Reply to “Factors Associated with Overutilization of Computed Tomography Cervical Spine Imaging”

Author Affiliation Karl Chamberlin, MD, MBA University of Massachusetts Chan Medical School, Emergency Medicine, Worcester, Massachusetts; UMass Memorial Health, Department of Emergency Medicine, Worcester, Massachusetts   November 29, 2023 Dear Editor: We appreciate the feedback and commentary on our recently published study. First, we would like to acknowledge the limitations of having a single reviewer […]

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Factors Associated with Overutilization of Computed Tomography Cervical Spine Imaging

Author Affiliation Tessy La Torre Torres, DO ChristianaCare Hospital, Department of Emergency Medicine, Newark, Delaware Jonathan McGhee, DO ChristianaCare Hospital, Department of Emergency Medicine, Newark, Delaware   Dear Editor: We are writing to provide some comments on the scientific paper recently published in your journal titled “Factors Associated with Overutilization of Computed Tomography of the […]

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Ultrasound Performed by Emergency Physicians for Deep Vein Thrombosis: A Systematic Review

Daniel Hercz, MD

Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported.

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Space Ultrasound: A Proposal for Competency-based Ultrasound Training for In-flight Space Medicine

Chanel Fischetti, MD

Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standard of training for astronaut preparation. We suggest an organized and structured methodology by which astronauts should best prepare for space with the medical equipment available on board. As technology continues to evolve, the assistance of other artificial intelligence and augmented reality systems are likely to facilitate training and dynamic real-time needs during space emergencies.

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Diagnostic Accuracy of a Handheld Ultrasound vs a Cart-based Model: A Randomized Clinical Trial

Ryan C. Gibbons, MD

Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model.

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Novel Scoring Scale for Quality Assessment of Lung Ultrasound in the Emergency Department

Jessica R. Balderston, MD

The use of a reliable scoring system for quality assessment (QA) is imperative to limit inconsistencies in measuring ultrasound acquisition skills. The current grading scale used for QA endorsed by the American College of Emergency Physicians (ACEP) is non-specific, applies irrespective of the type of study performed, and has not been rigorously validated. Our goal in this study was to determine whether a succinct, organ-specific grading scale designed for lung-specific QA would be more precise with better interobserver agreement.

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Development and Validation of a Scoring Rubric for Editorial Evaluation of Peer-review Quality: A Pilot Study

Jeffrey N. Love, MD, MHPE, MSc

Despite the importance of peer review to publications, there is no generally accepted approach for editorial evaluation of a peer review’s value to a journal editor’s decision-making. The graduate medical education editors of the Western Journal of Emergency Medicine Special Issue in Educational Research & Practice (Special Issue) developed and studied the holistic editor’s scoring rubric (HESR) with the objective of assessing the quality of a review and an emphasis on the degree to which it informs a holistic appreciation for the submission under consideration.

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Pediatric Outcomes of Emergency Medical Services Non-Transport Before and During the COVID-19 Pandemic

Lori Pandya, MD

Pediatric patients account for 6–10% of emergency medical services (EMS) activations in the United States. Approximately 30% of these children are not transported to an emergency department (ED). Adult data in the literature reports higher hospitalization and complications following non-transport. Few studies discuss epidemiology and characteristics of pediatric non-transport; however, data on outcome is limited. Our primary aim was to determine outcomes of non-transported children within our urban EMS system before and during the COVID-19 pandemic. Our secondary objective was to explore reasons for non-transport.

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National Characteristics of Emergency Care for Children with Neurologic Complex Chronic Conditions

Kaileen Jafari, MD

Most pediatric emergency care occurs in general emergency departments (GED), where less pediatric experience and lower pediatric emergency readiness may compromise care. Medically vulnerable pediatric patients, such as those with chronic, severe, neurologic conditions, are likely to be disproportionately affected by suboptimal care in GEDs; however, little is known about characteristics of their care in either the general or pediatric emergency setting. In this study our objective was to compare the frequency, characteristics, and outcomes of ED visits made by children with chronic neurologic diseases between general and pediatric EDs (PED).

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Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study

Mackenzie A. McKnight, MD

Older adults often have multiple comorbidities; therefore, they are at high risk for adverse events after discharge. The 4Ms framework—what matters, medications, mentation, mobility—has been used in acute and ambulatory care settings to identify risk factors for adverse events in older adults, although it has not been used in the emergency department (ED). We aimed to determine whether 1) use of the 4Ms worksheet would help emergency clinicians understand older adult patients’ goals of care and 2) use of the worksheet was feasible in the ED.

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The Effect of a Simulation-based Intervention on Emergency Medicine Resident Management of Early Pregnancy Loss

Shawna D. Bellew, MD, MPH

The evaluation of patients with first-trimester vaginal bleeding and concern for early pregnancy loss (EPL) frequently occurs in the emergency department (ED), accounting for approximately 1.6% of all ED visits.
Unfortunately, these patients consistently report negative experiences with ED care.

In addition to environmental concerns, such as long wait times, patients often describe negative interactions with staff, including a perceived lack of empathy, the use of insensitive language, and inadequate counseling.


These patients and their partners often view EPL as a traumatic loss of life and commonly experience prolonged grief reactions, including anxiety and depression.

Poor satisfaction with care has been associated with worse mental health outcomes.
These complaints represent an important opportunity for improvement in emergency medicine (EM) training.

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Integrating Hospice and Palliative Medicine Education Within the American Board of Emergency Medicine Model

Rebecca Goett, MD

Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list.

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Foundations of Emergency Medicine: Impact of a Standardized, Open-access, Core Content Curriculum on In-Training Exam Scores

Jaime Jordan, MD, MAEd

Learners frequently benefit from modalities such as small-group, case-based teaching and interactive didactic experiences rather than passive learning methods. These contemporary techniques are features of Foundations of Emergency Medicine (FoEM) curricula, and particularly the Foundations I (F1) course, which targets first-year resident (PGY-1) learners. The American Board of Emergency Medicine administers the in-training exam (ITE) that provides an annual assessment of EM-specific medical knowledge. We sought to assess the effect of F1 implementation on ITE scores.

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Simulation Improves Emergency Medicine Residents’ Clinical Performance of Aorta Point-of-Care Ultrasound

Brandon M. Wubben, MD

Using point-of-care ultrasound (POCUS) to diagnose abdominal aortic aneurysm (AAA) is an essential skill in emergency medicine (EM). While simulation-based POCUS education is commonly used, the translation to performance in the emergency department (ED) is unknown. We investigated whether adding case-based simulation to an EM residency curriculum was associated with changes in the quantity and quality of aorta POCUS performed by residents in the ED.

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Rapid Cycle Deliberate Practice Training for Simulated Cardiopulmonary Resuscitation in Resident Education

Jaron D. Raper, MD

Simulation-based medical education has been used in medical training for decades. Rapid cycle deliberate practice (RCDP) is a novel simulation strategy that uses iterative practice and feedback to achieve skill mastery. To date, there has been minimal evaluation of RCDP vs standard immersive simulation (IS) for the teaching of cardiopulmonary resuscitation to graduate medical education (GME) learners. Our primary objective was to compare the time to performance of Advanced Cardiac Life Support (ACLS) actions between trainees who completed RCDP vs IS.

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Analysis of Anonymous Student Narratives About Experiences with Emergency Medicine Residency Programs

Molly Estes, MD

Academic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific “applicant spreadsheets” as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants’ authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students’ EM program experiences through a publicly available AOC.

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Virtual Interviews and the Pediatric Emergency Medicine Match Geography: A National Survey

Aline Baghdassarian, MD, MPH

Virtual interviews (VI) are now a permanent part of pediatric emergency medicine (PEM) recruitment, especially given the cost and equity advantages. Yet inability to visit programs in person can impact decision-making, leading applicants to apply to more programs. Moreover, the cost advantages of VI may encourage applicants to apply to programs farther away than they might otherwise have been willing or able to travel. This could create unnecessary strain on programs. We conducted this study to determine whether PEM fellowship applicants would apply to a larger number of programs and in different geographic patterns with VI (2020 and 2021) as compared to in-person interviews (2018 and 2019).

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Staffing Patterns of Non-ACGME Fellowships with 4-Year Residency Programs: A National Survey

David A. Haidar, MD

Emergency medicine (EM) is one of few specialties with variable training lengths. Hiring a three-year graduate to continue fellowship training in a department that supports a four-year residency program can lead to conflicts around resident supervision. We sought to understand hiring and clinical supervision, or staffing, patterns of non-Accreditation Council for Graduate Medical Education (ACGME) fellowships hosted at institutions supporting four-year residency programs.

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Performance of Intra-arrest Echocardiography: A Systematic Review

Yi-Ju Ho, MD

Intra-arrest transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been introduced in adult patients with cardiac arrest (CA). Whether the diagnostic performance of TTE or TEE is superior during resuscitation is unclear. We conducted a systematic review following PRISMA guidelines.

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Bridging the Gap: Evaluation of an Electrocardiogram Curriculum for Advanced Practice Clinicians

Steven Lindsey, MD

Training programs for advanced practice providers (APP) often have significant variability in their curriculum, including electrocardiogram (ECG) education. Despite limitations in formal ECG training, APPs in the emergency department (ED) may be the first practitioner to interpret an ECG. Foundations of Emergency Medicine (FoEM) offers free, open-access curricula that are widely used for resident education. We sought to improve APP ECG interpretation skills by implementing the FoEM ECG I course.

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Characteristics for Low, High and Very High Emergency Department Use for Mental Health Diagnoses from Health Records and Structured Interviews

Marie-Josée Fleury, PhD

Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED users (1–3 visits/year), compared to high (4–7) and very high (8+) ED users with MHD.

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Buprenorphine for High-dose Tramadol Dependence: A Case Report of Successful Outpatient Treatment

Author Affiliation Leslie Mukau, MD University of California San Diego, Department of Emergency Medicine, San Diego, California; El Centro Regional Medical Center, Department of Emergency Medicine, El Centro, California Kadia Wormley, MD Highland Hospital-Alameda Health System, Department of Emergency Medicine, Oakland, California Christian Tomaszewski, MD, MS, MBA University of California San Diego, Department of Emergency […]

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

3800 W Chapman Ave Ste 3200
Orange, CA 92868, USA
Phone: 1-714-456-6389


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

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.