J Emerg Med
· 2026 Apr · PMID 41723977
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BACKGROUND: The federal Ending the Human Immunodeficiency Virus (HIV) Epidemic (EHE) initiative emphasizes targeted efforts in "priority" jurisdictions to reduce new infections through earlier diagnosis and treatment. In...BACKGROUND: The federal Ending the Human Immunodeficiency Virus (HIV) Epidemic (EHE) initiative emphasizes targeted efforts in "priority" jurisdictions to reduce new infections through earlier diagnosis and treatment. In California, the Emergency Department Screening Program (EDSP) was recently implemented to expand HIV and sexually transmitted infection (STI) testing in emergency departments (EDs)-key access points for underserved populations. OBJECTIVE: To evaluate whether EDSP funding allocation aligns with EHE geographic and demographic priorities, and to identify opportunities to optimize ED-based HIV screening strategies. METHODS: We conducted an observational, retrospective analysis of California EDs using publicly available data; ED ZIP codes were used to stratify EDs by their funding status and priority county designation and to link them to corresponding county-level Centers for Disease Control and Prevention (CDC) data on population-adjusted estimates of HIV, syphilis, gonorrhea, and chlamydia. RESULTS: Of the 313 EDs analyzed, 27 (8.6%) received EDSP funding. Funded EDs were more often teaching hospitals and served higher proportions of patients who were homeless, Hispanic or Latino, Black or African American, or insured through Medi-Cal (all p < 0.01). Nearly all (90%) statewide ED visits occurred in nonfunded hospitals. Although median population-adjusted STI and HIV rates were similar by funding status, nonfunded EDs in priority counties had higher HIV prevalence than funded EDs in nonpriority counties (p < 0.001). Only a minority of the highest-burden EDs received EDSP funding. CONCLUSION: While EDSP-funded EDs effectively reach populations at elevated risk for HIV, allocation did not consistently align with CDC-designated priority counties or areas of highest HIV burden. Future statewide funding strategies should prioritize high-burden jurisdictions while maintaining flexibility to support nonpriority areas with demonstrated need.
BACKGROUND: High-quality bystander cardiopulmonary resuscitation (CPR) is a key element in successful resuscitation from out-of-hospital cardiac arrests (OHCA). However, less than 40% of adults receive bystander-initiate...BACKGROUND: High-quality bystander cardiopulmonary resuscitation (CPR) is a key element in successful resuscitation from out-of-hospital cardiac arrests (OHCA). However, less than 40% of adults receive bystander-initiated CPR. OBJECTIVES: To investigate the relationship between socioeconomic variables and initiation of bystander CPR in OHCA. METHODS: A total of 504 adults were treated at one of three Emergency Departments between January 1, 2020, and December 31, 2022, for nontraumatic OHCA. Bystander CPR administration was the grouping variable, while socioeconomic variables included Area Deprivation Index (ADI), population density, income, primary language, and poverty level. Chi-squared and group t-tests were performed. RESULTS: Overall, 4.9% of all OHCA survived to hospital discharge. Survival for bystander CPR patients was 8.4% compared to 2.7% with no bystander CPR (p < 0.004). OHCA without bystander CPR occurred in places with higher state and national decile ADI (mean 6.63 vs. 4.87, p < 0.001 and 70.25 vs. 55.39, p < 0.001, respectively), a higher percentage of families below the poverty level (mean 14.17 vs. 9.58, p < 0.001), and a lower median household income (mean $63,116 vs. $75,539, p < 0.001) than cases with bystander CPR. Cases without bystander CPR happened in locales with higher population density (mean 4428 vs. 3017 persons/square mile, p < 0.001), and a higher percentage of the population speaking a language other than English (mean 27.42% vs. 19.64%, p < 0.001). CONCLUSION: Bystander CPR improves OHCA survivability. Lower socioeconomic status, higher population density, and higher percentage of non-English-speaking population have lower rates of bystander CPR use. Community engagement should target these areas to improve CPR training, bystander CPR initiation, and OHCA survivability.
BACKGROUND: Point-of-care ultrasound can be used in the emergency department to quickly diagnose intraocular lens dislocation, a rare but vision-threatening condition. Traumatic dislocated intraocular lenses may also be...BACKGROUND: Point-of-care ultrasound can be used in the emergency department to quickly diagnose intraocular lens dislocation, a rare but vision-threatening condition. Traumatic dislocated intraocular lenses may also be associated with iridodonesis, which is rapid vibration of the iris with eye movements due to lack of normal iris support from the lens. CASE REPORT: We present the case of a 69-year-old female with traumatic acute lens dislocation sustained after mechanical ground-level fall at her nursing facility. Additionally, she was found to have iridodonesis, which was recorded with ultrasound video. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should know that point-of-care ultrasound is a fast, reliable, and inexpensive way to diagnose lens dislocation, which may cause irreversible vision loss if missed. Further, when appreciated on ultrasound, iridodonesis should significantly raise concern for a diagnosis of lens dislocation.
BACKGROUND: Synthetic cathinones (SC) are a class of psychoactive stimulants structurally similar to amphetamines. Despite a high prevalence of SC detection in emergency department (ED) drug surveillance in Taiwan, detai...BACKGROUND: Synthetic cathinones (SC) are a class of psychoactive stimulants structurally similar to amphetamines. Despite a high prevalence of SC detection in emergency department (ED) drug surveillance in Taiwan, detailed reports of SC-related fatalities and their acute clinical course in the emergency medicine literature are limited. This case series describes the presentations, clinical course, and outcomes of four fatal SC-associated intoxications, highlighting critical emergency management insights. CASE REPORTS: We report four fatalities involving young, previously healthy adults in Taiwan, all presenting with severe sympathomimetic toxidrome. All patients presented with extreme hyperthermia (core temperature of > 40°C) and severe metabolic acidosis (blood gas pH < 7.0). Life-threatening complications included refractory ventricular tachycardia leading to cardiac arrest in three cases, status epilepticus, rhabdomyolysis, and rapid progression to multiorgan failure. Postmortem toxicology confirmed the presence of multiple SC (including mephedrone and N-ethylpentylone) and co-ingestion of other stimulants (e.g., PMMA, methamphetamine, ketamine) in all patients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: SC intoxication, particularly when combined with polydrug use, presents a complex and rapidly progressing emergency challenging to diagnose and manage. Early recognition of the sympathomimetic toxidrome and the immediate implementation of aggressive cooling measures are paramount. Emergency physicians must anticipate refractory dysrhythmias and rapid multiorgan failure to potentially improve outcomes.
BACKGROUND: Ureterolithiasis is a major cause of severe flank pain in the Emergency Department (ED). Given the disadvantages of opioids, alternative yet effective therapies for ureterolithiasis are sorely needed. OBJECTI...BACKGROUND: Ureterolithiasis is a major cause of severe flank pain in the Emergency Department (ED). Given the disadvantages of opioids, alternative yet effective therapies for ureterolithiasis are sorely needed. OBJECTIVES: To determine the feasibility and analgesic efficacy of an erector spinae plane block (ESPB) with ropivacaine 0.5% compared with normal saline (NS) in patients with ureterolithiasis. METHODS: We conducted a single-blinded, randomized clinical trial, on a convenience sample of adult ED patients with ureteral stones with a numeric pain score of > 4. Baseline characteristics were recorded, and patients were randomly allocated to an ESPB using 20 mL ropivacaine 0.5% or NS. Pain scores were recorded at 10, 20, 40, and 60 minutes. Between-group pain scores were compared with a Mann Whitney U test and repeated measures analysis of variance. RESULTS: The study included 24 patients, 12 in each of the study groups. Mean (SD) age was 45.6 (12.8) years, 54% were male. Baseline pain scores were similar in both groups. Median (IQR) pain scores at 60 minutes were 1 (0-3.7) and 4 (1.2-5) in patients randomized to ropivacaine and NS, respectively (p = 0.11). Patient satisfaction scores and time to discharge were similar in both groups. CONCLUSIONS: In this pilot study of ED patients with ureterolithiasis performance of a randomized controlled trial (RCT) comparing ESPB with ropivacaine and NS was feasible and showed clinically significant differences but not statistically significant between-group differences in pain scores. The study also raises the possibility that fascial plane injection of NS may have analgesic benefit as well.
Peters GA, Allerhand T, Hayes JM
… +5 more, Misra AJ, Walsh LV, Akbar A, Cash RE, Goldberg SA
J Emerg Med
· 2026 Mar · PMID 41713251
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BACKGROUND: Prehospital respiratory distress is a common and high-risk condition that often requires critical interventions, including noninvasive positive pressure ventilation (NIPPV). OBJECTIVE: We aimed to describe U....BACKGROUND: Prehospital respiratory distress is a common and high-risk condition that often requires critical interventions, including noninvasive positive pressure ventilation (NIPPV). OBJECTIVE: We aimed to describe U.S. emergency medical services (EMS) state protocols and nationwide practice patterns related to the prehospital use of NIPPV. METHODS: We completed a cross-sectional analysis of all publicly available, active state-level EMS protocols in the United States related to the prehospital use of NIPPV. Second, we completed a cross-sectional analysis of nationwide EMS practice patterns related to NIPPV use in 2023. We included EMS patient care reports filed by the unit that treated and transported the patient in which NIPPV was administered during a 9-1-1 scene response. Descriptive statistics were computed, stratified by suspected diagnostic indication. RESULTS: Among 30 states with an NIPPV protocol, early use of NIPPV was recommended in eight protocols for suspected pulmonary edema, compared with two for bronchospasm. Among an analytic sample of 30,358,677 EMS encounters, 133,768 (0.6%) included NIPPV use. Bronchospasm was suspected in 44.0% of encounters, 16.2% pulmonary edema, 7.1% mixed (i.e., bronchospasm and pulmonary edema), and 32.8% either other or unspecified indication. CONCLUSION: State EMS protocols tended to recommend NIPPV use as first-line for pulmonary edema and only a salvage measure for bronchospasm; however, NIPPV was used nearly three times more often for bronchospasm. Further research is encouraged to enable an evidence-based approach to achieving improved alignment between protocols and practice to better support EMS when administering critical care for respiratory distress.
J Emerg Med
· 2026 Mar · PMID 41707308
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BACKGROUND: Chronic intranasal cocaine use can cause destruction of sinonasal osteocartilaginous structures. Communication between the paranasal sinuses and the orbit may result in orbital emphysema. CASE REPORT: A 47-ye...BACKGROUND: Chronic intranasal cocaine use can cause destruction of sinonasal osteocartilaginous structures. Communication between the paranasal sinuses and the orbit may result in orbital emphysema. CASE REPORT: A 47-year old man with a history of chronic intranasal cocaine use presented to the emergency department with two months of recurrent episodes of right eye proptosis exacerbated by nose blowing. Maxillofacial computed tomography revealed a large amount of right orbital emphysema, with obvious destruction of the lateral border of the right ethmoid sinus. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Orbital emphysema requires specific treatment depending on its level of severity. Damage to the midface sinuses from chronic intranasal cocaine use may result in orbital emphysema.
J Emerg Med
· 2026 Mar · PMID 41707306
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BACKGROUND: Malignancy-hemophagocytic lymphohistiocytosis (M-HLH) is a life-threatening disorder characterized by an aberrant hyperinflammatory immune response triggered by a neoplasm, inherited immune disorders that pre...BACKGROUND: Malignancy-hemophagocytic lymphohistiocytosis (M-HLH) is a life-threatening disorder characterized by an aberrant hyperinflammatory immune response triggered by a neoplasm, inherited immune disorders that predispose patients to the development of M-HLH, chemotherapy, infections, and immunotherapy. Due to its aggressive presentation, patients with M-HLH are reported to have a high mortality rate. CASE REPORT: We describe a 66-year-old woman with a history of stage IV breast cancer that presented with multiple admissions for unresolved septic-like presentations. Due to the high clinical suspicion and HLH-2004 criteria, HLH was placed on the differential and further testing revealed a new-onset lymphoma. Treatment was eventually initiated to suppress the hyperinflammatory state of M-HLH and to target the new-onset stage IVB pleomorphic mantle cell lymphoma. Even though treatment was delayed, the patient survived for multiple months longer than the median survival rate. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of M-HLH due the hyperaggressive nature of this disease and its elusive presentation; often mimicking common emergency department presentations such as sepsis. The role of the emergency physician should be to stabilize the patient, assess red flags, identify HLH on the differential, and consult with the hematology/oncology service for further testing and potential early treatment.
Sahin AS, Dilaver E, Candas KB
… +4 more, Cekic OG, Beser MF, Imamoglu M, Pasli S
J Emerg Med
· 2026 Mar · PMID 41691832
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BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) is critical for maintaining effective circulation during cardiac arrest. CPR success depends on uninterrupted, high-quality chest compressions delivered at an...BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) is critical for maintaining effective circulation during cardiac arrest. CPR success depends on uninterrupted, high-quality chest compressions delivered at an appropriate rate and depth. However, whether this performance can be sustained under prolonged working conditions is uncertain. OBJECTIVES: This simulation-based study evaluated the impact of fatigue developing during 24-h shifts on CPR quality among emergency medicine residents. METHODS: This prospective simulation study included 37 emergency medicine residents from two tertiary hospitals. Participants performed CPR on a manikin equipped with feedback devices at 0, 8, 16, and 24 h of a 24-h shift. Each session lasted 10 min and consisted of five 2-min cycles of chest compressions, interspersed with 2-min rest periods. Compression rate, depth, and quality metrics were recorded. Fatigue levels were assessed using the Modified Borg Scale before and after each session. RESULTS: Mean chest compression rate and depth remained within guideline-recommended ranges at all time points, indicating sustained clinical performance. Although subjective fatigue scores increased significantly and progressively throughout the shift (p < 0.001), this physiological strain did not correlate with a significant decline in CPR quality metrics. While minor statistical fluctuations were observed in compression rate relative to baseline, the group performance consistently met standard resuscitation targets. CONCLUSION: Emergency medicine residents maintained guideline-compliant CPR throughout 24-hour shifts despite fatigue. However, implementing fatigue management strategies, including optimized scheduling and structured rest, is recommended for provider and patient safety.
Ponce Simal S, Martínez Fleta M, Prados Arnedo M
… +3 more, Pilar Montón Blasco I, Peribáñez Belanche S, Jimeno Sánchez J
J Emerg Med
· 2026 Mar · PMID 41687429
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BACKGROUND: Fluoropyrimidines are widely used chemotherapy agents in the treatment of solid tumors, particularly colorectal cancer (CRC). The cardiotoxic effect most commonly associated with 5-fluorouracil (5-FU) is coro...BACKGROUND: Fluoropyrimidines are widely used chemotherapy agents in the treatment of solid tumors, particularly colorectal cancer (CRC). The cardiotoxic effect most commonly associated with 5-fluorouracil (5-FU) is coronary vasospasm, which typically occurs within the first hours or days following administration and can present with a spectrum of manifestations ranging from stable angina to acute coronary syndrome with hemodynamic instability. Capecitabine, a prodrug of 5-FU, has less defined cardiovascular side effects. CASE REPORT: A 66-year-old man with lower rectal adenocarcinoma, receiving capecitabine, presented with chest pain and diaphoresis 48 h after starting therapy. Initial electrocardiogram (ECG) showed new biphasic T waves. During evaluation, he developed recurrent chest pain and hyperacute T waves in repeat ECG. Nitroglycerin relieved symptoms and normalized ECG changes. Suspecting high-risk Non-ST Elevation Acute Coronary Syndrome, he was admitted and underwent coronary angiography, which showed no obstructive coronary disease. However, acetylcholine provocation induced severe focal vasospasm with corresponding symptoms and ischemic ECG changes, confirming vasospastic angina. Echocardiography revealed normal left ventricular function. Capecitabine was discontinued, and the patient was treated with calcium channel blockers and nitrates. He was discharged after five days and remained symptom-free at follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should suspect fluoropyrimidine-induced cardiotoxicity in patients with chest pain after starting capecitabine, even without cardiac risk factors. Early recognition, drug discontinuation, and vasodilator therapy are critical to prevent serious complications and ensure timely cardiology-oncology coordination.
J Emerg Med
· 2026 Mar · PMID 41633259
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BACKGROUND: Vasculitis is characterized by inflammation of blood vessels, and can manifest as characteristic skin rashes and, in severe cases, lead to end-organ damage. Causes of vasculitis include autoimmune conditions,...BACKGROUND: Vasculitis is characterized by inflammation of blood vessels, and can manifest as characteristic skin rashes and, in severe cases, lead to end-organ damage. Causes of vasculitis include autoimmune conditions, infections, and allergens. CASE REPORT: We describe a 63-year-old woman who presented to the Emergency Department with petechiae, ecchymosis, and purpura after topical diclofenac application, initially diagnosed with a hypersensitivity vasculitis. Further investigation revealed a case of mycoplasma-induced IgA vasculitis that required several months of multidisciplinary care to treat and resolve. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of a broad differential and workup in cases of suspected vasculitis. Any rash with petechiae and purpura may indicate underlying vasculitis. Early investigation into causes of vasculitis, including infection, hypersensitivity, and autoimmune conditions, as well as signs of end-organ damage are crucial to initiate proper treatment and prevent further complications.
Jeffers K, Keim SM, Long B
… +2 more, Gottlieb M, Adhikari SR
J Emerg Med
· 2026 Mar · PMID 41633258
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BACKGROUND: Abdominal aortic aneurysm (AAA) is a high-risk condition that can be associated with morbidity and mortality if untreated. Ultrasound is a primary means of diagnosis. CLINICAL QUESTION: What is the utility of...BACKGROUND: Abdominal aortic aneurysm (AAA) is a high-risk condition that can be associated with morbidity and mortality if untreated. Ultrasound is a primary means of diagnosis. CLINICAL QUESTION: What is the utility of point-of-care ultrasound (POCUS) for diagnosing AAA? EVIDENCE REVIEW: Studies retrieved included 4 systematic reviews and meta-analyses evaluating the use of POCUS for diagnosing AAA. These studies provide estimates of the potential utility of POCUS, with a sensitivity of 97.5 to 100% and specificity of 94.1 to 100%. CONCLUSION: Based upon the available literature, POCUS by emergency clinicians can reliably diagnose AAA.
Fritz CL, Thomas SH, Bloom B
… +4 more, Petcu R, Chase M, Bilello L, Rosen CL
J Emerg Med
· 2026 Mar · PMID 41619639
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BACKGROUND: Ovarian and testicular torsion are fertility threatening surgical emergencies and represent relatively frequent emergency department (ED) presentations. OBJECTIVES: The current study aimed to evaluate for ass...BACKGROUND: Ovarian and testicular torsion are fertility threatening surgical emergencies and represent relatively frequent emergency department (ED) presentations. OBJECTIVES: The current study aimed to evaluate for association between demographics and time-related endpoints related to evaluation and management of gonadal torsion in adults presenting to the ED. The primary endpoint was time from ED presentation to arrival in the operating room (tOR). Secondary endpoints included times from ED presentation to radiology-performed ultrasound (tUS) and to specialist consultation. METHODS: We assessed four years (2020-23) of adult (age > 18) gonadal torsion patients diagnosed in an urban academic center. Eligible cases were those with a primary diagnosis of gonadal torsion. RESULTS: Of 57 patients, 45 were female sex (79.0%). Race was most commonly White (35, 61.4%), with 9 patients (15.8%) each in categories of Hispanic or Black/African-American and remaining 4 patients (7.0%) were Asian. 48 (84.2%) of 57 torsion patients went directly from the ED to OR. Univariate analysis found that compared to males, tOR for females was prolonged by 156 min (95% CI: 79-239), and tUS was prolonged by 32 min (95% CI: 7-66). Multivariable QR confirmed longer tOR for females (128 min, 95% CI: 5-251, p = 0.042) and found prolonged tOR for Asians as compared to Whites (229 min, 95% CI: 49-409, p = 0.014) although with small subgroup numbers. CONCLUSIONS: Despite constituting a substantial majority of adult ED patients with gonadal torsion, time from presentation to ultrasound was prolonged by more than 30 min and operative intervention was prolonged by over 2 h for females as compared to males.
Wimmer M, Donovan M, O'Brien M
… +2 more, Hall C, Snyder GE
J Emerg Med
· 2026 Mar · PMID 41619638
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BACKGROUND: Challenges with the acute central venous catheter (ACVC) insertion procedure can introduce potential delays in treatment, clinician stress, and an increase in clinical risk. A novel all-in-one insertion syste...BACKGROUND: Challenges with the acute central venous catheter (ACVC) insertion procedure can introduce potential delays in treatment, clinician stress, and an increase in clinical risk. A novel all-in-one insertion system may improve efficiency by decreasing procedure steps, reducing procedural challenges, and lowering the risk of some insertion-related complications. OBJECTIVES: The primary objective of this study was to quantify the difference in total procedure time when comparing insertion of a novel all-in-one ACVC insertion system and a traditional ACVC among less experienced placers. Secondary objectives were to investigate the frequency of common procedural challenges, especially guidewire kinking, and to evaluate differences in kit and component usage. METHODS: A prospective, randomized crossover simulation study was conducted at a Medical Simulation Center. Fifty participants each placed one traditional and one novel ACVC insertion system, in randomized order, in simulated patient mannequins. RESULTS: The novel insertion system had a shorter total procedure time (mean difference 2.58 min, [SD ± 4.757]) when compared with a traditional ACVC (p = 0.0005). Guidewire kinking was observed across 0/49 (0%) novel insertion system placements, whereas the traditional ACVC had a significantly higher number of occurrences in 9/49 (18.4%) placements (p = 0.0039). CONCLUSION: In a simulated environment, the novel insertion system reduced total procedure time and procedural challenges, particularly guidewire kinking, which may aid in prevention of guidewire complications when compared with a traditional ACVC.
Murray E, Munoz K, Hopkins E
… +3 more, Gravitz S, Haukoos J, Trent S
J Emerg Med
· 2026 Mar · PMID 41619637
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BACKGROUND: Disparities in emergency care for acute coronary syndrome (ACS) have been reported across sex and race/ethnicity. Evidence-based decision tools may help reduce these gaps if their components are objective. Th...BACKGROUND: Disparities in emergency care for acute coronary syndrome (ACS) have been reported across sex and race/ethnicity. Evidence-based decision tools may help reduce these gaps if their components are objective. The history, electrocardiogram (ECG), age, risk factors, troponin levels (HEART) Score is a validated tool for cardiac risk stratification that may support more equitable care. OBJECTIVES: To assess whether HEART Score implementation in a large, urban, safety-net emergency department (ED) increased referral for guideline-recommended cardiac testing, and whether effects differed by sex or race/ethnicity. METHODS: We conducted a secondary analysis of a pre-post quasi-experiment evaluating HEART Score-based ACS guideline implementation. Adults (≥18 years) were included if they had a troponin completed and an ICD-10 code for chest pain or ACS. The primary outcome was appropriate referral, defined as HEART Score ≥4, no normal objective testing within the year, and receipt of ED testing, urgent outpatient testing ordered, or inpatient admission for testing. We calculated descriptive statistics and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Among 1170 patients (521 preimplementation; 649 postimplementation), 498 had a HEART Score ≥4 and were included in the primary model. Implementation was associated with higher odds of appropriate referral (adjusted OR 2.74, 95% CI: 1.87-4.03). Sex and race/ethnicity were not independently associated with referral in either period (p = 0.23-0.76). CONCLUSIONS: Implementation of the HEART Score was associated with increased odds of appropriate referrals for cardiac testing, with no observed disparities by sex, race, or ethnicity. Standardized risk stratification using the HEART Score may support more equitable ACS evaluation in the ED.
Chaliki K, Hughes D, LoVecchio F
… +2 more, Ofori E, Stecher C
J Emerg Med
· 2026 Mar · PMID 41616515
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BACKGROUND: Sepsis remains a significant public health concern, with evidence of significant racial and ethnic disparities in outcomes. OBJECTIVES: This study investigates how racial and ethnic disparities in severe seps...BACKGROUND: Sepsis remains a significant public health concern, with evidence of significant racial and ethnic disparities in outcomes. OBJECTIVES: This study investigates how racial and ethnic disparities in severe sepsis and septic shock outcomes may have changed following the implementation of the 2015 Severe Sepsis and Septic Shock Early Management (SEP-1) Bundle. METHODS: This was a retrospective analysis of a patient cohort from the 2013-2017 National Inpatient Sample datasets. ICD codes from the SEP-1 manual were used to identify eligible patients with severe sepsis or septic shock. Mortality rates, length of stay, and total costs were examined as primary outcomes using multivariable logistic and linear regression models, and an event study design was used to estimate changes in these outcomes post-SEP-1 implementation. Racial and ethnic disparities were assessed pre- and post-SEP-1 implementation, and differences in post-SEP-1 time trends in each outcome were compared across groups. RESULTS: At baseline, racial and ethnic minorities, particularly Black patients, demonstrated significantly higher mortality rates, lengths of stay, and costs compared to White patients. Following SEP-1 implementation, there were overall reductions in mortality and costs; however, racial and ethnic disparities remained statistically unchanged. The event study analysis indicated a statistically significant decline in mortality rates post-SEP-1 bundle, and the benefits were experienced equally across all racial and ethnic groups. CONCLUSIONS: Despite the introduction of the SEP-1 guidelines leading to some improvements in severe sepsis and septic shock outcomes, racial and ethnic disparities in mortality, length of stay, and costs remained statistically significant.