Barboza-Salerno GE, Watson-Grace AC, Harrington TR
… +4 more, Shockley McCarthy KJ, Yang H, Alhajjaj Z, McCarthy M
Am J Emerg Med
· 2026 May · PMID 41720040
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BACKGROUND: Billing codes frequently underestimate the prevalence of injuries related to intimate partner violence (IPV) in emergency department (ED) visits, due to their lack of specificity regarding IPV. Limited data i...BACKGROUND: Billing codes frequently underestimate the prevalence of injuries related to intimate partner violence (IPV) in emergency department (ED) visits, due to their lack of specificity regarding IPV. Limited data is available concerning how EDs respond to IPV, particularly in the documentation of IPV incidents within patient records. METHODS: We analyzed NEISS data from 2013 to 2024, identifying IPV cases through a systematic review of narrative text using a rule-based natural language processing approach. All cases involving detected IPV were included, whether the patient's injury resulted from direct victimization or object-directed aggression. Survey weights generated national estimates, and logistic regression models assessed demographic predictors of head/neck injuries and hospital admissions. RESULTS: From 2013 to 2024, an estimated 41,214 IPV-related ED visits occurred nationally (mean = 3400; 0.025%). Fractures occurred in 12.2% (5029) of incidents, commonly involving the upper extremities; head/neck fractures were less frequent but more severe. Males accounted for the majority of extremity injuries; females were disproportionately represented among head/neck fractures. Adults over the age of 45 had over fivefold higher odds of hospital admission compared to persons under 30. Alcohol involvement was associated with a 70% increase in the odds of head/neck injury, and differences were observed by patient sex. Narrative review indicated that females' injuries frequently occurred in defensive or self-directed contexts, whereas males' injuries more often reflected object-directed aggression during an IPV incident and commonly co-occurred with alcohol use. CONCLUSION: Narrative-based surveillance of ED event descriptions captures IPV-related visits regardless of who was injured and can inform ED screenings, safety planning, and targeted prevention.
Shlomovitz Y, Brooks R, Rekhtman D
… +3 more, Hashavya S, Cohen DM, Shavit I
Am J Emerg Med
· 2026 May · PMID 41720039
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BACKGROUND: Ileocolic intussusception (ILIC) represents a medical emergency in pediatric emergency medicine. Some patients suspected of ILIC actually have small bowel intussusception (SMBI), which may appear clinically s...BACKGROUND: Ileocolic intussusception (ILIC) represents a medical emergency in pediatric emergency medicine. Some patients suspected of ILIC actually have small bowel intussusception (SMBI), which may appear clinically similar and can only be differentiated from the ileocolic type by ultrasound. The study aimed to compare pain and irritability among children presenting with ILIC versus SMBI. METHODS: This retrospective cohort study included children aged 4 months to 4 years diagnosed with ILIC or SMBI at two tertiary pediatric EDs between January 2021 and May 2025. Pain was assessed at triage using the FLACC scale, and irritability was recorded based on reports from caregivers or medical staff. The primary outcome was pain at triage (score > 0); the secondary outcome was irritability. Multivariable regression examined associations between intussusception type and outcomes, adjusting for age, sex, symptom duration, vomiting, and lethargy. RESULTS: The study included 141 patients with a median (IQR) age of 12 (9-22) months: 84 (59.6%) ILIC and 57 (40.4%) SMBI. Pain at ED triage occurred in 37.0% with ILIC and 35.1% with SMBI, with no significant association between intussusception type and pain presence. Irritability was more common in patients with SMBI (adjusted OR 7.9, 95% CI 2.2-28.9, p < 0.02) and in those with symptom duration <24 h (adjusted OR 4.8, 95% CI 1.6-14.8, p < 0.01). Lethargy was observed more frequently in ILIC cases. Vomiting rates were similar. CONCLUSION: Triage pain was mild and comparable between ILIC and SMBI. Although irritability was more frequent in SMBI, neither symptom reliably distinguished the two conditions.
Am J Emerg Med
· 2026 May · PMID 41720038
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OBJECTIVE: This study aimed to compare the diagnostic and prognostic performance of optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) in patients presenting to the emergency department with isolated head...OBJECTIVE: This study aimed to compare the diagnostic and prognostic performance of optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) in patients presenting to the emergency department with isolated head trauma. MATERIALS AND METHODS: Patients over 18 years of age who presented to the emergency department with a history of isolated head trauma were included. Exclusion criteria were age under 18 years, lack of informed consent, the presence of an orbital hematoma or laceration large enough to interfere with ultrasonographic evaluation, maxillofacial trauma involving orbital injury, optic neuritis, periorbital masses, and pregnancy. Demographic characteristics, vital signs, physical examination findings, and Glasgow Coma Scale (GCS) scores were recorded. ONSD and ODE measurements were obtained. Discharge status, need for surgical intervention, and in-hospital mortality were documented. The predictive abilities of ONSD and ODE for pathological CT findings, surgical intervention, and mortality were compared. RESULTS: A total of 257 patients were included. Left-sided ODE was associated with a 4.2-fold increase in in-hospital mortality. For predicting the need for surgical intervention, the areas under the curve (AUCs) for right ONSD, right ODE, left ONSD, and left ODE were 0.80 (95% CI: 0.75-0.85), 0.87 (95% CI: 0.82-0.91), 0.80 (95% CI: 0.75-0.85), and 0.86 (95% CI: 0.81-0.90), respectively (p < 0.05). For predicting abnormal CT findings, the AUCs for right ONSD, right ODE, left ONSD, and left ODE were 0.85 (95% CI: 0.80-0.89), 0.87 (95% CI: 0.82-0.90), 0.85 (95% CI: 0.80-0.89), and 0.87 (95% CI: 0.82-0.90), respectively (p > 0.05). CONCLUSION: ODE appears to be a more robust predictor of mortality and the need for surgical intervention compared with ONSD. Both ONSD and ODE demonstrate similar test performance in identifying abnormal CT findings.
Burton V, Eshraghi N, Burstein J
… +4 more, Arastehmanesh D, Mangino A, Wolfe RE, Grossman SA
Am J Emerg Med
· 2026 May · PMID 41713151
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BACKGROUND: Health care quality reviews are often thought to be of limited value as they react to human behavior rather than reflect varied processes throughout the healthcare system. OBJECTIVE: To evaluate if questionin...BACKGROUND: Health care quality reviews are often thought to be of limited value as they react to human behavior rather than reflect varied processes throughout the healthcare system. OBJECTIVE: To evaluate if questioning ED physician reviewers as to whether they would have done something differently (WYHDSD) can be a useful marker to improve patient care processes in the emergency department. METHODS: Prospective data were collected on all patients presenting to an academic medical center ED with an annual census of 55,000 patients between November 2017 and November 2021. All cases who met the following standard criteria were identified for review by an electronic medical record system: 1) returned to the ED within 72 h and admitted on second visit; 2) admitted from the ED to the floor and then transferred to the ICU within 24 h; 3) expired within 24 h of ED arrival; or 4) were referred to the QA committee as the result of physician or patient complaints. Cases were randomly assigned to EM physicians not involved in the patient's care. After cases were reviewed using a structured electronic tool to assess for error and adverse events, reviewers were mandated to report whether they would have done anything differently (WYHDSD) in the management of the case. If a reviewer answered affirmatively, they were required to document specifics in a narrative format. RESULTS: During the study period, 6773 cases were reviewed. There were 815 cases where reviewers would have done something differently. In 297 cases, reviewers would have done something differently even though there were no near misses or adverse events found by standard QA reviews. Of those 297 cases, 261 of the WYHDSD responses were found to be due to 1 of the 5 following issues: communication, not acting on data acquired, not acquiring necessary information, systems issue/preventative measures, and knowledge gaps of clinicians. CONCLUSION: Asking reviewers if they would have done something differently could potentially be a useful quality marker to improve patient care systems in the ED even in cases where reviewers did not identify errors or adverse events.
Kohara S, Takada H, Hirose T
… +1 more, Hasegawa E
Am J Emerg Med
· 2026 May · PMID 41713150
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BACKGROUND: Paradoxical bronchoconstriction is a rare phenomenon in which airway obstruction worsens after inhalation therapy. Although uncommon, it is clinically important because it may lead to severe deterioration and...BACKGROUND: Paradoxical bronchoconstriction is a rare phenomenon in which airway obstruction worsens after inhalation therapy. Although uncommon, it is clinically important because it may lead to severe deterioration and is often underrecognized in emergency and critical care settings. CASE PRESENTATION: A woman in her 50s with a history of asthma presented with acute respiratory distress. Initial treatment with dry powder inhalers was tolerated; however, immediately after nebulized inhalation therapy, her respiratory status rapidly deteriorated, necessitating endotracheal intubation and mechanical ventilation. During intensive care, nebulized therapy was re-administered using a different nebulizer device, which reproducibly induced bronchoconstriction, characterized by severe coughing, elevated airway pressure, and impaired ventilation. Nebulized therapy was discontinued, and alternative non-nebulized inhalation strategies were adopted, resulting in gradual clinical improvement. The patient was successfully extubated and discharged without recurrence after modification of the inhalation therapy. DISCUSSION: Previous studies have reported that paradoxical bronchoconstriction is uncommon in asthma but is associated with an increased risk of exacerbations, and rare cases requiring mechanical ventilation have been described. The reproducible induction of paradoxical bronchoconstriction during mechanical ventilation, as observed in this case, has been extremely limited in previous reports. The underlying mechanisms are thought to be multifactorial, involving not only pharmacological agents but also other factors related to inhalation therapy. CONCLUSION: Paradoxical bronchoconstriction should be considered when acute respiratory worsening occurs immediately after inhalation therapy, even in patients receiving mechanical ventilation. Early recognition and reassessment of inhalation strategies may help prevent inappropriate escalation of treatment and improve patient outcomes.
Chang JC, Wang TY, Lin PY
… +3 more, Chen YJ, Yen DH, Huang HH
Am J Emerg Med
· 2026 May · PMID 41713149
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BACKGROUND: Sarcopenia, characterized by age-related decline in muscle mass and function, is associated with falls, disability, frailty, and mortality in older adults. However, sarcopenia frequently remains unrecognized...BACKGROUND: Sarcopenia, characterized by age-related decline in muscle mass and function, is associated with falls, disability, frailty, and mortality in older adults. However, sarcopenia frequently remains unrecognized in the emergency department (ED). We aimed to determine the prevalence, risk factors, and short-term outcomes of sarcopenia among older adults presenting to the ED. METHODS: We conducted a prospective observational study of adults aged ≥65 years presenting to the ED of a tertiary medical center from September 2019 to November 2021. Sarcopenia was defined using the 2019 Asian Working Group for Sarcopenia criteria. Demographics, functional status, nutritional status, frailty, and clinical outcomes were compared between patients with and without sarcopenia. RESULTS: Among 867 enrolled patients, 420 (48.4%) had sarcopenia. Patients with sarcopenia were older, had lower body mass index, skeletal muscle index, and handgrip strength, and had poorer functional performance. Independent predictors of sarcopenia included age (odds ratio [OR] 1.07; 95% confidence interval (CI), 1.044-1.088; p < 0.001), malnutrition (OR 3.83; 95% CI 2.249-6.530; p < 0.001), and frailty (OR 1.91; 95% CI 1.313-2.766; p = 0.001). Sarcopenia patients had higher hospital admission rates (66.7% vs. 59.1%; p = 0.021) and higher 30-day mortality (5.7% vs. 1.8%; p = 0.002). CONCLUSION: Nearly half of older patients presenting to the ED had sarcopenia, which was independently associated with short-term mortality and increased admission risk. Early recognition of sarcopenia in the ED may guide targeted nutritional and functional interventions and inform safe discharge planning and post-acute care referrals.
Elkhodair S, Lalor J, Altaher M
… +6 more, Limbad C, Pradhan-Bhatt S, Perez FS, Garcia B, Meta S, Camas-Lomibao E
Am J Emerg Med
· 2026 May · PMID 41707328
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INTRODUCTION: Computed tomography (CT) is the standard imaging modality for evaluating mild traumatic brain injury (mTBI) in emergency settings. However, most CT scans reveal no intracranial injury, raising concerns abou...INTRODUCTION: Computed tomography (CT) is the standard imaging modality for evaluating mild traumatic brain injury (mTBI) in emergency settings. However, most CT scans reveal no intracranial injury, raising concerns about unnecessary radiation exposure, healthcare costs, and diagnostic delays. Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) are promising biomarkers for mTBI assessment. The i-STAT® TBI Plasma cartridge enables rapid assessment of these biomarkers. This study evaluated clinical performance of the TBI Plasma cartridge, focusing on its potential to reduce unnecessary CT utilization and improve diagnostic turnaround times. METHODS: A single-centre observational study was conducted in an academic emergency department. Adult patients presenting with head trauma and a GCS of 15 were enrolled. TBI biomarker testing was performed and compared to CT findings. RESULTS: In 141 adult patients, the TBI plasma cartridge demonstrated 100% sensitivity, 34.1% specificity, 6.3% positive predictive value (PPV), and 100% negative predictive value (NPV). Among patients <90 and <65 years old, specificity was 34.6% and 60.7% respectively. In patients with non-elevated biomarkers, CT imaging could have been avoided in 32.6% of patients, saving an estimated 72.8 h. Diagnostic wait time associated with TBI biomarker testing was 14.3 h (4.6%) less than waiting for CT results alone. CONCLUSION: The TBI plasma cartridge demonstrated excellent sensitivity and NPV in identifying patients without intracranial injury on CT. These findings suggest the potential for the TBI cartridge to efficiently and safely rule-out unnecessary CT imaging and reduce turnaround times for diagnostic test results, which may facilitate improved ED throughput.
Bicket MC, Nguyen T, Dahlem G
… +4 more, Dora-Laskey A, Brummett CM, Gunaseelan V, Kocher KE
Am J Emerg Med
· 2026 May · PMID 41702232
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BACKGROUND: Buprenorphine, despite effectiveness as a medication for opioid use disorder (MOUD), remains underutilized in emergency departments (EDs), with few scalable, statewide programs to improve prescribing. This st...BACKGROUND: Buprenorphine, despite effectiveness as a medication for opioid use disorder (MOUD), remains underutilized in emergency departments (EDs), with few scalable, statewide programs to improve prescribing. This study evaluated whether a tailored, emergency medicine-specific training offered by the Overdose Prevention Engagement Network (OPEN) across Michigan increased buprenorphine prescribing. METHODS: This pre-post cohort study compared 9-month periods before vs. after training using IQVIA dispensing data linked by National Provider Identifier (NPI) to participating clinicians. Eligible participants were ED clinicians attending a single, expert-led, incentivized OPEN training session (2020-2023). Clinician-level outcomes of buprenorphine prescription fills (primary), unique patients treated, and new patient initiations were analyzed using adjusted mixed model regression. Fills among non-participating ED clinicians were descriptively examined. RESULTS: Among 203 ED clinicians, buprenorphine fills increased after training from 531 to 963 fills or from 2.6 to 4.7 fills/clinician (adjusted difference + 2.1 fills/clinician, 95% CI 0.9 to 3.3). Unique patients dispensed buprenorphine increased from 162 to 457 (adjusted difference + 1.5 patients/clinician, 95% CI 1.1 to 1.9), and new initiations increased from 53 to 222 (adjusted difference/clinician +0.8, 95% CI 0.6 to 1.0). Non-participants had 2.2 and 2.4 fills/clinician in pre- and post-training periods, respectively. CONCLUSION: A tailored training session for MOUD prescribing for ED clinicians was associated with increased buprenorphine prescription fills, patients treated, and new initiations. These findings suggest that this scalable, low-resource approach to enhance prescriber skills in emergency care settings may inform state and national strategies to expand buprenorphine access as part of efforts to address the opioid crisis.
Jeong JH, Kim DH, Sung A
… +2 more, Shin H, Shin S
Am J Emerg Med
· 2026 May · PMID 41689865
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OBJECTIVE: Acute pyelonephritis in older adults is associated with high morbidity, but clinical characteristics and outcomes in long-term care facility (LTCF) residents-a particularly vulnerable population-remain poorly...OBJECTIVE: Acute pyelonephritis in older adults is associated with high morbidity, but clinical characteristics and outcomes in long-term care facility (LTCF) residents-a particularly vulnerable population-remain poorly defined. This study compared clinical features and mortality outcomes of acute pyelonephritis between LTCF residents and community-dwelling older patients (≥65 years) presenting to the emergency department. METHODS: We conducted a retrospective analysis of patients aged ≥65 years diagnosed with acute pyelonephritis between January 2018 and December 2023. Patients were classified as LTCF-acquired or community-acquired acute pyelonephritis. Clinical presentations, laboratory values, and in-hospital mortality were compared. Logistic regression analyses identified independent predictors of in-hospital mortality. RESULTS: Among 831 participants, 187 (22.5%) were LTCF residents. Compared with community-dwelling patients (median age, 78.0 years), the LTCF group was significantly older (median age, 83.0 years). They also showed significantly higher rates of cerebrovascular disease (53.5% vs. 27.9%) and long-term catheter use (37.4% vs. 6.1%), and more frequently presented with altered mental status (42.8% vs. 19.3%), but exhibited fewer urinary tract symptoms (28.3% vs. 73.0%). Overall in-hospital mortality was 4.0% (n = 33). Multivariable analysis identified LTCF residence (OR, 3.73; 95% CI, 1.54-9.04; p = 0.004) and lactate-to-albumin ratio (OR, 2.48; 95% CI, 1.46-4.21; p = 0.001) as independent predictors of mortality. CONCLUSIONS: LTCF residents with acute pyelonephritis exhibit atypical clinical presentations, with more frequent altered mental status and fewer urinary symptoms than community-dwelling patients. Both LTCF residency and elevated lactate-to-albumin ratio independently predict mortality, supporting the need for heightened clinical vigilance and tailored management in this vulnerable population.
Nasef H, Brown A, Prashar S
… +5 more, Bundschu I, Rogers L, Havron W, Zito T, Elkbuli A
Am J Emerg Med
· 2026 May · PMID 41687156
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BACKGROUND: Emergency exploratory laparotomy (ex-lap) is a commonly performed procedure in hemorrhaging trauma patients. Currently, there is a lack of consensus on ideal surgical timing, especially in conjunction with th...BACKGROUND: Emergency exploratory laparotomy (ex-lap) is a commonly performed procedure in hemorrhaging trauma patients. Currently, there is a lack of consensus on ideal surgical timing, especially in conjunction with the use of whole blood and resuscitative endovascular balloon occlusion of the aorta (REBOA). OBJECTIVE: To evaluate the impact of timing of emergency hemorrhage control exploratory laparotomy (ex-lap) on clinical outcomes in hemodynamically unstable trauma patients with penetrating abdominal injuries and hemorrhagic shock. METHODS: This retrospective cohort analysis of adult trauma patients with penetrating abdominal injuries undergoing hemorrhage control laparotomy within 24 h of arrival used the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) from 2017 to 2023. RESULTS: Patients undergoing ex-lap within 2 h were 9.5 times significantly more likely to experience 24-h mortality compared to those undergoing ex-lap between 2 and 24 h (OR 9.476, 95% CI 1.276-70.397, p = 0.028). No independent association was found between WB use and in-hospital mortality (OR 1.024, 95% CI 0.716-1.465, p = 0.897). Patients who required REBOA for hemodynamic stabilization had 3.9 significantly greater odds of in-hospital mortality (OR 3.888, 95% CI 1.506-10.039, p = 0.005) and required 4498 mL significantly greater transfusion volume (95% CI 1966.115-7030.269, p < 0.001) compared to non-REBOA patients. CONCLUSION: Emergency exploratory laparotomy within 2 h in hemodynamically unstable patients in hemorrhagic shock with moderate-severe penetrating abdominal trauma was associated with significantly higher 24-h mortality. No independent association was found between whole blood use and mortality, while REBOA was associated with significantly higher mortality and need for blood products as expected due to critical hemodynamic instability.
Am J Emerg Med
· 2026 May · PMID 41671670
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A middle-aged woman presented with nausea and vomiting after consumption of dinner. Her son experienced similar symptoms after sharing the meal. The patient had a history of syncope and had been treated with a dual-chamb...A middle-aged woman presented with nausea and vomiting after consumption of dinner. Her son experienced similar symptoms after sharing the meal. The patient had a history of syncope and had been treated with a dual-chamber pacemaker years prior to the incident. While being treated by emergency medical services (EMS), the patient developed pulseless wide complex tachycardia. EMS performed cardiopulmonary resuscitation (CPR) and several defibrillation attempts. After being referred to our intensive care unit (ICU), initial workup revealed no evidence of structural heart disease, coronary artery disease, or electrolyte imbalances. The patient was treated with multiple defibrillations, including double-sequence defibrillation, antiarrhythmic drugs, and continuous Veno-Venous hemodialysis in the following hours. Due to similar symptoms in both the patient and her son following food intake, multiple body fluids were sampled for toxicological screening. The results revealed evidence of acute aconitine poisoning. Despite undergoing CPR for approximately 45 min, the patient stabilized over the following days and ultimately showed no significant neurological deficiencies. The legal review of the case concluded that the poisoning had occurred in a homicidal context.
Farrell CM, Kearney RB, Peddiraju A
… +1 more, Pino EC
Am J Emerg Med
· 2026 May · PMID 41671669
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BACKGROUND: Incarcerated individuals have increased rates of chronic diseases, including cardiovascular disease, but often receive no regular medical care. The primary objectives of this study were to examine the associa...BACKGROUND: Incarcerated individuals have increased rates of chronic diseases, including cardiovascular disease, but often receive no regular medical care. The primary objectives of this study were to examine the associations between incarceration and the presence of undiagnosed or uncontrolled hypertension in a patient population treated in the emergency department (ED) of a large, urban, safety-net hospital. We hypothesized that incarcerated patients would have higher odds of undiagnosed and uncontrolled hypertension compared to non-incarcerated patients. METHODS: This cross-sectional analysis identified all adult patients ≥25 years presenting to the Boston Medical Center ED. Multivariable generalized estimating equation logistic regression modeling was conducted to estimate odds ratios (ORs) and 95% confidence intervals (95%CI) to evaluate associations between incarceration status and undiagnosed/uncontrolled hypertension. RESULTS: Of 352,772 ED visits among 130,268 patients, 3216 visits (1%) were among incarcerated patients. Compared to non-incarcerated patients, incarcerated patients had 14% higher odds of hypertension (OR = 1.14, 95%CI = 1.03-1.27, p = 0.01) and 56% higher odds of undiagnosed hypertension (OR = 1.56, 95%CI = 1.41-1.73, p < 0.0001). The prevalence of undiagnosed hypertension was higher for incarcerated patients (24.1% versus 15.4%) among all age groups, but the difference was greatest for the oldest patients aged 65 years or older (40.1% versus 17.0%). Among patients with a hypertension diagnosis and prescription medication for high blood pressure, incarcerated patients were at 64% higher odds of having uncontrolled high blood pressure (OR = 1.64, 95%CI = 1.21-2.21, p = 0.001). Despite these health disparities, incarcerated patients had equal odds of the ED visit resulting in a new prescription for hypertension medication. CONCLUSION: Incarceration has profound impacts on the health of inmates. Interaction with emergency department clinicians provides an opportunity for chronic disease diagnosis and management in a population with limited healthcare access.
Tanikawa A, Takahashi K, Yamaguchi K
… +5 more, Bent CI, Siletz A, Martin M, Inaba K, Matsushima K
Am J Emerg Med
· 2026 May · PMID 41671668
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OBJECTIVE: Selective non-operative management (SNOM) is increasingly used for hemodynamically stable patients with abdominal gunshot wounds (GSW). Although peritoneal signs traditionally mandate emergency laparotomy, the...OBJECTIVE: Selective non-operative management (SNOM) is increasingly used for hemodynamically stable patients with abdominal gunshot wounds (GSW). Although peritoneal signs traditionally mandate emergency laparotomy, the clinical value in the era of computed tomography (CT) remains unclear. This study evaluated the clinical value of peritoneal signs and the adjunctive use of CT for identifying patients requiring therapeutic laparotomy. METHODS: We conducted a retrospective cohort study of patients with abdominal GSW admitted to a Level I trauma center between 2016 and 2023. Patients with systolic blood pressure < 90 mmHg, Glasgow Coma Scale<9 or intubation in the emergency department were excluded. Patients were categorized by the presence of peritoneal signs upon arrival. Clinical data, CT, and operative findings were reviewed. The primary outcome was intra-abdominal injuries requiring therapeutic laparotomy. RESULTS: Among 308 patients, 57 (18.5%) had peritoneal signs. Of those, 50 (89.3%) had therapeutic laparotomy. Peritoneal signs alone demonstrated sensitivity of 36.8% and specificity of 95.9% (95% confidence interval [CI]: 28.7-45.4 and 91.7-98.3, respectively). Among 251 patients without peritoneal signs, 95 underwent laparotomy based on CT findings, with 85 (89.5%) having therapeutic laparotomy. Only two of 157 patients managed non-operatively after CT required laparotomy following clinical observation. Combining peritoneal signs with CT findings yielded sensitivity of 99.3% and specificity of 87.8% (95% CI: 96.0-100.0 and 81.8-92.4, respectively). CONCLUSIONS: Peritoneal signs alone had high specificity but limited sensitivity for detecting intra-abdominal injuries requiring therapeutic laparotomy. With selective CT use, our results supported the safety of SNOM in hemodynamically stable patients with abdominal GSW.