Use of HINTS exam in emergency department is of limited value
The HINTS exam, a bedside ocular motor test, is not accurate for central cause identification. The test is frequently misused in patients without nystagmus or intermittent symptoms.
Emergency Medicine
Articles tagged with Emergency Medicine
SARS-CoV-2 vaccination rates among US emergency department health care personnel
A surveillance project found high COVID-19 vaccine acceptance among physicians and advance practice providers, but lower rates among nurses and nonclinical healthcare workers. The authors suggest educating these groups about the vaccine's safety profile to enhance vaccination rates.
People with HIV at high risk for intimate partner violence
A new study finds that people with HIV who experienced intimate partner violence are more likely to engage in riskier behaviors and have poor adherence to HIV treatment. IPV is associated with increased depression, anxiety, and poor clinical outcomes, highlighting the need for screening and supportive services.
Urgent care centers deter some emergency department visits, but costs remain high
A recent study published in Health Affairs found that urgent care centers are associated with increased spending for lower-acuity visits across both emergency departments and urgent care centers. For every 37 urgent care visits, one fewer lower acuity ED visit occurs, but total costs increase rather than decrease.
Virtual "urgent care" may lead to higher rates of downstream follow-up care
A new study from Michigan Medicine found that patients who had virtual 'urgent care' visits for upper respiratory infections were more likely to receive additional follow-up care compared to those with in-person visits. This contradicts the expectation that virtual care would reduce downstream visits and emergency department use.
Lowder evaluating Recovery Works treatment program
A study is evaluating Recovery Works, a Indiana program focusing on pre-incarceration diversion and post-incarceration re-entry services to reduce recidivism by 20%. The research aims to assess the impact of services on health-related outcomes and recidivism rates among low-level offenders.
Nearly half of poison control calls for supersized alcopops involve underage drinkers
A new study found that 46.3% of US poison control center calls involving supersized alcopops were made by underage drinkers, posing a distinct threat to youth. The study highlights the need for better regulation and policies to limit the availability of these products.
Outpatient management following diagnosis of acute pulmonary embolism
A study of over 61,000 patients with acute pulmonary embolism found that disposition practices vary significantly between hospitals, resulting in high emergency department revisit rates. Most return visits did not lead to hospitalization, highlighting the need for standardized care and improved outpatient management protocols.
Study finds racial equity in crisis standard of care guidelines
A study found no racial disparities in simulated patient prioritization for resource allocation using crisis standards of care guidelines at two Miami hospitals. However, experts warn that further research is needed to ensure these guidelines do not disproportionately harm marginalized communities during public health crises.
Aspirin use may decrease ventilation, ICU admission and death in COVID-19 patients
Researchers found that low-dose aspirin reduced the need for mechanical ventilation, ICU admission, and in-hospital mortality in hospitalized COVID-19 patients. Aspirin use was associated with a decreased risk of these severe outcomes, including a 44% reduction in mechanical ventilation.
'Time lost is brain lost'
A new study finds that mobile stroke units (MSUs) improve patient outcomes and lessen the chance for disability by delivering care faster than standard stroke care. MSU patients received tPA treatment within 60 minutes, resulting in better outcomes and less disability.
Study finds lower dose of ketamine equally effective in reducing pain
A recent Loyola Medicine study found that reducing the standard dose of IV-administered ketamine in half is as effective as the larger dose in reducing pain in adults. The study involved 98 patients and showed similar results at 30 minutes, with lower adverse event rates in the low-dose group.
Hospital-based violence intervention program engages vulnerable populations
A hospital-based violence intervention program effectively engages vulnerable populations by addressing specific client needs. The study highlights the complexities of program attrition and altering life courses for victims of violence, emphasizing the need for targeted strategies to address upstream factors of community violence.
Study: Alcohol withdrawal rates among hospitalized patients rose 34% during COVID pandemic
A study found that alcohol withdrawal rates among hospitalized patients rose 34% during the COVID-19 pandemic. The study, conducted at ChristianaCare, suggests that hospital systems need to screen for and treat alcohol use withdrawal and refer patients for ongoing treatment.
Rapid administration of methoxyflurane versus standard care for pain management in the ED
A study published in Academic Emergency Medicine found that methoxyflurane administration resulted in lower pain scores compared to standard care. However, it did not achieve the desired substantial reduction in pain as prescribed.
Geriatric emergency departments associated with lower medicare expenditures
Specialized geriatric emergency care reduces hospitalizations and costs for Medicare beneficiaries, with savings ranging up to $2,905 after 30 days. The study found a significant reduction in total costs of care when patients were seen by transitional care nurses or social workers trained in geriatric emergency care.
Financial incentives for hospitals boost rapid changes to opioid use disorder treatment
Researchers found that financial incentives encouraged hospitals to enact rapid system and practice changes to support treatment for opioid use disorder. However, smaller or independent hospitals struggled to invest in resources due to internal barriers.
Findings of study comparing analgesics in acute post-trauma pain
Researchers found paracetamol alone is superior to high-dose NSAID alone for posttraumatic extremity pain. A study published in Academic Emergency Medicine shows taking paracetamol as a first-line therapy can effectively manage mild to moderate post-traumatic extremity pain after discharge from the emergency department.
Tool predicts which mini-strokes could lead to major strokes
A new Canadian TIA Score tool helps emergency physicians predict patients at greatest risk of having a major stroke within the week. The study showed the Canadian TIA Score accurately categorized patients into three risk groups, outperforming existing ABCD2 score.
Initiative gives rural EMS responders 24-hour access to emergency medicine physicians
The Arizona Rural EMS Advanced Telemedicine Demonstration Initiative (AzREADI) provides rural EMS responders with real-time consultations with board-certified EMS physicians. This improves the time from symptom onset to treatment, especially for stroke or traumatic brain injury cases.
Lack of ICU beds tied to thousands of excess COVID-19 deaths, Yale study finds
A Yale University study found that hospitals with fewer resources per COVID-19 patient were associated with more deaths in April 2020. The study showed a strong correlation between ICU bed availability and a one-fifth decrease in death incidence rate.
Lesbian, gay, bisexual medical students are more likely to experience burnout, study finds
A study found that lesbian, gay, and bisexual medical students experience higher rates of burnout compared to their heterosexual peers. LGB students reported frequent perceived mistreatment, leading to increased emotional strain and a higher likelihood of burnout.
Care delivery, cost reduction and quality improvement at heart of improving access to care
Research examines the role of transforming cardiovascular care in rural clinics, optimizing emergency room use, and successful adoption of virtual care. Studies show that hybrid models can provide more than 30% virtual care after COVID-19 restrictions lift, while also reducing unnecessary ER visits by 55.7%.
Racial, ethnic differences in diagnostic imaging at children's hospitals emergency departments
Researchers discovered racial and ethnic differences in diagnostic imaging for children at pediatric emergency departments in the United States. The study found that these disparities are not solely due to patient factors, but also reflect biases in healthcare providers' decision-making.
Nearly one in four families hesitant to take their child to ER during COVID-19 pandemic
A survey found nearly 1 in 4 families reluctant to bring their child to the Emergency Department for non-COVID emergencies, exacerbating health inequities. Greater hesitancy was observed in under-resourced communities, families of color, and those relying on public insurance.
In ED patients with chest and abdominal pain, care delivered by physicians and APPs is similar
A study published in Academic Emergency Medicine found that advanced practice providers (APPs) and emergency physicians deliver similar care to ED patients presenting with chest and abdominal pain. The authors recommend further research on the optimal use of APPs in the emergency department.
Age matters in identifying maltreatment in infants and young children with fractures
Children under 3 years old presenting with rib fractures are 77% likely to be abused; those under 18 months with humeral fractures show similar results. Diagnostic evaluation for abuse is recommended in these cases to minimize morbidity and mortality.
Fewer patient encounters drive decline in total primary care office visits
Over a 15-year period, the total number of unique patients seeing PCPs decreased by 2.5%, while frequency of contact dropped from 4.3 to 3.7 visits per patient, contributing to the primary care decline.
Researchers addressing anxiety as a root cause of chest pain and emergency department visits
A study aims to reduce return visits to ED by low-risk patients with anxiety-caused chest pain. Researchers will explore online and telehealth care delivery options for anxious patients.
Significant number of patients with sudden loss of consciousness need pre-hospital critical care
A significant number of patients with sudden loss of consciousness require pre-hospital critical care, according to a recent study. The research found that air ambulance dispatch teams can select patients needing HEMS-specific interventions and identify opportunities to improve triage.
Chest pain risk assessment may reduce treatment disparities
A standardized tool for assessing chest pain risk was associated with comparable care for high-risk women, while low- and intermediate-risk women received consistent care with guidelines. Despite less care, women had fewer reports of heart attacks or death within 30 days compared to men.
LOOP technique for I&D of abscesses in adults is safe, effective alternative to I&D with packing
The LOOP technique has been found to be a safe and effective alternative to traditional incision and drainage (I&D) with packing for treating subcutaneous abscesses in adults. In children, the technique resulted in significantly fewer failures compared to standard I&D techniques.
Researchers identify predictors of timely enrollment in treatment for opioid use disorder
Researchers analyzed Medicaid databases to identify predictors of timely enrollment in treatment for opioid use disorder among Medicaid recipients. Prior overdose, alcohol use disorder, and back problems were associated with non-enrollment, while frequent emergency room visits or primary care provider visits were linked to timely enrol...
Costs, COVID-19 risk and delays top older adults' concerns about seeking emergency care
A national poll of people aged 50 to 80 found that nearly one in four have visited an emergency department in the last two years due to cost, COVID-19 risk, or delays. Health providers can improve acute care by better supporting older adults during and after medical emergencies.
Study shows women less likely to survive out-of-hospital cardiac arrest than men
A study published in Circulation found that women are significantly less likely to survive out-of-hospital cardiac arrest compared to men. Women received therapeutic hypothermia and coronary angiography at lower rates, leading to a 22.5% survival rate compared to 36.3% for men.
Fewer than 2 percent of OB-GYN doctors can prescribe life-saving opioid treatment
Only 1.8% of US obstetrician-gynecologists have an X-waiver, allowing them to prescribe buprenorphine for opioid addiction. Rural areas and cities with high neonatal abstinence syndrome rates have higher X-waiver rates among OB-GYNs.
Advance care planning may influence place of death, avoid dying in hospital
A study of 21,231 UK urgent care register records found that advance care planning significantly influenced the place of death, with patients who had recorded preferences dying at home or in their chosen setting. Patients without a recorded preference were more likely to die in hospital.
Research shows disparities in how communities respond to cardiac arrest
Researchers at UTHealth analyzed data from over 18,000 out-of-hospital cardiac arrests to identify disparities in automated external defibrillator use. Hispanic/Latino and black neighborhoods showed significantly lower rates of AED use compared to non-Hispanic/Latino white communities.
329 people injured by firearms in US each day, but for every death, 2 survive
A new study reveals an average of 120,232 firearm injuries per year in the US, with nonfatal cases being twice as prevalent as deaths. The research highlights the need for effective prevention strategies beyond just addressing fatal injuries.
Study shows minimal impact of APPs on ED productivity, flow, safety, patient experience
Advanced practice providers (APPs) have lower productivity compared to emergency department physicians, but no apparent impact on patient satisfaction and safety metrics. The study suggests that APPs can be effectively integrated into EDs with staffing models accounting for their lower productivity.
Minorities benefit less from regionalizing heart attack care
A new study by UC San Francisco researchers found that California's Black and Hispanic communities received less benefit from regionalized heart attack care protocols. Despite improved access to PCI-capable hospitals, survival rates remained unchanged for minority groups, whereas whites in non-minority communities showed better outcomes.
Lung ultrasound training to help rural emergency medicine providers diagnose COVID-19
The University of Arizona College of Medicine is developing a lung ultrasound education program for rural emergency medicine providers to better diagnose COVID-19. Lung ultrasound can be particularly useful in rural EDs due to limited access to COVID-19 testing and the disparate impact of COVID-19 on rural populations.
EMS dispatches for asthma greatly reduced after expanded access to health insurance
A study by Massachusetts General Hospital found that expanded access to health insurance significantly reduced ambulance dispatches for asthma emergencies in New York City. Improved access to outpatient management of the chronic condition is believed to be the likely reason for this decline.
November/December 2020 Annals of Family Medicine tip sheet
Research finds that buprenorphine therapy in primary care can be financially sustainable, with rural practices and physician-led treatment generating the most revenue. Effective hearing loss screening also shows promise, with increased referral rates to audiology specialists leading to improved health outcomes.
Six ways primary care "medical homes" are lowering health care spending
Patient clinical data leverages reduce healthcare spending and utilization by reminding patients for preventive services, setting health goals, and improving quality improvement. Practices with targeted outreach and population health monitoring also see lower Medicare spending and utilization
ACA results in fewer low-income uninsured, but non-urgent ER visits haven't changed
A recent study by Washington State University's Bidisha Mandal found that the Affordable Care Act's Medicaid expansion program has reduced the number of uninsured low-income residents, particularly in rural areas. However, the likelihood of repeated emergency room visits for non-urgent reasons has not decreased.
Emergency care doctors not getting sufficient 'down time', new study shows
A survey of over 4,000 UK emergency care doctors found their median average 'need for recovery' score was 70, higher than previous studies. Factors like reducing antisocial shift patterns and improving access to leave could help alleviate wellbeing issues.
COVID-19 news from Annals of Internal Medicine
The American College of Physicians publishes COVID-19 news from Annals of Internal Medicine. Experts from the University of Pennsylvania and NYU Grossman School of Medicine discuss the legal, ethical, and clinical ramifications of restricting patient access to EUA-approved COVID-19 drugs and vaccines.
Study suggests increased risk of restraint use in black patients in the emergency setting
A recent study published in Academic Emergency Medicine found that Black patients are more likely to experience restraint use in emergency settings compared to white patients. The study also identified higher rates of restraint among homeless patients and those with public insurance or no insurance.
Mobile smartphone technology is associated with better clinical outcomes for OHCA
A study published in Academic Emergency Medicine found that mobile smartphone technology can improve out-of-hospital cardiac arrest (OHCA) survival. The 'Staying Alive' app, which alerts trained responders to nearby cardiac arrest victims, was found to reduce response times and potentially improve outcomes.
Dr. Thea James receives Social Emergency Medicine Lifetime Achievement Award
Dr. Thea James has been recognized with the inaugural Dr. Thea James Social Emergency Medicine Lifetime Achievement Award, created in her honor. The award recognizes her outstanding contribution to advancing social emergency medicine and improving health equity through her work.
NEJM: clinical trial indicates monoclonal antibody lowered hospitalizations and emergency visits
A Phase II clinical trial found that LY-CoV555, a monoclonal antibody, lowered viral load and reduced hospitalization rates in outpatients with mild to moderate COVID-19. The treatment was effective across all demographic groups, including high-risk patients.
Researchers present findings on role of google search early in COVID-19 pandemic
A study by George Washington University researchers analyzed Google Trends data to assess public perception of COVID-19 exposure and disease prevalence. The team found that specific queries related to testing and diagnosis were associated with higher SVI values in states with the highest COVID-19 cases.
Risk score predicts prognosis of outpatients with COVID-19
A new AI-based tool, CoVA, has been developed to predict the prognosis of patients with COVID-19, identifying those at highest risk for complications. The tool was tested on over 9,381 adult outpatients and demonstrated excellent performance in predicting hospitalization, critical illness, or death within seven days.
COVID-19 recovery at home possible for most patients
A new study published in Journal of the American College of Emergency Physicians Open confirms that most patients with COVID-19 symptoms can recover safely at home. The study found that none of the patients died and fewer than 1% required intensive care.
WVU receives $1.2 million telehealth grant to connect rural ERs with medical specialists
West Virginia University has received a $1.2 million grant to establish telehealth connections between rural emergency departments and medical specialists. The program aims to provide acute, emergent subspecialty care in rural areas, reducing the need for hospital transfers and readmissions.
Antacid monotherapy more effective in relieving epigastric pain than in combination with lidocain
A double-blind, randomized clinical trial found antacid monotherapy to be the most palatable solution and had fewer side effects compared to antacid/lidocaine combinations. Antacid monotherapy was also found to be equally efficacious in relieving epigastric pain as lidocaine/antacid combination therapy.
Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
A digital alarm clock streamlined time-sensitive acute stroke care, reducing neurological examination completion times to 7.28 minutes compared to 10 minutes without the clock. However, its impact on long-term outcomes remains uncertain, with further research needed to determine its effectiveness.
Waste generation by hospital emergency departments is highlighted for first time
A study published in the Western Journal of Emergency Medicine found that 85% of medical waste does not meet regulated standards for disposal. By implementing changes such as reusable devices, better sorting of infectious waste, and effective recycling, hospitals can reduce waste while saving costs. The study suggests that hospitals co...
Phone system for assessing chest troubles is unsafe and unreliable
A semi-automatic phone triage system designed to help people with chest discomfort during out-of-hours periods has been found to be unsafe and unreliable. The system underestimated the severity of more than a quarter of patients with serious heart conditions, highlighting the need for input from nurses to ensure accurate assessment.