AuBuchon KE, Amaru A, Cepero TQ
… +10 more, Creed S, Caputo J, Cogan A, Verwiel C, Kim V, Zhang R, Ahn J, Arem H, McCabe P, Goyal M
J Emerg Med
· 2026 May · PMID 41932269
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BACKGROUND: After rapid sequence intubation (post-RSI), patients require analgesia to ensure adequate pain management; however, extant research suggests that in other medical procedures, there are demographic differences...BACKGROUND: After rapid sequence intubation (post-RSI), patients require analgesia to ensure adequate pain management; however, extant research suggests that in other medical procedures, there are demographic differences in analgesic prescribing. OBJECTIVES: We examined potential sociodemographic differences in post-RSI opioid prescribing across a Med-Atlantic healthcare system. We hypothesized that Black (vs. White), female (vs. male), and older (vs. younger) patients would receive lower opioid doses post-RSI. METHODS: We conducted a retrospective chart review of all intubated adults (analytic n = 1211; 65.81% Black; 46.05% Female; Age Median = 61.00 [60.00, 63.00]) in 2019. We extracted demographics (sex, racial group, age), comorbidities, and opioid dose in Milligram Morphine Equivalent (MME). As only 29.4% of patients received an opioid, we tested our hypotheses with a zero-inflated Poisson model. RESULTS: Increasing age was associated with a significantly lower likelihood of receiving an opioid (odds ratios [OR] = 0.81, p = 0.021) and lower MME doses when they received an opioid (rate ratio [RR] = 0.87, p < 0.001). Black (vs. White) patients had significantly higher odds of receiving an opioid (OR = 1.66, p = 0.010), but lower MME doses (RR = 0.71, p < 0.001). Sex did not significantly influence opioid prescribing likelihood, but if they received an opioid, female patients received lower MME than male patients (RR = 0.90, p = 0.018). CONCLUSION: Our data revealed significant racialized, sex-, and age-based disparities and inequities in opioid prescribing postintubation. Future work is needed to examine best practices in age-related post-RSI opioid recommendations and establish standardized practices that promote equitable analgesia for all patients.
J Emerg Med
· 2026 May · PMID 41903404
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BACKGROUND: Toxic keratoconjunctivitis from plant exposure is a rare but potentially vision-threatening condition. Milkweed (Asclepias tuberosa) contains cardiac glycosides that disrupt corneal endothelial pump function,...BACKGROUND: Toxic keratoconjunctivitis from plant exposure is a rare but potentially vision-threatening condition. Milkweed (Asclepias tuberosa) contains cardiac glycosides that disrupt corneal endothelial pump function, resulting in acute corneal edema and rapid vision loss. This entity is frequently misdiagnosed as benign conjunctivitis in the emergency setting. CASE REPORT: A healthy adult presented with sudden visual loss and corneal haze hours after gardening. She had been wearing contact lenses and reported handling milkweed plants. An initial evaluation at an outside emergency department (ED) was unrevealing, and she was discharged with a diagnosis of conjunctivitis. She returned to the ED with worsening symptoms, including vision limited to motion detection. On further questioning, exposure to A. tuberosa was identified. Examination revealed corneal haze with a small abrasion. She was treated with corticosteroids and antibiotics, resulting in rapid improvement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Milkweed-induced toxic keratoconjunctivitis is a rare but important cause of corneal edema and acute vision loss. A thorough exposure history is critical to diagnosis. Early initiation of corticosteroids may accelerate recovery.
O'Leary J, Davis C, Johnson J
… +3 more, Waasdorp C, Gumayan JD, Lareau S
J Emerg Med
· 2026 May · PMID 41903403
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BACKGROUND: Accidental hypothermia is the unintentional decrease in core body temperature below 35°C due to environmental exposure. Severe hypothermia, defined as a core body temperature less than 28°C, can cause hemodyn...BACKGROUND: Accidental hypothermia is the unintentional decrease in core body temperature below 35°C due to environmental exposure. Severe hypothermia, defined as a core body temperature less than 28°C, can cause hemodynamic instability, cardiac arrest, and death; therefore, rapid rewarming is indicated. In centers without extracorporeal membrane oxygenation or cardiopulmonary bypass capabilities, invasive rewarming can be performed via thoracic lavage. Thoracic lavage is performed by placing two thoracostomy tubes and continuously infusing warm fluids through the thoracic cavity or using intermittent dwells. There is no evidence as to whether continuous infusion or dwells are more efficacious for rewarming. OBJECTIVES: We aimed to provide experimental data to determine which thoracic lavage method more rapidly increases core body temperature. METHODS: A total of five continuous trials and five dwell trials were performed utilizing five fresh cadavers. Warm fluid infusion at 36°C was performed using a Belmont Rapid infuser RI-2 at a rate of 200 mL/min for continuous lavage and a 500 mL dwell of at least 15 minutes. Core and infusion fluid temperature measurements were recorded, and the rewarming rate across each trial was calculated. RESULTS: The median continuous and dwell rewarming rate was 1.37°C/h (interquartile range (IQR) 1.31-2.18) and 1.33°C/h (IQR 0.74-1.43), respectively. A paired Wilcoxon signed-rank test was performed, indicating no significant difference in rewarming rate between the two techniques (p = 0.63). CONCLUSION: These results suggest that the thoracic lavage technique does not significantly impact the rewarming rate. Therefore, physicians should consider additional factors, such as resource availability, when choosing the appropriate thoracic lavage rewarming method.
Babu KM, Haddad YK, Krotulski AJ
… +17 more, Causey ST, Vargas-Torres CC, Martinez PM, Goldberg EM, Dorfman JD, Bailey M, Chapman BP, Graham P, Lai JT, Saif R, Elhoussan R, Romero AC, Londoño-Barreras R, Walton SE, Thomas DD, Logan BK, Merchant RC
J Emerg Med
· 2026 May · PMID 41894896
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BACKGROUND: Falls among adults aged 55 and older lead to significant morbidity and mortality. The contribution of alcohol and other sedating drugs (including benzodiazepines, cannabinoids, opioids, and ethanol) is diffic...BACKGROUND: Falls among adults aged 55 and older lead to significant morbidity and mortality. The contribution of alcohol and other sedating drugs (including benzodiazepines, cannabinoids, opioids, and ethanol) is difficult to quantitate in acute care environments due to inconsistent clinical practice. OBJECTIVES: This goal of this study was to assess the effect of recent substance use on adverse clinical outcomes among adults aged 55+ undergoing trauma evaluation after a fall. METHODS: We conducted a retrospective observational study of adults (55+) evaluated at a Level 1 trauma center from May 2020 to July 2021. We paired archival data from the study site's trauma registry and electronic health records (EHR) to toxicological analyses of each cohort member's bio-banked blood sample for ethanol, benzodiazepines, cannabinoids, and opioids. Regression models were used to analyze the relationship between substance use and adverse outcomes, adjusting for injury severity score (ISS). RESULTS: Among 274 adults aged 55+, detection rates were 21.2% for opioids, 18.6% for ethanol, 13.9% for benzodiazepines, and 9.1% for cannabinoids. Injuries identified included 16.4% spinal fractures, 9.5% extremity fractures, 7.7% hip/thigh/pelvic fractures. Intracranial hemorrhages were more likely if the patient had been recently taking a benzodiazepine (aOR = 3.92), while extremity fractures were more common with opioid use (aOR = 7.67). No associations were found for spinal fractures, hip/thigh/pelvis fractures, or death. CONCLUSION: In this study, nearly 20% of adults 55+ presenting for fall-related trauma recently used substances that impair psychomotor function. Screening for substance use in routine clinical care may reduce severity of fall-related injuries.
J Emerg Med
· 2026 May · PMID 41875513
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BACKGROUND: Emergency department (ED) hallway spaces (HS) are frequently used during overcrowding, exposing patients to safety, privacy, and equity risks. While vertical split flow (VSF) improves throughput, safety-focus...BACKGROUND: Emergency department (ED) hallway spaces (HS) are frequently used during overcrowding, exposing patients to safety, privacy, and equity risks. While vertical split flow (VSF) improves throughput, safety-focused hallway interventions are underreported. At Duke University Hospital (DUH) ED, increasing patient volume and acuity resulted in frequent HS use as active treatment areas. Safety reports identified critically ill patients being triaged to or deteriorating within HS due to inconsistent processes and oversight. OBJECTIVES: A multidisciplinary workgroup implemented standardized HS workflows through iterative Plan-Do-Study-Act cycles. Interventions included standardized staffing, patient selection criteria, remote monitoring, privacy enhancements, and application of VSF principles to hallway operations. METHODS: A retrospective analysis of adult patient acuity and disposition for 11,602 HS encounters over 53 weeks evaluated the effect of the interventions. The DUH Institutional Review Board determined this activity did not meet the definition of research. RESULTS: Patients in vertical HS were less likely to be high-acuity (incidence rate ratios [IRR] 0.68, 95% CI 0.65-0.71) and less likely to be admitted (IRR 0.30, 95% CI 0.27-0.33) than those in horizontal HS. No HS-related safety reports occurred during the intervention. CONCLUSION: Standardized hallway workflows and patient selection criteria safely operationalized HS for continuous use, reducing exposure of high-acuity patients to hallway care.
Fischetti CE, Frisch EH, Rodriguez G
… +4 more, Marshall ADA, Cash RE, Meeker M, Weiner SG
J Emerg Med
· 2026 May · PMID 41875512
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BACKGROUND: Large language models, such as ChatGPT (cGPT), are being integrated increasingly into clinical workflows and medical education. However, concerns persist regarding their susceptibility to bias, especially in...BACKGROUND: Large language models, such as ChatGPT (cGPT), are being integrated increasingly into clinical workflows and medical education. However, concerns persist regarding their susceptibility to bias, especially in high-stakes areas like pain management, when disparities across race, socioeconomic status, and substance use history are well documented. OBJECTIVE: This study investigated whether cGPT-4 generates consistent and equitable pain management recommendations when patient demographic variables are altered. METHODS: Using cGPT-4, researchers created six clinical scenarios representing common pain complaints (e.g., migraine, chest pain, and deep vein thrombosis). Each scenario was systematically modified to reflect diverse patient demographic characteristics, including race, housing status, language proficiency, and history of opioid use disorder. Three investigators input a total of 60 prompts into cGPT-4 and compared outputs for agreement using Fleiss' κ and Gwet's AC1 statistics. RESULTS: Overall agreement across investigators was high (i.e., 82% for emergency department (ED) medications and 78% for discharge medications). When using cGPT, demographic factors such as race, language, and socioeconomic status often did not alter recommendations. However, patients with history of opioid use disorder consistently received different pain management suggestions-typically opioid-sparing regimens-indicating cGPT's responsiveness to clinically relevant safety concerns. Scenario-specific variation was observed, particularly in cases of migraine and sciatica. CONCLUSIONS: cGPT-4 often produced consistent and equitable pain management plans across diverse patient profiles. Although bias was observed in opioid use disorder-related scenarios, it seemed aligned with clinical best practices. These findings suggest that, when properly monitored and refined, large language models can support equitable decision making in health care. Continued evaluation and prompt engineering are critical to minimizing unintended bias and maximizing utility in clinical settings.
J Emerg Med
· 2026 May · PMID 41863907
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BACKGROUND: Upper gastrointestinal bleeding (UGIB) frequently presents to the emergency department (ED). Existing scores (Glasgow-Blatchford, etc.) may not capture early ED predictors of adverse outcomes. OBJECTIVES: To...BACKGROUND: Upper gastrointestinal bleeding (UGIB) frequently presents to the emergency department (ED). Existing scores (Glasgow-Blatchford, etc.) may not capture early ED predictors of adverse outcomes. OBJECTIVES: To identify independent ED predictors of in-hospital mortality and adverse outcomes in endoscopically confirmed UGIB. METHODS: We conducted a 5-year retrospective cohort at a tertiary ED. Adults (≥18 years) with hematemesis, melena, or hematochezia and endoscopic confirmation were included. We extracted demographics, comorbidities, vital signs, laboratory values (including admission lactate), ED resuscitation, and endoscopic findings. Outcomes were in-hospital mortality and a composite of adverse outcome (intensive care unit admission, transfusion, or rebleeding). Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Of 2527 screened, 476 met criteria (median age 66 years; 69.5% male). Adverse outcomes occurred in 208 patients (43.7%), and in-hospital mortality was 5.7%. Independent predictors were hemodynamic instability (aOR 3.24, 95% CI 1.89-5.61), chronic liver disease (2.87, 1.49-5.52), lower hemoglobin (1.42, 1.12-1.80), need for intravenous fluids (2.98, 1.76-5.04), active endoscopic bleeding (5.12, 2.23-11.76), and higher lactate (1.36, 1.14-1.63). In adjusted analyses, in-hospital mortality was independently associated with active endoscopic bleeding, history of malignancy, and higher admission lactate. In receiver operating characteristic (ROC) analyses, adding lactate improved discrimination for in-hospital mortality (area under the ROC curve [AUC] 0.73 vs. 0.61; ΔAUC 0.119, 95% CI 0.065-0.173; p < 0.001). CONCLUSION: Admission lactate, hemodynamic instability, and active endoscopic bleeding are robust early predictors of mortality and adverse outcomes in UGIB. Integrating these markers with existing scores may refine ED risk stratification and guide timely interventions.
J Emerg Med
· 2026 May · PMID 41833262
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BACKGROUND: Beta blocker or calcium channel blocker toxicity is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of beta blocker a...BACKGROUND: Beta blocker or calcium channel blocker toxicity is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of beta blocker and calcium channel blocker toxicity, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Beta blocker and calcium channel blocker toxicity is a life-threatening emergency that requires prompt identification and management. Patients commonly present with both hypotension and bradycardia. The rare exception to this involves overdoses with dihydropyridines such as amlodipine which can initially present with hypotension and tachycardia before eventually developing bradycardia. Beta blockers such as propranolol can present with altered mentation, seizures, and ventricular dysrhythmias resulting from their ability to block sodium channels. Sotalol can cause significant QT prolongation in addition to hypotension and bradycardia. While laboratory evaluation does not confirm the diagnosis of beta blocker or calcium channel blocker toxicity, laboratory testing such as renal function and lactate can be used to evaluate for end organ perfusion, while acetaminophen, salicylate, and digoxin concentrations can be sent to evaluate for possible concomitant ingestions. Initial treatment should focus on fluids, atropine, calcium, and in select patients, gastrointestinal (GI) decontamination with activated charcoal. For more significant toxicity that does not respond to initial treatments, vasopressors and high-dose insulin should be considered, while intralipid and extracorporeal membrane oxygenation should be considered in the cases of refractory toxicity despite maximal therapy. Patients should be admitted to the intensive care unit for close hemodynamic monitoring. CONCLUSION: An understanding of beta blocker and calcium channel blocker toxicity can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
BACKGROUND: Despite evidence of sex-related survival differences in postpubertal trauma populations, whether biological sex influences mortality after infant trauma remains underexplored. Infant trauma largely reflects t...BACKGROUND: Despite evidence of sex-related survival differences in postpubertal trauma populations, whether biological sex influences mortality after infant trauma remains underexplored. Infant trauma largely reflects the caregiving environment and should be examined separately from older ages. OBJECTIVES: To investigate whether biological sex is associated with in-hospital mortality among infants with trauma and describe patterns of infant injury in Japan. METHODS: This retrospective, observational study used data from the Japan Trauma Data Bank, a nationwide registry. It included infants (<1 year) who sustained trauma between 2004 and 2023. The exposure variable was biological sex. The primary outcome was all-cause in-hospital mortality. Multivariable logistic regression was adjusted for year of injury (categorized into 4-year intervals) and major trauma. RESULTS: Among 1135 infants (63.8% male), blunt injuries predominated (95.6%), and falls accounted for 70.4% of incidents. Approximately 80% of cases with major trauma involved moderate-to-severe traumatic brain injury (TBI; Abbreviated Injury Scale ≥ 3). Overall, 51.5% were admitted directly to the intensive care unit. All-cause in-hospital mortality was 2.7% (3.0% in males vs. 2.2% in females). Multivariable analysis showed no significant association between sex and mortality (adjusted odds ratio for females, 0.94; 95% confidence interval, 0.40-2.03). CONCLUSION: In this nationwide cohort of infants with trauma, there was no statistically significant difference in in-hospital mortality between biological sexes, supporting sex-independent approaches for acute trauma care. Most major trauma involved moderate-to-severe TBI, with falls being the leading cause of injury. Simple, broadly applicable prevention strategies, especially fall prevention, may help prevent infant trauma.
Shaw DL, Orcutt RK, Wales ET
… +4 more, Nathanson LA, Stenson BA, Chiu DT, Masser BA
J Emerg Med
· 2025 Dec · PMID 41790516
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BACKGROUND: Monitoring hemoglobin A1c (HbA1c) is a population health quality metric associated with improved outcomes in diabetic patients. However, the utility of emergency department (ED)-based interventions for monito...BACKGROUND: Monitoring hemoglobin A1c (HbA1c) is a population health quality metric associated with improved outcomes in diabetic patients. However, the utility of emergency department (ED)-based interventions for monitoring HbA1c for institutional quality metrics is unknown. OBJECTIVES: The purpose of this study is to evaluate a program to improve measurement of HbA1c for at-risk ED patients. METHODS: This was a retrospective observational pre-/poststudy at an academic medical center. In November 2017, an alert was programmed into the ED Information System (EDIS) to identify diabetic patients within the health system who were overdue for HbA1c testing and prompt physicians to order HbA1c levels. Data were extracted from the EDIS from January 1, 2017, to September 30, 2023. The primary outcome was placement of an ED order for HbA1c testing. The secondary outcome was change in HbA1c on follow-up testing. RESULTS: Of 348,490 ED patient encounters during the study period, 13,609 (3.91%) were diabetic patients within the health system who were identified as noncompliant with institutional HbA1c metrics. Following the intervention, HbA1c ordering for target patients increased from 1.5% to 12.1% (p < 0.001), but rates of testing decreased over time. Postintervention, 313 of 1416 patients (23%) who had an HbA1c ordered in the ED had follow-up HbA1c testing available, with a small average decrease in HbA1c of -0.42% (standard deviation 1.7). However, this was not statistically different compared to the preintervention group (-0.60%, p = 0.40). CONCLUSION: A targeted ED intervention was associated with increased testing for HbA1c; however, this effect decreased over time. The program demonstrated operational feasibility, but did not appear to significantly improve HbA1c levels relative to the overall ED population. Further study is needed to assess optimal approaches to targeted population health interventions in the ED for chronic illnesses like diabetes.
BACKGROUND: Sepsis is a life-threatening condition with high mortality and complex pathophysiology that requires urgent diagnosis and treatment. Oxidative stress and disturbances in redox balance play a significant role...BACKGROUND: Sepsis is a life-threatening condition with high mortality and complex pathophysiology that requires urgent diagnosis and treatment. Oxidative stress and disturbances in redox balance play a significant role in its pathogenesis. Thiol-disulfide homeostasis is a biochemical marker of oxidative stress and may have diagnostic potential in sepsis. OBJECTIVES: This study aimed to evaluate the diagnostic value of thiol-disulfide homeostasis in sepsis patients and its relationship with inflammatory markers and mortality. METHODS: Fifty sepsis patients and fifty age- and sex-matched healthy controls were included. Serum levels of total thiol, native thiol, disulfide, reduced thiol, and oxidized thiol were measured. Inflammatory markers, including C-reactive protein (CRP), procalcitonin, and lactate, were also assessed. Group comparisons and correlation analyses were performed. RESULTS: In the sepsis group, total thiol, native thiol, disulfide, and reduced thiol levels were significantly lower, while oxidized thiol levels and thiol oxidation-reduction ratios were significantly higher compared to controls. CRP, procalcitonin, and lactate levels were markedly elevated in sepsis patients. A negative correlation was observed between CRP and thiol-disulfide ratios. No significant association was found between thiol-disulfide homeostasis parameters and 30-day mortality. CONCLUSIONS: Thiol-disulfide homeostasis parameters may serve as useful biomarkers in the diagnosis of sepsis but do not appear to predict mortality. Larger-scale studies are warranted to validate their clinical applicability and prognostic value.
BACKGROUND: The optimal airway management strategy in out-of-hospital cardiac arrest has been controversial. Whereas endotracheal intubation currently represents the gold standard, supraglottic airway securement may prov...BACKGROUND: The optimal airway management strategy in out-of-hospital cardiac arrest has been controversial. Whereas endotracheal intubation currently represents the gold standard, supraglottic airway securement may provide advantages with respect to handling out-of-hospital cardiac arrest. OBJECTIVES: This meta-analysis of randomized controlled and clinical studies evaluates the effects of the advanced airway strategy (supraglottic vs. endotracheal intubation) on return of spontaneous circulation (ROSC). METHODS: This systematic review and meta-analysis was performed based on a predefined protocol. Literature search included PubMed, Web of Science, and the Cochrane Library. RESULTS: A total of eight clinical studies including 14,797 patients were analyzed. Pooled analysis indicated no higher rate of ROSC in patients treated with supraglottic airway vs. endotracheal intubation (risk difference [RD] 0.02, 95% confidence interval [CI] 0.0-0.04, p = 0.11) and no higher rate of survival to hospital discharge (RD 0.01, 95% CI -0.01-0.02, p = 0.30). Interestingly, additional training indicated a significant effect of supraglottic airway on ROSC, whereas the subgroup difference was not significant (RD [additional training] 0.02, 95% CI 0.0-0.04, p = 0.02, RD [no additional training] 0.01, 95% CI -0.05-0.01, p = 0.72, test for subgroup differences, p = 0.73). Training programs differed between the investigated studies. Statistical heterogeneity was not observed. CONCLUSION: Overall, the type of advanced airway (supraglottic vs. endotracheal intubation) did not impact ROSC or survival to hospital discharge. However, after additional training, supraglottic airway use may have a positive effect on ROSC in out-of-hospital cardiac arrest.
BACKGROUND: Euglycemic diabetic ketoacidosis (EDKA) is most commonly associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. However, emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor ag...BACKGROUND: Euglycemic diabetic ketoacidosis (EDKA) is most commonly associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. However, emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists and dual incretin agents such as tirzepatide (Mounjaro) may also precipitate EDKA, though reports remain rare. CASE REPORT: We report a case of EDKA in a patient on tirzepatide monotherapy, with no concurrent SGLT2 inhibitor use. The patient presented with nausea, vomiting, and abdominal pain. Laboratory evaluation revealed a severe anion gap metabolic acidosis (CO₂ 7 mmol/L, anion gap 28, pH 7.1) and ketonuria, with mild hyperglycemia (glucose 167 mg/dL). The patient was managed with intravenous fluids, dextrose, and insulin infusion per standard diabetic ketoacidosis protocol, resulting in resolution of the anion gap. STUDY OBJECTIVE: This case highlights a potential association between tirzepatide and EDKA, possibly related to mechanisms involving starvation ketosis and reduced insulin availability. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should consider EDKA in patients taking incretin-based therapies such as tirzepatide who present with metabolic acidosis and ketosis in the absence of significant hyperglycemia.
BACKGROUND: Procedural sedation and analgesia (PSA) is an essential component of emergency medicine practice. Preprocedural fasting is recommended to reduce aspiration risk, but compliance with fasting in emergency setti...BACKGROUND: Procedural sedation and analgesia (PSA) is an essential component of emergency medicine practice. Preprocedural fasting is recommended to reduce aspiration risk, but compliance with fasting in emergency settings is not necessarily feasible. Gastric ultrasound provides an objective method to assess fasting status. OBJECTIVES: To evaluate the agreement between sonographically estimated gastric contents and reported last meal on fasting status of adults undergoing PSA in the emergency department (ED). METHODS: This study was conducted in an academic ED between July 2022 and July 2024. A convenience sample of adults aged 18 to 65 years requiring PSA in the ED was enrolled. Gastric point-of-care ultrasound (POCUS) was performed to assess gastric content and volume. Sonographic classification was compared to reported fasting status using percent agreement and linear weighted Cohen's kappa with 95% CI. RESULTS: A total of 182 patients (77.5% male, mean age 42.98 years ±15.48) were enrolled, with 56.5% endorsed fasting in the preceding 3 h. Gastric POCUS identified stomach contents as Grade 0 in 42.3% of patients, Grade 1 in 9.8%, and Grade 2 in 47.8%. When comparing to reported fasting history with POCUS findings, overall agreement between reported oral intake in 3 h and gastric POCUS risk grade was 73.1% (95% CI: 66.2-79.0%). Linear weighted Cohen's kappa was 0.58 (95% CI: 0.49-0.68), indicating moderate agreement. Disagreement occurred in 49 patients (26.9%), with 47 patients showing higher-risk contents by POCUS than predicted by history. CONCLUSION: In general, gastric POCUS demonstrated moderate agreement with reported fasting status; however, there was a subset of patients in which POCUS findings deviated from the expected contents based on reported fasting times. Gastric POCUS could potentially improve risk stratification of patients undergoing PSA in the ED.
BACKGROUND: Intravenous (IV) contrast extravasation (IVCE) is a rare but potentially serious complication that can lead to tissue necrosis, compartment syndrome, prolonged emergency department (ED) length of stays, and t...BACKGROUND: Intravenous (IV) contrast extravasation (IVCE) is a rare but potentially serious complication that can lead to tissue necrosis, compartment syndrome, prolonged emergency department (ED) length of stays, and the diversion of resources to monitoring extravasation injury. However, studies on IVCE in the ED are limited. OBJECTIVES: This study aims to identify risk factors associated with IVCE in ED patients undergoing contrast-enhanced computed tomography scans. METHODS: We performed a multicenter retrospective 1- to 2-case-control matching study of ED patients from January 2016 to October 2023 by reviewing the institutions' adverse event reporting system. Adult patients with IVCE were identified and matched to controls based on demographics and department environmental factors that may have introduced unmeasurable variability in the risk of IVCE. Multivariable logistic regression was performed to assess clinical factors related to IVCE. RESULTS: We identified 141 IVCE cases and matched them with 266 controls. The mean (±standard deviation) age was 58 years (±14.5), with 59% of patients being female. Common comorbidities included substance abuse (18.4%), heart failure (13.3%), and chronic kidney disease (10.3%). The most common catheter size was 20-gauge (76.7%). IVCE patients had a significantly longer ED stay compared to controls (653 vs. 525 min, p < 0.001). Ultrasound-guided peripheral IV (USGIV) placement (OR 3.67, 95% CI 2.21-6.09, p < 0.001), and substance abuse (OR 1.86, 95% CI 1.04-3.31, p = 0.036) were associated with increased risk of IVCE. CONCLUSION: USGIV placement was associated with increased odds of IVCE in the ED. Further prospective studies are needed to confirm these findings and explore additional risk factors.