The American Journal Of Emergency Medicine[JOURNAL]
Sun
200 papers
Quantity matters: Impact of PIT deployment on advanced imaging utilization.
Thom C, Spirek B, Mullins C … +1 more , Moak J
Am J Emerg Med · 2026 Jul · PMID 42000674 · Publisher ↗
INTRODUCTION: To determine the impact of Provider-in-Triage (PIT) deployment on advanced imaging utilization, including amongst patients presenting with abdominal pain. METHODS: This single-center retrospective study at...
INTRODUCTION: To determine the impact of Provider-in-Triage (PIT) deployment on advanced imaging utilization, including amongst patients presenting with abdominal pain. METHODS: This single-center retrospective study at a tertiary academic center evaluated changes in advanced imaging utilization following implementation of a PIT "split-flow" model in July 2023. Imaging incidence amongst adult Emergency Department (ED) patients was compared during the 18 months before and 18 months after PIT implementation using regression analysis adjusted for admission proportion and emergency severity index score. Additionally, patients presenting with abdominal pain in 2024 were evaluated for PIT exposure and computed tomography (CT) utilization adjusting for the covariates of age, sex, race, and admission disposition. CT positivity rates were compared between PIT and no-PIT cohorts. RESULTS: There were 76,731 adult ED visits in the pre-PIT period and 89,105 in the PIT period. CT utilization increased from 0.36 to 0.49 studies per ED visit, with the PIT period associated with an absolute increase of 0.135 CTs per visit (p < 0.001). Smaller increases were observed for magnetic resonance imaging and radiology ultrasound, while point-of-care ultrasound (POCUS) showed a non-significant decrease. In the 2024 abdominal pain analysis, PIT was independently associated with increased CT utilization (OR 1.27, 95% CI 1.01-1.60). CT positivity was lower in the PIT cohort (38.7% vs 46.9%; absolute risk difference 8.2%, p = 0.03). CONCLUSION: The deployment of PIT was associated with increased advanced imaging utilization. Patients exposed to PIT when arriving with a chief complaint of abdominal pain undergo more CT scans. Further work is needed to explore any possible causal relationship between PIT and advanced imaging utilization.
Did an emergency department flow optimization protocol reduce wait times? A multiple-site interrupted time series analysis in Newfoundland and Labrador, Canada.
Yoosefi M, Manukumar AG, Mariathas HH … +7 more , Hatefi A, Patey C, Norman P, Ahmadzadeh B, Walsh A, Hurley O, Asghari S
Am J Emerg Med · 2026 Jul · PMID 42000673 · Publisher ↗
OBJECTIVE: This study aims to evaluate the effect of a surge protocol on the emergency department (ED) waiting times and the percentage of patients who leave without being seen in hospitals in the Eastern Health region i...
OBJECTIVE: This study aims to evaluate the effect of a surge protocol on the emergency department (ED) waiting times and the percentage of patients who leave without being seen in hospitals in the Eastern Health region in Newfoundland and Labrador (NL), Canada. METHODS: Data for this study were obtained from electronic medical records of four emergency departments across NL. SurgeCon is a real-time, action-based electronic platform designed to monitor patient flow, support timely clinical decision-making, and prioritize patient-centred care. We evaluated the impact of the SurgeCon intervention using interrupted time series (ITS) analysis, examining key performance indicators including physician initial assessment time, length of stay (LOS), and the proportion of patients who left without being seen (LWBS). Outcomes were compared between a 12-month pre-intervention period (October 2020-September 2021) and a 12-month sustainment period (October 2023-September 2024). RESULTS: At the three adherent sites, the level change at the onset of the sustainment period indicated higher values for all three outcomes compared with the control period: physician initial assessment time increased by 1 h 31 m (p < 0.001), LOS by 2 h 3 m (p < 0.001), and the odds of LWBS by a factor of 2.30 (p < 0.001), consistent with system-wide post-pandemic pressures. However, the slope change during the sustainment period was negative and statistically significant for all three outcomes, indicating progressive improvement over time: physician initial assessment time decreased by 2.28 min per month (p < 0.001), LOS by 2.6 min per month (p < 0.001), and the odds of LWBS by 5.3% per month (p < 0.001). In contrast, the non-adherent hospital exhibited worsening trends across all outcomes. CONCLUSIONS: Our study demonstrates that the SurgeCon intervention was associated with a significant improvement in ED wait times and the LWBS rate over time. Despite an initial rise in mean wait times, negative temporal trends indicate sustained gains over time, underscoring the value of structured surge management systems in enhancing ED performance.
High risk and low incidence diseases: Peripartum cardiomyopathy.
Lamparter LE, Koyfman A, Long B
Am J Emerg Med · 2026 Jul · PMID 41997009 · Publisher ↗
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of peripartum cardiomyopathy, i...
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of peripartum cardiomyopathy, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: PPCM presents in the last month of pregnancy and up to five months postpartum. The presentation is similar to other forms of heart failure with fatigue, dyspnea on exertion, and lower extremity edema, but these mimic many other symptoms typical of pregnancy. Therefore, emergency physicians must consider PPCM in appropriate scenarios. Evaluation includes an echocardiogram, laboratory studies, electrocardiogram, and chest x-ray. While PPCM is a diagnosis of exclusion, evidence of left ventricular dysfunction is required for diagnosis. B-type natriuretic peptide (BNP) carries high sensitivity if elevated, but this is not specific to PPCM. Management focuses on afterload reduction and preload optimization utilizing nitrates and loop diuretics which are both safe intrapartum and postpartum. Noninvasive positive pressure ventilation is helpful for those with pulmonary edema and respiratory distress. Early consultation with obstetrics-gynecology and cardiology specialists can assist with determining further interventions and disposition. CONCLUSIONS: An understanding of PPCM can assist emergency physicians in diagnosing and managing this potentially deadly disease.
Closing the treatment gap: Identifying current barriers to thrombolysis in acute ischemic stroke within the treatment time window.
Zehnder C, Morra F, Globas C … +4 more , Kulcsar Z, Luft AR, Wegener S, Westphal LP
Am J Emerg Med · 2026 Jul · PMID 41997008 · Publisher ↗
BACKGROUND: Despite the proven effectiveness of intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) presenting within 4.5 h of symptom onset, less than 40% receive the treatment. We aimed to unde...
BACKGROUND: Despite the proven effectiveness of intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) presenting within 4.5 h of symptom onset, less than 40% receive the treatment. We aimed to understand current reasons for withholding IVT to increase its administration. METHODS: We conducted a retrospective single-center analysis of AIS patients arriving within the treatment time window of 4.5 h at the hospital not undergoing IVT. 493 patients of the Swiss Stroke Registry (SSR) met the inclusion criteria between 2020 and 2022. We revisited medical records to identify the reasons for not administering IVT. RESULTS: 958 patients with suspicion of AIS arrived within 4.5 h at the University Hospital Zurich (USZ), 493 (51.5%) did not undergo IVT. The primary reasons for not administering IVT were mild symptoms (41.8%, n = 167), prior use of Direct-Oral-Anticoagulants (DOACs) (27%, n = 108), or a demarcated subacute infarction on neuroimaging (8.3%, n = 41). Among patients with DOAC intake, specific anti-factor-Xa-(aFXa)-activity was not tested in 50% (n = 54). The posthoc-imaging analysis classified 41.2% (n = 14) of patients among the initially described demarcated infarction on NCCT as early signs of brain ischemia (EIS). CONCLUSION: Mild symptoms and prior DOAC intake were the main reasons for withholding IVT in stroke patients arriving within the treatment time window. Furthermore, EIS on neuroimaging classified as a subacute demarcated infarction by the neuroradiologist in charge constituted another important factor to reconsider IVT among other coexisting reasons. Identification of EIS and more data about the safety of IVT despite DOAC therapy have the potential to change clinical routine and enhance the number of patients suitable for IVT.
Gaps in knowledge, receipt, and acceptance of measles, mumps, rubella vaccines in a National Sample of emergency department patients.
Malireddy S, Eftimie A, Ge S … +9 more , Alvarez C, Torres J, Chinnock B, Gottlieb M, Kumar VA, Rising KL, Kean ER, Eucker S, Rodriguez RM
Am J Emerg Med · 2026 Jul · PMID 41966547 · Publisher ↗
BACKGROUND: Measles cases are increasing in the U.S., raising concern about gaps in adult measles, mumps, and rubella (MMR) vaccination, which is poorly captured by current surveillance. Emergency departments (EDs) act a...
BACKGROUND: Measles cases are increasing in the U.S., raising concern about gaps in adult measles, mumps, and rubella (MMR) vaccination, which is poorly captured by current surveillance. Emergency departments (EDs) act as safety-nets for underserved populations and can help identify gaps in adult MMR uptake. We assessed adult MMR up-to-date status, knowledge, and willingness to receive vaccination in the ED, nationally. METHODS: We conducted a cross-sectional survey of adults aged 18-64 at ten U.S. EDs from April-December 2024. Participants completed a structured survey assessing MMR knowledge, self-reported vaccination status, reasons for non-receipt, and willingness to receive MMR in the ED. Outcomes were summarized as proportions with 95% confidence intervals (CIs). Multivariable logistic regression identified factors associated with not being up to date and willingness to accept vaccination. RESULTS: Among 2456 participants, 25.0% (95% CI 23.3-26.7%) had not heard of the MMR vaccine, and 44.0% (42.5-46.4%) were not up to date. Factors associated with being unvaccinated included male sex (OR 2.21 [1.84-2.66]), African American (non-Hispanic) race (OR 2.27 [1.75-2.96]), Hispanic ethnicity (OR 1.98 [1.49-2.62]), non-English speakers (OR 1.53 [1.12-2.09]), and lack of primary care access (OR 1.25 [1.01-1.58]). Among those not up to date, 36.5% (33.6-39.4%) were willing to receive MMR vaccine if offered in the ED. CONCLUSIONS: Substantial gaps in adult MMR vaccination persist, especially among underserved populations. ED-based strategies might support targeted vaccine education and delivery during periods of increased transmission.
Shifts in pediatric orthopedic injury patterns in the emergency department before, during, and after the COVID-19 pandemic.
Volz M, Craver E, Rivera-Sepulveda A
Am J Emerg Med · 2026 Jul · PMID 41966546 · Publisher ↗
BACKGROUND: Pediatric orthopedic injuries represent a significant proportion of emergency department (ED) visits and are closely tied to physical activity, particularly organized sports. The COVID-19 pandemic imposed sub...
BACKGROUND: Pediatric orthopedic injuries represent a significant proportion of emergency department (ED) visits and are closely tied to physical activity, particularly organized sports. The COVID-19 pandemic imposed substantial disruptions on children's routines and healthcare utilization, offering a unique opportunity to examine changes in orthopedic injury patterns across different pandemic phases. The objective of the current study was to evaluate temporal shifts in pediatric orthopedic injury characteristics and ED management before, during, and after the COVID-19 pandemic. METHODS: This retrospective observational study included ED visits from two freestanding pediatric hospitals between January 2019 and December 2023. Patients aged 0-18 years with chief complaints related to upper or lower extremity injuries were analyzed. Demographic, clinical, and ED resource utilization variables were compared across pre-pandemic (2019), pandemic (2020-2021), and post-pandemic (2022-2023) periods using non-parametric statistical tests and trend analyses. RESULTS: Among 29,777 encounters, orthopedic ED visits declined sharply in 2020, with relative increases in upper extremity and decreases in lower extremity injuries. ED length of stay peaked post-pandemic, and procedural sedation use increased during COVID but became more efficient over time. Imaging use dropped among low-acuity patients in 2020 and rebounded afterward. Public insurance coverage rose, while uninsured rates declined. Racial/ethnic representation also fluctuated during the pandemic. CONCLUSIONS: The COVID-19 pandemic significantly influenced pediatric orthopedic ED presentations and management. While some trends have normalized, others - such as improved procedural efficiency - suggest enduring shifts in clinical practice. These insights can guide future preparedness and resource planning in pediatric emergency care.
A national survey of emergency department syphilis screening and sexually transmitted infection testing and treatment practices.
Stanford KA, White D, Mason J … +3 more , Buresh C, Shechter-Perkins EM, Faryar K
Am J Emerg Med · 2026 Jul · PMID 41962530 · Publisher ↗
BACKGROUND: As syphilis cases increase across the U.S., the emergency department (ED) has emerged as a critical venue for screening. However, little is known about the current ED screening landscape. This study aims to e...
BACKGROUND: As syphilis cases increase across the U.S., the emergency department (ED) has emerged as a critical venue for screening. However, little is known about the current ED screening landscape. This study aims to evaluate the national landscape of ED syphilis screening, identify barriers to implementation, and characterize existing infrastructure that may support expansion of syphilis screening in the ED. METHODS: Electronic surveys were distributed via email to 281 institutions with emergency medicine residency programs. Survey responses were also solicited from institutions both with and without residency programs utilizing relevant professional society listservs and in-person conference recruitment from October 2023 through May 2024. Responses were summarized using descriptive statistics and stratified by hospital type. RESULTS: A total of 138 unique EDs responded (105 academic, 33 non-academic). Systematic syphilis screening was reported by only 12.6% of EDs and was more frequent in academic centers. Most screening protocols were risk-based; universal screening was rare. HIV screening programs were present in 60.0% of academic and 30.3% of non-academic EDs. Most EDs relied on designated staff for result review and patient notification, but more than one-quarter reported no defined treatment location for syphilis. Commonly cited facilitators to screening included standardized guidelines, electronic medical record integration, and additional staffing, while major barriers included time constraints, limited resources, and challenges with follow-up. CONCLUSIONS: Despite rising syphilis rates, ED-based syphilis screening remains uncommon. Existing HIV and sexually transmitted infection screening and treatment infrastructure may provide a foundation for expanding syphilis screening through operationally feasible, guideline-supported approaches.
Controlled thoracic drainage with intermittent clamping during resuscitation of critically unstable patient before surgery: A potentially lifesaving strategy for massive hemothorax in a conflict zone mass casualty incident.
AbuMousa MS, Alslaibi KM, Alharazin JO
Am J Emerg Med · 2026 Jul · PMID 41962529 · Publisher ↗
BACKGROUND: Massive hemothorax after penetrating trauma is a rapidly lethal condition. Standard management calls for immediate chest tube drainage, that aims for lung expansion tamponading bleeding vessels. Paradoxically...
BACKGROUND: Massive hemothorax after penetrating trauma is a rapidly lethal condition. Standard management calls for immediate chest tube drainage, that aims for lung expansion tamponading bleeding vessels. Paradoxically, draining a massive hemothorax that is resulting from heart, major vessels or deep lung parenchyma laceration may abolish tamponade and precipitate catastrophic hemorrhage before surgical control is achieved. In resource-limited settings or mass casualty incidents (MCIs), surgical delay compounds this risk. CASE PRESENTATION: A 30-year-old male sustained a gunshot injury during a conflict-zone MCI, presenting with hypotension (weak radial pulse, HR 90) and right massive hemothorax confirmed by e-FAST. With no immediate surgical access and ongoing blood product preparation, controlled thoracic drainage was initiated. The chest tube was clamped twice. This strategy preserved temporary tamponade, allowed time for transfusion and operative preparation, and enabled safe transfer to definitive surgery. Surgery revealed a 10 cm right lower lobe laceration, which went on to receive primary repair. The patient survived without major complications and remains under follow-up. CONCLUSION: This case should open discussion about the heterogencity of interathoracic bleeding and its source. In some cases, controlled drainage with intermittent clamping may balance preservation of tamponade effect and hemorrhage control: this provides a vital bridge in resource-constrained environment with delayed access to thoracotomy. Incorporating this approach in trauma protocols should be further investigated and considered.
Corrigendum to "Early vasopressin plus norepinephrine versus delayed or no vasopressin in septic shock: A systematic review and meta-analysis" [The American Journal of Emergency Medicine 99 (2026), 225-231].
Mamede I, Arêa L, Carvalhal G … +3 more , Bessa R, Lenzi M, Dos Santos MCF
Am J Emerg Med · 2026 Jul · PMID 41956874 · Publisher ↗
Abstract loading — click title to view on PubMed.
A POCUS stewardship framework for optimizing pediatric FAST in trauma: A conceptual model and evidence synthesis.
Montoya K, Weinstein R, Kharasch S … +2 more , Gottlieb M, Shokoohi H
Am J Emerg Med · 2026 Jul · PMID 41950714 · Publisher ↗
OBJECTIVE: The Focused Assessment with Sonography in Trauma (FAST) exam is widely used in adult trauma, but its role in pediatric blunt abdominal trauma remains uncertain due to variability in diagnostic accuracy. Point-...
OBJECTIVE: The Focused Assessment with Sonography in Trauma (FAST) exam is widely used in adult trauma, but its role in pediatric blunt abdominal trauma remains uncertain due to variability in diagnostic accuracy. Point-of-care ultrasound (POCUS) stewardship offers a framework to potentially optimize pediatric FAST (FAST-P) by integrating clinical context, such as indication, pre-test probability, patient stability, and injury severity. This study evaluates how applying POCUS stewardship principles may potentially improve FAST-P diagnostic performance and utility in children. METHODS: We developed a conceptual POCUS stewardship framework based on established stewardship principles, then synthesized current literature to support and refine the model. Studies on FAST-P in pediatric blunt trauma published from January 2000 through December 2025 were reviewed, focusing on four framework components: clinical indication, pre-test probability, hemodynamic status, and injury severity with free fluid volume. Diagnostic performance and CT utilization were analyzed when available. RESULTS: POCUS stewardship provides a framework that may enhance diagnostic value by aligning FAST-P use with clinical context. Intervention likelihood rose from 0.4% in children with <1% pre-test probability to 41.4% in those with >50%, supporting the importance of proper indication and risk assessment. FAST-P performed best in unstable patients (sensitivity 78.6%, specificity up to 100%), and less effectively in stable ones (sensitivity 50-64%, specificity 83-95%). Adding physical exam findings and risk stratification improved accuracy, with combined approaches achieving up to 96.9% sensitivity and 98.6% negative predictive value. Sensitivity and specificity were highest with large fluid volumes (89%, 99%). FAST-P reduced CT rates from 22.5% to 18.6% in <1% risk patients, and from 92.3% to 78.9% in 6-10% risk. CONCLUSIONS: Integrating POCUS stewardship may potentially improve FAST-P diagnostic utility in pediatric trauma by aligning its use with clinical risk and reducing unnecessary imaging. This conceptual framework requires prospective validation but offers a structured approach to optimizing FAST-P application in clinical practice.
Trauma-Informed Care in Emergency Ultrasound (TIES): A prospective matched patient-clinician survey study.
Al Jalbout N, Meeker MA, Joseph K … +7 more , Vigue D, Maldonado G, Fischetti L, Park R, Drummond JM, Riscinti M, Shokoohi H
Am J Emerg Med · 2026 Jul · PMID 41945976 · Publisher ↗
OBJECTIVES: Point-of-care ultrasound (POCUS) is widely used in emergency departments (EDs) but often requires close patient contact and body exposure, which may increase patient vulnerability. Trauma-informed care (TIC)...
OBJECTIVES: Point-of-care ultrasound (POCUS) is widely used in emergency departments (EDs) but often requires close patient contact and body exposure, which may increase patient vulnerability. Trauma-informed care (TIC) principles have not been formally studied in the context of POCUS. This study aimed to evaluate and compare patient and clinician perspectives on TIC behaviors during ED POCUS. METHODS: We conducted a cross-sectional study at two urban academic EDs using matched patient-clinician surveys. The Trauma-Informed Emergency Sonography (TIES) survey was developed following a seven-step framework, including literature review, expert content validation, cognitive interviews, and pilot testing. The survey assessed behaviors across the six core TIC domains using 5-point Likert-scale items. Patients completed 26 experience-related items and clinicians completed 29 behavior-related items following each POCUS encounter. Responses were summarized as percent agreement and compared between matched pairs using Wilcoxon signed-rank tests. RESULTS: Among 143 matched patient-clinician pairs, patients consistently reported higher agreement with TIC practices than clinicians reported performing. The largest differences were in informing patients they could stop the exam (77% patients vs 45% clinicians, p < 0.001), asking about companion preferences (78% vs 48%, p < 0.001), and allowing time to redress before discussing results (87% vs 56%, p < 0.001). Significant differences were observed in four of six TIC domains: empowerment, voice, and choice (p = 0.001); peer support (p < 0.001); trustworthiness and transparency (p = 0.024); and collaboration and mutuality (p = 0.035). Clinicians with prior TIC training and advanced practice providers demonstrated stronger alignment with TIC behaviors. CONCLUSION: Patients perceived their POCUS experience as more trauma-informed than clinicians recognized in their own practice, with the largest differences in communication, consent, and eliciting patient preferences. The TIES survey may serve as an exploratory tool to assess TIC behaviors during ED POCUS encounters and inform future training efforts.
Ocular ultrasound lowers threshold for lumbar puncture in varicella zoster virus meningitis: A case report.
Galske J, Patel P, Packard B … +1 more , Herbst MK
Am J Emerg Med · 2026 Jul · PMID 41945975 · Publisher ↗
Headache is a common presenting concern among patients presenting to the emergency department, with etiologies ranging from benign primary headaches to potentially life-threatening intracranial infection, hemorrhage, or...
Headache is a common presenting concern among patients presenting to the emergency department, with etiologies ranging from benign primary headaches to potentially life-threatening intracranial infection, hemorrhage, or mass lesions. Ocular ultrasound can rapidly and noninvasively detect papilledema, making it a valuable first-line tool for guiding diagnosis and management decisions. We describe a case of an otherwise healthy 37-year-old female who presented to the emergency department with a five-day history of headache. She had previously been evaluated at two other emergency departments, where laboratory testing and non-contrast head computed tomography were unremarkable, and was discharged on both occasions. During this third visit, ocular ultrasound demonstrated papilledema, leading to a lumbar puncture that confirmed a diagnosis of varicella zoster virus meningitis. Ocular ultrasound is widely available and easy to perform, allowing physicians to rapidly distinguish serious causes of headache from the many benign causes. Given the finite resources and time of an emergency physician, using this quick imaging technology may help direct the utilization of more invasive testing, such as lumbar puncture or neuroimaging, and improve diagnostic accuracy.
Best practices for critically ill patients boarding in the emergency department: A Delphi study.
Garcia SI, Finch AS, Smith LM … +2 more , Mullan AF, Litell JM
Am J Emerg Med · 2026 Jul · PMID 41935431 · Publisher ↗
BACKGROUND: Boarding of critically ill patients in the emergency department is common and associated with worse outcomes due to delays in time-sensitive interventions. This study used a Delphi process to develop a checkl...
BACKGROUND: Boarding of critically ill patients in the emergency department is common and associated with worse outcomes due to delays in time-sensitive interventions. This study used a Delphi process to develop a checklist of best practices for managing these patients during this vulnerable period. METHODS: Study personnel recruited a representative Delphi panel of 18 intensivists who are board certified in emergency medicine and critical care. We used a structured literature review to identify candidate items for a best practices checklist. This included a PubMed search of English language articles from 2011 to 2021 using terms like "critical illness," "emergency ward," "ICU," and "boarding." We scrutinized existing best practice checklists and specialty society guidelines. Panel members rated interventions using a seven-point Likert scale via web-based surveys and submitted comments, which were visible to co-panelists in subsequent rounds. Consensus for inclusion was defined a priori as ≥80% of panelists rating the item 5-7 on the Likert scale. RESULTS: An initial list of 92 candidate checklist items was evaluated by 18 expert panelists across three Delphi rounds, with response rates exceeding 85% in each round. The modified Delphi process identified 101 items that achieved consensus for inclusion in the final checklist. Consensus items addressed management of post-cardiac arrest syndrome, increased intracranial pressure, intracerebral hemorrhage, respiratory failure, and shock. Examples of highly rated items included vasopressor selection in shock, lung-protective ventilation strategies for mechanically ventilated patients, and protocolized sedation and analgesia after intubation. Additional consensus items addressed management of gastrointestinal hemorrhage, electrolyte imbalances, renal and liver failure, coagulopathy, endocrine abnormalities, infectious diseases, and considerations for devices and logistics. CONCLUSIONS: A Delphi process identified 101 expert consensus items for a checklist designed to support the care of critically ill patients boarding in the ED. Future studies are needed to evaluate implementation and potential effects on care processes and patient outcomes.
Evaluating maternal mortality, risk factors, and emergency c-section timing in polytrauma pregnant patients.
Indorewala Y, Prashar S, Lee P … +6 more , Nasef Y, Nishida C, Yates Z, Elangovan D, Hersperger SG, Elkbuli A
Am J Emerg Med · 2026 Jul · PMID 41932264 · Publisher ↗
BACKGROUND: Trauma is a leading non-obstetric cause of maternal morbidity and mortality, yet standardized guidelines for the management of pregnant polytrauma patients remain limited. Physiologic changes of pregnancy may...
BACKGROUND: Trauma is a leading non-obstetric cause of maternal morbidity and mortality, yet standardized guidelines for the management of pregnant polytrauma patients remain limited. Physiologic changes of pregnancy may alter trauma response and complication risk, but data guiding risk stratification and time-sensitive interventions are sparse. OBJECTIVE: To evaluate maternal mortality and complications among pregnant polytrauma patients, with particular focus on maternal age, early blood transfusion, and timing of emergency cesarean section. METHODS: This retrospective cohort study analyzed data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) from 2017 to 2023. Pregnant trauma patients aged 18-45 years with moderate to severe injuries (ISS ≥9) were included. Maternal outcomes were assessed across subgroups stratified by maternal age, receipt of blood products within 4 h of hospital presentation, and timing of emergency cesarean section (≤4 h vs >4 h). RESULTS: Among 2086 pregnant polytrauma patients, maternal age was not independently associated with statistically significant differences in mortality or major complications; however, older patients demonstrated higher point estimates for thromboembolic complications and longer ICU length of stay. Receipt of blood products within 4 h was strongly associated with increased 24-h mortality (aOR 10.923, p = 0.003) and in-hospital mortality (aOR 15.033, p = 0.005). Emergency cesarean section after 4 h of admission was associated with a significantly shorter ICU length of stay (β: -3.196, 95% CI: -6.25 to -0.14, p = 0.040). CONCLUSIONS: In pregnant polytrauma patients, early blood transfusion identified a subgroup at markedly increased risk of early and in-hospital mortality, underscoring injury severity and resuscitation needs as primary drivers of adverse outcomes rather than maternal age alone. These findings emphasize the importance of timely, multidisciplinary trauma-obstetric decision-making & risk-stratification approach to optimize maternal outcomes.
Comparison of neck-extended and modified ramped positions for locating the cricothyroid membrane in obese anesthetized patients.
Chang JE, Seol T, Won D … +4 more , Lee JM, Kim TK, Goo Y, Hwang JY
Am J Emerg Med · 2026 Jul · PMID 41932263 · Publisher ↗
OBJECTIVE: Precise localization of the cricothyroid membrane in obese women is challenging. This randomized comparative study aimed to evaluate the neck-extended position versus the modified ramped position in terms of s...
OBJECTIVE: Precise localization of the cricothyroid membrane in obese women is challenging. This randomized comparative study aimed to evaluate the neck-extended position versus the modified ramped position in terms of success rate, time required, and perceived difficulty in identifying the cricothyroid membrane in anesthetized obese female patients. METHODS: After the induction of anesthesia in 112 obese female patients, the cricothyroid membrane was identified using the laryngeal handshake technique in the neck-extended or modified ramped position. In the neck-extended position, a pillow was placed beneath the shoulders in the supine position. The modified ramped position was achieved by combining a ramped position with full head extension using a specialized pillow. The success rate of accurate identification of the cricothyroid membrane, time required to locate the cricothyroid membrane center, and the subjective difficulty of cricothyroid membrane palpation were recorded. RESULTS: The success rate of accurate identification of the cricothyroid membrane was significantly higher in the modified ramped position than in the neck-extended position (77% vs. 48%, respectively; P = 0.002). The time required for localization of the cricothyroid membrane center did not differ between the neck-extended and modified ramped positions (46.0 [23.2] s vs. 41.0 (15.0) s, respectively; P = 0.562). The subjective difficulty of cricothyroid membrane palpation as perceived by anesthesiologists was significantly lower in the modified ramped position than in the neck-extended position (P = 0.019). CONCLUSION: The modified ramped position facilitated accurate identification of the cricothyroid membrane and reduced the difficulty of cricothyroid membrane palpation in anesthetized obese female patients compared with the neck-extended position.
The role of serum subfatin levels in the diagnosis of epileptic seizures: A case-control study.
Özdal MT, Işler Y, Kaya H … +2 more , Yüksel M, Ay MO
Am J Emerg Med · 2026 Jul · PMID 41932262 · Publisher ↗
BACKGROUND: This study aims to investigate the potential role of serum subfatin levels as a biomarker in patients with epileptic seizures. METHODS: This prospective, single-center, case-control study included 132 patient...
BACKGROUND: This study aims to investigate the potential role of serum subfatin levels as a biomarker in patients with epileptic seizures. METHODS: This prospective, single-center, case-control study included 132 patients diagnosed with epilepsy and 131 age- and sex-matched healthy controls. Serum subfatin levels were measured using an ELISA method. Statistical analyses were performed using SPSS 27.0, and intergroup differences were assessed with appropriate statistical tests. RESULTS: Serum subfatin levels were significantly lower in the epilepsy group compared with the control group (0.42 ± 0.21 ng/mL vs. 0.68 ± 0.27 ng/mL; p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated good discriminatory power, with an area under the curve (AUC) of 0.84, 82% sensitivity, and 78% specificity at a cut-off value of 0.45 ng/mL. Multivariate logistic regression analysis identified serum subfatin levels as an independent predictor of epileptic seizures (odds ratio [OR]: 4.85; 95% confidence interval [CI]: 2.10-11.21; p < 0.001). CONCLUSION: Serum subfatin levels appear to be a promising biomarker for epileptic seizures. Decreased subfatin concentrations may reflect underlying neuroinflammatory processes associated with epileptogenesis. Particularly, serum subfatin levels below 0.30 ng/mL were associated with an increased risk of epileptic seizures within 180 days, indicating its potential utility for diagnostic and prognostic purposes.
Sudden-onset restless legs syndrome due to acute cerebral hemorrhage.
Mizoguchi T, Okazaki Y, Ichiba T
Am J Emerg Med · 2026 Jul · PMID 41930800 · Publisher ↗
Restless legs syndrome (RLS) is generally considered a chronic neurological condition or a post-stroke complication. However, its sudden onset as a presenting feature of acute stroke is rarely reported. We present a case...
Restless legs syndrome (RLS) is generally considered a chronic neurological condition or a post-stroke complication. However, its sudden onset as a presenting feature of acute stroke is rarely reported. We present a case of acute cerebral hemorrhage manifesting solely as sudden-onset RLS without other neurological deficits. A 58-year-old woman experienced an abrupt onset of an irresistible urge to move her legs. Upon arrival at the emergency department, she continued to experience this urge and displayed rhythmic leg trembling. Moving her legs relieved her discomfort, and she was able to consciously suppress the movements. Neurological examination revealed no motor or sensory deficits. Subsequent head computed tomography revealed a hemorrhage involving the lentiform nucleus and the body of the caudate nucleus, with sparing of the pyramidal tract. On hospital day 3, oral pramipexole was initiated, resulting in a gradual improvement of her RLS symptoms. She was discharged without neurological abnormalities. Restless leg syndrome may be an initial manifestation of acute stroke. Emergency physicians should consider the possibility of acute stroke in the differential diagnosis of sudden-onset involuntary movements resembling RLS, even in the absence of focal neurological deficits.
Practice changing articles: Early restrictive versus liberal oxygen for trauma patients.
Bridwell RE, Pourmand A, Gottlieb M … +1 more , Long B
Am J Emerg Med · 2026 Jul · PMID 41927435 · Publisher ↗
Abstract loading — click title to view on PubMed.
From forecasting to action: Operational playbooks for emergency department flow analytics.
Katipoglu B, Szarpak L
Am J Emerg Med · 2026 Jul · PMID 41905838 · Publisher ↗
Abstract loading — click title to view on PubMed.
Validation and implementation of the FLHASc score for risk stratification of patients with hemoptysis in the emergency department.
Pelagatti L, Bartalucci P, Fabiani G … +11 more , Giannasi G, Ruggiano G, De Curtis E, di Maria V, Coppa A, Pepe G, Magazzini S, Voza A, Morello F, Nazerian P, Vanni S
Am J Emerg Med · 2026 Jun · PMID 41905245 · Publisher ↗
BACKGROUND: Hemoptysis is a potentially life-threatening symptom that often prompts emergency department (ED) evaluation and hospitalization. Reliable prognostic tools to guide clinical decision-making and optimize resou...
BACKGROUND: Hemoptysis is a potentially life-threatening symptom that often prompts emergency department (ED) evaluation and hospitalization. Reliable prognostic tools to guide clinical decision-making and optimize resource use are currently lacking. OBJECTIVE: To prospectively validate the Florence Hemoptysis Assessment Score (FLHASc) in patients presenting with hemoptysis to the ED, and to eventually derive and validate an improved version of the score (FLHASc2). METHODS: We analyzed data from the POPEIHE study (NCT06067997), a multicenter prospective cohort of 546 consecutive adult patients presenting with hemoptysis to 9 Italian EDs. The primary outcome was a composite of in-hospital death, need for ventilatory support, intensive care unit (ICU) admission, blood transfusion, or invasive hemostatic procedures. We evaluated the prognostic performance of the original FLHASc, then derived a new model (FLHASc2) using multivariate logistic regression in a randomly selected derivation cohort (n = 321) and validated it in the remaining cohort (n = 225). A simplified version of the score was also tested. RESULTS: The original FLHASc demonstrated moderate discriminatory ability (AUC 0.71; 95% CI: 0.65-0.76) and suboptimal calibration. The FLHASc2 showed improved performance (AUC 0.79, 95% CI: 0.73-0.87 in derivation and 0.81, 95% CI: 0.73-0.88, in validation cohorts; Brier score < 0.10 in both). The simplified FLHASc2 (sFLHASc2), assigning one point per variable, maintained comparable accuracy (AUC 0.80, 95% CI: 0.72-0.87) and identified 47.8% of patients as low risk (2.7% event rate). When combined with a negative chest X-ray, the observed event rate in this subgroup dropped to 0.87%, with a negative predictive value of 99.1% (CI 95%, 96.5-100%). CONCLUSIONS: The FLHASc2 and its simplified version are accurate prognostic tools for identifying hemoptysis patients at low risk of short-term adverse outcomes. Use of the sFLHASc2 combined with chest X-ray may allow safe ED discharge in nearly half of cases. A prospective management trial is warranted to confirm its clinical impact. TRIAL REGISTRATION NUMBER: NCT06067997.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe