Hagerman TK, Ghosh S, Nour M
… +7 more, Cherukupalli C, Henry C, Peterson D, Lang T, Mowbray FI, Gunaga S, Miller J
Acad Emerg Med
· 2026 Jan · PMID 41575384
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BACKGROUND: Little is known about the referral timeframes emergency department (ED) providers recommend following emergency care and the frequency with which patients attend primary care provider (PCP) appointments withi...BACKGROUND: Little is known about the referral timeframes emergency department (ED) providers recommend following emergency care and the frequency with which patients attend primary care provider (PCP) appointments within these specific timeframes. METHODS: In this retrospective cohort study of adults aged 65 and older discharged home from nine EDs in Michigan, we evaluated patient attendance at PCP appointments within the timeframe recommended by the ED provider. We used descriptive statistics and multivariable regression (logistic and Cox proportional hazards) to identify factors associated with follow-up visit attendance and time to attendance. RESULTS: Among 1030 older adults, 81.9% of patients were recommended to follow up with a PCP. Of these patients, 39.9% and 13.7% were recommended follow-up within 1-3 days or 4-7 days, respectively. The overall rate of attendance at PCP visits within the recommended timeframe was 26.8% (95% CI 23.8-29.9). Only 15.2% (95% CI 12.3-18.5) of patients who were recommended follow-up within 7 days attended in that timeframe. Patients with shorter-interval follow-up recommendations and those seen at a safety-net ED were less likely to attend follow-up in the recommended timeframe. CONCLUSIONS: More than half of older adults were recommended primary care follow-up within 7 days, yet few attended visits in the timeframe recommended by the ED provider. Further research is needed to define appropriate follow-up timing and solutions to close the gap between a high portion of early follow-up recommendations and low visit attendance shortly after ED discharge.
Osman AD, Haywood CJ, Ho L
… +8 more, Yates P, Karahalios A, Zannino D, Mansouri N, Amadoru S, Yap C, Murray M, Braitberg G
Acad Emerg Med
· 2026 Jan · PMID 41540827
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BACKGROUND: The population aged over 75 is the fastest growing demographic presenting to the emergency department (ED). Various ED models have been implemented to address the needs of older patients, including care coord...BACKGROUND: The population aged over 75 is the fastest growing demographic presenting to the emergency department (ED). Various ED models have been implemented to address the needs of older patients, including care coordination and dedicated care zones. We describe the impact of the Geriatric Emergency Department Innovation (GEDI) with the aim of evaluating the proportion of older patients not admitted to hospital. Secondary outcomes of interest were ED length of stay (EDLOS), rate of admission to the secondary (Repatriation) campus, short stay unit (SSU) utilization, and re-presentation rates. METHOD: This single site study at a quaternary hospital with a main (Austin) campus and a secondary (Repatriation) campus employed interrupted time series analysis to assess the impact of GEDI while accounting for temporal trends. RESULTS: Before the introduction of GEDI, the rate of nonadmission of older patients to hospital was increasing by 0.1% per month (monthly change 1.001, 5% CI: 0.999, 1.002). After GEDI Implementation, this rate increased by 1.2% per month (1.012; 95% CI: 1.004, 1.020). The EDLOS increased by 0.08 (95% CI: 0.062, 0.099) hours per month prior to GEDI but then reduced by 0.207 (95% CI: -0.344, -0.069) hours per month afterwards. SSU utilization, re-presentations, and admissions to the Repatriation campus did not adversely change after GEDI introduction. CONCLUSION: The introduction of GEDI reduced EDLOS and inpatient admissions in older patients. Further research on economic benefit, patient-related outcome, and experience measures are needed to further evaluate the success of this program.
Gilman J, Alghamdi A, Hann M
… +10 more, Carlton E, Cooper JG, Cook E, Siriwardena AN, Phillips J, Thompson A, Bell S, Kirby K, Rosser A, Body R
Acad Emerg Med
· 2026 Jan · PMID 41528153
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OBJECTIVE: To evaluate the diagnostic accuracy of a novel point of care (POC) high-sensitivity troponin (hs-cTn) assay, used alone or incorporated within validated decision aids, for acute myocardial infarction (AMI) in...OBJECTIVE: To evaluate the diagnostic accuracy of a novel point of care (POC) high-sensitivity troponin (hs-cTn) assay, used alone or incorporated within validated decision aids, for acute myocardial infarction (AMI) in the prehospital setting. METHODS: A pre-specified secondary analysis of the Prehospital Evaluation of Sensitive Troponin (PRESTO) prospective diagnostic accuracy study, conducted in four ambulance services and 12 Emergency Departments (EDs; February 2019-March 2020). Paramedics included consenting adults with suspected AMI and no other reason for conveyance. Clinical data and venous blood were collected at the scene, and samples conveyed to hospital with participants. Plasma samples were later analyzed for hs-cTn using a novel POC hs-cTn assay (Abbott Point of Care i-STAT hs-TnI). The target condition was an adjudicated index diagnosis of type 1 AMI. RESULTS: Of 817 consenting participants, 704 were eligible for inclusion in this analysis, with type 1 AMI occurring in 89 (12.6%). At the limit of detection (< 2 ng/L), POC hs-cTn had 100.0% sensitivity (95% CI 95 9%-100.0%) but only 4.6% specificity (95% CI 3.1%-6.5%). A Troponin-only Manchester Acute Coronary Syndromes (T-MACS) very-low risk outcome identified 134 (19.7%) patients for non-conveyance with 98.9% sensitivity (95% CI 94.9%-100.0%), 99.3% negative predictive value (NPV, 95% CI 95.0%-99.9%), and 22.5% specificity (95% CI 19.2%-26.1%). A low-risk modified HEART score identified 150 (22.0%) patients with 93.2% sensitivity (95% CI 85.8%-97.5%), 96.0% NPV (91.6%-98.1%), and 24.3% specificity (95% CI 20.9%-27.9%). In an exploratory analysis, hs-cTn < 5 ng/L identified 295 (41.9%) patients with 98.9% sensitivity (93.9%-100.0%), 99.7% NPV (97.7%-100.0%), and 47.8% specificity (95% CI 43.8%-51.8%). CONCLUSIONS: This novel POC hs-cTn assay achieves high sensitivity and NPV when used alongside the T-MACS decision aid, but efficiency may be greater at a 5 ng/L threshold without requiring any decision aid. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03561051.
Hansen M, Stephens SW, Elman MR
… +19 more, Shah MI, Bosson N, Gausche-Hill M, VanBuren JM, Jacobsen K, Elsholz C, Brown B, Goldkind SF, Nishijima DK, Swanson D, Leonard JC, Brown KM, Elston C, Wilkinson M, Whitfield D, Colella MR, Gaither JB, Faris G, Wang H
Acad Emerg Med
· 2026 Jan · PMID 41524561
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BACKGROUND: Federal Exception from Informed Consent (EFIC) regulations allow emergency care research without a priori consent under limited conditions by integrating feedback from community consultation and notification...BACKGROUND: Federal Exception from Informed Consent (EFIC) regulations allow emergency care research without a priori consent under limited conditions by integrating feedback from community consultation and notification of communities through public disclosure (CC/PD) activities (21 CFR 50.24). Our objectives were to evaluate community acceptance of a pediatric emergency care trial using a commercial survey tool and to determine the characteristics associated with supportive respondents. METHODS: The Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) is an EFIC trial designed to compare pediatric prehospital airway management strategies. Pedi-PART conducted community consultation/public disclosure (CC/PD) activities in March-April 2024. The CC/PD process used a commercial marketing research platform (Qualtrics Inc.) to provide study information and solicit feedback via an 18-question survey. Participants indicated support for the study through three specific questions and provided demographic characteristics. We determined the predictors of trial approval among survey respondents. RESULTS: A total of 6753 individuals completed surveys. The median age was 42 (IQR: 30-59) years, 62% were female, 13% were Black, and 15% were Hispanic. Survey respondents indicated support for conducting Pedi-PART in their community as follows: 90% of males, 91% of females, 89% of Blacks, 92% of Hispanics, 92% of Whites, 90% of other race/ethnicities, and 93% of parents of a child < 18 years. Among respondents with less than a high school education, 84% approved of the study compared to 93% in those with a post-graduate degree. Among those with an annual household income < $20,000, 85% approved of the study compared to 94% of those with an > $100,000 annual household income. In multivariable analysis, higher education and being the parent/guardian of a minor child were associated with support of the trial. CONCLUSIONS: Survey respondents largely supported the Pedi-PART trial. Respondents who were parents or who had higher education were more likely to support the trial.
Lee JA, Quao NSA, Collier A
… +12 more, Rees CA, Broccoli MC, Dawson-Amoah NA, Kampalath VN, Ciano J, Jacobson A, Jones J, Leanza J, Skarpiak B, Strong JM, Hexom BJ, Global Emergency Medicine Literature Review (GEMLR) Group
Acad Emerg Med
· 2026 Mar · PMID 41437522
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OBJECTIVE: The Global Emergency Medicine Literature Review (GEMLR) identifies impactful research in global emergency care. This 20th annual edition reviews GEM literature published in 2024 and highlights the growth of GE...OBJECTIVE: The Global Emergency Medicine Literature Review (GEMLR) identifies impactful research in global emergency care. This 20th annual edition reviews GEM literature published in 2024 and highlights the growth of GEMLR over the years. METHODS: We conducted a scoping review of 2024 GEM articles through structured PubMed and gray literature searches. Reviewers and editors from 10 countries screened abstracts using predefined criteria for three domains: disaster and humanitarian response (DHR), emergency care in limited-resource settings (ECLRS), and emergency medicine development (EMD). Duplicates and articles lacking authorship equity or ethical oversight were excluded. Remaining publications were scored using tailored rubrics for original research (OR), review articles (RE), and gray literature (GRAY). The top 5% in each category were selected for critical appraisal. A retrospective summary of 20 years of GEMLR reviews was also completed. RESULTS: The search identified 46,714 PubMed and 12,575 gray literature articles. A total of 473 met inclusion criteria and were scored; 33 were selected as the top 5%, a decrease from 55 in 2023. Although the search string was unchanged, 2024 yielded ~10,000 fewer articles. Common themes included trauma, pediatrics, and clinical/triage protocols, with a new focus on mental health among clinicians and disaster victims. Over 20 years, 230 individuals have contributed 810 service-years to GEMLR. Nearly 75% of members were from the USA, while 32 (13.9%) were from LMICs and 27 (11.7%) from non-USA high-income countries. In total, 398,904 articles have been screened, 8476 scored, and 517 top articles narratively reviewed since 2005. CONCLUSIONS: Over two decades, GEMLR has evolved into a large-scale, multinational, methodologically rigorous initiative, highlighting more than 500 high-impact GEM publications. In 2024, despite fewer articles screened, 33 top studies were identified across key domains. GEMLR emphasizes equitable LMIC representation, rigorous quality standards, and authorship equity, aiming to help shape the future of emergency care research.
Gunaga S, Miller J, Cook B
… +29 more, Gandolfo C, Hawatian K, Brennan B, Husain A, Nasseredine H, Tuttle J, Sidani M, Mahler S, Levy P, Parikh S, Krupp S, Nour K, Klausner H, Gindi R, Lewandowski A, Hudson M, Perrotta G, Zweig B, Lanfear D, Kim H, Morton T, Bills G, Vieder J, Rockoff S, Colucci A, Kim B, Plemmons E, McCord J, RACE‐IT Research Group
Acad Emerg Med
· 2026 Mar · PMID 41437417
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STUDY OBJECTIVES: Significant variability exists in patient populations and diagnostic capabilities among hospital-based emergency departments (HBEDs) and freestanding emergency departments (FSEDs). While high sensitivit...STUDY OBJECTIVES: Significant variability exists in patient populations and diagnostic capabilities among hospital-based emergency departments (HBEDs) and freestanding emergency departments (FSEDs). While high sensitivity cardiac troponin (hs-cTn) research has focused on HBEDs, its application in FSEDs remains unexplored. This study assesses the comparative, real-world effectiveness of a 0/1-h accelerated protocol (AP) using hs-cTn between HBEDs and FSEDs. METHODS: We conducted a pre-planned, secondary analysis of a stepped-wedge cluster randomized trial involving nine EDs within an integrated health system, from July 2020 to March 2021, comprised of five HBEDs and four FSEDs. The trial implemented a 0/1-h AP utilizing hs-cTnI to evaluate acute myocardial infarction (AMI). Adult ED patients with an ECG and cardiac troponin ordered were eligible, excluding those with STEMI, hs-cTnI > 18 ng/L, or trauma-related symptoms. The primary outcome was safe ED discharge, defined as discharge without death or AMI within 30 days. RESULTS: The trial included 32,609 patients, 26,957 in HBEDs and 5652 in FSEDs. Safe discharge from HBED occurred 53.7% (5935/11,062) of the time in the standard care arm and 50.3% (7991/15895) under the AP (aOR 1.04, 95% CI 0.94-1.15, p = 0.50). Safe discharge from a FSED occurred 86.0% (2102/2443) of the time in the standard care arm and increased to 95.0% (3049/3209) under the AP (aOR 1.48, 95% CI 1.03-2.13, p = 0.033). Overall, the observed association between the AP and safe discharge was stronger in FSEDs than in HBEDs ( log(aOdds) 1.05, 95% CI (0.82, 1.29), p < 0.001). CONCLUSION: Implementing a 0/1-h AP using hs-cTnI to evaluate for AMI was associated with higher rates of safe discharge in FSEDs compared to HBEDs.
Haimovich AD, Chary A, Burke L
… +8 more, Janke AT, Rodman A, Landon B, Shapiro NI, Naik AD, Schoenfeld E, Ouchi K, Schonberg MA
Acad Emerg Med
· 2026 Mar · PMID 41416819
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BACKGROUND: ED disposition decisions for older adults are complex and often uncertain, yet studies rarely capture emergency physicians' real-time perspectives. OBJECTIVE: To assess patient outcomes based on emergency phy...BACKGROUND: ED disposition decisions for older adults are complex and often uncertain, yet studies rarely capture emergency physicians' real-time perspectives. OBJECTIVE: To assess patient outcomes based on emergency physician-perceived need for admission. DESIGN: Single-site prospective cohort study conducted between July and November 2024. SETTING: A Boston-area academic tertiary care ED. PARTICIPANTS: Patients aged 65 and older dispositioned by attending physicians, excluding patients who were handed off, left without being seen, or eloped. MEASUREMENTS: Physicians rated admission need using a 5-point Likert scale (2-4 considered marginal). Primary outcome was ED disposition stratified by rating. Secondary outcomes were hospital length-of-stay (LOS), 7-day ED return, and 30-day mortality. RESULTS: Of the 489 patients (mean age 76.9 years [SD 7.5], 51.1% female), 55.8% were non-marginal admissions, 26.0% were non-marginal discharges, and 18.2% were marginal dispositions. Patients with marginal dispositions had longer workup times than non-marginal admissions or discharges (3.3 vs. 2.8 vs. 2.4 h, p < 0.05). Thirty-day mortality was greater for non-marginal admissions (8.8%) than non-marginal discharges (1.6%, p = 0.01), but not significantly different than marginal dispositions (3.4%). Marginal admissions had shorter median LOS (3.1 vs. 5 days, p < 0.01) and higher early discharge rates (27.8% vs. 13.2%, p = 0.01) than non-marginal admissions. Marginal discharges had fewer 7-day returns than non-marginal discharges (0% vs. 11.7%, p = 0.04). For marginal cases, physicians discussed admission benefits more than risks (70.1% vs. 43.3%, p < 0.01) for marginal cases. LIMITATIONS: Single-site and need for admission were reported contemporaneous with disposition decision. CONCLUSIONS: One in six older adult ED dispositions was identified as marginal. These patients are potential targets for shared decision-making and alternative care pathways.