Emergency Medicine Commons^™

Mental Health Vs Substance Misuse: Predicting Restraint Use In The Emergency Department, Chloe Lafosse Bs, Michael Witt Md, Mph

Rowan-Virtua Research Day

Introduction: Violence in the emergency department affects approximately 30% of hospital staff every 6 months. Presenting complaints may contribute to violence risk, particularly in those with mental health or substance misuse issue where there are heightened risks of cognitive impairment and involuntary holds.

Methods: We conducted a systematic review of literature published between 1957-2025 using multiple databases, identifying studies that observed physical restraint use on adult emergency department patients. All relevant data was recorded and imputed into SPSS for a chi-square test.

Results: Thirteen studies (2019-2025) met inclusion criteria, with sample sizes ranging from 58 to 1,035,522 participants. All studies …

Expansion Of Hand Trauma Transfers At A Level 1 Trauma Center Following Integration With The Assh Hand Trauma Center Network, William Delahoussaye, Madeline Gautreaux, Patrick A. Palines, Ramin Shekouhi, Kelly L. Babineaux

School of Medicine Faculty Publications

Purpose: This study sought to evaluate how joining the National Hand Trauma Center Network (NHTCN) affected the volume, demographics, and severity of hand trauma transfers to our institution. Methods: Data for this study were collected retrospectively over a 6-year period from 2016 to 2021 from our institutional trauma registry. Patients were selected based on the criterion of being transferred to our facility because of isolated hand trauma. Analyses of transfer rates, transfer distance, sending facilities, injury patterns, insurance type, path of care, and hospital charges prior to and after joining the NHTCN were performed. Results: There was a total of …

A New Approach: Evaluating The Effectiveness Of Artificial Intelligence Developments For Trauma Triage In The Emergency Department, William C. Anoka

2025 Spring Honors Capstone Projects - Archive

Triage in emergent situations occurs when patients are assigned to areas of the hospital with different levels of care according to the perceived risks determined by their signs and symptoms. The variability of current triage protocols substantially increases the proportion of lower acuity patients who die unexpectedly due to improper risk stratification. However, recent artificial intelligence (AI) developments have been applied to trauma triage situations to improve accuracy and patient outcomes. To further evaluate the effectiveness of this new tool, this study used various AI models to assess the presenting assessments of multiple situations and determine the appropriate level of …

Staphylococcal Scalded Skin Syndrome In Melanatedskin: A Pediatric Case Report, Aleah Lafrancis-Ream, Hannah Chotiner, Scott Gutovitz

South Atlantic Division GME Research Day 2025

No abstract provided.

Empathy Unmasked: Patient Perception Of Physician Empathy In An Oncologic Emergency Setting A Randomized Controlled Trial Comparing Personal Protective Equipment Wear Versus Unmasked Video Communication, Kathryn J Burk, John J Stroh, Kelly Larkin, Patrick Chaftari, Denise M Langabeer, Jazmin R Menendez, Jeanie F Woodruff, Jan Hargrave, Hongxu Zhu, James P Long, Sai-Ching J Yeung, Kumar Alagappan, Aiham Qdaisat

Faculty, Staff and Student Publications

Background: Amidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear.

Objective: To evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach.

Methods: In this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients' perceptions of the physicians' relational empathy were assessed …

A Systematic Review Of Racial Disparities In Emergency Department Pain Evaluation And Treatment In The United States, Cyrus Wolff

Theses and Graduate Projects

Background: Providers working in emergency departments (ED) must balance the need to relieve patients’ pain with the dangers of overprescribing opioids. Lack of standardization of pain evaluation and treatment may contribute to inequities in the management of pain in emergency departments. Evaluating differences in how different populations receive care in emergency departments can help to identify problems and areas where improvements need to occur.

Purpose: The purpose of this literature review is to evaluate what current research states about the prevalence and causes of racial disparities in pain evaluation and treatment in United States emergency departments and determine what gaps …

Intraosseuous Versus Intravenous Access In The Setting Of Prehospital Cardiac Arrest, Drake Dixon, Alexa Ragusa, Kevin Sze, Jeffrey Katz, Linh Nguyen, Shayne Gue

North Florida Division GME Research Day 2024

No abstract provided.

Immune-Related Adverse Event In The Emergency Department: Methodology Of The Immune-Related Emergency Disposition Index (Iredi), Cielito C Reyes-Gibby, Jeffrey M Caterino, Christopher J Coyne, Demetrios N Kyriacou, Aiham Qdaisat, Jennifer Mcquade, Dwight H Owen, Jason J Bischof, Sanjay Shete, Sai-Ching Jim Yeung

Faculty, Staff and Student Publications

For many cancer patients, immune checkpoint inhibitors (ICIs) can be life-saving. However, the immune-related adverse events (irAEs) from ICIs can be debilitating and can quickly become severe or even be fatal. Often, irAEs will precipitate visits to the emergency department (ED). Therefore, early recognition and the decision to admit, observe, or discharge these patients from the ED can be key to a cancer patient's morbidity and mortality. ED clinicians typically make their decision for disposition (admit, observe, or discharge) within 2-6 h from their patient's ED presentation. However, irAEs are particularly challenging in the ED because of atypical presentations, the …

Pocus Use For Emergency Airway Management In Rural Emergency Departments, Margaret Downing

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

- Preparation and accurate prediction of difficult airways in emergent situations is necessary for successful first pass intubation

- Current methods for airway assessments require patient cooperation and may vary by provider

• Mallampati score: open mouth, protrude tongue, see what structures are visible³
• LEMON criteria: look externally, evaluate 3-3-2 rule, Mallampati score, obstruction, neck mobility
• Thyromental distance: measure thyroid cartilage to tip of chin with neck extended³

- Difficult airways have successful first pass intubation only 82.2% of the time (vs 92.4% for non-difficult airways)⁶

- Adverse effects occurred in 14.2% of patients with successful first …

Pelvic Fractures - An Overview, Shashank Cheemalapati

Digital Journal of Clinical Medicine

Pelvic fractures are injuries commonly caused by high-energy trauma, such as motor vehicle accidents and falls from a height. Understanding the anatomy, mechanisms of injury, classification, diagnosis and the management of these fractures is crucial to improve patient outcomes. This short article aims to provide a comprehensive overview of the current state of knowledge regarding pelvic fractures.

Artificial Intelligence Cad Tools In Trauma Imaging: A Scoping Review From The American Society Of Emergency Radiology (Aser) Ai/Ml Expert Panel, David Dreizin, Pedro V Staziaki, Garvit D Khatri, Nicholas M Beckmann, Zhaoyong Feng, Yuanyuan Liang, Zachary S Delproposto, Maximiliano Klug, J Stephen Spann, Nathan Sarkar, Yunting Fu

Faculty, Staff and Student Publications

BACKGROUND: AI/ML CAD tools can potentially improve outcomes in the high-stakes, high-volume model of trauma radiology. No prior scoping review has been undertaken to comprehensively assess tools in this subspecialty.

PURPOSE: To map the evolution and current state of trauma radiology CAD tools along key dimensions of technology readiness.

METHODS: Following a search of databases, abstract screening, and full-text document review, CAD tool maturity was charted using elements of data curation, performance validation, outcomes research, explainability, user acceptance, and funding patterns. Descriptive statistics were used to illustrate key trends.

RESULTS: A total of 4052 records were screened, and 233 full-text …

Evaluating The Usability Of An Emergency Department After Visit Summary: Staged Heuristic Evaluation, Hanna J Barton, Megan E Salwei, Rachel A Rutkowski, Kathryn Wust, Sheryl Krause, Peter Lt Hoonakker, Paula Vw Dail, Denise M Buckley, Alexis Eastman, Brad Ehlenfeldt, Brian W Patterson, Manish N Shah, Barbara J King, Nicole E Werner, Pascale Carayon

Faculty, Staff and Student Publications

BACKGROUND: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients-with the potential to prevent adverse outcomes-is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how …

Factors Affecting Emergency Department Mental Health Visits, Logan Daul

Honors Thesis

Research has shown that current quantities of emergency department visits for mental health and substance use are increasing at a startling rate. These increases are acknowledged in quantitative studies and some important information can be gathered from qualitative studies however determining specific causes for these emergent visits are difficult. The purpose of this study is to derive findings from statistical analyses focusing on quantities of emergency department visits for mental health and substance use disorders. Comparisons will be drawn at the state level between the per capita quantity of emergency department visits and poverty rate, climate, psychiatric healthcare infrastructure, urban …

Increasing Staff Compliance With Routine Hcv Screening And Improving Linkage To Care Among Patients Testing Hepatitis C Positive In The Emergency Department, Carson G. Swartz

DNP Projects

Background: Hepatitis C virus (HCV) is a blood-borne pathogen that can cause severe liver disease, cancer, and death and is a significant source of morbidity and mortality in the United States. Several academic medical centers including University of Kentucky Healthcare have implemented routine HCV screening for patients presenting to the emergency department (ED) and have discovered a large viral burden amongst patients who are often symptomatic.

Purpose: The purpose of this doctoral project is to increase staff compliance, confidence, and education regarding the HCV screening process in an urban, Level I emergency department, as well as to evaluate whether an …

Management Of Fall Patients – What Should Be Done For Emergency Department Fall Patients?, Katherine Selman, Christine Binkley, Katherine Davenport, Shan W. Lliu, Maura Kennedy

Journal of Geriatric Emergency Medicine

Falls are the leading cause of injury-related emergency visits in older adults, translating into an estimated 3 million ED visits and 32,000 deaths from fall-related injuries annually in the United States. Falls subsequently result in diminished functional ability and higher risk for future falls and mortality. Despite this, ED clinicians focus primarily on injuries that result from a fall and often defer the modifiable causes of the fall and future fall prevention to outpatient providers. We review two articles that address the feasibility of performing interventions from the ED and the efficacy of a multifactorial fall intervention program.

Sex-Based Differences In Depth Of Soft Tissue And Bone Diameter At The Sternal Intraosseous Catheter Insertion Site, Tristan Lemon, Ryan Kelly, Revelle Gappy, Sarah Meram, James Paxton

Medical Student Research Symposium

Background

Intraosseous (IO) catheters are commonly used to rapidly obtain vascular access for critically-ill patients in the emergency department (ED). While the sternum is a common IO insertion site for adult subjects, little is known about sex-based variation in the proper depth of insertion.

Methods

A retrospective cohort study was performed, utilizing CT scans obtained from DMC over a ten-year period (2009-2018) to estimate soft tissue depth overlying the recommended sternal IO insertion site. Depths of soft tissue from skin surface to bone surface (Measurement A) and from skin surface to the opposite bony cortex (Measurement B) were measured using …

Signing Your Life Away? Emergency Department Patient Recall And Understanding Of Ed Consent For Treatment Based On Triage Level, Daniel Ross

Scholarship in Medicine - All Papers

Objective: The determine the correlation between patient recall and understanding of Emergency Department (ED) consent for treatment and patient triage level. Methods: This was a prospective study based on demographical and triage data collected from patient charts, in combination with patient responses to the consent for treatment survey. Results: Of the 293 that participated in the study, the mean age was 52, with 122 (41.6%) males and 171 (58.4%) females. 179 (61.5%) identified as white/Caucasian and 100 (34.4%) identified as African-American. Most patients, 210 (72.4%), arrived by walk-in and the rest, 80 (27.6%), were by ambulance. Participants with lower triage …

Improving Safety Using Hfmea And Insitu Simulation Prior To Initiating Contrast Mri Studies In An Ambulatory Setting, Micheline Chipman, Todd Dadaleares, Heather Beaulieu, Leah Mallory

Costas T. Lambrew Research Retreat 2021

The objective of this event was to test a new system for emergency response to MRI contrast reactions by ensuring staff familiarity with emergency equipment and a newly drafted emergency response protocols, and to mitigate any LST identified.

Improving Emergency Department Quality Of Care, Carmen Smith

Doctor of Nursing Practice Projects

Emergency department (ED) crowding can cause an extended length of stay (LOS) and high rates of patients who leave without being seen (LWBS). This quality improvement ED project sought to reduce LOS and LWBS by implementing a triage (PIT) team. The design included an outcomes evaluation with available data and a staff pre and posttest. Length of stay and LWBS rates were compared before and after implementation. Results indicated a reduction in the average LOS and LWBS rates for the 30 days of project implementation compared to the 30 days before the project initiation. The overall goal of the PIT …

Coping Skills, Emotional Intelligence, Attachment, And Resilience On Post-Traumatic Stress Disorder In Private Sector Emergency Medical Technicians, Brenda-Joyce Gonzales Orozco Markert-Green

Dissertations

Problem

Private sector Emergency Medical Technicians (EMTs) are first responders who respond to traumatic incident scenes along with firefighters and police officers. However, news agencies and the public do not acknowledge private sector EMTs with the same vigor or accolade as public sector EMTs, nor are the risks to life, health, and mental well-being recognized among this population. Thus, the research literature has been sparse regarding how private sector EMTs experience PTSD, and what unique risk factors and needs may be present.

Purpose Statement

The purpose of this study was to examine the relationship between PTSD symptoms and coping skills, …

Acute Hyperkalemia In The Emergency Department: A Summary From A Kidney Disease: Improving Global Outcomes Conference, Gregor Lindner, Emmanuel A Burdmann, Catherine M Clase, Brenda R Hemmelgarn, Charles A Herzog, Jolanta Małyszko, Masahiko Nagahama, Roberto Pecoits-Filho, Zubaid Rafique, Patrick Rossignol, Adam J Singer

Faculty, Staff and Students Publications

Hyperkalemia is a common electrolyte disorder observed in the emergency department. It is often associated with underlying predisposing conditions, such as moderate or severe kidney disease, heart failure, diabetes mellitus, or significant tissue trauma. Additionally, medications, such as inhibitors of the renin-angiotensin-aldosterone system, potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, succinylcholine, and digitalis, are associated with hyperkalemia. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened a conference in 2018 to identify evidence and address controversies on potassium management in kidney disease. This review summarizes the deliberations and clinical guidance for the evaluation and management of acute hyperkalemia in this setting. …

Skin And Soft Tissue Infections In The Emergency Department, Nicole Martinez

Dissertations

Background/Purpose: Skin and soft tissue infections (SSTI) represent a diverse group of infections varying in clinical presentation and degree of severity. The International Classification of Diseases codes for patients presenting with cellulitis or abscess account for $5.5 billion in annual health care costs and 1.4% of all hospital admissions nationally. Data are needed to inform admission and management decisions. The purpose of this study is to examine relationships among sociodemographic, physical examination findings, and treatment modality and management in patients with SSTIs.

Theoretical/Conceptual Framework: Web of Causation Theoretical Framework explores multiple causative factors treated with equal prominence, thus …

The Covid-19 Intubation And Ventilation Pathway (Civp); A Commentary, Muhammad Akbar Baig

Department of Emergency Medicine

No abstract provided.

The Verbal Numeric Pain Scale: Ed Patient Understanding And Perspectives, Bracey Bayonnet

Scholarship in Medicine - All Papers

Objective: The objective of this study is to identify patient self-reported pain scores and understanding and perspectives of the Verbal Numeric Pain Scale. Methods: In this prospective survey study, eligible participants were interviewed by research assistants. Data collected included ED patients self-reported pain scores, previous painful experiences, and their understanding of the Verbal Numeric Pain Scale,

Results: Among 164 participants (92% response rate), the mean triage pain score was 6.4 (95% CI 6.0-6.9). Many participants had experienced significant painful experiences in the past, including major surgery (N = 113), broken bone (N = 102), childbirth (N = 89) and kidney …

The Relationship Between Generalized Anxiety Disorder And Patient Age Among Emergency Department Patients, Mitchell Mcmurray

Scholarship in Medicine - All Papers

The objective of this study was to determine the relationship between Generalized Anxiety Disorder (GAD) and patient age in emergency department patients. The GAD-7 screening tool was used in an urban ED setting to survey patients about their anxiety, with a score of 8 or higher suggesting a diagnosis of GAD. Eligible participants included ED patients over the age of 18 with a painful condition ranging from 1-10 on the verbal numeric rating pain scale (VNRS). Participants were excluded if they were in distress and/or did not speak English. Of the 320 patients surveyed, the mean patient age was determined …

Assessment Of Patient-Centered Approaches To Collect Sexual Orientation And Gender Identity Information In The Emergency Department: The Equality Study, Adil H. Haider, Rachel R. Adler, Eric Schneider, Tarsicio Uribe Leitz, Anju Ranjit, Christina Ta, Adele Levine, Omar Harfouch, Danielle Pelaez, Lisa Kodadek

Section of General Surgery

Importance: Health care and government organizations call for routine collection of sexual orientation and gender identity (SOGI) information in the clinical setting, yet patient preferences for collection methods remain unknown.
Objective: To assess of the optimal patient-centered approach for SOGI collection in the emergency department (ED) setting.
Design, setting, and participants: This matched cohort study (Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity [EQUALITY] Study) of 4 EDs on the east coast of the United States sequentially tested 2 different SOGI collection approaches between February 2016 and March 2017. Multivariable ordered logistic regression was used to …

Comparison Of Two Methods Of Pediatric Triage Education, Catherine Recznik

Electronic Theses and Dissertations

Introduction. The majority of pediatric emergency patients are seen in mixed-age emergency departments and triaged by general emergency nurses. Educational methods for teaching pediatric triage education to general emergency nurses have not been well studied, and previous studies of the use of the Emergency Severity Index in children have been performed primarily in centers that are high volume for pediatrics. Methods. A repeated measures, randomized crossover study comparing two different methods of pediatric triage education was conducted. Participants were general emergency triage nurses recruited from a general emergency department that is classified as low volume for pediatrics. Each participant was …

When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber

Evidence-Based Practice Project Reports

There has been an exponential rise in mass casualty incidents (MCI) internationally. These human induced and naturally occurring events have affected over 4.6 billion people, and are not discriminatory to region or community (World Health Organization, 2011). Governing bodies require training and education, but nurses continue to report suboptimal competence and self-reported readiness, and a need for standardized, evidence-based training remains. The purpose if this evidence-based practice project is to authenticate current research supporting implementation of competency-based education, to improve nurses’ self- perceived preparedness and confidence in their ability to respond to MCI. The project results can be utilized for …

Burn Injury Characteristics: Findings From Pakistan National Emergency Department Surveillance Study, Emaduddin Siddiqui, Nukhba Zia, Asher Feroze, Safia Awan, Arifa Liaquat Ali, Junaid Razzak, Adnan Hyder, Asad Latif

Department of Emergency Medicine

Background: Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.
Methods: Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.
Results: There were 403 burn injury patients in …

Unforgiving Heat Wave Deaths In The Largest Metropolitan City Of Pakistan: Lessons Learned, Muhammad Akbar Baig, Shahan Waheed, Asad Mian, Erfaan Hussain

Department of Emergency Medicine

Heat stroke is a deadly condition that needs astute care and timely management. Recently, the city of Karachi in Pakistan has been the victim of an intense heat wave, which has resulted in an insurmountable loss of life. We observed various deficiencies in dealing with this national threat that provides us with a valuable lesson regarding the measures that can be undertaken to avoid such a disaster from occurring again.