Vijayan B, Ayyan SM, Palaniappan P
… +3 more, Pudhiyasamy PR, Ramesh S, Muthanikkatt AM
Acad Emerg Med
· 2026 Mar · PMID 41387636
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STUDY OBJECTIVE: We evaluated the efficacy and safety of ultrasound-guided pericapsular nerve group (PENG) block for initial pain management in adult emergency department (ED) patients with hip fractures. METHODS: This p...STUDY OBJECTIVE: We evaluated the efficacy and safety of ultrasound-guided pericapsular nerve group (PENG) block for initial pain management in adult emergency department (ED) patients with hip fractures. METHODS: This prospective, randomized, double-blinded, controlled trial was conducted at a tertiary care academic ED. Adult patients (≥ 18 years) with traumatic hip fractures and Numerical Rating Scale (NRS) pain scores > 4 were randomized to ultrasound-guided PENG block with bupivacaine or sham procedure. Both groups received standard intravenous analgesia. The primary outcome was the difference in NRS scores over 3 h. Secondary outcomes included total rescue analgesia (morphine equivalents) and adverse events. RESULTS: Of 167 screened, 80 patients were enrolled (40 per group). Pain scores were significantly lower in the PENG block group at 30 min (mean difference [MD] -3.2; 95% confidence interval [CI]-4.2 to -2.2), 60 min (MD -3.1; 95% CI -4.1 to -2.1), and 120 min (MD -2.0; 95% CI -2.6, -1.4), compared with sham. Total rescue analgesia was significantly lower in the PENG block group (MD -4.6 mg morphine equivalents; 95% CI -6.2 to -3.1). No significant adverse events were reported, such as hematoma, quadriceps weakness, signs of local anesthetic systemic toxicity (LAST), or significant opioid-related adverse events. CONCLUSION: In adult ED patients with hip fractures, ultrasound-guided PENG block significantly reduced pain scores and opioid requirements compared with sham, with no significant adverse events reported. PENG block may be an effective, opioid-sparing analgesic strategy for acute hip fractures in the ED. TRIAL REGISTRATION: Clinical Trial Registry-India: CTRI/2023/08/056595.
Southerland LT, Curiati PK, Shih RD
… +12 more, Lo AX, Harper K, Tarnovsky I, Brengartner A, Ragsdale L, Raukar N, Ryer S, Hunold KM, Mowbray F, Maddow CL, Carpenter CR, Liu SW
Acad Emerg Med
· 2026 Mar · PMID 41354970
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BACKGROUND: Older adults are at high risk for severe injuries and death from falls. Physical therapist (PT) and occupational therapist (OT) evaluations have been introduced into Emergency Department (ED) care to assist w...BACKGROUND: Older adults are at high risk for severe injuries and death from falls. Physical therapist (PT) and occupational therapist (OT) evaluations have been introduced into Emergency Department (ED) care to assist with fall risk evaluation and fall prevention care. An evaluation of current evidence was undertaken to inform the Geriatric ED Guidelines 2.0. METHODS: Systematic review of physical and/or occupational therapy evaluation for fall prevention in the ED. The intervention was evaluation by a rehabilitation therapist (PT, OT, or both) for fall prevention, fall assessment, or mitigation of fall risk factors. Studies that did not perform the evaluation during the ED or ED Observation Unit visit were excluded, such as referrals for home consultation. The published literature was searched using strategies created by a medical librarian and was implemented in Embase and PubMed in March 2025. Covidence was used for article collation and review. Risk of bias was assessed using the Cochrane Risk of Bias v2 and the Ottawa-Newcastle scale. RESULTS: The search resulted in 387 articles with 52 duplicates, for 335 unique citations. Ten articles on 6 datasets were included (4 abstracts and 6 published manuscripts). One article was at high risk of bias as very few intervention patients received therapist evaluation. The remaining 5 datasets had varied co-interventions in addition to PT and/or OT evaluations. PT or OT evaluation in the ED was associated with reduced ED revisits at 1, 2, and 6 months. Evaluations in the ED were not associated with increased hospital admission rates or ED length of stay. A meta-analysis was infeasible due to varied outcome timeframes. CONCLUSIONS: PT and/or OT evaluations for fall prevention were associated with reduced subsequent ED revisits for older adults. However, the impact of co-interventions and heterogeneity limits strong conclusions.
Cowan E, D'Onofrio G, Perrone J
… +8 more, Anderson E, Dziura J, Hawk K, Herring A, McCormack R, Phadke M, Samuels EA, Fiellin DA
Acad Emerg Med
· 2026 Mar · PMID 41287157
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STUDY OBJECTIVE: To characterize opioid and nonopioid drug use in the week following emergency department (ED)-initiated extended-release buprenorphine (XR-BUP) treatment using both self-reported data and urine drug scre...STUDY OBJECTIVE: To characterize opioid and nonopioid drug use in the week following emergency department (ED)-initiated extended-release buprenorphine (XR-BUP) treatment using both self-reported data and urine drug screens (UDS). METHODS: This study uses data collected during a nonrandomized clinical trial of patients with untreated opioid use disorder (OUD), testing the safety and feasibility of initiating XR-BUP in patients presenting with minimal to mild withdrawal. The study was conducted from July 2020 to May 2023 across four urban academic EDs in the Northeast, Mid-Atlantic, and Pacific regions of the United States. A total of 100 participants, 18 years or older with OUD defined by DSM-5 criteria, a clinical opiate withdrawal scale (COWS < 8), and a positive opioid urine screen were included. Individuals with recent MOUD treatment, presentation for overdose, or concurrent methadone use were excluded. All participants received a single subcutaneous injection of 24 mg XR-BUP (CAM2038) during their ED visit. The primary outcomes were self-reported daily opioid and nonopioid drug use over 7 days postinjection using daily Qualtrics surveys and UDS results on day 7. RESULTS: Among participants who received XR-BUP and completed daily surveys, 98% reported at least one opioid-free day, and 63% reported no opioid use across all 7 days. Day 7 UDS results showed decreased detection of opioids, stimulants, and benzodiazepines. Reported polysubstance use also declined over the observation period. CONCLUSIONS: ED-initiated XR-BUP was associated with substantial reductions in opioid and polysubstance use during the first week post-discharge, supporting its role in early overdose risk mitigation and highlighting its value as an ED-based intervention for opioid use disorder. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03658642.
Ordonez E, Bhananker A, Molina M
… +8 more, Thomas YT, Gallegos M, Owda D, Adesina A, Kuo D, Ramont V, Torres B, Chary A
Acad Emerg Med
· 2026 Feb · PMID 41217099
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BACKGROUND: The "minority tax", also known as the "diversity tax" refers to the additional burden placed on minoritized individuals in advancing diversity, equity, and inclusion (DEI). Although DEI efforts have evolved o...BACKGROUND: The "minority tax", also known as the "diversity tax" refers to the additional burden placed on minoritized individuals in advancing diversity, equity, and inclusion (DEI). Although DEI efforts have evolved over time, evidence on its emotional, professional, and institutional impacts in academic emergency medicine (EM) is limited. We examined the various impacts of the minority tax in this population. METHODS: We conducted a qualitative study using a descriptive phenomenological framework to explore the lived experiences of 21 academic EM faculty leaders engaged in DEI work. Participants were purposively sampled across U.S. regions. Semi-structured interviews were conducted (March-May 2023), transcribed, and analyzed using thematic analysis informed by both inductive and deductive coding strategies. We explored personal and professional impacts of DEI engagement, experiences with the minority tax, and strategies for mitigation. RESULTS: Participants described their DEI roles as a "double-edged sword," balancing meaningful engagement with substantial emotional and professional costs. Sixteen of 21 participants identified direct experiences with the minority tax, including expectations to serve as cultural representatives, provide uncompensated labor, and experiences of institutional marginalization. Despite these challenges, many participants found personal fulfillment in their work and emphasized mentorship as both a key source of support and a driver of career advancement. Suggested strategies for addressing the minority tax included stronger institutional support, appropriate compensation for DEI contributions, and equitable distribution of DEI responsibilities across all faculty, regardless of identity. CONCLUSIONS: The minority tax in academic emergency medicine presents a complex challenge that carries significant emotional and professional costs even as DEI work can provide personal meaning and career advancement. Addressing this burden requires systemic changes, including recognition of DEI efforts in career progression and shared responsibility across all faculty demographics.
Keister A, Stephens SW, Adelgais K
… +19 more, Bosson N, Brown K, Elsholz C, Faris GW, Frey J, Gausche-Hill M, Goldkind SF, Hansen M, Jacobsen K, Leonard JC, Nishijima DK, Rice AD, Saidinejad M, Shah MI, Swanson D, VanBuren JM, Wendt WJ, Wilkinson M, Wang HE
Acad Emerg Med
· 2026 Feb · PMID 41214427
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BACKGROUND: Community consultation (CC) is crucial for exception from informed consent (EFIC) trials. Digital marketing platforms offer a novel and efficient way to gather community input through surveys. This study aime...BACKGROUND: Community consultation (CC) is crucial for exception from informed consent (EFIC) trials. Digital marketing platforms offer a novel and efficient way to gather community input through surveys. This study aimed to determine if the demographics of digital CC survey respondents align with those of their targeted communities. METHODS: We deployed an EFIC CC digital survey for Pedi-PART, a multicenter study on paramedic airway management in critically ill children. A seven-item survey, developed to gauge community perspectives on emergency care research and the trial, was disseminated through a digital marketing platform (Qualtrics Inc.). The survey targeted adults aged 18-65 residing within the geographic service areas of 10 participating EMS agencies. We determined community demographic data from the 2022 American Community Survey (ACS) for the dominant county in each service area. We compared survey respondent demographics (age, sex, race, ethnicity, household income, education) with those of the corresponding communities. RESULTS: We received 6630 completed surveys (528 to 913 per community). The proportion of individuals over 35 years old was similar between survey and community populations (67.1% vs. 66.5%). Survey respondents were more likely to be female (60.0% vs. 50.9%) and report household incomes < $100,000 (77.5% vs. 60.2%). Survey respondents were less likely to be Black, American Indian, Pacific Islander, or other race (33.9% vs. 52.1%), Hispanic ethnicity (15.3% vs. 34.9%), or have at least a high school education (23.2% vs. 34.9%). Demographic differences between survey respondents and communities varied across the 10 communities. CONCLUSIONS: Demographic differences may exist between digital survey respondents and their targeted communities. Study teams should account for these factors when utilizing such platforms for EFIC CC.