Emergency Medicine
Audio Summaries

Urgent Care and Emergency Department Visitors: A Latent Class Analysis

The authors aimed to identify distinct patterns of health care utilization among adults, particularly the interaction between emergency department (ED) and urgent care visits. Using latent class analysis on data from the National Health Interview Survey, they identified four classes of health care users, revealing that urgent care can either complement ED use or be utilized independently by those with fewer barriers to care. The findings highlight the need for targeted health system strategies to improve access and delivery of care based on these utilization patterns.

A Multidimensional Approach to Acute Traumatic Brain Injury: What the NIH-NINDS CBI-M Framework Means for Emergency Medicine

The authors aim to introduce and contextualize the NIH-NINDS CBI-M framework for acute traumatic brain injury (TBI) within emergency medicine, highlighting its potential to enhance injury characterization beyond traditional categorical labels. They discuss the framework's core components and its relevance to emergency practice, addressing both its alignment with current care and the implementation challenges that remain. Ultimately, the article seeks to foster dialogue among emergency physicians regarding this evolving approach to TBI assessment.

Disposition at Equipoise: A Qualitative Study of Emergency Physicians' Decision-Making About Hospitalizing People With Dementia

This study investigates how emergency physicians make decisions regarding the hospitalization of patients with dementia in situations where either admission or discharge could be appropriate. Through qualitative interviews, the authors identify key factors influencing these decisions, including caregiver availability, anticipated clinical trajectories, and the potential harms of hospitalization. The findings suggest that improving decision-making processes and health system support for outpatient care could enhance patient-centered outcomes for this vulnerable population.

Effects of age, sex and body anthropometry on needle thoracostomy in a Singapore paediatric cohort: a chest CT study

The authors aimed to investigate how age, sex, and body anthropometry influence chest wall thickness (CWT) at common needle thoracostomy (NT) landmarks in a pediatric population, as well as to assess the adequacy of needle lengths used for the procedure. Through a retrospective review of chest CT scans from children aged 0-17 years, they found that CWT varies significantly by age and recommended specific needle lengths for successful NT: 25 mm for infants, 32 mm for children, and 50 mm for adolescents.

Beyond Triage: Cognitive Profiles and ED-To-Inpatient Costs and Resource Pathways in Older Adults

This study investigates how different cognitive profiles in older adults affect hospital costs and resource utilization following emergency department visits. The authors found that while clinical severity was the primary factor influencing care costs, cognitive profiles—specifically delirium and cognitive impairment—were linked to variations in care pathways and resource allocation. Understanding these cognitive distinctions is crucial for improving care strategies and optimizing resources for older patients.

Diagnostic pitfalls of STI-related pelvic inflammatory disease

The authors aimed to identify diagnostic and triage pitfalls in emergency department patients with CT-imaged, STI-confirmed pelvic inflammatory disease (PID). They found that a significant percentage of patients were discharged without a PID diagnosis or admitted to non-gynecologic services, particularly when presenting with gastrointestinal symptoms and less specific imaging findings. The study suggests that improving the recognition of PID in acute abdominal pain pathways could enhance timely diagnosis and treatment.

Early Clinical Deterioration Among Emergency Department Boarders: A Retrospective Analysis

The authors aimed to define the incidence and identify factors associated with early clinical deterioration among patients boarding in the emergency department (ED). Their retrospective analysis of over 173,000 encounters revealed that 3.6% of patients experienced deterioration, with longer boarding times significantly increasing the risk. Key predictors included care at academic safety-net hospitals, overnight admissions, and elevated lactate levels, highlighting the patient safety risks associated with prolonged ED boarding.

Sex Differences in Clinical Outcomes and Resource Utilization Among Emergency Department Patients With Unexplained Syncope or Presyncope: A Prospective, Observational, Cohort Study

The study aimed to investigate sex differences in baseline characteristics, physician risk estimation, admission rates, and clinical outcomes among emergency department patients aged 40 and older with unexplained syncope or presyncope. The findings revealed that men had higher rates of baseline cardiac disease, were more frequently admitted, and experienced a greater incidence of serious adverse events within 30 days; however, these differences were attributed to variations in baseline clinical factors rather than inherent sex differences. Ultimately, after adjusting for these factors, no significant disparities in admission rates or clinical outcomes remained between men and women.

Chronological Sequence of Convulsive Status Epilepticus Treatment Steps in a Real-Life Scenario for Patients Enrolled in a Large Multicenter Trial

This study investigates the timing of treatment steps for patients with generalized convulsive status epilepticus (SE) in a real-world setting, using data from the Established Status Epilepticus Treatment Trial (ESETT). The authors aim to assess adherence to guideline-recommended timeframes and identify factors contributing to delays in treatment, finding that while many interventions occurred within recommended windows, significant variability and a lack of prehospital benzodiazepine use were prevalent. The results suggest that earlier administration of second-line therapy is associated with better treatment outcomes, highlighting the need for improved adherence to treatment guidelines.

The infusion after the bolus: a quality improvement programme to support emergency department airway governance in Ireland

The authors aimed to develop and evaluate a sustainable airway governance framework for emergency departments (EDs) in Ireland, addressing the variability in training and governance of intubation procedures. Through a quality improvement project involving structured interventions, they demonstrated that implementing leadership, standardized checklists, and continuous feedback led to a first-pass success rate of over 90% and low complication rates across multiple cycles. This framework not only maintained high performance metrics despite staff turnover but also offers a replicable model for establishing airway governance standards in other EDs.