Articles

Population Health Research Design

Understanding the Use of Composite Endpoints in Clinical Trials

McCoy, MD, MPH.

Researchers have been increasingly using composite endpoints in lieu of the customary single primary endpoint. Although statistically treated like a single primary endpoint, composite endpoints provide unique challenges for patient care. If used or interpreted incorrectly, they have the potential for detrimental impact on patient care on a large scale. This paper defines composite endpoints, discusses the rationale for their use, and provides a practical approach to understand whether they should be used in medical decision-making.

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Emergency Department Time Course for Mild Traumatic Brain Injury Workup

Michelson, MD, et al.

Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients. To examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13–15) – from initial presentation to the ED to discharge.

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Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone

Dworkis, MD, PhD, et al.

An alternate approach would be to position naloxone kits where they are most needed in a community, in a manner analogous to automated external defibrillators. We hypothesized that opioid overdoses would show geospatial clustering within a community, leading to potential target sites for such publicly deployed naloxone (PDN).

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Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model

Strony, DO, et al.

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. The purpose of this paper was to create a model for SWCUS development and implementation.

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Critical Care

Simple Changes to Emergency Department Workflow Improve Analgesia in Mechanically Ventilated Patients

Isenberg, MD, et al.

In 2013 the Society for Critical Care Medicine (SCCM) published guidelines for the management of pain and agitation in the intensive care unit (ICU). We sought to determine whether a simple educational intervention for emergency department (ED) staff, as well as two simple changes in workflow, would improve adherence to the SCCM guidelines.

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Anaphylaxis-related Malpractice Lawsuits

Lindor, MD, JD, et al.

Anaphylaxis continues to cause significant morbidity and mortality. Healthcare providers struggle to promptly recognize and appropriately treat anaphylaxis patients. The goal of this study was to characterize anaphylaxis-related malpractice lawsuits.

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Initial Standardized Framework for Reporting Social Media Analytics in Emergency Care Research

Roland, PhD, et al.

While tools exist to standardize the reporting of clinical studies and systematic reviews, there is no agreed framework for examining social media–based research. This article presents a publication and appraisal checklist for such work and invites further collaboration in the form of a Delphi technique to clarify, expand, improve, and validate the proposal.

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Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality

Sasso, MD, et al.

Asphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the United States (U.S.) and to identify factors associated with mortality in this population.

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Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality

Author Affiliation Roula Sasso, MD American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon Rana Bachir, MPH American University of Beirut Medical Center, Department of Emergency Medicine, Emergency Medical Services and Prehospital Care Program, Beirut, Lebanon Mazen El Sayed, MD, MPH American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, […]

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Computed Tomography Risk Disclosure in the Emergency Department: A Survey of Pediatric Emergency Medicine Fellowship Program Leaders

Marin, MD, MSc, et al.

We conducted a cross-sectional survey study of the United States and Canadian PEM fellowship directors and associate/assistant directors. We developed a web-based survey using a modified Dillman technique. Primary outcome was the proportion who “almost always” or “most of the time” discussed potential malignancy risks from CT prior to ordering this test.

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Transaminase and Creatine Kinase Ratios for Differentiating Delayed Acetaminophen Overdose from Rhabdomyolysis

Radke, MD, et al.

Establishing the cause of elevated transaminases may be especially difficult because of limited or inaccurate histories of acetaminophen ingestion. We hypothesized that the comparative ratios of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine kinase (CK) can differentiate acetaminophen hepatotoxicity from rhabdomyolysis.

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Closing the Gap Between Entrustment and Resuscitation

Camp-Rogers, MD, MS, et al.

In 2014, the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine more specifically defined the skills required of graduating medical students. These skill sets are rooted in the United States’ and Canada’s movement toward a competency-based undergraduate medical education (UME) and are termed the Core “entrustable professional activities” (EPAs)

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Scholarship in Emergency Medicine: A Primer for Junior Academics: Part II: Promoting Your Career and Achieving Your Goals

Langabeer, PhD, et al.

In this article, we provide expert consensus recommendations for improving junior faculty’s scholarship in emergency medicine (EM). Specific focus is given to promoting your research career, obtaining additional training opportunities, networking in EM, and other strategies for strategically directing a long-term career in academic medicine.

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Endemic Infections

Comparing Quick Sequential Organ Failure Assessment Scores to End-tidal Carbon Dioxide as Mortality Predictors in Prehospital Patients with Suspected Sepsis

Hunter, MD, et al.

We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
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Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: westjem@gmail.com

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.