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Review Article

AI & Digital Health

From non-agentic large language models to multi-agent systems in emergency medicine: a scoping review
Hyeseong Kim, Seunghoon Jo, Min Hyuk Lim, Dong Hyun Choi
In Press, Received March 19, 2026  Accepted April 6, 2026  Available online April 8, 2026  
DOI: https://doi.org/10.15441/ceem.26.136    [Accepted]

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From non-agentic large language models to multi-agent systems in emergency medicine: a scoping review
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From non-agentic large language models to multi-agent systems in emergency medicine: a scoping review
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Objective
This study aimed to conduct a scoping review of studies on non-agentic large language models (LLMs), LLM-based agents, and multi-agent systems reported in emergency medicine, and to identify current research trends and major gaps by analyzing their clinical application scope, system structures, evaluation approaches, and input data characteristics.
Methods
The Web of Science, Scopus, PubMed, and CINAHL databases were searched for literature published from March 8, 2021, to March 7, 2026. Among English full-text articles, studies addressing the application, evaluation, or benchmarking of non-agentic LLMs, LLM-based agents, or multi-agent systems in emergency medicine or the emergency department (ED) were included. Through reference tracking, 35 studies were analyzed.
Results
Of the 35 included studies, 26 were application studies, 6 were framework studies, and 3 were benchmark studies. The studies were concentrated on a limited set of tasks, including triage, diagnostic and treatment decision support, and documentation. In terms of system type, non-agentic LLMs were the most common (n=25), followed by LLM-based agents (n=7) and multi-agent systems (n=3). Inputs were predominantly text-based, and evaluation mainly relied on expert comparison, retrospective record review, vignette-based comparison, and task-specific performance metrics. In contrast, workflow-level, prospective, and safety and trustworthiness-oriented evaluation were limited.
Conclusion
LLMs in emergency medicine have shown potential for task-level decision support and documentation. However, current literature remains focused on non-agentic LLM-based task support, while studies reflecting the dynamic workflow of real EDs remain limited. Future research should expand toward workflow-aware design, operational evaluation, multimodal data integration, multi-agent–based role coordination, and safety and trustworthiness validation.

Citations

Citations to this article as recorded by  Crossref logo
  • An Evidence-Based Framework for Patient-Facing Artificial Intelligence Integration in the Emergency Department
    Tehreem Rehman, Philip Jarrett, Joshua Lesko, James Augustine, Bradley D. Shy, Rohit B. Sangal, Nicholas Genes, Donald U. Apakama, Ethan E. Abbott, Abhi Mehrotra, Richard Andrew Taylor
    JACEP Open.2026; 7(5): 100466.     CrossRef
  • 1,272 View
  • 112 Download
  • 1 Crossref

Original Articles

Education & Simulation

Entrustable professional activity–aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors
Kyung Hye Park, Young Taeck Oh, Ju Ok Park
Clin Exp Emerg Med 2025;12(4):391-399.   Published online December 26, 2025
DOI: https://doi.org/10.15441/ceem.24.377

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Entrustable professional activity–aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors
Clin Exp Emerg Med. 2025;12(4):391-399.   Published online December 26, 2025
DOI: https://doi.org/10.15441/ceem.24.377
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Entrustable professional activity–aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors
Clin Exp Emerg Med. 2025;12(4):391-399.   Published online December 26, 2025
DOI: https://doi.org/10.15441/ceem.24.377
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Objective
Workplace-based assessment (WBA) plays a crucial role in assessing entrustable professional activities (EPAs) in the competency-based medical education era. This pilot study explored the perceptions of residents and assessors of two WBAs for three Korean Society of Emergency Medicine EPAs.
Methods
Eight emergency medicine (EM) residents underwent WBAs, with mini-clinical evaluation exercises (mini-CEX) conducted by nine EM faculty members and multisource feedback (MSF) provided by two internal medicine faculty members and four emergency room nurses, for a total of 69 assessments. We conducted an anonymous online survey to gather feedback on experiences, perceptions, and recommendations for improving WBA, such as mini-CEX and MSF, with responses scored on a 5-point Likert scale.
Results
Of the 23 initial participants, 15 (65.2%) responded, including 5 residents and 10 assessors. EM faculty viewed mini-CEX favorably, noting its strong integration of supervision and effectiveness in assessing resident performance. EM residents reported comfort issues during assessments, preferring immediate feedback and multiple assessors. MSF was generally perceived positively but showed discrepancies in the utilities of rating scales and feedback types, indicating potential areas for improvement.
Conclusion
Two WBAs for three Korean Society of Emergency Medicine EPAs were found to be feasible and acceptable in the context of Korean EM residency training. However, perceptions varied between assessors and residents, necessitating clear communication about WBA objectives and processes. Our findings are useful for shaping future EPA-based training programs, balancing traditional and WBA methods, and enhancing feedback quality.

Citations

Citations to this article as recorded by  Crossref logo
  • Required training experience and essential emergency procedures for a competency-based emergency medicine residency program in Korea: two modified Delphi consensus studies
    Kyung Hye Park, Young-Min Kim
    Clinical and Experimental Emergency Medicine.2026; 13(2): 221.     CrossRef
  • Development of a competency-based emergency medicine residency training model in Korea
    Young-Min Kim, Chan Woong Kim, Kyung Hye Park, Hyo Joon Kim, Kyung Jun Song, Sung Phil Chung, Dong Ryul Ko, Tae Han Kim
    Clinical and Experimental Emergency Medicine.2026; 13(2): 227.     CrossRef
  • Development and Clinical Validation of an Entrustable Professional Activities Framework for Respiratory Nurses: A Longitudinal Workplace-Based Study
    Yufei He, Kouying Liu, Jiaxuan Li, Hao Huang, Yan Ji
    Healthcare.2026; 14(15): 2426.     CrossRef
  • 2,910 View
  • 42 Download
  • 3 Web of Science
  • 3 Crossref

Research Perspectives

Global academic productivity in emergency medicine and research output by countries of different income levels
Alexei A. Birkun
In Press, Received June 28, 2025  Accepted August 3, 2025  Available online December 2, 2025  
DOI: https://doi.org/10.15441/ceem.25.144    [Accepted]

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Global academic productivity in emergency medicine and research output by countries of different income levels
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Global academic productivity in emergency medicine and research output by countries of different income levels
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Objective
Despite disparities in the availability and quality of emergency care, the extent to which countries with different incomes participate in research on emergency medicine (EM) remains understudied. This study evaluated productivity in EM research depending on national income.
Methods
Research published since 2004 in Scopus-indexed journals dealing with EM was analyzed quantitatively. Publication, citation, journal impact, and national socioeconomic data were compared. Automated topic modeling was applied using a latent Dirichlet allocation model.
Results
The analysis included 154,458 publications (89.7% in English) from 177 countries. The studies received 1,817,635 citations. High-income countries (HICs) outperformed upper-middle-income countries (UMICs), lower-middle-income countries (LMICs), and low-income countries (LICs) by 11-, 41-, and 72-fold, respectively, by the weighted number of publications (per million population per country) by 21-, 54-, and 171-fold, respectively, and by the weighted count of citations. The annual number of publications is predicted to rise considerably for HICs, to a lesser extent for UMICs, and to far less for LMICs, but not for LICs. Research productivity was significantly related to national socioeconomic indicators. Topic modeling revealed that HICs pay relatively more attention to advances in resuscitation, whereas LICs focus more on injuries.
Conclusion
. While global research productivity for EM is rising, LICs lag far behind HICs. Priorities in EM research differ among countries with different incomes. The development of country-specific EM research agendas would help boost national academic productivity and determine context-appropriate interventions for improving outcomes in emergency care.

Citations

Citations to this article as recorded by  Crossref logo
  • Global patterns and regional disparities in library and information science research productivity
    Adebowale Jeremy Adetayo
    IFLA Journal.2026;[Epub]     CrossRef
  • 550 View
  • 24 Download
  • 1 Crossref

Review Article

AI & Digital Health | Ethics

Ethical considerations of artificial intelligence in emergency medicine for triage and resource allocation: a scoping review
Hyunjae Cha, Junhewk Kim
Clin Exp Emerg Med 2025;12(4):306-319.   Published online September 24, 2025
DOI: https://doi.org/10.15441/ceem.25.199

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Ethical considerations of artificial intelligence in emergency medicine for triage and resource allocation: a scoping review
Clin Exp Emerg Med. 2025;12(4):306-319.   Published online September 24, 2025
DOI: https://doi.org/10.15441/ceem.25.199
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Ethical considerations of artificial intelligence in emergency medicine for triage and resource allocation: a scoping review
Clin Exp Emerg Med. 2025;12(4):306-319.   Published online September 24, 2025
DOI: https://doi.org/10.15441/ceem.25.199
Close
Objective
This study aims to systematically review the ethical and legal discussions regarding the utilization of artificial intelligence (AI) for patient triage and resource allocation in emergency medicine, and to identify the current state of discussions, their limitations, and future research directions.
Methods
A comprehensive literature search was conducted following scoping review methodology. Relevant literature published after January 2020 was searched in the Web of Science, Scopus, CINAHL, PubMed, and Cochrane Library databases. Based on a PCC (population, concept, and context) framework (emergency patients/medical staff; triage, resource allocation; and emergency medicine with AI application), a final selection of 27 articles was analyzed.
Results
The selected literature raised various ethical and legal issues related to the introduction of AI triage systems and AI utilization in emergency medicine, including data privacy, algorithmic bias, automation dependency, accountability, and explainability. In response to these issues, human-centered design, implementation of explainable AI, establishment of regulatory frameworks, continuous verification and evaluation, and ensuring human-in-the-loop were discussed as major solutions. However, discussions on the risks of “persuasive AI” that could mislead users, ethical issues of generative AI, and social validation and patient and public involvement were found to be insufficient.
Conclusion
Ethical and legal discussions regarding AI in emergency medicine are evolving toward seeking concrete solutions at technical, institutional, and relational dimensions. However, in-depth research on ethical challenges, such as reflecting the specificity of rapidly developing AI and the values of emergency medicine, is urgently required.

Citations

Citations to this article as recorded by  Crossref logo
  • The AI-IARA framework: How to cultivate human agency before artificial intelligence optimizes it a(ny)way
    Llewellyn E. van Zyl
    The Journal of Positive Psychology.2026; : 1.     CrossRef
  • Sex-Consistent Performance of an AI-Enabled ECG for Acute Myocardial Infarction
    Hak Seung Lee, Sora Kang, Joon-myoung Kwon, Tae Gun Shin, Youngjoo Lee, Dong Hoon Kim, Sung Hyuk Choi, Hanjin Cho, Mi Jin Lee, Ki Young Jeong, Won Young Kim, Young Gi Min, Chul Han, Jae Chol Yoon, Eujene Jung, Woo Jeong Kim, Chiwon Ahn, Jeong Yeol Seo, Ta
    JACC: Advances.2026; 5(6): 102813.     CrossRef
  • 5,732 View
  • 135 Download
  • 2 Web of Science
  • 2 Crossref

Original Articles

Pain Management & Sedation

Comparison of the efficacy of bolus low-dose ketamine versus bolus plus infusion low-dose ketamine on pain management in emergency departments: a randomized clinical trial
Reza Azizikhani, Ali Sanaei, Farhad Heydari, Saeed Majidinejad, Keihan Golshani, Fateme Sadeghi, Pardis Rafiei
Clin Exp Emerg Med 2025;12(3):259-266.   Published online January 14, 2025
DOI: https://doi.org/10.15441/ceem.24.244

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Comparison of the efficacy of bolus low-dose ketamine versus bolus plus infusion low-dose ketamine on pain management in emergency departments: a randomized clinical trial
Clin Exp Emerg Med. 2025;12(3):259-266.   Published online January 14, 2025
DOI: https://doi.org/10.15441/ceem.24.244
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Comparison of the efficacy of bolus low-dose ketamine versus bolus plus infusion low-dose ketamine on pain management in emergency departments: a randomized clinical trial
Clin Exp Emerg Med. 2025;12(3):259-266.   Published online January 14, 2025
DOI: https://doi.org/10.15441/ceem.24.244
Close
Objective
Ketamine is a promising drug for analgesia in emergency medicine, but the high rate of side effects is a barrier to widespread usage. We hypothesized that ketamine bolus followed by ketamine infusion would provide a more even and longer duration of analgesia and lower rates of side effects in comparison to bolus-only administration.
Methods
This was a double-blinded clinical trial. Eligible trauma patients were randomly allocated with the numeric rating scale ≥6 in two study groups. The first group received a dose of 0.3 mg/kg of ketamine over 1 minute, followed by an infusion of saline 0.9% over the next 30 minutes (bolus-only group). The second group was given 0.15 mg/kg of ketamine over 1 minute, followed by an infusion of 0.15 mg/kg over the next 30 minutes (bolus-and-infusion group). The primary outcome was to measure the average reduction in pain scores.
Results
In total, 80 patients were recruited. Of these, 77 patients were analyzed. Both groups achieved a statistically significant decrease in pain scores (all P<0.001). After 30 minutes, patients in the bolus-and-infusion group reported lower pain scores in all intervals with lower rates of need for rescue analgesia, but this difference was not statistically significant. Vital signs remained stable during the study in both groups. No statistically significant difference was observed between study groups for any side effect (P<0.05).
Conclusion
Both administration protocols resulted in significant pain control. No statistically significant difference was observed between study groups in terms of analgesic efficacy and side effects.

Citations

Citations to this article as recorded by  Crossref logo
  • Updated European Society for Emergency Medicine Guidelines for acute pain management in emergency departments and prehospital care
    Saïd Hachimi-Idrissi, Viliam Dobias, Wolf E. Hautz, Robert Leach, Carlos Lojo Rial, Thomas C. Sauter, Idanna Sforzi, Frank Coffey
    European Journal of Emergency Medicine.2026; 33(3): 152.     CrossRef
  • A Systematic Review of Low-Dose Ketamine for Acute Pain Management in the Emergency Department
    Nasser Almulhim, Abdullah Alibrahim, Ali Alajwad, Hanan Alzahrani, Ibrahim Aldandan, Abdulelah Aldabbab, Ahmad Aljaziri, Mayar Ibrahim
    Psychoactives.2026; 5(2): 15.     CrossRef
  • 6,317 View
  • 120 Download
  • 2 Web of Science
  • 2 Crossref

Emergency Medicine Practice and Administration

Factors that predict emergency department length of stay in analysis of national data
Minha Kim, Sujeong Lee, Minyoung Choi, Doyeop Kim, Junsang Yoo, Tae Gun Shin, Jin-Hee Lee, Seongjung Kim, Hansol Chang, Eunsil Ko
Clin Exp Emerg Med 2025;12(1):35-46.   Published online October 16, 2024
DOI: https://doi.org/10.15441/ceem.24.309

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Factors that predict emergency department length of stay in analysis of national data
Clin Exp Emerg Med. 2025;12(1):35-46.   Published online October 16, 2024
DOI: https://doi.org/10.15441/ceem.24.309
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Factors that predict emergency department length of stay in analysis of national data
Clin Exp Emerg Med. 2025;12(1):35-46.   Published online October 16, 2024
DOI: https://doi.org/10.15441/ceem.24.309
Close
Objective
This study used a nationwide database to identify and analyze factors that influence emergency department (ED) length of stay (LOS) and improve the efficiency of emergency care. Methods This retrospective study analyzed data from the National Emergency Department Information System (NEDIS) database in Korea: 25,578,263 ED visits from 2018 to 2022. Patient demographics, clinical characteristics, and ED operational variables were examined. Univariate and multivariate logistic regression analyses were used to assess the associations between the variables and prolonged ED LOS, defined as 6 hours or more. Results Among the 25,578,263 patients, the median ED LOS was 2.1 hours (interquartile range, 1.050–3.830 hours), with 12.6% experiencing a prolonged ED LOS. Elderly patients (aged ≥65 years) were significantly more likely than younger patients to experience prolonged ED LOS (adjusted odds ratio [aOR], 1.415; 95% confidence interval [CI]: 1.411–1.419). Patients transferred from other hospitals (aOR, 1.469; 95% CI, 1.463–1.474) and those arriving by emergency medical services (aOR, 1.093; 95% CI, 1.077–1.108) also had high odds of prolonged LOS. Conversely, pediatric patients had a low likelihood of extended stay (aOR, 0.682; 95% CI, 0.678–0.686). Severe illness, including sepsis (aOR, 1.324; 95% CI, 1.311–1.340) and COVID-19 infection (aOR, 1.413; 95% CI, 1.399–1.427), was strongly associated with prolonged LOS. Conclusion Prolonged ED LOS is influenced by a combination of patient demographics, clinical severity, and systemic factors. Targeted interventions for older adults, severe illness, and operational inefficiencies such as hospital transfers are essential for reducing ED LOS and improving overall emergency care delivery.

Citations

Citations to this article as recorded by  Crossref logo
  • Bridging women's emergency and primary healthcare: Factors associated with prolonged obstetrics and gynecology emergency room stay in a Saudi university hospital
    Nouf A. AlShamlan, Reem S. AlOmar, Nourah H. Al Qahtani, Fatimah S. Badghaish, Rehab F. Alghamdi, Omar Y. Almukhadhib, Nurah Salham Alnuaimi, Amani M. AlQarni, Adam F. Aldhawyan, Amani S. AlOtaibi, Abdullah H. Alreedy
    International Journal of Gynecology & Obstetrics.2026; 173(1): 239.     CrossRef
  • Prevalence and associated factors of prolonged emergency department length of stay among adults patients attending University Hospital, South Ethiopia: a cross-sectional study
    Twedrose Fentahun Mamo, Nigus Habtamu Zenebe, Ytbarek Jemberie Getnet, Paulos Mada Mazga, Sorressa Letta Desisa, Hindu Argeta Hailemariam, Wondimagegn Genaneh Shiferaw
    International Journal of Africa Nursing Sciences.2026; 24: 100958.     CrossRef
  • Prognostic Performance of the Korean Triage and Acuity Scale Combined with the National Early Warning Score for Predicting Mortality and ICU Admission at Emergency Department Triage: A Retrospective Observational Study
    Jungtaek Park, Sang Hoon Oh, Ae Kyung Gong, Jee Yong Lim, Sun Hee Woo, Won Jung Jeong, Ji Hoon Kim, In Soo Kim, Soo Hyun Kim
    Diagnostics.2026; 16(2): 345.     CrossRef
  • Determinants of Emergency Department Length of Stay and the Mediation Effect of Disposition Among Injury Patients in South Korea: A Nationwide Retrospective Study
    Min-Seok Choi, Su-il Kim, Yun-Deok Jang
    Healthcare.2026; 14(4): 469.     CrossRef
  • Characteristics and clinical outcomes of cancer patients presenting to the emergency department in Korea: a retrospective descriptive study
    Hyun Bin Kim, Eun Ji Seo
    Journal of Korean Biological Nursing Science.2026; 28(1): 206.     CrossRef
  • Association between emergency department crowding and mortality: a nationwide analysis stratified by emergency department levels: a retrospective cohort study
    Minha Kim, Jin-Hee Lee, Minyoung Choi, Doyeop Kim, Hanseok Chang, Sejin Heo, Seung Jin Maeng, Tae Gun Shin, Eunsil Ko, Hansol Chang
    BMC Emergency Medicine.2026;[Epub]     CrossRef
  • Operational Challenges and Management Strategies Affecting Emergency Department Length of Stay: A Literature Review
    Vindy Vanessa Wennas
    Indonesian Journal of Innovation Multidisipliner Research.2026; 4(2): 5167.     CrossRef
  • Patient and emergency department factors influencing surgery timing in patients with hip fracture
    Aejin Sung, Dong Hoon Kim, Dong-Hee Kim, Jin Hee Jeong
    Scientific Reports.2025;[Epub]     CrossRef
  • Epidemiological trends and features of pediatric hand and elbow fractures in emergency department visits in Korea: a nationwide population-based study
    Sang Beom Ma, Joonha Lee
    Archives of Hand and Microsurgery.2025; 30(4): 212.     CrossRef
  • Determinants of Emergency Department Length of Stay Using the Time Frame Emergency Care Model: A Retrospective Study
    Lydia Maryendi Sompie, Retno Lestari, Suryanto Suryanto
    Journal of Applied Nursing and Health.2025; 7(3): 820.     CrossRef
  • Epidemiological trends in emergency department visits by age group: a report from the National Emergency Department Information System (NEDIS) of Korea, 2020–2024
    Hang A Park, Taehui Kim, Hyo Jin Kim, So-hyun Han
    Clinical and Experimental Emergency Medicine.2025; 12(4): 405.     CrossRef
  • 9,670 View
  • 213 Download
  • 7 Web of Science
  • 11 Crossref

Education & Simulation | Emergency Medicine Practice and Administration

Measuring burnout and professional fulfillment among emergency medicine residency program leaders in the United States: a cross-sectional survey study
Carl Preiksaitis, Kalen N. Wright, Al’ai Alvarez, Teresa M. Chan, Michael Gottlieb, Andrew G. Little, Adaira Landry
Clin Exp Emerg Med 2025;12(1):76-85.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.255

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Measuring burnout and professional fulfillment among emergency medicine residency program leaders in the United States: a cross-sectional survey study
Clin Exp Emerg Med. 2025;12(1):76-85.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.255
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Measuring burnout and professional fulfillment among emergency medicine residency program leaders in the United States: a cross-sectional survey study
Clin Exp Emerg Med. 2025;12(1):76-85.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.255
Close
Objective
Emergency medicine (EM) physicians face high burnout rates, even in academic settings. Research on burnout among EM residency program leaders is limited, despite their role in shaping the training environment and influencing resident well-being. This study aims to measure burnout and professional fulfillment among EM residency program leaders and identify contributing factors. Methods A cross-sectional survey using the adapted Stanford Professional Fulfillment Index was conducted in 2023 to assess burnout and professional fulfillment among EM residency program leaders at US programs. The survey, tailored to EM leaders, was distributed to all current EM program directors (PDs) and assistant/associate PDs (APDs) from accredited US programs. Descriptive statistics and odds ratios were used to compare burnout and professional fulfillment across various groups. Results A total of 112 of 281 PDs (response rate, 39.9%) and 130 of 577 APDs (response rate, 22.5%) participated. Professional fulfillment was reported by 59.8% of PDs and 58.5% of APDs. Burnout was experienced by 42.0% of PDs and 26.9% of APDs. Higher professional fulfillment correlated with alignment with expectations, positive work environments, and perceived appreciation, while burnout was strongly associated with negative impacts on personal health and relationships. Approximately 27.7% of PDs and 23.8% of APDs expressed an intention to leave their current position within 18 months. Conclusion A significant proportion of US EM residency program leaders experience burnout and low professional fulfillment. Addressing well-being in this population has important implications for education and mentorship provided to future physicians in the field.

Citations

Citations to this article as recorded by  Crossref logo
  • Automated chain-of-thought evaluation framework for large language model–generated emergency department documentation: a simulation-based study
    Dasol Choi, Junhyuk Seo, Won Cul Cha, Minha Kim, Sejin Heo, Hansol Chang, Taerim Kim
    Clinical and Experimental Emergency Medicine.2026; 13(1): 53.     CrossRef
  • Advancing emergency medicine across Asia: a roadmap for leadership, collaboration, and digital transformation
    Arif Alper Cevik, Saravana Kumar, Pauline Convocar, Saleh Fares Al-Ali, Bobi Prabowo, Yuet Chung Axel Siu
    International Journal of Emergency Medicine.2026;[Epub]     CrossRef
  • Leadership in Graduate Medical Education
    Andrei Brateanu, Jeremy Lipman
    Medical Clinics of North America.2026;[Epub]     CrossRef
  • The Magnitude of Anesthesiology Residents Burnout at Shahid Beheshti University of Medical Sciences: A Cross-Sectional Study
    Maedeh Karimian, Ali Dabbagh, Parisa Sezari, Kamal Fani, Marzieh Shahrabi, Alireza Shakeri
    Anesthesiology and Pain Medicine.2025;[Epub]     CrossRef
  • 7,101 View
  • 101 Download
  • 2 Web of Science
  • 4 Crossref

Case Report

Pediatrics | Resuscitation

Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report
Koji Kanno, Kentaro Watanabe, Yu Kanokogi, Marina Tsujimura, Akira Yoshida, Tomoya Hanada, Yuji Yamagami, Yusuke Ito
Clin Exp Emerg Med 2025;12(2):169-172.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.213

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Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report
Clin Exp Emerg Med. 2025;12(2):169-172.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.213
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Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report
Clin Exp Emerg Med. 2025;12(2):169-172.   Published online September 6, 2024
DOI: https://doi.org/10.15441/ceem.24.213
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While nonocclusive mesenteric ischemia (NOMI) has been reported in a significant percentage of adults who were resuscitated after cardiac arrest, it is rare in children. This report presents the first known Japanese case of pediatric NOMI after return of spontaneous circulation following cardiac arrest. A 16-month-old boy experienced cardiac arrest due to asphyxiation from foreign bodies in the airway. After receiving 10 doses of adrenaline, with a maximum arrest time of 95 minutes, the patient achieved return of spontaneous circulation. However, 40 hours after onset, the patient developed NOMI, resulting in refractory hypotensive shock with decreased blood pressure, distended abdomen, and increased intravesical pressure. The patient was successfully rescued with two laparotomies and was discharged. Although NOMI is uncommon in children, appropriate treatment can be lifesaving.

Citations

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  • Intestinal necrosis due to nonocclusive mesenteric ischemia in a child with Mycoplasma pneumoniae pneumonia: a case report
    Xuejing Li, Tingting Lin, Ken Chen, Danli Wang, Jiahui Yu, Lei Wu, Lanfang Tang
    BMC Infectious Diseases.2025;[Epub]     CrossRef
  • 4,102 View
  • 76 Download
  • 1 Web of Science
  • 1 Crossref

Review Articles

Airway

Current trends in emergency airway management: a clinical review
Sangun Nah, Yonghee Lee, Sol Ji Choi, Jeongwoo Lee, Soyun Hwang, Seongmi Lim, Inhye Lee, Young Soon Cho, Hyun Soo Chung, on behalf of the Korean Emergency Airway Management Society
Clin Exp Emerg Med 2024;11(3):243-258.   Published online March 15, 2024
DOI: https://doi.org/10.15441/ceem.23.173

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Current trends in emergency airway management: a clinical review
Clin Exp Emerg Med. 2024;11(3):243-258.   Published online March 15, 2024
DOI: https://doi.org/10.15441/ceem.23.173
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Current trends in emergency airway management: a clinical review
Clin Exp Emerg Med. 2024;11(3):243-258.   Published online March 15, 2024
DOI: https://doi.org/10.15441/ceem.23.173
Close
Airway management is a fundamental and complex process that involves a sequence of integrated tasks. Situations requiring emergency airway management may occur in the emergency department, intensive care units, and various other clinical spaces. A variety of challenges can arise during emergency airway preparation, intubation, and postintubation, which may result in significant complications for patients. Therefore, many countries are establishing step-by-step systemization and detailed guidelines and/or updating their content based on the latest research. This clinical review introduces the current trends in emergency airway management, such as emergency airway management algorithms, comparison of video and direct laryngoscopy, rapid sequence intubation, pediatric airway management, prehospital airway management, surgical airway management, and airway management education.

Citations

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  • 600 Download
  • 6 Web of Science
  • 9 Crossref

AI & Digital Health

Explainable artificial intelligence in emergency medicine: an overview
Yohei Okada, Yilin Ning, Marcus Eng Hock Ong
Clin Exp Emerg Med 2023;10(4):354-362.   Published online November 28, 2023
DOI: https://doi.org/10.15441/ceem.23.145

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Explainable artificial intelligence in emergency medicine: an overview
Clin Exp Emerg Med. 2023;10(4):354-362.   Published online November 28, 2023
DOI: https://doi.org/10.15441/ceem.23.145
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Explainable artificial intelligence in emergency medicine: an overview
Clin Exp Emerg Med. 2023;10(4):354-362.   Published online November 28, 2023
DOI: https://doi.org/10.15441/ceem.23.145
Close
Artificial intelligence (AI) and machine learning (ML) have potential to revolutionize emergency medical care by enhancing triage systems, improving diagnostic accuracy, refining prognostication, and optimizing various aspects of clinical care. However, as clinicians often lack AI expertise, they might perceive AI as a “black box,” leading to trust issues. To address this, “explainable AI,” which teaches AI functionalities to end-users, is important. This review presents the definitions, importance, and role of explainable AI, as well as potential challenges in emergency medicine. First, we introduce the terms explainability, interpretability, and transparency of AI models. These terms sound similar but have different roles in discussion of AI. Second, we indicate that explainable AI is required in clinical settings for reasons of justification, control, improvement, and discovery and provide examples. Third, we describe three major categories of explainability: pre-modeling explainability, interpretable models, and post-modeling explainability and present examples (especially for post-modeling explainability), such as visualization, simplification, text justification, and feature relevance. Last, we show the challenges of implementing AI and ML models in clinical settings and highlight the importance of collaboration between clinicians, developers, and researchers. This paper summarizes the concept of “explainable AI” for emergency medicine clinicians. This review may help clinicians understand explainable AI in emergency contexts.

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Resuscitation | Ethics

To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
Nirdosh Kumar, Meraj Fatima, Sara Ghaffar, Faysal Subhani, Shahan Waheed
Clin Exp Emerg Med 2023;10(2):138-146.   Published online May 15, 2023
DOI: https://doi.org/10.15441/ceem.23.027

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To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
Clin Exp Emerg Med. 2023;10(2):138-146.   Published online May 15, 2023
DOI: https://doi.org/10.15441/ceem.23.027
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To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department
Clin Exp Emerg Med. 2023;10(2):138-146.   Published online May 15, 2023
DOI: https://doi.org/10.15441/ceem.23.027
Close
Emergency physicians (EPs) working in low-resource settings, where patients mainly bear the cost of healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusses some of the common bioethical issues in the resuscitation and postresuscitation phases of treatment. Solutions are proposed and the necessity for evidence-based ethics and unanimity on ethical standards is emphasized. After a consensus was reached on the structure of the article, smaller groups of authors (2–3) wrote narrative reviews of ethical issues such as patient autonomy and honesty, beneficence and nonmaleficence, dignity, justice, and specific practices and circumstances such as family presence during resuscitation after discussions with senior EPs. Ethical dilemmas were discussed, and solutions were proposed. Cases related to medical decision-making by proxy, financial constraints in management, and resuscitation in the face of medical futility have been discussed. Solutions proposed include the early-stage involvement of hospital ethics committees, financial assurance in place beforehand, and allowing some leverage on a case-to-case basis when care is futile. We recommend developing evidence-based national ethical guidelines and incorporating societal and cultural norms with autonomy, beneficence, nonmaleficence, honesty, and justice principles.

Citations

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    Nuraini Nazeha, Desmond Renhao Mao, Dehan Hong, Nur Shahidah, Ivan Si Yong Chua, Yih Yng Ng, Benjamin S.H. Leong, Ling Tiah, Michael Y.C. Chia, Wei Ming Ng, Nausheen E Doctor, Marcus Eng Hock Ong, Nicholas Graves
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  • 349 Download
  • 9 Web of Science
  • 10 Crossref

Brief Research Report

Education & Simulation | Imaging

Utilization of point-of-care ultrasound among graduates of a 4-year longitudinal medical school ultrasound curriculum
Andy Phan Nguyen, Soheil Saadat, Michelle Thao Nguyen, Monica Devang Desai, Jonathan Wesley Rowland, John Christian Fox
Clin Exp Emerg Med 2023;10(2):224-229.   Published online January 30, 2023
DOI: https://doi.org/10.15441/ceem.22.357

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Utilization of point-of-care ultrasound among graduates of a 4-year longitudinal medical school ultrasound curriculum
Clin Exp Emerg Med. 2023;10(2):224-229.   Published online January 30, 2023
DOI: https://doi.org/10.15441/ceem.22.357
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Utilization of point-of-care ultrasound among graduates of a 4-year longitudinal medical school ultrasound curriculum
Clin Exp Emerg Med. 2023;10(2):224-229.   Published online January 30, 2023
DOI: https://doi.org/10.15441/ceem.22.357
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Objective
In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, Irvine alumni.
Methods
We surveyed University of California, Irvine alumni from the class of 2011 and beyond. Survey questions included POCUS reliance, frequency of use, and comfort with image acquisition and interpretation compared with peers. The primary outcomes were self-reported comfort and reliance on POCUS.
Results
We received 93 responses from 624 surveyed alumni (response rate, 14.9%), of which 87 were analyzed. Although 46 respondents (52.9%) reported more reliance on POCUS, three (3.4%) relied on it less than their peers. At the same time, 72 (82.7%) and 67 (77.0%) felt more comfortable than their colleagues in obtaining and interpreting POCUS, respectively. No respondents felt less comfortable obtaining or interpreting POCUS than their peers. The frequency of POCUS use correlated directly with the frequency with which POCUS changed the responder’s case management (rho, 0.860; P<0.001). POCUS reliance also correlated with respondents’ comfort level in obtaining (rho, 0.321; P<0.001) and interpreting (rho, 0.378; P<0.001) POCUS results.
Conclusion
University of California, Irvine graduates had higher reliance on POCUS than peers in their respective specialties. Their POCUS findings frequently changed their case management.

Citations

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  • Real-Time Tracheal Ultrasound vs. Capnography for Intubation Confirmation during CPR Wearing a Powered Air-Purifying Respirator in COVID-19 Era
    Seungwan Eun, Hee Yoon, Soo Yeon Kang, Ik Joon Jo, Sejin Heo, Hansol Chang, Guntak Lee, Jong Eun Park, Taerim Kim, Se Uk Lee, Sung Yeon Hwang, Sun-Young Baek
    Diagnostics.2024; 14(2): 225.     CrossRef
  • Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective
    Wookjin Choi, Young Soon Cho, Young Rock Ha, Je Hyeok Oh, Heekyung Lee, Bo Seung Kang, Yong Won Kim, Chan Young Koh, Ji Han Lee, Euigi Jung, Youdong Sohn, Han Bit Kim, Su Jin Kim, Hohyun Kim, Dongbum Suh, Dong Hyun Lee, Ju Young Hong, Won Woong Lee
    Clinical and Experimental Emergency Medicine.2023; 10(4): 363.     CrossRef
  • 6,532 View
  • 155 Download
  • 2 Web of Science
  • 2 Crossref

Original Article

Imaging

Head computed tomography for elderly patients with acute altered mental status in the emergency setting: value for decision-making and predictors of abnormal findings
Camille Gerlier, Mélanie Forster, Audrey Fels, Marc Zins, Gilles Chatellier, Olivier Ganansia
Clin Exp Emerg Med 2022;9(4):333-344.   Published online November 29, 2022
DOI: https://doi.org/10.15441/ceem.22.286

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Head computed tomography for elderly patients with acute altered mental status in the emergency setting: value for decision-making and predictors of abnormal findings
Clin Exp Emerg Med. 2022;9(4):333-344.   Published online November 29, 2022
DOI: https://doi.org/10.15441/ceem.22.286
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Head computed tomography for elderly patients with acute altered mental status in the emergency setting: value for decision-making and predictors of abnormal findings
Clin Exp Emerg Med. 2022;9(4):333-344.   Published online November 29, 2022
DOI: https://doi.org/10.15441/ceem.22.286
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Objective
This study evaluated the impact of head computed tomography (CT) on clinical decision-making about older adults with acute altered mental status (AMS) in the emergency department in terms of CT’s diagnostic yield, emergency department length of stay, and changes in medical strategy. It also attempted to find predictors of an acute imaging abnormality.
Methods
This was a 1-year, retrospective, single-center observational study of patients aged ≥75 years who underwent noncontrast head CT because of an isolated episode of AMS. The acute positive CT findings were ischemic strokes, hemorrhages, tumors, demyelinating lesions, hydrocephalus, and intracranial infections.
Results
A total of 594 CTs were performed, of which 38 (6.4%) were positive. The main etiology of AMS was sepsis (29.1%). Changes in medical strategy were more common in patients with a positive CT, and the major changes were ordering additional neuro exams (odds ratio [OR], 95.3; 95% confidence interval [CI], 38.4–233.8; P<0.001), adjusting treatments (OR, 12.2; 95% CI, 5.0–29.5; P<0.001), and referral to a neurologic unit (OR, 7.3; 95% CI, 3.0–17.5; P<0.01). Three factors were significantly associated with a positive outcome: Glasgow Coma Scale <13 (OR, 8.5; 95% CI, 2.3–28.9; P<0.001), head wound (OR, 3.1; 95% CI, 1.1–8.2; P=0.025), and dehydration (OR, 0.3; 95% CI, 0.1–0.4; P=0.021). For elderly patients with a Glasgow Coma Scale ≥13 and no head wound or clinical dehydration, the probability of a positive CT was 0.02 (95% CI, 0.01–0.04). Considering only those patients, the diagnostic yield fell to 1.7%.
Conclusion
In elderly patients, the causes of AMS are primarily extracerebral. Randomized clinical trials are needed to validate a clinical pathway for selecting patients who require emergent neuroimaging.

Citations

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  • Accuracy of Prehospital Head Injury Assessment: Emergency Medical Dispatcher Versus Emergency Department
    Xavier Dubucs, Frédéric Balen, Éric Mercier, Sandrine Charpentier, Marcel Émond
    Journal of Trauma Nursing.2026; 33(2): 116.     CrossRef
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    Grace Pham, Sophia Hahjean Kim, Madan M Rehani
    British Journal of Radiology.2026; 99(1182): 1073.     CrossRef
  • Diagnosis of delirium, confusion, and altered mental status in the emergency department using head computed tomography: A meta-analysis
    Yiting Xie, Qingyun Wang
    Journal of Radiation Research and Applied Sciences.2026; 19(3): 102540.     CrossRef
  • Association Between Frailty and Head Impact Location After Ground-Level Fall in Older Adults
    Xavier Dubucs, Éric Mercier, Valérie Boucher, Samuel Lauzon, Frederic Balen, Sandrine Charpentier, Marcel Emond
    The Journal of Emergency Medicine.2024; 66(5): e606.     CrossRef
  • Diagnostic Approach to the Patient with Altered Mental Status
    Ori J. Lieberman, Aaron L. Berkowitz
    Seminars in Neurology.2024; 44(06): 579.     CrossRef
  • 10,500 View
  • 210 Download
  • 5 Web of Science
  • 5 Crossref

Case Report

Injury & Prevention

A case report of furosemide extravasation in the hand: a rare cause of compartment syndrome
Sertaç Güler, Dilber Üçöz Kocaşaban
Clin Exp Emerg Med 2023;10(4):446-449.   Published online November 22, 2022
DOI: https://doi.org/10.15441/ceem.22.325

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A case report of furosemide extravasation in the hand: a rare cause of compartment syndrome
Clin Exp Emerg Med. 2023;10(4):446-449.   Published online November 22, 2022
DOI: https://doi.org/10.15441/ceem.22.325
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A case report of furosemide extravasation in the hand: a rare cause of compartment syndrome
Clin Exp Emerg Med. 2023;10(4):446-449.   Published online November 22, 2022
DOI: https://doi.org/10.15441/ceem.22.325
Close
In emergency departments, many drugs, fluids, and materials for medical examinations and treatment are typically administered to patients intravenously. One of the most common complications of the intravenous bolus or infusion of drugs is extravasation injuries. These injuries may cause certain morbidities for the patient, increase the cost of treatment, and prolong hospital stays. At the same time, these injuries also carry medicolegal risks for health personnel. Furosemide is a potent diuretic that is commonly used in emergency departments for volume overload conditions. To the best of our knowledge, there have been no cases reported in the literature of furosemide-induced extravasation injury with subsequent compartment syndrome that has required surgical intervention. Presented herein is the case of a 70-year-old female patient who was administered intravenous furosemide from the dorsum of the left hand and whose extravasation injury progressed to compartment syndrome requiring an emergency fasciotomy.

Citations

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  • Furosemide

    Reactions Weekly.2024; 1994(1): 84.     CrossRef
  • Extravasation of Noncytotoxic Agents: Skin Injury and Risk Classification
    Yuuka Shibata, Takanori Taogoshi, Hiroaki Matsuo
    Biological and Pharmaceutical Bulletin.2023; 46(6): 746.     CrossRef
  • 11,943 View
  • 392 Download
  • 2 Crossref

Commentary

Emergency Medicine Practice and Administration

Palliative and end-of-life care in the emergency department
Alice Chang, James Espinosa, Alan Lucerna, Neelesh Parikh
Clin Exp Emerg Med 2022;9(3):253-256.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.341

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Palliative and end-of-life care in the emergency department
Clin Exp Emerg Med. 2022;9(3):253-256.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.341
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Palliative and end-of-life care in the emergency department
Clin Exp Emerg Med. 2022;9(3):253-256.   Published online September 30, 2022
DOI: https://doi.org/10.15441/ceem.22.341
Close
With current medical advances, the human population continues to age. This presents healthcare practitioners with the increasing complexity of providing care to elderly patients with multifactorial medical and personal needs. This is a particular challenge in the emergency department, where patients often present for care in the last months of their lives. Early identification of palliative care needs and initiation of comfort care can drastically improve patient care and quality of life. Although emergency physicians agree that palliative care is an important area of knowledge, there is a gap in palliative care training in emergency medicine residencies. It is increasingly important for emergency medicine providers to have the resources and training to provide palliative care and to understand end-of-life issues.

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    Eric P. Martinez
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    Anna Ivana Mareta, Evy Dwi Rahmawati, Dian Rizki Ramadhani, Raodah Tul Ikhsan, Decky Nurhadi Sopyan, Setyawan, Sri Setiyarini
    Australasian Emergency Care.2026; 29(1): 65.     CrossRef
  • Patient characteristics and palliative care eligibility in public vs. private emergency care: A cross-sectional observational study
    Carla Bertelli, Cristina Terzi, Marileise Roberta Fonseca, Felipe Cecílio, Luciana Nucci, Luana Aranha, Paulo de Campos, Fernanda Engelbrecht, Renan Oliveira, Elisa Teixeira Mendes
    Clinics.2026; 81: 100859.     CrossRef
  • Rapid discharge checklists for people at the end of life who present to the emergency department
    Karl Cook, Conaill Kelly
    Emergency Nurse.2026; 34(4): 20.     CrossRef
  • Integrating Palliative Care into Emergency Medicine in Greece: A Novel Model Using ED-Based Palliative Care Hubs
    Dimitrios Babalis, Jennifer Reyes Lin, Ephrem Abathun, Andrew Ulrich, Joshua Hauser, Dimitrios Tsiftsis, Eleanor Reid
    Palliative Medicine Reports.2026;[Epub]     CrossRef
  • A pilot study of the Palliative Care and Rapid Emergency Screening (P-CaRES) tool to screen older emergency department patients for palliative care in Malaysia
    Raja Amir Fikri Raja Sulong Ahmad, Diana Katiman, Ab Halim Sanib, Mohd Amin Mohd Mokthtar
    Internal and Emergency Medicine.2026;[Epub]     CrossRef
  • Factors affecting access to palliative care in the emergency department for older adults with serious life- limiting illnesses: a qualitative study
    Latifah Jehloh, Anuchit Maropi, Kittikorn Nilmanat, Anne Bourbonnais
    BMC Palliative Care.2026;[Epub]     CrossRef
  • Drivers of avoidable emergency department visits in older adults with multiple long-term conditions and palliative care needs: a qualitative survey across six care providers
    Hanna Bring, Monica Bergqvist, Karin Modig, Pia Bastholm-Rahmner, Katharina Schmidt-Mende
    Scandinavian Journal of Primary Health Care.2026;[Epub]     CrossRef
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    D. G. Bove, S. S. Simonsen, S. F. Herling, H. Timm
    Journal of Advanced Nursing.2025; 81(3): 1543.     CrossRef
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    Hermioni L. Amonoo, Preeti N. Malani, Stephen M. Schenkel
    JAMA.2025; 333(7): 574.     CrossRef
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    Jennifer Johnson, Timmy Li, Megan Mandile, Santiago Lopez, Molly McCann-Pineo, Landon Witz, Payal Sud
    JACEP Open.2025; 6(4): 100165.     CrossRef
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    Gonçalo Botas, Sara Pires, Cesar Fonseca, Ana Ramos
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    Nancy J. Denke
    Journal of Emergency Nursing.2025; 51(5): 770.     CrossRef
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    Dimitri E Lin, Satheesh Gunaga, Fabrice I Mowbray, Eric D Isaacs, Daniel Markwalter, Naomi George, Alison E Hay, Rita Manfredi, Erica Westlake, Murtaza Akhter, Jason K Bowman, Naomi Rebollo-Lee, Brian Gacioch, Alexander D Ginsburg, Justin Kenneth Brooten,
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    Lizeth Estefania Campaña Sarango, Ricardo David Collahuazo Espinosa
    Arandu UTIC.2025; 12(1): 1078.     CrossRef
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    Amy L Sweeny, Nemat Alsaba, Laurie Grealish, Kerina Denny, Bill Lukin, Andrew Broadbent, Ya-Ling Huang, Jamie Ranse, Kristen Ranse, Katya May, Julia Crilly
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    Martin W. Dünser, Matthias Noitz, Thomas Tschoellitsch, Markus Bruckner, Markus Brunner, Bernhard Eichler, Romana Erblich, Stephan Kalb, Marius Knöll, Johannes Szasz, Wilhelm Behringer, Jens Meier
    Wiener klinische Wochenschrift.2024; 136(23-24): 651.     CrossRef
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    Joanna M Davies, Javiera Leniz, Kia-Chong Chua, Lesley E Williamson, Sabrina Bajwah, Thomas Bolton, Anna E Bone, Mevhibe Hocaoglu, Julia Verne, Lorna K Fraser, Stephen Barclay, Fliss E M Murtagh, Irene J Higginson, Katherine E Sleeman
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    Mike B. Astorp, Dorte Melgaard, Johannes Riis, Anne Lund Krarup
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    Rebecca Wright, Natalie G. Regier, Ashley Booth, Valerie T. Cotter, Bryan R. Hansen, Janiece L. Taylor, Sarah Won, Gary Witham
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    Sun Young Lim, You Hwan Jo, Seongjung Kim, Eunsil Ko, Young Sun Ro, Jungeon Kim, Sumin Baek
    Clinical and Experimental Emergency Medicine.2023; 10(S): S26.     CrossRef
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  • 20 Web of Science
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Case Report

Toxicology

Fatal arrhythmia following ingestion of hawthorn root (Crataegus pubescens) extract: a case report
Sergio Villegas-Belman, Thania Carolina Esparza-Gallegos, José Alfredo Lizalde-Moreno, Juan Manuel Marquez-Romero
Clin Exp Emerg Med 2022;9(4):373-376.   Published online July 22, 2022
DOI: https://doi.org/10.15441/ceem.21.086

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Fatal arrhythmia following ingestion of hawthorn root (Crataegus pubescens) extract: a case report
Clin Exp Emerg Med. 2022;9(4):373-376.   Published online July 22, 2022
DOI: https://doi.org/10.15441/ceem.21.086
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Fatal arrhythmia following ingestion of hawthorn root (Crataegus pubescens) extract: a case report
Clin Exp Emerg Med. 2022;9(4):373-376.   Published online July 22, 2022
DOI: https://doi.org/10.15441/ceem.21.086
Close
The use of extracts from the hawthorn plant as cardiovascular agents dates back to the 1st century; recently, they have also been made available online as weight loss aids. Herein, we present a case of intentional intoxication with hawthorn root extract (HRE) in an adult patient that resulted in death. A 20-year-old female patient, who was clinically diagnosed with depression, developed hypotension, bradycardia, and depressed consciousness after ingestion of this extract. An electrocardiogram recorded a sinus arrest with a slow nodal rhythm, which rapidly deteriorated, leading to cardiac arrest. This case report illustrates the potentially fatal consequences of HRE for which the constituents have not yet been characterized. All physicians, especially those in the emergency department, should be aware of the dangerous, even potentially fatal interactions of HRE with prescription medications.

Citations

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  • When herbal supplements cause heart problems: Clinical case report and forensic toxicological analysis
    Theresa Theuer, Katrin Faber, Lisa Oberli, Thomas Schweingruber, Marie-Alice Fraiture, Nancy Roosens, Adrian Kindler, Alain Rudiger, Roman Leist, Celine Vanhee
    Toxicology Reports.2026; 16: 102239.     CrossRef
  • Interactions Between Depression, Alcohol Intake, and Smoking on the Risk of Acute Coronary Syndrome
    Eujene Jung, Hyun Ho Ryu, Young Ju Cho, Byeong Jo Chun
    Psychiatry Investigation.2024; 21(1): 1.     CrossRef
  • A case report of cardiac glycoside-like intoxication following reported exposure to tejocote
    Mounir Contreras Cejin, Jason D. Vadhan, Kelsey Martin, Kapil Sharma, Mengchen Cao
    Medical Reports.2024; 6: 100080.     CrossRef
  • Analysis of Adverse Reactions Associated with the Use of Crataegus-Containing Herbal Products
    Herman J. Woerdenbag, Melissa Ursidae, Corine Ekhart, Martina Schmidt, Annabella Vitalone, Florence P. A. M. van Hunsel
    Pharmaceuticals.2024; 17(11): 1490.     CrossRef
  • Multiple drugs

    Reactions Weekly.2023; 1944(1): 422.     CrossRef
  • Tejocote Root's Role in Symptomatic Mobitz Type 1 Heart Block: A Compelling Case Report
    Heabah Assi, Carolina Najera, Omar Aboudawoud, Sahithi Nadella, Jared J Bies, Mariam Hassan, Chanwit Roongsritong
    Cureus.2023;[Epub]     CrossRef
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  • 307 Download
  • 3 Web of Science
  • 6 Crossref

Study Protocol

Cardiovascular

Finding acute coronary syndrome with serial troponin testing for rapid assessment of cardiac ischemic symptoms (FAST-TRAC): a study protocol
W. Frank Peacock, Alan S. Maisel, Christian Mueller, Stefan D. Anker, Fred S. Apple, Robert H. Christenson, Paul Collinson, Lori B. Daniels, Deborah B. Diercks, Salvatore Di Somma, Gerasimos Filippatos, Gary Headden, Brian Hiestand, Judd E. Hollander, Juan C. Kaski, Joshua M. Kosowsky, John T. Nagurney, Richard M. Nowak, Donald Schreiber, Gary M. Vilke, Marvin A. Wayne, Martin Than
Clin Exp Emerg Med 2022;9(2):140-145.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.21.154

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Finding acute coronary syndrome with serial troponin testing for rapid assessment of cardiac ischemic symptoms (FAST-TRAC): a study protocol
Clin Exp Emerg Med. 2022;9(2):140-145.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.21.154
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Finding acute coronary syndrome with serial troponin testing for rapid assessment of cardiac ischemic symptoms (FAST-TRAC): a study protocol
Clin Exp Emerg Med. 2022;9(2):140-145.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.21.154
Close
Objective
To determine the utility of a highly sensitive troponin assay when utilized in the emergency department.
Methods
The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin. These include a very early presenting population in whom prospective data collection of risk score parameters and the physician’s clinical impression of the probability of acute coronary syndrome before any troponin data were available. Furthermore, two gold standard diagnostic definitions were determined by a pair of cardiologists reviewing two separate data sets; one that included all local troponin testing results and a second that excluded troponin testing so that diagnosis was based solely on clinical grounds. By this method, a statistically valid head-to-head comparison of contemporary and high sensitivity troponin testing is obtainable. Finally, because of a significant delay in sample processing, a unique ability to define the molecular stability of various troponin assays is possible. Trial registration ClinicalTrials.gov Identifier NCT00880802

Citations

Citations to this article as recorded by  Crossref logo
  • Is an ED discharge safe after a single cardiac troponin: Analysis of the FAST-TRAC study
    W. Frank Peacock, Christian Mueller, Stefan D. Anker, Fred S. Apple, Robert H. Christenson, Lori B. Daniels, Deborah B. Diercks, Salvatore Di Somma, Gerasimos Filippatos, Gary Headden, Brian Hiestand, Judd E. Hollander, Joshua M. Kosowsky, Gary M. Vilke,
    The American Journal of Emergency Medicine.2026; 106: 102.     CrossRef
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    Yini Wang, Bingji Huang, Mengru Sun, Bo Yu, Ping Lin
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    Jacqui A Lee, Jessika Wise, Sara D Raudsepp, Louise N Paton, Jan Powell, Kieran Jina, Sally Aldous, Richard W Troughton, Philip D Adamson, A Mark Richards, W Frank Peacock, James L Januzzi, Noah Erceg, Luca Koechlin, Jasper Boeddinghaus, Pedro Lopez-Ayala
    European Heart Journal Open.2025;[Epub]     CrossRef
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    Eujene Jung, Hyun Ho Ryu, Young Ju Cho, Byeong Jo Chun
    Psychiatry Investigation.2024; 21(1): 1.     CrossRef
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    Bora Chae, Shin Ahn, Seung Mok Ryoo, Youn-Jung Kim, Dong-Woo Seo, Chang Hwan Sohn, Won Young Kim
    The American Journal of Emergency Medicine.2023; 64: 51.     CrossRef
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    Bora Chae, Shin Ahn, Youn-Jung Kim, Seung Mok Ryoo, Chang Hwan Sohn, Dong-Woo Seo, Won Young Kim
    Korean Circulation Journal.2023; 53(9): 635.     CrossRef
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  • 7,039 View
  • 181 Download
  • 7 Web of Science
  • 7 Crossref

Case Report

Critical Care | Hematology & Oncology

Concomitant intravascular and extravascular obstructive shock: a case report of cardiac angiosarcoma presenting with pericardial tamponade
Mor Zuler, Joseph Offenbacher, Yotam Deri, Baruch Berzon
Clin Exp Emerg Med 2022;9(2):150-154.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.20.052

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Concomitant intravascular and extravascular obstructive shock: a case report of cardiac angiosarcoma presenting with pericardial tamponade
Clin Exp Emerg Med. 2022;9(2):150-154.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.20.052
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Concomitant intravascular and extravascular obstructive shock: a case report of cardiac angiosarcoma presenting with pericardial tamponade
Clin Exp Emerg Med. 2022;9(2):150-154.   Published online June 30, 2022
DOI: https://doi.org/10.15441/ceem.20.052
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Atraumatic pericardial tamponade and intracardiac masses are both recognized etiologies of acute obstructive shock. Pericardial tamponade, is a cardiovascular emergency commonly considered by emergency physicians and, as a result, evaluation for this process has been incorporated into standardized point of care ultrasound algorithms for assessing hypotension. Obstructive shock secondary to intracardiac tumors is an atypical clinical presentation, and although it is evaluated by the same ultrasound imaging modality, it is generally not considered or evaluated for in the emergency department setting. The concomitant presentation of these two pathologic processes is an extremely rare oncologic emergency. Existing literature on the subject is found in a small number of case reports with nearly no prior descriptions in emergency medicine references. In the right clinical context this unique presentation should be considered and evaluated for in the emergency department via point of care ultrasound modality to help guide in the management of the resulting obstructive shock.
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Original Article

Ethics

Medical professionalism among emergency physicians in South Korea: a survey of perceptions and experiences of unprofessional behavior
Sangun Nah, Sangsoo Han, Kyunghye Park, Chanwoong Kim, Hyun Noh, Eunkyung Eo
Clin Exp Emerg Med 2022;9(1):54-62.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.21.133

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Medical professionalism among emergency physicians in South Korea: a survey of perceptions and experiences of unprofessional behavior
Clin Exp Emerg Med. 2022;9(1):54-62.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.21.133
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Medical professionalism among emergency physicians in South Korea: a survey of perceptions and experiences of unprofessional behavior
Clin Exp Emerg Med. 2022;9(1):54-62.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.21.133
Close
Objective
The purpose of this study was to analyze the current situation concerning professionalism among emergency physicians in South Korea by conducting a survey regarding their perceptions and experiences of unprofessional behavior.
Methods
In October 2018, the authors evaluated the responses to a questionnaire administered to 548 emergency physicians at 28 university hospitals. The participants described their perceptions and experiences concerning 45 unprofessional behaviors classified into the following five categories: patient care, communication with colleagues, professionalism at work, research, and violent behavior and abusive language. Furthermore, the responses were analyzed by position (resident vs. faculty). Descriptive statistics were generated on the general characteristics of the study participants. To compare differences in responses by position and sex, the chi-square and Fisher exact tests were performed.
Results
Of the 548 individuals invited to participate in this study, 253 responded (response rate, 46.2%). In 34 out of 45 questionnaires, more than half of participants reported having experienced unprofessional behavior despite their negative perceptions. Eleven perception questions and 38 experience questions for unprofessional behavior showed differences by position.
Conclusion
Most emergency physicians were well aware of what constituted unprofessional behavior; nevertheless, many had engaged in or observed such behavior.

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  • Perception of professionalism among Latin American physicians in 2024: A multi-national survey
    Raúl Emilio Real-Delor, Alberto Guevara Tirado, Eduardo Enrique Chibas Muñoz, Ruth Stephany Benítez Penayo, Bárbara Girhfietl Caje Román, Jonatas De Oliveira Borba, Lucio Fabián Duarte Irala, Mirtha Sofía Fleitas Armoa, Elena Cecilia Franco Cácer
    Anales del Sistema Sanitario de Navarra.2025;[Epub]     CrossRef
  • Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
    Shin Ahn, Eunsil Ko, Young Sun Ro
    Clinical and Experimental Emergency Medicine.2023; 10(S): S42.     CrossRef
  • PROFESSIONAL RESPONSIBILITIES OF NURSING STUDENTS IN CLINICAL EDUCATION: A DELPHI STUDY
    Fatemeh Keshmiri, Khadijeh Nasiriani
    Nursing and Midwifery Journal.2022; 20(5): 398.     CrossRef
  • 7,253 View
  • 193 Download
  • 2 Web of Science
  • 3 Crossref

Case Report

Imaging

Cat got your artery? Point of care ultrasound in the evaluation of penetrating trauma by a feline: a case report
Campbell Belisle Haley, David Mackenzie
Clin Exp Emerg Med 2022;9(1):63-66.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.20.065

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Cat got your artery? Point of care ultrasound in the evaluation of penetrating trauma by a feline: a case report
Clin Exp Emerg Med. 2022;9(1):63-66.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.20.065
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Cat got your artery? Point of care ultrasound in the evaluation of penetrating trauma by a feline: a case report
Clin Exp Emerg Med. 2022;9(1):63-66.   Published online March 31, 2022
DOI: https://doi.org/10.15441/ceem.20.065
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Point of care ultrasound is an important tool for diagnosis of musculoskeletal and vascular pathology in patients presenting to the emergency department. Superficial vascular and soft tissue structures are well-visualized at the bedside using modern ultrasound systems and have image characteristics that can be rapidly identified. This report describes the use of point of care ultrasound to distinguish between rapidly progressive soft tissue infection and vascular injury following penetrating trauma from a cat scratch. Ultrasound allowed the physician to rapidly make accurate decisions about the next necessary steps in the patient’s care. Point of care ultrasound provides immediate diagnostic information to supplement indeterminate physical examination findings. In this case, it allowed the treating physician to make the diagnosis of arterial injury using ultrasound image characteristics. An integrative approach to ultrasonography of superficial musculoskeletal and vascular structures could enhance clinical decision making and improve care of patients with similar complaints.

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  • Diagnostic technologies for neuroblastoma
    Leena Khelifa, Yubing Hu, Jennifer Tall, Rasha Khelifa, Amina Ali, Evon Poon, Mohamed Zaki Khelifa, Guowei Yang, Catarina Jones, Rosalia Moreddu, Nan Jiang, Savas Tasoglu, Louis Chesler, Ali K. Yetisen
    Lab on a Chip.2025; 25(15): 3630.     CrossRef
  • 6,627 View
  • 175 Download
  • 1 Web of Science
  • 1 Crossref

Original Articles

Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians
Seong Geun Lee, Hanjin Cho, Joo Yeong Kim, Juhyun Song, Jong-Hak Park
Clin Exp Emerg Med 2021;8(3):207-215.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.118

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Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians
Clin Exp Emerg Med. 2021;8(3):207-215.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.118
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Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians
Clin Exp Emerg Med. 2021;8(3):207-215.   Published online September 30, 2021
DOI: https://doi.org/10.15441/ceem.20.118
Close
Objective
Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans.
Methods
This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis.
Results
Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78).
Conclusion
Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.

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  • Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis
    Yong Suk Park, Hee Yoon, Soo Yeon Kang, Ik Joon Jo, Sookyoung Woo, Guntak Lee, Jong Eun Park, Taerim Kim, Se Uk Lee, Sung Yeon Hwang, Won Chul Cha, Tae Gun Shin
    Diagnostics.2022; 12(3): 721.     CrossRef
  • 8,506 View
  • 84 Download
  • 2 Web of Science
  • 1 Crossref

Emergency Medicine Practice and Administration

Association between burnout and wellness culture among emergency medicine providers
Revathi Jyothindran, James P d’Etienne, Kevin Marcum, Amy F Ho, Richard D Robinson, Aubre Tijerina, Clare Graca, Heidi C Knowles, Nestor R Zenarosa, Hao Wang
Clin Exp Emerg Med 2021;8(1):55-64.   Published online March 31, 2021
DOI: https://doi.org/10.15441/ceem.20.074

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Association between burnout and wellness culture among emergency medicine providers
Clin Exp Emerg Med. 2021;8(1):55-64.   Published online March 31, 2021
DOI: https://doi.org/10.15441/ceem.20.074
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Association between burnout and wellness culture among emergency medicine providers
Clin Exp Emerg Med. 2021;8(1):55-64.   Published online March 31, 2021
DOI: https://doi.org/10.15441/ceem.20.074
Close
Objective
Burnout is a common occurrence among healthcare providers and has been associated with provider wellness culture. However, this association has not been extensively studied among emergency medicine (EM) providers. We aim to determine the association between EM provider burnout and their culture of wellness, and to elicit the independent wellness culture domains most predictive of burnout prevention.
Methods
This was a multi-center observational study. We enrolled EM physicians and advanced practice providers from sixteen different emergency departments (EDs). Provider wellness culture and burnout surveys were performed. The wellness culture domains included in this study are personal/organizational value alignment, provider appreciation, leadership quality, self-controlled scheduling, peer support, and family support. Correlations between each wellness culture domain and burnout were analyzed by Pearson correlation co-efficiency, and their associations were measured by multivariate logistic regression with adjustments of other confounders.
Results
A total of 242 ED provider surveys were entered for final analysis. The overall burnout rate was 54% (130/242). Moderate correlations were found between burnout and two wellness culture domains (value alignment: r=-0.43, P<0.001 and provider appreciation: r=-0.49, P<0.001). The adjusted odds ratio of provider appreciation associated with burnout was 0.44 (95% confidence interval, 0.25–0.77; P=0.004), adjusted odds ratio of family support was 0.67 (95% confidence interval, 0.48–0.95; P=0.025).
Conclusion
ED providers have a relatively high burnout rate. Provider burnout might have certain associations with wellness culture domains. Provider appreciation and family support seem to play important roles in burnout protection.

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  • Emergency medicine advances healthcare systems: the importance of recognizing EM as a specialty
    Marko Erak, Nour Khatib, Amanda Collier, Rodrick Lim, Eddy Lang, Eric Heymann
    Internal and Emergency Medicine.2026; 21(3): 1033.     CrossRef
  • Common antecedents and outcomes of burnout among healthcare workers in the Emergency Department: A scoping review
    Luhuan Yang, Yunhong Lei, Rong Zhang, Firdaus Mukhtar, Poh Ying Lim, Jiawei Jiang, Zifeng Li, Yilan Zhang, Abd Rahman Anita
    The American Journal of Emergency Medicine.2025; 96: 140.     CrossRef
  • Development of Wellness Culture through corrective gymnastics
    Darinka Ignatova
    Physical Culture, Recreation and Rehabilitation.2025; 4(1): 9.     CrossRef
  • Factors influencing emergency medicine worker shift satisfaction: A rapid assessment of wellness in the emergency department
    Brooke Senken, Julie Welch, Elisa Sarmiento, Elizabeth Weinstein, Emma Cushman, Heather Kelker
    JACEP Open.2024; 5(6): e13315.     CrossRef
  • Investigating Correlates of Home Visitor Burnout, Compassion Fatigue, and Compassion Satisfaction in New York State: Implications for Home Visiting Workforce Development and Sustainability
    Abigail M. Ross, Rahbel Rahman, Debbie Huang, Gwyneth Kirkbride
    Maternal and Child Health Journal.2023; 27(10): 1787.     CrossRef
  • Not just a figurehead: improved resident perception of training following the addition of Administrative Chief Residents in a general surgery residency program
    Steven A. Wisel, Clara I. Gomez-Sanchez, Lily S. Cheng, Anamaria J. Robles, Patricia S. O’Sullivan, Linda M. Reilly, Kenzo Hirose
    Global Surgical Education - Journal of the Association for Surgical Education.2022;[Epub]     CrossRef
  • 8,674 View
  • 126 Download
  • 5 Web of Science
  • 6 Crossref

Education & Simulation

Getting to the heart of the issue: senior emergency resident electrocardiogram interpretation and its impact on quality assurance events
Leslie A Bilello, Céline Pascheles, Kiersten Gurley, Douglas Rappaport, David T Chiu, Shamai A Grossman, Carlo L Rosen
Clin Exp Emerg Med 2020;7(3):220-224.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.070

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Getting to the heart of the issue: senior emergency resident electrocardiogram interpretation and its impact on quality assurance events
Clin Exp Emerg Med. 2020;7(3):220-224.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.070
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Getting to the heart of the issue: senior emergency resident electrocardiogram interpretation and its impact on quality assurance events
Clin Exp Emerg Med. 2020;7(3):220-224.   Published online September 30, 2020
DOI: https://doi.org/10.15441/ceem.19.070
Close
Objective
Electrocardiogram (ECG) interpretation skills are of critical importance for diagnostic accuracy and patient safety. In our emergency department (ED), senior third-year emergency medicine residents (EM3s) are the initial interpreters of all ED ECGs. While this is an integral part of emergency medicine education, the accuracy of ECG interpretation is unknown. We aimed to review the adverse quality assurance (QA) events associated with ECG interpretation by EM3s.
Methods
We conducted a retrospective study of all ED ECGs performed between October 2015 and October 2018, which were read primarily by EM3s, at an urban tertiary care medical center treating 56,000 patients per year. All cases referred to the ED QA committee during this time were reviewed. Cases involving a perceived error were referred to a 20-member committee of ED leadership staff, attendings, residents, and nurses for further consensus review. Ninety-five percent confidence intervals (CIs) were calculated.
Results
EM3s read 92,928 ECGs during the study period. Of the 3,983 total ED QA cases reviewed, errors were identified in 268 (6.7%; 95% CI, 6.0%–7.6%). Four of the 268 errors involved ECG misinterpretation or failure to act on an ECG abnormality by a resident (1.5%; 95% CI, 0.0%–2.9%).
Conclusion
A small percentage of the cases referred to the QA committee were a result of EM3 misinterpretation of ECGs. The majority of emergency medicine residencies do not include the senior resident as a primary interpreter of ECGs. These findings support the use of EM3s as initial ED ECG interpreters to increase their clinical exposure.

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  • Does Inclusion of Emergency Medicine (EM) Residents in ECG Screening for STEMI Change the Time to Catheterization Lab Activation?
    Sarah Aly, Kelsey Coolahan, Kirk Tomlinson, Duncan Grossman, Joseph Bove, Steven Hochman
    Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine.2023; 22(2): 50.     CrossRef
  • 9,904 View
  • 105 Download
  • 1 Crossref

Emergency Medicine Practice and Administration

Parental presence during pediatric emergency procedures: finding answers in an Asian context
Peter Choong Yi Wong, Manasvin Tripathi, Aswin Warier, Zi Ying Lim, Shu-Ling Chong
Clin Exp Emerg Med 2019;6(4):340-344.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.075

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Parental presence during pediatric emergency procedures: finding answers in an Asian context
Clin Exp Emerg Med. 2019;6(4):340-344.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.075
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Parental presence during pediatric emergency procedures: finding answers in an Asian context
Clin Exp Emerg Med. 2019;6(4):340-344.   Published online December 31, 2019
DOI: https://doi.org/10.15441/ceem.18.075
Close
Objective
The practice of allowing parental presence during invasive procedures in children varies depending on setting and individual provider preference. We aim to understand the attitudes, preferences, and practices of physicians and nurses with regard to parental presence during invasive pediatric emergency procedures in an Asian cultural context.
Methods
We surveyed physicians and nurses in the pediatric emergency department of a large tertiary hospital using separate self-administered questionnaires over three months. The data collected included the demographics and clinical experience of interview respondents. Each provider was asked about their attitude and preference regarding parental presence during specific invasive procedures.
Results
We surveyed 90 physicians and 107 nurses. Most physicians in our context preferred to perform pediatric emergency procedures without parental presence (82, 91.1%). Forty physicians (44.4%) reported that parental presence slowed down procedures, while 75 (83.3%) felt it increased provider stress. Most physicians made the decision to allow parents into the procedure room based on parental attitude (69, 76.7%) and the child’s level of cooperation (64, 71.1%). Most nurses concurred that parental presence would add to provider stress during procedures (69, 64.5%). We did not find a significant relationship between provider experience (P=0.26) or age (P=0.50) and preference for parental presence.
Conclusion
In our cultural context, most physicians and nurses prefer to perform procedures for children in the absence of parents. We propose that this can be changed by health professional training with role play and simulation, adequate supervision by experienced physicians, and clear communication with parents.

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  • Strengthening the parental role: parents’ experiences of family presence during invasive procedures in pediatric and neonatal intensive care units
    Laia Ventura Expósito, Esperanza Zuriguel-Pérez, Jesús Corrionero Alegre, Antonia Arreciado Marañón
    Intensive and Critical Care Nursing.2026; 93: 104279.     CrossRef
  • “Being There”: An Empirical Logic Model for Family Presence During Resuscitation and Invasive Procedures
    Margo A. Halm, Halley Ruppel, Jessica Sexton
    American Journal of Critical Care.2025; 34(4): 302.     CrossRef
  • Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey
    Laia Ventura Expósito, Antonia Arreciado Marañón, Mireia Gomà Tous, Mercè Ferrerons Sánchez, Esperanza Zuriguel‐Pérez
    Journal of Clinical Nursing.2024; 33(10): 3979.     CrossRef
  • ENA Clinical Practice Guideline Synopsis: Family Presence During Resuscitation and Invasive Procedures
    Judith Young Bradford, Alison Camarda, Lisa Gilmore, Ann E. Horigan, Janet Kaiser, Robin MacPherson-Dias, Andrea Perry, Andrew Slifko, Andrea Slivinski, Kathy Van Dusen, Jessica Bishop-Royse, Altair M. Delao
    Journal of Emergency Nursing.2024; 50(3): 463.     CrossRef
  • A presença dos pais durante procedimentos pediátricos invasivos: depende de quê?
    Laura Palomares González, Iván Hernández Caravaca, Carmen Isabel Gómez García, Manuel Sánchez-Solís de Querol
    Revista Latino-Americana de Enfermagem.2023;[Epub]     CrossRef
  • Presencia de los padres durante procedimientos pediátricos invasivos: ¿De qué depende?
    Laura Palomares González, Iván Hernández Caravaca, Carmen Isabel Gómez García, Manuel Sánchez-Solís de Querol
    Revista Latino-Americana de Enfermagem.2023;[Epub]     CrossRef
  • Parental presence during invasive pediatric procedures: what does it depend on?
    Laura Palomares González, Iván Hernández Caravaca, Carmen Isabel Gómez García, Manuel Sánchez-Solís de Querol
    Revista Latino-Americana de Enfermagem.2023;[Epub]     CrossRef
  • 9,730 View
  • 99 Download
  • 4 Web of Science
  • 7 Crossref
Concordance between the underlying causes of death on death certificates written by three emergency physicians
Hyeji Lee, Sun Hyu Kim, Byungho Choi, Minsu Ock, Eun Ji Park
Clin Exp Emerg Med 2019;6(3):218-225.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.050

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Concordance between the underlying causes of death on death certificates written by three emergency physicians
Clin Exp Emerg Med. 2019;6(3):218-225.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.050
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Concordance between the underlying causes of death on death certificates written by three emergency physicians
Clin Exp Emerg Med. 2019;6(3):218-225.   Published online September 30, 2019
DOI: https://doi.org/10.15441/ceem.18.050
Close
Objective
This study was conducted to evaluate the concordance between the underlying causes of death (UCOD) on the death certificates written by three emergency physicians (EPs). We investigated errors on the death certificates committed by each EP.
Methods
This study included 106 patients issued a death certificate in the emergency department of an academic hospital. Three EPs reviewed the medical records retrospectively and completed 106 death certificates independently. The selection of the UCOD on the death certificates by each EP (EP-UCOD) was based on the general principle or selection rules. The gold standard UCOD (GS-UCOD) was determined for each patient by unanimous consent between three EPs. We also compared between the EP-UCOD and the GS-UCOD. In addition, we compared between UCODs of three EPs. The errors on the death certificates were investigated by each EP.
Results
The rates of concordance between EP-UCOD and the GS-UCOD were 86%, 81%, and 67% for EP-A, EP-B, and EP-C, respectively. The concordance rates between EP-A and EP-B were the highest overall percent agreement (0.783), and those between EP-A and EP-C were the lowest overall percent agreement (0.651). Although each EP had differences in the errors they committed, none of them listed the mode of dying as UCOD.
Conclusion
This study confirmed that each EP wrote death certificates indicating different causes of death for the same decedents; however, the three EPs made fewer errors on the patients’ death certificates compared with those reported in previous studies.

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  • Nationwide estimates of all-cause and cause-specific mortality among individuals with gender dysphoria in Sweden, 2001–2023: a register-based cohort study
    Kristen D. Clark, Richard A. White, Sarah S. Jackson, Alkistis Skalkidou, Thomas Frisell, Fotios C. Papadopoulos
    eClinicalMedicine.2026; 98: 104088.     CrossRef
  • Do Death Certificate Errors Decrease as Clinical Experience in an Emergency Department Increases?
    Jung Jun Kim, Sun Hyu Kim, Sangyup Chung, Byeong Ju Park, Soobeom Park, Song Yi Park
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Causes of death in children with congenital anomalies up to age 10 in eight European countries
    Anke Rissmann, Joachim Tan, Svetlana V Glinianaia, Judith Rankin, Anna Pierini, Michele Santoro, Alessio Coi, Ester Garne, Maria Loane, Joanne Given, Abigail Reid, Amaia Aizpurua, Diana Akhmedzhanova, Elisa Ballardini, Ingeborg Barisic, Clara Cavero-Carbo
    BMJ Paediatrics Open.2023; 7(1): e001617.     CrossRef
  • Factors Associated with Major Errors on Death Certificates
    Sangyup Chung, Sun-Hyu Kim, Byeong-Ju Park, Soobeom Park
    Healthcare.2022; 10(4): 726.     CrossRef
  • Errors in pediatric death certificates issued in an emergency department
    Byeong Ju Park, Sun Hyu Kim
    Pediatric Emergency Medicine Journal.2022; 9(1): 17.     CrossRef
  • 8,737 View
  • 131 Download
  • 4 Web of Science
  • 5 Crossref

Review Article

Wound Management

Updates in emergency department laceration management
Karalynn Otterness, Adam J Singer
Clin Exp Emerg Med 2019;6(2):97-105.   Published online April 8, 2019
DOI: https://doi.org/10.15441/ceem.18.018

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Updates in emergency department laceration management
Clin Exp Emerg Med. 2019;6(2):97-105.   Published online April 8, 2019
DOI: https://doi.org/10.15441/ceem.18.018
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Updates in emergency department laceration management
Clin Exp Emerg Med. 2019;6(2):97-105.   Published online April 8, 2019
DOI: https://doi.org/10.15441/ceem.18.018
Close
Lacerations are a common reason for patients to seek medical attention, and are often acutely managed in the emergency department. Recent studies pertaining to closure techniques, sedation and analgesia, advances in wound care, and various other topics have been published, which may enhance our understanding of this injury and improve our management practices. This article will review pertinent studies published in the past few years relevant to laceration management. Understanding the current literature and appreciating which areas warrant further investigation will help us optimize outcomes for patients who sustain laceration injuries.

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    Khedija Zaouche, Hana Harzallah, Emna Rezgui, Emna Kallel, Rania Hmaissi, Wicem Hannachi, Fedya El Ayech, Manel Kallel
    Forensic Science International: Reports.2026; 13: 100446.     CrossRef
  • A simple instrument-ring technique for rapid localization of scalp bleeding in the emergency department
    Huseyin Cahit Halhalli, Emrah Celik
    The American Journal of Emergency Medicine.2026; 107: 120.     CrossRef
  • BEnefit of HYpnosis on Pain during stitches in an Emergency Room: a study protocol using a randomised controlled trial – the BE-HYPER protocol
    Léa Pérard, Maëlys Clinchamps, Frédéric Dutheil, Sarah De Saint-Vincent, Camille Lucchini-Roche, Jeannot Schmidt, Farès Moustafa, Julien S Baker, Bruno Pereira, Jean-Baptiste Bouillon-Minois
    BMJ Open.2026; 16(7): e108925.     CrossRef
  • Prophylactic Antibiotics for Uncomplicated Upper-Extremity Lacerations: A Retrospective Cohort Study of Private Insurance Claims
    Cecil S. Qiu, Gabriel Yohe, Eliana Schaefer, Gongliang Zhang, Oluseyi Aliu, Aviram M. Giladi
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  • 38,897 View
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Original Articles

Emergency Medicine Practice and Administration | Nursing

Night shift preparation, performance, and perception: are there differences between emergency medicine nurses, residents, and faculty?
John R. Richards, Taylor L. Stayton, Jason A. Wells, Aman K. Parikh, Erik G. Laurin
Clin Exp Emerg Med 2018;5(4):240-248.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.270

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Night shift preparation, performance, and perception: are there differences between emergency medicine nurses, residents, and faculty?
Clin Exp Emerg Med. 2018;5(4):240-248.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.270
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Night shift preparation, performance, and perception: are there differences between emergency medicine nurses, residents, and faculty?
Clin Exp Emerg Med. 2018;5(4):240-248.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.270
Close
Objective
Determine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects.
Methods
Survey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine.
Results
Forty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Bedroom temperature preference was similar. The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. as median nadir. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. All had similar opinions regarding night shift-associated health effects. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence.
Conclusion
Faculty, residents, and nurses shared many characteristics. Faculty tended to not use pharmacologic sleep aids, not eat before their shift, fall asleep at a higher rate while driving home, and enjoy night shift work less.

Citations

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  • Forensic integrity of blood alcohol sampling in the emergency department, Part I: Epidemiology and factors affecting turnaround time
    Maria Sapio, Anna Criniti, Simona Giglio, Gioacchino Galardo, Orietta Gandini, Antonio Angeloni, Cristiano Ialongo
    Biochemia Medica.2026;[Epub]     CrossRef
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    Roberta Petrino, Luis Garcia-Castrillo, Davide Castiglioni, Basak Yilmaz, Ilenia Mascherona
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    Megan Konkol, Elisabeth L. George, Paul W. Scott, Christopher C. Imes
    Journal of Nursing Care Quality.2024; 39(1): 10.     CrossRef
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    Katie Pawloski, Wendy Moore, Foroozan Atashzadeh-Shoorideh
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    Yasser A Alaska, Bader AlYahya, Lama AlFakhri, Bader AlHarbi, Faisal Alkattan, Rami Mohammad Alhayaza
    Advances in Medical Education and Practice.2022; Volume 13: 167.     CrossRef
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    Elsa Vitale
    Endocrine, Metabolic & Immune Disorders - Drug Targets.2022; 22(13): 1235.     CrossRef
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    Open Access Emergency Medicine.2021; Volume 13: 343.     CrossRef
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    JACEP Open.2021; 2(6): e12601.     CrossRef
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Changes in medical care due to the absence of internal medicine physicians in emergency departments
Kyoung Ho Kim, Jang Young Lee, Won Suk Lee, Won Young Sung, Sang Won Seo
Clin Exp Emerg Med 2018;5(2):120-130.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.235

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Changes in medical care due to the absence of internal medicine physicians in emergency departments
Clin Exp Emerg Med. 2018;5(2):120-130.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.235
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Changes in medical care due to the absence of internal medicine physicians in emergency departments
Clin Exp Emerg Med. 2018;5(2):120-130.   Published online April 30, 2018
DOI: https://doi.org/10.15441/ceem.17.235
Close
Objective
Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents.
Methods
This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department.
Results
The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P<0.001); lengths of stay decreased by 15.1% (95% CI, P<0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021).
Conclusion
Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients.

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  • The Lived Experiences of Discharged Patients on Quality Care in a Crowded Emergency Department
    Ian C. Abordo, Jahsel Amber F. Benabaye, Maria Donna Lyn F. Bombeza, Hannica M. Cogtas, Raymond M. Salvador, RN, Man, Donna Bell P Sumugat, Rn Man
    International Journal of Innovative Science and Research Technology (IJISRT).2024; : 1133.     CrossRef
  • MINIMIZING PATIENT LENGTH OF STAY IN THE EMERGENCY DEPARTMENT AT ANNA MEDIKA GENERAL HOSPITAL, MADURA
    Ida Lumintu, Hidayatur Rohman, Rullie Annisa
    J@ti Undip: Jurnal Teknik Industri.2024; 19(3): 115.     CrossRef
  • 8,946 View
  • 91 Download
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Cardiovascular

Safety and efficiency of emergency department interrogation of cardiac devices
James F. Neuenschwander, W. Frank Peacock, Madgy Migeed, Sara A. Hunter, John C. Daughtery, Ian C. McCleese, Brian C. Hiestand
Clin Exp Emerg Med 2016;3(4):239-244.   Published online December 30, 2016
DOI: https://doi.org/10.15441/ceem.15.118

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Safety and efficiency of emergency department interrogation of cardiac devices
Clin Exp Emerg Med. 2016;3(4):239-244.   Published online December 30, 2016
DOI: https://doi.org/10.15441/ceem.15.118
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Safety and efficiency of emergency department interrogation of cardiac devices
Clin Exp Emerg Med. 2016;3(4):239-244.   Published online December 30, 2016
DOI: https://doi.org/10.15441/ceem.15.118
Close
Objective
Patients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff.
Methods
Prospective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee.
Results
Of 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event.
Conclusion
ED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP.

Citations

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  • Initial treatment of presumed pacemaker or implantable cardioverter defibrillator malfunctions: algorithm and rationale
    Matthias Mueller, Christoph Weiser, Michael Pfeffer, Thomas Mitteregger
    Emergency Medicine Journal.2026; : emermed-2026-215963.     CrossRef
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    Yuval Avidan, Razi Khoury, Amir Aker
    Pacing and Clinical Electrophysiology.2025; 48(1): 30.     CrossRef
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    Samikshya Neupane, Tarun Goswami
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    Felix Busch, Keno K. Bressem, Phillip Suwalski, Lena Hoffmann, Stefan M. Niehues, Denis Poddubnyy, Marcus R. Makowski, Hugo J. W. L. Aerts, Andrei Zhukov, Lisa C. Adams
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    Tinh Le, James Neuenschwander, Parker Cordial, Mackenzie Sankoe, Ankur Parekh, Brian Hiestand, WF Peacock
    Clinical and Experimental Emergency Medicine.2022; 9(1): 24.     CrossRef
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    Bradley M. Pitman, Vincent Schirripa, Dian A. Munawar, Kadhim Kadhim, Catherine J. O’Shea, Ricardo S. Mishima, Kurt Roberts-Thomson, Glenn D. Young, Christopher X. Wong, Prashanthan Sanders, Dennis H. Lau
    Heart, Lung and Circulation.2022; 31(8): 1119.     CrossRef
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    Pirbhat Shams, Muhammad Mehdi, Jamshed Ali, Intisar Ahmed, Sheema Saadia, Sameen Iqbal, Aamir Hameed Khan, Yawer Saeed
    Annals of Medicine & Surgery.2021;[Epub]     CrossRef
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    James Neuenschwander, Tinh Le, Ankur Parekh, Brian Hiestand, Parker Cordial, Hana Le, Eric Hammil, Tumay Kojasoy, W. Frank Peacock, Anna Marie Chang
    Academic Emergency Medicine.2020; 27(12): 1344.     CrossRef
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    Brian Hiestand
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Emergency Medicine Practice and Administration

Sense of meaning as a predictor of burnout in emergency physicians in Israel: a national survey
Shulamit Ben-Itzhak, Jonathan Dvash, Maya Maor, Noa Rosenberg, Pinchas Halpern
Clin Exp Emerg Med 2015;2(4):217-225.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.074

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Sense of meaning as a predictor of burnout in emergency physicians in Israel: a national survey
Clin Exp Emerg Med. 2015;2(4):217-225.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.074
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Sense of meaning as a predictor of burnout in emergency physicians in Israel: a national survey
Clin Exp Emerg Med. 2015;2(4):217-225.   Published online December 28, 2015
DOI: https://doi.org/10.15441/ceem.15.074
Close
Objective
Burnout is common in physicians and particularly acute in emergency physicians. Physician burnout may adversely affect physicians’ lives and the quality of care they provide, but much remains unknown about its main contributing factors. The present study evaluated burnout rates and contributing factors in emergency physicians in Israel, specifically focusing on the role of a sense of meaning, which has received little attention in the literature concerning burnout in emergency physicians.
Methods
A multicenter study, involving a convenience sample of physicians working full-time in the emergency departments of 16 general hospitals in Israel, was conducted. Questionnaires were used to assess burnout, demographic characteristics, professional stress, emotional distress, satisfaction, and quality of professional life, and open-ended questions were used to evaluate subjective perception of job satisfaction.
Results
Seventy physicians completed the questionnaires; 71.4% reported significant burnout levels in at least one of the burnout measures, while 82% also reported medium or high levels of competency. Burnout levels were associated with work-life balance, work satisfaction, social support, depressive symptoms, stress, and preoccupying thoughts. Regression analysis yielded two significant factors associated with burnout: worry and a sense of existential meaning derived from work. In addition, 61%, 51%, and 17% of participants exhibited high emotional exhaustion, high depersonalization, and a low sense of personal accomplishment, respectively.
Conclusion
These results indicate a high burnout rate in emergency physicians in Israel and highlight relevant positive and negative factors including the importance of addressing existential meaning in designing specific intervention programs to counter burnout.

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CEEM : Clinical and Experimental Emergency Medicine