to corrosive substance ingestion. Endoscopic evaluation of 19 patients with hypersalivation revealed oesophageal corrosion stages as follows: grade I in 5 patients, grade II-A in 1 patient, grade II-B in 3 patients, and normal findings in the remaining patients. Of the 14 patients with dysphagia, 1 had grade I, 2 had grade II-A, and 4 had grade II-B corrosion, and the remaining patients had normal endoscopic findings. In the long-term follow-up of the patients without hypersalivation and dysphagia, no complications developed and no additional treatment was required. In patients presenting with suspicion of ingestion of high risk corrosive substances, there is no need for endoscopy unless hypersalivation and dysphagia are present simultaneously.

Abstract 5945: Cancer care in rural America: factors associated with acute care utilization following chemotherapy at a community cancer center

Abstract Background Acute care use (ACU) events, including emergency department visits and hospitalizations following chemotherapy, are costly and often preventable with outpatient interventions. The Centers for Medicare &amp; Medicaid Services track ACU within 30 days of outpatient chemotherapy through the OP-35 measure. While predictive models exist to identify at-risk patients, few have been validated on diverse populations. We aimed to quantify the differences between those who experience ACU and those who do not. Patients and Methods In a retrospective study of 5, 575 patients receiving chemotherapy between October 2021 and May 2024, we assessed ACU within 180 days of any chemotherapy visit using institutional records and claims data. Of these, 3, 230 patients (57.9%) experienced an ACU event, with a median of 75 days between chemotherapy and ACU. Among those with an ACU event, 2, 491 patients (77.1%) experienced an event within 30 days of chemotherapy, 509 (15.8%) within 90 days, and 230 (7.1%) by 180 days. Results Demographics and comorbidities differed significantly between groups. Patients with ACU events were older (66 vs. 64; p &amp;lt; .0001), more likely to be former smokers (38% vs. 33%; p &amp;lt; .0001) or alcohol users (14% vs. 9%; p &amp;lt; .0001), less likely to live rurally (28% vs. 31%; p = .003), more likely to use Medicare (59% vs 53%; p &amp;lt;.0001), and more likely to be mobility impaired (38% vs 17%; p &amp;lt;.0001). These patients were also more likely to have multiple primary tumors (40% vs. 23%; p &amp;lt; .0001) and had higher weighted Charlson Comorbidity Index scores (4.52 vs. 3.19; p &amp;lt; .0001). There were notable differences between groups in terms of prior hospital utilization. Patients with ACU had a greater number of previous inpatient admissions (7 vs. 4; p &amp;lt; .0001) and spent more days hospitalized per admission (4.7 vs. 3.8 days; p &amp;lt; .0001). There was also variation in laboratory markers. Patients with ACU events exhibited lower pre-chemotherapy albumin levels (3.83 vs. 4.03 g/dL; p &amp;lt; .0001) and higher neutrophil-to-lymphocyte ratios (3.16 vs. 2.79; p &amp;lt; .0001), suggestive of greater inflammation. A LASSO logistic regression model was applied to predict ACU within 30-day and 180-day windows, achieving prediction accuracies of 69% and 72%, respectively (AUC: 0.76 and 0.79). Conclusions These findings show various factors are associated with increased risk of ACU, which is essential for determining which patients may benefit most from proactive outpatient support to reduce ACU rates, drive patient satisfaction, and lower costs. This work will be applied prospectively to triage patients at highest risk. Additionally, future work will focus on distinguishing preventable from non-preventable ACU events. Citation Format: McKenna Deaton, Crystal Hattum, Sam Gaster, Samantha Olson, Sheena Lewis, Katherine Rehfeld, Christina Early, Lacey Roberts, Maren Ernst, Cynthia Kannenberg, Mary Hughes, Julia Althoff, Jamie Arens, Tobias Meissner. Cancer care in rural America: factors associated with acute care utilization following chemotherapy at a community cancer center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5945.

Barriers to recruitment of an observational SARS-CoV-2 emergency department cohort at Boston Medical Center

BackgroundSuccessful recruitment of study participants is a challenging component of research, and recruitment barriers are amplified in safety-net hospital (SNH) settings. However, engaging historically underrepresented groups in research is critically important to improve health disparities and outcomes. We summarize challenges we encountered while recruiting patients with COVID-19 from the emergency department (ED), actions to improve inclusivity, and implementation hurdles in an SNH setting.MethodsWe conducted an observational study at the largest safety-net hospital in New England, recruiting patients in the ED with confirmed COVID-19. Investigators prioritized recruitment inclusivity through language translations of study materials, compensation (including transport and travel reimbursement), flexible sample delivery options, and clinical staff engagement. We identified and categorized major impediments to recruitment success.ResultsRecruitment and retention efforts were largely unsuccessful (n = 4 enrolled of n = 113 eligible by electronic medical record (EMR) review). Barriers to recruitment success included clinical teams’ perception of good candidacy, persistent language barriers, limited consent capacity, burden of participation, and ED discharge logistics.ConclusionsDespite efforts to improve opportunities to participate in research, SNH EDs present unique challenges for recruitment. Study teams should prioritize clinical staff engagement and work with institutions to promote inclusivity and community engagement efforts to improve research engagement in these settings.Clinical trial numberNot applicable.

Triage decisions and health outcomes among oncology patients: a comparative study of medical and surgical cancer cases in emergency departments

BackgroundCancer-related emergencies are a significant challenge for healthcare systems globally, including Jordan. Effective triage is critical in ensuring timely and accurate prioritization of care, especially for surgical cancer patients requiring urgent intervention. However, under-triage—misclassification of high-acuity patients into lower urgency categories—can lead to significant delays and worsened outcomes. Despite the recognized importance of accurate triage, limited research has evaluated its impact on cancer patients in Jordan, particularly those requiring surgical care.ObjectivesThis study aimed to evaluate the timeliness and prioritization of care for cancer patients admitted through the emergency department (ED) in Jordan. The specific objectives were to examine the association between under-triage and treatment delays and assess its impact on key outcomes, including time to physician assessment, time to treatment, and hospital length of stay.MethodsA retrospective cohort design was used to analyze data from 481 cancer patients admitted through the ED in four governmental hospitals across Jordan. Two cohorts were established: surgical cancer patients requiring emergency interventions and non-surgical cancer patients presenting with other oncological emergencies. Triage accuracy was assessed using the Canadian Triage and Acuity Scale (CTAS), and under-triage was identified when patients requiring high urgency care (CTAS I-III) were misclassified into lower urgency categories (CTAS IV-V). Data were collected from electronic health records and analyzed using multiple linear regression to evaluate the association between under-triage and treatment outcomes.ResultsThe majority of patients were elderly, with a mean age of 62.6 years (± 10.7), and a significant proportion presented with advanced-stage cancer (83.4% in stages III and IV). Surgical patients frequently exhibited severe symptoms such as acute pain (51.6%) and respiratory discomfort (41.1%). Under-triage rates were 44.1% for surgical patients and 39.4% for non-surgical patients. Among surgical patients, under-triage significantly delayed time to physician assessment (β = 34.9 min, p < 0.001) and time to treatment (β = 68.0 min, p < 0.001). For non-surgical patients, under-triage delays were even greater, with prolonged physician assessment times (β = 48.6 min, p < 0.001) and ED length of stay (β = 7.3 h, p < 0.001). Both cohorts experienced significant increases in hospital length of stay (surgical: β = 3.2 days, p = 0.008; non-surgical: β = 3.2 days, p < 0.001).ConclusionUnder-triage in Jordanian EDs is strongly associated with significant delays in care for both surgical and non-surgical cancer patients, highlighting systemic gaps in acuity recognition and triage processes. These findings underscore the need for targeted interventions to improve triage accuracy, particularly through oncology-specific training and the integration of evidence-based tools like SIRS criteria. Enhancing ED processes for cancer patients is crucial to reducing delays, optimizing resource allocation, and improving clinical outcomes in this vulnerable population.Clinical trial numberNot applicable.

The Role of Psychological Capital and Job Burnout in the Serial Mediation Between Social Support and Leisure Crafting of Nurses in Emergency Department.

This study examines the effects of social support and psychological capital on job burnout and leisure crafting among emergency department nurses, focusing on the serial-mediating roles of psychological capital and job burnout. AMOS 26 was used to test serial mediation by administering 317 survey questionnaires to conveniently selected nurses employed at nine Grade-A hospitals in China. Results showed social support significantly influenced leisure crafting (β = 0.94, p = 0.014, CI = 0.150-2.131), with psychological capital (β = 0.82, p = 0.005, CI = 0.315-10.354) and job burnout (β = 0.28, p = 0.036, CI = 0.032-0.722) serving as significant mediators. A serial-mediating effect was also observed (β = 0.16, p = 0.042, CI = 0.003-0.477), accounting for 57.3% of the total effect. The findings suggest that enhancing social support, psychological capital, and reducing burnout can improve nurses' well-being, work performance, and leisure crafting.

The perils of pickleball: A two decade analysis of upper and lower extremity injuries from America's fastest growing sport.

This study seeks to evaluate the epidemiology of pickleball upper/lower extremity injuries presenting to US emergency departments (E.D). The National Electronic Injury and Surveillance System (NEISS) database was queried from 2003-2022 to identify patients presenting to the ED with injuries sustained during 'pickleball' to upper/lower extremities. Patients were subsequently divided into pediatric, adult, and geriatric age groups. Demographic and clinical variables were assessed among age groups utilizing two-proportion z-tests with Bonferroni correction. A total of 749 patients with extremity pickleball injuries were identified from NEISS (33 pediatric, 286 adult, 430 geriatric). Pickleball extremity injuries dramatically increased from 2012 to 2022 by 3,650%. Geriatric and pediatric patients had greater frequencies of upper extremity injuries relative to adults (60.2% vs. 40.6%; p < 0.001 and 63.6% vs 40.6%; p = 0.022, respectively). Adults had a significantly greater frequency of lower extremity injuries (59.4%) relative to both pediatric (36.4%; p = 0.022) and geriatric (39.8%; p < 0.001) patients. Patients who were hospitalized after injury were significantly older (68.8 vs. 62.5; p = 0.033) and most commonly incurred a fracture (88.9% vs 34.8%; p < 0.001). This study provides a critical epidemiological analysis of injury trends captured in this popular sport.

The Development of Acute Outreach Services in Aged Care Facilities (Nursing Homes): Using Telemedicine in Rural Areas

Acute outreach services for older patients in nursing homes are being developed as our population ages rapidly, putting stress on the resources of hospitals and emergency departments. Since the COVID pandemic, the acceleration of the utilization of telemedicine has also been adopted for acute outreach services in metropolitan areas, with preliminary evidence supporting safety, but the generalization of the service to other settings, such as rural areas, is less clear.

Reorganization of the Danish out-of-hours primary care - a descriptive study.

Increasing demand for healthcare due to demographic changes and shortage of healthcare professionals challenges the provision of unplanned care. In Denmark, different organizational changes across all regions have been implemented to meet these challenges. This provides great potential for research on the effect of different organizational choices on the use and quality of healthcare. Thus, we aim to provide a comprehensive overview of the current organizational models for acute unplanned out-of-hours primary care (OOHPC) across the five Danish regions, incorporating key contextual factors to characterize these regional systems. Nationwide cross-sectional survey study on OOHPC models in all Danish regions (North, Central, Southern, Capital, and Zealand). Survey questions covered a list of predefined topics created in the author group. One survey was completed per region. OOHPC models differ across regions and time of day. In the North, Central, and Southern regions from 4 PM-11 PM, general practitioner (GP) cooperatives deliver OOHPC (telephone triage, tele- and clinic consultations, and home visits). From 11 PM-8 AM, the regional emergency medical services provide OOHPC in the North (GPs/physicians, paramedics) and Central (physicians, nurses, paramedics) regions. In the Southern region, the administrative responsibility of the OOHPC lies with the emergency department, but GPs provide healthcare aided by paramedics. The Capital, Central (nights), and Zealand regions have nurses and physicians performing telephone triage. All regions provide clinic consultations with physicians. In the Capital region, these consultations are hospital-based. Currently, no OOHPC data is transferred to national registries in four regions during nighttime. Danish OOHPC models differ substantially regarding the use of healthcare professionals for delivering acute unplanned care. All regions still provide gatekeeping, where OOHPC performs a primary evaluation before a possible hospital contact. Delivery of relevant data to registries has decreased substantially with the current models, potentially creating a barrier for nationwide research on OOHPC.