Recent westjem items

Contraception in the ED: Understanding Education and Opportunities for Clinicians to Advise Patients

Thu, 14 May 2026 00:00:00 +0000

Introduction: The United States faces a high rate of unwanted pregnancies. Despite this, many people continue to face barriers to accessing contraception. The emergency department (ED) can help bridge these gaps, but emergency clinicians must first feel comfortable offering contraceptive services. In this study, we sought to determine emergency clinician comfort in prescribing contraceptives and educating patients on their use. We also gauged clinician interest in receiving education specifically geared toward contraceptive care.

Methods: We conducted an online survey of ED residents, attendings, and advanced practice clinicians at Thomas Jefferson Univerity Hospital and affiliates in both the urban and suburban setting. Questions focused on current practices and interest in an educational session on contraceptive care in the ED.

Results: We received 106 responses representing clinicians from 12 hospitals (estimated...

Enroller Experience and Parental Familiarity of Disease Influence Participation in a Pediatric Trial

Thu, 14 May 2026 00:00:00 +0000

Introduction: Acquiring parental consent is critical to pediatric clinical research, especially in interventional trials. In this study we investigated demographic, clinical, and environmental factors associated with likelihood of parental permission for enrollment in a study of therapies for diabetic ketoacidosis (DKA) in children. Methods: We analyzed data from patients and parents who were approached for enrollment in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) trial at one major participating center. We determined the influence of various factors on patient enrollment, including gender, age, distance from home to hospital, insurance status, known vs new onset of diabetes, glycemic control (hemoglobin A1c), DKA severity, gender of the enroller, experience of the enroller, and time of enrollment. Patients whose parents consented to participate were compared to those who declined participation using bivariable...

Assessment of Inter-rater Variability in the Diagnosis of Urinary Tract Infections in the Emergency Department

Thu, 14 May 2026 00:00:00 +0000

Introduction: Urinary tract infections (UTI) are among the most common bacterial infections diagnosed in the emergency department (ED), yet the urinalysis results can be neither sensitive nor specific for UTI. Our objective was to quantify inter-rater variability of three emergency attending physicians for the clinical diagnosis of UTI, and secondarily to compare the diagnosis made at bedside by the treating clinician with the evaluations of three emergency physician-chart reviewers after the fact.

Methods: Chart reviewers read 18 articles on the diagnosis of UTI before retrospectively evaluating a convenience sample of 473 ED encounters where patients received both a urinalysis and urine culture as part of their ED evaluation. The chart reviewers were blinded to the urine culture results, medications administered and prescribed, and to the treating clinician’s diagnoses. Reviewers were asked to rate the likelihood of UTI based on a...

Randomized Controlled Pilot Study of Transcutaneous Electrical Nerve Stimulation for Acute Back Pain in Emergency Department Patients

Thu, 14 May 2026 00:00:00 +0000

Background: Musculoskeletal back pain is a common presenting complaint to emergency departments (ED) worldwide. In this study we aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunct to standard care in reducing pain for patients presenting with acute low back pain.

Methods: This study has a dual-center, open-label, cluster-randomized controlled trial design. Participants were recruited from two tertiary-care EDs in Canada. We included patients with acute or acute-on-chronic back pain of < 3 weeks duration. Participants were randomized to receive either TENS for 30 minutes plus standard care, or standard care alone. We measured pain scores using the Visual Analogue Scale (VAS) at baseline, 30 minutes, and 60 minutes after initiation of the intervention. The primary outcome was the difference in mean VAS pain scores at 60 minutes between the two groups.

Results:...

Non-Opioid Pharmaceutical Alternatives for Acute Pain Management in the Emergency Department: A Scoping Review

Thu, 14 May 2026 00:00:00 +0000

Objectives: In light of the ongoing opioid epidemic, emergency clinicians have faced the difficult challenge of managing acute pain while reducing opioid prescriptions. Improved use of non-opioid analgesics could decrease the need for opioid medications in the management of acute pain. Limited work has been done to systematically produce a comprehensive list of non-opioid pharmaceuticals targeted to specific pain-associated conditions.

Methods: We conducted a scoping review of recent literature for non-opioid pharmaceuticals that could help manage five painful conditions commonly treated in our institution’s ED: abdominal pain; back pain; chest pain; fracture pain; and headache. In November 2023, we identified reviews published from November 2018–2023 in PubMed to curate a list of alternatives to opioids to effectively manage acute pain.

Results: We screened 246 studies that reviewed management approaches...

Unequal Relief: Sex Disparities in Opioid Use for Cardiac Chest Pain in the Emergency Department

Thu, 14 May 2026 00:00:00 +0000

Introduction: Acute chest pain, commonly caused by coronary artery disease, is a frequent reason for emergency department (ED) visits. While sex disparities in the evaluation and treatment of chest pain are well known, there is limited research on sex differences in the use of opioid analgesics for this condition in the ED. In this study we aimed to evaluate sex differences in the administration of opioid analgesics (morphine and fentanyl) and to compare the time to medication administration in patients presenting with acute cardiac chest pain.

Methods: This retrospective observational study included adult patients (≥ 18 years of age) presenting with acute cardiac chest pain and confirmed elevated troponin between 2019–2024. The primary outcome was receipt of intravenous (IV) morphine and/or IV fentanyl. The secondary outcome was time from medication order to administration. For male vs female comparisons, we used t-tests or Mann-Whitney...

XGBoost (eXtreme Gradient Boosting) Can Predict Organisms Growing in Urine Culture from the Emergency Department

Thu, 14 May 2026 00:00:00 +0000

Introduction: Urinary tract infections are common in the emergency department (ED) but are frequently misdiagnosed and mismanaged. We sought to determine whether eXtreme Gradient Boosting (XGBoost), an open-source machine-learning library, could predict the organisms growing in urine cultures ordered from the ED.

Methods: We developed XGBoost algorithms to retrospectively examine 62,963 Mayo Clinic ED encounters between January 1, 2017–December 31, 2021, during which a urinalysis and urine culture were performed. The model used 1,303 patient variables. All patient ages were included. Data were from the electronic health record and available to the clinician during the patient encounter.

Results: For the most common bacteria growing in urine culture, XGBoost was able to predict the presence of a member of the Enterobacteriaceae family with an area under the receiver operating curve (AUC) of 0.90 and an accuracy...

Prospective Assessment of Depression and Anxiety Trajectories Among Emergency Department Patients with Somatic Complaints

Thu, 14 May 2026 00:00:00 +0000

Introduction: Emergency department (ED) patients exhibit higher rates of depression than those in primary care and the general population, but it is unclear whether these symptoms reflect chronic conditions or transient responses to acute stress. Our objective in this study was to evaluate the longitudinal trajectory of depression and anxiety identified in the ED to inform evidence-based screening and intervention strategies.

Methods: Adult, English-speaking ED patients with adequate literacy who presented to two urban academic EDs with somatic (non-psychiatric) chief complaints completed six mental health screening assessments at enrollment. Of 262 approached patients, 188 were enrolled, representing approximately 0.5% of all adult ED visits (188/37,898) during the study period. Follow-up assessments were completed through a secure phone app at one, two, and four weeks after ED discharge. The primary outcome was the longitudinal stability...

Worth the Wait? Comparison of Emergency Department Patients’ Waiting Room Tolerance for Real Patient Care vs Training/Simulation Scenarios

Thu, 14 May 2026 00:00:00 +0000

Introduction: In-situ simulation offers a realistic training environment with a higher level of fidelity compared to other simulation models. It is associated with enhanced knowledge retention and a higher level of composure during real clinical encounters. One common barrier to undertaking in-situ simulation is the concern that it contributes to a delay in providing patient care. In this study we gave patients in the waiting room seven hypothetical emergency medical scenarios, two of which were training simulation scenarios, and we asked them how long they would be willing to delay their care if the different scenarios were actually occurring in the emergency department (ED). Our objective was to investigate whether patients in the ED waiting room would be willing to delay their care if they knew that there were simulation training scenarios occurring.

Methods: This was a prospective convenience sample of participants conducted...

Articles in Press

Thu, 14 May 2026 00:00:00 +0000
Once articles have been accepted for publication but have not yet been assigned to an issue, we place them here.

Documentation of Extended Focused Assessment with Sonography in Trauma (eFAST) Is Frequently Incomplete: A Prospective Observational Study

Thu, 14 May 2026 00:00:00 +0000

Introduction: The extended focused assessment with sonography in trauma (eFAST) is a point-of-care ultrasound protocol that identifies life-threatening thoracoabdominal trauma. Clinical documentation of the eFAST is essential to convey medical decisions, but the extent of documentation in clinical practice is unknown. This study describes the proportion of eFAST exams that are documented in the medical record, the type of documentation (free text vs procedure note), and clinical factors associated with documentation.

Methods: This prospective, single-center study evaluated the documentation of consecutive eFAST exams performed at a single Level I trauma center between November 2021–November 2022. Research coordinators observed all trauma activations and noted whether any portion of an eFAST was performed. Our primary outcome was the presence of any documentation in the chart. We analyzed secondary outcomes using a multivariable logistic...

Association Between Substance Use and Trauma Outcomes in Adolescents

Thu, 14 May 2026 00:00:00 +0000

Introduction: Adolescent substance use and substance use disorders are significant public health issues. Our goal was to evaluate the association between adolescent substance use, detected via blood alcohol levels and urine drug screens, and trauma-related outcomes at a Level I pediatric trauma center. Most of the literature is focused on adult trauma patients with limited data in the pediatrics.

Methods: In this retrospective cohort study, we analyzed data from adolescent trauma patients 13-17 years of age presenting to a Level I pediatric trauma emergency department (ED). Demographic data, Injury Severity Score (ISS), intensive care unit (ICU) admission, hospital length of stay (LOS), and ED disposition were extracted from the Pennsylvania Trauma Systems Foundation Database Collection System, which includes comprehensive information on demographics, clinical characteristics, and outcomes of trauma patients. These data were...

Pilot Simulation Task Trainer for Prehospital Management of Neck Hemorrhage

Thu, 14 May 2026 00:00:00 +0000

Introduction: Traumatic injuries are the leading cause of death in the U.S. of persons < 45 years of age, with 5-10% of all traumas caused by penetrating neck injuries (PNI). The neck contains several large blood vessels that supply the brain; thus, exsanguination is the leading cause of fatality in PNI. Vascular neck trauma is common in assaults, motor vehicle accidents, battlefields, and sporting events, particularly in ice hockey. There is a general lack of guidance on prehospital management of these injuries, and educating first responders, medics, and sports trainers on how to manage these complex injuries is challenging due to high costs, limited availability, and ethical considerations regarding use of cadavers or live animals. Here, we describe the development of a prehospital PNI-hemorrhage curriculum paired with a novel hands-on simulator and its pilot implementation with a group of professional hockey athletic trainers.

Methods:...

Early Recognition and Referral of Acute Stroke in Primary and Emergency Care: A Systematic Review

Thu, 14 May 2026 00:00:00 +0000

Introduction: Early recognition and referral are critical to minimizing morbidity and mortality in acute stroke, but evaluation and referral processes differ worldwide. In this systematic review we examined the accuracy of recognition tools, referral patterns, outcomes, and factors affecting efficiency in primary and emergency care settings.

Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Cochrane Library for studies published January 2003–December 2025. Eligible studies included randomized controlled trials, cohort, case-control, cross-sectional, and large case series (> 30 patients) involving adults with acute ischemic or hemorrhagic stroke. Risk of bias was assessed using Cochrane Risk-of-Bias 2 (RoB) and RoB in non-standardized studies-I. We extracted data on diagnostic accuracy, referral pathways, outcomes, and systemic factors.

Results: We identified 206 papers,...

Association of Hypertension Severity with 30-Day Major Adverse Cardiovascular Events in Patients with Intermediate High-Sensitivity Cardiac Troponin I

Thu, 14 May 2026 00:00:00 +0000

Introduction: Hypertension is a recognized risk factor for acute coronary syndrome and major adverse cardiovascular events, yet its influence on high sensitivity cardiac troponin (hscTn) concentrations and on the prognostic value of intermediate hscTnI results remains uncertain. We assessed whether blood pressure category confounds the relationship between intermediate hscTnI values (4-18 nanograms per liter [ng/L]) and 30-day major adverse cardiovascular events.

Methods: We performed a secondary analysis of the Rapid Acute Coronary Syndrome Evaluation-Implementation Trial (steppedwedge randomized trial across nine Michigan emergency departments [ED] (July 2020–April 2021). From 32,609 patients in the primary trial, we analyzed only those with available hs-cTnI values reported to be in the intermediate range (4-18 ng/L). The first recorded ED blood pressure-determined category: normotensive (< 140/< 90 millimeters of mercury [mm...

Impact of Bystander Naloxone on Emergency Medical Transport Refusal After Opioid Overdose: A Statewide Retrospective Analysis

Thu, 14 May 2026 00:00:00 +0000

Introduction: The opioid epidemic remains a public health crisis in the United States. Naloxone is a cornerstone of overdose reversal, and its increasing availability to bystanders has improved immediate survival. However, little is known about how bystander naloxone administration influences use of emergency medical services (EMS), particularly patient refusal of transport. Understanding these dynamics is critical for development of EMS protocol and harm reduction strategies.

Methods: We performed a retrospective cohort study of suspected opioid overdoses reported to the Connecticut Statewide Opioid Reporting Directive (SWORD) between November 1, 2019–June 30, 2024. The primary outcome was EMS transport refusal, defined as non-transport after naloxone administration. The primary exposure was initial naloxone administrator (bystander vs first responder). Secondary variables included naloxone dose frequency, patient demographics,...

HIV and Syphilis Testing Among Patients Tested for Gonorrhea and Chlamydia in Emergency Departments

Thu, 14 May 2026 00:00:00 +0000

Introduction: Sexually transmitted infections (STIs), including HIV and syphilis, are increasing. In 2023, there were over 2.4 million reported cases of chlamydia, gonorrhea, and syphilis in the United States, a 32.5% increase from 2014. Emergency departments (EDs) are vital touchpoints for STI testing, yet HIV and syphilis testing among patients undergoing Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) testing is suboptimal. We aimed to determine testing frequency and to identify factors associated with HIV and syphilis co-testing among ED patients undergoing NG/CT testing.

Methods: We conducted a retrospective observational study of all patients tested for NG/CT from 2021–2024 at two Los Angeles EDs. Covariates including sociodemographic and behavioral data were extracted from the medical record. The primary outcome was complete STI testing, defined as both HIV and syphilis testing during or up to six months...

Pilot Study Comparing Emergency Physician and Artificial Intelligence-supported Interpretations of Electrocardiograms

Thu, 14 May 2026 00:00:00 +0000

Background: Artificial intelligence (AI) tools are increasingly being explored for medical applications; however, their effectiveness in emergency electrocardiogram (ECG) interpretation is under-investigated. In this pilot study we aimed to evaluate the diagnostic performance of AI interpretation of ECGs by comparing its results to those of an experienced emergency physician.

Methods: We sourced 20 ECG cases representing common critical conditions from publicly available academic repositories—ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, third-degree atrioventricular block, left and right bundle branch block, hyperkalemia, Brugada syndrome, Wellens syndrome, fusion beats, and torsades de pointes.The AI tool ChatGPT-4 and an experienced emergency physician, who served as the reference (gold standard) interpreter, independently...

Outcomes of Succinylcholine and Rocuronium for Rapid Sequence Intubation in the Emergency Department

Thu, 14 May 2026 00:00:00 +0000

Introduction: Succinylcholine and rocuronium are neuromuscular blocking agents commonly used as paralytics in the emergency department (ED) during rapid sequence intubation. Prior studies have shown mixed results regarding the preferred agent aside from settings where there are contraindications. This study compares outcomes of death, myocardial infarction, and post-traumatic stress disorder for succinylcholine vs rocuronium when used in rapid sequence intubation using data from a large, multicenter database.

Methods: In this retrospective study, we extracted 105 million patient records from 61 healthcare organizations in the United States from the TriNetX database between 2004–2023. Adults ≥ 18 years of age who underwent intubation on the same day as an ED visit and received succinylcholine or rocuronium with the hypnotic anesthetic etomidate were included. The outcomes evaluated were mortality and myocardial infarction within 60 days...

Assessment of Artificial Intelligence-based Translation Tools for Emergency Department Discharge Instructions

Thu, 14 May 2026 00:00:00 +0000

Introduction: Emergency departments (ED) in the United States serve as a safety net for millions, including those with limited English proficiency (LEP). Eight percent of individuals living in the United States have LEP, placing them at risk for language barriers that can adversely affect the quality and safety of their care. Many hospitals lack language-concordant care, especially at the time of discharge. Miscommunication at discharge can lead to adverse health outcomes, including medication errors, poor compliance, and unnecessary return visits to the ED. Our objectives in this study were to evaluate the quality and safety of artificial intelligence (AI)-generated translations of physician-written, patient-specific ED discharge instructions and to assess performance across varying levels of instruction complexity.

Methods: Emergency physicians wrote free-form discharge instructions, representing patient-specific guidance, which...

Relationship of Clinical Encounters to End-of-rotation Exam Scores for Fourth-year Students in Emergency Medicine

Wed, 13 May 2026 00:00:00 +0000

Background: Emergency medicine (EM) clerkship directors view end-of-rotation exam scores as one of the most important components in the assessment of medical student performance. Understanding factors that may impact end-of-rotation exam scores is important because strong performance during fourth-year EM clerkships is crucial for matching in EM residency. One factor that may affect exam scores is increased experience through clinical encounters. Our objective in this study was to assess the relationship between the number of clinical encounters and end-of- rotation exam scores.

Methods: This was a single-site, retrospective study involving fourth-year medical students who completed a four-week EM elective between 2021–2024. We obtained exam scores and student home/away rotation status from clerkship evaluation records. The number of clinical encounters was extracted from electronic health records (EHR) via two exposure measurement...

Emergency Department Boarding for Psychiatric Hospitalization in Older Adults: Placement Challenges and Associated Risks

Wed, 13 May 2026 00:00:00 +0000

Introduction: Older adults are increasingly presenting to emergency departments (ED) with psychiatric emergencies amid limited inpatient psychiatric capacity, resulting in prolonged ED boarding. Our primary objective was to quantify ED boarding duration for older adults awaiting psychiatric hospitalization in community EDs. We examined whether longer boarding was associated with functional decline and physical restraint.

Methods: We conducted a retrospective cohort study of ED encounters among adults ≥ 65 years of age who received a behavioral health evaluation by emergency services program (ESP) clinicians (non-prescriptive behavioral health professionals) who determined psychiatric level of care in two community EDs. The study period was from January 2023–June 2024. The primary outcome was boarding duration. We measured boarding duration from initiation of a psychiatric bed search to ED departure or psychiatric clearance. Secondary...

Perceptions of Health Effects of Electronic Cigarettes in Young Adults: Emergency Department Patients vs. Medical Students

Wed, 13 May 2026 00:00:00 +0000

Introduction: As electronic cigarette (e-cigarette) use becomes more prevalent, understanding how populations perceive the harms associated with use is vital for tailoring public health interventions. Our aims in this study were to explore the perceptions of health risk associated with e-cigarettes among young patients in the emergency department (ED) who consume e-cigarettes as well as similarly aged medical students regardless of e-cigarette use and to determine medical students’ perception of their curriculum to prepare them for future counseling of patients on e-cigarette use.

Methods: A cross-sectional survey was completed by 276 participants: 90 ED patients 18-35 years of age who had ever used e-cigarettes (4.2% response rate) and 187 medical students from a U.S. allopathic medical school (17.7% response rate). Our primary outcomes were perceptions of health risks associated with e-cigarette use and medical student perceptions...

Implementing a Climate Health Education Curriculum for Emergency Medicine Trainees and Faculty

Wed, 13 May 2026 00:00:00 +0000

As climate-related health impacts intensify, emergency physicians (EP) increasingly encounter patients whose conditions are influenced by environmental change. To provide care for climate- vulnerable patients in the emergency department (ED), EPs should be educated on the impacts of climate change. The goal of our intervention was to provide a structured climate health educational curriculum to attending physicians, residents, and medical students and assess the perceived effectiveness of the curriculum. A longitudinal climate health curriculum was delivered in a four-part lecture series over the course of three months to medical students, postgraduate year 1-3 emergency medicine residents, and academic emergency attending physicians. We measured learners’ perceived knowledge pre- and post-curriculum with surveys assessing four core areas: 1) climate change topics; 2) climate impacts on human health; 3) confidence in treating medical conditions exacerbated by climate change;...

Selected Impacts of Urban Heat Islands on Emergency Medical Services Utilization in Rhode Island

Wed, 13 May 2026 00:00:00 +0000

Introduction: Excessive environmental heat exposure is clearly associated with an increased likelihood that individual patients will suffer adverse health outcomes. Such heat exposure also strains healthcare systems via increased utilization, a burden which can challenge systems’ capacities. Health impacts vary geographically with urban heat islands potentially contributing to higher temperatures and greater health risks. However, those most vulnerable to this exposure are not well identified. Our objective in this novel study was to compare and quantify differences in emergency medical services (EMS) use by selected patients during hot days in Rhode Island. Patients were recruited from low socioeconomic residential locations, stratified by whether they accessed EMS from within one of the state’s “urban heat islands,” or from other locations without “heat island” effects. We also compared selected patient demographic characteristics, and other EMS run data,...

Operationalizing Competency-based Medical Education Within Clinical Competency Committees

Wed, 13 May 2026 00:00:00 +0000

This scholarly perspective explores the integration of competency-based medical education (CBME) within graduate medical education assessment systems, specifically the clinical competency committee (CCC). We discuss the role of the CCC in operationalizing the core components of CBME, providing guidance on best practices-related meeting structure, assessment data, and learner outcomes. By analyzing the evolving responsibilities of faculty assessors and the impact on learner progression toward unsupervised practice, this perspective highlights challenges and strategies for successful implementation of CBME principles in medical education, including an outline to use when discussing each trainee in CCC meetings.

National Survey of Telemedicine Curricula Among Emergency Medicine Residencies

Wed, 13 May 2026 00:00:00 +0000

Introduction: Telehealth continues to reshape healthcare delivery in the United States. Recognizing its growing importance and the need for advances in education, the Association of American Medical Colleges released telehealth competencies in 2021, and the Accreditation Council of Graduate Medical Education (ACGME) recently proposed a structured telemedicine experience as part of all emergency medicine (EM) residencies. Despite these efforts, it is unclear whether EM residencies have adopted these new educational mandates. Our primary objective in this study was to understand whether (and how) U.S. EM residencies have implemented telehealth education.

Methods: We developed a cross-sectional, national survey to describe existing telehealth curricula among ACGME-accredited EM residencies. Program directors were surveyed via email. Our primary outcome measure was the percentage of residencies with existing telehealth curricula. Secondary...

Mechanisms and Intervention Strategies for Heat Stroke-Associated Myocardial Dysfunction: A Narrative Review

Wed, 13 May 2026 00:00:00 +0000

Introduction: Heatstroke is a life-threatening condition defined by a core body temperature exceeding 40° C and central nervous system dysfunction. Its onset is potentiated by high heat and humidity, especially if superimposed upon high thermal loads due to exertion or to impaired ability to sweat as associated with the use of certain medications. The condition can trigger systemic inflammation and potentially fatal multi-organ failure. The heart is a primary organ affected; heatstroke-associated myocardial dysfunction may present as tachycardia, arrhythmias, heart failure, or ischemic injury.

Methods: This narrative review was informed by a structured search of PubMed and Embase. The search focused on literature from the past 10 years, supplemented by earlier seminal studies where necessary. Key search terms included heatstroke, myocardial injury, dysfunction, biomarkers, cooling strategies, monitoring, and circulatory support....

Beyond the Numbers: How Clinical Performance Metrics Impact Emergency Medicine Residents

Wed, 13 May 2026 00:00:00 +0000

Introduction: Emergency physicians commonly receive feedback in the form of performance metrics such as patients seen per hour. Reviewing metrics has been associated with increased stress and burnout. Although effects on efficiency have been examined, studies have not yet investigated the potential psychological and motivational impacts of providing performance metrics to residents during training. In this study we explore residents’ interest in receiving performance metrics during training and how receiving performance metrics might affect their 1) perceived pressure and motivation to change performance, 2) perspectives on the importance and actionability of metrics, 3) perceived readiness to receive metrics after graduation, and 4) possible effects on their postgraduate career plans.

Methods: Senior emergency medicine residents at a single, quaternary-care training center completed an anonymous pre-metric survey using a...

Creating and Maintaining a “Climate-Smart” Emergency Department: A Scoping Review of Current Progress and Future Potential

Wed, 13 May 2026 00:00:00 +0000

Introduction: Climate change represents one of the most significant global health threats, with emergency departments (ED) serving as frontline responders to climate-related health emergencies. While EDs are major contributors to healthcare’s environmental footprint and critical responders for climate disasters, no comprehensive review has examined sustainability and climate-resilience initiatives specifically implemented in ED settings.

Methods: We conducted a scoping review examining literature on sustainable and climate-resilient measures in EDs. Comprehensive searches of PubMed, Scopus, and Embase were performed from inception through November 2024, using terms related to EDs combined with sustainability and climate-resilience concepts. Two reviewers independently screened papers, with inclusion criteria requiring ED-specific focus and concrete sustainability or resilience interventions.

Results: Seven studies...

WestJEM Full-Text Issue

Wed, 13 May 2026 00:00:00 +0000
WestJEM Full-Text Issue

Climate Change and Emergency Medicine: A Scoping Review Across Emergency Medicine Subspecialties

Wed, 13 May 2026 00:00:00 +0000

Introduction: Climate change is reshaping emergency medicine (EM) practice through rising temperatures, extreme weather events, and deteriorating air quality. Emergency medicine serves as a critical frontline indicator for climate-sensitive health conditions, yet evidence describing climate impacts across EM subspecialties remains fragmented. This scoping review synthesizes existing literature at the intersection of climate change and EM to identify key findings, knowledge gaps, and priorities for building climate-resilient emergency care systems.

Methods: We conducted a scoping review with reporting aligned to the PRISMA Extension for Scoping Reviews. We searched PubMed, Scopus, and Embase through March 2025, combining climate-related terms with EM terms. Two independent reviewers screened 794 articles, with 35 studies meeting inclusion criteria. We extracted data on study characteristics, climate exposures, EM outcomes, vulnerable...

Reducing Waste: Instrument Recycling in the Emergency Department

Wed, 13 May 2026 00:00:00 +0000

Introduction: Emergency medicine (EM) residency programs are required to teach quality improvement (QI), yet few adopt a sustainability lens to QI despite broad recognition of the importance of climate sustainability in healthcare. To address this gap, some programs have piloted innovative approaches such as sustainability QI electives or projects, although evidence of their effectiveness remains limited.

Methods: We designed and implemented a sustainability QI initiative to recycle used instruments from three bedside procedure kits (laceration repair, incision and drainage, chest tube placement) commonly used in the emergency department to reduce waste. Our goal was to describe the effectiveness of a financial intervention on instrument recycling by comparing the differences in recycling rates between the baseline and incentive periods using a quasi-Poisson regression analysis.

Results: At the end of the first...

Evidence-based Medicine Questions Logged by Emergency Medicine Residents On Shift in Relation to American Board of Emergency Medicine Content Areas

Wed, 13 May 2026 00:00:00 +0000

Introduction: Evidence-based medicine (EBM) skills are fundamental to lifelong learning. These can be tracked the same way that procedural skills are tracked—via residency program logs. Review of the logs can inform faculty on the EBM activity of their trainees. An understanding of the topics residents query while on shift can provide insight into where they need further knowledge to provide optimal patient care. Our objective in this project was to categorize the relationship of the clinical questions posed by emergency medicine (EM) residents while working in the emergency department to the American Board of Emergency Medicine (ABEM) Model of Clinical Practice.

Methods: We conducted this institutional review board-approved study (deemed exempt research) in a postgraduate year (PGY) 1-4 EM residency. A toxicology rotation and fellowship were established during the study period. Residents were required to submit three to five descriptions...

Comparing the Standardized Letter of Evaluation (SLOE) 2.0 with SLOE for Non-residency-based EM Physicians

Thu, 30 Apr 2026 00:00:00 +0000
Comparing the Standardized Letter of Evaluation (SLOE) 2.0 with SLOE for Non-residency-based EM Physicians

CORD Abstracts 2024

Thu, 30 Apr 2026 00:00:00 +0000
CORD Abstracts 2024

Physician Gestalt for Anemia Detection in the Emergency Department: A Prospective Study

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Anemia is common in the emergency department (ED). Physicians often rely on inspecting conjunctival pallor or other body parts for gestalt estimates. We aimed to evaluate the validity and reliability of physician gestalt for anemia detection and examine the impact of clinical experience and incorporating images of multiple body parts on physician gestalt-based anemia detection.

Methods: Prospective observational study in the ED at an academic medical center between January–November 2023. Using convenience sampling, we included patients ≥ 18 years with recent laboratory hemoglobin (Hgb) measurements. We used a smartphone to capture the images of the patient’s conjunctiva, palm, and fingernails. Five board-certified attending emergency physicians (two junior, two mid-level, and one senior) reviewed the patient images and provided gestalt predictions of Hgb levels and anemia likelihood on a 1-10 scale. Two pairs of physicians...

Environmental Advocacy by the American College of Emergency Physicians: A Brief History of Climate and Sustainability Resolutions

Thu, 23 Apr 2026 00:00:00 +0000

Emergency physicians are on the front lines of climate-driven illness and disaster. Reducing healthcare’s carbon footprint and increasing sustainability can improve planetary and patient health, lower healthcare costs, and boost healthcare job satisfaction. Over the last decade, the American College of Emergency Physicians (ACEP) progressed from early recognition of climate impacts on health to actionable sustainability advocacy. Council resolutions—ACEP’s formal mechanism for policy development—reflects this trajectory, beginning with requests to study climate effects, advancing to coalition engagement, and culminating in operational guidance for reducing emergency department waste and carbon emissions. This paper summarizes the climate and sustainability resolutions presented to the ACEP Council, including brief descriptions and their outcomes. It provides emergency physicians and health system leaders a framework to track and implement ACEP’s sustainability advocacy, with...

12-Year Case Series of Patients with Heat Illness from an Urban Hospital System in the American Southwest

Thu, 23 Apr 2026 00:00:00 +0000

Objectives: Climate change has led to more frequent and intense heat events with dramatic increases in heat illness and heat-related deaths. We compared demographic characteristics such as age, sheltering status, and underlying health conditions that contribute to susceptibility to extreme heat. We described the clinical course of these patients, presenting over a 12-year span, who were diagnosed with heat-related illness, to inform local risk stratification.

Methods: We conducted retrospective chart abstraction of encounters between January 1, 2012–December 31, 2023, which included adults 18-89 years of age, presenting to a single hospital system’s emergency department (ED), with an International Classification of Diseases, 10th Revision, discharge diagnosis within the T67 heat-related diagnosis code family. We compared demographic characteristics to baseline ED presentations and summarized clinical characteristics in frequencies....

Association of Electrocardiogram Abnormalities with Clinical Outcomes in Emergency Department Sepsis Patients

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Sepsis, a critical condition caused by dysregulated host responses to infection, frequently involves cardiac complications. Electrocardiogram (ECG) provides valuable insights into the cardiovascular status of sepsis patients and may guide early interventions. However, comprehensive data on ECG patterns in sepsis patients within the emergency department (ED) is limited. In this study we aimed to identify common ECG rhythms and patterns in sepsis patients presenting to the ED and analyze their association with poor clinical outcomes, including intensive care unit (ICU) admission, prolonged hospital stay (> 14 days), and in-hospital mortality.

Methods: We conducted a retrospective observational study using data from 3,598 adult sepsis patients presenting to the ED of Srinagarind Hospital, Khon Kaen, Thailand, between January–December 2023. ECG abnormalities were extracted from the automated ECG interpretation system. Cardiologists...

Epidemiology and Outcomes of Patients Presenting to United States Emergency Departments with Vaginal Bleeding

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: There are significant gaps in knowledge regarding the epidemiology, management, and outcomes of patients presenting to the emergency department (ED) with vaginal bleeding.

Methods: This was a retrospective, successional cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) examining all adult patients presenting to EDs with vaginal bleeding from 2011–2019. Patients were stratified by age, race/ethnicity, and pregnancy status. Main outcomes were ultimate outcome severity, presenting vital signs, and diagnostic tests performed. We defined high-severity outcome as any patient who was dead on arrival, died in the ED, or during that hospitalization; any patient admitted to the intensive care or stepdown units or to the cardiac catheterization lab or the operating room; or patients transferred to a non-psychiatric hospital. Moderate severity was defined as any patient admitted to...

Fascia Iliaca vs. Combined Iliaca Blocks for Proximal Hip Fractures in the Emergency Department

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Over 335,000 adults are hospitalized annually for proximal hip fractures, with the incidence of these injuries increasing as the population ages. Our objective in this study was to compare pain scores of patients with proximal hip fracture 30 minutes after undergoing a combined fascia iliaca plus femoral nerve block vs standard fascia iliaca block.

Methods: We performed a retrospective cohort study including all isolated proximal hip fracture patients > 18 years of age who underwent regional anesthesia by ultrasound fellowship-trained emergency physicians in a community hospital emergency department between January 1, 2022– September 26, 2024. We excluded patients with distal femur fractures, those who had received additional pain medications within 30 minutes of the block, or those who could not reliably relay a pain score. The primary outcome was subjective pain scores (scale 1-10) after undergoing regional anesthesia.

Results:...

A Cost Analysis of Mobile Integrated Health for Acute Care

Thu, 23 Apr 2026 00:00:00 +0000

Objectives: Mobile integrated health programs have emerged as a means to reduce avoidable emergency department (ED) visits and optimize healthcare resource utilization. Such models are estimated to cost less than ED encounters but may be more costly than traditional ambulatory services. However, mobile integrated health is not reimbursed by most payors, and its operational costs are poorly understood. Our objective if this study was to estimate the costs of delivering acute care services through a mobile integrated health program.

Methods: This study was performed at an urban academic tertiary care center with a hospital-affiliated emergency medical services agency in which a mobile integrated health program is embedded. Home visits are conducted by paramedics who collaborate with a remotely located, actively engaged physician to evaluate and treat patients. We compiled cost data derived from real-world mobile integrated health patient...

Obligated To Say “Yes”: The How and Why Behind Transfer Decisions in Moribund Patients

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: A core principle of emergency care is the rapid transport of severely injured patients to hospitals capable of providing definitive care. Although the social, financial, and emotional factors associated with transfers, and their impact on hospital crowding, may necessitate a more nuanced approach, little has been published on how physicians actually make the decision to transfer a potentially moribund patient. We, therefore, sought to better understand these factors as the next step toward optimizing transfer flow and patient care.

Methods: We conducted one-hour, semi-structured interviews with 16 emergency physicians at referring and referral centers, including eight accepting physicians at a quaternary-care center and eight transferring physicians at community hospitals. Interviews focused on decision-making regarding interhospital transfers for moribund patients, defined as those with injuries or disease processes judged...

COVID-19 and Emergency Department Visits: An Interrupted Time Series Analysis of Ontario and Alberta, Canada

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Emergency department (ED) use declined drastically in the early stages of the COVID-19 pandemic. While the immediate effects of the pandemic are well-characterized, the longer term recovery patterns in ED use and regional differences in these patterns remain poorly understood. In Canada, provincial differences in public health policy responses may have influenced ED utilization during the pandemic, where Ontario implemented more restrictive and prolonged public health measures compared to Alberta, making Canada an ideal place to examine how regional variation in policy impacted ED use. Our objective in this study was to evaluate the impact of the pandemic on patterns of ED use in Ontario and Alberta and explore the potential differences in these patterns.

Methods: Our primary outcome measure was the monthly count of all-cause ED visits in Ontario and Alberta. We obtained 146 entries of monthly counts of all-cause ED...

Decoding Emergency Department Dissatisfaction: Factors Associated with Patient Complaints

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Patient experience has important implications for hospitals and patient care including its ties to reputation, reimbursement, and clinical outcomes. Despite its importance, little is known about how operational factors in the emergency department (ED) impact formal complaints. In this study we aimed to identify encounter-level operational characteristics associated with the risk of formal patient complaints.

Methods: We conducted a retrospective matched-cohort study of ED encounters between October 2023–December 2024 at three EDs affiliated with a large academic health system. Each complaint case was matched to three non-complaint cases (3:1 matching) based on age, sex, race/ethnicity, acuity score, and chief complaint. We used logistic regression to assess the associations between operational factors and the likelihood of submitting a formal complaint. A Bonferroni correction was applied for multiple comparisons...

Isolated Distal Radius Fracture Reductions in Adult Emergency Department Patients in a Large Healthcare System

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Distal radius fractures account for up to 18% of fractures in older adults and up to 20% of all fractures treated in the emergency department (ED). These fractures often require reduction and immobilization, with different modalities to provide analgesia. Our objective in this study was to summarize the management for distal radius fracture reductions in the real world of community and academic EDs.

Methods: Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and retrospective chart review guidelines for cohort studies, we identified adult visits for isolated distal radius fractures over a four-year period across three academic and 18 community hospital EDs from more than 490,000 per annum total visits. Visits were grouped by whether they were reduced in the ED. Reductions were further categorized by use of ultrasound-guided nerve block (UGNB), procedural sedation, or hematoma block....

Gender- and Sex-equitable Submission Guidelines in Emergency Medicine Journals Are Associated with Enhanced Publication Metrics

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Gender and sex equity-promoting (GSEP) clinical research is essential to improving diversity and inclusivity in medicine. In this study we aimed to compare journal impact metrics in emergency medicine (EM) between journals that integrated gender- and sex-based considerations and those that did not.

Methods: We searched the 2023 Journal Citations Report (Clarivate Analytics) for EM journals. Submission guidelines of each EM journal were examined according to the SAGER (Sex and Gender Equity in Research) guidelines and stratified as conforming or non-conforming depending on whether at least one SAGER criterion was met. Our primary outcome measure was the journal impact factor. Secondary outcome measures included other citation and influence metrics: total citations; 5-year journal impact factor; journal citation indicator; article influence score, normalized Eigenfactor score; citable items; total articles; and immediacy...

Impact of Emergency Department Intravenous Fluid Conservation Strategies During a National Shortage: A Multi-Site Retrospective Study

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Effective disaster response in healthcare depends on coordinated strategies that maintain access to critical supplies across institutions. During Hurricane Helene in September 2024, a major intravenous (IV) fluid shortage caused by the destruction of a manufacturing plant exposed the vulnerability of centralized supply chains. Our objective in this study was to evaluate the impact of a multisite IV fluid conservation initiative on ordering patterns, cost, and environmental outcomes across three emergency departments (ED).

Methods: We conducted a retrospective study evaluating large-volume, IV fluid-bolus orders placed before, during, and after the critical shortage. Interventions included an interruptive alert in the electronic health record, clinician education, and workflow adjustments. Our primary outcome measure was the number of IV fluid-bolus orders placed during each period. Secondary outcomes included total fluid...

Association Between Socioeconomic Status and Emergency Department Use for Non-traumatic Dental Conditions

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Among ED visits, presentation for a non-traumatic dental condition represents one of the most preventable, as 79% of these visits are considered avoidable. Our goal was to investigate the association between individual-level socioeconomic status (SES) and emergency department (ED) use for non-traumatic dental conditions.

Methods: In this retrospective, pooled cross-sectional analysis we used data from a database of administrative health claims for members of large commercial and Medicare Advantage health plans. The sample included adults (≥ 18) who presented to the ED between 2017-2021 and had complete data on SES indicators (ie, income, education level, net worth, homeownership, and low-income subsidy status). The primary outcome was ED use for non-traumatic dental conditions, identified via International Classification of Diseases diagnosis codes. We used multivariate logistic regression models with marginal effects to...

US Emergency Department Use and Operations Amid Natural Disasters: A Narrative Review

Thu, 23 Apr 2026 00:00:00 +0000

In the United States from 2014-2024, an average of 18.2 national disasters per year caused over a billion dollars in inflation-adjusted damage, compared with 3.3 national disasters per year during the 1980s. The increased frequency and intensity of severe weather phenomena—attributed by climate science experts to climate change—have raised concerns about national emergency preparedness. One aspect of emergency preparedness is the functioning of emergency departments (ED). In this narrative review, we examine patterns of ED use and operations amid natural disasters in the US, with a special focus on vulnerable populations. The review highlights studies comparing ED use patterns between periods of disaster and non-disaster for specific disaster types, including hurricanes, wildfires, floods, winter storms, and earthquakes, as well as studies that identify disaster-mediated changes in ED visits among specific populations, including the elderly, individuals experiencing homelessness,...

Accuracy of Emergency Physicians in Grading Diastolic Dysfunction Using Visual Estimation of Waveforms

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Diastolic dysfunction occurs when the ventricular walls of the heart stiffen and fail to relax appropriately. Early recognition in the emergency department (ED) enables identification of heart failure with preserved ejection fraction, guides antihypertensive and diuretic therapy, and facilitates timely cardiology referral to reduce morbidity and readmissions. Prior studies show emergency physicians (EP) can diagnose diastolic dysfunction with point-of-care ultrasound using mitral valve inflow velocities and tissue Doppler indices, although quantitative measurements are time-consuming. This study evaluates whether EPs can accurately diagnose and grade diastolic dysfunction based solely on visualization of mitral valve inflow velocities and tissue Doppler wave forms.

Methods: After a focused training session, EPs (postgraduate year 1-3 residents, ultrasound fellows, and attendings) were randomized to review archived echocardiograms...

Clinical Predictors of Intracranial Pathology in Emergency Department Patients with Non-traumatic Headache and No Neurological Deficits: Prospective Study

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Non-traumatic headache is a common emergency department (ED) presentation, yet identifying intracranial causes remains challenging in the absence of neurological deficits. In this study we aimed to evaluate the incidence and predictive ability of clinical red flag signs and symptoms for intracranial pathology.

Methods: We conducted a prospective, multicenter, cross-sectional study across six academic EDs with residency programs in Türkiye. We enrolled consecutive adult patients with non-traumatic headache and no neurological deficits who had cranial computed tomography (CT) at the discretion of the treating attending physician. Exclusion criteria were recent trauma, pregnancy, fever, hematologic conditions, and known intracranial pathology. We recorded clinical features using standardized forms. The primary outcome was the presence of intracranial pathology confirmed by CT or subsequent diagnosis within a one-month follow-up.

Results:...

Revealing the Emergency Medicine Difference: Leveraging Specialty-Specific Strengths to Optimize Critical Care Training

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Emergency physicians pursuing critical care training must enter fellowships designed for internal medicine, anesthesiology, or surgery trainees. In this study we aimed to assess how emergency medicine (EM)-trained fellows are perceived by critical care fellowship leadership compared to their peers and to identify specialty-specific strengths and gaps that may inform targeted educational approaches.

Methods: We conducted a national, cross-sectional survey of program directors and associate/assistant directors of Accreditation Council of Graduate Medical Education-accredited critical care fellowships. Respondents rated the baseline competence of incoming fellows across 11 core critical care domains using a 5-point Likert scale. We compared competency ratings across residency training backgrounds using linear mixed models, accounting for clustering and adjusting for rater specialty where appropriate.

Results:...

Interdepartmental Commensality: A Strategy for Increased Interdepartmental Collaboration

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: The concept of commensality, the act of eating together, is as old as humanity and has been extensively explored in the social sciences and humanities. We sought to assess whether an interdepartmental commensality program would improve cross-departmental familiarity, willingness to engage in scholarly discussions, and enhance collaborative efforts.

Methods: A program was established to arrange dinners for emergency department (ED) faculty with six other departments, after which participants were surveyed about their thoughts on the dinner’s impact. Our primary outcome measure was change in perceived familiarity with interdepartmental colleagues. Secondary outcomes included willingness to engage in academic discussion and perceived likelihood of future collaboration. A program was established to arrange dinners between the ED and six other departments (obstetrics and gynecology, neurology, psychiatry, internal medicine,...

Model Resuscitation Leadership Curriculum for Emergency Medicine Residents: Modified Delphi Study

Thu, 23 Apr 2026 00:00:00 +0000

Objectives: Effective resuscitation leadership is essential for emergency physicians, yet formal training in this domain remains limited within emergency medicine (EM) residency programs. Generic healthcare teamwork frameworks do not fully address the unique demands of EM resuscitations, including diagnostic uncertainty, time pressure, and frequent interruptions. Without consensus on the key competencies or instructional strategies needed to teach these EM-specific resuscitation leadership skills, residency programs lack clear curricular guidance. We aimed to achieve expert consensus on the learning objectives and educational strategies for a longitudinal model resuscitation leadership curriculum for EM residents using a modified Delphi approach.

Methods: We conducted a three-round modified Delphi study from September 2024–March 2025. Panelists were selected based on expertise in resuscitation leadership education and scholarship. We...

Reducing Emergency Diagnostic Uncertainty with TRACE: Triage and Risk Assessment via Cost Estimation

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Diagnostic uncertainty significantly impacts patient safety in emergency medicine, leading to missed diagnoses and severe harm. Current predictive models primarily emphasize diagnostic likelihood without explicitly addressing potential clinical harm from errors. We propose Triage and Risk Assessment via Cost Estimation (TRACE), a machine-learning framework that incorporates expected-value calculations, defined as the probability-weighted estimate of clinical harm, and patient similarity metrics to address both diagnostic accuracy and risk assessment.

Methods: Using the Medical Information Mart for Intensive Care IV - Emergency Department dataset, we developed TRACE, comprising two modules: the expected value-powered triage index (TRACE-T), which calculates expected patient acuity from vital signs and chief complaints, and the patient similarity diagnosis engine (TRACE-Dx), which predicts diagnoses by identifying historically...

WestJEM Full-Text Issue

Thu, 23 Apr 2026 00:00:00 +0000
WestJEM Full-Text Issue

Modified SIRS Criteria for Patients ≥ 65 Years with Addition of Altered Mental Status and Reduced Heart Rate for Atrioventricular Nodal Blockers

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Sepsis is a life-threatening condition caused by an exaggerated immune response to infection, causing damage to the body’s own tissues and organ dysfunction. The elderly are at higher risk for mortality from sepsis compared to younger adults. Our objective in this study was to evaluate the use of a modified systemic inflammatory response syndrome (SIRS) criteria for patients ≥ 65 years of age including new criteria of reduced heart rate (> 75 rather than 90 beats per minute [bpm]) for patients taking atrioventricular nodal blocking drugs and altered mental status.

Methods: This was a retrospective observational study sampling patients ≥ 65 years of age diagnosed with sepsis. We compared our proposed modified SIRS criteria to the original criteria (heart rate, white blood cell count, respiratory rate, and temperature). Our primary outcome measure was comparing sensitivity and specificity of each model. We performed a...

Systematic Review of Interventions to Optimize Emergency Department Care of Patients with Cancer

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Approximately 12% of patients with cancer annually visit the emergency department (ED) for disease- or treatment-related issues. These patients often face delays in care, including prolonged wait times and extended length of stay (LOS), contributing to ED crowding, delayed treatment, and increased mortality. Numerous studies have investigated interventions to reduce LOS and prevent ED visits for patients with cancer. However, a systematic overview of these interventions is currently lacking. In this review we aimed to present interventions that optimize input, throughput and output in ED care by reducing ED LOS or ED visits for patients with cancer.

Methods: We searched five electronic library databases: Medline ALL via Ovid; Embase.com; Web of Science Core Collection; the Cochrane Central Register of Controlled Trials via Wiley; and Google Scholar. Inclusion criteria for this review were as follows: 1) research on (a subset...

Impact of Artificial Intelligence-supported Triage Systems on Emergency Department Management: A Comparison of Infermedica, Emergency Severity Index, and Manchester Triage System

Thu, 23 Apr 2026 00:00:00 +0000

Objective: The surge in the number of emergency department (ED) visits due to a growing population, aging society, and easier access to healthcare highlights the need for an effective triage process. Our goal in this study was to compare the clinical and operational performance of a triage system supported by artificial intelligence (AI) with two traditional methods—the Emergency Severity Index and the Manchester Triage System—in a high-volume ED.

Methods: In this prospective study, 18,000 adult patients were randomized equally to one of the three triage systems. Primary and secondary outcomes included patient wait time, complication and mortality rates, resource utilization, medical errors, legal issues, and patient satisfaction.

Results: Compared with the Manchester Triage System, the AI-supported system was associated with significantly lower in-ED mortality (OR 0.39, 95% CI, 0.32–0.47; P < .001) and lower...

From Evaluation to Elevation: Standardized Letter of Evaluation Domains Tied to Future Emergency Medicine Chief Residents

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: The Standardized Letter of Evaluation (SLOE) is a core component of emergency medicine (EM) residency applications, designed to assess clinical performance, professionalism, and leadership potential. While its utility in selecting residency candidates is well established, its association with future leadership roles, such as chief resident, remains unclear. Identifying early indicators of leadership potential could inform both recruitment and resident development efforts. In this study we aimed to evaluate whether medical students’ SLOEs are associated with subsequent selection as chief residents, offering insight into the SLOE’s potential to forecast future leadership within EM.

Methods: We conducted a retrospective review of 243 de-identified SLOEs from 101 residents at a single urban, academic EM residency program between 2015–2021; 21 residents (20.8%) went on to hold chief resident roles between 2018–2024. The SLOEs...

Effect of Ice Consistency and Sodium Chloride Additives on Cooling Speed and Final Temperature for Cold Water–Ice Immersion in Heat Stroke

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Heat stroke can rapidly progress to end organ damage and death if not promptly treated. The diagnosis is characterized by core body temperature > 40.5 °C. In this study we evaluate how the form of ice (crushed vs cubed), the addition of sodium chloride, and the initial temperature of water together affect the rate of cooling for standardized cooling bath mixtures used to treat patients experiencing heat stroke.

Methods: We prepared four cold water immersion mixtures using 12 quarts of ice and 12 quarts of water (11.36 liters) under different conditions:
Test Case 1: Cubed ice with trauma bay tap water (~35 °C);
Test Case 2: Crushed ice with cold tap water (~24 °C);
Test Case 3: Crushed ice with cold tap water plus four pounds of rock salt;
Test Case 4: Cubed ice with cold tap water,
After each mixture was poured into a 40-quart bucket and mixed thoroughly, we recorded the temperature at 20-second...

Comparison of Emergency Department Patients with Salpingitis and Oophoritis with and without Documented Social Determinants of Health

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Social determinants of health (SDoH) have emerged as a critical focus of research due to their significant impact on clinical outcomes; however, there is a gap in research specific to women’s health. Understanding the factors underlying trends in gynecologic emergency diagnoses requires a more comprehensive examination of SDoH. In this study we characterize the demographic and clinical profile of patients with documented SDoH International Classification of Diseases, 10th revision (ICD-10), Z codes (Z55-Z65) who presented to the emergency department (ED) with salpingitis and oophoritis, and explore patterns of healthcare utilization and management.

Methods: In this retrospective cohort study we used TriNetX Research Network data to compare adult females (18-49 years of age) presenting to the ED with diagnosed salpingitis and oophoritis between January 1, 2000–January 1, 2024, by presence or absence of SDoH Z codes. Propensity...

Feasibility of Implementing Evidence-based Practices for Suicidality Management in the Emergency Department

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Best practice recommendations and guidelines for the assessment and management of suicidality within the emergency department (ED) have recently been updated. Despite national efforts to improve the management of suicidality in the ED, evidence-based practices remain underused with varied uptake among EDs and clinical team members. Given that the ED is a common point of entry for many people with suicidality, implementation of evidence-based strategies are needed to increase access to these strategies and improve patient outcomes.

Methods: To generate insights about the feasibility of implementing evidence-based practices for suicidality management, we developed a semi-structured interview guide focused on factors expected to influence the implementation process using a novel application of the Organizational Readiness for Innovation Implementation Framework. Working from a list or 80 EDs in the state of Indiana, we recruited...

Use of D-dimer to Screen for Cerebral Pathology in ED Patients with Non-traumatic Headache and Normal Neurological Exam

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Our goal in this study was to evaluate the diagnostic utility of bedside D-dimer testing for identifying secondary headache due to intracranial pathology among patients presenting to the emergency department (ED) with non-traumatic headache and no neurological deficits.

Methods: We conducted this prospective, multicenter, cross-sectional study across six tertiary care EDs in Türkiye. Adult patients presenting with non-traumatic headache and no neurological deficits who underwent cranial computed tomography (CT) based on clinical suspicion for intracranial pathology were enrolled. Exclusion criteria were recent trauma, pregnancy, fever, hematologic conditions, and known intracranial pathology. We measured bedside D-dimer using a D-dimer assay with a predefined threshold of 500 nanograms per milliliter. The primary outcome was secondary headache related to intracranial pathologies as determined on the index CT and additional...

Cross-Sectional Examination of Hospital Visits in the Year Prior to Suicide Death in Illinois

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Suicide is a growing public health issue in the United States. Healthcare visits in the year prior to suicide death, including those to emergency departments (ED) and inpatient settings, may be missed opportunities for risk-screening and intervention delivery. Our objective in this study was to evaluate the distribution of hospital visits of suicide decedents in the year prior to death by setting (ED and inpatient), last visit proximity to death, and presence of suicide risk factors, and to consider each setting’s potential for reaching those at risk of suicide.

Methods: Using linked data from the Illinois Hospital Discharge Data Set and the Illinois Violent Death Reporting System, we examined suicide decedent hospital visits 365 days prior to suicide death. We described the distribution of visits by setting (ED vs inpatient), timing of the last visit prior to death, and groupings of visit primary diagnosis codes, as per...

Advances in Patient Monitoring Systems for Prehospital and Resource-Limited Settings

Thu, 23 Apr 2026 00:00:00 +0000

Introduction: Vital sign monitoring is essential to the management of critically ill and injured patients. Recent advances in patient monitoring systems have the potential to improve outcomes by providing real-time data and predictive insights, which are particularly valuable in prehospital and resource-limited settings. We conducted a systematic review of the literature to assess the capabilities, performance, and clinical impact of patient monitoring technologies designed for these environments.

Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review using PubMed and Scopus search engines on studies published between 2018-2022 that proposed or tested novel patient monitorint systems with utility in prehospital or resource-limited settings. Two reviewers independently screened studies, and discrepancies were resolved by a senior author. Of 217 studies...

CORD Abstracts 2026

Wed, 1 Apr 2026 00:00:00 +0000
CORD Abstracts 2026

Embedded Palliative Care in the Emergency Department Enhances Resident Confidence and Competency

Wed, 1 Apr 2026 00:00:00 +0000
Embedded Palliative Care in the Emergency Department Enhances Resident Confidence and Competency

Dispo Dash—A Novel Game for Optimizing Triage and Disposition Skills

Wed, 1 Apr 2026 00:00:00 +0000
Dispo Dash—A Novel Game for Optimizing Triage and Disposition Skills

Sports Medicine Training in Airway & Trauma (STAT) Curriculum for Sideline Event Providers

Fri, 27 Mar 2026 00:00:00 +0000
Sports Medicine Training in Airway & Trauma (STAT) Curriculum for Sideline Event Providers

Improving Emergency Medicine Resident Competency in Social Determinants of Health Through a Structured Instructional Training Framework: A Pre–Post Study

Fri, 27 Mar 2026 00:00:00 +0000
Improving Emergency Medicine Resident Competency in Social Determinants of Health Through a Structured Instructional Training Framework: A Pre–Post Study

Developing Resident Educators: A Cross- Specialty Graduate Medical Education Workshop Initiative

Fri, 27 Mar 2026 00:00:00 +0000
Developing Resident Educators: A Cross- Specialty Graduate Medical Education Workshop Initiative

“Actually, I’m Trans”: A Skills-Based Curriculum to Improve Emergency Care for Transgender and Gender Diverse Patients

Fri, 27 Mar 2026 00:00:00 +0000
“Actually, I’m Trans”: A Skills-Based Curriculum to Improve Emergency Care for Transgender and Gender Diverse Patients

Phased Separation of Emotions and Practice in Simulation to Improve Resident Training in Resuscitative Hysterotomy

Fri, 27 Mar 2026 00:00:00 +0000
Phased Separation of Emotions and Practice in Simulation to Improve Resident Training in Resuscitative Hysterotomy

Surprise Mass Casualty Incident Simulation

Fri, 27 Mar 2026 00:00:00 +0000
Surprise Mass Casualty Incident Simulation

A SLOE Shift: A Resident-Led Rethink of Faculty Evaluation

Fri, 27 Mar 2026 00:00:00 +0000
A SLOE Shift: A Resident-Led Rethink of Faculty Evaluation

A Longitudinal ABEM Certifying Exam Curriculum for Senior Residents

Fri, 27 Mar 2026 00:00:00 +0000
A Longitudinal ABEM Certifying Exam Curriculum for Senior Residents

Code Camp: Training Confident Resuscitationists through Small-Group Simulations Using Iterative Learning

Fri, 27 Mar 2026 00:00:00 +0000
Code Camp: Training Confident Resuscitationists through Small-Group Simulations Using Iterative Learning

Social Determinants of Health Workshop: Utilizing Simulation and Gamification to Increase Social Determinants of Health Education

Fri, 27 Mar 2026 00:00:00 +0000
Social Determinants of Health Workshop: Utilizing Simulation and Gamification to Increase Social Determinants of Health Education

Implementation of an Ultrasound Scavenger Hunt Increases both Point-Of- Care Ultrasound Use and Identification of Emergent Pathology

Fri, 27 Mar 2026 00:00:00 +0000
Implementation of an Ultrasound Scavenger Hunt Increases both Point-Of- Care Ultrasound Use and Identification of Emergent Pathology

Difficult Conversations Made Teachable: Building Resident Confidence in Delivering Bad News

Fri, 27 Mar 2026 00:00:00 +0000
Difficult Conversations Made Teachable: Building Resident Confidence in Delivering Bad News

All In: A Casino-Themed Emergency Medicine Conference Day

Fri, 27 Mar 2026 00:00:00 +0000
All In: A Casino-Themed Emergency Medicine Conference Day

Creating Individualized Learning Plans with Large Language Models for Emergency Medicine Residency In-Service Training Exam

Fri, 27 Mar 2026 00:00:00 +0000
Creating Individualized Learning Plans with Large Language Models for Emergency Medicine Residency In-Service Training Exam

A Novel Experiential Learning Curriculum for Rural Emergency Medicine Training

Fri, 27 Mar 2026 00:00:00 +0000
A Novel Experiential Learning Curriculum for Rural Emergency Medicine Training

Bedside Banter: A Serious Game for Practicing High-Stakes Communication in the Emergency Department

Fri, 27 Mar 2026 00:00:00 +0000
Bedside Banter: A Serious Game for Practicing High-Stakes Communication in the Emergency Department

Innovating Morbidity and Mortality Conference: “Capturing the Chaos” Through Simulation

Fri, 27 Mar 2026 00:00:00 +0000
Innovating Morbidity and Mortality Conference: “Capturing the Chaos” Through Simulation

Rural Emergency Department Simulation: Resource Limited, Multipart Case Well Received by Residents

Fri, 27 Mar 2026 00:00:00 +0000
Rural Emergency Department Simulation: Resource Limited, Multipart Case Well Received by Residents

A Humanities-Based Innovation: Narrative Medicine for Trauma-Informed Learning in the Emergency Medicine Clerkship

Fri, 27 Mar 2026 00:00:00 +0000
A Humanities-Based Innovation: Narrative Medicine for Trauma-Informed Learning in the Emergency Medicine Clerkship

Soundcheck: A Resident-Led Podcast Model for Peer Learning and Competency Development in Emergency Ultrasound

Fri, 27 Mar 2026 00:00:00 +0000
Soundcheck: A Resident-Led Podcast Model for Peer Learning and Competency Development in Emergency Ultrasound

Enhancing Empathy for Non-English- Speaking Patients: A Novel Simulation for Emergency Medicine Residents

Fri, 27 Mar 2026 00:00:00 +0000
Enhancing Empathy for Non-English- Speaking Patients: A Novel Simulation for Emergency Medicine Residents

A Novel Medical Student-Intern Mentorship Program in an Emergency Medicine Sub-Internship

Fri, 27 Mar 2026 00:00:00 +0000
A Novel Medical Student-Intern Mentorship Program in an Emergency Medicine Sub-Internship

Re-Engineering the CCC Meeting, Promoting a More Efficient and Evidence-Based Approach to Semi-Annual Resident Assessment

Fri, 27 Mar 2026 00:00:00 +0000
Re-Engineering the CCC Meeting, Promoting a More Efficient and Evidence-Based Approach to Semi-Annual Resident Assessment

The Benefits of Simwars in Second Year Medical Education

Fri, 27 Mar 2026 00:00:00 +0000
The Benefits of Simwars in Second Year Medical Education

Emergency Medicine Smackdown! A Novel Debate Session in Residency Didactics Using Artificial Intelligence

Fri, 27 Mar 2026 00:00:00 +0000
Emergency Medicine Smackdown! A Novel Debate Session in Residency Didactics Using Artificial Intelligence

Transforming Resident Efficiency Feedback: A Framework for Meaningful Productivity Metrics

Fri, 27 Mar 2026 00:00:00 +0000
Transforming Resident Efficiency Feedback: A Framework for Meaningful Productivity Metrics

Simulated ED Tracker Board Sign-Out: Enhancing Resident Confidence and Patient Safety

Fri, 27 Mar 2026 00:00:00 +0000
Simulated ED Tracker Board Sign-Out: Enhancing Resident Confidence and Patient Safety

Podcasts Are an Effective Tool for Teaching Evidence-Based Medicine to Emergency Medicine Residents

Fri, 27 Mar 2026 00:00:00 +0000
Podcasts Are an Effective Tool for Teaching Evidence-Based Medicine to Emergency Medicine Residents

Step by Step: A Novel Approach to Central Venous Catheter Training Utilizing Microskills Stations

Fri, 27 Mar 2026 00:00:00 +0000
Step by Step: A Novel Approach to Central Venous Catheter Training Utilizing Microskills Stations