The American Journal Of Emergency Medicine[JOURNAL]
Sun
200 papers
Frailty stratification in the emergency department using the triage frailty and comorbidity tool.
Zaboli A, Brigo F, Magnarelli G … +5 more , Clauser P, Garbin T, Cipriano A, Siller M, Turcato G
Am J Emerg Med · 2026 Jun · PMID 42320418 · Publisher ↗
INTRODUCTION: Frailty is increasingly recognised as a key determinant of adverse outcomes and resource use in the Emergency Department (ED), yet pragmatic, scalable strategies for timely identification and management are...
INTRODUCTION: Frailty is increasingly recognised as a key determinant of adverse outcomes and resource use in the Emergency Department (ED), yet pragmatic, scalable strategies for timely identification and management are lacking. We evaluated a workflow-compatible frailty stratification model by embedding the Triage Frailty and Comorbidity (TFC) Tool into routine triage for low-acuity patients. METHODS: We conducted a multicentre observational study in two Italian EDs. Adult patients triaged as Manchester Triage System (MTS) green/blue were eligible. As part of triage completion, nurses completed the TFC Tool; TFC ≥ 5% defined positivity. For TFC-positive patients, the waiting-list order was prioritised within the same MTS category. Primary outcome was time from triage completion to medical evaluation; secondary outcome was hospitalisation. RESULTS: Among 40,568 eligible visits, 1269 (3.1%) were TFC-positive (0.3% in 18-65 years; 9.8% in ≥65 years). In adjusted models, TFC positivity was associated with a + 1.45 (95%CI 1.19-1.70) minute longer triage duration but reduced waiting time to medical evaluation by -15.06 min (95%CI -20.85 to -9.27). Hospitalisation occurred in 19.4% of TFC-positive vs 4.8% of TFC-negative patients; TFC ≥ 5% was independently associated with admission (adjusted OR 1.69, 95%CI 1.43-1.99), and TFC as continuous increased admission odds per 1% point (OR 1.05, 95%CI 1.04-1.06). CONCLUSIONS: Routine implementation of the TFC Tool within standard triage was associated with shorter waiting times to medical assessment among vulnerable low-acuity patients, while maintaining acuity-based prioritisation. TFC positivity was also associated with higher odds of hospitalisation.
Patterns of emergency department visits for suicidal attempts associated with toxic ingestion: A retrospective cross-sectional study.
Harel E, Shopen N, Trotzky D … +1 more , Glatstein M
Am J Emerg Med · 2026 Jun · PMID 42320413 · Publisher ↗
BACKGROUND: Intentional self-poisoning is a growing cause of emergency department (ED) presentations worldwide. In Israel, where medication overdoses predominate, understanding the substances involved and their outcomes...
BACKGROUND: Intentional self-poisoning is a growing cause of emergency department (ED) presentations worldwide. In Israel, where medication overdoses predominate, understanding the substances involved and their outcomes is crucial for prevention and management. This study aimed to characterize substance patterns, evaluate clinical outcomes, and highlight the contribution of medical toxicology in the care of these patients. METHODS: A retrospective cross-sectional study was conducted using data from the Tel Aviv Sourasky Medical Center Toxicology Registry between 2017 and 2024. Patients presenting to the ED following intentional ingestion of pharmacological agents were included. Demographic, clinical, and laboratory variables were reviewed and compared between single-substance and polypharmacy ingestions. Clinical outcomes were categorized according to the American Association of Poison Control Centers (AAPCC) definitions. RESULTS: Of 322 patients, 179 (55.6%) involved single-substance and 143 (44.4%) multiple-substance ingestions. The mean age was 38 ± 21 years, and 68.9% were female. Polypharmacy was associated with higher involvement of CNS-acting agents-particularly benzodiazepines (42.0%), antidepressants (31.5%), and opioids (14.7%)-and a trend toward more biochemical abnormalities and intensive interventions. Most cases resulted in mild or moderate effects, while 21.1% experienced major toxicity and 2.5% died. All patients were reviewed by the toxicology service, with bedside consultations in 55% of cases, guiding antidote use and management decisions. CONCLUSIONS: Intentional self-poisoning in Israel is predominantly medication-related and frequently involves polypharmacy with CNS depressants. Early toxicology consultation is essential to guide treatment, prevent complications, and optimize outcomes. Beyond clinical management, medical toxicologists play a vital role in surveillance, prevention, and the humanistic duty of restoring both physical stability and psychological balance in patients at risk of self-harm.
Lumbar paraspinal compartment syndrome with concomitant rhabdomyolysis and multifidus necrosis.
Kucher VA, Sahlberg AR, Miller CL
Am J Emerg Med · 2026 Jun · PMID 42320412 · Publisher ↗
Acute lumbar paraspinal compartment syndrome is a rare, function-threatening emergency often misidentified as benign musculoskeletal strain. We describe a 29-year-old male who presented to the emergency department (ED) w...
Acute lumbar paraspinal compartment syndrome is a rare, function-threatening emergency often misidentified as benign musculoskeletal strain. We describe a 29-year-old male who presented to the emergency department (ED) with acute low back pain following a touch football game. Despite an initial discharge for muscle spasm, he returned 24 h later with refractory pain and laboratory evidence of rhabdomyolysis (creatine kinase 14,399 U/L). Magnetic resonance imaging revealed edema of the left paraspinal musculature. Due to persistent pain and progressive laboratory abnormalities, emergent surgical decompression was performed, confirming multifidus necrosis. This case highlights the bounce-back presentation as a critical red flag. Prompt recognition of disproportionate pain and unexplained rhabdomyolysis in the ED is essential to facilitate emergent fasciotomy and prevent irreversible myonecrosis and acute kidney injury.
Practice changing articles: Defibrillation in refractory ventricular fibrillation following out-of-hospital cardiac arrest.
Long B, Pourmand A, Bridwell RE … +1 more , Gottlieb M
Am J Emerg Med · 2026 Jun · PMID 42315461 · Publisher ↗
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A case of orbital compartment syndrome caused by orbital abscess in an immunocompetent pediatric patient.
McLaughlin D, Rait X, Janssens M … +2 more , Cutler K, Pelletier J
Am J Emerg Med · 2026 Jun · PMID 42314344 · Publisher ↗
Orbital compartment syndrome, a condition in which increased pressure within the orbit can cause permanent visual impairment, can be caused by infection or trauma. Orbital cellulitis is a spectrum of infection that can p...
Orbital compartment syndrome, a condition in which increased pressure within the orbit can cause permanent visual impairment, can be caused by infection or trauma. Orbital cellulitis is a spectrum of infection that can progress to abscess formation within the orbit, subsequently leading to orbital compartment syndrome. We describe the case of an immunocompetent pediatric patient who developed an orbital abscess from asymptomatic sinusitis, which led to orbital compartment syndrome. He received a lateral canthotomy and cantholysis followed by definitive management of his orbital abscess and experienced good visual outcomes. This case highlights the importance of checking intraocular pressures in patients presenting with orbital infections, and the need for swift intervention in cases of suspected orbital compartment syndrome.
Association between bedside medical toxicology consultation and hospital triage and resource utilization for poisoned patients.
McCabe DJ, Sun J, Vakkalanka JP … +2 more , Kang T, Radke J
Am J Emerg Med · 2026 Jun · PMID 42314343 · Publisher ↗
INTRODUCTION: Bedside medical toxicology consultation represents a specialized model of care distinct from remote poison center guidance. Despite the importance of toxicologic emergencies in emergency medicine, the assoc...
INTRODUCTION: Bedside medical toxicology consultation represents a specialized model of care distinct from remote poison center guidance. Despite the importance of toxicologic emergencies in emergency medicine, the association between bedside toxicology expertise and patterns of hospital care is understudied. We sought to characterize associations between bedside medical toxicology consultation and patterns of hospital disposition, length of stay, and selected therapies among poisoned patients. METHODS: We conducted a propensity score-matched retrospective cohort study using inverse probability treatment weighting to compare outcomes between patients managed with a medical toxicology consultation and those who were not, among all patients treated for a poisoning at a tertiary care academic medical center between July 1, 2017, and April 30, 2023. The exposure was receipt of a medical toxicology consultation within 48 h of presentation. Outcomes included ED management without medical admission, admission to higher levels of care (floor, intensive care unit [ICU]), length of stay, and use of targeted interventions and supportive therapies. We estimated adjusted odds ratios (aOR) and adjusted mean differences (aMD) with 95% confidence intervals (CI) using weighted multivariate logistic and linear regression models. RESULTS: Of 13,241 encounters for poisoning, 1077 (8.1%) received a MedTox consultation. A greater proportion of MedTox encounters were managed entirely in the ED without hospital admission compared with non-consult encounters (27.4% vs 9.1%). MedTox consultation was associated with higher odds of ED management without admission (aOR 3.20, 95% CI 2.70, 3.80), lower odds of floor admission (aOR 0.04, 95% CI 0.03, 0.04), and higher odds of ICU admission (aOR 14.00, 95% CI 12.05, 16.27). MedTox consultation was also associated with higher use of true targeted interventions and supportive therapies, including acetylcysteine (aOR 5.90, 95% CI 4.25, 8.10), sodium bicarbonate (aOR 9.39, 95% CI 6.90, 12.71), calcium gluconate (aOR 7.41, 95% CI 5.55, 9.81), and ventilator support (aOR 9.57, 95% CI 6.52, 14.00). MedTox encounters had similar or shorter lengths of stay across levels of care, including shorter ICU stays (aMD -3.65 h, 95% CI -6.34, -0.96). CONCLUSION: Bedside medical toxicology consultation was associated with distinct patterns of hospital triage, including higher odds of ED-based medical clearance and ICU admission for higher-acuity cases, greater use of targeted therapies, and similar or shorter lengths of stay across levels of care. These findings suggest that integrating medical toxicology services into emergency and inpatient care may enhance the precision and timeliness of management for poisoned patients while supporting efficient use of hospital resources.
Echoes of the pandemic: Patterns in youth suicide risk screening in an urban emergency department.
Vidal C, Prichett L, Yang A … +3 more , Siddiqua A, Benefield H, Ryan LM
Am J Emerg Med · 2026 Jun · PMID 42314342 · Publisher ↗
OBJECTIVE: Youth suicide rates have increased over the last three decades, translating into an increase in related pediatric emergency department (ED) visit demands. However, these trends shifted during the pandemic. We...
OBJECTIVE: Youth suicide rates have increased over the last three decades, translating into an increase in related pediatric emergency department (ED) visit demands. However, these trends shifted during the pandemic. We describe demographic and clinical characteristics of pediatric patients who were evaluated for suicide-related pediatric ED visits for four consecutive years surrounding the COVID-19 pandemic. METHODS: We conducted a retrospective analysis using electronic health records of patients ages 10-17 years with encounters between January 1, 2019 and December 31, 2022 from one urban pediatric ED setting. We examined trends in quarterly rates of positive Ask Suicide-Screening Questionnaire (ASQ) screenings and encounters. We performed an interrupted time series (ITS) regression analysis to evaluate pandemic-attributable trend changes. RESULTS: There were no significant changes in rates and trends of positive ASQ screening pre/post pandemic. There were changes in admission rates of patients with positive ASQs immediately after compared to before the pandemic began (β = 19.21, p = 0.002). A stratified ITS analysis showed a downward trend in the quarterly rate of positive ASQ screenings for encounters in patients ages 10-13 pre-pandemic (β = -1.44, p = 0.026) and an increase of 5.02 percentage points (p = 0.037) at the onset of the pandemic. There were no significant differences among 14- to 17-year-olds, males, and females in pre- and post-pandemic ASQ positivity. CONCLUSIONS: The oscillations in mental health visits during the years post-pandemic differed from those in the pre-pandemic period and may suggest a readjustment during the relaxation of restrictions.
ICU diagnoses associated with increased early emergency department downgrades by a novel emergency critical care program.
Gupta PB, Levin NM, Gordon AJ … +4 more , Htet NN, Lee JE, Wilson JG, Mitarai T
Am J Emerg Med · 2026 Jun · PMID 42302510 · Publisher ↗
BACKGROUND: The Emergency Critical Care Program (ECCP) utilizes an ECC attending with dual board certification in Emergency Medicine and Critical Care Medicine providing longitudinal care for MICU patients in the ED afte...
BACKGROUND: The Emergency Critical Care Program (ECCP) utilizes an ECC attending with dual board certification in Emergency Medicine and Critical Care Medicine providing longitudinal care for MICU patients in the ED after initial resuscitation by the ED team during ECCP hours (2 pm to midnight, weekdays). It is unclear which admission diagnoses of critically ill ED patients are most responsive to the ECCP regarding timely ED downgrades to mitigate ICU overcrowding. METHODS: This single-center retrospective cohort study included adult ED patients with initial admission orders to the MICU or ECC service between 2015 and 2019. Our primary outcome was the proportion of patients who received a transfer order to a non-ICU service within six hours of their critical care admission order while still in the ED ("Early ED Downgrades"), stratified by admission diagnosis category and adjusted by illness severity. A difference-in-differences analysis compared the change in proportion of "Early ED Downgrades" between the preintervention period (2015-2017) and the intervention period (2017-2019) relative to non-ECCP hours. RESULTS: Our cohort included 1882 patients (mean age 63 years, 53.2% male). The ECCP was associated with a 19.0% (95% CI, 13.0% - 25.0%) increase in severity-adjusted Early ED Downgrades. By diagnosis, significant increases were seen in Respiratory (22.9%; 95% CI, 11.0% - 34.9%), Sepsis (14.2%; 95% CI, 3.0% - 25.5%), and Renal (43.0%; 95% CI, 7.4% - 78.5%) categories. No increases in mortality or transfers to the MICU within 24 h of the downgrades were observed. CONCLUSIONS: The ECCP significantly increased Early ED Downgrades, particularly for Respiratory, Sepsis and Renal diagnosis categories, optimizing ICU resources without compromising patient safety.
Tackling the lack of standardised reporting of first aid: A call for unified Utstein-style guidelines.
Birkun AA, Charlton NP, Macneil F
Am J Emerg Med · 2026 Jun · PMID 42297707 · Publisher ↗
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Perspectives on artificial intelligence supported firearm access screening and storage counseling in pediatric emergency care.
Cohen JS, Clarke A, DeVinney A … +2 more , Nestadt P, Badaki-Makun O
Am J Emerg Med · 2026 Jun · PMID 42296675 · Publisher ↗
BACKGROUND: Lethal means counseling in the emergency department (ED) is associated with increased firearm safe storage, and ED based screening and counseling programs can identify and create opportunities for interventio...
BACKGROUND: Lethal means counseling in the emergency department (ED) is associated with increased firearm safe storage, and ED based screening and counseling programs can identify and create opportunities for intervention for at risk youth; however, implementation in pediatric EDs remains inconsistent. While artificial intelligence (AI) tools may help address barriers, little is known about providers perspectives on AI tools for firearm screening and safe storage counseling. OBJECTIVES: Assess Pediatric Emergency Medicine (PEM) physicians' attitudes toward firearm screening and counseling, perceived barriers to implementation, and acceptability of AI enabled strategies to support firearm injury prevention in the pediatric ED. METHODS: We conducted a national, cross-sectional survey of PEM physicians. The survey assessed current screening practices, perceived barriers, and attitudes toward AI powered tools. Descriptive statistics summarized quantitative responses, and qualitative thematic analysis was performed on open-ended responses. RESULTS: Of 687 eligible physicians, 296 responded (43.1%), with 274 (39.9%) completing the survey. Most respondents endorsed the importance of firearm access screening and counseling. Commonly reported barriers included limited time, lack of standardized protocols, unclear role responsibility, insufficient training, and limited resources. More than half of respondents reported prior exposure to AI tools, and many expressed openness to AI assisted approaches, particularly for identifying patients for screening, providing counseling language, and facilitating documentation. Concerns focused on workflow burden, accuracy, and patient safety. CONCLUSIONS: PEM physicians recognize firearm screening and counseling as important, but face implementation barriers. Clinician centered, workflow integrated AI tools may offer a promising strategy to enhance firearm injury prevention in pediatric emergency care.
Subway-related trauma at an urban level I trauma center.
Grin EA, Weiss H, Yagoda S … +6 more , Stylianos S, Hanke R, Tashiro J, Tomita S, Huang P, Hidalgo ET
Am J Emerg Med · 2026 Jun · PMID 42296674 · Publisher ↗
INTRODUCTION: Subway-related trauma is an understudied category of urban injury. Prior work has focused on high-acuity train-contact events, with less attention to more common mechanisms and the roles of psychiatric illn...
INTRODUCTION: Subway-related trauma is an understudied category of urban injury. Prior work has focused on high-acuity train-contact events, with less attention to more common mechanisms and the roles of psychiatric illness and substance use. We analyzed a large contemporary cohort to define epidemiology, injury patterns, and outcome predictors across the full spectrum of subway trauma. METHODS: We performed a retrospective cohort study of adults presenting with subway-related injury to a Level I trauma center (2018-2024). Registry data and manual chart review captured demographics, mechanisms, comorbidities, intoxication, injury severity, and outcomes. Injuries were categorized using validated natural language processing. Multivariable logistic regression identified predictors of train-contact mechanism, major trauma (ISS ≥ 15), TBI, and assault. RESULTS: Among 809 patients, median age was 50 years and 81.2% were male. Falls were most common (57.2%), followed by train contact (16.8%) and assault (16.7%). Median ISS was 9, with 25.0% sustaining major trauma. TBI occurred in 40.5% and did not differ by mechanism. Train contact was the most severe mechanism and the only independent predictor of major trauma (aOR 5.08). Psychiatric diagnosis (aOR 1.59) and acute intoxication (aOR 1.69) independently predicted train contact, while intoxication predicted TBI (aOR 1.66). Psychiatric illness and substance use disorder were associated with longer hospitalization independent of injury severity. Assault exposure varied by race/ethnicity. CONCLUSION: Most subway injuries result from falls rather than intentional mechanisms. Train contact drives severity, while intoxication increases TBI risk. Psychiatric and substance use comorbidities prolong hospitalization, supporting routine behavioral health screening and targeted prevention strategies.
Mean airway pressure as the missing link in CPR physiology: A prehospital comparison of manual and mechanical chest compressions.
Tackaert T, Hemeryck J, Duchatelet C … +2 more , Vanwulpen M, Hachimi-Idrissi S
Am J Emerg Med · 2026 Jun · PMID 42288074 · Publisher ↗
BACKGROUND: The impact of manual versus mechanical chest compressions on mean airway pressure (mPAW) during cardiopulmonary resuscitation (CPR) is poorly understood. This exploratory pilot study assessed intratracheal ai...
BACKGROUND: The impact of manual versus mechanical chest compressions on mean airway pressure (mPAW) during cardiopulmonary resuscitation (CPR) is poorly understood. This exploratory pilot study assessed intratracheal airway pressures during prehospital CPR in out-of-hospital cardiac arrest (OHCA). METHODS: Adult OHCA patients treated by the prehospital Medical Emergency Team of the Ghent University Hospital (Belgium) were prospectively enrolled. Intratracheal pressure was recorded immediately after intubation, mPAW was calculated for both the first and last minutes of advanced life support (ALS). The results were compared between mechanical compressions using the Stryker LUCAS3® device and manual chest compressions (with chest compression feedback). RESULTS: Nineteen patients were included (manual n = 10; mechanical n = 9). Initial median mPAW was low (7.74 mbar) and showed a slight increase over time. Mechanical compressions generated higher early mPAW than manual compressions (8.96 vs. 6.54 mbar). mPAW increased over time with manual compressions and decreased with mechanical compressions. Patients who achieved return of spontaneous circulation (ROSC) showed higher mPAW, though this difference was not statistically significant. CONCLUSIONS: Prehospital mPAW values were substantially lower than those reported in previous ED-based studies. While airway pressure patterns differed between compression modalities, overall pressures were similar. These findings highlight complex airway mechanics during CPR and support further research into whether higher airway pressures could improve airway patency, oxygenation, and hemodynamics in selected OHCA patients.
Re-evaluating pediatric laryngoscope blade size recommendations: Comparable intubation performance across blade sizes in pediatric manikin models.
Reardon K, Auger C, Robinson AE … +3 more , Driver BE, Belani K, Reardon RF
Am J Emerg Med · 2026 Jun · PMID 42288073 · Publisher ↗
BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation per...
BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation performance varies across a range of blade sizes, and whether a Macintosh 2 blade performs comparably across multiple pediatric age groups in a simulation setting. METHODS: We conducted a randomized crossover simulation study using three pediatric airway manikins (neonate, infant, and child age groups). Emergency medicine residents and faculty physicians performed intubations using multiple laryngoscope blade types and sizes, including standard and nonstandard options. Primary outcomes were intubation time and first-attempt success. Secondary outcomes included complications and operator-rated ease of glottic view and tube passage. Between-blade differences were estimated with 95% confidence intervals. RESULTS: Across manikin sizes and blade types, intubation times were short and first-attempt success rates exceeded 98% in most conditions. Performance remained consistent even with blade sizes outside conventional age-based recommendations. Between-blade differences in intubation time were small, and complication rates were low across conditions. The Macintosh 2 blade performed comparably across all manikin sizes, with similar intubation times, high success rates, and favorable ease ratings. CONCLUSIONS: Intubation performance in pediatric manikin models was similar across a wide range of blade sizes. These hypothesis-generating findings warrant prospective clinical evaluation of simplified blade selection strategies for pediatric intubation.
Closing the gaps in hyperacute stroke care: Pharmacologic and systems-level considerations.
Rech MA, DeWitt K, Ray LC
Am J Emerg Med · 2026 Jun · PMID 42285877 · Publisher ↗
Abstract loading — click title to view on PubMed.
Endovascular intervention for acute stroke in the very late window: A meta-analysis of 90-day mRS and procedural outcomes.
Thomas VK, Babu MCC
Am J Emerg Med · 2026 Jun · PMID 42284631 · Publisher ↗
OBJECTIVE: This study investigates the effectiveness of Endovascular Therapy (EVT) in very late windows (beyond 24 h) for patients with ischemic stroke, focusing on 90-day mortality, functional outcomes, and procedural s...
OBJECTIVE: This study investigates the effectiveness of Endovascular Therapy (EVT) in very late windows (beyond 24 h) for patients with ischemic stroke, focusing on 90-day mortality, functional outcomes, and procedural success. METHODS: This systematic review and meta-analysis followed Cochrane and PRISMA guidelines to evaluate the effectiveness of endovascular therapy (EVT) in acute ischemic stroke patients. Literature from PubMed, Embase, Web of Science, and Scopus was reviewed using specific keywords. Studies included those after 2000 with outcomes such as functional independence (mRS 0-2), mortality, TICI scores, and neurological improvements. RESULTS: The data findings reveal mixed outcomes across studies on EVT beyond 24 h. Sarraj et al. (2023) found a significant improvement in functional independence with EVT (38% vs. 10%, p < 0.05), despite an increased risk of sICH. The forest plots for mRS and procedural outcomes show some significant results, such as Sarraj (2023) for mortality (p < 0.05), but most other studies indicated no statistically significant differences (p > 0.05). CONCLUSION: The study has concluded that Endovascular Therapy (EVT) beyond 24 h can improve functional outcomes and reduce mortality in selected ischemic stroke patients, though patient selection remains crucial.
Carotid artery velocity-time integral as a surrogate for left ventricular outflow tract velocity-time integral during fluid resuscitation in the emergency department.
Korkan Ü, Pekdemir M, Özturan İU … +3 more , Doğan NÖ, Yaka E, Yılmaz S
Am J Emerg Med · 2026 Jun · PMID 42269319 · Publisher ↗
BACKGROUND: Accurate stroke volume assessment is essential for guiding fluid resuscitation in critically ill patients. Although left ventricular outflow tract velocity-time integral (LVOT-VTI) is widely used, its acquisi...
BACKGROUND: Accurate stroke volume assessment is essential for guiding fluid resuscitation in critically ill patients. Although left ventricular outflow tract velocity-time integral (LVOT-VTI) is widely used, its acquisition is often challenging in the ED, whereas the easier-to-measure common carotid artery velocity-time integral (CCA-VTI) has limited supporting evidence in heterogeneous ED populations. This study aimed to evaluate the correlation and agreement between CCA-VTI and LVOT-VTI in critically ill ED patients undergoing fluid resuscitation. METHODS: This prospective cross-sectional study was conducted in a tertiary-care ED between May and September 2025. Adult patients with critical illness and indications for intravenous fluid resuscitation were enrolled. Bedside ultrasound measurements of LVOT-VTI and CCA-VTI were obtained before and after fluid administration. Correlation was assessed using Spearman's coefficient, and agreement was evaluated using Bland-Altman analysis. RESULTS: Fifty patients were included. LVOT-VTI and CCA-VTI showed strong correlation before fluid resuscitation (r = 0.88; p < 0.001), which increased after resuscitation (r = 0.92; p < 0.001). Among fluid responders (n = 24), correlation increased from r = 0.62 to r = 0.94. Percentage (Δ) changes in CCA-VTI were strongly correlated with LVOT-VTI (r = 0.74, p < 0.001). Bland-Altman analysis demonstrated good agreement between CCA-VTI and LVOT-VTI, with a mean bias of 0.12 cm before resuscitation (95% limits of agreement [LoA], -2.07 to 2.32 cm) and 0.08 cm after resuscitation (95% LoA, -1.26 to 1.41 cm). CONCLUSION: CCA-VTI demonstrated strong correlation and acceptable agreement with LVOT-VTI in critically ill ED patients and may serve as a practical bedside adjunct when LVOT imaging is challenging.
When the body speaks during wartime: Clinical presentation of older vs. younger adults in psychiatric emergencies during wartime.
Shalev L, Bistre M, Avni A … +3 more , Lubin G, Rose AJ, Eitan R
Am J Emerg Med · 2026 Jun · PMID 42269318 · Publisher ↗
INTRODUCTION: Mass trauma events have documented psychiatric consequences across all ages, and with an aging global population, more older individuals will face disasters, increasing the psychiatric burden. Reactions to...
INTRODUCTION: Mass trauma events have documented psychiatric consequences across all ages, and with an aging global population, more older individuals will face disasters, increasing the psychiatric burden. Reactions to trauma include post-traumatic stress disorder and exacerbation of pre-existing disorders. Research on age-related trauma vulnerability shows mixed results, with some studies indicating higher vulnerability in older adults, and others suggesting greater resilience. Older adults may present stress symptoms as somatic complaints rather than emotional distress. However, their unique psychiatric presentation remains understudied, especially in emergency settings. The aim of this cohort study is to compare clinical characteristics and emergency department (ED) arrival reasons between older adults (≥60 years) and younger adults (18-59 years) following Israel's October 7, 2023 armed assault and with historical controls from the previous year. METHODS: The study examined psychiatric patients who visited Sourasky Medical Center's ED during two 30-day periods: "wartime" (October 7-November 5, 2023) and "controls" (October 17-November 15, 2022). Excluded were patients brought by police or with primary physical injuries. Data from medical records included demographics, clinical characteristics, self-referral status, prior mental illness, ED diagnosis, suicidal ideation, and visit reasons. Statistical analyses compared outcomes across age groups and periods. Ethical approval was obtained. RESULTS: During wartime, psychiatric ED visits increased by 65% (230 visits) compared to the control period (139). Older adults saw an 80% increase, while younger adults had a 64% increase. The proportion of self-referrals remained similar across both periods (72% vs. 75%, p=), but older adults compared with younger adults were less likely to self-refer during wartime (56% vs. 74%, p = 0.047). The total proportion of patients with a prior psychiatric diagnosis was lower during wartime than in the previous year (66% vs. 89%, p > 0.001). Fewer patients with severe mental illnesses were presented during wartime compared with the previous year (18% vs. 32%, p = 0.001), with younger adults showing a more significant decrease between the wartime and control periods (34% vs. 16%, p < 0.001). More patients were diagnosed with trauma-related disorders during wartime compared with the control period (72% vs. 50%, p < 0.001), particularly younger adults, while older adults showed stable rates. Suicidal ideation was lower during wartime compared with the previous year (8% vs. 15%, p = 0.03), especially in older adults. During the control period, older adults were slightly more likely than younger adults to have a somatic chief complaint (33% vs. 24%, p = 0.31). However, during wartime, this difference widened significantly (44% vs. 16%, p = 0.001). CONCLUSIONS: These findings suggest that psychiatric symptoms in older adults may be underdiagnosed, as they are often masked by physical complaints, emphasizing the need for clinicians to consider underlying psychological distress during crises.
The impact of an ambulance destination policy change on emergency department care metrics in New York City.
Youssef E, Benabbas R, Sweeny A … +6 more , Kalantari H, Weedon J, Taitt HA, Malekghassemi H, Xiao K, Zehtabchi S
Am J Emerg Med · 2026 Jun · PMID 42269317 · Publisher ↗
STUDY OBJECTIVE: In March 2025, the Fire Department of New York implemented a policy directing EMS to transport patients to hospitals assigned by computer-aided dispatch, typically the nearest facility. This replaced the...
STUDY OBJECTIVE: In March 2025, the Fire Department of New York implemented a policy directing EMS to transport patients to hospitals assigned by computer-aided dispatch, typically the nearest facility. This replaced the prior policy allowing transport to a nearby hospital within a 10-min drive based on patient preference. We evaluated the policy's impact on emergency department (ED) operations across New York City Health + Hospitals, the largest public health system in the United States. METHODS: This retrospective, multicenter study included all ED visits across NYC H + H hospitals from April 1-August 30, 2024 (pre-implementation) and April 1-August 30, 2025 (post-implementation). Primary outcomes were time-to-clinician, triage-to-disposition decision time (length of stay, LOS), leaving without being seen (LWBS), daily ED volume, interfacility transfers, and boarding time. Mann-Whitney tests were used for univariate comparisons. Regression models adjusted for site effects compared outcomes between periods. RESULTS: Among 943,658 ED visits (481,260 pre; 462,398 post), the geometric mean time-to-clinician decreased by 16.4% (15 to 12 min; 95% CI, 15.8-16.9%). ED LOS decreased by 1% (151 to 149 min; 95% CI, 0.7-1.6%). LWBS declined from 0.9% to 0.7%. Mean daily ED volume decreased from 286 to 275 visits. Interfacility transfers increased slightly (0.34% to 0.35%) but were not statistically significant. Boarding times were unchanged (141 vs 140 min). CONCLUSION: EMS destination policies can affect ED care delivery metrics. As such, stakeholders and policymakers should remain mindful of these downstream effects and incorporate patient-centered considerations when planning and implementing policy changes.
Cranial CT yield and predictors in children aged 0-36 months with head trauma.
Gültekin M, Yeşildağ CÖ, Gül F … +1 more , Yıldız AF
Am J Emerg Med · 2026 Jun · PMID 42269316 · Publisher ↗
INTRODUCTION: Cranial computed tomography (CT) is frequently used in young children with head trauma, although its diagnostic yield may be limited without specific clinical risk factors. This study evaluated cranial CT f...
INTRODUCTION: Cranial computed tomography (CT) is frequently used in young children with head trauma, although its diagnostic yield may be limited without specific clinical risk factors. This study evaluated cranial CT findings and clinical predictors of pathological CT findings in children aged 0-36 months presenting to the emergency department with head trauma. METHODS: This retrospective observational study included 1434 children aged 0-36 months who presented with head trauma and underwent cranial CT between January 1 and December 31, 2022. Clinical variables included scalp hematoma, scalp laceration, vomiting, clinical deterioration during observation, and trauma mechanism. The primary outcome was pathological cranial CT findings. Multivariable logistic regression and receiver operating characteristic analyses were performed. RESULTS: The median age was 1 year, and falls accounted for 97.8% of injuries. CT findings were normal in 92.2% of patients, while pathological findings were detected in 7.8%. Pathological CT findings were more frequent in symptomatic than asymptomatic patients (18.4% vs. 2.4%; p < 0.001) and in infants younger than 12 months compared with children aged 12 months or older (11.7% vs. 5.6%; p < 0.001). Clinical deterioration (OR: 20.22; 95% CI: 8.86-46.13), scalp hematoma (OR: 11.29; 95% CI: 7.05-18.06), and vomiting (OR: 3.73; 95% CI: 1.87-7.43) were independent predictors of pathological CT findings. The multivariable model showed good discrimination (area under the curve: 0.841; sensitivity: 76.8%; specificity: 83.5%). CONCLUSION: Cranial CT findings were normal in most imaged children aged 0-36 months with head trauma. Clinical deterioration, scalp hematoma, and vomiting may support more selective neuroimaging decisions.
Intravenous thrombolysis in acute mild non-disabling ischemic stroke: A retrospective cohort study.
Lei J, Cai Y, Liu X … +6 more , Li W, Peng Y, Mai W, Tang C, Luo S, Zhang L
Am J Emerg Med · 2026 Jun · PMID 42263336 · Publisher ↗
BACKGROUND: The benefit of intravenous thrombolysis (IVT) in patients with acute mild, non-disabling ischemic stroke remains uncertain. We evaluated the real-world effectiveness and safety of IVT and explored heterogenei...
BACKGROUND: The benefit of intravenous thrombolysis (IVT) in patients with acute mild, non-disabling ischemic stroke remains uncertain. We evaluated the real-world effectiveness and safety of IVT and explored heterogeneity of treatment effects in prespecified subgroups. METHODS: We conducted a single-center retrospective observational cohort study of consecutive adults with acute mild, non-disabling ischemic stroke treated at the Stroke Center of the Fifth Affiliated Hospital of Sun Yat-sen University (March 2019-October 2023). Eligible patients presented within 6 h, had baseline NIHSS ≤ 5 with each item ≤ 1 (and 0 on consciousness items), and had no deficits perceived as potentially disabling. Patients receiving endovascular therapy after IVT or scheduled cerebrovascular intervention within 3 months were excluded. The primary outcome was excellent functional outcome (90-day mRS 0-1). Secondary outcomes were functional independence (90-day mRS 0-2) and early neurological deterioration (END; NIHSS increase>2 within 7 days). Safety outcomes included hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH). Group comparisons used standard univariable tests; prespecified subgroup analyses were performed. RESULTS: Among 228 patients (mean age 60.7 ± 12.5 years; 66.3% male), 185 received IVT and 43 did not. Baseline characteristics were similar, except for a slightly higher median admission NIHSS in the IVT group (2 [IQR 1-2] vs 1 [IQR 1-2]; P < 0.001). At 90 days, mRS 0-1 occurred in 84.9% with IVT versus 74.4% without IVT (P = 0.117); functional independence (mRS ≤ 2) was 94.1% vs 90.7% (P = 0.492). END occurred in 12.4% vs 25.6% (P = 0.054). Any HT occurred in 5.9% vs 4.7% (P = 0.542); sICH was rare (1.1% vs 0.0%; P = 0.658). Subgroup analyses suggested a potential benefit of IVT in patients aged ≥ 65 years for achieving mRS 0-1. CONCLUSIONS: In acute mild, non-disabling ischemic stroke, IVT was not associated with increased hemorrhagic complications and did not significantly improve overall 90-day excellent functional outcome. Patients aged ≥ 65 years may derive greater functional benefit from IVT, warranting confirmation in larger prospective studies.
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