Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 8 Articles
Objectives: Pain is common among patients presenting to the emergency department (ED) but is frequently underdetected and undertreated in older people living with dementia (PLWD). This systematic review examined whether dementia- specific pain assessment tools improve pain management compared with usual care in the ED. Methods: We conducted a systematic review and have reported the methods and results following PRISMA (PROSPERO: CRD420251044828). Eligible studies included randomized, quasi- experimental, and observational designs enrolling ED patients aged ≥ 65 years with dementia or cognitive impairment. Interventions were pain assessment tools developed for PLWD, and comparisons were with standard pain scales. Primary outcomes were patient- reported outcome measures and analgesia administration; secondary outcomes included repeated pain scores, ED revisits, functional decline, mortality, and adverse events. Five databases (Ovid MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo) and two clinical trial registries were searched without language or date restrictions on April 22, 2025, and December 16, 2025, respectively. Two reviewers independently screened, extracted data, and assessed risk of bias using Cochrane RoB- 2. Results: Of 987 records identified, 18 underwent full- text review, and one study met eligibility criteria. Fry et al. (2017) conducted a multicenter, cluster- randomized controlled trial of 602 older adults with suspected long bone fractures, comparing the Pain Assessment in Advanced Dementia (PAINAD) tool with standard pain scales. No significant differences were observed in median time to first analgesia (83 vs. 82 min, p = 0.42) or proportion receiving analgesia within 60 min (28% vs. 32%, p = 0.19). Evidence certainty was rated very low. Conclusions: Evidence on dementia- specific pain assessment tools in the ED is extremely limited. Available data suggest PAINAD does not improve timeliness of analgesia, underscoring the urgent need for rigorous studies to guide pain management for PLWD in the ED....
Objective: The objective of this study is to evaluate the diagnostic accuracy of Extended Focused Assessment with Sonography for Trauma (E‐FAST) performed by senior emergency medicine residents compared with computed tomography (CT) in patients with blunt thoracoabdominal trauma. Methods: This prospective observational diagnostic accuracy study was conducted at a Level 1 trauma center between December 2023 and June 2024. Adult patients presenting with isolated blunt thoracoabdominal trauma who underwent both E‐FAST and thoracoabdominal CT were included. E‐FAST examinations were performed at the bedside by senior emergency medicine residents certified in ultrasonography. CT served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of E‐FAST were calculated. Concordance between E‐FAST and CT findings was analyzed using Fisher's exact test wherever appropriate. Results: A total of 170 patients were analyzed (124 males [72.9%] and mean age: 38.2 ± 14.7 years). E‐FAST demonstrated a sensitivity of 100%, specificity of 98.7%, PPV of 88.2%, and NPV of 100% compared to CT. Concordance between E‐FAST and CT findings was statistically significant for intra‐abdominal free fluid, pneumothorax, and hemothorax (p < 0.001 for each). No pericardial effusion was detected by either modality. Conclusion: E‐FAST performed by adequately trained emergency medicine residents is a rapid, reliable, and highly accurate diagnostic tool in the initial evaluation of blunt thoracoabdominal trauma. Incorporating E‐FAST into standard trauma assessment protocols can enhance diagnostic efficiency and reduce unnecessary CT utilization....
Introduction: Andrological emergencies include the various pathologies affecting the male genital tract that can endanger the patient’s vital prognosis or the functional prognosis of the tract. The aim of this study was to improve the management of andrological emergencies at Abeche University Hospital. Patients and Method: This was a prospective, descriptive study conducted over a 12-month period from July 2023 to June 2024 at Abeche University Hospital. Consenting male patients of all ages presenting with an andrological emergency were included. The variables studied were epidemiological, clinical and therapeutic. Results: During the study period, 5399 patients were received in the emergency ward, 94 of whom had presented with an andrological emergency, or 1.74% of cases. The average age was 28.5 ± 15.7 years. Patients had consulted for painful swelling of the scrotum in 41.5% of cases. Acute epididymo- orchitis dominates our series with 29.80%. 33% of our patients were put on probabilistic antibiotics. The most commonly performed surgical procedure was debridement in 18.1% of cases. Conclusion: The management of andrological emergencies is medical-surgical. These data highlight the importance of andrological emergencies at Abeche University Hospital and the need to implement structures and personnel specifically trained for their optimal management....
Background: Prolonged emergency department waiting times are associated with increased mortality among older patients. In January 2025, the ED of Linkoping University Hospital, Sweden, implemented a low- resource routine to expedite the workup of older patients living with frailty by prioritized physician assessment and subsequent workup. Aim: To investigate if a frailty alert using the Clinical Frailty Scale followed by prioritized clinical assessment influences ED operating metrics. Design: This was an observational before and after study of a pre- implementation group (control) and a post- implementation group (intervention) between October 2024 and February 2025. Setting/Participants: Consecutive patients aged > 64 years, with a documented CFS assessment during the ED visit at the Linkoping University Hospital, Sweden, who consented to participation, were included. Method: Standard ED operating metrics, Time to physician, ED length of stay (LOS), and admission rates were compared between a pre- implementation group and a post- implementation group. Results: A total of 542 ED visits were analyzed (248 pre- implementation, 294 post- implementation). Time to physician was shorter in the post- implementation group at 31 min (IQR 15, 65) versus 44 min (IQR 20, 94) (p < 0.001). ED LOS was reduced from 352 (IQR 266, 515) to 319 (IQR 240, 458) minutes (p = 0.014). The admission rate was unchanged at 59% and 60% (p = 0.4). Conclusion: Frailty alerts based on the CFS with prioritized workup reduced ED LOS and time to physician in older patients living with frailty in this single center study and may be a low- resource intervention to reduce the risks of adverse events in the ED. Trial Registration: Clini calTr ials. gov identifier: NCT06869148....
Frailty is a multidomain reduction in physiologic reserve that impacts recovery and can contribute to poor outcomes following trauma beyond what chronological age, comorbidities, or injury severity predicts. In geriatric trauma patients, a large proportion are frail or prefrail on initial encounter in the emergency department, and because there are opportunities for actionable management plans, major trauma guidelines endorse systematic screening integrated into coordinated geriatric trauma care. We reviewed the literature and identified practical instruments used in the acute trauma setting for risk stratification. Additionally, we highlight the feasibility of using these instruments, as some can be completed via patient report, proxy input, or chart review when cognition, language, or caregiver availability limits history-taking. Implementation efforts succeed when shared mental models are leveraged and screening is embedded in the electronic health record system, linked to order sets and trigger-based pathways that offer downstream goal-directed care management, such as early mobility, delirium prevention, nutrition, medication review, and comprehensive geriatric assessment. Additionally, we highlight the importance of initiating early goals-of-care discussions and coordinating care with palliative care services. Resource-limited systems can preserve the same architecture by using nurse-led or allied staff-led screening, tele-geriatric consultation, and virtual interdisciplinary huddles. Lastly, we expand upon opportunities for longitudinal post-discharge follow-up. We describe how targeted initiatives translate research into practice, improve outcomes, and support longitudinal reassessment through in-person and telehealth follow-up visits....
Timely stroke diagnosis is essential for delivering life-saving treatments, yet current prehospital stroke assessment tools often lead to missed or delayed diagnoses. Emergency Medical Services (EMS) increasingly collect detailed data during transport, offering an opportunity to develop AI-based tools to support early stroke detection. In this retrospective study, we evaluated the availability and reliability of prehospital data compared to Emergency Department (ED) records. We tested the potential of machine learning to support EMS stroke triage. Our cohort included 4,333 patients across 8,221 ambulance encounters from 2015 to 2020 with stroke rate of 2.0% (64% severe strokes). Vital signs such as heart rate, respiratory rate, blood pressure, oxygen saturation, and GCS scores, recorded in over 88%, were generally higher than their ED counterparts. We trained and evaluated random forest, XGBoost, and sequential neural networks for detecting stroke and severe stroke. The XGBoost model performed best for stroke detection (ROC-AUC 0.843 [0.77–0.89], PR-AUC 0.293 [0.16–0.45]), while Random Forest performed best for severe strokes (ROC-AUC 0.826 [0.75–0.90], PR-AUC 0.186 [0.07–0.35]). Models were calibrated to improve reliability, and feature importance was assessed using SHAP to enhance interpretability. These findings highlight the promise of AI-based tools in improving prehospital stroke triage with real-time EMS data....
Background: The transition from trainee to new attending physician can be overwhelming. Simulation has been shown to be effective in orienting trainees to the emergency department (ED) but there is limited literature on simulation for the orientation of newly hired attending physicians. Objective of the Innovation: The objective of this innovation was to develop, implement, and evaluate a simulation curriculum to supplement the orientation of newly hired attending physicians in our emergency department. Development Process and Implementation: We developed a year- long quarterly simulation curriculum guided by Kern's sixstep curricular design model. Based on a targeted needs assessment, nine scenarios were chosen for inclusion. These scenarios were arranged to start the curriculum with those simulation scenarios that highlight systems and processes particular to our institution, with a transition towards scenarios requiring more complex team leadership and medical management decisions in the latter portions of the curriculum. Outcomes: We have completed two years of this curriculum and have had 14 participants in total. Thirteen participants completed the end- of- year evaluation. The curriculum has been well received by participants with unanimous agreement that the curriculum helped them lead acute patient scenarios in the resuscitation bay during their first year as a new hire. Conclusions: Simulation for the orientation of new attending physicians can be implemented successfully and received well by the targeted learners and by leadership invested in supporting new attending physicians. While the specific scenario topics and institutional procedures are site- specific, the approach to curricular design and implementation is widely generalizable to other EDs....
Background: Since the 1980s, the global twinning rate has risen to about 1.6 million twin pairs annually due to the widespread use of IVF. Twin pregnancies carry a higher risk of complications compared to singleton pregnancies, with cervical insufficiency being a significant concern that can lead to preterm birth and adverse perinatal outcomes. It is estimated that around 430 000 cases of twins deliver prior to 28 weeks of gestation annually. The twin miscarriage rate at the second trimester is estimated at 5%–10%, amounting to 80–160 000 losses annually in the pre‐viable period. Emergency cerclage is often used in such cases to provide mechanical support to the cervix and prolong gestation. This report presents two cases of emergency cerclage in the second trimester for twin pregnancies, with delivery of the second twin after intervals of 110 and 123 days. Case 1: A 36‐year‐old woman at 21 + 1 weeks presented with bulging membranes. Despite initial attempts to manage the condition, the membranes ruptured, necessitating the extraction of the first twin. Emergency cerclage was successfully performed to preserve the remaining twin, and was delivered by caesarean section at 36 + 6 weeks. Case 2: A 48‐year‐old woman at 16 + 6 weeks with premature rupture of membranes underwent extraction of the non‐viable twin, followed by emergency cerclage. The second twin was delivered by caesarean section at 34 + 3 weeks. Both cases involved close monitoring of inflammatory markers and regular follow‐ups. Prophylactic antibiotics were administered post‐operatively, with no tocolysis required. Indomethacin and progesterone were used to manage uterine activity and inflammation. Conclusion: These cases highlight the potential benefits of emergency cerclage in twin pregnancies with cervical insufficiency. Success was attributed to rigorous monitoring, appropriate antibiotic use and careful management of uterine activity. These cases contribute valuable insights into the complex decision‐making process involved in such high‐risk pregnancies and highlight the importance of individualised care plans....
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