Acad Emerg Med
· 2026 May · PMID 42188673
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BACKGROUND: Existing literature indicates that patients respond positively to point-of-care ultrasound (POCUS) across various clinical settings. However, limited research explores how patient-families perceive its use in...BACKGROUND: Existing literature indicates that patients respond positively to point-of-care ultrasound (POCUS) across various clinical settings. However, limited research explores how patient-families perceive its use in pediatric emergency department (ED) care. Our study aims to evaluate POCUS's impact on patient experience, stress, and anxiety in the pediatric ED. METHODS: We conducted a randomized study (1:1) of pediatric patients (≤ 17 years) presenting with a clinical indication for POCUS (lung, FAST, cardiac, or soft tissue applications). Patients were assigned to either a POCUS or non-POCUS group, excluding those who were unstable or had prior POCUS evaluations. Patient-families completed pre- and post-surveys (5-point Likert scale) at triage and ED disposition. Demographic data were obtained from the electronic medical record. Statistical analyses included Chi-Square, Fisher's Exact, Wilcoxon, and sign tests (α = 0.05) to compare group responses and assess for changes in responses over time. RESULTS: A total of 200 patient-families were enrolled. The cohort was primarily English-speaking, non-Hispanic White males, with an average age of 5.16 years (SEM ±0.37). Common chief complaints included cough (34%), fever (15%), abdominal pain (14%), and shortness of breath (13%). No significant differences were observed in patient experience or ED length of stay. Sign tests indicated significant reductions in stress and anxiety within both groups from pre- to post-survey assessments [Anxiety: p < 0.0001 (POCUS), p = 0.0003 (non-POCUS); Stress: p < 0.0001 (POCUS), p < 0.0001 (non-POCUS)]. POCUS patient-families reported a significantly greater perceived importance of imaging and stated that POCUS directly alleviated their stress and anxiety. CONCLUSION: The primary outcome, magnitude of change in stress and anxiety, demonstrated significant reductions in both POCUS and non-POCUS groups. Despite similar findings within each group, families receiving POCUS reported greater perceived importance of imaging and strong support for its use, highlighting its potential to enhance patient-centered care and support further research into its optimal implementation in pediatric emergency care.
Perice L, Azzo C, Cowan M
… +8 more, Kheirbek T, Driver L, Tokarz S, Gallegos H, Kharel R, Jarabana SG, Baird J, Pare JR
Acad Emerg Med
· 2026 May · PMID 42159402
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STUDY OBJECTIVES: Managing pain associated with acute rib fractures remains a challenge in the emergency department. The current standard of care involves multimodal pain management and pulmonary hygiene. The Serratus An...STUDY OBJECTIVES: Managing pain associated with acute rib fractures remains a challenge in the emergency department. The current standard of care involves multimodal pain management and pulmonary hygiene. The Serratus Anterior Plane Block (SAPB) is easily performed at the bedside, offers a favorable risk profile, and provides targeted analgesia for patients with rib fractures. Here, we investigated whether SAPB performed by an emergency medicine (EM) physician in addition to usual care improves the pain, inspiratory capacity, and cough (PIC) score in patients with acute rib fractures compared to usual care alone. METHODS: We conducted a prospective, open-label, randomized controlled trial at an academic Level 1 Trauma Center. We enrolled adult patients with anterior or lateral rib fractures T2 through T9 and a pain score ≥ 5 out of 10. Participants were randomized to either receive a SAPB plus usual care or usual care alone. The primary outcome was an improvement in the PIC score. The secondary outcome was oral morphine equivalents (OMEs) administered at 24 h. We analyzed changes in PIC scores using a linear mixed-effects model and compared OME consumption using the Wilcoxon rank-sum test. RESULTS: Thirty-eight patients were included in the final analysis (19 intervention, 19 control). The SAPB group demonstrated a significant improvement in PIC scores at 5 h post-enrollment compared with the control group (estimated average effect 0.90; 95% CI: 0.10 to 1.69; p = 0.03). Patients in the intervention arm received 32.2 mg OMEs versus 54.1 mg OMEs in the control arm at 24 h, which was not statistically significant (p = 0.44). No complications were observed. CONCLUSIONS: Adding the SAPB to usual care produced a statistically significant improvement in PIC scores among emergency department (ED) patients with rib fractures. SAPB was performed safely by emergency physicians and represents a feasible, scalable adjunct for acute rib fracture analgesia in the ED. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06299137.
Metts E, Carroll S, Posen A
… +2 more, Rech MA, Weant K
Acad Emerg Med
· 2026 May · PMID 42141740
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Population aging is reshaping emergency care. Older adults already account for 15%-25% of U.S. emergency department (ED) visits and, compared with younger patients, present with greater numbers of comorbidities, higher r...Population aging is reshaping emergency care. Older adults already account for 15%-25% of U.S. emergency department (ED) visits and, compared with younger patients, present with greater numbers of comorbidities, higher resource utilization, longer stays, and markedly higher admission rates (35%-45%), return visits, and mortality. Medication exposure is a central driver of risk with an estimated ~10% of older-adult ED visits being medication-related. We conducted a narrative review of the literature surrounding medication safety for geriatric patients presenting to the ED and strategies that can be employed to optimize pharmacotherapy management. Medication-safety elements include medication reconciliation, the systematic reduction of potentially inappropriate medications using tools such as Beers, STOPP/START, or GEMS-Rx, and geriatric-tailored order sets for common presentations (e.g., pain, delirium, hip fracture). Additionally, system-based interventions such as utilization of Clinical Decision Support Systems (CDSS), Geriatric Emergency Department Accreditation (GEDA), and alignment with regulatory agencies are explored. The combination of robust emergency medicine pharmacist integration, clinical decision support, and disciplined measurement offers a pragmatic path to reduce potentially inappropriate prescribing and ADEs resulting in improved safety and outcomes for older adults in the ED.
Follman SE, Canavan M, Rothenberg C
… +4 more, Iscoe M, Venkatesh AK, Ramachandran R, Gettel CJ
Acad Emerg Med
· 2026 May · PMID 42136546
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OBJECTIVES: Potentially inappropriate medication prescribing remains a common and preventable source of adverse drug events among older adults, particularly during transitions of care such as ED discharge. We assessed th...OBJECTIVES: Potentially inappropriate medication prescribing remains a common and preventable source of adverse drug events among older adults, particularly during transitions of care such as ED discharge. We assessed the prevalence and trends of older adults with high-risk medication fills based on the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) list. METHODS: We conducted a cross-sectional study using the 2017-2022 Merative™ MarketScan® Medicare Database. We included ED visits by older adults (65+ years of age) discharged from the ED. The primary outcome was met if a GEMS-Rx medication was filled within 3 days of ED discharge. Multivariable logistic regression estimated associations between patient- and system-level factors and GEMS-Rx fill after ED discharge. RESULTS: Among 616,980 unique ED visits, 58,284 (9.4%; 95% CI: 9.4%-9.5%) had a GEMS-Rx medication filled within 3 days of discharge. In 2017, 13,746 (11%) ED encounters resulted in a GEMS-Rx medication fill within 3 days of ED discharge compared to 6,524 (7%) ED encounters in 2022. Medication fills declined over time, with each additional year associated with a lower odds of GEMS-Rx medication fills. Benzodiazepines (37%), first-generation antihistamines (22%), and skeletal muscle relaxants (11%) were the most frequently filled GEMS-Rx medication classes. Female sex (OR 1.43, 95% CI: 1.41-1.46) and younger age (75-84 years: OR 0.69, 95% CI: 0.68-0.71; ≥ 85 years: OR 0.47, 95% CI: 0.46-0.48) were associated with higher odds of receiving a GEMS-Rx medication. CONCLUSIONS: Nearly 1 in 10 older adults filled a high-risk GEMS-Rx medication within 3 days of ED discharge between 2017 and 2022. Despite a decline in GEMS-Rx medication fills over time, younger cohorts of older adults and females were more likely to fill a high-risk medication upon ED discharge. These findings highlight opportunities to continue improving geriatric medication safety through targeted education, decision support, and system-level interventions.
Tsuchida RE, Schwei RJ, Boatright D
… +1 more, Padela AI
Acad Emerg Med
· 2026 May · PMID 42132360
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BACKGROUND: While EM departments have designated new leadership roles to focus on diversity, equity, and inclusion (DEI) in recent years, the experiences of DEI leaders have not been thoroughly investigated. The purpose...BACKGROUND: While EM departments have designated new leadership roles to focus on diversity, equity, and inclusion (DEI) in recent years, the experiences of DEI leaders have not been thoroughly investigated. The purpose of this study was to describe the factors that impact the effectiveness of DEI leaders within EM. METHODS: We conducted a national qualitative study of DEI leaders in EM. Participants participated in a 60-min semi-structured interview. An interview guide was pilot-tested and iteratively refined. The interview audio was recorded and professionally transcribed. Two team members developed a codebook, independently coded transcripts, and generated categories using content analysis. We analyzed the interview transcripts using inductive and deductive content analysis. Inductive analysis allowed us to identify emerging categories, while deductive analysis allowed us to overlay Camara Jones' Allegory of the Levels of Racism to our data. RESULTS: We completed 24 interviews, representing 21 unique institutions in 14 states. In our adapted allegory, the DEI leader is represented centrally within the ecosystem. The effectiveness of the DEI leader is influenced by institutionally mediated, personally mediated, and internally mediated factors. Institutionally mediated factors included the macroenvironment, administrative positioning, and promotion pathways. Personally mediated factors included communication skills, ongoing leadership development, change management prowess, and seeking colleagues' support. Internally mediated factors included personal commitment to DEI work, as well as feelings of workplace inclusion, imposter syndrome, and tokenism. CONCLUSIONS: This qualitative analysis of EM DEI leaders highlights how factors at various levels influence their experience. Jones's allegory helps conceptualize how a DEI leader functions in a dynamic, continually evolving environment that is sometimes beyond the leader's control. Our research identifies opportunities at the personal, departmental, and institutional levels, such as maintaining a personal commitment to the work, supporting leadership development, and improving administrative positioning that can assist DEI leaders' effectiveness.
Friedman AB, Adjei-Poku MN, Schadt LA
… +7 more, Li Y, Cappola AR, Kelz RR, Hwang U, Kowdley G, Mwinyogle A, Trueger NS
Acad Emerg Med
· 2026 May · PMID 42108559
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OBJECTIVES: Older adults with abdominal pain present diagnostic uncertainty due to less informative histories/exams, broader etiologies, and higher morbidity. Whether ED imaging decisions are calibrated to this risk is u...OBJECTIVES: Older adults with abdominal pain present diagnostic uncertainty due to less informative histories/exams, broader etiologies, and higher morbidity. Whether ED imaging decisions are calibrated to this risk is unclear. The objective of this study was to compare age-stratified clinical features, CT utilization, and CT diagnostic yield, and to assess how history/physical and clinician pretest suspicion relate to adverse outcomes. METHODS: This was a retrospective cohort analysis of data from a prospective cohort collected from March 2016-January 2017 at a single community teaching hospital emergency department in southwest Baltimore. We analyzed 1169 visits of adults presenting with nontraumatic abdominal pain including 229 (19.6%) aged ≥ 60 years. Patients < 18 years were excluded. Age groups were 18-39, 40-59, ≥ 60 years. Outcomes were CT ordering, acute actionable CT findings, admission, surgery, and a composite of adverse outcomes (any actionable CT finding, admission, surgery, or Emergency General Surgical diagnosis). History and physical examination operating characteristics (e.g., sensitivity/specificity of tenderness, rebound) were also calculated. RESULTS: Of 1169 visits, 19.6% were aged ≥ 60 years. CT ordering increased with age (41.7%, 66.2%, 70.7% for 18-39, 40-59, ≥ 60; p < 0.001), as did CT yield (18.4%, 31.2%, 37.7%; p < 0.001). Admissions (12.1%, 28.0%, 37.6%) and surgeries (4.6%, 9.0%, 10.6%) also rose with age. Clinician pretest suspicion was similar across age groups. Abdominal tenderness was less sensitive for adverse outcomes in older adults (sensitivity 0.58 in ≥ 60 vs. 0.73 in 18-39 and 0.73 in 40-59), while rebound tenderness was highly specific across ages (specificity 0.98, 0.96, 0.98). The number of potential diagnoses to consider rose with age. CONCLUSION: In this cohort, CT use and positivity increased with age and key exam findings (e.g., tenderness) being less informative in older adults, despite similar reported clinician pretest suspicion. These results support age-aware imaging decisions and motivate reframing ED abdominal pain as a geriatric-specific chief complaint.