Joseph AM, Michelson KA, Dewan ML
… +4 more, Lipstein EA, Babcock L, Davis BS, Kahn JM
Ann Emerg Med
· 2026 Jul · PMID 42390397
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STUDY OBJECTIVE: We sought to describe variation in emergency department (ED) volume of pediatric critical illness encounters, and to assess the geographic proximity of encounters at low-volume EDs relative to high-volum...STUDY OBJECTIVE: We sought to describe variation in emergency department (ED) volume of pediatric critical illness encounters, and to assess the geographic proximity of encounters at low-volume EDs relative to high-volume EDs. METHODS: We conducted a retrospective cohort study of the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases for 5 states from 2018 to 2022. Critical illness was defined as death, cardiopulmonary resuscitation, or endotracheal intubation in the ED or on hospital day 0 or 1 or ED critical care time billing. We calculated the ED-level incidence of critical illness and dichotomized EDs into low- or high-volume at the 75th percentile of volume for each state and year. We determined how many encounters at low-volume EDs occurred within a 15-minute drive of a high-volume ED. RESULTS: Of 14,313,896 pediatric ED encounters across 569 EDs, 40,483 (0.3%) were critical. The median ED managed 1,932 pediatric visits each year (interquartile range [IQR] 680 to 5,068) and 5 (IQR 1 to 14) with critical illness. We identified 181 (31.8%) EDs with a calendar year with no pediatric critical illness. We found 1,557 (16.8%) critically ill children were managed in low-volume EDs within a 15-minute drive of a high-volume ED. CONCLUSION: Most EDs infrequently care for critically ill children, and a minority of these encounters could be realistically diverted to high-volume EDs. Direct transport to high-volume centers is unlikely to be a universal strategy for ensuring access to high-quality emergency care for critically ill children.
Zymerman SA, Cramer N, Klein A
… +3 more, Cohen S, Nadir E, Katzir Y
Ann Emerg Med
· 2026 Jul · PMID 42390396
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STUDY OBJECTIVE: Our study objective was to describe our experience with POCUS-guided hydrostatic reductions of ileocolic intussusception performed by a PEM physician at the bedside in the pediatric emergency department...STUDY OBJECTIVE: Our study objective was to describe our experience with POCUS-guided hydrostatic reductions of ileocolic intussusception performed by a PEM physician at the bedside in the pediatric emergency department (PED). METHODS: We describe a case series of children aged 3 to 36 months with ileocolic intussusception in the PED who received a bedside POCUS-guided hydrostatic reduction between May 2022 and November 2025 in our secondary care hospital. Data collected included the time from presentation to successful POCUS-guided hydrostatic reduction, success rate, complications, and 24-hour recurrence. RESULTS: A total of 9 bedside POCUS-guided hydrostatic reductions were performed in the PED by a PEM provider. Successful reduction was achieved in 8 out of 9 (88.9%) cases. The median time from PED arrival to successful POCUS-guided reduction was 1.69 hours (interquartile range 1.04 to 2.45). No complications or 24-hour recurrences occurred. One unsuccessful case was later identified to have a lead point requiring definitive surgical repair. CONCLUSION: Our case series of POCUS-guided hydrostatic reduction performed by a trained PEM physician at the bedside in the PED appears to highlight a safe and expedient form of treatment for ileocolic intussusception. This approach eliminates radiation exposure and may shorten time to intervention in certain cases, particularly in settings without dedicated pediatric radiology services. Further larger studies are needed to validate our findings.
Schaefer L, Stein E, Schwarz A
… +3 more, Beck G, Krebs J, Boesing C
Ann Emerg Med
· 2026 Jul · PMID 42383960
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STUDY OBJECTIVE: Needle thoracostomy is a lifesaving intervention for tension pneumothorax, but increased chest wall thickness in obesity may reduce success rates. This study compared chest wall thickness at the second i...STUDY OBJECTIVE: Needle thoracostomy is a lifesaving intervention for tension pneumothorax, but increased chest wall thickness in obesity may reduce success rates. This study compared chest wall thickness at the second intercostal space in the midclavicular line (ICS 2-MCL) and fourth/fifth intercostal space in the anterior axillary line (ICS 4/5-AAL) across obesity categories and relative to needle length. METHODS: Prospective cross-sectional study including 110 patients with class II and III obesity (body mass index [BMI] 36 to 71 kg/m). Chest wall thickness was measured using ultrasound at ICS 2-MCL and ICS 4/5-AAL. Linear mixed-effects models assessed effects of BMI, location, and sex on chest wall thickness. The proportion with chest wall thickness exceeding 50 mm or 83 mm needle length was determined at each location. RESULTS: Chest wall thickness was greater at ICS 4/5-AAL than at ICS 2-MCL across the BMI range. The BMI effect on chest wall thickness differed between locations, increasing 11.3 mm per 10 kg/m at ICS 4/5-AAL versus 4.2 mm per 10 kg/m at ICS 2-MCL. Chest wall thickness exceeded 50 mm in 22% (95% confidence interval [CI] 15% to 31%) at ICS 2-MCL versus 82% (95% CI 73% to 89%) at ICS 4/5-AAL. No patient exceeded 83 mm at ICS 2-MCL; 21% (95% CI 14% to 30%) did at ICS 4/5-AAL. CONCLUSION: In patients with class II and III obesity, chest wall thickness at ICS 2-MCL is lower and less sensitive to increasing BMI than at ICS 4/5-AAL. No patient exceeded 83 mm at this site, suggesting this combination may maximize pleural space access.
Sethuraman KN, Lall MD, Gorman EF
… +4 more, Zeidan AJ, Agrawal P, Raukar NP, Cooper RJ
Ann Emerg Med
· 2026 Jul · PMID 42383959
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STUDY OBJECTIVE: We sought to summarize the last 20 years of published research on gender experience and disparities in the emergency medicine workforce. METHODS: We conducted a scoping review by searching MEDLINE ALL, E...STUDY OBJECTIVE: We sought to summarize the last 20 years of published research on gender experience and disparities in the emergency medicine workforce. METHODS: We conducted a scoping review by searching MEDLINE ALL, Embase, Cochrane Central Register of Controlled Trials, and Scopus from 2003 to 2024, to identify original research investigating gender experience and disparities among physicians in emergency medicine in North America. We abstracted study design, sample characteristics, and outcomes. We analyzed data using an ad hoc iterative thematic analysis of the content areas as well as a synthesis of the key findings and research limitations. RESULTS: We identified 5,740 candidate publications and, after exclusions, included 191 (99% observational studies). We identified 15 themes: (1) workforce, (2) childbearing, (3) attrition, (4) evaluations, (5) bias and discrimination, (6) wellness, (7) professional development groups and mentorship, (8) authorship, (9) editorial board membership, (10) research grants, (11) national speakers, (12) awards, (13) leadership roles, (14) academic rank and promotion, (15) financial compensation and one subtheme (pediatric emergency medicine). We mapped these themes to 5 domains: (1) Recruitment and Retention, (2) Culture and Environment, (3) Academic Scholarship, (4) Recognition and Promotion, and (5) Clinical Care and Decisionmaking. There were 3 to 33 publications per theme. The quality of evidence was variable. We found fewer disparities, and improvement over time in the percentage of women academic faculty, women authorship, national speaking, and educational awards. We found consistent evidence of gender disparities disadvantaging women emergency physicians in financial compensation, editorial board membership, executive leadership roles, academic rank, and experiences of gender bias, with little change over time. CONCLUSION: Although some areas remain understudied, our central findings confirm that gender-based disparities continue to exist among emergency physicians. Future efforts should be redirected toward the development and assessment of interventions that combat these disparities.