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"Adam J. Singer"

Editorials

AI & Digital Health

Artificial intelligence as cognitive support in emergency medicine
Samita M. Heslin, Adam J. Singer
In Press, Received February 27, 2026  Accepted March 24, 2026  Available online April 3, 2026  
DOI: https://doi.org/10.15441/ceem.26.104    [Accepted]

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Artificial intelligence as cognitive support in emergency medicine
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Celebrating a decade of excellence: the 10th anniversary of Clinical and Experimental Emergency Medicine
Adam J. Singer, Kyuseok Kim
Clin Exp Emerg Med 2024;11(4):323-324.   Published online November 13, 2024
DOI: https://doi.org/10.15441/ceem.24.348

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Celebrating a decade of excellence: the 10th anniversary of Clinical and Experimental Emergency Medicine
Clin Exp Emerg Med. 2024;11(4):323-324.   Published online November 13, 2024
DOI: https://doi.org/10.15441/ceem.24.348
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Celebrating a decade of excellence: the 10th anniversary of Clinical and Experimental Emergency Medicine
Clin Exp Emerg Med. 2024;11(4):323-324.   Published online November 13, 2024
DOI: https://doi.org/10.15441/ceem.24.348
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Original Articles

Emergency Medicine Practice and Administration

A physician-nurse team adjacent to triage shortens length of stay and left-without-being-seen rates
Samita M. Heslin, Robert Schwaner, Peter Viccellio, Candice King, Alision Rowe, Henry Thode, Adam J. Singer
Clin Exp Emerg Med 2025;12(1):26-34.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.248

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A physician-nurse team adjacent to triage shortens length of stay and left-without-being-seen rates
Clin Exp Emerg Med. 2025;12(1):26-34.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.248
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A physician-nurse team adjacent to triage shortens length of stay and left-without-being-seen rates
Clin Exp Emerg Med. 2025;12(1):26-34.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.248
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Objective
Staffing significantly influences emergency department (ED) throughput; however, there is a shortage of registered nurses (RNs), impacting ED flow and crowding. Non-RN providers, like licensed practical nurses (LPNs), could potentially assist with tasks traditionally assigned to RNs. To improve the front-end ED process, we implemented an attending physician–LPN team (PNT) positioned next to triage and utilized existing ED hallway space. Methods This study took place at a tertiary care ED with over 110,000 annual visits. We compared postintervention (post-PNT) data (November 1, 2022–February 28, 2023) to preintervention (pre-PNT) data (July 31, 2022–October 31, 2022). The PNT, positioned adjacent to triage, expedited care for ED patients awaiting open rooms. The PNT selected patients from the waiting room to bypass the main ED, evaluated them in a private room, and then moved them to the hallway pending further care. Multivariable regression analysis was utilized to measure the impact of different factors on ED length of stay (LOS). Results We analyzed 23,516 patient visits, 10,288 in the pre-PNT period and 13,288 in the postPNT period. Post-PNT consisted of 2,454 PNT visits and 10,834 non-PNT visits. The intervention led to significant improvements, including a decrease in mean ED LOS from 492 to 425 minutes, a decrease in 72-hour revisits from 5.1% to 4.0%, a decrease in left-without-being-seen rate from 6.7% to 3.3%, and a decrease in the mean arrival-to-provider time from 74 to 60 minutes. Multivariable regression analysis showed that ED LOS was significantly lower for post-PNT patients than pre-PNT. Conclusion By leveraging the scope of LPNs and utilizing existing ED space, the PNT model successfully reduced front-end bottlenecks, leading to improved throughput and reduced revisitation and left-without-being-seen rates.
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Medical Emergencies

Hyponatremia and hypernatremia in the emergency department: severity and outcomes
Karalynn Otterness, Adam J. Singer, Henry C. Thode Jr, W. Frank Peacock
Clin Exp Emerg Med 2023;10(2):172-180.   Published online January 30, 2023
DOI: https://doi.org/10.15441/ceem.22.380

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Hyponatremia and hypernatremia in the emergency department: severity and outcomes
Clin Exp Emerg Med. 2023;10(2):172-180.   Published online January 30, 2023
DOI: https://doi.org/10.15441/ceem.22.380
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Hyponatremia and hypernatremia in the emergency department: severity and outcomes
Clin Exp Emerg Med. 2023;10(2):172-180.   Published online January 30, 2023
DOI: https://doi.org/10.15441/ceem.22.380
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Objective
Hyponatremia and hypernatremia are common electrolyte disorders. Few studies to date have focused on patients presenting to the emergency department (ED) with sodium (Na) disorders. Our objective was to determine the incidence and outcomes of hyponatremia and hypernatremia in ED patients.
Methods
This study was a retrospective, single-center review of electronic medical records at an academic suburban ED with approximately 100,000 annual visits. Subjects included consecutive adult ED patients with Na levels measured while in the ED in 2019. Demographic, clinical, and laboratory data were recorded. Outcomes data, including hospital admission, intensive care unit (ICU) admission, mortality, and length of stay (LOS), were recorded. The primary outcome was inhospital death. Secondary outcomes were hospital admission, ICU admission, ED LOS, and hospital LOS. Univariable and multivariable linear and logistic regression analyses were performed to explore the association of candidate predictor variables and outcomes.
Results
Na was measured in 57,427 adults (54%) among a total of 106,764 assessed ED visits in 2019. The mean±standard deviation age was 54±21 years, and 47% of participants were male. Mild, moderate, and severe hyponatremia and hypernatremia occurred in 8%, 2%, and 0.1% of patients and 1%, 0.2%, and <0.1% of patients, respectively. Hospital and ICU admission and mortality rates increased as Na levels increased or decreased further from normal. Adjusted odds ratio (95% confidence interval) values for hospital mortality were 2.39 (1.97–2.90) for mild hyponatremia, 3.93 (2.95–5.24) for moderate hyponatremia, 6.98 (2.87–16.40) for severe hyponatremia, 3.65 (2.47–5.40) for mild hypernatremia, 8.58 (4.92–14.94) for moderate hypernatremia, and 55.75 (11.37–273.30) for severe hypernatremia. Hypernatremia was associated with a greater risk of death than hyponatremia. Patients with hyponatremia and hypernatremia had increased LOS times compared to those with normal Na levels.
Conclusion
Hyponatremia and hypernatremia were associated with greater rates of hospital admission, ICU admission, mortality, and prolonged hospital LOS times.

Citations

Citations to this article as recorded by  Crossref logo
  • Neutrophil-to-lymphocyte ratio as a predictor of in-hospital mortality in elderly emergency patients: a retrospective study from Southern Iran
    Latife Jabbari, Maryam Yousefzade, Saeed Hosseini Teshnizi, Leila Azizkhani, Saeed Hayati
    BMC Geriatrics.2026;[Epub]     CrossRef
  • Development A Novel Classification Based on Serum Sodium Level Integrated with Comorbid Conditions (BASIC) in Hyponatremia Patients Via Data-Driven Cluster Analysis
    Siyu Liang, Lize Sun, Yuelun Zhang, Nan Jiang, Shi Chen, Hui Pan
    The Tohoku Journal of Experimental Medicine.2026; 268(2): 199.     CrossRef
  • Association Between Rate of Hypernatremia Correction and Mortality: A Retrospective Cohort Study Across a Regional Health System
    Hyun S Lee, Keerthi Renjith, Afrah Misbah, Omer Ahmed, Sanjana Ramakrishnan, Mohammad Jawish
    Cureus.2025;[Epub]     CrossRef
  • Hypernatremia in Hospitalised Adult Patients—A Scoping Review
    Sine Wichmann, Rasmus Rønhøj, Karen L. Ellekjær, Morten H. Møller, Morten H. Bestle
    Acta Anaesthesiologica Scandinavica.2025;[Epub]     CrossRef
  • Comprehensive Overview of Hypernatremia: Pathophysiology, Diagnosis, and Management
    Rahul Mittal, Angela Man Wai Lai, Rebecca Coskin, Joshua M Kaplan, James Doyle
    British Journal of Hospital Medicine.2025; 86(12): 1.     CrossRef
  • Association between serum sodium and the risk of sepsis-related liver injury: a cross-sectional study based on the MIMIC-IV database
    Guiyun Li, Yixu Lin, Di Ren, Yanhong Chen, Sha Wen, Xiaomin Liang, Lin Zhang, Jiang Mei, Yongwen Feng, Shuiqing Gui, Ying Li
    BMC Infectious Diseases.2025;[Epub]     CrossRef
  • An Evaluation of the National Early Warning Score 2 and the Laboratory Data Decision Tree Early Warning Score in Predicting Mortality in Geriatric Patients
    Kadir Küçükceran, Mustafa Kürşat Ayrancı, Sedat Koçak, Abdullah Sadık Girişgin, Zerrin Defne Dündar, Sami Ataman, Enes Bayındır, Oğuz Karaçadır, İbrahim Tatar, Mustafa Doğru
    The Journal of Emergency Medicine.2024; 66(3): e284.     CrossRef
  • Hyponatremia after COVID-19 is frequent in the first year and increases re-admissions
    Betina Biagetti, Adrián Sánchez-Montalvá, Albert Puig-Perez, Isabel Campos-Varela, María Florencia Pilia, Emilie Anderssen-Nordahl, Didac González-Sans, Marta Miarons, Rafael Simó
    Scientific Reports.2024;[Epub]     CrossRef
  • Fluid Status Vulnerability in Older Adults
    Suzanne Purvis, Terry Gion
    Journal of Infusion Nursing.2024; 47(1): 49.     CrossRef
  • Trastornos electrolíticos inducidos por diuréticos de asa en los adultos mayores. Revisión sistemática
    Judith Guevara Sarmiento, Maritza del Rosario Martínez León
    Anatomía Digital.2024; 7(1.1): 26.     CrossRef
  • Ipernatriemia
    H. Quintard
    EMC - Anestesia-Rianimazione.2024; 29(3): 1.     CrossRef
  • Hipernatremia
    H. Quintard
    EMC - Anestesia-Reanimación.2024; 50(3): 1.     CrossRef
  • Complex mechanism of brugada phenocopy: moderate hyponatremia and right ventricular compression by liver metastatic tumor – case report
    Waldemar Elikowski, Anna Strzelecka, Natalia Fertała, Magdalena Zawodna-Marszałek, Marcin Żytkiewicz
    Wiadomości Lekarskie.2024; 77(8): 1633.     CrossRef
  • Hypernatrémie
    H. Quintard
    EMC - Anesthésie-Réanimation.2024; 44(2): 1.     CrossRef
  • 11,915 View
  • 378 Download
  • 10 Web of Science
  • 14 Crossref
Clinical utilization of four-factor prothrombin complex concentrate: a retrospective single center study
Zaina Naeem, Salsabeel Allan, Aneury Hernandez, Dennis K Galanakis, Adam J. Singer
Clin Exp Emerg Med 2021;8(2):75-81.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.017
Correction in: Clin Exp Emerg Med 2023;10(3):347

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Clinical utilization of four-factor prothrombin complex concentrate: a retrospective single center study
Clin Exp Emerg Med. 2021;8(2):75-81.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.017
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Clinical utilization of four-factor prothrombin complex concentrate: a retrospective single center study
Clin Exp Emerg Med. 2021;8(2):75-81.   Published online June 30, 2021
DOI: https://doi.org/10.15441/ceem.20.017
Close
Objective
Four-factor prothrombin complex concentrate (4F-PCC) was approved by the US Food and Drug Administration in 2013 for management of severely bleeding patients on warfarin therapy. We describe use of 4F-PCC at a large, suburban academic center.
Methods
We retrospectively reviewed all patients receiving 4F-PCC from its introduction through 2016 at a large level 1 trauma center. Clinical and demographic data were obtained, including indications for anticoagulation and antiplatelet agents, comorbidities, concomitant medications, etiology and site of bleeding, as well as disposition, length of stay, mortality, and thrombotic events.
Results
One hundred eighty-four patients received 4F-PCC. Mean age was 72 years; 40.8% were female. Indications for 4F-PCC administration included: active bleeding (74%), reversal prior to a procedure (14%), and elevated international normalized ratio (12%). Warfarin was the most common concomitant medication (71.1%). Most patients were receiving anticoagulation for atrial fibrillation (63%). Concomitant treatments for bleeding included vitamin K (58.2%), packed red blood cells (50%), fresh frozen plasma (38%), and platelets (26.1%), amongst others. Median length of hospital stay was 8.4 days. Nine patients (4.9%) developed thrombosis within 90 days of 4F-PCC. Mortality was 24.5%, with notably higher rates amongst those who received 4F-PCC for off-label indications (19.1% on-label mortality vs. 37.7% off-label mortality on chi-square analysis, P=0.01).
Conclusion
This study demonstrates that 4F-PCC is being utilized for indications other than the reversal of warfarin-induced coagulopathy. Further investigation is warranted to determine the efficacy and safety of 4F-PCC for these potential indications.

Citations

Citations to this article as recorded by  Crossref logo
  • Long-Term Safety of a Four-Factor Prothrombin Complex Concentrate (Kcentra®/Beriplex® P/N): An Updated Pharmacovigilance Review
    Truman J. Milling, Anna Voronov, Dirk S. Schmidt, Edelgard Lindhoff-Last
    Thrombosis and Haemostasis.2025; 125(01): 046.     CrossRef
  • Erratum to “Clinical utilization of four-factor prothrombin complex concentrate: a retrospective single center study”

    Clinical and Experimental Emergency Medicine.2023; 10(3): 347.     CrossRef
  • Efficacy of Prothrombin Complex Concentrate versus Fresh Frozen Plasma in Patients with Bleeding in the Emergency Department
    Burak Demirci, Abuzer Coskun
    Medical Bulletin of Haseki.2022; 60(1): 64.     CrossRef
  • Coagulation and Transfusion Updates From 2021
    Michael Fabbro, Prakash A. Patel, Reney A. Henderson, Daniel Bolliger, Kenichi A. Tanaka, Michael A. Mazzeffi
    Journal of Cardiothoracic and Vascular Anesthesia.2022; 36(9): 3447.     CrossRef
  • 12,081 View
  • 176 Download
  • 3 Web of Science
  • 4 Crossref

Procedures | Education & Simulation

Emergency medicine physicians infrequently perform pediatric critical procedures: a national perspective
Shadd N. Cabalatungan, Henry C. Thode, Adam J. Singer
Clin Exp Emerg Med 2020;7(1):52-60.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.19.004

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Emergency medicine physicians infrequently perform pediatric critical procedures: a national perspective
Clin Exp Emerg Med. 2020;7(1):52-60.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.19.004
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Emergency medicine physicians infrequently perform pediatric critical procedures: a national perspective
Clin Exp Emerg Med. 2020;7(1):52-60.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.19.004
Close
Objective
To our knowledge, this is the first comprehensive study using a nationally representative database to estimate the frequency of critical procedures (endotracheal tube intubation [ETI], cardiopulmonary resuscitation [CPR], and central line insertion [CLI]) in children and adults.

Methods
The study was based on the secondary analysis of the 2010-2014 National Hospital Ambulatory Medical Care Survey. We included adult and pediatric patients undergoing critical procedures in the emergency department. We extracted demographic and clinical information, including the performance of critical procedures. For frequent procedures (≥1 per year), we estimated the annual number of critical procedures per emergency physician (EP) by dividing the total number of annual critical procedures by the total number of EPs (estimated at 40,000). For infrequent procedures, we calculated the average interval between procedures. We summarized the data with descriptive statistics and 95% confidence intervals (CIs).

Results
There were an estimated 668 million total emergency department visits (24% pediatric). On average, a single EP performed 8.6 (95% CI, 5.5 to 11.7) CLIs, 3.7 (95% CI, 2.4 to 5.0) CPRs, and 6.3 (95% CI, 5.3 to 7.4) ETIs per year in adults. In comparison, a single EP performed one pediatric CLI, CPR, and ETI every 3.2 (95% CI, 1.9 to 9.8), 5.2 (95% CI, 2.8 to 33.5), and 2.8 (95% CI, 1.6 to 8.9) years, respectively.

Conclusion
Our nationwide findings confirm those of previous smaller studies that critical procedures are significantly fewer in children than adults. We suggest that methods to retain skills in pediatric critical procedures should be developed for general EPs to ensure that they deliver the highest level of care across the entire age spectrum.

Citations

Citations to this article as recorded by  Crossref logo
  • Procedural Skills Decay in Emergency Medicine: A Scoping Review
    Kathryn Oskar, Elise Prehoda, Richard Sapp, Xin Qi, Brittany Botticelli, Janice C Palaganas
    Cureus.2026;[Epub]     CrossRef
  • Training for pediatric cannot intubate cannot oxygenate: surgical airway should replace needle cricothyrotomy
    Allison M. B. Lehman, Paul Amstutz, Jackson E. Moore, Matthew Johnson, Christopher Obersteadt, Dominique Williams, Mary J. Waxman, Morgan Blubaugh, Anaya Parikh, Timothy R. Walsh, Daniel E. Bruegger, Shawn B. Sood, Adrienne N. Malik, Andrew Pirotte
    Frontiers in Disaster and Emergency Medicine.2026;[Epub]     CrossRef
  • Medical practitioners’ confidence in performing paediatric critical procedures in the emergency department
    Shivanthra Ramdass, Matthew Zoghby, Nicholas Dufourq
    Journal of the Colleges of Medicine of South Africa.2025;[Epub]     CrossRef
  • Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation
    Kyle Schoppel, Ashley Keilman, Jabeen Fayyaz, Patricia Padlipsky, Maria Carmen G. Diaz, Robyn Wing, Mary Hughes, Marleny Franco, Nathan Swinger, Travis Whitfill, Barbara Walsh
    Pediatric Emergency Care.2024; 40(8): 591.     CrossRef
  • Procedural skill maintenance: What it means to physicians, how it motivates them, and what stops them from doing so
    Jia Le Ivan Tan, Sashikumar Ganapathy
    The Asia Pacific Scholar.2024; 9(3): 22.     CrossRef
  • Declines in the Number of Lumbar Punctures Performed at United States Children's Hospitals, 2009-2019
    Alexandra T. Geanacopoulos, John J. Porter, Kenneth A. Michelson, Rebecca S. Green, Vincent W. Chiang, Michael C. Monuteaux, Mark I. Neuman
    The Journal of Pediatrics.2021; 231: 87.     CrossRef
  • Exposure and confidence across critical airway procedures in pediatric emergency medicine: An international survey study
    Joshua Nagler, Marc Auerbach, Michael C. Monuteaux, John A. Cheek, Franz E. Babl, Ed Oakley, Lucia Nguyen, Arjun Rao, Sarah Dalton, Mark D. Lyttle, Santiago Mintegi, Rakesh D. Mistry, Andrew Dixon, Pedro Rino, Guillermo Kohn-Loncarica, Stuart R. Dalziel,
    The American Journal of Emergency Medicine.2021; 42: 70.     CrossRef
  • Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine
    Ashkon Shaahinfar, Zahra M. Ghazi-Askar
    Emergency Medicine Clinics of North America.2021; 39(3): 529.     CrossRef
  • Pediatric critical procedures in the emergency department
    Ashley Alexandra Foster, Matthew Adam Eisenberg
    Clinical and Experimental Emergency Medicine.2020; 7(3): 241.     CrossRef
  • 8,237 View
  • 127 Download
  • 7 Web of Science
  • 9 Crossref

Renal & Genitourinary | Medical Emergencies

Study design of Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): a multicenter, prospective, observational study
Zubaid Rafique, Mikhail Kosiborod, Carol L. Clark, Adam J. Singer, Stewart Turner, Joseph Miller, Douglas Char, W. Frank Peacock, on behalf of the REVEAL-ED study investigators
Clin Exp Emerg Med 2017;4(3):154-159.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.207

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Study design of Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): a multicenter, prospective, observational study
Clin Exp Emerg Med. 2017;4(3):154-159.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.207
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Study design of Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): a multicenter, prospective, observational study
Clin Exp Emerg Med. 2017;4(3):154-159.   Published online September 30, 2017
DOI: https://doi.org/10.15441/ceem.17.207
Close
Objective
Hyperkalemia affects up to 10% of hospitalized patients and, if left untreated, can lead to serious cardiac arrhythmias or death. Although hyperkalemia is frequently encountered in the emergency department (ED), and is potentially life-threatening, standard of care for the treatment is poorly defined, with little supporting evidence. The main objectives of this observational study are to define the overall burden of hyperkalemia in the ED setting, describe its causes, the variability in treatment patterns and characterize the effectiveness and safety of ED standard of care therapies used in the United States. Methods This is an observational study evaluating the management of hyperkalemia in the ED. Two hundred and three patients who presented to the ED with a potassium value ≥5.5 mmol/L were enrolled in the study at 14 sites across the United States. Patients were treated per standard of care practices at the discretion of the patient’s physician. In patients who received a treatment for hyperkalemia, blood samples were drawn at pre-specified time points and serum potassium values were recorded. The change in potassium over 4 hours and the adverse events after standard of care treatment were analyzed. Results and Conclusion This article describes the background, rationale, study design, and methodology of the REVEAL-ED (Real World Evidence for Treatment of Hyperkalemia in the Emergency Department) trial, a multicenter, prospective, observational study evaluating contemporary management of patients admitted to the ED with hyperkalemia.

Citations

Citations to this article as recorded by  Crossref logo
  • Real-world treatment of hyperkalemia among patients in emergency department in China (POETRY-E): A study protocol for multicenter, prospective, observational study
    Fu Yangyang, Wu Yao, Dai Yili, Gan Miao, Zhu Huadong, Yu Xuezhong, Xu Jun, Tian Zhaoxing
    Journal of International Medical Research.2026;[Epub]     CrossRef
  • Treatment of hyperkalemic emergencies
    Yao Wu, Yang-yang Fu, Hua-dong Zhu, Jun Xu, Joseph Harold Walline
    World Journal of Emergency Medicine.2022; 13(3): 232.     CrossRef
  • Prise en charge de l’hyperkaliémie aux urgences
    L. Lemoine, M. Legrand, G. Potel, P. Rossignol, E. Montassier
    Annales françaises de médecine d’urgence.2019; 9(2): 102.     CrossRef
  • Management of hyperkalemia in the acutely ill patient
    François Dépret, W. Frank Peacock, Kathleen D. Liu, Zubaid Rafique, Patrick Rossignol, Matthieu Legrand
    Annals of Intensive Care.2019; 9(1): 32.     CrossRef
  • Impact of Different Serum Potassium Levels on Postresuscitation Heart Function and Hemodynamics in Patients with Nontraumatic Out-of-Hospital Cardiac Arrest
    Yan-Ren Lin, Yuan-Jhen Syue, Tsung-Han Lee, Chu-Chung Chou, Chin-Fu Chang, Chao-Jui Li
    Bioinorganic Chemistry and Applications.2018; 2018: 1.     CrossRef
  • Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL–ED): A Multicenter, Prospective, Observational Study
    W. Frank Peacock, Zubaid Rafique, Carol L. Clark, Adam J. Singer, Stewart Turner, Joseph Miller, Douglas Char, Anthony Lagina, Lane M. Smith, Andra L. Blomkalns, Jeffrey M. Caterino, Mikhail Kosiborod
    The Journal of Emergency Medicine.2018; 55(6): 741.     CrossRef
  • 13,399 View
  • 199 Download
  • 6 Web of Science
  • 6 Crossref

Cardiovascular | Medical Emergencies

Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective
Adam J. Singer, Henry C. Thode, W. Frank Peacock
Clin Exp Emerg Med 2016;3(3):126-131.   Published online September 30, 2016
DOI: https://doi.org/10.15441/ceem.15.096

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Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective
Clin Exp Emerg Med. 2016;3(3):126-131.   Published online September 30, 2016
DOI: https://doi.org/10.15441/ceem.15.096
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Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective
Clin Exp Emerg Med. 2016;3(3):126-131.   Published online September 30, 2016
DOI: https://doi.org/10.15441/ceem.15.096
Close
Objective
Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients.
Methods
We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006–2010 including all adult patients with a primary diagnosis of DVT or PE. Simplified pulmonary embolus scoring index (sPESI) scores were determined in patients with PE to identify low risk patients.
Results
There were an estimated 652,000 and 394,000 ED visits for DVT and PE over the 5-year period (0.17%). Mean (SE) age was 59 (1.3), 50% were female, and 40% were > 65 years. Admission rates for DVT and PE were 52% and 90% respectively with no significant changes over time. In patients with DVT, predictors for admission were age (odds ratio, 1.03 per year of age [95% confidence interval, 1.01 to 1.05]) and race (odds ratio, 4.1 [95% confidence interval, 0.9 to 19.8] for Hispanics and 2.9 [1.2 to 7.4] for Blacks). Of all ED patients with PE, 51% were low risk based on sPESI scores.
Conclusion
Admission rates for DVT and PE have remained high and unchanged, especially with PE, minorities, and in older patients. Based on sPESI scores, up to half of PE patients might be eligible for early discharge or outpatient therapy.

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Editorial

Clinical and Experimental Emergency Medicine: a dawn of a new era
Adam J. Singer
Clin Exp Emerg Med 2014;1(1):1-2.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.038

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Clinical and Experimental Emergency Medicine: a dawn of a new era
Clin Exp Emerg Med. 2014;1(1):1-2.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.038
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Clinical and Experimental Emergency Medicine: a dawn of a new era
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DOI: https://doi.org/10.15441/ceem.14.038
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Review Article

Environmental

The evaluation and management of thermal injuries: 2014 update
Jimmy Toussaint, Adam J. Singer
Clin Exp Emerg Med 2014;1(1):8-18.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.029

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The evaluation and management of thermal injuries: 2014 update
Clin Exp Emerg Med. 2014;1(1):8-18.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.029
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Clin Exp Emerg Med. 2014;1(1):8-18.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.029
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Burns are among the most common injuries presenting to the emergency department. While burns, especially large ones, may be associated with significant morbidity and mortality, most are minor and can be managed by emergency practitioners and discharged home with close follow-up. In contrast, patients with large burns require aggressive management of their airway, breathing and circulation in order to reduce mortality and morbidity. While early endotracheal intubation of patients with actual or impending airway compromise and aggressive fluid resuscitation have been emphasized, it appears that the pendulum may have swung a bit too far towards the extreme. The current review will briefly cover the epidemiology, pathogenesis and diagnosis of burn injuries with greater emphasis on airway and fluid management. We will also discuss the local management of the burn wound, which is all that is required for most burn patients in the emergency department.

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Original Article

Resuscitation | Experimental study

The effect of controlled mild hypothermia on large scald burns in a resuscitated rat model
Nhi Tan, Henry C Thode Jr, Adam J. Singer
Clin Exp Emerg Med 2014;1(1):56-61.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.027

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The effect of controlled mild hypothermia on large scald burns in a resuscitated rat model
Clin Exp Emerg Med. 2014;1(1):56-61.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.027
Download Citation

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Include:
The effect of controlled mild hypothermia on large scald burns in a resuscitated rat model
Clin Exp Emerg Med. 2014;1(1):56-61.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.027
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Objective

Early surface cooling of burns reduces pain, depth of injury and improves healing. We hypothesized that controlled mild hypothermia would also prolong survival in a fluid resuscitated rat model of large scald burns.

 Methods

Forty rats were anesthetized and a single full-thickness scald burn covering 40% of total body surface area was created on each of the rats. The rats were then randomized to hypothermia (n=20) or no hypothermia (n=20). Mild hypothermia (a reduction of 2°C) was induced with intraperitoneal 4°C normal saline and ice packs. After 2 hours of hypothermia, the rats were rewarmed back to their baseline temperature with a heating pad. The control rats received room temperature intraperitoneal saline. The difference in survival between the groups was determined using Kaplan-Meier analysis and the log-rank test.

 Results

Hypothermia was induced in all experimental rats within a mean of 22 minutes (95% confidence interval, 17 to 27). The number of normothermic and hypothermic rats that expired at each time interval were: at 1 hour, 4 vs. 0; at 10 hours, 2 from each group; at 24 hours, 0 vs. 1; at 48 hours, 2 vs. 2; at 72 hours, 1 vs. 1; and at 120 hours, 1 vs. 1 respectively. There were no differences in time to survival between the groups.

 Conclusion

Induction of brief, mild hypothermia does not prolong survival in a resuscitated rat model of large scald burns.

Citations

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CEEM : Clinical and Experimental Emergency Medicine