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Articles of interest in Annals of Emergency Medicine - February 2020

Sam Shahid, MBBS, MPH
Practice Management Manager, ACEP

ACEP would like to provide you with very brief synopses of the latest articles and articles coming soon to JACEP Open or to Annals of Emergency Medicine. Some of these have not appeared in print. These synopses are not meant to be thorough analyses of the articles, simply brief introductions. Before incorporating into your practice, you should read the entire articles and interpret them for your specific patient population.



Brenner, JM, Marco, CA, Kluesner, NH, Schears, RM, Martin, DR. Assessing psychiatric safety in suicidal emergency department patients. JACEP Open. 2020; 1– 8. https://doi.org/10.1002/emp2.12017

The publication provides a review of the assessment of suicidal emergency department patients, including tools of assessment, and includes a perspective on the legal and ethical issues, such as patient autonomy, accountability of the emergency physician, and consultant to Emergency Medical Treatment and Labor Act (EMTALA) as well as confidentiality, privacy, and social issues. Screening tools and psychiatric consultation are important adjuncts to the ED evaluation of potentially suicidal patients. Suicide risk should be assessed, and if positive, an appropriate and safe disposition should be arranged. Full text available here.

ACEP has a free, online Point of Care tool for the Management of Suicidal Patients in the ED called Icar2e. Access it here


Crowe, RP, Fernandez, AR, Pepe, PE, et al. The association of job demands and resources with burnout among emergency medical services professionals. JACEP Open. 2020; 1– 11. https://doi.org/10.1002/emp2.12014

This study sought to evaluate variation in burnout between agencies and to quantify the relationship between burnout and job‐related demands/resources among emergency medical services (EMS) professionals. The authors found that among 1271 EMS professionals working at 248 EMS agencies, the median agency‐level burnout was 35%. Job‐related demands, including time pressure, were associated with increased burnout and traditional job‐related resources, including pay and benefits, were associated with reduced burnout. In summary, the authors findings suggest that there is an opportunity to address burnout at the EMS agency level. Full text available here.


Annals of Emergency Medicine

Ashburn, Nicklaus P. et al. One-Year Mortality and Associated Factors in Patients Receiving Out-of-Hospital Naloxone for Presumed Opioid Overdose. Annals of Emergency Medicine. DOI: https://doi.org/10.1016/j.annemergmed.2019.11.022

The objectives of this study were to describe the 1-year mortality of presumed opioid overdose victims identified by receiving out-of-hospital naloxone and to determine which patient factors were associated with subsequent mortality. In this study, of 3,085 out-of-hospital naloxone encounters, 72.7% of patients improved, whereas 27.3% had no improvement with naloxone. The authors concluded that opioid overdoses identified by receiving out-of-hospital naloxone with clinical improvement carried a 13-fold increase in mortality compared to the general population. This suggested that this is a high-risk population that deserves attention from public health officials, policymakers, and health care providers in regard to the development of long-term solutions. Full text available here.


Fauteux-Lamarre, Emmanuelle et al. Oral Ondansetron to Reduce Vomiting in Children Receiving Intranasal Fentanyl and Inhaled Nitrous Oxide for Procedural Sedation and Analgesia: A Randomized Controlled Trial. Annals of Emergency Medicine. DOI: https://doi.org/10.1016/j.annemergmed.2019.11.019

Intranasal fentanyl and inhaled nitrous oxide are increasingly combined to provide procedural sedation and analgesia in the pediatric emergency setting, and the authors of this study were aiming to assess whether prophylactic oral ondansetron use could reduce the incidence of vomiting associated with intranasal fentanyl and nitrous oxide for procedural sedation compared with placebo. There were 436 participants included for analysis and there was no significant difference in the primary outcome, early vomiting associated with procedural sedation, between the groups. Therefore, the authors concluded that oral ondansetron did not significantly reduce vomiting during or shortly after procedural sedation with combined intranasal fentanyl and inhaled nitrous oxide. Full text available here.


Shenvi, Christina et al. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Annals of Emergency Medicine, Volume 75, Issue 2, 136 – 145. DOI: https://doi.org/10.1016/j.annemergmed.2019.07.023

Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED) and providing care for this population in the ED setting can be challenging for emergency physicians. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat (ADEPT) tool, and to provide the background for and explain the importance of these principles related to the care of older adults with agitation. Full text available here.

ACEP has a free, online Point of Care tool for the Management of Confusion and Agitation in the Elderly ED Patient called ADEPT. Access it here.


Probst, Marc A. et al. Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score. Annals of Emergency Medicine, Volume 75, Issue 2, 147 – 158. DOI: https://doi.org/10.1016/j.annemergmed.2019.08.429

Older adults with syncope are commonly treated in the emergency department (ED), and the authors were seeking to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. They enrolled 3,177 older adults with unexplained syncope or near syncope, with a mean age was 73 years and the incidence of the primary outcome was 5.7%. Using Bayesian logistic regression, they derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. Their results showed that a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. The authors also concluded that if externally validated, this tool could improve resource use for this common condition. Full text available here.

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