Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Suicide is the 10th leading cause of death in the United States. Prior research suggests that 10% of people who died by suicide received some form of emergency department (ED) treatment in the 2 months preceding death. The risk of attempted suicide is high during transition back to the community after discharge from the ED, so this is an important opportunity to develop effective empirically validated prevention methods. However, the physical layout and crowded nature of most contemporary EDs, resulting in high rates of "hallway bed" assignments, presents some ethical challenges to conducting the requisite behavioral health research in ED settings. ⋯ This example illustrates the ethical considerations when enrolling patients who occupy a hallway bed into research and the value of a collaborative/problem solving focused dialogue between investigators, ethicists, and IRB personnel.
-
Vertigo is a priority for training and decision support in emergency departments (ED). Benign paroxysmal positional vertigo (BPPV), though manageable at bedside, remains frequently underdiagnosed and undertreated. This study assessed the effectiveness of a two-tiered educational intervention on posterior and horizontal BPPV management in the ED setting. ⋯ A standardized educational intervention demonstrated enhancing BPPV screening and improved evidence-based diagnosis, showing promise of more efficient treatment in the ED. Further multicenter studies are warranted to evaluate impacts on patient-reported outcomes and resource optimization.
-
Gender-minority youth, whose gender identity differs from their sex assigned at birth, have elevated suicide risk compared to cisgender youth, yet few studies examine their suicide risk in the emergency department (ED). Our objectives were to determine the prevalence of and assess risk and protective factors associated with prior suicide attempt (SA) and recent suicide ideation (SI) among gender-minority adolescents in the ED. ⋯ Among gender-minority ED adolescent patients, one in three experienced a SA prior to the ED visit. One in four endorsed SI within 2 weeks of the ED visit. The identified risk and protective factors among gender-minority adolescents may inform future ED-based efforts to detect and reduce suicide risk.
-
For emergency department (ED) patients, lung cancer may be detected early through incidental lung nodules (ILNs) discovered on chest CTs. However, there are significant errors in the communication and follow-up of incidental findings on ED imaging, particularly due to unstructured radiology reports. Natural language processing (NLP) can aid in identifying ILNs requiring follow-up, potentially reducing errors from missed follow-up. We sought to develop an open-access, three-step NLP pipeline specifically for this purpose. ⋯ We developed an accurate, open-access pipeline to identify ILNs with recommended follow-up on ED chest CTs. While the prevalence of recommended follow-up is lower than some prior studies, it more accurately reflects the prevalence of truly incidental findings without prior or known malignancy. Incorporating this tool could reduce errors by improving the identification, communication, and tracking of ILNs.