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Original Article

Emergency Medical Services

Declining Ambulance Offload Delays and Stabilised Emergency Department Length of Stay Post-COVID: An Interrupted Time Series Analysis
Edward Stacey, Liam Hemingway, Gabriel E. Blecher, Cameron M. Gosling, Clifford Connell, Nadine Andrew, Brendan Shannon
In Press, Received October 2, 2025  Accepted February 22, 2026  Available online April 3, 2026  
DOI: https://doi.org/10.15441/ceem.25.240    [Accepted]

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Declining Ambulance Offload Delays and Stabilised Emergency Department Length of Stay Post-COVID: An Interrupted Time Series Analysis
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Declining Ambulance Offload Delays and Stabilised Emergency Department Length of Stay Post-COVID: An Interrupted Time Series Analysis
Close
Objective
Ambulance offload delays and emergency department [ED] crowding worsened during COVID-19 and remain critical in Victoria, where <62 % of ambulances offload on time. Evidence on post-pandemic trends is limited. We analysed offload delays and ED length of stay [LOS] at a major Melbourne health service [Jan 2018–Aug 2024] across three periods: pre-COVID, during COVID and post-COVID, stratified by admission status.
Methods
Monthly median offload times and ED LOS were examined using interrupted time-series models to detect level and slope changes.
Results
Among 529 261 presentations, median offload times for non-admitted patients increased 12.7 min at the post-COVID transition then fell 0.62 min per month, ending below pre-COVID projections. Admitted patients showed a median 14.2 min increase and a 0.73 min per month decline. ED LOS median time rose post-COVID by 53.6 min for non-admitted and 124.8 min for admitted patients. Thereafter, non-admitted patient LOS declined, whereas admitted patient LOS remained persistently elevated and stabilised at a high level.
Conclusions
Although ambulance offload delays have improved, now below pre-COVID counterfactual levels, emergency department length of stay remains elevated particularly for admitted patients. Targeted interventions such as dedicated offload staff, real-time bed management, and streamlined discharge pathways are needed to address persistent emergency department crowding.
  • 1,251 View
  • 55 Download

Review Article

Pain Management & Sedation

Pain management in the emergency department: a clinical review
Sergey M. Motov, Katherine Vlasica, Igor Middlebrook, Alexis LaPietra
Clin Exp Emerg Med 2021;8(4):268-278.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.161

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Pain management in the emergency department: a clinical review
Clin Exp Emerg Med. 2021;8(4):268-278.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.161
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Pain management in the emergency department: a clinical review
Clin Exp Emerg Med. 2021;8(4):268-278.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.161
Close
Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

Citations

Citations to this article as recorded by  Crossref logo
  • Intranasal Versus Subcutaneous Ketamine for the Treatment of Acute Traumatic Pain in the Emergency Department: A Randomized Clinical Trial
    Randa Dhaoui, Cyrine Kouraichi, Marwa Toumia, Khaoula Bel Haj Ali, Adel Sekma, Rahma Jaballah, Hajer Yaakoubi, Lotfi Boukadida, Kaouthar Beltaief, Zied Mezgar, Mariem Khrouf, Amira Sghaier, Nahla Jerbi, Imen Zemni, Wahid Bouida, Mohamed Habib Grissa, Jame
    Annals of Emergency Medicine.2026; 88(3): 314.     CrossRef
  • Retrospective Study on Pain Reports and Treatments at Sexual Assault Medical Forensic Examinations: Clinical Practice Implications
    Leslie W. Miles, Julie L. Valentine, Alyssa Hildt Moxley, Abby Anderson Cullimore, Bob Wong
    Journal of Forensic Nursing.2026; 22(1): E33.     CrossRef
  • IDENTIFICAÇÃO DO PERFIL DE DOR E ANALGESIA EM PACIENTES ADULTOS NA EMERGÊNCIA EM UM HOSPITAL NO SUL DE SANTA CATARINA
    Rosilda Ribeiro Cardozo , Larissa Rocha Mejía Giessel , Monica Paulina Kruk , Maria Clara Ribeiro Cardozo , Fabiana Schuelter-Trevisol
    Arquivos Catarinenses de Medicina.2026; 54(3): 83.     CrossRef
  • Ketamine for acute and chronic pain: beyond anaesthesia
    Hao G. Duong, Tariq G. Pulskamp, Daniel J. Berlau
    Pain Management.2026; 16(5): 523.     CrossRef
  • Defining the need for analgesia in the emergency department: an international consensus statement
    Barbara Scotti, Christian H. Nickel, Bojana Degen, Olivier Hugli, Sandy Jean-Scherb, Lucrezia Rovati, Monika Kirsch, Fiona C. Sampson, Gernot Mayer, Heike Thomys, Bruno Minotti
    European Journal of Emergency Medicine.2026; 33(3): 176.     CrossRef
  • Managing Pediatric Pain in Low-Resource Emergency Settings: Barriers, Advances, and Future Directions
    Mohammed Alaswad, Eslam Abady, Elsayed S. Moubarak, Mayar M. Aziz, Shree Rath, Olalekan John Okesanya, Mohammed Alsabri
    Sage Open Pediatrics.2026;[Epub]     CrossRef
  • Osteopathic manipulative treatment vs. standard therapy in the management of acute neck and low back pain in the emergency department
    Steven M. Hochman, Katherine Vlasica, Alexis LaPietra, Bhargavi K. Patel, Christine Ju, Nicholas J. Mota, Scott Wilder
    Journal of Osteopathic Medicine.2026; 126(9): 431.     CrossRef
  • Updated European Society for Emergency Medicine Guidelines for acute pain management in emergency departments and prehospital care
    Saïd Hachimi-Idrissi, Viliam Dobias, Wolf E. Hautz, Robert Leach, Carlos Lojo Rial, Thomas C. Sauter, Idanna Sforzi, Frank Coffey
    European Journal of Emergency Medicine.2026; 33(3): 152.     CrossRef
  • Influencing factors of pain management knowledge and attitudes among emergency nurses in China: a cross-sectional study
    Qin Jiang, Junjie Zhao, Rong Wu
    Frontiers in Public Health.2026;[Epub]     CrossRef
  • Acute pain management in older adults presenting to the emergency department: a clinical review
    Sirasa Kampan, Kwannapa Thong-on, Kanokporn Pongvirat, Monalin Veeraditthakij, Jiraporn Sri-on
    Singapore Medical Journal.2026; 67(4): 211.     CrossRef
  • A novel nerve block and anatomy workshop for emergency medicine residents: A pilot study
    Geoffery D. Fernquist, Derek Harmon, Lauren D. Branditz, Andrew Kendle, Melissa M. Quinn
    Anatomical Sciences Education.2026; 19(7): 1191.     CrossRef
  • The First Strike
    Ariel M. Baria
    Physical Medicine and Rehabilitation Clinics of North America.2026; 37(3): 451.     CrossRef
  • Intranasal ketamine versus intravenous opioids for acute pain in the emergency department: A scoping review
    Hannah Downing, D. Kristy Asbell, Erika McCarthy, Jason Brumitt
    The American Journal of Emergency Medicine.2026; 108: 26.     CrossRef
  • Approach to the Agitated or Violent Trauma Patient
    Sheaffer Gilliam
    Emergency Medicine Clinics of North America.2026;[Epub]     CrossRef
  • Does Early Opioid Use for Relief of Acute Abdominal Pain Increase Use of Abdominal CT or Prolong Emergency Department Length of Stay?
    Ben Bloom, Christie Fritz, Shivani Gupta, Jason Pott, Imogen Skene, Raine Astin-Chamberlain, Carlo L. Rosen, Stephen H. Thomas, Giulio Mari
    Emergency Medicine International.2026;[Epub]     CrossRef
  • Non-pharmacological Interventions for Pain-Related Anxiety and Distress in Emergency Department Patients: A Systematic Review With Narrative Synthesis
    Afnan M Hamed , Reem E Elshaikh, Amer A Laradhi, Ahmad M Fnjan, Anas M Berro, Asim Ahmed, Rayan Saeed
    Cureus.2026;[Epub]     CrossRef
  • Rise of Regional Anesthesia in Emergency Medicine: A Bibliometric Analysis of Global Research Trends and Collaborative Networks
    Abhijit Nair, Badar Al Hamrashdi, Tuhin Mistry, Ahmed Al-Jabri
    Cureus.2026;[Epub]     CrossRef
  • Emergency Physician Perceptions and Experiences in Acute Pain Management: A Qualitative Interview Study
    Scott J. Keating, Ann M. Menzie, KD Jacobs, Lauren A. Crowder, Kelly L. Johnston, Scott G. Weiner
    JACEP Open.2026; 7(5): 100485.     CrossRef
  • Tratamiento farmacológico del dolor agudo en urgencias en un hospital de Colombia
    Jhon Andrés Díaz Pérez, Juan Jacobo Gutierrez Hurtado, Olga Alicia Nieto Cárdenas
    Revista Salud Bosque.2025; 14(2): 1.     CrossRef
  • Adolescents’ and Parents’ Perspectives on Using the MedSMARxT Families Intervention in Emergency Departments for Opioid Medication Safety Education: Mixed Methods Study
    Olufunmilola Abraham, Sara Nadi, Irene Hurst
    JMIR Serious Games.2025; 13: e68814.     CrossRef
  • Variations in Prehospital Analgesic Use Based on Pain Etiology
    Nikolina Marić, Radojka Jokšić-Mazinjanin, Aleksandar Đuričin, Luka Ivanišević, Goran Rakić, Zoran Gojković, Mirka Lukić Šarkanović, Milena Jokšić Zelić, Lucija Vasović, Velibor Vasović
    Biomedicines.2025; 13(7): 1620.     CrossRef
  • Safety and effectiveness of opioid use in adult patients presenting to emergency services with suspected acute appendicitis: a protocol for a systematic review of the literature and network meta-analysis
    Sergio Arciniegas, Jorge Acosta-Reyes, Juan Jose Espitia de la Hoz, Stephania Arias-Rodriguez, Luis Jose Cotes-Mendoza, Ivan D Florez
    BMJ Open.2025; 15(8): e102525.     CrossRef
  • Radiofrequency Ablation and Pulsed Radiofrequency of Suprascapular Nerves for Managing Chronic Shoulder Pain
    Alaa Abd-Elsayed, Tristan R. Argall, Lukas J. Henjum, Dustin M. McKindsey, Nathan A. Perkins, Kenneth J. Fiala
    Brain Sciences.2025; 15(9): 915.     CrossRef
  • Acute Pain Management in the Emergency Department of Essos Hospital Centre: A Leading-Edge Care Model in a High-Reference Hospital in Central Africa
    Serge Vivier Nga Nomo, Charles Emmanuel Toussaint Binam Bikoi, Aristide Gilles Kuitchet Njeunji, Cristella Raissa Iroume Bifouna, Amos Kounde, Bonaventure Jemea, Fidèle Binam
    Open Journal of Emergency Medicine.2025; 13(01): 44.     CrossRef
  • Influences of Software Changes on Oxycodone Prescribing at an Australian Tertiary Emergency Department: A Retrospective Review
    Giles Barrington, Katherine Davis, Zach Aandahl, Brodie-Anne Hose, Mitchell Arthur, Viet Tran
    Pharmacy.2024; 12(2): 44.     CrossRef
  • The use and outcomes of non-pharmacological analgesia in the adult emergency department
    Aisha Amzaidy M. Assiry, Nathan J. Brown, Sarah Hazelwood, Anna-Lisa Lyrstedt, Rajeev Jarugula, Lee Jones, Kevin Chu, James A. Hughes
    International Emergency Nursing.2024; 74: 101458.     CrossRef
  • Tramadol use in U.S. Adults With Commercial Health Insurance, 2005–2021
    Christopher Andrew Basham, Heba Edrees, Krista F. Huybrechts, Catherine S. Hwang, Brian T. Bateman, Katsiaryna Bykov
    American Journal of Preventive Medicine.2024; 67(4): 558.     CrossRef
  • Renaissance of Ketamine
    Kinga Kocur, Katarzyna Camlet, Anna Ziobro, Mateusz Ziomek, Wojciech Kaźmierski, Paulina Lis, Jakub Jurek, Anna Lis
    Prospects in Pharmaceutical Sciences.2024; 22(3): 156.     CrossRef
  • Caracterizacion y manejo de los pacientes que consultan por dolor agudo en un servicio de urgencias
    Johana Carolina Oliveros M., Carlos Alberto Duque, Gloria Angelica Vanegas R.
    Revista Chilena de Anestesia.2023; 52(6): 570.     CrossRef
  • Acupuncture is a feasible alternative to procedural sedation for shoulder reduction in the emergency department
    Kyle Ackerman, Alexandra Atkins, Adrian Robles, Garrett Prince, Lisa Seaman, Frank Yurasek, Mark B. Mycyk
    The American Journal of Emergency Medicine.2023; 74: 196.e5.     CrossRef
  • Patterns of Use of Nonsteroidal Anti-Inflammatory Analgesic Drugs in Emergency Room Pharmacy Services at Regional Hospitals. Dr. Pirngadi Medan
    Fidiah Suryaningsih, Darwin Syamsul, Peri Aisyah Zubaidi
    Jurnal Indah Sains dan Klinis.2023; 4(3): 12.     CrossRef
  • 10.1016/s1959-5182(23)46578-6

    CrossRef Listing of Deleted DOIs.2000;[Epub]     CrossRef
  • 41,117 View
  • 700 Download
  • 25 Web of Science
  • 32 Crossref

Original Articles

Critical Care

In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
Gabriele Valli, Elisabetta Galati, Francesca De Marco, Chiara Bucci, Paolo Fratini, Elisa Cennamo, Carlo Ancona, Nicola Volpe, Maria Pia Ruggieri
Clin Exp Emerg Med 2021;8(4):325-332.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.020

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In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
Clin Exp Emerg Med. 2021;8(4):325-332.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.020
Download Citation

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In-hospital mortality in the emergency department: clinical and etiological differences between early and late deaths among patients awaiting admission
Clin Exp Emerg Med. 2021;8(4):325-332.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.21.020
Close
Objective
Given that there are no studies on diseases that occur by waiting for hospitalization, we aimed to evaluate the main causes of death in the emergency room (ER) and their relationship with overcrowding.
Methods
Patients who died in the ER in the past 2 years (pediatrics and trauma victims excluded) were divided into two groups: patients who died within 6 hours of arrival (emergency department [ED] group) and patients who died later (LD group). We compared the causes of death, total vital signs, diagnostic tests performed, and therapy between the groups. We assessed for possible correlation between the number of monthly deaths per group and four variables of overcrowding: number of patients treated per month, waiting time before medical visit (W-Time), mean intervention time (I-Time), and number of patients admitted to the ward per month (NPA).
Results
During the two years, 175 patients had died in our ER (52% in ED group and 48% in LD group). The total time spent in the ER was, respectively, 2.9±0.2 hours for ED group and 17.9± 1.5 hours for LD group. The more frequent cause of death was cardiovascular syndrome (30%) in ED group and sepsis (27%) and acute respiratory failure (27%) in LD group. Positive correlations between number of monthly deaths and W-Time (R2 0.51, P<0.001), I-Time (R2 0.73, P< 0.0001), and NPA (R2 0.37, P<0.01) were found only in LD group.
Conclusion
Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients.

Citations

Citations to this article as recorded by  Crossref logo
  • Non-Surgical Causes of Death in the Emergency Department: A Five-Year Monocentric Clinicopathological Study
    Adrian-Iosif Moldoveanu, Diana Maria Orzata, Gabriel Veniamin Cozma, Radu Gheorghe Dan, Ovidiu Alexandru Mederle, Flavia Zara
    Medicina.2026; 62(2): 293.     CrossRef
  • Using space technology approach to improve quality in emergency departments in India: a quality improvement program
    Saravana Kumar, Gunaseelan Vikneswaran, Jitendra Suryavamshi, Srinath Kumar, Manzoor Shaik, G K Reshma, M R Suresh, Alben Sigamani, V C Shanmuganandan, Alexander Thomas, A N Venkatesh, Imron Subhan, M Rajadurai, Sateesh Kumar Kailasam, B Nivetha, K U Sham
    International Journal for Quality In Health Care.2026;[Epub]     CrossRef
  • Standardized Perioperative Protocols Are Associated With Reduced Length of Stay and Readmission in Cushing Disease: Results From the Multicenter RAPID Study
    Carter M. Suryadevara, Jorge E. Salcedo-Sifuentes, Andrew S. Little, Kevin C. J. Yuen, Michelle Magana Mendoza, Paul Gardner, Georgios Zenonos, Julie M. Silverstein, Albert H. Kim, James J. Evans, Garni Barkhoudarian, Juan C. Fernandez-Miranda, William T.
    Neurosurgery.2026;[Epub]     CrossRef
  • Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department
    Gioacchino Galardo, Luca Crisanti, Andrea Gentile, Marco Cornacchia, Francesca Iatomasi, Iacopo Egiddi, Emanuele Puscio, Danilo Menichelli, Francesco Pugliese, Daniele Pastori
    Internal and Emergency Medicine.2025; 20(2): 553.     CrossRef
  • Diagnostic performance of S100B assay for intracranial hemorrhage detection in patients with mild traumatic brain injury under antiplatelet or anticoagulant therapy
    Paul-André Poislane, Mathilde Papin, Damien Masson, Nicolas Goffinet, Arthur David, Quentin Le Bastard, Hugo De Carvalho
    Scientific Reports.2025;[Epub]     CrossRef
  • Invited Editorial: Waiting Room Care is Not the Solution to Emergency Department Boarding
    Andrew J. Bouland, Juan A. March
    JACEP Open.2025; 6(3): 100161.     CrossRef
  • Shortening emergency department length of stay: Fast track, short-stay unit and acute medical unit
    Bei Huang
    Exploratory Research in Clinical and Social Pharmacy.2025; 19: 100626.     CrossRef
  • Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting
    Mia Werrett, Joanna McIlveen, Mim Fox
    Hospitals.2025; 2(3): 15.     CrossRef
  • OrthoMortPred: Predicting one-year mortality following orthopedic hospitalization
    Filipe Ricardo Carvalho, Paulo Jorge Gavaia, António Brito Camacho
    International Journal of Medical Informatics.2024; 192: 105657.     CrossRef
  • Comment on: "30 days mortality prognostic value of POCT bio-adrenomedullin and proenkephalin in patients with sepsis in the emergency department"
    Gabriele VALLI, Francesca DE MARCO, Silvia CASALBONI, Maria P. RUGGIERI
    Italian Journal of Emergency Medicine.2023;[Epub]     CrossRef
  • Can Acute Care Biomarkers Change Patient’s Management in Sepsis?
    Salvatore Di Somma, Luca Crisanti
    Eurasian Journal of Emergency Medicine.2022; 21(2): 79.     CrossRef
  • Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience
    Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli
    Acute and Critical Care.2022; 37(4): 644.     CrossRef
  • 30 Days Mortality Prognostic Value of POCT Bio-Adrenomedullin and Proenkephalin in Patients with Sepsis in the Emergency Department
    Silvia Casalboni, Gabriele Valli, Ferdinando Terlizzi, Marina Mastracchi, Giacomo Fidelio, Francesca De Marco, Caterina Bernardi, Anastasia Chieruzzi, Alessia Curcio, Francesco De Cicco, Nicola Colella, Ilaria Dafne Papasidero, Emanuele Tartarone, Maria P
    Medicina.2022; 58(12): 1786.     CrossRef
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    Sookyung Park, Hansol Chang, Weon Jung, Se Uk Lee, Sung Yeon Hwang, Hee Yoon, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Taerim Kim
    BMC Health Services Research.2022;[Epub]     CrossRef
  • Utility of Measuring Circulating Bio-Adrenomedullin and Proenkephalin for 30-Day Mortality Risk Prediction in Patients with COVID-19 and Non-COVID-19 Interstitial Pneumonia in the Emergency Department
    Ilaria Dafne Papasidero, Gabriele Valli, Dario Marin, Alberto Del Sasso, Antonio De Magistris, Elisa Cennamo, Silvia Casalboni, Francesca De Marco, Roberta Rocchi, Brice Ndogmo Beumo, Valeria Cusani, Mariarosa Gaudio, Oliver Hartmann, Andreas Bergman, Mar
    Medicina.2022; 58(12): 1852.     CrossRef
  • Usefulness of High-Sensitivity Troponin I in Risk Stratification and Final Disposition of Patients with Acute Heart Failure in the Emergency Department: Comparison between HFpEF vs. HFrEF
    Luca Crisanti, Gabriele Valli, Elisa Cennamo, Alessandro Capolino, Paolo Fratini, Claudio Cesaro, Gloria Adducchio, Antonio De Magistris, Ferdinando Terlizzi, Maria Pia Ruggieri, Enrico Mirante, Claudio Savoriti, Kalyarat Sukruang, Valentina Valeriano, Fr
    Medicina.2022; 59(1): 7.     CrossRef
  • 11,419 View
  • 223 Download
  • 14 Web of Science
  • 16 Crossref
A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Manita Thodphetch, Boriboon Chenthanakij, Borwon Wittayachamnankul, Kamphee Sruamsiri, Theerapon Tangsuwanaruk
Clin Exp Emerg Med 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145

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A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Clin Exp Emerg Med. 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145
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A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection
Clin Exp Emerg Med. 2021;8(4):289-295.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.145
Close
Objective
We aimed to compare the modified National Early Warning Score (mNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, modified Systemic Inflammatory Response Syndrome (mSIRS) score, and modified Search Out Severity (mSOS) score in predicting mortality and sepsis among patients suspected of first observed infections in the emergency department. The modified scores were created by removing variables for simplicity.
Methods
This was a prospective cohort study that enrolled adult patients presenting at the emergency department with signs and symptoms suggesting infection. The mNEWS, qSOFA score, mSIRS score, and mSOS score were calculated using triage data. The SOFA score was a reference standard for sepsis diagnosis. All patients were monitored for up to 30 days after the initial visit to measure each scoring system’s ability to predict 30-day mortality and sepsis.
Results
There were 260 patients included in the study. The 30-day mortality prediction with mNEWS ≥5 had the highest sensitivity (91.18%). The highest area under the receiver operating characteristic curve (AUC) for the 30-day mortality prediction was mNEWS (0.607), followed by qSOFA (0.605), mSOS (0.550), and mSIRS (0.423). The sepsis prediction with mNEWS ≥5 had the highest sensitivity (96.48%). The highest AUC for the sepsis prediction was also mNEWS (0.685), followed by qSOFA (0.605), mSOS (0.480), and mSIRS (0.477).
Conclusion
mNEWS was an acceptable scoring system screening tool for predicting mortality and sepsis in patients with a suspected infection.

Citations

Citations to this article as recorded by  Crossref logo
  • Early Recognition of Sepsis in Prehospital Settings
    William C. Tirado
    Advanced Emergency Nursing Journal.2025; 47(2): 152.     CrossRef
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    German Alberto Devia-Jaramillo, Lilia Erazo-Guerrero, Vivian Laguado-Castro, Juan Manuel Alfonso-Parada
    Journal of Clinical Medicine.2025; 14(14): 4869.     CrossRef
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    Wisanu Wanlumkhao, Duangduan Rattanamongkolgul, Chatchai Ekpanyaskul
    Antibiotics.2025; 14(7): 708.     CrossRef
  • Predictive performance of clinical scores and survival outcomes in critically ill patients with sepsis: a prospective longitudinal study at a tertiary medical centre in Ethiopia
    Girum Tesfaye Kiya, Zeleke Mekonnen, Elsah Tegene Asefa, Edosa Kejela, Edosa Tadasa, Esayas Kebede Gudina, Tilahun Yemane, Gemeda Abebe
    PeerJ.2025; 13: e20109.     CrossRef
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    Dejana Bajic, Milica Plazacic, Andrea Mihajlovic
    Srpski arhiv za celokupno lekarstvo.2025; 153(11-12): 542.     CrossRef
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    Venkat Reddy, Harshitha Reddy, Rinkle Gemnani, Sunil Kumar, Sourya Acharya
    Cureus.2024;[Epub]     CrossRef
  • Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department
    Rex Pui Kin Lam, Zonglin Dai, Eric Ho Yin Lau, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer
    World Journal of Emergency Medicine.2024; 15(4): 273.     CrossRef
  • Evaluating the Accuracy of the SIL Score for Predicting the Sepsis Mortality in Emergency Department Triages: A Comparative Analysis with NEWS and SOFA
    German Devia Jaramillo, Lilia Erazo Guerrero, Natalia Florez Zuñiga, Ronal Mauricio Martin Cuesta
    Journal of Clinical Medicine.2024; 13(24): 7787.     CrossRef
  • SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis
    Xia Qiu, Yu-Peng Lei, Rui-Xi Zhou
    Expert Review of Anti-infective Therapy.2023; 21(8): 891.     CrossRef
  • Prognostic Performance of Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation III, and Simplified Acute Physiology Score II Scores in Patients with Suspected Infection According to Intensive Care Unit Type
    Sung-Yeon Hwang, In-Kyu Kim, Daun Jeong, Jong-Eun Park, Gun-Tak Lee, Junsang Yoo, Kihwan Choi, Tae-Gun Shin, Kyuseok Kim
    Journal of Clinical Medicine.2023; 12(19): 6402.     CrossRef
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    Megan De Silva, William Chadwick, Navindhra Naidoo
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2023;[Epub]     CrossRef
  • A quick Sequential Organ Failure Assessment–negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry
    Heesu Park, Tae Gun Shin, Won Young Kim, You Hwan Jo, Yoon Jung Hwang, Sung-Hyuk Choi, Tae Ho Lim, Kap Su Han, Jonghwan Shin, Gil Joon Suh, Gu Hyun Kang, Kyung Su Kim
    Clinical and Experimental Emergency Medicine.2022; 9(2): 84.     CrossRef
  • Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department
    Ken Dewitte, Elyne Scheurwegs, Sabrina Van Ierssel, Hilde Jansens, Karolien Dams, Ella Roelant
    International Journal of Emergency Medicine.2022;[Epub]     CrossRef
  • 16,126 View
  • 341 Download
  • 15 Web of Science
  • 13 Crossref

Procedures | Pain Management & Sedation

Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study
Erdal Tekin, Muhammed Enes Aydin, Mehmet Cenk Turgut, Selahattin Karagoz, Irem Ates, Elif Oral Ahiskalioglu
Clin Exp Emerg Med 2021;8(4):307-313.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.136

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Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study
Clin Exp Emerg Med. 2021;8(4):307-313.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.136
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Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study
Clin Exp Emerg Med. 2021;8(4):307-313.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.136
Close
Objective
Ultrasound-guided infraclavicular nerve block (IB) has become a well-established method in several outpatient procedures; however, its use in emergency departments (EDs) remains limited. The aim of this study was to compare procedural sedation and anlagesia (PSA) and IB in the pain management for patients who underwent forearm fracture reduction in the ED.
Methods
This prospective randomized study included 60 patients aged 18 to 65 years, who visited the ED with forearm fractures. They were randomly divided into two groups: Group PSA (n=30) and Group IB (n=30). The pain scores of patients were evaluated before and during the procedure with the visual analog scale. Complications and patient and operator satisfaction levels were recorded.
Results
There was no difference between the two groups in terms of demographic characteristics. The median (interquartile range) pain scores observed during the procedures were significantly higher in Group PSA than in Group IB (4 [4–6] vs. 2 [0–2], respectively; P<0.001). Patient and operator satisfaction levels were significantly higher in Group IB (P<0.001). Oxygen desaturation was statistically higher in Group PSA than in Group IB (40.00% vs. 3.33%, respectively; P=0.002).
Conclusion
IB was an effective alternative for reducing pain and increasing patient satisfaction in ED patients undergoing forearm fracture reduction.

Citations

Citations to this article as recorded by  Crossref logo
  • Procedural sedation and analgesia in the emergency department: a review of current practices and clinical implications
    Burcu Özen Karabulut, Metin Akgün
    Anesthesiology and Perioperative Science.2026;[Epub]     CrossRef
  • Complications of Ultrasound-Guided Peripheral Nerve Blocks in the Emergency Department: A Systematic Review and Meta-Analysis
    Joyce Hanyue Gu, Adrian Cotarelo, Mark Samarneh
    The Journal of Emergency Medicine.2025; 75: 256.     CrossRef
  • Ultrasound‐Guided Nerve Blocks Improve Success Rate of Closed Reduction of Colles' Fractures: A Randomised Controlled Trial
    Anette B. Christensen, Christine IIkjær, Torben K. Laustrup, Esben Sejer, Camilla Rønnøw, Kaj V. Døssing, Troels B. Jensen, Jacob K. Andersen, Christoffer G. Sølling
    Acta Anaesthesiologica Scandinavica.2025;[Epub]     CrossRef
  • Pain management with ketamine procedural sedation and infraclavicular block for forearm fracture in the emergency department
    Emine Sarcan, Ahmet Burak Erdem, Şerife Büşra Uysal, Evrim Duman, Zübeyir Cebeci, Emine Arık
    The American Journal of Emergency Medicine.2025; 96: 256.     CrossRef
  • Ultrasound-guided nerve blocks in emergency medicine practice: 2022 updates
    Andrew J. Goldsmith, Joseph Brown, Nicole M. Duggan, Tomer Finkelberg, Nick Jowkar, Joseph Stegeman, Matthew Riscinti, Arun Nagdev, Richard Amini
    The American Journal of Emergency Medicine.2024; 78: 112.     CrossRef
  • Peripheral nerve blocks for closed reduction of distal radius fractures—A systematic review with meta‐analysis and trial sequential analysis
    Sanja Pisljagic, Jens L. Temberg, Mathias T. Steensbæk, Sina Yousef, Mathias Maagaard, Lana Chafranska, Kai H. W. Lange, Christian Rothe, Lars H. Lundstrøm, Anders K. Nørskov
    Acta Anaesthesiologica Scandinavica.2024; 68(9): 1149.     CrossRef
  • Regional anesthesia for acute pain management in pre-hospital and in-hospital emergency medicine
    Andreas Fichtner, Benedikt Schrofner-Brunner, Tina Magath, Peik Mutze, Thea Koch
    Deutsches Ärzteblatt international.2023;[Epub]     CrossRef
  • Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis
    Soo-Yeon Kang, Sookyung Park, Ik-Joon Jo, Kyeongman Jeon, Seonwoo Kim, Guntak Lee, Jong-Eun Park, Taerim Kim, Se-Uk Lee, Sung-Yeon Hwang, Won-Chul Cha, Tae-Gun Shin, Hee Yoon
    Medicina.2022; 58(2): 217.     CrossRef
  • Regional Anesthesia for Trauma in the Emergency Department
    Nadia Hernandez, Johanna B. de Haan
    Current Anesthesiology Reports.2022; 12(2): 240.     CrossRef
  • Ultrasound-Guided Peripheral Nerve Blocks: A Practical Review for Acute Cancer-Related Pain
    David Hao, Michael Fiore, Christopher Di Capua, Amitabh Gulati
    Current Pain and Headache Reports.2022; 26(11): 813.     CrossRef
  • 9,044 View
  • 189 Download
  • 8 Web of Science
  • 10 Crossref

Pediatrics

A clinical prediction tool to predict urinary tract infection in pediatric febrile patients younger than 2 years old: a retrospective analysis of a fever registry
Yun Seong Park, Jin Hee Lee, Young Ho Kwak, Jae Yun Jung, Hyuksool Kwon, Yoo Jin Choi, Dong Bum Suh, Bongjin Lee, Min-Jung Kim, Do Kyun Kim
Clin Exp Emerg Med 2021;8(4):314-324.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.134

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A clinical prediction tool to predict urinary tract infection in pediatric febrile patients younger than 2 years old: a retrospective analysis of a fever registry
Clin Exp Emerg Med. 2021;8(4):314-324.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.134
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A clinical prediction tool to predict urinary tract infection in pediatric febrile patients younger than 2 years old: a retrospective analysis of a fever registry
Clin Exp Emerg Med. 2021;8(4):314-324.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.134
Close
Objective
Urinary tract infection (UTI) is a significant issue in young febrile patients due to potential long-term complications. Early detection of UTI is crucial in pediatric emergency departments (PEDs). We developed a tool to predict UTIs in children.
Methods
Clinical data of patients <24 months of age with a fever and UTI or viral infection were extracted from the fever registry collected in two PEDs. Stepwise multivariate logistic regression was performed to establish predictors of identified eligible clinical variables for the derivation of the prediction model.
Results
A total of 1,351 patients were included in the analysis, 643 patients from A hospital (derivation set) and 708 patients from B hospital (validation set). In the derivation set, there were more girls and a lower incidence of a past history of UTI, older age, less fever without source, and more family members with upper respiratory symptoms in the viral infection group. The stepwise regression analysis identified sex (uncircumcised male), age (≤12 months), a past history of UTI, and family members with upper respiratory symptoms as significant variables.
Conclusion
Young febrile patients in the PED were more likely to have UTIs if they were uncircumcised boys, were younger than 12 months of age, had a past history of UTIs, or did not have families with respiratory infections. This clinical prediction model may help determine whether to perform urinalysis in the PED.

Citations

Citations to this article as recorded by  Crossref logo
  • Diagnosis of urinary tract infections in the pediatric population – current practices, advances and progress
    Maria Bitsori, Roza-Ioanna Poulaki, Emmanouil Galanakis
    Expert Review of Anti-infective Therapy.2026; 24(1): 139.     CrossRef
  • Pediatric malaria in a non-endemic European setting: clinical patterns, laboratory markers, and the ambiguous role of immunity
    Roberta Caiazzo, Benedetta Panero, Marta Carello, Crescenzo Coppola, Raffaella Di Tonno, Anna Hermine Markowich, Marta Stracuzzi, Maria Sole Valentino, Silvia Grosso, Anna Gigantiello, Vania Giacomet
    Infection.2026; 54(3): 1465.     CrossRef
  • Role of the National Early Warning score and Modified Early Warning score for predicting mortality in geriatric patients with non-traumatic coma
    Dong Ki Kim, Dong Hun Lee, Byung Kook Lee
    Heliyon.2024; 10(6): e28338.     CrossRef
  • 8,717 View
  • 163 Download
  • 3 Web of Science
  • 3 Crossref

Cardiovascular

Validation and modification of HEART score components for patients with chest pain in the emergency department
Min Jae Kim, Sang Ook Ha, Young Sun Park, Jeong Hyeon Yi, Won Seok Yang, Jin Hyuck Kim
Clin Exp Emerg Med 2021;8(4):279-288.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.106
Correction in: Clin Exp Emerg Med 2022;9(4):386

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Validation and modification of HEART score components for patients with chest pain in the emergency department
Clin Exp Emerg Med. 2021;8(4):279-288.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.106
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Validation and modification of HEART score components for patients with chest pain in the emergency department
Clin Exp Emerg Med. 2021;8(4):279-288.   Published online December 31, 2021
DOI: https://doi.org/10.15441/ceem.20.106
Close
Objective
This study aimed to clarify the relative prognostic value of each History, Electrocardiography, Age, Risk Factors, and Troponin (HEART) score component for major adverse cardiac events (MACE) within 3 months and validate the modified HEART (mHEART) score.
Methods
This study evaluated the HEART score components for patients with chest symptoms visiting the emergency department from November 19, 2018 to November 19, 2019. All components were evaluated using logistic regression analysis and the scores for HEART, mHEART, and Thrombolysis in Myocardial Infarction (TIMI) were determined using the receiver operating characteristics curve.
Results
The patients were divided into a derivation (809 patients) and a validation group (298 patients). In multivariate analysis, age did not show statistical significance in the detection of MACE within 3 months and the mHEART score was calculated after omitting the age component. The areas under the receiver operating characteristics curves for HEART, mHEART and TIMI scores in the prediction of MACE within 3 months were 0.88, 0.91, and 0.83, respectively, in the derivation group; and 0.88, 0.91, and 0.81, respectively, in the validation group. When the cutoff value for each scoring system was determined for the maintenance of a negative predictive value for a MACE rate >99%, the mHEART score showed the highest sensitivity, specificity, positive predictive value, and negative predictive value (97.4%, 54.2%, 23.7%, and 99.3%, respectively).
Conclusion
Our study showed that the mHEART score better detects short-term MACE in high-risk patients and ensures the safe disposition of low-risk patients than the HEART and TIMI scores.

Citations

Citations to this article as recorded by  Crossref logo
  • Reassessing risk stratification in the ED: HEART, HET, SVEAT, and the emerging role of HASI
    Hsih-Hao Huang, Chien-Chieh Hsieh, Fu-Shan Jaw, Che-Ming Yeh
    The American Journal of Emergency Medicine.2025; 96: 278.     CrossRef
  • Chest Pain Risk Stratification in the Emergency Department: Current Perspectives
    Zeynep Yukselen, Vidit Majmundar, Mahati Dasari, Pramukh Arun Kumar, Yuvaraj Singh
    Open Access Emergency Medicine.2024; Volume 16: 29.     CrossRef
  • Performance of the EDACS-ADP incorporating high-sensitivity troponin assay: Do components of major adverse cardiac events matter?
    Yedalm Yoo, Shin Ahn, Bora Chae, Won Young Kim
    World Journal of Emergency Medicine.2024; 15(3): 175.     CrossRef
  • Adapting the HEART Pathway for Korean Patients: The Potential Impact on Chest Pain Management at Emergency Department
    Hack-Lyoung Kim
    Korean Circulation Journal.2023; 53(9): 645.     CrossRef
  • Computed tomography coronary angiography after excluding myocardial infarction: high-sensitivity troponin versus risk score-guided approach
    Won Jae Yoo, Shin Ahn, Bora Chae, Won Young Kim
    World Journal of Emergency Medicine.2023; 14(6): 428.     CrossRef
  • Erratum to “Validation and modification of HEART score components for patients with chest pain in the emergency department”
    Min Jae Kim, Sang Ook Ha, Young Sun Park, Jeong Hyeon Yi, Won Seok Yang, Jin Hyuck Kim
    Clinical and Experimental Emergency Medicine.2022; 9(4): 386.     CrossRef
  • 12,039 View
  • 213 Download
  • 6 Web of Science
  • 6 Crossref

Brief Review

COVID-19

Adverse events and preventive measures related to COVID-19 vaccines
Tae Kyu Ahn, Soo Kang, Jin Hui Paik, Young Ho Seo
Clin Exp Emerg Med 2021;8(3):153-159.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.21.067

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Adverse events and preventive measures related to COVID-19 vaccines
Clin Exp Emerg Med. 2021;8(3):153-159.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.21.067
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Adverse events and preventive measures related to COVID-19 vaccines
Clin Exp Emerg Med. 2021;8(3):153-159.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.21.067
Close
The coronavirus disease 2019 (COVID-19) vaccines are categorized according to the manufacturing technique, including mRNA vaccines and adenovirus vector vaccines. According to previous studies, the reported efficacy of the COVID-19 vaccine is excellent regardless of the type of vaccine, and the majority of studies have shown similar results for safety. Most of the adverse reactions after vaccination were mild or moderate grade, and severe reactions were reported in a very small proportion. However, the adverse reactions that might occur after nationwide vaccinations can contribute to crowding of emergency departments, and this can further lead to significant obstacles to providing necessary treatment for life-threatening conditions. Therefore, as emergency physicians, we would like to present some concerns and suggestions to prevent these predictable problems.

Citations

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  • Post-vaccination incidence and side effects of COVID-19 in a cohort of Brazilian healthcare professionals: an internet-based survey
    Matheus Ballestero, Renato Lucas Passos de Souza, Thiago Mamoru Sakae, Luiz Guilherme Villares da Costa, Luciano Furlanetti, Ricardo Santos de Oliveira
    einstein (São Paulo).2022;[Epub]     CrossRef
  • 8,917 View
  • 145 Download
  • 1 Web of Science
  • 1 Crossref

Original Articles

Emergency Medical Services | Epidemiology

Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data
Soyoon Kim, Hyunggoo Kang, Yongil Cho, Heekyung Lee, Sung Woo Lee, Jinwoo Jeong, Won Young Kim, Su Jin Kim, Kap Su Han
Clin Exp Emerg Med 2021;8(2):128-136.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.098

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Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data
Clin Exp Emerg Med. 2021;8(2):128-136.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.098
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Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data
Clin Exp Emerg Med. 2021;8(2):128-136.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.098
Close
Objective
With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs.
Methods
This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression.
Results
A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure <100 mmHg, respiratory rate >20/min, heart rate >100/min, body temperature <36°C, and altered mental status were associated with in-hospital mortality.
Conclusion
Development of appropriate decision-making algorithms and treatment protocols for high risk older patients visiting the ED might facilitate appropriate allocation of medical resources to optimize outcomes.

Citations

Citations to this article as recorded by  Crossref logo
  • Development and Internal Validation of an Early Warning Predictive Model for Critically Ill Patients in the Emergency Department Utilizing Easily Obtainable Clinical Indicators
    Xurui Li, Jian Lv, Hui Guo, Hongling Li, Qian Zhao, Huijun Qi, Jianguo Li
    Risk Management and Healthcare Policy.2026; Volume 19: 1.     CrossRef
  • Emergency department presentations for suicide and self-harm in Korea, 2020–2024: an epidemiological study using the National Emergency Department Information System (NEDIS) database
    Yuri Choi, Jinwoo Jeong, Borami Lim, Myeong Il Cha
    Clinical and Experimental Emergency Medicine.2026; 13(1): 98.     CrossRef
  • Impact of the 2024 Korean medical workforce crisis on transfers in a pediatric emergency center: including comparative analyses with adults
    Sung-Ha Kim, Jin Hee Kim, Jae-Hyun Kwon, Soo Hyun Park, Min-Jung Kim, Young-Hoon Byun, Ho-Young Song, So-Hyun Paek, Inge Roggen
    PLOS One.2026; 21(5): e0348189.     CrossRef
  • Hypothermia and Mortality Among Children in the Emergency Department
    Lucy Campbell, Aarthi Kottapalli, Leslie Hueschen, Jonathan R. Higgins, Erin J. Meyer, Laura F. Sartori, Paria M. Wilson, Naghma S. Khan, Alexander Rogers, Sriram Ramgopal
    Pediatrics.2026;[Epub]     CrossRef
  • Factors associated with hospitalization among older patients with mild traumatic injuries presenting to the emergency department in Korea: a retrospective observational study
    Songhee Jeong, Younghui Hwang
    Journal of Korean Biological Nursing Science.2026; 28(2): 353.     CrossRef
  • Commentary on “Predictive value of the Hemoglobin, Albumin, Lymphocyte and Platelet score for mortality in geriatric patients presenting to the emergency department”
    Zeinab Mohseni Afshar, Mohammad Barary, Farhad Bagherian, Arefeh Babazadeh, Soheil Ebrahimpour
    Geriatrics & Gerontology International.2025; 25(6): 830.     CrossRef
  • Comparison of early warning scores for predicting outcomes in adult and older patients in emergency department: Multicenter study
    Sung Jin Bae, Ho Sub Chung, Yunhyung Choi, Yoon Hee Choi, Ji Yeon Lim, Keon Kim, Dong Hoon Lee
    The American Journal of Emergency Medicine.2025; 96: 91.     CrossRef
  • Cyber-Secure IoT and Machine Learning Framework for Optimal Emergency Ambulance Allocation
    Jonghyuk Kim, Sewoong Hwang
    Applied Sciences.2025; 15(13): 7156.     CrossRef
  • Transfer versus direct-visit patients in medically underserved emergency departments: a retrospective cohort study
    Kyongmin Sun, Youjin Lee, Jungsil Lee
    BMC Emergency Medicine.2025;[Epub]     CrossRef
  • Factors related to the frequent use of emergency department services in Korea
    Eun Deok Cho, Bomgyeol Kim, Do Hee Kim, Sang Gyu Lee, Suk-Yong Jang, Tae Hyun Kim
    BMC Emergency Medicine.2023;[Epub]     CrossRef
  • Emergency department utilization in elderly patients: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022
    Sun Young Lim, You Hwan Jo, Seongjung Kim, Eunsil Ko, Young Sun Ro, Jungeon Kim, Sumin Baek
    Clinical and Experimental Emergency Medicine.2023; 10(S): S26.     CrossRef
  • Epidemiology of suicide attempts and self-harm in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Kwang Yul Jung, Taehui Kim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S69.     CrossRef
  • Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Hyun Ho Yoo, Young Sun Ro, Eunsil Ko, Jin-Hee Lee, So-hyun Han, Taerim Kim, Tae Gun Shin, Seongjung Kim, Hansol Chang
    Clinical and Experimental Emergency Medicine.2023; 10(S): S1.     CrossRef
  • Mortality and incidence rate of acute severe trauma patients in the emergency department: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Jung-Youn Kim, Young-Hoon Yoon, Sung Joon Park, Won Pyo Hong, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S55.     CrossRef
  • Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Sung Eun Lee, Hyo Jin Kim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S48.     CrossRef
  • Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Shin Ahn, Eunsil Ko, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S42.     CrossRef
  • Factors Associated with Emergency Department Visits and Consequent Hospitalization and Death in Korea Using a Population-Based National Health Database
    Junhee Park, Yohwan Yeo, Yonghoon Ji, Bongseong Kim, Kyungdo Han, Wonchul Cha, Meonghi Son, Hongjin Jeon, Jaehyun Park, Dongwook Shin
    Healthcare.2022; 10(7): 1324.     CrossRef
  • 10,546 View
  • 129 Download
  • 18 Web of Science
  • 17 Crossref

Pulmonary

Dexmedetomidine as an adjunctive treatment for acute asthma
Hassan Motamed, Arash Forouzan, Meisam Moezzi, Hossein Alizadeh
Clin Exp Emerg Med 2021;8(2):89-93.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.038

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Dexmedetomidine as an adjunctive treatment for acute asthma
Clin Exp Emerg Med. 2021;8(2):89-93.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.038
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Dexmedetomidine as an adjunctive treatment for acute asthma
Clin Exp Emerg Med. 2021;8(2):89-93.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.038
Close
Objective
This study aimed to compare the efficacy of using dexmedetomidine with salbutamol and salbutamol nebulization alone in patients with acute exacerbation of asthma presenting to the emergency department.
Methods
This clinical trial included 60 patients, in the age range of 18 to 55 years, with signs of bronchospasm presenting to the emergency department. In the intervention group, dexmedetomidine 0.5 µg/kg was injected intravenously and three doses of salbutamol nebulization were administered over 60 minutes. In the control group, salbutamol nebulization was administered for 60 minutes three times. The patient’s clinical status, based on clinical symptoms, consciousness, speech, breathing rate, heart rate, and blood pressure were recorded before the intervention, and peak expiratory flow rate and forced expiratory volume in 1 second were measured at 20, 40, and 60 minutes after intervention. Patients who did not respond to the intervention were excluded from the study within 60 minutes.
Results
The increased mean forced expiratory volume in 1 second and mean peak expiratory flow rate were found to be similar in both groups during the treatment (P=0.304). The mean systolic and diastolic blood pressure recorded at 40 and 60 minutes were significantly lower in the intervention group. During this study, no patient was excluded before 60 minutes.
Conclusion
Administration of dexmedetomidine in addition to standard salbutamol treatment has no beneficial effect in patients with acute asthma attacks and merely causes hypotension in patients.

Citations

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  • The use of dexmedetomidine in the emergency department: A systematic review
    Kevin Baumgartner, Veronica Groff, Lauren H. Yaeger, Brian M. Fuller
    Academic Emergency Medicine.2023; 30(3): 196.     CrossRef
  • 11,634 View
  • 99 Download
  • 1 Web of Science
  • 1 Crossref

Cardiovascular

Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome
Cansu Alyeşil, Serkan Yilmaz, İbrahim Ulaş Özturan, Murat Pekdemir, Elif Yaka, Nurettin Özgür Doğan
Clin Exp Emerg Med 2020;7(4):275-280.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.088

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Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome
Clin Exp Emerg Med. 2020;7(4):275-280.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.088
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Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome
Clin Exp Emerg Med. 2020;7(4):275-280.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.088
Close
Objective
The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED.
Methods
This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission.
Results
A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer.
Conclusion
We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.

Citations

Citations to this article as recorded by  Crossref logo
  • Increased cardiovascular risk among cancer survivors presenting with chest pain
    Kobi Faierstein, Rotem Tal-Ben Ishay, Ranel Loutati, Lynn Idan, Ido Cohen, Tal Caller, Yaacov R Lawrence, Roy Raphael, Yovel Peretz, Dana Fourey, Haim Mayan, Noya Shilo, Amit Segev, Elad Maor, Joerg Herrmann
    European Heart Journal Open.2025;[Epub]     CrossRef
  • Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants
    Abdullah Kürşat Işik, İbrahim Ulaş Özturan, Murat Pekdemir, Nurettin Özgür Doğan, Elif Yaka, Serkan Yilmaz
    Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine.2023; 22(4): 128.     CrossRef
  • Relation of CHA2DS2 -VASc score with severity and complexity of coronary artery disease in patients with non-ST segment elevation myocardial infarction
    Muhammed Raşit TANIRCAN, İbrahim Ulaş ÖZTURAN, Nihat ŞEN
    Acta Medica Nicomedia.2022; 5(3): 136.     CrossRef
  • 7,503 View
  • 113 Download
  • 1 Web of Science
  • 3 Crossref

Emergency Medicine Practice and Administration | Psychosocial

Effects of screening and brief intervention on alcohol consumption in an emergency department
Soo Chul Im, Duk Hee Lee
Clin Exp Emerg Med 2020;7(4):310-318.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.080

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Effects of screening and brief intervention on alcohol consumption in an emergency department
Clin Exp Emerg Med. 2020;7(4):310-318.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.080
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Effects of screening and brief intervention on alcohol consumption in an emergency department
Clin Exp Emerg Med. 2020;7(4):310-318.   Published online December 31, 2020
DOI: https://doi.org/10.15441/ceem.19.080
Close
Objective
Alcohol use is associated with high levels of morbidity and mortality. Alcohol problems are common in emergency departments (EDs). This study investigated the effect of screening and a new brief intervention (BI) protocol on alcohol consumption of ED patients.
Methods
The participants of this study were those aged 18 years or older who visited the ED due to injury over 12 weeks. BI was offered to patients with a score of 8 or higher on alcohol use disorders identification test (AUDIT) screening. Follow-up telephone assessments were conducted at one week, one month, and three months.
Results
The risk drinker (RD) group (AUDIT 8–15) comprised 101 patients, and the alcohol use disorder (AUD) group (AUDIT >16) comprised 41 patients. Before the BI, the weekly mean alcohol intake amount for the RD group was 180.90±98.34 g and for the AUD group was 358.00± 110.62 g. Alcohol consumption was reduced to 132.39±75.87 g in the RD group and 181.86± 78.11 g in the AUD group in the 3-month follow-up assessment. Alcohol consumption in the AUD group reduced significantly compared to the RD group (P<0.001).
Conclusion
Alcohol screening and BI contributed to alcohol intake reduction in ED patients. Specifically, the BI effect was greater in the AUD group than the RD group. The ED can be an effective place to begin implementing screening and intervention for alcohol use patients at risk.

Citations

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  • Alcohol-related minor injuries in an emergency room setting (ARMIERo): a case-crossover study on alcohol consumption and alcohol attributable fraction of minor injuries
    Théophile Paris, Pierre-Nicolas Carron, Gerhard Gmel, Bastien Trächsel, Nicolas Beysard
    Emergency Medicine Journal.2026; : emermed-2025-215799.     CrossRef
  • Implementation of mandatory blood alcohol screening in trauma patients: A retrospective study from a tertiary trauma center in a Middle Eastern country
    Ayman El-Menyar, Ahammed Mekkodathil, Rafael Consunji, Aisha Abeid, Rifat Latifi, Sandro Rizoli, Hassan Al-Thani
    Alcohol.2024; 119: 7.     CrossRef
  • The effectiveness of reduction in alcohol consumption achieved by the provision of non-alcoholic beverages associates with Alcohol Use Disorders Identification Test scores: a secondary analysis of a randomized controlled trial
    Shohei Dobashi, Kyoko Kawaida, Go Saito, Yukiko Owaki, Hisashi Yoshimoto
    BMC Medicine.2024;[Epub]     CrossRef
  • Factores asociados a la intención de disminuir el consumo de alcohol en personas con consumo riesgoso en un hospital universitario de Bogotá, Colombia
    Maylin Peñaloza, Virginia Cuevas, Peter Olejua, Lina Olaya, Ingrid Almonacid, Luz Helena Alba
    Revista de la Facultad de Medicina.2022; 71(2): e98969.     CrossRef
  • Intoxication éthylique aiguë
    P. Leveau
    EMC - Médecine d 'urgence.2022; 16(2): 1.     CrossRef
  • 9,339 View
  • 117 Download
  • 3 Web of Science
  • 5 Crossref

Pulmonary

Predicting 30-day mortality of patients with pneumonia in an emergency department setting using machine-learning models
Soo Yeon Kang, Won Chul Cha, Junsang Yoo, Taerim Kim, Joo Hyun Park, Hee Yoon, Sung Yeon Hwang, Min Seob Sim, Ik Joon Jo, Tae Gun Shin
Clin Exp Emerg Med 2020;7(3):197-205.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.052

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Predicting 30-day mortality of patients with pneumonia in an emergency department setting using machine-learning models
Clin Exp Emerg Med. 2020;7(3):197-205.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.052
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Predicting 30-day mortality of patients with pneumonia in an emergency department setting using machine-learning models
Clin Exp Emerg Med. 2020;7(3):197-205.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.052
Close
Objective
This study aimed to confirm the accuracy of a machine-learning-based model in predicting the 30-day mortality of patients with pneumonia and evaluating whether they were required to be admitted to the intensive care unit (ICU).
Methods
The study conducted a retrospective analysis of pneumonia patients at an emergency department (ED) in Seoul, Korea, from January 1, 2016 to December 31, 2017. Patients aged 18 years or older with a pneumonia registry designation on their electronic medical record were enrolled. We collected their demographic information, mental status, and laboratory findings. Three models were used: the pre-existing CURB-65 model, and the CURB-RF and Extensive CURB-RF models, which were machine-learning models that used a random forest algorithm. The primary outcomes were ICU admission from the ED or 30-day mortality. Receiver operating characteristic curves were constructed for the models, and the areas under these curves were compared.
Results
Out of the 1,974 pneumonia patients, 1,732 patients were eligible to be included in the study; from these, 473 patients died within 30 days or were initially admitted to the ICU from the ED. The area under receiver operating characteristic curves of CURB-65, CURB-RF, and extensive-CURB-RF were 0.615 (0.614–0.616), 0.701 (0.700–0.702), and 0.844 (0.843–0.845), respectively.
Conclusion
The proposed machine-learning models could predict the mortality of patients with pneumonia more accurately than the pre-existing CURB-65 model and can help decide whether the patient should be admitted to the ICU.

Citations

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  • Implementation of machine learning in emergency departments: A systematic review
    Banafshe Hosseini, Atushi Patel, Megan Landes, Samuel Vaillancourt, Muhammad Mamdani, Kevin Maruthananth, Neha Matharu, Zuha Pathan, Krishihan Sivapragasam, Onlak Ruangsomboon, Becky Skidmore, Andrew D Pinto
    DIGITAL HEALTH.2026;[Epub]     CrossRef
  • Multimodal AI-based 28-day mortality prediction of pneumonia patients at ED discharge: a multicenter study
    Sunjin Hwang, Sejin Heo, Sungjun Hong, Kyu-Hwan Jung, Won Chul Cha, Junsang Yoo
    Scientific Reports.2026;[Epub]     CrossRef
  • Artificial Intelligence Applications in Pneumonia: Diagnosis and Outcome Prediction
    Mengou Zhu, Melissa J. Bak, Catherine A. Gao
    Current Pulmonology Reports.2026;[Epub]     CrossRef
  • Machine-learning-based Fall-prediction Model for Inpatients in Military Hospitals
    YunJung Choi, WooJin Lee, Juyeon Baek
    CIN: Computers, Informatics, Nursing.2026;[Epub]     CrossRef
  • Comparison of Predictive Models for Keloid Recurrence Based on Machine Learning
    Yan Hao, Mengjie Shan, Hao Liu, Yijun Xia, Xinwen Kuang, Kexin Song, Youbin Wang
    Journal of Cosmetic Dermatology.2025;[Epub]     CrossRef
  • Machine learning-based model for predicting all-cause mortality in severe pneumonia
    Weichao Zhao, Xuyan Li, Lianjun Gao, Zhuang Ai, Yaping Lu, Jiachen Li, Dong Wang, Xinlou Li, Nan Song, Xuan Huang, Zhao-hui Tong
    BMJ Open Respiratory Research.2025; 12(1): e001983.     CrossRef
  • Enhanced super-resolution generative adversarial network augmented convolution neural network for pneumonia prognosis in India: promising health policy implications
    Tapan Kumar, R. L. Ujjwal
    International Journal of System Assurance Engineering and Management.2025; 16(4): 1438.     CrossRef
  • Inteligencia Artificial en la identificación de la Neumonía Pediátrica en Radiografías de Tórax
    Elizabeth Espinoza-Portilla, Milagro Henríquez-Suárez, Catia Cilloniz
    Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.2025;[Epub]     CrossRef
  • Enhancing pneumonia prognosis in the emergency department: a novel machine learning approach using complete blood count and differential leukocyte count combined with CURB-65 score
    Yin-Ting Lin, Ko-Ming Lin, Kai-Hsiang Wu, Frank Lien
    BMC Medical Informatics and Decision Making.2024;[Epub]     CrossRef
  • Systematic Literature Review: The Role of Artificial Intelligence in Emergency Department Decision Making
    Sumaiya Amin Adrita
    medtigo Journal of Medicine.2024; 1(1): 1.     CrossRef
  • Machine-Learning Model for Mortality Prediction in Patients With Community-Acquired Pneumonia
    Catia Cilloniz, Logan Ward, Mads Lause Mogensen, Juan M. Pericàs, Raúl Méndez, Albert Gabarrús, Miquel Ferrer, Carolina Garcia-Vidal, Rosario Menendez, Antoni Torres
    CHEST.2023; 163(1): 77.     CrossRef
  • Haemogram indices are as reliable as CURB-65 to assess 30-day mortality in Covid-19 pneumonia
    OKAN BARDAKCI, MURAT DAS, GÖKHAN AKDUR, CANAN AKMAN, DUYGU SIDDIKOGLU, OKHAN AKDUR, YAVUZ BEYAZIT
    The National Medical Journal of India.2023; 35: 221.     CrossRef
  • Prediction of mortality in pneumonia patients with connective tissue disease treated with glucocorticoids or/and immunosuppressants by machine learning
    Dongdong Li, Liting Ding, Jiao Luo, Qiu-Gen Li
    Frontiers in Immunology.2023;[Epub]     CrossRef
  • Machine learning-based prediction of in-ICU mortality in pneumonia patients
    Eun-Tae Jeon, Hyo Jin Lee, Tae Yun Park, Kwang Nam Jin, Borim Ryu, Hyun Woo Lee, Dong Hyun Kim
    Scientific Reports.2023;[Epub]     CrossRef
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    Zhixiao Xu, Kun Guo, Weiwei Chu, Jingwen Lou, Chengshui Chen
    Frontiers in Bioengineering and Biotechnology.2022;[Epub]     CrossRef
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    Boris Garber
    Current Emergency and Hospital Medicine Reports.2022; 10(3): 36.     CrossRef
  • Benchmarking emergency department prediction models with machine learning and public electronic health records
    Feng Xie, Jun Zhou, Jin Wee Lee, Mingrui Tan, Siqi Li, Logasan S/O Rajnthern, Marcel Lucas Chee, Bibhas Chakraborty, An-Kwok Ian Wong, Alon Dagan, Marcus Eng Hock Ong, Fei Gao, Nan Liu
    Scientific Data.2022;[Epub]     CrossRef
  • Incorporation of Suppression of Tumorigenicity 2 into Random Survival Forests for Enhancing Prediction of Short-Term Prognosis in Community-ACQUIRED Pneumonia
    Teng Zhang, Yifeng Zeng, Runpei Lin, Mingshan Xue, Mingtao Liu, Yusi Li, Yingjie Zhen, Ning Li, Wenhan Cao, Sixiao Wu, Huiqing Zhu, Qi Zhao, Baoqing Sun
    Journal of Clinical Medicine.2022; 11(20): 6015.     CrossRef
  • Machine Learning Model Development and Validation for Predicting Outcome in Stage 4 Solid Cancer Patients with Septic Shock Visiting the Emergency Department: A Multi-Center, Prospective Cohort Study
    Byuk Sung Ko, Sanghoon Jeon, Donghee Son, Sung-Hyuk Choi, Tae Gun Shin, You Hwan Jo, Seung Mok Ryoo, Youn-Jung Kim, Yoo Seok Park, Woon Yong Kwon, Gil Joon Suh, Tae Ho Lim, Won Young Kim
    Journal of Clinical Medicine.2022; 11(23): 7231.     CrossRef
  • Predicting ventilator-associated pneumonia with machine learning
    Christine Giang, Jacob Calvert, Keyvan Rahmani, Gina Barnes, Anna Siefkas, Abigail Green-Saxena, Jana Hoffman, Qingqing Mao, Ritankar Das
    Medicine.2021; 100(23): e26246.     CrossRef
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    Syunsuke Yamanaka, Koji Morikawa, Hiroshi Morita, Ji Young Huh, Osamu Yamamura
    Frontiers in Medical Technology.2021;[Epub]     CrossRef
  • Evaluation and management of pleural sepsis
    Justin K. Lui, Ehab Billatos, Frank Schembri
    Respiratory Medicine.2021; 187: 106553.     CrossRef
  • Real‐time interactive artificial intelligence of things–based prediction for adverse outcomes in adult patients with pneumonia in the emergency department
    You‐Ming Chen, Yuan Kao, Chien‐Chin Hsu, Chia‐Jung Chen, Yu‐Shan Ma, Yu‐Ting Shen, Tzu‐Lan Liu, Shu‐Lien Hsu, Hung‐Jung Lin, Jhi‐Joung Wang, Chien‐Cheng Huang, Chung‐Feng Liu
    Academic Emergency Medicine.2021; 28(11): 1277.     CrossRef
  • 9,207 View
  • 162 Download
  • 23 Web of Science
  • 23 Crossref

Trauma

Comparison of traumatic brain injury patients with brain computed tomography in the emergency department by age group
Kwang Real Huh, Jung-Youn Kim, Sung-Hyuk Choi, Young-Hoon Yoon, Sung Jun Park, Eu Sun Lee
Clin Exp Emerg Med 2020;7(2):81-86.   Published online June 30, 2020
DOI: https://doi.org/10.15441/ceem.19.076

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Comparison of traumatic brain injury patients with brain computed tomography in the emergency department by age group
Clin Exp Emerg Med. 2020;7(2):81-86.   Published online June 30, 2020
DOI: https://doi.org/10.15441/ceem.19.076
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Comparison of traumatic brain injury patients with brain computed tomography in the emergency department by age group
Clin Exp Emerg Med. 2020;7(2):81-86.   Published online June 30, 2020
DOI: https://doi.org/10.15441/ceem.19.076
Close
Objective
Traumatic brain injury (TBI) is an important public health concern due to its high prevalence and mortality rate among young people. We investigated the clinical and social characteristics of patients who visited the emergency department due to TBI in whom brain computed tomography, was performed by age.
Methods
We retrospectively analyzed 15,567 TBI patients who received a brain computed tomography evaluation at the emergency department of Korea University Hospital from March 2013 to February 2016. We divided patients into age groups by decade and analyzed factors such as sex, trauma mechanism, need for operation, hospitalization, and results of treatment.
Results
The mean age was 42.0±22.8 years; the most common age group was the 50s (16.5%). Except for the age group over 70 years, males predominated. Under 9 years of age, public ambulance usage rate was lower than in other age groups. Regarding severity based on the Glasgow Coma Scale score, the proportion of mild cases was higher in those under 9 years of age (99.3%) and the proportion of severe cases was higher in those in their 20s (4.6%). The most common injury mechanism was blunt trauma, followed by car accidents. For those under 9 years of age, falls were more common than in other age groups. Only 20.5% of TBI patients were hospitalized and 11.9% were treated surgically, while 70.6% of patients were discharged home after treatment.
Conclusion
TBI may present with different characteristics depending on the age of the patients, thus prevention policies and clinical practice should be tailored to age.

Citations

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  • Simultaneous High-Frame-Rate Acoustic Plane-Wave and Optical Imaging of Intracranial Cavitation in Polyacrylamide Brain Phantoms during Blunt Force Impact
    Eric J. Galindo, Riley R. Flores, Ricardo Mejia-Alvarez, Adam M. Willis, Michaelann S. Tartis
    Bioengineering.2024; 11(2): 132.     CrossRef
  • Area-Level Socioeconomic Inequalities in Intracranial Injury-Related Hospitalization in Korea: A Retrospective Analysis of Data From Korea National Hospital Discharge Survey 2008–2015
    Hang A Park, Federico E. Vaca, Kyunghee Jung-Choi, Hyesook Park, Ju Ok Park
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Mortality and incidence rate of acute severe trauma patients in the emergency department: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Jung-Youn Kim, Young-Hoon Yoon, Sung Joon Park, Won Pyo Hong, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S55.     CrossRef
  • Trends in traumatic brain injury–related emergency department visits in Korea: a report from the National Emergency Department Information System (NEDIS) 2018–2022
    Hang A Park, Borami Lim, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S63.     CrossRef
  • The circadian clock regulator Bmal1 affects traumatic brain injury in rats through the p38 MAPK signalling pathway
    Bing Li, Di Li, Haibo Ni, Chenglin Liu, Jian Xiong, Huixiang Liu, Rong Gao, Li Zhang, Gang Chen
    Brain Research Bulletin.2022; 178: 17.     CrossRef
  • Analysis of the Adequacy of Prehospital Emergency Medical Services Use of Patients Who Visited Emergency Departments in Korea from 2016 to 2018: Data from the National Emergency Department Information System
    Sung Joon Park, Jung-Youn Kim, Young-Hoon Yoon, Eu Sun Lee, Hyun-Jin Kim, Seoung Bum Kim, Hyun Gu Kahng, Yan-Ren Lin
    Emergency Medicine International.2021; 2021: 1.     CrossRef
  • 8,756 View
  • 130 Download
  • 6 Web of Science
  • 6 Crossref

Cardiovascular

External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge
Kajal Patel, Sharon Klim, Peter Ritchie, Ieuan Johns, Anne-Maree Kelly
Clin Exp Emerg Med 2020;7(2):107-113.   Published online June 28, 2020
DOI: https://doi.org/10.15441/ceem.19.051

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External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge
Clin Exp Emerg Med. 2020;7(2):107-113.   Published online June 28, 2020
DOI: https://doi.org/10.15441/ceem.19.051
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External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge
Clin Exp Emerg Med. 2020;7(2):107-113.   Published online June 28, 2020
DOI: https://doi.org/10.15441/ceem.19.051
Close
Objective
Recently, a novel score for risk stratification of patients with pulmonary embolism (PE)—the HOPPE score—was derived. We aimed to externally validate the HOPPE score in emergency department-diagnosed PE, using SpO2 as a surrogate for PaO2—the modified HOPPE score.
Methods
Retrospective observational study of adult patients with an emergency department diagnosis of PE was performed. Data collected included demographics, co-morbidities, clinical features, electrocardiogram and test results, in-hospital mortality and non-fatal major adverse clinical events (MACE; survived cardiac arrest, cardiogenic shock or thrombolysis administration). The primary outcome of interest was clinical performance of the modified HOPPE score for inhospital mortality and the composite outcome of in-hospital death and MACE. A secondary outcome was comparison of predictive performance between the modified HOPPE score and the simplified Pulmonary Embolism Severity Index score.
Results
Two hundred and six patients were studied (median age 61, 55% female). There were no deaths or MACE in patients with a low risk modified HOPPE score of 0 to 6 (0%; 95% confidence interval, 0% to 1.8%). Negative predictive value of a low risk score was 100% (95% confidence interval, 92.2% to 100%) for in-hospital mortality and for the composite of in-hospital mortality or MACE. The modified HOPPE score had similar predictive performance to the simplified Pulmonary Embolism Severity Index score with an area under the curve of 0.88 vs. 0.80 for the composite outcome of in-hospital mortality or MACE (P=0.052). Twenty-eight percent of the patients were classified as low risk and potentially suitable for management as outpatients.
Conclusion
The modified HOPPE score showed good clinical performance. Prospective validation is warranted.

Citations

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  • Serum Lactate, an Independent Prognostic Marker in Normotensive Patients With Acute Pulmonary Thromboembolism
    Rodica Lucia Avram, Monica Mariana Băluță, Caterina Delcea, Anna Maria Andronescu, Elena Lechea, Gabriela Vladu, Alexandru Cristian Nechita
    Romanian Journal of Cardiology.2022; 32(4): 182.     CrossRef
  • 7,623 View
  • 80 Download
  • 1 Crossref
Multicenter observational study on the reliability of the HEART score
Nicola Parenti, Giuseppe Lippi, Maria Letizia Bacchi Reggiani, Antonio Luciani, Mario Cavazza, Antonello Pietrangelo, Alberto Vegetti, Lucio Brugioni, Laura Bonfanti, Gianfranco Cervellin
Clin Exp Emerg Med 2019;6(3):212-217.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.045

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Multicenter observational study on the reliability of the HEART score
Clin Exp Emerg Med. 2019;6(3):212-217.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.045
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Multicenter observational study on the reliability of the HEART score
Clin Exp Emerg Med. 2019;6(3):212-217.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.045
Close
Objective
To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians.
Methods
The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study’s aim.
Results
After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively).
Conclusion
The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluating the Efficacy of CPS, HEART and TIMI Score in Emergency Department Patients with Non-Traumatic Chest Pain: A Pilot Study
    Pietro Pozzessere, Mattia Di Lauro, Francesco Incantalupo, Alessandro Cinquantasei, Stefano Palazzo, Mario Erminio Lepera, Antonella Pistone, Sandra De Matteis, Marco Matteo Ciccone, Vincenzo Brescia, Roberto Lovero, Marcello Albanesi, Angela Pia Cazzolla
    Medical Sciences.2026; 14(1): 151.     CrossRef
  • Natural Language Processing for Risk Stratification of Emergency Department Patients with Chest Pain
    Reza Valimoradi, George Cao, Allen Ding, Cristian Toarta, Seung Ho Lee, David Le Nguyen, Alexandra Wudwud, Preeti Gupta, Phuong Anh (Iris) Nguyen, Bahareh Ghaedi, Jonathan Yu-Meng Li, Venkatesh Thiruganasambandamoorthy
    CJC Open.2026;[Epub]     CrossRef
  • Unlocking the Potential of the HEART Pathway: Predicting MACE and Facilitating Nurse–Physician Collaboration in Chest Pain Unit
    Zahra Behpour, Zahra Amirsardari, Haniye Aghakhani, Mohammadesmaeil Zanganehfar, Shiva Khaleghparast, Fidan Shabani, Hooman Bakhshandeh, Parham Sadeghipour
    Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine.2025; 24(1): e0374.     CrossRef
  • Automated computation of the HEART score with the GPT-4 large language model
    Donald S. Wright, Vimig Socrates, Thomas Huang, Conrad W. Safranek, Rohit B. Sangal, Monisha Dilip, Zachary Boivin, Nickolas Srica, Catherine X. Wright, Attila Feher, Edward J. Miller, David Chartash, Richard Andrew Taylor
    The American Journal of Emergency Medicine.2025; 93: 120.     CrossRef
  • Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts
    Tonje R Johannessen, Indra M B Melessen, Odd Martin Vallersnes, Amy Manten, Sigrun Halvorsen, Dan Atar, Ralf E Harskamp
    Open Heart.2025; 12(2): e003362.     CrossRef
  • Evaluation of Providers' Assessment of Clinical History When Using the HEART Score in the Emergency Department in the Kingdom of Saudi Arabia Hospitals: A Cross-Sectional Study
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    Cureus.2025;[Epub]     CrossRef
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Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway
Ken Monahan, Margaret Pan, Chinonso Opara, Maame Yaa A. B. Yiadom, Daniel Munoz, Benjamin B. Holmes, Davis Stephen, Kristopher J. Swiger, Sean P. Collins
Clin Exp Emerg Med 2019;6(3):196-203.   Published online July 12, 2019
DOI: https://doi.org/10.15441/ceem.18.066

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Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway
Clin Exp Emerg Med. 2019;6(3):196-203.   Published online July 12, 2019
DOI: https://doi.org/10.15441/ceem.18.066
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Potential impact of cardiology phone-consultation for patients risk-stratified by the HEART pathway
Clin Exp Emerg Med. 2019;6(3):196-203.   Published online July 12, 2019
DOI: https://doi.org/10.15441/ceem.18.066
Close
Objective
Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.
Methods
We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.
Results
For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.
Conclusion
For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.

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  • Telecardiology in the Management of Acute Cardiovascular Diseases: Case of the Ivorian Experience
    LA Gnaba, KF Diby, PAE Ouattara, A Coulibaly, M Diomandé, KG Ayegnon, F Sall-Meneas, MN Koffi, S Abro, E Erika, KA Adoubi
    The Journal of Medical Research.2023; 9(6): 147.     CrossRef
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Review Article

Emergency Medicine Practice and Administration | Patient Safety

Emergency department and hospital crowding: causes, consequences, and cures
Peter McKenna, Samita M Heslin, Peter Viccellio, William K Mallon, Cristina Hernandez, Eric J Morley
Clin Exp Emerg Med 2019;6(3):189-195.   Published online July 12, 2019
DOI: https://doi.org/10.15441/ceem.18.022

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Emergency department and hospital crowding: causes, consequences, and cures
Clin Exp Emerg Med. 2019;6(3):189-195.   Published online July 12, 2019
DOI: https://doi.org/10.15441/ceem.18.022
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Emergency department and hospital crowding: causes, consequences, and cures
Clin Exp Emerg Med. 2019;6(3):189-195.   Published online July 12, 2019
DOI: https://doi.org/10.15441/ceem.18.022
Close
Overcrowding with associated delays in patient care is a problem faced by emergency departments (EDs) worldwide. ED overcrowding can be the result of poor ED department design and prolonged throughput due to staffing, ancillary service performance, and flow processes. As such, the problem may be addressed by process improvements within the ED. A broad body of literature demonstrates that ED overcrowding can be a function of hospital capacity rather than an ED specific issue. Lack of institutional capacity leads to boarding in the ED with resultant ED crowding. This is a problem not solvable by the ED and must be addressed as an institution-wide problem. This paper discusses the causes of ED overcrowding, provides a brief overview of the drastic consequences, and discusses possible cures that have been successfully implemented.

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    OTO Open.2021;[Epub]     CrossRef
  • Do automatic push notifications improve patient flow in the emergency department? analysis of an ED in a large medical center in Israel
    Daniel Trotzky, Liron Posner, Jonathan Mosery, Aya Cohen, Shiran Avisar, Gal Pachys, Robert Jeenchen Chen
    PLOS ONE.2021; 16(10): e0258169.     CrossRef
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  • Forecasting hourly emergency department arrival using time series analysis
    Avishek Choudhury, Estefania Urena
    British Journal of Healthcare Management.2020; 26(1): 34.     CrossRef
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    Maia Dorsett
    Science Advances.2020;[Epub]     CrossRef
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    Tae Han Kim, Youdong Sohn, Wonpyo Hong, Kyoung Jun Song, Sang Do Shin
    Resuscitation.2020; 153: 136.     CrossRef
  • Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy
    Andrea Strada, Niccolò Bolognesi, Lamberto Manzoli, Giorgia Valpiani, Chiara Morotti, Francesca Bravi, Roberto Bentivegna, Elena Forini, Antonella Pesci, Armando Stefanati, Eugenio Di Ruscio, Tiziano Carradori
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  • Intravenous Cetirizine Versus Intravenous Diphenhydramine for the Treatment of Acute Urticaria: A Phase III Randomized Controlled Noninferiority Trial
    Benjamin S. Abella, William E. Berger, Michael S. Blaiss, Ian G. Stiell, Joseph P. Herres, Joseph J. Moellman, Selim Suner, Adam Kessler, Howard A. Klausner, Jeffrey M. Caterino, Jie Du
    Annals of Emergency Medicine.2020; 76(4): 489.     CrossRef
  • Boarding of Critically Ill Patients in the Emergency Department
    Nicholas M. Mohr, Brian T. Wessman, Benjamin Bassin, Marie-Carmelle Elie-Turenne, Timothy Ellender, Lillian L. Emlet, Zachary Ginsberg, Kyle Gunnerson, Kevin M. Jones, Bridgette Kram, Evie Marcolini, Susanna Rudy
    Critical Care Medicine.2020; 48(8): 1180.     CrossRef
  • Boarding of critically Ill patients in the emergency department
    Nicholas M. Mohr, Brian T. Wessman, Benjamin Bassin, Marie‐Carmelle Elie‐Turenne, Timothy Ellender, Lillian L. Emlet, Zachary Ginsberg, Kyle Gunnerson, Kevin M. Jones, Bridgette Kram, Evie Marcolini, Susanna Rudy
    JACEP Open.2020; 1(4): 423.     CrossRef
  • Man vs. machine: Predicting hospital bed demand from an emergency department
    Filipe Rissieri Lucini, Mateus Augusto dos Reis, Giovani José Caetano da Silveira, Flavio Sanson Fogliatto, Michel José Anzanello, Giordanna Guerra Andrioli, Rafael Nicolaidis, Rafael Coimbra Ferreira Beltrame, Jeruza Lavanholi Neyeloff, Beatriz D'Agord S
    PLOS ONE.2020; 15(8): e0237937.     CrossRef
  • Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden
    Björn af Ugglas, Niclas Skyttberg, Andreas Wladis, Therese Djärv, Martin J. Holzmann
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2020;[Epub]     CrossRef
  • Emergency Medicine Challenges in Ecuador
    Andrés Patiño, Santiago Cantillo-Campos, Alexis Kearney, Sean Kivlehan, Augusto Maldonado
    Western Journal of Emergency Medicine.2020;[Epub]     CrossRef
  • Association between Emergency Department Overcrowding and Mortality at a Teaching Hospital in Saudi Arabia
    Fatimah Yahyia Khubrani, Mona Faisal Al-Qahtani
    The Open Public Health Journal.2020; 13(1): 756.     CrossRef
  • Forced Centralized Allocation of Patients to Temporarily ‘Closed’ Emergency Departments
    Harald Dormann
    Deutsches Ärzteblatt international.2020;[Epub]     CrossRef
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    Avishek Choudhury
    SSRN Electronic Journal .2019;[Epub]     CrossRef
  • 42,112 View
  • 950 Download
  • 169 Web of Science
  • 177 Crossref
Original Articles
Large observational study on risks predicting emergency department return visits and associated disposition deviations
Charles Huggins, Richard D. Robinson, Heidi Knowles, Jennalee Cizenski, Rosalia Mbugua, Jessica Laureano-Phillips, Chet D. Schrader, Nestor R. Zenarosa, Hao Wang
Clin Exp Emerg Med 2019;6(2):144-151.   Published online May 7, 2019
DOI: https://doi.org/10.15441/ceem.18.024

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Large observational study on risks predicting emergency department return visits and associated disposition deviations
Clin Exp Emerg Med. 2019;6(2):144-151.   Published online May 7, 2019
DOI: https://doi.org/10.15441/ceem.18.024
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Large observational study on risks predicting emergency department return visits and associated disposition deviations
Clin Exp Emerg Med. 2019;6(2):144-151.   Published online May 7, 2019
DOI: https://doi.org/10.15441/ceem.18.024
Close
Objective
A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.
Methods
We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.
Results
A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.
Conclusion
Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.

Citations

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  • Integrating comprehensive geriatric care into emergency departments: the GIROT-ED model
    Francesca Verga, Matteo Bulgaresi, Giacomo Fortini, Chiara Bandinelli, Simone Pupo, Elena Ballini, Simone Magazzini, Michele Lanigra, Germana Ruggiano, Gianfranco Giannasi, Guglielmo Bonaccorsi, Fabrizio Chiesi, Marzia Paffetti, Enrico Mossello, Giulia Ri
    Internal and Emergency Medicine.2026;[Epub]     CrossRef
  • Reduced left‐without‐being‐seen rates and impact on disparities after guest services ambassadors implementation
    Samuel R. Wing, Ciara Barclay‐Buchanan, Shawn Arneson, Denise Buckley, Daniel J. Hekman, Joshua Gauger, Collin Michels, Jenna Brink, Irene Hurst, Daniel R. Rutz, Ryan E. Tsuchida
    Academic Emergency Medicine.2025; 32(3): 216.     CrossRef
  • Critical revisits after discharge from the emergency department
    Zhenghong Liu, Raziyeh Mohammadi, Seyed Ehsan Saffari, Wei Lin Tallie Chua, Mingwei Ng, Fahad Javaid Siddiqui, Marcus Eng Hock Ong
    International Journal of Emergency Medicine.2025;[Epub]     CrossRef
  • A holistic evaluation of perceived factors associated with emergency department return among COVID-19 patients
    Jessica E. Galarraga, Erin Giovannetti, Hayley Rogovin, Brian P. Fitzgerald, Laura C.M. Ndjonko
    The American Journal of Emergency Medicine.2025; 94: 249.     CrossRef
  • Outpatient Follow-Up After Rural Emergency Department Discharge: A Quality Improvement Initiative
    Madeline Boyce, Kelly Snyder, Kristen Slabaugh, Anne Woods
    Journal of Emergency Nursing.2025; 51(4): 616.     CrossRef
  • Who has incomplete emergency department care among mental health patients in Australia? Does it impact short and longer-term representations?
    Shanley Chong, Helen M. Achat, Joanne M. Stubbs, Mark McLean
    Australasian Emergency Care.2025; 28(4): 287.     CrossRef
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    Jenny Müller, Dagmar I. Keller, Ksenija Slankamenac
    Frontiers in Disaster and Emergency Medicine.2024;[Epub]     CrossRef
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    Maryam Al Ali, Maitha R Alfalasi, Hamda A Taimour, Aiman M Ahmed, Omar Q Muhammed Noori
    Cureus.2023;[Epub]     CrossRef
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    Sung-Wei Liu
    Tzu Chi Medical Journal.2021; 33(2): 169.     CrossRef
  • Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children’s Hospitals, 2016-2019
    Jennifer R. Marin, Jonathan Rodean, Matt Hall, Elizabeth R. Alpern, Paul L. Aronson, Pradip P. Chaudhari, Eyal Cohen, Stephen B. Freedman, Rustin B. Morse, Alon Peltz, Margaret Samuels-Kalow, Samir S. Shah, Harold K. Simon, Mark I. Neuman
    JAMA Network Open.2021; 4(1): e2033710.     CrossRef
  • Discharge against medical advice from the emergency department in a university hospital
    Feras H. Abuzeyad, Moonis Farooq, Salah Farhat Alam, Mudhaffar Ismael Ibrahim, Luma Bashmi, Shaikha Sami Aljawder, Najeh Ellouze, Abdulla Almusalam, Stephanie Hsu, Priya Das
    BMC Emergency Medicine.2021;[Epub]     CrossRef
  • Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities
    Stefan H. Meyering, Chet D. Schrader, Darren Kumar, Yuan Zhou, Naomi Alanis, Sajid Shaikh, Radhika Cheeti, Rebecca Smiley, Chukwuagozie Iloma, Hao Wang
    Journal of International Medical Research.2021;[Epub]     CrossRef
  • Reasons for unscheduled return visits within 72 hours to the adult emergency department in Riyadh
    Majed H. Nasradeen, Muhannad I. Althunayan, Alwaleed K. Aljamaan, Abdulrahman M. Aljehani, Fajr B. Alqahtani, Nawfal Aljerian, Mohammed Alhelail, Aamir Omair
    Saudi Journal of Emergency Medicine.2021; 2(2): 112.     CrossRef
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    Dong-uk Kim, Yoo Seok Park, Joon Min Park, Nathan J. Brown, Kevin Chu, Ji Hwan Lee, Ji Hoon Kim, Min Joung Kim
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    M. C. (Christien) van der Linden, H. M. E. (Jet) van Ufford, N. (Naomi) van der Linden
    International Journal of Emergency Medicine.2019;[Epub]     CrossRef
  • 12,440 View
  • 177 Download
  • 13 Web of Science
  • 15 Crossref

Trauma

Trends in demographics and outcome of patients presenting with traumatic brain injury
Rachel Kadar, Daniel Rochford, Ellen Omi, Yalaunda Thomas, Kunal Patel, Erik Kulstad
Clin Exp Emerg Med 2019;6(2):113-118.   Published online April 8, 2019
DOI: https://doi.org/10.15441/ceem.18.010

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Trends in demographics and outcome of patients presenting with traumatic brain injury
Clin Exp Emerg Med. 2019;6(2):113-118.   Published online April 8, 2019
DOI: https://doi.org/10.15441/ceem.18.010
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Trends in demographics and outcome of patients presenting with traumatic brain injury
Clin Exp Emerg Med. 2019;6(2):113-118.   Published online April 8, 2019
DOI: https://doi.org/10.15441/ceem.18.010
Close
Objective
To analyze the trends in demographics and outcomes of patients presenting with traumatic brain injury by performing a retrospective database review of the Illinois Department of Public Health (IDPH) Trauma Registry.
Methods
We utilized the IDPH Trauma Registry to retrieve data on patients treated for traumatic brain injuries at our large, tertiary care hospital from 2004 to 2012, inclusive. From this data, logistic regression models were used to analyze and compare basic demographics such as age, sex, and clinical outcome.
Results
Three thousand and thirty-nine patients were analyzed with a mean age of 43 (standard deviation, 24) and a median age of 41 (interquartile range, 23 to 60). Over the study period, patients’ age increased steadily from 32 to 49 years. The percentage of female patients increased, from 16.4% to 27.5% over the last 4 years. Overall mortality was greater for males than females (22.1% vs. 17.3%; odds ratio [OR], 1.36; 95% confidence interval [CI], 1.10 to 1.68). Mortality decreased over the period (OR, 0.88; 95% CI, 0.85 to 0.91), with a greater decrease in females (OR, 0.84; 95% CI, 0.78 to 0.90) than in males (OR, 0.90; 95% CI, 0.86 to 0.94).
Conclusion
Although the age of patients presenting with traumatic brain injury is increasing substantially, the data suggests that overall mortality appears to be decreasing, and this decrease appears to be greater in females than in males. These changes in trends found in the IDPH Trauma Registry supports the importance for further analysis of other reliable public datasets to identify areas of future study.

Citations

Citations to this article as recorded by  Crossref logo
  • Association Between Sex and Mortality After Traumatic Brain Injury: A Systematic Review and Meta-Analysis
    Elise Beijer, Floor J. Mansvelder, Romein W. G. Dujardin, Nicole P. Juffermans, Linda J. Schoonmade, Leo M. G. Geeraedts, Frank W. Bloemers, Charissa E. van den Brom, Patrick Schober
    Neurocritical Care.2026; 45(1): 395.     CrossRef
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    Berthold Behle, Kerim Beseoglu, Thomas Beez, Athanasios K. Petridis, Igor Fischer, Daniel Hänggi, Hans-Jakob Steiger
    Journal of Neurological Surgery Part A: Central European Neurosurgery.2022; 83(01): 020.     CrossRef
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    Teemu Luostarinen, Juho Vehviläinen, Matias Lindfors, Matti Reinikainen, Stepani Bendel, Ruut Laitio, Sanna Hoppu, Tero Ala-Kokko, Markus Skrifvars, Rahul Raj
    Acta Neurochirurgica.2022; 164(1): 87.     CrossRef
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    Roh-Eul Yoo, Seung Hong Choi
    Investigative Magnetic Resonance Imaging.2021; 25(2): 76.     CrossRef
  • COVID-19 and Traumatic Brain Injury (TBI); What We Can Learn From the Viral Pandemic to Better Understand the Biology of TBI, Improve Diagnostics and Develop Evidence-Based Treatments
    Denes V. Agoston
    Frontiers in Neurology.2021;[Epub]     CrossRef
  • 9,756 View
  • 128 Download
  • 4 Web of Science
  • 5 Crossref

Critical Care

Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
Kyung Su Kim, Gil Joon Suh, Kyuseok Kim, Woon Yong Kwon, Jonghwan Shin, You Hwan Jo, Jae Hyuk Lee, Huijai Lee
Clin Exp Emerg Med 2019;6(1):77-83.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.294

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Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
Clin Exp Emerg Med. 2019;6(1):77-83.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.294
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Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
Clin Exp Emerg Med. 2019;6(1):77-83.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.294
Close
Objective
To test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients.
Methods
Patients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar’s test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value.
Results
Among the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score <2. The sensitivity of a qSOFA score ≥2 was 61.9%, which was significantly lower than the sensitivity of SIRS ≥2 (82.7%, P<0.001) and SOFA ≥2 (99.1%, P<0.001). The specificity, positive predictive value, and negative predictive value of a qSOFA score ≥2 for 28-day mortality were 58.1%, 32.9%, and 82.2%, respectively.
Conclusion
The current clinical criteria of the qSOFA are less sensitive than the SIRS assessment and SOFA to predict 28-day mortality in ED patients with sepsis.

Citations

Citations to this article as recorded by  Crossref logo
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    Duo Li, Zhu Yue, Genshen Zhen
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    Victoria Castilho Bartolomeu, Luiz Humberto Vieri Piacezzi, Karina Aparecida Lopes da Costa, Ruth Ester Assayag Batista, Cássia Regina Vancini Campanharo, Maria Carolina Barbosa Teixeira Lopes
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    Victoria Castilho Bartolomeu, Luiz Humberto Vieri Piacezzi, Karina Aparecida Lopes da Costa, Ruth Ester Assayag Batista, Cássia Regina Vancini Campanharo, Maria Carolina Barbosa Teixeira Lopes
    Revista da Escola de Enfermagem da USP.2025;[Epub]     CrossRef
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    Victoria Castilho Bartolomeu, Luiz Humberto Vieri Piacezzi, Karina Aparecida Lopes da Costa, Ruth Ester Assayag Batista, Cássia Regina Vancini Campanharo, Maria Carolina Barbosa Teixeira Lopes
    Revista da Escola de Enfermagem da USP.2025;[Epub]     CrossRef
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    Ahmed S Salem, Mohamed A Zaghloul, Alfred M Boctor, Mohamed Maher Abd Elfattah, Oliver M Shehata
    Indian Journal of Critical Care Medicine.2025; 29(12): 1002.     CrossRef
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    Batuhan Başpınar, Efe Cem Erdat, Ebru Ersoy Ortaç, Arzu Topeli
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    Rahma Hellali, Zaineb Chelly Dagdia, Ahmed Ktaish, Karine Zeitouni, Djillali Annane
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    Venkat Reddy, Harshitha Reddy, Rinkle Gemnani, Sunil Kumar, Sourya Acharya
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    David F. Gaieski, Brendan Carr, Melanie Toolan, Kim Ciotti, Amy Kidane, Joseph Christina, Rajesh Aggarwal
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    Xia Qiu, Yu-Peng Lei, Rui-Xi Zhou
    Expert Review of Anti-infective Therapy.2023; 21(8): 891.     CrossRef
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    Can Wang, Rufu Xu, Yuerong Zeng, Yu Zhao, Xuelian Hu, Ali Rostami
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    Priya A Prasad, Margaret C Fang, Sandra P Martinez, Kathleen D Liu, Kirsten N Kangelaris
    Journal of Hospital Medicine.2021; 16(8): 453.     CrossRef
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    Dongze Li, Yisong Cheng, Jing Yu, Yu Jia, Bofu Liu, Yiqin Xia, Qin Zhang, Yanmei Liu, Yan Ma, Rong Yao, Zhi Zeng, Yu Cao, Shuyun Xu
    Clinical Chemistry and Laboratory Medicine (CCLM).2020; 58(4): 625.     CrossRef
  • Accuracy of the qSOFA Score and RED Sign in Predicting Critical Care Requirements in Patients with Suspected Infection in the Emergency Department: A Retrospective Observational Study
    Jong Eun Park, Sung Yeon Hwang, Ik Joon Jo, Min Seob Sim, Won Chul Cha, Hee Yoon, Tae Rim Kim, Gun Tak Lee, Hye Seung Kim, InSuk Sohn, Tae Gun Shin
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    Sarah M. Perman, Mark E. Mikkelsen, Munish Goyal, Adit Ginde, Abhishek Bhardwaj, Byron Drumheller, S. Cham Sante, Anish K. Agarwal, David F. Gaieski
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Emergency Medicine Practice and Administration

Prognostic value of a modified surprise question designed for use in the emergency department setting
Samir A. Haydar, Tania D. Strout, Alicia G. Bond, Paul KJ Han
Clin Exp Emerg Med 2019;6(1):70-76.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.293

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Prognostic value of a modified surprise question designed for use in the emergency department setting
Clin Exp Emerg Med. 2019;6(1):70-76.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.293
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Prognostic value of a modified surprise question designed for use in the emergency department setting
Clin Exp Emerg Med. 2019;6(1):70-76.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.293
Close
Objective
Few reliable and valid prognostic tools are available to help emergency physicians identify patients who might benefit from early palliative approaches. We sought to determine if responses to a modified version of the surprise question, “Would you be surprised if this patient died in the next 30 days” could predict in-hospital mortality and resource utilization for hospitalized emergency department patients.
Methods
For this observational study, emergency physicians responded to the modified surprise question with each admission over a five-month study period. Logistic regression analyses were completed and standard test characteristics evaluated.
Results
6,122 visits were evaluated. Emergency physicians responded negatively to the modified surprise question in 918 (15.1%). Test characteristics for in-hospital mortality were: sensitivity 32%, specificity 85%, positive predictive value 6%, negative predictive value 98%. The risk of intensive care unit use (relative risk [RR], 1.87; 95% confidence interval [CI], 1.45 to 2.40), use of ‘comfort measures’ orders (RR, 3.43; 95% CI, 2.81 to 4.18), palliative-care consultation (RR, 3.06; 95% CI, 2.62 to 3.56), and in-hospital mortality (RR, 2.18; 95% CI, 1.72 to 2.76) were greater for patients with negative responses.
Conclusion
The modified surprise question is a simple trigger for palliative care needs, accurately identifying those at greater risk for in-hospital mortality and resource utilization. With a negative predictive value of 98%, affirmative responses to the modified surprise question provide reassurance that in-hospital death is unlikely.

Citations

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  • Clinical Gestalt to Predict Bacterial Infection and Mortality in Emergency Department Patients: A Prospective Observational Study
    Tanguy Espejo, Ricardo Nieves-Ortega, Livia Amsler, Henk Börje Riedel, Gianmarco Balestra, Christiane Rosin, Christoph Becker, Kriemhild Lippay, Christian Hans Nickel, Roland Bingisser
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    Susanny J. Beltran, Lainey Dorris, Marie Hamel, Shanelle Harvey, Mustafa Ozkaynak, Kenan Sualp
    Journal of Palliative Medicine.2026;[Epub]     CrossRef
  • Improving End-of-Life Screening in the Emergency Department With Collaborative Artificial Intelligence
    Adrian D. Haimovich, Gabriel Erion-Barner, Larry A. Nathanson, Caroline Cohen, Roger Orcutt, Smit Desai, David Rubins, Ula Hwang, Richard Andrew Taylor, Nathan I. Shapiro, Kei Ouchi, Mara A. Schonberg
    Annals of Emergency Medicine.2026;[Epub]     CrossRef
  • The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis
    Ankit Gupta, Ruth Burgess, Michael Drozd, John Gierula, Klaus Witte, Sam Straw
    BMJ Supportive & Palliative Care.2025; 15(1): 12.     CrossRef
  • Recognising uncertainty: an integrated framework for palliative care in perinatal medicine
    Dominic Wilkinson, Sophie Bertaud, Alexandra Mancini, Edile Murdoch
    Archives of Disease in Childhood - Fetal and Neonatal Edition.2025; 110(3): 236.     CrossRef
  • The surprise question: predictive accuracy in an unselected emergency department population – a prospective study in nurses and physicians
    Maurice Theunissen, Sacha Lardenoye, Marieke H. J. van den Beuken-van Everdingen, Patricia M. Stassen
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  • The Prognostic Value of the Modified Surprise Question in Critically Ill Emergency Department Patients
    Young Woo Um, You Hwan Jo, Hee Eun Kim, Seung Hyun Kang, Dong Kwan Han, Jae Hyuk Lee, Inwon Park
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  • EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU
    Wendy G. Lichtenthal, Lindsay Lief, Madeline Rogers, David Russell, Martin Viola, Hillary Winoker, Sophia Kakarala, Chani Traube, Taylor Coats, Carol Fadalla, Kailey E. Roberts, Madison Pavao, Francesco Osso, Chris R. Brewin, Cynthia X. Pan, Paul K. Macie
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  • Accuracy of the “Surprise Question” in Predicting Long-Term Mortality Among Older Patients Admitted to the Emergency Department: Comparison Between Emergency Physicians and Nurses in a Multicenter Longitudinal Study
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Cardiovascular

Effectiveness and safety of electrical cardioversion for acute-onset atrial fibrillation in the emergency department: a real-world 10-year single center experience
Laura Bonfanti, Antonio Annovi, Fabian Sanchis-Gomar, Carlotta Saccenti, Tiziana Meschi, Andrea Ticinesi, Gianfranco Cervellin
Clin Exp Emerg Med 2019;6(1):64-69.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.286

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Effectiveness and safety of electrical cardioversion for acute-onset atrial fibrillation in the emergency department: a real-world 10-year single center experience
Clin Exp Emerg Med. 2019;6(1):64-69.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.286
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Effectiveness and safety of electrical cardioversion for acute-onset atrial fibrillation in the emergency department: a real-world 10-year single center experience
Clin Exp Emerg Med. 2019;6(1):64-69.   Published online March 28, 2019
DOI: https://doi.org/10.15441/ceem.17.286
Close
Objective
Despite limited evidence, electrical cardioversion of acute-onset atrial fibrillation (AAF) is widely performed in the emergency department (ED). The aim of this study was to describe the effectiveness and safety of electrical cardioversion of AAF performed by emergency physicians in the ED.
Methods
All episodes of AAF electrically cardioverted in the ED were retrieved from the database for a 10-year period. Most patients not already receiving anticoagulants were given enoxaparin before the procedure (259/419). Procedural complications were recorded, and the patients were followed-up for 30 days for cardiovascular and hemorrhagic complications.
Results
Four hundred nineteen eligible cases were identified; men represented 69%, and mean age was 61±13 years. The procedure was effective in 403 cases (96.2%; 95.4% in women, 96.5% in men), with considerable differences with respect to the age of the patients, the procedure being effective in 100% of patients aged 18 to 39 and only 68.8% in those >80 years. New ED visits (33/419) were identified within 30 days (31 due to atrial fibrillation/atrial flutter recurrence, 1 due to iatrogenic hypokalemia, 1 due to hypertensive emergency). No strokes, major bleeding, life-threatening arrhythmias or peripheral thromboembolism were recorded. Nine small and mild skin burns were observed.
Conclusion
Electrical cardioversion is an effective and safe procedure in the vast majority of patients, albeit less effective in patients aged >80 years. It appears reasonable to avoid anticoagulation in low-risk patients with AAF and administer peri-procedural heparin to all remaining patients. Long-term anticoagulation should be planned on an individual basis, after assessment of thromboembolic and hemorrhagic risk.

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Infectious Disease | Clinical Laboratory

Effect of rapid influenza diagnostic tests on patient management in an emergency department
Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Ju-Hyun Song, Ju Young Kim, Yu-Sang Ahn
Clin Exp Emerg Med 2019;6(1):43-48.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.281

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Effect of rapid influenza diagnostic tests on patient management in an emergency department
Clin Exp Emerg Med. 2019;6(1):43-48.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.281
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Effect of rapid influenza diagnostic tests on patient management in an emergency department
Clin Exp Emerg Med. 2019;6(1):43-48.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.281
Close
Objective
We evaluated the effect of rapid influenza diagnostic tests (RIDTs) on patient management in an emergency department for 3 years after 2009, and also identified factors associated with the choice of treatment for patients with influenza-like illnesses.
Methods
The study period consisted of three influenza epidemic seasons. Patients older than 15 years who underwent RIDTs in the emergency department and were then discharged without admission were included.
Results
A total of 453 patients were enrolled, 114 of whom had positive RIDT results and 339 had negative results. Antiviral medication was prescribed to 103 patients (90.4%) who had positive RIDT results, while 1 patient (0.3%) who tested negative was treated with antivirals (P<0.001). Conservative care was administered to 11 RIDT-positive patients (9.6%) and 244 RIDT-negative patients (72.0%) (P<0.001). Symptom onset in less than 48 hours, being older than 65 years, and the presence of comorbidities were not associated with the administration of antiviral therapy.
Conclusion
RIDT results had a critical effect on physician decision-making regarding antiviral treatment for patients with influenza-like illnesses in the emergency department. However, symptom onset in less than 48 hours, old age, and comorbidities, which are all indications for antiviral therapy, were not found to influence the administration of antiviral treatment.

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  • Comparison of rapid nucleic acid amplification tests and rapid antigen tests for influenza in the emergency department
    Sukyo Lee, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sejoong Ahn
    The American Journal of Emergency Medicine.2026; 99: 25.     CrossRef
  • The “timeless” use of influenza-like illness criteria for influenza detection in the tropics
    Aung H. Aung, David C. Lye, Lin Cui, Chee K. Ooi, Angela L.P. Chow
    International Journal of Infectious Diseases.2021; 106: 160.     CrossRef
  • 12,736 View
  • 156 Download
  • 2 Web of Science
  • 2 Crossref

Imaging

The difference of Use of CT in the general versus pediatric emergency departments for adolescent patients in the same tertiary hospital
Seul Ki Kim, Jin Hee Jung, Jin Hee Lee, Jae Yun Jung, Hyuksool Kwon, So Hyun Paek, Young Ho Kwak, Do Kyun Kim
Clin Exp Emerg Med 2019;6(1):19-24.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.274

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The difference of Use of CT in the general versus pediatric emergency departments for adolescent patients in the same tertiary hospital
Clin Exp Emerg Med. 2019;6(1):19-24.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.274
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The difference of Use of CT in the general versus pediatric emergency departments for adolescent patients in the same tertiary hospital
Clin Exp Emerg Med. 2019;6(1):19-24.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.274
Close
Objective
The use of computed tomography (CT) in pediatric patients has decreased since the association between radiation and cancer risk has been reported. However, in adolescent patients being treated as adult patients, there has been a high incidence of CT use in emergency departments (EDs). Thus, this study aimed to evaluate the CT use in adolescent patients with complaints of headache or abdominal pain in the general and pediatric EDs of the same hospital.
Methods
A retrospective chart review of patients aged 15 to 18 years, who presented with headache or abdominal pain at the general and pediatric EDs of Seoul National University Hospital from January 2010 to December 2014, was conducted.
Results
A total of 407 adolescent patients with complaints of headache and 980 with abdominal pain were included in this study. The adolescent patients in the general ED were more likely to undergo CT scans than those in the pediatric ED, with both patients having headache (42.4% vs. 20.5%, respectively, P<0.001) and abdominal pain (29.0% vs. 18.4%, respectively, P<0.001). There was no statistical difference in the rates of positive CT findings between the general and pediatric EDs. The frequency of visits to the general ED was associated with high rates of CT use in adolescent patients with complaints of headache (odds ratio, 3.95; 95% confidence interval, 2.01 to 7.77) and those with abdominal pain (odds ratio, 1.76; 95% confidence interval, 1.18 to 2.64).
Conclusion
The ED setting influences the use of CT on adolescent patients, and a child-friendly environment could reduce the radiation risks.

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Critical Care | Pulmonary

Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
Hwan Song, Hyung Gi Moon, Soo Hyun Kim
Clin Exp Emerg Med 2019;6(1):1-8.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.262

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Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
Clin Exp Emerg Med. 2019;6(1):1-8.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.262
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Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
Clin Exp Emerg Med. 2019;6(1):1-8.   Published online February 20, 2019
DOI: https://doi.org/10.15441/ceem.17.262
Close
Objective
Community-acquired pneumonia (CAP) is a major cause of sepsis, and sepsis-related acute organ dysfunction affects patient mortality. Although the quick Sequential Organ Failure Assessment (qSOFA) is a new screening tool for patients with suspected infection, its predictive value for the mortality of patients with CAP has not been validated. Lactate concentration is a valuable biomarker for critically ill patients. Thus, we investigated the predictive value of qSOFA with lactate concentration for in-hospital mortality in patients with CAP in the emergency department (ED).
Methods
From January 2015 to June 2015, 443 patients, who were diagnosed with CAP in the ED, were retrospectively analyzed. We defined high qSOFA or lactate concentrations as a qSOFA score ≥2 or a lactate concentration >2 mmol/L upon admission at the ED. The primary outcome was all-cause in-hospital mortality.
Results
Among the 443 patients, 44 (9.9%) died. Based on the receiver operating characteristic (ROC) analysis, the areas under the curves for the prediction of mortality were 0.720, 0.652, and 0.686 for qSOFA, CURB-65 (confusion, urea, respiratory rate, blood pressure, and age), and Pneumonia Severity Index, respectively. The area under the ROC curve of qSOFA was lower than that of SOFA (0.720 vs. 0.845, P=0.004). However, the area under the ROC curve of qSOFA with lactate concentration was not significantly different from that of SOFA (0.828 vs. 0.845, P=0.509). The sensitivity and specificity of qSOFA with lactate concentration were 71.4% and 83.2%, respectively.
Conclusion
qSOFA with lactate concentration is a useful and practical tool for the early prediction of in-hospital mortality among patients with CAP in the ED.

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  • Comparison of Shock Indexes, Lactate Level, and Base Deficit in Predicting Mortality in Community-Acquired Pneumonia: A Retrospective Analysis
    İlter Ağaçkıran, Merve Ağaçkıran
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Emergency Medical Services

Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department
Sang Bum Lee, Jae Hun Oh, Jeong Ho Park, Seung Pill Choi, Jung Hee Wee
Clin Exp Emerg Med 2018;5(4):249-255.   Published online December 31, 2018
DOI: https://doi.org/10.15441/ceem.17.261

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Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department
Clin Exp Emerg Med. 2018;5(4):249-255.   Published online December 31, 2018
DOI: https://doi.org/10.15441/ceem.17.261
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Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department
Clin Exp Emerg Med. 2018;5(4):249-255.   Published online December 31, 2018
DOI: https://doi.org/10.15441/ceem.17.261
Close
Objective
As aging progresses, clinical characteristics of elderly patients in the emergency department (ED) vary by age. We aimed to study differences among elderly patients in the ED by age group.
Methods
For 2 years, patients aged 65 and older were enrolled in the study and classified into three groups: youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, ≥85 years. Participants’ sex, reason for ED visit, transfer from another hospital, results of treatment, type of admission, admission department and length of stay were recorded.
Results
During the study period, a total 64,287 patients visited the ED; 11,236 (17.5%) were aged 65 and older, of whom 14.4% were 85 and older. With increased age, the female ratio (51.5% vs. 54.9% vs. 69.1%, P<0.001), medical causes (79.5% vs. 81.3% vs. 81.7%, P=0.045), and admission rate (35.3% vs. 42.8% vs. 48.5%, P<0.001) increased. Admissions to internal medicine (57.5% vs. 59.3% vs. 64.7%, P<0.001) and orthopedic surgery (8.5% vs. 11.6% vs. 13.8%, P< 0.001) also increased. The ratio of admission to intensive care unit showed no statistical significance (P=0.545). Patients over age 85 years had longer stays in the ED (330.9 vs. 378.9 vs. 407.2 minutes, P<0.001), were discharged home less (84.4% vs. 78.9% vs. 71.5%, P<0.001), and died more frequently (6.3% vs. 10.4% vs. 13.0%, P<0.001).
Conclusion
With increased age, the proportion of female patients and medical causes increased. Rates of admission and death increased with age and older patients had longer ED and hospital stays.

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Emergency Medicine Practice and Administration

Changes in medical care due to the absence of internal medicine physicians in emergency departments
Kyoung Ho Kim, Jang Young Lee, Won Suk Lee, Won Young Sung, Sang Won Seo
Clin Exp Emerg Med 2018;5(2):120-130.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.235

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Changes in medical care due to the absence of internal medicine physicians in emergency departments
Clin Exp Emerg Med. 2018;5(2):120-130.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.235
Download Citation

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Include:
Changes in medical care due to the absence of internal medicine physicians in emergency departments
Clin Exp Emerg Med. 2018;5(2):120-130.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.235
Close
Objective
Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents.
Methods
This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department.
Results
The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P<0.001); lengths of stay decreased by 15.1% (95% CI, P<0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021).
Conclusion
Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients.

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    Ian C. Abordo, Jahsel Amber F. Benabaye, Maria Donna Lyn F. Bombeza, Hannica M. Cogtas, Raymond M. Salvador, RN, Man, Donna Bell P Sumugat, Rn Man
    International Journal of Innovative Science and Research Technology (IJISRT).2024; : 1133.     CrossRef
  • MINIMIZING PATIENT LENGTH OF STAY IN THE EMERGENCY DEPARTMENT AT ANNA MEDIKA GENERAL HOSPITAL, MADURA
    Ida Lumintu, Hidayatur Rohman, Rullie Annisa
    J@ti Undip: Jurnal Teknik Industri.2024; 19(3): 115.     CrossRef
  • 8,952 View
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Pain Management & Sedation

Quality improvement activity for improving pain management in acute extremity injuries in the emergency department
Hyung Lan Chang, Jin Hee Jung, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jae Yun Jung, Hyuksool Kwon, So Hyun Paek, Joong Wan Park, Jonghwan Shin
Clin Exp Emerg Med 2018;5(1):51-59.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.17.260

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Quality improvement activity for improving pain management in acute extremity injuries in the emergency department
Clin Exp Emerg Med. 2018;5(1):51-59.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.17.260
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Quality improvement activity for improving pain management in acute extremity injuries in the emergency department
Clin Exp Emerg Med. 2018;5(1):51-59.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.17.260
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Objective
The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED).
Methods
This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40–S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse’s pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription.
Results
A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P< 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%.
Conclusion
ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.

Citations

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  • Time from pain assessment to opioid treatment in the Danish emergency departments—A multicenter cohort study
    Katrine H. Gull, Marianne Lisby, Sara V. Leth, Stine F. Galili
    Acta Anaesthesiologica Scandinavica.2025;[Epub]     CrossRef
  • Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project
    Anuusha Sadasivam S, Aswin Kumaran, S Manu Ayyan, S N Sindujaa
    BMJ Open Quality.2024; 13(2): e002815.     CrossRef
  • Assessment of the implementation of a nurse-initiated pain management protocol in the emergency department
    Marcia Boessio dos Santos, Cristiana Maria Toscano, Ruth Ester Assayag Batista, Elena Bohomol
    Revista Brasileira de Enfermagem.2021;[Epub]     CrossRef
  • The investigation of open hand injury patients presenting to emergency department
    İsa Gökhan YALÇIN, Cihan BEDEL, Önder TOMRUK, Nesrin Gökben BECEREN, Hamit Hakan ARMAĞAN
    Journal of Health Sciences and Medicine.2018; 1(4): 75.     CrossRef
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  • 168 Download
  • 4 Web of Science
  • 4 Crossref

Injury & Prevention

Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study
Jeong Ho Park, Ju Ok Park, Young Sun Ro, Sang Do Shin
Clin Exp Emerg Med 2018;5(1):7-13.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.16.180

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Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study
Clin Exp Emerg Med. 2018;5(1):7-13.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.16.180
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Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study
Clin Exp Emerg Med. 2018;5(1):7-13.   Published online March 30, 2018
DOI: https://doi.org/10.15441/ceem.16.180
Close
Objective
This study aimed to evaluate the effect of alcohol use on emergency department (ED) length of stay (LOS) among minimally injured patients by mechanism of injury. Methods This was a retrospective study of injury surveillance data for injured patients (except poisoning), aged over 18 years, discharged home from the ED, and treated at seven academic EDs in Korea during 2008 to 2012. Patients were divided into alcohol-related and alcohol-unrelated groups based on self-report. We used multivariable quantile regression models for the analysis and adjusted covariates including age, sex, consciousness status, severity of injury, emergency medical service use, the season, day and time of visit, and hospital. To determine if there were different effects of alcohol use across mechanism of injury, all analyses were stratified by each mechanism.
Results
Among 192,200 patients, 95,807 patients were analyzed. The number of participants in the alcohol-related group was 16,249 (17.0%). In the multivariable quantile regression model, the alcohol-related group had significantly longer ED LOS at the 10th (7 minutes; 95% confidence interval [CI], 6 to 8), 50th (21 minutes; 95% CI, 19 to 23), and 90th (81 minutes; 95% CI, 74 to 87) percentiles when compared to the alcohol-unrelated group. The effect of alcohol use on increased ED LOS was most prominent in motor vehicle injuries.
Conclusion
We found that alcohol use was associated with increased emergency ED LOS. Furthermore, if we limited our attention to the effect of alcohol use on the number of patients, the burden of alcohol use on the ED would have been underestimated.

Citations

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    Firman Firman, Andi Masyitha Irwan, Amy Buckenmeyer
    International Emergency Nursing.2025; 80: 101607.     CrossRef
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    Sunmi Lee, Hyunjin Oh
    Australasian Emergency Care.2023; 26(1): 90.     CrossRef
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    Thomas Wilson, Torben Wisborg, Vigdis Vindenes, Ragnhild Elèn Gjulem Jamt, Stig Tore Bogstrand
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2023;[Epub]     CrossRef
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    Seung Taeg Seong, Jae Hee Lee, Duk Hee Lee
    Journal of Public Health.2022; 30(9): 2283.     CrossRef
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    Wanlu Gu, Neng Fan, Haitao Liao
    IISE Transactions on Healthcare Systems Engineering.2021; : 1.     CrossRef
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    Mncedisi Junior Manyoni, Muhammed Irfaan Abader
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    Wirachin Hoonpongsimanont, Ghadi Ghanem, Soheil Saadat, Maria Nguyen, Christine Louis, PreetK Sahota, Leila Danishgar, Christy Carroll, Cristobal Barrios, Shahram Lotfipour
    Journal of Emergencies, Trauma, and Shock.2021; 14(1): 42.     CrossRef
  • Analysis of Factors Associated With Length of Stay of Opioid-Related Emergency Department Visits
    Keshab Subedi
    Cureus.2021;[Epub]     CrossRef
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    Adeline Dozois, Paulina Nkondora, Erin Noste, Juma A. Mfinanga, Hendry R. Sawe, Michael S. Runyon
    African Journal of Emergency Medicine.2021; 11(4): 390.     CrossRef
  • Effect of alcohol intake on the severity of injuries caused by slipping down
    Kyoung Sung Yun, Jin-Seong Cho, Yong Su Lim, Jae Ho Jang, Hyuk Jun Yang, Woo Sung Choi
    Clinical and Experimental Emergency Medicine.2020; 7(3): 170.     CrossRef
  • 9,200 View
  • 128 Download
  • 13 Web of Science
  • 10 Crossref
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CEEM : Clinical and Experimental Emergency Medicine