Sacco DL, Suh EH, Winskill C
… +9 more, Wan EY, DeAngelis J, Nishijima DK, Schimmel J, Storrow AB, Thiruganasambandamoorthy V, Wood N, Weiss RE, Probst MA
Ann Emerg Med
· 2026 Mar · PMID 41860508
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STUDY OBJECTIVE: Clinical management of emergency department (ED) patients with syncope may differ between women and men. We investigated differences by patient sex in baseline characteristics, physician risk estimation,...STUDY OBJECTIVE: Clinical management of emergency department (ED) patients with syncope may differ between women and men. We investigated differences by patient sex in baseline characteristics, physician risk estimation, admission rates, and clinical outcomes in patients with syncope or presyncope. METHODS: Patients 40 years or older with syncope or presyncope were enrolled in a prospective, observational study across 6 EDs in the United States. Clinical, demographic, and 30-day outcomes were collected. Treating physicians provided an estimate of 30-day risk of a serious adverse event. We used risk differences and multivariable logistic regression to examine the relationship between sex and outcomes. RESULTS: Of 1,263 patients analyzed, 676 (53.5%) were woman. Men were more likely to have baseline cardiac disease, such as coronary artery disease (27.8% vs 11.8%; risk difference [RD]: 16%; 95% CI 11 to 20) or heart failure (15.3% vs 8.0%; RD: 7.0%; 95% CI 4 to 11). Mean physician estimate of the 30-day serious adverse event risk was 7.2% in men and 6.1% in women (RD: 1.2%; 95% CI -0.26 to 2.6). Men were more often admitted (50.4% vs 39.6%; RD: 11%; 95% CI 5 to 16). The rate of 30-day serious adverse events was higher in men (7.3% vs 4.6%; RD: 2.7%; 95% CI 0.14 to 5.5). After adjustment for baseline clinical variables, no differences in admission rates or clinical outcomes remained. CONCLUSION: There were significant baseline clinical differences between men and women with syncope or presyncope. We explained the higher admission rates and 30-day serious adverse events among men vs women by differences in baseline clinical factors.
Morley-Fletcher A, Raghavan VR, Geanacopoulos AT
… +4 more, Maher M, Waltzman M, Barak Corren Y, Fine AM
Ann Emerg Med
· 2026 Mar · PMID 41854578
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STUDY OBJECTIVE: To assess the feasibility and acceptability of using ChatGPT to obtain histories of present illnesses directly from patients or caregivers in a pediatric emergency department waiting room in a pilot stud...STUDY OBJECTIVE: To assess the feasibility and acceptability of using ChatGPT to obtain histories of present illnesses directly from patients or caregivers in a pediatric emergency department waiting room in a pilot study. METHODS: In a prospective mixed-methods pilot study, patients (n=31) with Emergency Severity Index scores 3 to 5 used a HIPAA-compliant instance of ChatGPT-4 to generate histories of present illnesses which were collected in parallel with usual care and were not used to inform clinical decision-making. Participants used an 11-point scale to rate their experiences around usability and satisfaction and rated the quality of the generated history of present illness. Thematic analysis of open-ended responses was performed. Pediatric emergency physicians reviewed summaries for accuracy, completeness, efficiency, readability and overall satisfaction, using an 11-point rating scale. RESULTS: Participants reported high usability (median 10, interquartile range 8 to 10), satisfaction (8 and 7 to 10), and overall quality (9 and 8 to 10) of the summary history of present illness. Participants particularly commented on the ease of use, the objectivity of the system, and the accuracy of the summary. Physician reviewers gave favorable ratings across all 5 domains of accuracy, completeness, efficiency, readability, and overall satisfaction, with the highest for readability (9 and 7 to 9), and all others with a median score of 8/10. Clinicians noted that the summaries sometimes lacked important features of prior visits. They noted no hallucinations in the final transcripts. CONCLUSION: This pilot study of ChatGPT-enabled patient history taking in the pediatric emergency department waiting room was feasible, well accepted, and produced accurate, complete, readable, and efficient summaries. This approach has potential to reduce documentation burden, enhance patient engagement, and support more streamlined triage.
Ann Emerg Med
· 2026 Jul · PMID 41854577
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STUDY OBJECTIVES: Disparities in physical restraint use among emergency department (ED) patients are well described. Less is known about the intramuscular (IM) administration of sedating medications. We evaluated patient...STUDY OBJECTIVES: Disparities in physical restraint use among emergency department (ED) patients are well described. Less is known about the intramuscular (IM) administration of sedating medications. We evaluated patient characteristics and adverse outcomes associated with receiving IM chemical sedation in the ED. METHODS: This retrospective cross-sectional evaluation at Kaiser Permanente Northern California from January 1, 2017, to December 31, 2021, included ED patients aged 18-64 years who received a mental health consultation. We assessed the frequency of IM chemical sedation, associated characteristics, and adverse events. We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess characteristics associated with IM chemical sedation. RESULTS: Of 94,204 ED visits (56,154 patients) meeting inclusion criteria, 11,048 (11.7%) received IM chemical sedation. Median patient age was 34 years (IQR 25-48), and 46,948 (49.8%) visits were for male patients. Higher adjusted odds of IM chemical sedation were observed for patients of Black race (aOR 1.38, 95% CI 1.27 to 1.50), concomitant physical restraint (aOR 33.05, 95% CI 30.28 to 36.08), Emergency Medical Services (EMS)/law enforcement arrival (aOR 1.51, 95% CI 1.43 to 1.60), and involuntary mental health hold placement (aOR 1.66, 95% CI 1.56 to 1.77). Patients' age, sex, and need for interpreter services were not associated with IM chemical sedation. Supplemental oxygen administration was the most common adverse event (n = 2,662, 2.8%). CONCLUSIONS: Among ED patients with mental health consultation, IM chemical sedation was associated with EMS/law enforcement arrival, Black race, and involuntary mental health hold. Further work is needed to understand how comorbid mental health conditions, implicit bias, and unmeasured confounders may impact the use of IM chemical sedation.
Ann Emerg Med
· 2026 Mar · PMID 41817488
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STUDY OBJECTIVE: Frequent past-year emergency department (ED) use is a risk factor for suicide but also presents an intervention opportunity. This study aimed to quantify ED visit timing among suicide decedents by past-y...STUDY OBJECTIVE: Frequent past-year emergency department (ED) use is a risk factor for suicide but also presents an intervention opportunity. This study aimed to quantify ED visit timing among suicide decedents by past-year ED use and characterize differences between suicide decedents and other ED patient populations. METHODS: ED records were obtained from the North Carolina Disease Event Tracking and Epidemiological Collection Tool (NC DETECT), and death records were obtained from the NC Violent Death Reporting System (NC-VDRS). ED visits corresponding to the decedent's suicide were probabilistically linked to their corresponding death record. Decedents were classified as frequent (≥4) and infrequent (<4) users based on nonfatal ED visits occurring within one year of their death. Timing from decedents' final nonfatal visit to death was assessed. Decedents' demographics and visit characteristics were compared with all ED patients and mental health patients, stratified by past-year use. RESULTS: From 2019 to 2020, 670 of 2,883 NC-VDRS suicide decedents linked to an ED visit associated with their suicide. One third (n=213) of linked decedents had past-year ED use. Among these individuals, 21.6% (n=46) were frequent users. Within 30 days of their final nonfatal visit, only 28% of frequent users survived, compared with 65% of infrequent users (difference: -36.4% [-51.3% to -21.5%]). Suicide decedents with frequent use were distinct from infrequent users and from both reference groups regarding demographic and visit-level characteristics. CONCLUSION: Suicide decedents who visited the ED once or who were frequent users were demographically distinct from the overall population of ED patients. Timing from final nonfatal ED visit to death by suicide varied with past-year use.
Kilaru AS, Mondal A, Jesteen S
… +4 more, Geng Z, Isenberg D, Zikry HE, Meisel ZF
Ann Emerg Med
· 2026 Jun · PMID 41817487
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STUDY OBJECTIVE: To describe the use of telemedicine for outpatient follow-up care after discharge from the emergency department (ED) in a large cohort of patients with commercial insurance or Medicare Advantage and dete...STUDY OBJECTIVE: To describe the use of telemedicine for outpatient follow-up care after discharge from the emergency department (ED) in a large cohort of patients with commercial insurance or Medicare Advantage and determine whether telemedicine follow-up was associated with greater return hospitalizations compared with in-person care. METHODS: Using administrative claims data, we conducted a retrospective cohort study of adults discharged from the ED with congestive heart failure, diabetes, chronic obstructive pulmonary disease, or asthma, from 2020 to 2022. The primary outcome was modality of the first outpatient visit within 14 days, either in person or via telemedicine. We used multivariable logistic regression to examine patient characteristics associated with use of telemedicine compared with in-person follow-up. We also used time-to-event methods to estimate the risk of return hospitalization for patients who obtained telemedicine versus in-person follow-up. RESULTS: Among 147,561 patients discharged from the ED (mean age 63.9 years; 56.5% women), we found that 4,107 (2.8%) obtained telemedicine follow-up visits and 34,882 (23.6%) obtained in-person follow-up. An additional 7,487 (5.1%) patients were hospitalized prior to obtaining any follow-up. Use of telemedicine varied across conditions and was associated with younger age, female sex, more comorbidities, and ED visit complexity. Telemedicine was not associated with greater risk of return hospitalization compared with in-persnon follow-up. CONCLUSION: ED patients used telemedicine for outpatient follow-up visits at low rates, with comparable rates of return hospitalization to those who obtained in-person follow-up. Future studies may examine focused interventions to deploy telemedicine to expand access to follow-up care for selected patients.
Ann Emerg Med
· 2026 Jul · PMID 41758080
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Although aortoenteric fistula is traditionally associated with aortic aneurysms or grafts, modern multimodal oncologic therapies have introduced a new paradigm of aortic injury in native vessels. We describe a rare case...Although aortoenteric fistula is traditionally associated with aortic aneurysms or grafts, modern multimodal oncologic therapies have introduced a new paradigm of aortic injury in native vessels. We describe a rare case of treatment-related aortoenteric fistula arising from a nonaneurysmal aorta in a 56-year-old woman with fallopian tube carcinoma. Her history included para-aortic lymph node excision, pelvic radiation, and recent bevacizumab therapy. Although these factors may act synergistically, bevacizumab represents a potential primary driver of vascular wall compromise. The patient presented with weakness and intermittent melena representing multiple herald bleeds but subsequently suffered a sudden inhospital cardiac arrest. Emergent computed tomography obtained prior to endoscopic evaluation revealed an aortoduodenal fistula despite a nonaneurysmal aorta, prompting successful endovascular aortic repair. This case illustrates that a nonaneurysmal caliber does not rule out aortoenteric fistula in patients with this specific risk profile. This report highlights one of the few documented cases of such vascular pathology following this specific combination of therapies. For unstable oncology patients with gastrointestinal bleeding and recent antiangiogenic therapy, emergency physicians should broaden the diagnostic workup to include early vascular imaging and enlist vascular specialists alongside standard endoscopic evaluation.