Am J Emerg Med
· 2026 Jun · PMID 41903287
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BACKGROUND: Urinary tract infections (UTIs) are among the most common pediatric infections, but urine culture, the diagnostic gold standard, requires 1-3 days for results. This delay may lead to unnecessary antibiotic us...BACKGROUND: Urinary tract infections (UTIs) are among the most common pediatric infections, but urine culture, the diagnostic gold standard, requires 1-3 days for results. This delay may lead to unnecessary antibiotic use or treatment delays. OBJECTIVE: To develop and validate a machine learning (ML) model that predicts urine culture positivity in pediatric emergency department (ED) encounters using electronic health record (EHR) data. METHODS: We conducted a cross-sectional study of patients aged 3 months-18 years who had urine cultures obtained during ED visits at a quaternary academic medical center between January 2020 and December 2023. Demographics, arrival mode, chief complaint, labs, vitals, and encounter characteristics were extracted from the EHR. Logistic regression, K-nearest neighbors, neural networks, and gradient-boosted trees (XGBoost) were trained on 80% of encounters and tested on 20%. Model performance was assessed using accuracy, precision, recall, F1-score, and AUC-ROC. Feature importance was evaluated with Shapley Additive Explanations (SHAP). RESULTS: Among 3788 encounters with urine cultures, 47.5% were positive. The XGBoost model achieved the best performance (accuracy 72.0%, precision 71.3%, recall 69.3%, AUC-ROC 78.1%). The model demonstrated appropriate probability calibration with a Brier score of 0.194. Key predictive features included ED diagnosis of UTI, urine collection method, sex, temperature, urinalysis findings, and select laboratory and vital sign measures. CONCLUSION: A machine learning model applied to routinely collected EHR data accurately predicted urine culture positivity in pediatric ED patients. Such models may support clinician decision-making, reduce unnecessary antibiotic use, and minimize delays in UTI treatment.
Imran MN, Amrithanand VT, Anukarthika S
… +1 more, Roobini S
Am J Emerg Med
· 2026 Jun · PMID 41895068
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High-quality cardiopulmonary resuscitation (CPR) requires effective chest compressions, yet real-time physiologic assessment during ongoing resuscitation in the emergency department (ED) remains limited. End-tidal carbon...High-quality cardiopulmonary resuscitation (CPR) requires effective chest compressions, yet real-time physiologic assessment during ongoing resuscitation in the emergency department (ED) remains limited. End-tidal carbon dioxide (ETCO₂) is a guideline-endorsed surrogate of CPR quality, but its measurement is influenced by ventilation and pulmonary factors. We report a prospective case series of 20 adult cardiac arrest patients evaluating the feasibility of femoral artery collapse ratio (FACR) measurement using M-mode point-of-care ultrasound during uninterrupted CPR and its relationship with ETCO₂ and return of spontaneous circulation (ROSC). FACR was successfully obtained in all patients without interrupting chest compressions. Higher FACR values were observed in patients with a mean ETCO₂ ≥20 mmHg and among those achieving ROSC. FACR demonstrated physiologic concordance with ETCO₂ across the cohort. FACR may represent a practical, ultrasound-based adjunct for real-time physiologic assessment of chest compression effectiveness in the emergency department, particularly when interpretation of end-tidal carbon dioxide is limited. Further prospective studies are needed to define clinically meaningful thresholds and outcome impact.
Am J Emerg Med
· 2026 Jun · PMID 41895067
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OBJECTIVES: Traumatic hemothorax, pneumothorax, and hemopneumothorax are life-threatening conditions which are often treated with thoracostomy. Prior research has identified thoracostomy as an independent risk factor for...OBJECTIVES: Traumatic hemothorax, pneumothorax, and hemopneumothorax are life-threatening conditions which are often treated with thoracostomy. Prior research has identified thoracostomy as an independent risk factor for both mortality and increased hospital length of stay (LOS). Given the coexistence of increased mortality and LOS, the objective of this study was to examine whether this mortality risk is driven by iatrogenic factors such as in-hospital complications. METHODS: This retrospective cohort study used data from the 2019 American College of Surgeons-Trauma Quality Program database. This study included all adult patients in the database with traumatic hemothorax, pneumothorax, or hemopneumothorax. Patients with missing data or no signs of life upon arrival were excluded. Patients were propensity score matched. Rates of mortality, LOS, and rates of complications were compared between groups. Mediation analysis was performed to link thoracostomy, complications, and mortality. RESULTS: Our post-match sample consisted of 36,550 patients, 18,275 who underwent thoracostomy and 18,275 who did not. Thoracostomy was associated with increased mortality and LOS (p < 0.001). After correcting for multiple comparisons, thoracostomy was also associated with increased incidence of 17 of the 21 in-hospital complications that the database tracks (p < 0.05). Mediation analysis showed the association between thoracostomy and mortality is mediated by complications, with cardiac arrest accounting for 35% of mortality risk. CONCLUSIONS: This study suggests that in-hospital complications may partially drive the increased mortality associated with thoracostomy in patients with traumatic hemothorax, pneumothorax, or hemopneumothorax. We recommend a reexamination of clinical guidelines regarding the threshold for thoracostomy as well as increased caution post-procedure to minimize downstream complications.
Gartner HT, Simmons RE, Stott M
… +12 more, Perez V, Crespo J, Allison B, Howard A, Patt A, Wan HZ, Cowdery C, Sollee DR, Rashid SS, Moran TP, Morgan B, Sheikh S
Am J Emerg Med
· 2026 Jun · PMID 41886998
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INTRODUCTION: The objectives of this study were to characterize and compare clinical outcomes in patients with high-risk acetaminophen overdose who received fomepizole as an adjunct to N-acetylcysteine treatment to those...INTRODUCTION: The objectives of this study were to characterize and compare clinical outcomes in patients with high-risk acetaminophen overdose who received fomepizole as an adjunct to N-acetylcysteine treatment to those who received N-acetylcysteine only. MATERIAL AND METHODS: This was a retrospective cohort study of patients reported to four United States poison control centers between January 2018 and December 2022. Patients with high-risk acetaminophen ingestion-defined as a serum concentration ≥ 300 μg/mL at 4 h or more post-ingestion, or a multiplication product (acetaminophen concentration in mcg/mL multiplied by either aspartate aminotransferase in units per liter or alanine aminotransferase in units per liter) ≥10,000-upon admission who received N-acetylcysteine were included. Exclusion criteria included documented history of pre-existing liver disease, insufficient case details, or co-ingestion of either a toxic alcohol or another hepatotoxic substance. Clinical characteristics and outcomes were compared using logistic regressions between patients who received fomepizole as an adjunct to N-acetylcysteine treatment to those who received N-acetylcysteine only. A subgroup analysis assessed the impact of fomepizole timing (≤24 h versus >24 h) after N-acetylcysteine initiation. RESULTS: Among the 391 patients included, there were no significant differences in National Poison Data System outcome severity, intensive care unit stay, or N-acetylcysteine duration between patients who received fomepizole and those who did not. In the subgroup analysis of fomepizole recipients, outcomes were also similar regardless of whether fomepizole was administered within or after 24 h of N-acetylcysteine initiation. DISCUSSION: Fomepizole as an adjunct to N-acetylcysteine in patients with high-risk acetaminophen overdose did not improve clinical outcomes. Although no adverse effects to fomepizole were reported, routine use in this setting remains unsupported by this study.
Young D, Wageuspack A, Boyle L
… +3 more, McCuller C, Moore S, Everitt B
Am J Emerg Med
· 2026 Jun · PMID 41886997
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Heat stroke is a life-threatening condition defined as core body temperature > 40 °C plus end organ damage, most notably CNS dysfunction. Standard of care has long included the use of evaporative and convective cooling t...Heat stroke is a life-threatening condition defined as core body temperature > 40 °C plus end organ damage, most notably CNS dysfunction. Standard of care has long included the use of evaporative and convective cooling techniques; however, Cold Water Immersion (CWI) has emerged as a potential new standard of care. Thermal Emergency Management Patient (TEMP) bags (ie. body bags) allow for cooling rates that meet or exceed ideal rates of 0.2 °C/min. We investigated several commercially available bags to assess which characteristics would make up the ideal TEMP bag for CWI cooling. We conducted an observational study to test the characteristics of different bags that optimize cooling for CWI by obtaining seven commercially available body bags. Each bag was put through the same real-life simulation of patient cooling, both on the ground and with movement to patient stretcher utilizing 38 L of ice water. We evaluated water depth and residual volume, as well as the integrity and strength of each bag. On average, bags lost 14.49 L of water during testing, with a median amount of water loss of 10.7 L Bags with center zippers and those with handles lost the least amount of water. Five out of the seven bags experienced some sort of structural failure. The characteristics found to be most beneficial include thicker bag material, double sewn or fused seams, and center zippers. Further research into which characteristics or specific bag would be optimal for CWI needs to be conducted to ensure patient safety and efficacy of treatment.
Akkaya B, Özcan AS, Erdem FŞ
… +5 more, Öztürk B, Yaradılmış RM, Aydın O, Güngör A, Tuygun N
Am J Emerg Med
· 2026 Jun · PMID 41886996
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INTRODUCTION: Acute visual changes-including blurred vision, diplopia, photopsia, visual hallucinations, and vision loss-pose a diagnostic challenge in children due to limited symptom description and limited cooperation...INTRODUCTION: Acute visual changes-including blurred vision, diplopia, photopsia, visual hallucinations, and vision loss-pose a diagnostic challenge in children due to limited symptom description and limited cooperation during examination. We aimed to (1) characterize the etiologies of children presenting to a pediatric emergency department (PED) with acute visual changes and (2) identify clinical predictors of pathologic neuroimaging findings. METHODS: We conducted a retrospective, single-center study at a tertiary PED between 2022 and 2024. Patients aged 1 month to 18 years were identified through structured chief complaint fields and keyword searches of electronic medical records (e.g., "blurred vision," "vision loss," "double vision"). Acute visual changes were defined as sudden-onset symptoms occurring within 72 h before presentation. Clinical features were compared between patients with pathologic neuroimaging findings and those with normal imaging results. RESULTS: We included 444 patients in the study. The most common etiologies were neurological (29%), ocular (23%), and systemic (18%). Neuroimaging was performed in 178 patients (40%); among them, 63 (35%) demonstrated pathologic findings. Vision loss, pain with eye movements, focal neurological deficits, signs of meningeal irritation, dysmetria, tremor, papilledema, abnormal pupillary light reflexes, and a positive Romberg sign were significantly more frequent among patients with pathologic neuroimaging findings (p < 0.001). In multivariable analysis, focal neurological deficits, pain with eye movement, paresthesia, tremor, and abnormal pupillary light reflex abnormalities were independently associated with pathologic imaging findings. CONCLUSION: Although most pediatric acute visual changes are benign, a clinically important proportion are associated with significant neuroimaging abnormalities. Specific neurological examination findings may help identify children at higher risk for intracranial pathology. Prospective multicenter studies are needed to validate these predictors and refine imaging strategies in the PED.
McGinnis P, Camp S, Cheema M
… +8 more, Zinabu S, Michael M, Elhamdani A, Gaasch S, Andersen B, Pourmand A, Downing JV, Tran QK
Am J Emerg Med
· 2026 Jun · PMID 41880713
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BACKGROUND: Central line-associated bloodstream infections (CLABSIs) remain a major source of hospital-related morbidity and mortality. Replacing central venous catheters (CVCs) with midline catheters (MLCs), when clinic...BACKGROUND: Central line-associated bloodstream infections (CLABSIs) remain a major source of hospital-related morbidity and mortality. Replacing central venous catheters (CVCs) with midline catheters (MLCs), when clinically appropriate, has been proposed as a strategy to reduce the incidence of CLABSI cases. We hypothesized that increased MLC utilization would correlate with decreased CLABSI incidence. RESEARCH QUESTION: Is increased use of midline catheters, in place of central venous catheters, associated with reduced CLABSI incidence over time? STUDY DESIGN AND METHODS: We conducted a retrospective analysis using the TriNetX database, which includes de-identified data from over 130 million patients across 94 healthcare organizations (2016-2024). Adults with ICD-10 procedure codes for CVC or MLC placement were included. Propensity score matching, logistic-binomial and Poisson regression (with log line-count offset), and time-series modeling were used to evaluate device utilization and CLABSI incidence. Matching covariates included demographics and clinical proxies of acuity and infection risk e.g., ICU admission, vasopressor use, mechanical ventilation, parenteral nutrition, chemotherapy, immunosuppression, transplant, CKD, diabetes. Post-match balance was assessed using standardized mean differences (SMDs); all covariates achieved SMD <0.1 (Supplementary Fig. S1). This study was reviewed and determined to be exempt from full review by an institutional review board, as it only utilized anonymized, retrospective data. As such, the requirement for informed consent from participants was waived. RESULTS: Among 268,401 adults, 58,205 (22%) received a midline catheter (MLC) and 168,098 (63%) received a central venous catheter (CVC); 7036 received both during the study period, yielding 42,098 CLABSI events. MLC use increased from 3200 in 2016 to 10,449 in 2024, while CVC use declined from 23,316 to 11,912. In propensity-matched CVC cohorts, the crude proportion of CLABSI remained stable (0.5-0.8% annually; p for trend = 0.55). Poisson regression adjusting for device exposure estimated each year a 14% increase in CLABSI incidence (IRR per year = 1.14, p < 0.001); midline share was not an independent predictor (IRR = 1.19, p = 0.66). After propensity score matching, odds of CLABSI decreased by ∼0.8% per year although this effect was not statistically significant (p = 0.745). Candidal sepsis was rare (<0.5% annually) without device-type differences; bacterial/unspecified sepsis was modestly higher among midline recipients in select years. INTERPRETATION: Despite increased MLC use and reduced CVC utilization, CLABSI rates did not decline, suggesting that catheter type alone may not drive infection risk. A multifaceted infection prevention approach, including site selection, maintenance practices, and patient-specific considerations is needed when determining catheter choice.
Meller N, Hassidov-Rosenberg L, Saukhat O
… +3 more, Shaham L, GIlat EK, Peretz-Machluf R
Am J Emerg Med
· 2026 Jun · PMID 41861634
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OBJECTIVE: To describe diagnostic and triage pitfalls in patients with CT-imaged, STI-confirmed pelvic inflammatory disease (PID) in the emergency department (ED) settings, and to identify factors associated with missed...OBJECTIVE: To describe diagnostic and triage pitfalls in patients with CT-imaged, STI-confirmed pelvic inflammatory disease (PID) in the emergency department (ED) settings, and to identify factors associated with missed diagnosis and non-gynecologic admission. METHODS: Single-center, retrospective cohort (2016-2024) of women who underwent computed tomography (CT) scan during ED evaluation, tested positive for Chlamydia trachomatis and/or Neisseria gonorrhoeae, and clinically diagnosed with PID. Missed PID diagnosis was defined as (i) discharge after the initial gynecologic ED evaluation without a PID diagnosis or (ii) admission to Internal Medicine/General Surgery rather than Gynecology among hospitalized patients. Univariable comparisons used Chi-square and Mann-Whitney U tests. RESULTS: Forty-four women were included (mean age 32.7 years). GI symptoms were common (nausea 52.3%, vomiting 34.1%), while fever >38 °C was uncommon (6.8%). CT was interpreted as suggestive of PID in 52.3% of cases. Overall, 68.2% were discharged after the initial gynecologic ED evaluation without a diagnosis of PID. Among twenty-nine hospitalized patients, 51.7% were admitted to Gynecology and 48.3% to Internal Medicine/General Surgery. Correct PID diagnosis at initial evaluation was associated with CT interpreted as PID (78.6% vs 40.0%, p = 0.02). Non-gynecologic admission was associated with nausea (85.7% vs 33.3%, p = 0.004), fewer specific ultrasound findings (14.3% vs 57.1%, p = 0.02), and higher white blood cell count (15.8 vs 11.0 K/μL, p = 0.02). CONCLUSION: In CT-imaged, STI-confirmed PID, missed diagnosis, and non-gynecologic triage were frequent, particularly in gastrointestinal-dominant presentations and when imaging lacked specific PID features. Integrating PID more explicitly into acute abdominal pain pathways may improve the timely recognition and treatment of PID.
Am J Emerg Med
· 2026 Jun · PMID 41849833
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INTRODUCTION: Errors in emergency department (ED) documentation can lead to patient harm and medicolegal risk, however manual document auditing is resource-intensive and difficult to scale. Large language models (LLMs) m...INTRODUCTION: Errors in emergency department (ED) documentation can lead to patient harm and medicolegal risk, however manual document auditing is resource-intensive and difficult to scale. Large language models (LLMs) may offer an automated alternative, but their performance for task-specific error detection remains uncertain. This study evaluated four state-of-the-art LLMs for automated auditing of ED documentation. METHODS: A total of 600 ED discharge notes from real-world encounters were evaluated, including 500 notes with a single injected documentation error across five predefined categories (patient/encounter, medication/allergy, clinical findings, investigation failure/contradiction, or disposition/follow-up), and 100 error-free reference notes. Four LLMs (Claude Sonnet 4.5, Gemini 2.5 Pro, GPT-5, and Grok 4) independently audited each note under blinded conditions. Model performance was assessed using accuracy, precision, recall, and F1 score, with pairwise comparisons performed using McNemar's test. RESULTS: Model accuracies ranged from 93.2% to 94.2% for detection of any documentation error, with precision exceeding 98% and F1 scores above 0.95 for all models. Claude Sonnet 4.5 achieved the highest overall accuracy (94.2%) and F1 score (0.964). Pairwise comparisons showed no statistically significant differences in overall error detection between models (p > 0.05). At the category level, all models demonstrated near-perfect performance for patient/encounter inconsistencies and medication/allergy errors (F1 scores >0.96), with lower performance for investigation failures/contradictions, followed by disposition/follow-up errors and clinical finding inconsistencies. CONCLUSION: LLMs demonstrate strong performance in auditing ED documentation, supporting their potential role as quality assurance tools in emergency care. Future work should explore how these systems can be integrated into real clinical workflows.
Bremmer J, Sarangarm P, Fernandez E
… +1 more, Neubrand T
Am J Emerg Med
· 2026 Jun · PMID 41844012
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OBJECTIVES: In the pediatric emergency department (PED), minimal sedation is commonly used for procedures such as laceration repairs or radiological imaging, we sought to evaluate high-dose versus low-dose intranasal mid...OBJECTIVES: In the pediatric emergency department (PED), minimal sedation is commonly used for procedures such as laceration repairs or radiological imaging, we sought to evaluate high-dose versus low-dose intranasal midazolam (INM) and correlation with the need for additional rescue sedation medications. METHODS: We conducted a single center, retrospective cohort analysis of pediatric patients admitted to the PED who received INM from August 1, 2022 to August 31, 2023. Patients were included if they were <18 years old, weighed ≤22 kg, and required INM for minimal sedation. The primary outcome was a composite measure of additional sedation medications administration following the initial dose of INM, defined as any additional dose given between 5 and 15 min, 15-45 min, or provider-documented failure after the initial dose of low-dose INM (0.2 mg/kg) or high-dose INM (0.5 mg/kg). RESULTS: During the study period, 336 patients received INM, with 161 patients meeting inclusion criteria. Among these patients, 25 patients received low-dose INM and 136 patients received high dose INM. Most patients received INM for a laceration repair. More patients required additional sedation medications to complete the procedure in the low-dose vs high-dose INM group (28.0% vs 7.4%, p = 0.01). There was no difference between groups on PED length of stay, time from arrival to initial INM, or time from initial INM to time of discharge. DISCUSSION: In this study, patients who received high dose INM for minimal sedation were less likely to need additional sedatives without an increase in adverse events or a longer PED length of stay.
Hernes C, Boehme E, Sidebottom A
… +2 more, Castro-Pearson S, Boley S
Am J Emerg Med
· 2026 Jun · PMID 41831299
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OBJECTIVE: Patients with Limited English Proficiency (LEP) experience delays in the initiation of their emergency department (ED) care due to barriers in obtaining a medical interpreter. This delay may negatively affect...OBJECTIVE: Patients with Limited English Proficiency (LEP) experience delays in the initiation of their emergency department (ED) care due to barriers in obtaining a medical interpreter. This delay may negatively affect their experience and lead to downstream health inequities. This study aimed to analyze whether LEP patients wait longer to be seen once they are moved into an ED room. METHODS: This is a retrospective analysis of data from two affiliated EDs with similar ED triage processes. The primary aim was defined as the time to physician self-assignment (TTPS). The TTPS was compared between those who required an interpreter and those who did not. These differences were analyzed using appropriate descriptive and inferential statistical methods. RESULTS: 47,038 encounters were included for analysis, with 3259 (6.9%) of these for patients who had a documented need for an interpreter. Weighted median TTPS for patients who required an interpreter was 7.4 [6.7, 8.2] minutes while those who did not require an interpreter was 5.8 [5.7, 5.9] minutes. This difference represented a 27% increase in TTPS relative to patients without interpreter need. When TTPS was stratified by race, this remained statistically significant for White (4.5 min) and Black patients (2.1 min). CONCLUSIONS: In this patient population, patients who required an interpreter waited longer to be evaluated by an emergency provider. The reasons for this difference and the downstream implications of this result remain unclear.
Am J Emerg Med
· 2026 Jun · PMID 41819051
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OBJECTIVES: To assess whether fall height and impact surface are associated with clinically important traumatic brain injury (ciTBI) in children under two years. METHODS: We performed a single-center retrospective cohort...OBJECTIVES: To assess whether fall height and impact surface are associated with clinically important traumatic brain injury (ciTBI) in children under two years. METHODS: We performed a single-center retrospective cohort study (Tokyo, Japan, 2017-2021) including children under two years with head trauma. We excluded those with conditions affecting ciTBI risk, unreliable clinical histories, or injury mechanisms that did not involve ground impact. The primary outcome was ciTBI; abnormal head computed tomography (CT) findings were secondary. Multivariable logistic regression modeled fall height per 10-cm increment and impact surface (flooring, soft, hard), adjusted for age and exposures. Generalized additive models (GAMs) explored potential nonlinear associations. RESULTS: Among 3067 eligible children, 1893 were included in the analysis; 44 (2.3%) had ciTBI. After adjustment for age and mutual adjustment of exposures, impact surface type was not significantly associated with ciTBI (soft surface vs flooring: adjusted odds ratio [aOR] 0.30, 95% CI 0.07-1.34; hard surface vs flooring: aOR 1.10, 95% CI 0.52-2.31). Fall height was significantly associated with ciTBI risk (aOR 1.31 per 10 cm increase, 95% CI 1.19-1.45). Similar associations were observed for abnormal head CT findings. GAMs demonstrated an approximately linear increase in risk with increasing fall height, without an inflection point. CONCLUSIONS: In children under two years with head trauma, fall height was associated with ciTBI risk, whereas impact surface type was not. The association between fall height and ciTBI appeared approximately linear across the observed range, suggesting that fixed height thresholds may not fully reflect clinical risk.
Am J Emerg Med
· 2026 Jun · PMID 41819050
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Emergency medicine pharmacists (EMPs) are essential to optimizing medication use in the emergency department (ED), yet research in emergency medicine (EM) pharmacotherapy has remained fragmented and largely single-center...Emergency medicine pharmacists (EMPs) are essential to optimizing medication use in the emergency department (ED), yet research in emergency medicine (EM) pharmacotherapy has remained fragmented and largely single-centered. To address this, the EM Pharmacotherapy Research Network (EMPHARM-NET) was established in 2019 as a national, EMP-led collaboration designed to unify investigators, foster mentorship, and advance high-quality, generalized research in acute care pharmacotherapy. Operating as a grassroots, volunteer-driven network, EMPHARM-NET connects over 25 sites and 50 investigators across diverse practice settings, enabling multicenter studies supported by standardized methodologies, shared resources, and inclusive participation from learners to senior researchers. Since its inception, EMPHARM-NET has completed multiple multicenter investigations, produced over a dozen peer-reviewed publications, and earned national recognition for its scholarship, and impact on clinical practice. Despite challenges such as limited protected research time for clinical pharmacists and logistical complexities of coordinating across institutions, EMPHARM-NET has demonstrated that a distributed, pharmacist-led model can generate rigorous, practice-changing evidence while fostering a sustainable culture of mentorship and collaboration. Looking ahead, the network aims to expand its scope through implementation science, pragmatic clinical trials, and health services research, to solidify EMPHARM-NET as a leading model for advancing pharmacotherapy and patient outcomes in EM.
Am J Emerg Med
· 2026 Jun · PMID 41812521
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Standardized order sets are common in Emergency Departments (EDs), but the extent of use, effectiveness, and associated outcomes remain unclear. The objective of this scoping review was to describe the current evidence r...Standardized order sets are common in Emergency Departments (EDs), but the extent of use, effectiveness, and associated outcomes remain unclear. The objective of this scoping review was to describe the current evidence regarding standardized order set use in the ED by examining conditions for which order sets are used, implementation and evaluation strategies, and clinical outcomes. We searched MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and the Cochrane Library from inception to April 3, 2025 for studies comparing the use of standardized order sets to usual care for ED patients. Two reviewers independently screened citations and extracted data. We reported study characteristics, order set development and implementation strategies, compliance, and outcomes by target condition. Our search identified 3373 citations and we included 24 studies. There were 19 retrospective, 3 prospective, and 2 before-and-after studies; no randomized trials were identified. Asthma was the most common target condition, followed by sepsis, transient ischemic attack, renal colic, and sickle cell disease. There was significant heterogeneity in the types of outcomes reported as well as the results of the outcomes. Many studies demonstrated improvements in process outcomes such as decreased time to initial therapy and increased adherence to guideline recommended management. Results for patient-oriented outcomes such as hospital admission and ED return visits varied across studies. In the ED setting, order sets may improve process outcomes for many acute conditions; however, the effects on patient-oriented outcomes remain unclear. Order set use in the ED should be accompanied by well-defined development, implementation, and evaluation strategies.