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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 focuses on the variation in firearm screening and access based on LGBT status among Veterans with the risk of firearm-related suicide in both LGBT individuals and Veterans. It mentions that the study aims to fill this gap by examining LGBTQI+ status, emergency department visits, and firearm screening and access using natural language processing and machine learning algorithms applied to clinical notes in the Veterans Affairs (VA) electronic health records.

Objective: While guidelines recommend outpatient management of patients with low‐risk pulmonary embolism (PE), little is known about the disposition of patients with PE diagnosed in United States emergency departments (EDs). We sought to determine disposition practices and subsequent health care utilization in patients with acute PE in U.S. EDs. Methods: This was a retrospective cohort study of adult ED patients with a new diagnosis of acute PE treated at 740 U.S. acute care hospitals from July 1, 2016, through June 30, 2018. The primary outcome was the initial disposition following an ED visit for acute PE. Additional measures included hospital cost and 30‐day revisit rate to the ED. Results: A total of 61,070 cases were included in the overall cohort, of which 4.1% of new cases of PE were discharged from the ED. The median hospital‐specific proportion of patients discharged was 3.1% (interquartile range = 0.8%–6.8%). The median odds ratio, representing the importance of the hospital in initial disposition decisions, was 2.21 (95% confidence interval = 2.05 to 2.37), which was greater than any patient‐level factor with the exception of concurrent ED diagnosis of hypoxemia/respiratory failure, shock, or hypotension. Within 30 days of discharge, 17.9% of discharged cases had an ED return visit to the ED only and 10.3% of patients were hospitalized. Of the 30‐day ED return visits in patients initially managed as outpatients, 1.3% had a bleeding‐associated diagnosis. Conclusion: Despite guidelines promoting outpatient management, few patients are currently discharged home in the United States; however, practice varies widely across hospitals. Return visit rates were high but most did not result in hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to provide a longitudinal assessment of anxiety levels and work and home concerns of U.S. emergency physicians during the COVID‐19 pandemic. Methods: We performed a longitudinal, cross‐sectional email survey of clinically active emergency physicians (attending, fellow, and resident) at seven academic emergency departments. Follow‐up surveys were sent 4 to 6 weeks after the initial survey and assessed the following: COVID‐19 patient exposure, availability of COVID‐19 testing, levels of home and workplace anxiety/stress, changes in behaviors, and performance on a primary care posttraumatic stress disorder screen (PC‐PTSD‐5). Logistic regression explored factors associated with a high PC‐PTSD‐5 scale score (≥3), indicating increased risk for PTSD. Results: Of the 426 surveyed initial respondents, 262 (61.5%) completed the follow‐up survey. While 97.3% (255/262) reported treating suspected COVID‐19 patients, most physicians (162/262, 61.8%) had not received testing themselves. In follow‐up, respondents were most concerned about the relaxing of social distancing leading to a second wave (median score = 6, IQR = 4–7). Physicians reported a consistently high ability to order COVID‐19 tests for patients (median score = 6, IQR = 5–7) and access to personal protective equipment (median score = 6, IQR = 5–6). Women physicians were more likely to score ≥ 3 than men on the PC‐PTSD‐5 screener on the initial survey (43.3% vs. 22.5%; Δ 20.8%, 95% confidence interval [CI] = 9.3% to 31.5%), and despite decreases in overall proportions, this discrepancy remained in follow‐up (34.7% vs. 16.8%; Δ 17.9%, 95% CI = 7.1% to 28.1%). In examining the relationship between demographics, living situations, and institution location on having a PC‐PTSD‐5 score ≥ 3, only female sex was associated with a PC‐PTSD‐5 score ≥ 3 (adjusted odds ratio = 2.48, 95% CI = 1.28 to 4.79). Conclusions: While exposure to suspected COVID‐19 patients was nearly universal, stress levels in emergency physicians decreased with time. At both initial and follow‐up assessments, women were more likely to test positive on the PC‐PTSD‐5 screener compared to men. [ABSTRACT FROM AUTHOR]

Background: Containment of the coronavirus disease 2019 (COVID‐19) pandemic requires the public to change behavior under social distancing mandates. Social media are important information dissemination platforms that can augment traditional channels communicating public health recommendations. The objective of the study was to assess the effectiveness of COVID‐19 public health messaging on Twitter when delivered by emergency physicians and containing personal narratives. Methods: On April 30, 2020, we randomly assigned 2,007 U.S. adults to an online survey using a 2 × 2 factorial design. Participants rated one of four simulated Twitter posts varied by messenger type (emergency physician vs. federal official) and content (personal narrative vs. impersonal guidance). The main outcomes were perceived message effectiveness (35‐point scale), perceived attitude effectiveness (PAE; 15‐point scale), likelihood of sharing Tweets (7‐point scale), and writing a letter to their governor to continue COVID‐19 restrictions (write letter or none). Results: The physician/personal (PP) message had the strongest effect and significantly improved all main messaging outcomes except for letter writing. Unadjusted mean differences between PP and federal/impersonal (FI) were as follows: perceived messaging effectiveness (3.2 [95% CI = 2.4 to 4.0]), PAE (1.3 [95% CI = 0.8 to 1.7]), and likelihood of sharing (0.4 [95% CI = 0.15 to 0.7]). For letter writing, PP made no significant impact compared to FI (odds ratio = 1.14 [95% CI = 0.89 to 1.46]). Conclusions: Emergency physicians sharing personal narratives on Twitter are perceived to be more effective at communicating COVID‐19 health recommendations compared to federal officials sharing impersonal guidance. [ABSTRACT FROM AUTHOR]

In the article, the authors leverage a public opinion survey to assess the differences between emergency department (ED) and urgent care (UC) users for low-acuity health needs. Also cited are how UC centers or retail clinics are better alternatives for low-acuity complaints than EDs, as well as the independent variables on the use of ED or UC like household income, health insurance, and chronic illnesses.

The article discusses frequent use of the emergency departments (EDs) which remains a prominent issue in emergency medicine for its potential to contribute to ED overcrowding and increased health care costs. It mentions research by examining frequent ED use by sexual orientation using nationally representative data.

Abstract: Background: Acute aortic dissection (AAD) is a rare condition with a high mortality that is often missed. The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and in a low‐risk control group. Methods: This was a historical matched case–control study: participants were adults > 18 years old presenting to two tertiary care emergency departments (EDs) or one regional cardiac referral center. Cases were patients with new ED or in‐hospital diagnosis of nontraumatic AAD confirmed by computed tomography or echocardiography. Controls were patients with a triage diagnosis of truncal pain (<14 days) and an absence of a clear diagnosis on basic investigation. Cases and controls were matched in a 1:4 ratio by sex and age. A sample size of 165 cases and 660 controls was calculated based on 80% power and confidence interval of 95% to detect an odds ratio of greater than 2. Results: Data were collected from 2002 to 2014 yielding 194 cases of AAD and 776 controls (mean ± SD age = 65 ± 14.1 years; 66.7% male). Absence of abrupt‐onset pain (sensitivity = 95.9%, negative likelihood ratio = 0.07 [0.03–0.14]) can help rule out AAD. Presence of tearing/ripping pain (specificity = 99.7%, positive likelihood ratio [LR+] = 42.1 [9.9–177.5]), aortic aneurysm (specificity = 97.8%, LR+ = 6.35 [3.54–11.42]), hypotension (specificity = 98.7%, LR+ = 17.2 [8.8–33.6]), pulse deficit (specificity = 99.3, LR+ = 31.1 [11.2–86.6]), neurologic deficits (specificity = 96.9%, LR+ = 5.26 [2.9–9.3]), and a new murmur (specificity = 97.8%, LR+ = 9.4 [5.5–16.2]) can help rule in the diagnosis of AAD. Conclusions: Patients with one or more high‐risk feature should be considered high risk, whereas patients with no high‐risk and multiple low‐risk features are at low risk for AAD. [ABSTRACT FROM AUTHOR]