Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Artificial intelligence (AI) prediction is increasingly used for decision making in health care, but its application for adverse outcomes in emergency department (ED) patients with acute pancreatitis (AP) is not well understood. This study aimed to clarify this aspect. ⋯ The first real-time AI prediction model implemented in the HIS for predicting adverse outcomes in ED patients with AP shows favorable initial results. However, further external validation is needed to ensure its reliability and accuracy.
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Timely reperfusion is necessary to reduce morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI). Initial care by facilities with percutaneous coronary intervention (PCI) capabilities reduces time to reperfusion. We sought to examine whether insurance status was associated with initial care at emergency departments (EDs) with PCI capabilities among adult patients with STEMI. ⋯ Uninsured patients with STEMI had significantly lower odds of first receiving care at facilities with PCI capabilities. Our results suggest potential disparities in accessing high-quality and time-sensitive treatment for uninsured patients with STEMI.
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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. ⋯ 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.
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Primary aldosteronism (PA) is a common but underdiagnosed secondary cause of hypertension. Emergency departments (EDs) often assess patients with severe hypertension or its sequelae, some of whom have underlying PA. We aimed to determine the proportion of patients presenting to the ED with hypertension who meet the Endocrine Society criteria for PA testing and the proportion who were screened. ⋯ As far as we are aware, our study is the first to evaluate PA testing in hypertensive patients who present to ED. More than 40% of adults presenting to the EDs with hypertension met the current criteria for testing for PA but only few were tested. These results emphasize that increased awareness of PA in the ED is needed to encourage opportunistic testing, referral, and treatment, especially in patients who present with hypertensive emergencies. Prospective studies are required to determine the feasibility and effectiveness of this.
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Written a year and a half into the pandemic during a particularly difficult week, this poem explores the moral injury and emotional distress that emergency physicians encounter and must process daily. These repeated microtraumas throughout our day frequently contribute to depersonalization and it is important to recognize those factors that "break the routine" and help to improve physician well-being.