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The article presents a cross-sectional study which examined the percentage of abstracts published in peer-reviewed journal in 2011-2015. The abstracts were taken from websites of national and international emergency medicine (EM) societies. Among the data collected in the study are abstract title, conference name, publication year, and total number of manuscript authors.

Objectives The purpose of this study was to characterize the publication fate of a recent 2-year sample of manuscripts declined by Academic Emergency Medicine ( AEM), the journal of the Society for Academic Emergency Medicine. Methods This was a retrospective analysis of manuscripts submitted to AEM in 2010 and 2011 that were declined by the AEM editorial review process. An online search was conducted for each declined paper, to determine whether or not it was published in another clinical/scientific journal after being declined by AEM. The investigators used Scopus and Google Scholar, using the submitting author's name, the verbatim title, and key words and phrases from the title, to search for subsequent publication of each paper. Results Of 1,542 manuscript submissions to the journal in 2010 and 2011, 1,052 papers were declined. Of these, 693 (65.9%) were subsequently published elsewhere, in a total of 229 journals: 362 papers in 22 different EM journals, 81 in 14 EM subspecialty journals, 237 in 185 non- EM journals, and 13 in eight nursing journals. Papers were published a median of 16.7 months (interquartile range [ IQR] = 11.8 to 22.0 months) after being declined at AEM. Of the 229 journals, 19 do not have h-indices. The median h-index of the remaining 210 journals is 36 ( IQR = 17 to 64; maximum = 229; AEM's h-index is 78). Thirty of these 210 journals, publishing 43 papers, have higher h-indices than AEM; the other 650 papers were published in journals either with lower h-indices than AEM's ( n = 180 journals) or in journals without h-indices ( n = 19 journals). U.S. and non-U.S. authors had similar rates of subsequent publication (65.3% vs 66.6%, p = 0.69) for papers initially declined by AEM. Papers in the educational advances category were less likely to be subsequently published than those in the original contributions (p < 0.0001) and brief reports (p = 0.0137) categories. Conclusions Nearly two-thirds of manuscripts declined by SAEM's journal are eventually published elsewhere, in a large number and wide variety of both EM and non- EM journals, in a median of 16.7 months. Authors of manuscripts declined by AEM should consider submission elsewhere, as subsequent publication of these manuscripts in another journal is probable. [ABSTRACT FROM AUTHOR]

The 2014 outbreak of Ebola virus disease ( EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments ( EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians ( EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD. [ABSTRACT FROM AUTHOR]

Objective: We hypothesized that "perfect" 100% sample sensitivity or specificity (PSSS) is common in the emergency medicine (EM) literature. When results yield PSSS, calculating the likelihood ratio (LR) 95% confidence interval (CI) has been challenging. Consequently, we also hypothesized that studies with PSSS would be less likely to report the LR and associated CI, and those that did would use imperfect methods. Methods: We searched PubMed or Scopus for all articles reporting diagnostic test results in the 20 top EM journals from 2011 to 2016 and randomly sampled 124 articles. Trained researchers coded the articles as having PSSS or not ("controls"). We separately sampled 100 articles with PSSS and compared them to 100 controls in terms of their reporting of diagnostic tests and associated CIs. Results: Of the 124 articles, 19.4% (95% CI = 13% to 27.6%) feature a diagnostic test with PSSS. The LR is reported significantly less often in PSSS studies versus control studies: 18 of 100 articles (18% [95% CI = 11.3% to 27.2%]) versus 34 of 100 articles (34% [95% CI = 25% to 44.2%]), with an odds ratio (OR) of 0.43 (95% CI = 0.21 to 0.86). The LR 95% CI is also reported less often in PSSS versus control studies: five of 100 articles (5% [95% CI = 1.9% to 11.8%]) versus 27 of 100 articles (27% [95% CI = 18.8% to 37%]), with an OR of 0.11 (95% CI = 0.02 to 0.44). Five articles with perfect sample sensitivity reported their negative LR CI. The bootstrap method resulted in CIs that were 42.7% smaller on average (range = 16.6% to 63.6%). Conclusion: This analysis provides systematic evidence of diagnostic test reporting in the EM literature. Sample sensitivity or specificity of 100% is common. LRs and their associated 95% CIs are infrequently reported, particularly for PSSS samples. When the LR CI is reported in this scenario, it is overly wide. Improved reporting and methods can enhance the utility and confidence in diagnostic tests in EM. [ABSTRACT FROM AUTHOR]

Background: Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. Methods: We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM‐SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10‐item survey), absenteeism, recidivism, and satisfaction (5‐item Likert scale). Results: A total of 219 caregivers were randomized and 149 completed the 72‐hour follow‐up (72 paper and 77 video). The median (IQR) AOM‐SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM‐SOS score and medication at home (8 [7–11] vs. 10 [7–13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4–5] vs. 5 [4–5], respectively; p = 0.3). Conclusions: Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout. [ABSTRACT FROM AUTHOR]

Objectives Patients with chronic diseases are often forced to seek emergency care for exacerbations. In the face of large predicted increases in the prevalence of chronic diseases, there is increased pressure to avoid hospitalizing these patients at the end of the ED visit, if they can obtain the care they need in the outpatient setting. We performed this scoping study to provide a broad overview of the published literature on the transition of care between ED and primary care following ED discharge. Methods We performed a MEDLINE search of English-language articles published between 1990 and March 2015. We created a data-charting form a priori of the search. Papers were organized into themes, with new themes created when none of the existing themes matched the paper. Papers with multiple themes were assigned preferentially to the theme that was consistent with their primary objectives. We created a descriptive numerical summary of the included studies. Results Of 1,138 titles, there were 252 potentially relevant abstracts, and among those 122 met criteria for full paper review. An additional 11 papers were acquired from reference review. From the 133 papers, 85 were included in the study. The papers were categorized into seven themes. These included Follow-up compliance and its predictors (38 studies), Telephone calls to discharged ED patients (15 studies), ED navigators (14 studies), The current system (nine studies), Ways to alert primary care providers ( PCPs) of the ED visit (seven studies), and Patient views and PCP information requirements (one each). In the Follow-up compliance and predictors theme, the two most frequently identified significant predictors for increasing the frequency of follow-up care were the provision of a follow-up appointment time prior to ED departure and the presence of health insurance. Follow-up telephone calls to patients resulted in better follow-up rates, but increased ED return visits in some studies. In the current system patients themselves are the conduit, and the barriers to follow-up care can be high. E-mail and/or electronic medical record alerts to the PCP are relatively new, and no studies limited the alerts to patients who had a defined need for follow-up care. Conclusions A plethora of work has been published on the transition of care from ED to primary care. To decrease hospitalizations among the upcoming wave of patients with chronic diseases, it appears that the two most efficient areas to target are a primary care follow-up appointment system and health insurance. Further research is needed in particular to identify the patients who actually need follow-up care and to develop information technology solutions that can be effectively implemented within the current emergency healthcare system. [ABSTRACT FROM AUTHOR]

The article presents author's comments on the rise in operative mortality by 3 percent with the consequences of boarding inpatients related to the emergency departments (EDs). It offers information on the ED stay for admitted patients. Information on the specialty care floors for patient care including oncology and cardiology is presented.

Background: Critically ill children may require airway management to optimize delivery of oxygen and ventilation during resuscitation. We performed a systematic review of studies comparing the use of bag‐valve‐mask ventilation (BVM), supraglottic airway devices (SGA), and endotracheal intubation (ETI) in pediatric patients requiring prehospital airway management. Methods: We searched Ovid MEDLINE, EMBASE, and Cochrane databases for papers that compared SGA or ETI to BVM use in children, including studies that reported survival outcomes. We followed the Preferred Reporting Items in Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and assessed study quality using the Newcastle‐Ottawa Scale. We compared key characteristics of the candidate papers, including inclusion criteria, definitions of airway interventions, and association with outcomes. Results: Of 773 studies, eight met criteria for inclusion. Only one study was a randomized controlled trial; the other seven studies were observational. Four studies compared ETI to BVM, two studies compared SGA to BVM, one study compared ETI to SGA, and two studies compared advanced airway management (AAM) to BVM. Primary outcomes varied, ranging from overall mortality and 24‐h mortality to 1‐month survival, hospital survival, and neurologically favorable survival. Four of the studies found no difference in survival with the use of ETI, and four found increased mortality with the use of ETI. Associations with outcomes could not be assessed by meta‐analysis due to limited number of studies and the wide variation in the design, population, interventions, and outcome measures of the included studies. Conclusions: In this systematic review, studies of prehospital pediatric airway management varied in scope, design, and conclusions. There was insufficient evidence to evaluate efficacy of pediatric prehospital airway management; however, the current research suggests that there are equal or worse outcomes with the use of ETI compared to other airway techniques. Additional clinical trials are needed to assess the merits of this practice. [ABSTRACT FROM AUTHOR]

Abstract: Background: This systematic review addresses the controversy over the decision to anticoagulate patients with subsegmental pulmonary embolism (SSPE). Methods: We searched Ovid MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, Google Scholar, and bibliographies in March 2017. Two authors reviewed and retained papers with symptomatic patients who underwent computerized tomographic pulmonary angiography and had sufficient information to determine SSPE; decision to treat (or not) with systemic anticoagulation; and outcomes of bleeding, venous thromboembolism (VTE) recurrence, and death. Papers were assessed for selection and publication bias and heterogeneity, with Eggers and the inconsistency indexes (I2). Results: From 1,512 papers screened, we included 14 studies comprising 15,563 patients for full‐length review and analysis. Pooled data demonstrated I2 = 99% with an Eggers p < 0.001, suggesting significant publication bias. The pooled prevalence of SSPE was 4.6% (95% confidence interval [CI] = 1.8%–8.5%). The frequency of bleeding in SSPE patients treated with anticoagulation (n = 589) was 8.1% (95% CI = 2.8%–15.8%), with no available bleeding data in untreated patients (n = 126). The frequency of VTE recurrence within 90 days was 5.3% (95% CI = 1.6%–10.9%) for treated versus 3.9% (95% CI = 4.8%–13.4%) for untreated, while the frequency of death was 2.1% (95% CI = 3.4%–5.2%) for treated versus 3.0% (95% CI = 2.8%–8.6%) for untreated. Conclusion: This systematic review highlights the lack of any clinical trial to make a clear inference about harm or benefit of anticoagulation for SSPE. Comparison of pooled data from uncontrolled outcome studies shows no increase in VTE recurrence or death rates for patients who were not anticoagulated. These data suggest clinical equipoise for decision to anticoagulate or not anticoagulate patients with SSPE. However, this inference is limited by small numbers, imprecision, and the lack of a controlled clinical trial. [ABSTRACT FROM AUTHOR]

Objective: In recent years, the academic medicine community has produced numerous statements and calls to action condemning racism. Though health equity work examining health disparities has expanded, few studies specifically name racism as an operational construct. As emergency departments serve a high proportion of patients with social and economic disadvantage rooted in structural racism, it is critically important that racism be a focus of our academic discourse. This study examines the frequency at which four prominent emergency medicine journals, Annals of Emergency Medicine, Academic Emergency Medicine, the American Journal of Emergency Medicine, and the Western Journal of Emergency Medicine, publish on health disparities and racism. Methods: This is a descriptive analysis measuring the frequency of publications on health disparities and racism in U.S.‐based emergency medicine journals from 2014 to 2021. The search strategies for the concepts of "racism" and "health disparities" used a combination of MeSH and keywords. These search strategies were developed based on prior literature and the MEDLINE/PubMed Health Disparities and Minority Health Search Strategy. Articles identified through the PubMed search were then reviewed by two authors for final inclusion. Results: Since 2014, a total of 6248 articles were published by the four emergency medicine journals over the 8‐year study period. Of those, 82 research papers that focused on health disparities were identified and only 16 that focused on racism. Most emergency medicine publications on racism and health disparities were in 2021. Conclusions: Our findings suggest that the national discourse on racism and calls to action within emergency medicine were followed by an increase in publications on health disparities and racism. Continued investigation is needed to evaluate these trends moving forward. [ABSTRACT FROM AUTHOR]

Introduction: Patients in emergency departments (EDs) constitute a diverse population with multiple health‐related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at‐risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample. Methods: Research assistants surveyed 1037 married, cohabiting, or partnered patients in face‐to‐face interviews (87% response rate) regarding IPV exposure, alcohol and drug use, psychological distress, ACEs, and other sociodemographic features. IPV was measured with the Revised Conflict Tactics Scale. Interaction effects were examined in multinomial and logistic models. Results: Results showed a significant interaction of gender and PTSD (odds ratio [OR] 3.06, 95% CI 1.21–7.23, p < 0.05) for mutual IPV. Regarding main effects, there were also statistically significant positive associations between mutual physical IPV and at‐risk drinking (OR 1.73, 95% CI 1.07–2.77, p < 0.05), having a hazardous drinker partner (OR 2.19, 95% CI 1.35–3.55, p < 0.01), illicit drug use (OR 2.09, 95% CI 1.18–3.71, p < 0.01), ACEs (OR 1.23, 95% CI 1.06–1.42, p < 0.01), days of cannabis use past in the 12 months (OR 1.003, 95% CI 1.002–1.005, p < 0.001), and impulsivity (OR 2.04, 95% CI 1.29–3.22, p < 0.01). Conclusions: IPV risk assessment in EDs will be more effective if implemented with attention to patients' gender and the presence of various and diverse other risk factors, especially PTSD. [ABSTRACT FROM AUTHOR]

In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state‐level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The objective was to develop a patient decision aid (DA) to promote shared decision making (SDM) for stable, alert patients who present to the emergency department (ED) with syncope. Methods: Using input from patients, clinicians, and experts in the field of syncope, health care design, and SDM, we created a prototype of a paper‐based DA to engage patients in the disposition decision (admission vs. discharge) after an unremarkable ED evaluation for syncope. In phase 1, we conducted one‐on‐one semistructured exploratory interviews with 10 emergency physicians and 10 ED syncope patients. In phase 2, we conducted one‐on‐one directed interviews with 15 emergency care clinicians, five cardiologists, and 12 ED syncope patients to get detailed feedback on DA content and design. We iteratively modified the aid using feedback from each interviewee until clarity and usability had been optimized. Results: The 11 × 17‐inch, paper‐based DA, titled SynDA, includes four sections: 1) explanation of syncope, 2) explanation of future risks, 3) personalized 30‐day risk estimate, and 4) disposition options. The personalized risk estimate is calculated using a recently published syncope risk‐stratification tool. This risk estimate is stated in natural frequency and graphically displayed using a 100‐person color‐coded pictogram. Patient‐oriented questions are included to stimulate dialogue between patient and clinician. At the end of the development process, patient and physician participants expressed satisfaction with the clarity and usability of the DA. Conclusions: We iteratively developed an evidence‐based DA to facilitate SDM for alert syncope patients after an unremarkable ED evaluation. Further testing is required to determine its effects on patient care. This DA has the potential to improve care for syncope patients and promote patient‐centered care in emergency medicine. [ABSTRACT FROM AUTHOR]

Objectives: Survivors of acute cardiovascular disease (CVD) events, such as acute coronary syndrome (ACS) and stroke, may experience significant psychological distress during and following the acute event. Long‐term adverse effects may follow, including the development of posttraumatic stress disorder (PTSD), increased overall all‐cause mortality, and recurrent cardiac events. The goal of this concepts paper is to describe and summarize the rates of adverse psychological outcomes, such as PTSD, following cardiovascular emergencies, to review how these psychological factors are associated with increased risk of future events and long‐term health and to provide a theoretical framework for future work. Methods: A panel of two board‐certified emergency physicians, one with a doctorate in experimental psychology, along with one PhD clinical psychologist with expertise in psychoneuroendocrinology were co‐authors involved in the paper. Each author used various search strategies (e.g., PubMed, Psycinfo, Cochrane, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors Results: A meta‐analysis of 24 studies (N > 2,300) found the prevalence of ACS‐induced PTSD at nearly 12%, while a meta‐analysis of nine studies (N = 1,138) found that 25% of survivors of transient ischemic attack and stroke report PTSD symptoms. The presence of PTSD doubles 3‐year risk of CVD/mortality risk in ACS survivors. Cardiac patients treated during periods of ED overcrowding, hallway care, and perceived poor clinician–patient communication appear at greater risk for subsequent PTSD. Conclusions: Psychological stress is often present in patients undergoing evaluation for acute CVD events. Understanding such associations provides a foundation to appreciate the potential contribution of psychological variables on acute and long‐term cardiovascular recovery, while also stimulating future areas of research and discovery. [ABSTRACT FROM AUTHOR]

Clinical prediction models are created to help clinicians with medical decision making, aid in risk stratification, and improve diagnosis and/or prognosis. With growing availability of both prehospital and in‐hospital observational registries and electronic health records, there is an opportunity to develop, validate, and incorporate prediction models into clinical practice. However, many prediction models have high risk of bias due to poor methodology. Given that there are no methodological standards aimed at developing prediction models specifically in the prehospital setting, the objective of this paper is to describe the appropriate methodology for the derivation and validation of clinical prediction models in this setting. What follows can also be applied to the emergency medicine (EM) setting. There are eight steps that should be followed when developing and internally validating a prediction model: (1) problem definition, (2) coding of predictors, (3) addressing missing data, (4) ensuring adequate sample size, (5) variable selection, (6) evaluating model performance, (7) internal validation, and (8) model presentation. Subsequent steps include external validation, assessment of impact, and cost‐effectiveness. By following these steps, researchers can develop a prediction model with the methodological rigor and quality required for prehospital and EM research. [ABSTRACT FROM AUTHOR]

Objectives The objective was to critically appraise and highlight rigorous education research study articles published in 2014 whose outcomes advance the science of emergency medicine ( EM) education. Methods A search of the English language literature in 2014 querying Education Resources Information Center ( ERIC), Psych INFO, PubMed, and Scopus identified 243 EM-related articles using either quantitative (hypothesis-testing or observational investigations of educational interventions) or qualitative (exploring important phenomena in EM education) methods. Two reviewers independently screened all of the publications using previously established exclusion criteria. Six reviewers then independently scored the 25 selected publications using either a qualitative or a quantitative scoring system. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems use parallel scoring metrics and have been used previously within this annual review. Results Twenty-five medical education research papers (22 quantitative, three qualitative) met the criteria for inclusion and were reviewed. Five quantitative and two qualitative studies were ranked most highly by the reviewers as exemplary and are summarized in this article. Conclusions This annual critical appraisal series highlights seven excellent EM education research studies, meeting a priori criteria and published in 2014. Methodologic strengths in the 2014 papers are noted, and current trends in medical education research in EM are discussed. [ABSTRACT FROM AUTHOR]

Objectives Treatment guidelines for acute pulmonary embolism (PE) recommend risk stratifying patients to assess PE severity, as those at higher risk should be considered for therapy in addition to standard anticoagulation to prevent right ventricular (RV) failure, which can cause hemodynamic collapse. The hypothesis was that 12-lead electrocardiography (ECG) can aid in this determination. The objective of this study was to measure the prognostic value of specific ECG findings (the Daniel score, which includes heart rate > 100 beats/min, presence of the S1Q3T3 pattern, incomplete and complete right bundle branch block [RBBB], and T-wave inversion in leads V1-V4, plus ST elevation in lead aVR and atrial fibrillation suggestive of RV strain from acute pulmonary hypertension), in patients with acute PE. Methods Studies were identified by a structured search of MEDLINE, PubMed, EMBASE, the Cochrane library, Google Scholar, Scopus, and bibliographies in October 2014. Case reports, non-English papers, and those that lacked either patient outcomes or ECG findings were excluded. Papers with evidence of a predefined reference standard for PE and the results of 12-lead ECG, stratified by outcome (hemodynamic collapse, defined as circulatory shock requiring vasopressors or mechanical ventilation, or in hospital or death within 30 days) were included. Papers were assessed for selection and publication bias. The authors also assessed heterogeneity (I2) and calculated the odds ratios (OR) for each ECG sign from the random effects model if I2 > 24% and fixed effects if I2 < 25%. Funnel plots were used to examine for publication bias. Results Forty-five full-length studies of 8,209 patients were analyzed. The most frequent ECG signs found in patients with acute PE were tachycardia (38%), T-wave inversion in lead V1 (38%), and ST elevation in lead aVR (36%). Ten studies with 3,007 patients were included for full analysis. Six ECG findings (heart rate > 100 beats/min, S1Q3T3, complete RBBB, inverted T waves in V1-V4, ST elevation in aVR, and atrial fibrillation) had likelihood and ORs with lower-limit 95% confidence intervals above unity, suggesting them to be significant predictors of hemodynamic collapse and 30-day mortality. OR data showed no evidence of publication bias, but the proportions of patients with hemodynamic collapse or death and S1Q3T3 and RBBB tended to be higher in smaller studies. Patients who were outcome-negative had a significantly lower mean ± SD Daniel score (2.6 ± 1.5) than patients with hemodynamic collapse (5.9 ± 3.9; p = 0.039, ANOVA with Dunnett's post hoc), but not patients with all-cause 30-day mortality (4.9 ± 3.3; p = 0.12). Conclusions This systematic review and meta-analysis revealed 10 studies, including 3,007 patients with acute PE, that demonstrate that six findings of RV strain on 12-lead ECG (heart rate > 100 beats/min, S1Q3T3, complete RBBB, inverted T waves in V1-V4, ST elevation in aVR, and atrial fibrillation) are associated with increased risk of circulatory shock and death. [ABSTRACT FROM AUTHOR]

Abstract: Over the past decade, emergency medicine (EM) took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation‐based methodologies have the capacity to support training and research platforms that model micro‐, meso‐, and macrosystems of healthcare. To fully capitalize on the potential of simulation‐based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. The Academic Emergency Medicine (AEM) Consensus Conference “Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome” was conceived to foster discussion among experts in EM, engineering, and social sciences, focusing on key barriers and opportunities in simulation‐based research. This executive summary describes the overall rationale for the conference, conference planning, and consensus‐building approaches and outlines the focus of the eight breakout sessions. The consensus outcomes from each breakout session are summarized in proceedings papers published in this issue of Academic Emergency Medicine. Each paper provides an overview of methodologic and knowledge gaps in simulation research and identifies future research targets aimed at improving the safety and quality of healthcare. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex‐specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting. Methods: A panel of six board‐certified emergency physicians, one with fellowship training in stroke and one with training in sex‐ and sex‐based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors. Results: Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals. Conclusion: Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population. [ABSTRACT FROM AUTHOR]

Objective The objectives were to critically appraise the medical education research literature of 2015 and review the highest-quality quantitative and qualitative examples. Methods A total of 434 emergency medicine ( EM)-related articles were discovered upon a search of ERIC, Psych INFO, Pub MED, and SCOPUS. These were both quantitative and qualitative in nature. All were screened by two of the authors using previously published exclusion criteria, and the remaining were appraised by all authors using a previously published scoring system. The highest scoring articles were then reviewed. Results Sixty-one manuscripts were scored, and 10 quantitative and two qualitative papers were the highest scoring and are reviewed and summarized in this article. Conclusions This installment in this critical appraisal series reviews 12 of the highest-quality EM-related medical education research manuscripts published in 2015. [ABSTRACT FROM AUTHOR]

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Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department ( ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis ( CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation studies. [ABSTRACT FROM AUTHOR]

Objectives There are many barriers impeding the conduct of high-quality emergency care research, particularly in low- and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers. Methods An electronic survey was conducted of a purposive sample of global emergency medicine research experts from around the world to describe the major challenges and solutions to conducting emergency care research in low-resource settings and rank them by importance. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting utilized a modified Delphi technique for consensus-based decision making to categorize and expand upon these barriers and develop a comprehensive array of proposed solutions. Results The working group identified four broad categories of barriers to conducting emergency care research globally, including 1) the limited availability of research personnel, particularly those with prior research training; 2) logistic barriers and lack of standardization of data collection; 3) ethical barriers to conducting research in resource-limited settings, particularly when no local institutional review board is available; and 4) the relative dearth of funding for global emergency care research. Proposed solutions included building a diverse and interdisciplinary research team structured to promote mentorship of junior researchers, utilizing local research assistants or technologic tools such as telemedicine for language translation, making use of new tools such as mobile health ( mHealth) to standardize and streamline data collection, identifying alternatives to local institutional review board approval and the use of community consent when appropriate, and increased advocacy for global emergency care research funding. Conclusions Significant barriers to the conduct of high-quality global emergency care research persist, and innovative strategies need to be adopted to promote and grow the field of global emergency care research. This paper provides a global consensus on the most important barriers identified, as well as recommendations for cost-effective strategies for overcoming these barriers with the overall goal of promoting high-quality research and improving emergency care worldwide. [ABSTRACT FROM AUTHOR]

Background: The exception from informed consent (EFIC) rule was adopted in 1996, permitting waiver of informed consent for certain emergency research, including trials funded by the U.S. government. The rule requires prospective consent from patients or their legally authorized representative(s) (LAR) if practicable. For those enrolled without consent, the patient or their LAR must be given an opportunity to opt out from continued participation at the earliest opportunity. We sought to census the trials conducted under the EFIC rule to facilitate research to better understand how the rule is being used. Methods: We conducted a multipronged search to identify all trials conducted under the EFIC rule, drawing on reviews, database searches, examination of the FDA's docket, posting an inquiry on the institutional review board forum, and email requests to lead authors of all published EFIC trials and related review articles. We describe the trials, when they were started and completed, and whether they were terminated early. Results: We identified a total of 110 trials as of the end of April 2022: 78 complete, 13 recruiting, seven registered on clinicaltrials.gov but not yet recruiting, five trials that were abandoned before enrolling any subjects, and seven trials in early planning. Nine of the 78 completed trials were pilot or feasibility trials. Of 69 completed full trials, 30 (43.5%) were terminated early. The most common reason for early termination was futility (15 trials, 25.0%) followed by poor recruitment (10 trials, 14.5%). The rate of conduct of trials has been remarkably constant since 2001, with roughly 18 trials started in each 5‐year period. Conclusions: We have compiled a census of trials conducted under the U.S. FDA's EFIC rule, the availability of which we hope will stimulate further in‐depth data collection and analysis of this set of trials. [ABSTRACT FROM AUTHOR]

The article focuses on acute otitis media (AOM) is the second most commonly has diagnosed illness in children and the most common indication for antibiotic prescription. Topics include the discharge instruction complexity and inadequate comprehension has associated with medication errors, and the medication errors can be reduced using standardized discharge instructions, and parents prefer these to verbal summaries.

Objectives The study of preventable deaths is essential to trauma research for measuring service quality and highlighting avenues for improving care and as a performance indicator. However, variations in the terminology and methodology of studies on preventable prehospital trauma death limit the comparability and wider application of data. The objective of this study was to describe the heterogeneity in terminology and methodology. Methods We performed a systematic literature review and report this using the PRISMA guidelines. Searches were conducted using PubMed (including Medline), Ovid, and Embase databases. Studies, with a full text available in English published between 1990 and 2015, meeting the following inclusion criteria were included: analysis of 1) deaths from trauma, 2) occurring in the prehospital phase of care, and 3) application of criteria to ascertain whether deaths were preventable. One author screened database results for relevance by title and abstract. The full text of identified papers was reviewed for inclusion. The reference list of included papers was screened for studies not identified by the database search. Data were extracted on predefined core elements relating to preventability reporting and definitions using a standardized form. Results Twenty-seven studies meeting the inclusion criteria were identified: 12 studies used two categories to assess the preventability of death while 15 used three categories. Fifteen variations in the terminology of these categories and combination with death descriptors were found. Eleven different approaches were used in defining what constituted a preventable death. Twenty-one included survivability of injuries as a criterion. Methods used to determine survivability differed and eight variations in parameters for categorization of deaths were used. Nineteen used panel review in determining preventability with six implementing panel blinding. Panel composition varied greatly by expertise of personnel. Separation of prehospital deaths differed with 10 separating those dead at scene ( DAS) and dead on arrival, three excluding those DAS, three excluding deaths prior to EMS arrival, and 11 not separating prehospital deaths. Conclusions The heterogeneity in methodology, terminology, and definitions of 'preventable' between studies render data incomparable. To facilitate common understanding, comparability, and analysis, a commonly agreed ontology by the prehospital research community is required. [ABSTRACT FROM AUTHOR]

Objectives Alternative-level metrics (Altmetrics) are a new method to assess the sharing and spread of scientific knowledge. The primary objective of this study was to describe the traditional metrics and Altmetric scores of the 50 most frequently cited articles published in emergency medicine ( EM) journals. Since many articles related to EM are published in other journals, the secondary aim of this study was to describe the Altmetric scores of the most frequently cited articles relevant to EM in other biomedical journals. Methods A structured search of the Institute for Scientific Information Web of Science version of the Science Citation Index Expanded was conducted. The 200 most frequently cited articles in the top 10 EM journals (2011 Journal Citation Report) were identified. The 200 most frequently cited articles from the rest of the medical literature, matching a predefined list of keywords relevant to the specialty of EM, were identified. Two authors reviewed the lists of citations for relevance to EM and a consensus approach was used to arrive at the final lists of the top 50 cited articles. The Altmetric scores for the top 50 cited articles in EM and other journals were determined. Descriptive statistics and Spearman correlation were performed. Results The highest Altmetric score for EM articles was 25.0; the mean (± SD) was 1.9 (±5.0). The EM journal with the highest mean article Altmetric score was Resuscitation. The main clinical areas shared for articles from EM articles were trauma (mean ± SD = 11.0 ± 15.6, median = 11.0) and cardiac arrest (mean ± SD = 2.7 ± 5.8, median = 0). The highest Altmetric score for other journals was 176.0 (mean ± SD = 23.3 ± 40.8). The other journal with the highest mean article Altmetric score was the New England Journal of Medicine. The main clinical areas shared for articles were critical care (mean ± SD score = 36.5 ± 47.4, median = 36.5), sepsis (mean ± SD = 24.6 ± 48.8, median = 12.0), cardiology (mean ± SD = 19.2 ± 35.6, median = 7.0), and infectious diseases (mean ± SD = 17.0 ± 12.7, median = 17.0). Spearman correlation demonstrated weakly positive correlation between citation counts and Altmetric scores for EM articles and other journals. Conclusions This study is the first analysis of Altmetric scores for the top cited articles in EM. We demonstrated that there is a mild correlation between citation counts and Altmetric scores for the top papers in EM and other biomedical journals. We also demonstrated that there is a gap between the sharing of the top articles in EM journals and those related to EM in other biomedical journals. Future research to explore this relationship and its temporal trends will benefit the understanding of the reach and dissemination of EM research within the scientific community and society in general. [ABSTRACT FROM AUTHOR]

Background: Emergency departments (EDs) provide care to ethnically diverse populations with multiple health‐related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic‐specific 12‐month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample. Methods: Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features. Results: The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98–2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25–2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV. Conclusions: There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature. [ABSTRACT FROM AUTHOR]

The article reports that academic scholarship, journal impact factor, CiteScore, h‐index, hi‐10, and the alternative metrics (Altmetrics) are terms that are familiar to seasoned academics. It states that bibliometric and publication metrics should be used by junior scholars to quantify the reach of academic work.

Background: Due to the acuity and time‐sensitive needs of their clinical condition, patients presenting with certain emergent pathologies may lack capacity to provide meaningful prospective informed consent to participate in clinical research. For these reasons, these populations have often been excluded from research investigations. To mitigate this, regulations allowing exception from informed consent (EFIC; 21 CFR 50.24) or waiver of informed consent (WIC; 45 CFR 46.101) were developed in 1996. The purpose of this study was to identify trends in the utilization of EFIC and WIC in emergency research. We also sought to describe the disclosure of necessary prestudy regulatory requirements and justification for the use of EFIC/WIC as reported in completed EFIC/WIC clinical trials. Methods: This study is a review of 20 years of published trials using EFIC or WIC as the primary method of patient consent. Studies were identified using a MEDLINE search; ClinicalTrials.gov; queries to emergency and resuscitation researchers, research directors, department chairs, and principal investigators of acute care research networks; clinical review papers; and a query of the Federal Drug Administration (FDA) docket. All eligible studies were reviewed by three investigators and study data of interest were abstracted. Data are presented descriptively. Results: We identified 45 potentially eligible studies; 11 were ongoing (with no data yet available), four were completed (with no publications or data available), and two did not use EFIC or WIC. Of the remaining 28 studies, 24 (86%) used EFIC and four used WIC. The most common pathologies under study were cardiac arrest (10), hemorrhagic shock (six), and traumatic brain injury (five). Completion of the prestudy regulatory requirements was reported as follows: FDA investigational new drug/investigational device exemption application (for FDA regulated studies; 14, 50%), community consultation (13, 46%), public disclosure (10, 36%), and opt‐out procedures if requested by the institutional review board (seven, 25%). The justification of the need for the use of EFIC or WIC in the reported clinical trial, as defined as mention of at least one of the eight established criteria, was described in the text of 13 (46%) publications. Conclusions: Since their implementation in 1996, the EFIC/WIC regulations have allowed progress in research aimed at determining optimal care for devastating life‐threatening conditions. However, consistent and rigorous report of regulatory prestudy requirements and justification of the use of EFIC/WIC is lacking in clinical trial publications or on websites such as ClinicalTrials.gov. Since research without consent is an ethically sensitive issue and not widely understood, better justification of its needs within the presentation of the research itself may educate the general medical community and also reduce concerns about whether or not the regulations are being properly applied. [ABSTRACT FROM AUTHOR]

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The authors introduces the journal "Academic Emergency Medicine Education and Training" (AEM E&T) in which the staff will no longer review or accept manuscripts that center on education or training of emergency care providers. It cites that the authors of the manuscripts have options of either the paper be reviewed or withdrawing the manuscripts. It also cites that the journal will publish its first issue in 2017.

Abstract: Introduction: Point‐of‐care ultrasound (POCUS) has been suggested as an initial investigation in the management of renal colic. Our objectives were: 1) to determine the accuracy of POCUS for the diagnosis of nephrolithiasis and 2) to assess its prognostic value in the management of renal colic. Methods: The review protocol was registered to the PROSPERO database (CRD42016035331). An electronic database search of MEDLINE, Embase, and PubMed was conducted utilizing subject headings, keywords, and synonyms that address our research question. Bibliographies of included studies and narrative reviews were manually examined. Studies of adult emergency department patients with renal colic symptoms were included. Any degree of hydronephrosis was considered a positive POCUS finding. Accepted criterion standards were computed tomography evidence of renal stone or hydronephrosis, direct stone visualization, or surgical findings. Screening of abstracts, quality assessment with the QUADAS‐2 instrument, and data extraction were performed by two reviewers, with discrepancies resolved by consensus with a third reviewer. Test performance was assessed by pooled sensitivity and specificity, calculated likelihood ratios, and a summary receiver operator curve (SROC). The secondary objective of prognostic value was reported as a narrative summary. Results: The electronic search yielded 627 unique titles. After relevance screening, 26 papers underwent full‐text review, and nine articles met all inclusion criteria. Of these, five high‐quality studies (N = 1,773) were included in the meta‐analysis for diagnostic accuracy and the remaining yielded data on prognostic value. The pooled results for sensitivity and specificity were 70.2% (95% confidence interval [CI] = 67.1%–73.2%) and 75.4% (95% CI = 72.5%–78.2%), respectively. The calculated positive and negative likelihood ratios were 2.85 and 0.39. The SROC generated did not show evidence of a threshold effect. Two of the studies in the meta‐analysis found that the finding of moderate or greater hydronephrosis yielded a specificity of 94.4% (95% CI = 92.7%–95.8%). Four studies examining prognostic value noted a higher likelihood of a large stone when positive POCUS findings were present. The largest randomized trial showed lower cumulative radiation exposure and no increase in adverse events in those who received POCUS investigation as the initial renal colic investigation. Conclusion: Point‐of‐care ultrasound has modest diagnostic accuracy for diagnosing nephrolithiasis. The finding of moderate or severe hydronephrosis is highly specific for the presence of any stone, and the presence of any hydronephrosis is suggestive of a larger (>5 mm) stone in those presenting with renal colic. [ABSTRACT FROM AUTHOR]

Abstract: Value‐based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and the economic effects of potentially expensive simulation programs to rationalize the costs. Given the often‐disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Clinical educators need to be able to present thorough economic analyses demonstrating returns on investment and cost‐effectiveness to effectively communicate with administrators. At the 2017 Academic Emergency Medicine Consensus Conference “Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes,” our breakout session critically evaluated the cost‐benefit and return on investment of simulation. In this paper we provide an overview of some of the economic tools that a clinician may use to present the value of simulation training to financial officers and other administrators in the economic terms they understand. We also define three themes as a call to action for research related to cost–benefit analysis in simulation as well as four specific research questions that will help guide educators and hospital leadership to make decisions on the value of simulation for their system or program. [ABSTRACT FROM AUTHOR]

Abstract: Computer simulation is a highly advantageous method for understanding and improving health care operations with a wide variety of possible applications. Most computer simulation studies in emergency medicine have sought to improve allocation of resources to meet demand or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Theoretically, computer simulation could also be used to examine the impact of adding or modifying specific provider tasks. Doing so involves a number of unique considerations, particularly in the complex environment of acute care settings. In this paper, we describe conceptual advances and lessons learned during the design, parameterization, and validation of a computer simulation model constructed to evaluate changes in ED provider activity. We illustrate these concepts using examples from a study focused on the operational effects of HIV screening implementation in the ED. Presentation of our experience should emphasize the potential for application of computer simulation to study changes in health care provider activity and facilitate the progress of future investigators in this field. [ABSTRACT FROM AUTHOR]

Conflicts of interest ( COIs) are common in the practice of emergency medicine and may be present in the areas of clinical practice, relations with industry, expert witness testimony, medical education, research, and organizations. A COI occurs when there is dissonance between a primary interest and another interest. The concept of professionalism in medicine places the patient as the primary interest in any interaction with a physician. We contend that patient welfare is the ultimate interest in the entire enterprise of medicine. Recognition and management of potential, real, and perceived COIs is essential to the ethical practice of emergency medicine. This paper discusses how to recognize, address, and manage them. [ABSTRACT FROM AUTHOR]

Objectives Despite recent strides in the development of global emergency medicine ( EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments ( EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. Methods A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review ( GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. Results Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. Conclusions Despite recent strides in global EM research and a proliferation of scholarly output in the field, further work is required to advocate for and inform research priorities in global EM. The priorities outlined in this paper aim to guide future research in the field, with the goal of advancing the development of EM worldwide. [ABSTRACT FROM AUTHOR]

Background There is a lack of information on annual healthcare expenditures both per person and for the U.S. population associated with trauma, as identified by International Classification of Disease Ninth Revision, Clinical Modification ( ICD-9- CM) codes. Methods This paper employed a two-part model to estimate the unadjusted and adjusted annual per individual expenditures and population burden of trauma exposure for the U.S. population, using a nationally representative survey of medical care expenditures. In addition, we estimated a logit model to examine the demographic and comorbidity factors associated with the likelihood of experiencing trauma. Results Approximately 18.2% of U.S. adults were found to have trauma exposure during the survey year of 2011. The most frequent trauma ICD-9- CM code was injury not elsewhere classified/not otherwise specified. Adjusted likelihood of trauma was higher among individuals under the age of 65; males; non-Hispanic whites; nonmarried or never married; and individuals living with comorbidities of stroke, joint pain, arthritis, and asthma. The most expensive of the top 10 ICD-9- CM trauma codes was dislocation of the knee. Significant differences in expenditure categories were found for office-based, outpatient, emergency department ( ED), dental, and other medical care. After adjustment for comorbidities and demographics, the adjusted per-person burden of trauma was estimated to be $1,689 (95% confidence interval [ CI] = $1,006 to $2,372), with an incremental burden on the U.S. population of $60.8 billion per year. Conclusions Trauma results in a significant healthcare expenditure burden, both per person and on the U.S. population. Clinicians should be aware that individuals in the U.S. population with certain comorbidities such as stroke, joint pain, arthritis, and asthma are more likely to have trauma and that differences exist in expenditures for office-based, outpatient, dental, and the ED. [ABSTRACT FROM AUTHOR]

Loss to follow-up of enrolled patients (a.k.a. attrition) is a major threat to study validity and power. Minimizing attrition can be challenging even under ideal research conditions, including the presence of adequate funding, experienced study personnel, and a refined research infrastructure. Emergency care research is shifting toward enrollment through multisite networks, but there have been limited descriptions of approaches to minimize attrition for these multicenter emergency care studies. This concept paper describes a stepwise approach to minimize attrition, using a case example of a multisite emergency department prospective cohort of over 3,000 patients that has achieved a 30-day direct phone follow-up attrition rate of <3%. The seven areas of approach to minimize attrition in this study focused on patient selection, baseline contact data collection, patient incentives, patient tracking, central phone banks, local enrollment site assistance, and continuous performance monitoring. Appropriate study design, including consideration of these methods to reduce attrition, will be time well spent and may improve study validity. [ABSTRACT FROM AUTHOR]

In 2012 the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine released the emergency medicine milestones. The Patient Care 12 ( PC12) subcompetency delineates staged and progressive accomplishment in emergency ultrasound. While valuable as an initial framework for ultrasound resident education, there are limitations to PC12. This consensus paper provides a revised description of criteria to define the subcompetency. A multiorganizational task force was formed between the American College of Emergency Physicians Ultrasound Section, the Council of Emergency Medicine Residency Directors, and the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine. Representatives from each organization created this consensus document and revision. [ABSTRACT FROM AUTHOR]

The article presents the discussion on addressing health equity starting at home. Topics include diagnostic terms and associated words having potential unintended consequences of harming people and contributing to social injustice; and offering little resistance while simultaneously shielding police from accountability.

The article focuses on loop technique versus drainage and packing in emergency department abscess management. Topics include the management of cutaneous abscesses is bread and butter emergency medicine work, the studies show wide practice variations in the process of draining and treating abscesses, and the patients were reviewed at 36 hours and treatment was deemed to have failed.

A personal narrative is presented in which the author talks about his experience at the trauma bay for emergency department (ED) shift in 2018, where he was wearing red shoes in memory of Dr. Tamara O'Neal, who was murdered by her ex-fiance.

The article focuses on patient satisfaction scores and rankings are reflected in administrative decisions and have been used for survey results can determine physician compensation at the group level and create rankings of individual providers. Topics include the satisfaction data are used to rank hospitals against peers and competitors, and the emergency medicine provides a unique setting for analysis of patient satisfaction reports.

The article reports that a gender gap has been seen in emergency medicine with a 2007 study reporting that several percentage of first authors were identified as women. Topics include considered that a 2019 article reported that the proportion of women first authors increased to several percentage in 2019 and there are less data regarding overall authorship or across specific author positions beyond first.

Objectives There is currently no consolidated list of existing simulation fellowship programs in emergency medicine ( EM). In addition, there are no universally accepted or expected standards for core curricular content. The objective of this project is to develop consensus-based core content for EM simulation fellowships to help frame the critical components of such training programs. Methods This paper delineates the process used to develop consensus curriculum content for EM simulation fellowships. EM simulation fellowship curricula were collected. Curricular content was reviewed and compiled by simulation experts and validated utilizing survey methodology, and consensus was obtained using a modified Delphi methodology. Results Fifteen EM simulation fellowship curricula were obtained and analyzed. Two rounds of a modified Delphi survey were conducted. The final proposed core curriculum content contains 47 elements in nine domains with 14 optional elements. Conclusion The proposed consensus content will provide current and future fellowships a foundation on which to build their own specific and detailed fellowship curricula. Such standardization will ultimately increase the transparency of training programs for future trainees and potential employers. [ABSTRACT FROM AUTHOR]

Background The Palliative Care and Rapid Emergency Screening (P-Ca RES) Project is an initiative intended to improve access to palliative care ( PC) among emergency department ( ED) patients with life-limiting illness by facilitating early referral for inpatient PC consultations. In the previous two phases of this project, we derived and validated a novel PC screening tool. This paper reports on the third and final preimplementation phase. Objectives Examine the acceptability of the P-Ca RES tool among PC and ED providers as well as test its reliability on case vignettes. Compare variations in reliability and acceptability of the tool based on ED providers' roles (attendings, residents, and nurses) and lengths of experience. Methods A two-part electronic survey was distributed to ED providers at multiple sites across the United States. We tested the reliability of the tool in the first part of the survey, through a series of case vignettes. A criterion standard of correct responses was first defined by consensus input from expert PC physicians' interpretations of the vignettes. The experts' input was validated using the Gwet's AC1 coefficient for inter-rater reliability. ED providers were then presented with the case vignettes and asked to use the P-Ca RES tool to correctly identify which patients had unmet PC needs. ED provider responses were compared both against the criterion standard and against different subsets of respondents (divided both by role and by level of experience). The second part of the survey assessed acceptability of the P-Ca RES tool among ED providers using responses to questions from a modified Ottawa Acceptability of Decision Rules Instrument, based on a 1-5 Likert rating scale. Descriptive statistics were used to report all outcomes. Results In total, 213 ED providers employed in three different regions across the country responded to the survey (39.4%) and 185 (86.9%) of those completed it. The majority of providers felt that the tool would be useful in their practice (80.5%), agreed that the tool was clear and unambiguous (87.1%), thought that use of the tool would likely benefit patients (87.5%), and thought that it would result in improved use of resources to help severely ill patients (83.6%). Over three-quarters of ED providers (78.5%) also self-reported that they refer patients with unmet PC needs less than 10% of the time, and only 10.8% of respondents believed that they are already utilizing an effective strategy to screen or refer patients to PC. Applying our P-Ca RES tool to case vignettes, ED providers generated PC referrals in concordance with PC experts over 88.7% of the time (95% confidence interval = 86.4% to 90.6%), with an overall sensitivity of more than 90%. These results varied minimally regardless of the respondent's role in the ED or their level of experience. Conclusion Screening by emergency medicine providers for unmet PC needs using a brief, novel, content-validated screening tool is acceptable and is also reliable when applied to case vignettes-regardless of provider role or experience. Clinical trial and further study are warranted and are currently under way. [ABSTRACT FROM AUTHOR]

The Patient-Centered Outcomes Research Institute ( PCORI) was established by Congress in 2010 to promote the conduct of research that could better inform patients in making decisions that reflect their desired health outcomes. PCORI has established five national priorities for research around which specific funding opportunities are issued: 1) assessment of prevention, diagnosis, and treatment options; 2) improving healthcare systems; 3) communication and dissemination research; 4) addressing disparities; and 5) improving methods for conducting patient-centered outcomes research. To date, implementation of patient-centered research in the emergency care setting has been limited, in part because of perceived challenges in meeting PCORI priorities such as the need to focus on a specific disease state or to have planned follow up. We suggest that these same factors that have been seen as challenges to performing patient-centered research within the emergency setting are also potential strengths to be leveraged to conduct PCORI research. This paper explores factors unique to patient-centered emergency care research and highlights specific areas of potential alignment within each PCORI priority. [ABSTRACT FROM AUTHOR]

Objectives In 2006, Academic Emergency Medicine ( AEM) published a special issue summarizing the proceedings of the AEM consensus conference on the 'Science of Surge.' One major goal of the conference was to establish research priorities in the field of 'disasters' surge. For this review, we wished to determine the progress toward the conference's identified research priorities: 1) defining criteria and methods for allocation of scarce resources, 2) identifying effective triage protocols, 3) determining decision-makers and means to evaluate response efficacy, 4) developing communication and information sharing strategies, and 5) identifying methods for evaluating workforce needs. Methods Specific criteria were developed in conjunction with library search experts. PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases were queried for peer-reviewed articles from 2007 to 2015 addressing scientific advances related to the above five research priorities identified by AEM consensus conference. Abstracts and foreign language articles were excluded. Only articles with quantitative data on predefined outcomes were included; consensus panel recommendations on the above priorities were also included for the purposes of this review. Included study designs were randomized controlled trials, prospective, retrospective, qualitative (consensus panel), observational, cohort, case-control, or controlled before-and-after studies. Quality assessment was performed using a standardized tool for quantitative studies. Results Of the 2,484 unique articles identified by the search strategy, 313 articles appeared to be related to disaster surge. Following detailed text review, 50 articles with quantitative data and 11 concept papers (consensus conference recommendations) addressed at least one AEM consensus conference surge research priority. Outcomes included validation of the benchmark of 500 beds/million of population for disaster surge capacity, effectiveness of simulation- and Internet-based tools for forecasting of hospital and regional demand during disasters, effectiveness of reverse triage approaches, development of new disaster surge metrics, validation of mass critical care approaches (altered standards of care), use of telemedicine, and predictions of optimal hospital staffing levels for disaster surge events. Simulation tools appeared to provide some of the highest quality research. Conclusion Disaster simulation studies have arguably revolutionized the study of disaster surge in the intervening years since the 2006 AEM Science of Surge conference, helping to validate some previously known disaster surge benchmarks and to generate new surge metrics. Use of reverse triage approaches and altered standards of care, as well as Internet-based tools such as Google Flu Trends, have also proven effective. However, there remains significant work to be done toward standardizing research methodologies and outcomes, as well as validating disaster surge metrics. [ABSTRACT FROM AUTHOR]

Objectives The objectives were to review published reports of secondary neurologic deterioration in the early stages of care after blunt spinal trauma and describe its nature, context, and associated risk factors. Methods The authors searched the MEDLINE, EMBASE, and CINAHL databases for English-language studies. Cases were included meeting the criteria age 16 years or older, nonpenetrating trauma, and experiencing neurologic deterioration during prehospital or emergency department ( ED) care prior to definitive management (e.g., discharge, spinal clearance by computed tomography, admission to an inpatient service, or surgical intervention). Results were qualitatively analyzed for characteristics and themes. Results Forty-one qualifying cases were identified from 12 papers. In 30 cases, the new deficits were apparently spontaneous and were not detected until routine reassessment. In 12 cases the authors did attribute deterioration to temporally associated precipitants, seven of which were possibly iatrogenic; these included removal of a cervical collar, placement of a halo device, patient agitation, performance of flexion/extension films, 'unintentional manipulation,' falling in or near the ED, and forced collar application in patients with ankylosing spondylitis. Thirteen cases occurred during prehospital care, none of them sudden and movement-provoked, and all reported by a single study. Conclusions Published reports of early secondary neurologic deterioration after blunt spinal trauma are exceptionally rare and generally poorly documented. High-risk features may include altered mental status and ankylosing spondylitis. It is unclear how often events are linked with spontaneous patient movement and whether such events are preventable. [ABSTRACT FROM AUTHOR]